WEBVTT

1
00:00:12.566 --> 00:00:14.230
- I know all of you, I
think you all know me.

2
00:00:14.230 --> 00:00:16.513
I'm Carolyn du Bois, I'm
the director of field work

3
00:00:16.513 --> 00:00:18.273
here at the School for Social Work

4
00:00:18.273 --> 00:00:21.104
and I welcome you to our
annual field conference.

5
00:00:21.568 --> 00:00:23.286
I'm absolutely thrilled that you're here,

6
00:00:23.286 --> 00:00:25.312
I say it every single year to you,

7
00:00:25.312 --> 00:00:27.285
we could not do this field program

8
00:00:27.285 --> 00:00:30.069
or run this master's
program, for that matter,

9
00:00:30.069 --> 00:00:32.730
without the contributions
of our field affiliates.

10
00:00:32.874 --> 00:00:34.591
So we're thrilled that you're here,

11
00:00:34.591 --> 00:00:36.868
thank you for all that you do all year.

12
00:00:37.471 --> 00:00:40.212
I'd also like to thank my field team,

13
00:00:40.212 --> 00:00:42.698
Maria del Mar Farina, our
assistant director of field,

14
00:00:42.698 --> 00:00:46.345
and Katelin Lewis-Kulin, our
associate director of field,

15
00:00:46.345 --> 00:00:48.436
both of whom are out running
errands for me right now

16
00:00:48.436 --> 00:00:50.606
but will be back, and we thank them.

17
00:00:51.657 --> 00:00:55.838
It is my pleasure to introduce
to you tonight Dr. Jon Allen,

18
00:00:55.838 --> 00:01:00.451
who is this year's E. Diane
Davis Memorial Lecturer.

19
00:01:00.990 --> 00:01:04.062
I want to say a word
first about Diane Davis,

20
00:01:04.062 --> 00:01:07.752
who was a beloved and
highly respected member

21
00:01:07.752 --> 00:01:10.163
of our adjunct faculty who passed away

22
00:01:10.163 --> 00:01:14.668
at an extremely young age in 1986.

23
00:01:14.898 --> 00:01:17.735
This lecture is given
each year in her memory

24
00:01:17.735 --> 00:01:20.402
and in honor of her
contributions to the field of

25
00:01:20.402 --> 00:01:23.868
clinical social work, to
psychodynamic practice

26
00:01:23.868 --> 00:01:26.710
and to the Smith College
School for Social Work.

27
00:01:28.017 --> 00:01:29.767
And now I'd like to tell you a bit

28
00:01:29.767 --> 00:01:32.316
about our distinguished
speaker, Dr. Jon Allen,

29
00:01:32.316 --> 00:01:36.305
an internationally-renowned
expert in trauma treatment

30
00:01:36.305 --> 00:01:39.281
about which he will speak this
evening in a lecture entitled

31
00:01:39.281 --> 00:01:42.133
"Trauma Treatment As Plain Old Therapy".

32
00:01:43.163 --> 00:01:46.064
Dr. Allen is a senior psychologist
at The Menninger Clinic

33
00:01:46.064 --> 00:01:49.083
and professor in psychiatry
in the Menninger Department

34
00:01:49.083 --> 00:01:51.397
of Psychiatry at Baylor
School of Medicine,

35
00:01:51.397 --> 00:01:54.629
in addition to which he holds
adjunct faculty appointments--

36
00:01:54.629 --> 00:01:58.064
thank you-- at the Institute
for Religion and Health

37
00:01:58.064 --> 00:01:59.898
at Texas Medical Center,

38
00:01:59.898 --> 00:02:01.871
and at the Center for
Psychoanalytic Studies

39
00:02:01.871 --> 00:02:03.519
in Houston, Texas.

40
00:02:04.655 --> 00:02:06.660
Dr. Allen received his bachelor's degree

41
00:02:06.660 --> 00:02:08.612
from the University of Connecticut,

42
00:02:08.612 --> 00:02:11.599
his Ph.D from the University
of Rochester in New York,

43
00:02:11.599 --> 00:02:14.457
and completed a two-year
post-doc fellowship

44
00:02:14.457 --> 00:02:16.174
at the Menninger Clinic.

45
00:02:16.174 --> 00:02:19.406
He is, as you know, an
internationally-known scholar,

46
00:02:19.406 --> 00:02:21.582
researcher and educator.

47
00:02:21.582 --> 00:02:24.718
Dr. Allen has received
numerous honors and awards

48
00:02:24.718 --> 00:02:27.438
including the Scientific Achievement Award

49
00:02:27.438 --> 00:02:29.902
of the Kansas Psychological Association

50
00:02:29.902 --> 00:02:32.984
and the Arthur Marshall
Distinguished Alumnus award

51
00:02:32.984 --> 00:02:36.163
and the David Rapaport Award
for Excellence in Teaching,

52
00:02:36.163 --> 00:02:38.460
both at the Menninger Foundation.

53
00:02:38.861 --> 00:02:40.461
He has held faculty appointments at

54
00:02:40.461 --> 00:02:42.487
a number of academic institutions

55
00:02:42.487 --> 00:02:45.869
and is a prolific author,
having published 12 books,

56
00:02:45.869 --> 00:02:48.546
numerous book reviews, editorials,

57
00:02:48.546 --> 00:02:52.332
and 160 articles and book chapters.

58
00:02:52.332 --> 00:02:53.953
I counted them up.

59
00:02:53.953 --> 00:02:55.969
(laughter from crowd)

60
00:02:55.969 --> 00:02:58.337
I just don't know how
one person does that.

61
00:02:58.337 --> 00:03:01.217
And then, furthermore, I learned at dinner

62
00:03:01.217 --> 00:03:02.913
that he's a jazz pianist and has

63
00:03:02.913 --> 00:03:05.413
almost 100 compositions to his name.

64
00:03:05.558 --> 00:03:07.024
(chatter from crowd)

65
00:03:07.211 --> 00:03:09.142
So I don't know what to begin to say.

66
00:03:09.142 --> 00:03:10.582
(laughter from crowd)

67
00:03:10.582 --> 00:03:15.582
The 160 articles and books'
chapters cover topics

68
00:03:16.821 --> 00:03:19.914
which include mentalization
in clinical practice,

69
00:03:19.914 --> 00:03:22.816
the treatment of trauma and dissociation,

70
00:03:22.816 --> 00:03:25.087
psychosis and depression.

71
00:03:25.087 --> 00:03:26.965
His book on traumatic relationships

72
00:03:26.965 --> 00:03:30.175
and serious mental disorders
has been used extensively

73
00:03:30.175 --> 00:03:32.010
here at the School for Social Work

74
00:03:32.010 --> 00:03:34.100
and has been extremely
helpful to our students

75
00:03:34.100 --> 00:03:35.977
as they prepare to serve the clients

76
00:03:35.977 --> 00:03:38.505
with whom they work in the field.

77
00:03:38.505 --> 00:03:41.641
Dr. Allen has served on the
editorial and review panels

78
00:03:41.641 --> 00:03:44.478
of numerous publications
and has served as the editor

79
00:03:44.478 --> 00:03:46.942
of The Bulletin of the Menninger Clinic,

80
00:03:46.942 --> 00:03:48.958
the associate editor of
the Journal of Trauma

81
00:03:48.958 --> 00:03:51.838
and Dissociation, and as
an editorial consultant

82
00:03:51.838 --> 00:03:54.622
to the American Psychiatric Press.

83
00:03:54.622 --> 00:03:56.392
He's the principal
investigator of Menninger's

84
00:03:56.392 --> 00:03:58.707
hospital-wide outcomes project

85
00:03:58.707 --> 00:04:01.544
and has presented the
research and scholarly work,

86
00:04:01.544 --> 00:04:03.400
his research and scholarly work,

87
00:04:03.400 --> 00:04:05.858
across an international range.

88
00:04:06.354 --> 00:04:09.153
It's truly a gift to have
him with us here tonight.

89
00:04:09.362 --> 00:04:11.703
Please join me in welcoming Dr. Jon Allen.

90
00:04:11.965 --> 00:04:14.721
(audience applauds)

91
00:04:24.816 --> 00:04:26.580
- Thank you, Carolyn.

92
00:04:26.973 --> 00:04:29.015
I don't know who that person is.

93
00:04:29.554 --> 00:04:32.428
I'm gonna talk to you
about plain old therapy.

94
00:04:34.727 --> 00:04:36.417
Plain old presentation.

95
00:04:37.287 --> 00:04:42.287
Okay. I am really thrilled
that you asked me to come back.

96
00:04:42.321 --> 00:04:45.547
I made a note that I was here in 2004.

97
00:04:45.873 --> 00:04:49.045
Yeah, 2004, and I'm
gonna give the same talk.

98
00:04:49.755 --> 00:04:50.656
(audience laughs)

99
00:04:51.142 --> 00:04:54.374
So probably if you were
here, you don't remember it.

100
00:04:54.374 --> 00:04:55.504
(audience laughs)

101
00:04:55.504 --> 00:05:00.389
I hope. I didn't remember it. (laughs) So.

102
00:05:00.389 --> 00:05:05.306
And that talk actually, Jerry Seamus and I

103
00:05:05.306 --> 00:05:07.866
had spent quite a bit of time together,

104
00:05:07.866 --> 00:05:10.394
and after the talk, I was,

105
00:05:10.394 --> 00:05:12.719
I don't know if you know
the word "whinging".

106
00:05:12.719 --> 00:05:16.571
I think the Brits use it,
and Peter Fonagy told me,

107
00:05:16.571 --> 00:05:19.958
"'Whinging' is peevish complaining."

108
00:05:20.359 --> 00:05:23.047
So when I was here in 2004,

109
00:05:23.047 --> 00:05:27.185
I was whinging about science and its take

110
00:05:27.185 --> 00:05:30.086
over the practice of psychotherapy.

111
00:05:30.086 --> 00:05:32.667
And I had an interesting experience.

112
00:05:32.667 --> 00:05:34.427
At the end of my talk,

113
00:05:34.427 --> 00:05:37.350
and it was in this
auditorium, I'm quite sure,

114
00:05:37.350 --> 00:05:40.699
Laurie Pearlman, who
some of you might know,

115
00:05:40.699 --> 00:05:44.549
she was sitting about there and she said,

116
00:05:44.549 --> 00:05:46.682
"Well, you know, it's
interesting that you--",

117
00:05:46.682 --> 00:05:48.890
she didn't say I was
whinging, but she said,

118
00:05:48.890 --> 00:05:52.143
"It's interesting that you
were so critical of science

119
00:05:52.143 --> 00:05:56.457
"and your whole talk was
based on scientific research."

120
00:05:56.922 --> 00:06:01.922
So, I actually, I'm still
struggling with this

121
00:06:02.148 --> 00:06:04.889
and I didn't know how
much until Phebe Sessions

122
00:06:04.889 --> 00:06:08.996
did a videotape interview
of me this afternoon,

123
00:06:08.996 --> 00:06:11.481
kind of a precedes of this talk,

124
00:06:11.481 --> 00:06:16.153
and she says, "So tell
me what's going on here.

125
00:06:16.153 --> 00:06:18.659
"I've read your stuff, you review all this

126
00:06:18.659 --> 00:06:22.584
"very complicated science and theory

127
00:06:22.584 --> 00:06:24.717
"and you're telling me
you're gonna talk about

128
00:06:24.717 --> 00:06:28.285
"plain old therapy. How
does this go together?"

129
00:06:28.568 --> 00:06:31.917
So what I said is, and I
realized it for the first time

130
00:06:31.917 --> 00:06:34.935
in our talk, that I have mastered the art

131
00:06:34.935 --> 00:06:37.655
of talking out of both sides of my mouth.

132
00:06:37.655 --> 00:06:38.807
(audience laughs)

133
00:06:38.807 --> 00:06:43.807
So I do think since 2004 I've
got a bit better perspective

134
00:06:45.015 --> 00:06:47.607
on this, and of course
there's a ton of science

135
00:06:47.607 --> 00:06:50.796
that has emerged pertinent
to the treatment of trauma

136
00:06:50.796 --> 00:06:53.392
since that time.

137
00:06:53.622 --> 00:06:56.662
So I'm gonna aspire to present

138
00:06:56.662 --> 00:06:58.550
maybe a bit more balanced view

139
00:06:58.550 --> 00:07:03.550
of science and, as that
paper said, art in therapy.

140
00:07:05.419 --> 00:07:06.997
And I'll probably whinge because

141
00:07:06.997 --> 00:07:09.594
I just whinge about stuff all the time.

142
00:07:09.664 --> 00:07:11.941
So I'll probably do it here, too.

143
00:07:12.341 --> 00:07:16.128
I do wanna say that
there's a lot more material

144
00:07:16.128 --> 00:07:19.093
on the slides and on your handout

145
00:07:19.093 --> 00:07:21.113
than I'm gonna cover.

146
00:07:21.162 --> 00:07:23.604
Having this in your handout frees me

147
00:07:23.604 --> 00:07:27.082
to not go over it, but it's kind of a,

148
00:07:27.082 --> 00:07:29.311
it'll give you a bit of
a guide to the literature

149
00:07:29.311 --> 00:07:32.287
and you should have also a bibliography

150
00:07:32.287 --> 00:07:35.561
that you can use for more detail.

151
00:07:35.561 --> 00:07:38.185
So I'm gonna hit the highlights,

152
00:07:38.185 --> 00:07:40.873
and I'm kind of tethered
to this computer here

153
00:07:40.873 --> 00:07:44.168
since I don't have a clicker
and the print's rather small,

154
00:07:44.168 --> 00:07:45.837
so I'm gonna have to read it.

155
00:07:45.939 --> 00:07:49.160
So I wanna talk about
rethinking psychotherapy.

156
00:07:49.160 --> 00:07:51.411
I think, to be very blunt,

157
00:07:51.411 --> 00:07:54.323
the field of psychotherapy is nuts.

158
00:07:54.323 --> 00:07:56.242
That's my diagnosis.

159
00:07:56.242 --> 00:07:58.333
And so I wanna talk about that,

160
00:07:58.333 --> 00:08:02.668
and I really think we do
need plain old therapy.

161
00:08:02.749 --> 00:08:06.102
We need more than that,
but we certainly need that.

162
00:08:06.503 --> 00:08:09.180
And I wanna talk about
probably why you came

163
00:08:09.180 --> 00:08:12.609
to attachment trauma and its treatment.

164
00:08:13.052 --> 00:08:15.025
But I do think all of these things,

165
00:08:15.025 --> 00:08:17.483
I hope, will hang together.

166
00:08:17.628 --> 00:08:21.851
Now, this case material
is not on your handouts.

167
00:08:21.851 --> 00:08:24.849
It's disguised but I
prefer not to circulate it.

168
00:08:24.849 --> 00:08:28.635
But I wanna start, just
to give you some feel

169
00:08:28.635 --> 00:08:31.302
for how I work as a therapist,

170
00:08:31.302 --> 00:08:34.853
and this patient illustrates
something, I think,

171
00:08:34.853 --> 00:08:36.955
very important about attachment.

172
00:08:37.292 --> 00:08:38.769
So this patient--

173
00:08:39.105 --> 00:08:41.772
by the way, this therapy was conducted,

174
00:08:41.772 --> 00:08:44.366
twice-a-week psychotherapy in the context

175
00:08:44.376 --> 00:08:47.238
of a several-week inpatient treatment.

176
00:08:47.638 --> 00:08:49.889
So this is intensive hospital treatment

177
00:08:49.889 --> 00:08:52.491
which includes group
therapy, family therapy,

178
00:08:52.491 --> 00:08:55.947
all kinds of therapies and psychotherapy,

179
00:08:55.947 --> 00:08:59.429
individual psychotherapy which
I was doing as part of it.

180
00:09:03.908 --> 00:09:07.653
Okay, so rethinking psychotherapy.

181
00:09:08.214 --> 00:09:13.214
I like this quote, and I'm
very fond of philosophy

182
00:09:13.813 --> 00:09:16.085
as you will see.

183
00:09:16.085 --> 00:09:18.528
Now I was thinking, for
this talk, I thought

184
00:09:18.528 --> 00:09:21.503
"Okay, so how do I think about therapy?"

185
00:09:21.503 --> 00:09:25.770
And this is the way I would
think about it, basically.

186
00:09:25.770 --> 00:09:27.956
And I'm talking about plain old therapy

187
00:09:27.956 --> 00:09:29.930
and what's crucial in therapy,

188
00:09:29.930 --> 00:09:31.828
making meaning of a person's life

189
00:09:31.828 --> 00:09:34.900
in a trusting relationship,
coming to know and understand

190
00:09:34.900 --> 00:09:37.310
a person by means of engaging her or him

191
00:09:37.310 --> 00:09:40.116
in self-understanding, engaging the person

192
00:09:40.116 --> 00:09:43.347
in a reflective and empathic dialogue

193
00:09:43.347 --> 00:09:46.968
about how best to live and
the obstacles to doing so.

194
00:09:47.059 --> 00:09:49.779
And there's one other thought
I had as an afterthought,

195
00:09:49.779 --> 00:09:53.683
but I'm convinced it's
crucially important in therapy,

196
00:09:53.683 --> 00:09:58.683
that we need to find a way
of appreciating the person

197
00:09:59.389 --> 00:10:01.271
that we're working with.

198
00:10:01.522 --> 00:10:04.375
This is crucial. I'm not
just talking about liking.

199
00:10:04.477 --> 00:10:07.905
Doesn't quite get there.
Appreciating the person.

200
00:10:08.093 --> 00:10:10.044
And often this isn't hard,

201
00:10:10.044 --> 00:10:12.129
but sometimes it is quite hard.

202
00:10:12.604 --> 00:10:15.339
Some people, it's hard to appreciate.

203
00:10:15.665 --> 00:10:18.289
What's hardest for me is people who are

204
00:10:18.289 --> 00:10:23.289
pretty consistently...whinging,
actually. (laughs)

205
00:10:23.441 --> 00:10:28.441
Complaining, somewhat
arrogant, and contempt.

206
00:10:28.899 --> 00:10:31.502
A little vignette: I worked with a person

207
00:10:31.502 --> 00:10:34.563
who was extremely angry.

208
00:10:34.563 --> 00:10:37.379
She was very angry, and she had a battle

209
00:10:37.379 --> 00:10:40.067
with her family and she
came into the session

210
00:10:40.067 --> 00:10:43.783
and she told me about
how she cussed them out.

211
00:10:44.482 --> 00:10:48.636
And I said, "Boy, that sounds nasty."

212
00:10:48.962 --> 00:10:53.962
Now she was, I think
rightly, feeling criticized

213
00:10:54.530 --> 00:10:56.641
that I was, in a sense, saying,

214
00:10:56.641 --> 00:10:58.273
"Boy, you were being nasty."

215
00:10:58.273 --> 00:11:00.225
I think that message was pretty clear.

216
00:11:00.225 --> 00:11:01.473
And she really objected.

217
00:11:01.473 --> 00:11:04.353
She, basically, she said,
"Well, this is PTSD,

218
00:11:04.353 --> 00:11:07.489
"and I have trauma and
anger is part of trauma

219
00:11:07.489 --> 00:11:10.064
"and this is just part and
parcel of being angry."

220
00:11:10.507 --> 00:11:13.380
And so, okay, I didn't challenge it,

221
00:11:13.380 --> 00:11:16.815
but I thought about it after the session,

222
00:11:16.815 --> 00:11:19.066
and actually, what I understood,

223
00:11:19.066 --> 00:11:20.868
anger was not the problem.

224
00:11:20.868 --> 00:11:23.194
Now I was worried,
because patients like this

225
00:11:23.194 --> 00:11:26.148
get thrown out of our hospital,
believe it or not, if it's

226
00:11:26.148 --> 00:11:30.905
bad enough that it's just
impossible to work with them.

227
00:11:30.905 --> 00:11:33.107
I was worried about her treatment.

228
00:11:33.316 --> 00:11:36.355
But I realized something
that was very important

229
00:11:36.355 --> 00:11:38.617
and I said it to her
and she appreciated it.

230
00:11:38.617 --> 00:11:41.629
The problem wasn't anger; it was contempt.

231
00:11:42.168 --> 00:11:44.648
The cussing was contempt.

232
00:11:44.974 --> 00:11:46.706
That's what bothers people.

233
00:11:46.968 --> 00:11:49.507
I think anger is unpleasant, but contempt

234
00:11:49.507 --> 00:11:51.842
is what really riles people up.

235
00:11:51.842 --> 00:11:56.301
These, by the way, are, you
could say it's moralizing.

236
00:11:57.981 --> 00:12:01.105
These are not scientific interventions.

237
00:12:01.772 --> 00:12:05.292
This is, you know, a way
of thinking about people

238
00:12:05.292 --> 00:12:09.963
that goes beyond science,
but it has to do with

239
00:12:09.963 --> 00:12:14.963
understanding people as people
and how they affect people.

240
00:12:15.787 --> 00:12:17.552
So that's a tip.

241
00:12:18.048 --> 00:12:20.928
Think about contempt
in the context of anger

242
00:12:20.928 --> 00:12:23.733
and that's where the trouble is gonna lie.

243
00:12:23.733 --> 00:12:28.733
So I wrote a paper with
this title, long title,

244
00:12:29.333 --> 00:12:33.039
and the first paragraph is one word: "No."

245
00:12:33.109 --> 00:12:34.799
(audience laughs)

246
00:12:35.477 --> 00:12:37.620
Beautiful book by Martha Nussbaum,

247
00:12:37.620 --> 00:12:41.332
who's a University of Chicago
contemporary philosopher,

248
00:12:41.332 --> 00:12:44.137
and she, and the book is a tome,

249
00:12:44.137 --> 00:12:49.137
but she goes back to the
Hellenistic philosophers,

250
00:12:50.036 --> 00:12:53.779
the stoics were examples, and actually,

251
00:12:53.779 --> 00:12:56.819
she makes a case that they
were doing psychotherapy.

252
00:12:56.819 --> 00:13:01.182
This is post-Socrates, and
they were doing psychother--

253
00:13:01.182 --> 00:13:03.805
all the issues we deal
with, they were dealing.

254
00:13:03.805 --> 00:13:05.896
They were dealing with it in dialogue,

255
00:13:05.896 --> 00:13:09.746
they were keenly aware of
family issues, all these things.

256
00:13:09.746 --> 00:13:13.282
This is old, old, old stuff.

257
00:13:13.586 --> 00:13:15.559
This is the essence of therapy,

258
00:13:15.559 --> 00:13:18.241
this is the essence of plain old therapy.

259
00:13:18.556 --> 00:13:20.780
It's two millenia old.

260
00:13:20.946 --> 00:13:24.796
This is venerable work
that we're engaged in.

261
00:13:24.796 --> 00:13:27.100
And there's a wonderful literature

262
00:13:27.100 --> 00:13:30.294
from 2,000 years ago to today.

263
00:13:30.492 --> 00:13:33.670
I started reading philosophy
about 15 years ago,

264
00:13:33.670 --> 00:13:38.670
ethics, and I realized that it
really is more helpful to me

265
00:13:39.195 --> 00:13:42.512
than a lot of what I read in the journals,

266
00:13:42.512 --> 00:13:45.787
this old wonderful literature,
and contemporary literature

267
00:13:45.787 --> 00:13:49.317
of people who are thinking
about what it is to be human

268
00:13:49.317 --> 00:13:52.778
and to relate to other people as humans.

269
00:13:53.200 --> 00:13:58.068
So now, here's how I get
beyond whinging about science.

270
00:13:59.717 --> 00:14:03.407
I think there's no reason
to complain about science

271
00:14:03.407 --> 00:14:05.988
and no reason for
ambivalence about science.

272
00:14:05.988 --> 00:14:09.241
We obviously have great reason to be

273
00:14:09.241 --> 00:14:13.166
ambivalent about technology,
no question about it.

274
00:14:13.166 --> 00:14:17.411
We may destroy the earth,
so that's one example

275
00:14:17.411 --> 00:14:21.475
of something that relates to technology.

276
00:14:21.475 --> 00:14:24.867
But science is, you know,
we can distinguish between,

277
00:14:24.867 --> 00:14:27.331
science generates
knowledge, there's no reason

278
00:14:27.331 --> 00:14:29.091
to be ambivalent about it.

279
00:14:29.091 --> 00:14:31.619
The problem is that, I don't
know if you're familiar

280
00:14:31.619 --> 00:14:35.341
with the word scientism,
is overvaluing science.

281
00:14:35.341 --> 00:14:39.543
That's the problem, and I think
the field of psychotherapy

282
00:14:39.543 --> 00:14:43.036
is threatened by it.

283
00:14:43.693 --> 00:14:47.014
I think I would say damaged by scientism.

284
00:14:47.436 --> 00:14:49.527
And that's the problem.

285
00:14:49.527 --> 00:14:52.055
We need to make lots of use of science,

286
00:14:52.055 --> 00:14:56.534
but not only science, and this
is what I want to emphasize

287
00:14:56.534 --> 00:14:58.561
in the first part of this talk.

288
00:14:58.561 --> 00:15:02.806
Another thing is that we
need to rely on judgment.

289
00:15:02.806 --> 00:15:07.806
And the therapy field
is filled with manuals

290
00:15:07.958 --> 00:15:10.720
of how to do therapy.

291
00:15:10.720 --> 00:15:15.157
Now, at the extreme, the
manuals are trying to provide

292
00:15:15.157 --> 00:15:18.176
rules about how to behave, what to do,

293
00:15:18.176 --> 00:15:22.073
and I think, to the exclusion of judgment.

294
00:15:22.303 --> 00:15:24.025
We're looking for rules.

295
00:15:24.031 --> 00:15:27.231
Tell me what to do, and
judgment is difficult,

296
00:15:27.231 --> 00:15:29.994
because judgment, there
are no rules for judgment

297
00:15:29.994 --> 00:15:32.575
because judgment is how to apply the rules

298
00:15:32.575 --> 00:15:35.359
in specific cases, and
there aren't any rules

299
00:15:35.359 --> 00:15:37.609
for how to apply the rules.

300
00:15:37.609 --> 00:15:40.579
And I think this is what we need to face.

301
00:15:41.204 --> 00:15:45.481
Now, jazz. I wrote a blog post called,

302
00:15:45.481 --> 00:15:48.360
"Psychotherapy Should Be Like Jazz,"

303
00:15:48.360 --> 00:15:52.051
and the essence of the blog post

304
00:15:52.051 --> 00:15:56.461
is that we need to be able to improvise.

305
00:15:57.651 --> 00:16:00.808
And jazz has a lot of structure,

306
00:16:00.808 --> 00:16:04.359
but we need to be able to
improvise around the structure.

307
00:16:04.359 --> 00:16:06.983
See, for me the formulation
provides a structure,

308
00:16:06.983 --> 00:16:08.957
some sense of what the problems are

309
00:16:08.957 --> 00:16:11.111
and some sense about how to go forward,

310
00:16:11.111 --> 00:16:13.985
but the rest is improvisation.

311
00:16:14.204 --> 00:16:17.340
And this is the way relationships are.

312
00:16:17.340 --> 00:16:21.280
Therapy is only a relationship,
a good relationship.

313
00:16:21.862 --> 00:16:24.956
It's not fundamentally
different from any other,

314
00:16:24.956 --> 00:16:26.971
a love relationship, a good friendship,

315
00:16:26.971 --> 00:16:30.677
a parenting relationship, it's
not fundamentally different.

316
00:16:30.715 --> 00:16:34.310
This is what I mean by plain old therapy.

317
00:16:34.310 --> 00:16:38.672
Now ethical thinking, I think, is crucial.

318
00:16:38.672 --> 00:16:40.443
Here's the main stream: we need to do

319
00:16:40.443 --> 00:16:44.133
evidence-based practice
based on scientific knowledge

320
00:16:44.133 --> 00:16:47.685
and, of course, a few
hours a year we gotta go

321
00:16:47.685 --> 00:16:50.022
to some place and get ethics credits.

322
00:16:50.022 --> 00:16:51.317
(audience laughs)

323
00:16:53.925 --> 00:16:58.149
I suppose that's probably
true for you; it's true of us.

324
00:16:58.149 --> 00:17:02.170
So I think we oughta turn
this around, actually.

325
00:17:02.170 --> 00:17:06.042
And that fundamentally, as
it's been for 2,000 years,

326
00:17:06.042 --> 00:17:11.042
if this is ethical work, in
other words, how to live,

327
00:17:11.407 --> 00:17:16.100
getting to know a person and
so forth, as is parenting,

328
00:17:16.100 --> 00:17:19.528
and that science is a part of it.

329
00:17:19.534 --> 00:17:22.222
So I just want to flip the balance around.

330
00:17:22.222 --> 00:17:24.505
Science is hugely important.

331
00:17:24.505 --> 00:17:27.897
Now the idea of personal
knowledge, there's a philosopher,

332
00:17:27.897 --> 00:17:31.118
I really love his work, Michael Polanyi.

333
00:17:31.118 --> 00:17:36.061
Basically, we all acquire
personal knowledge.

334
00:17:36.131 --> 00:17:41.131
Knowledge doesn't exist in
Google or in encyclopedias,

335
00:17:41.912 --> 00:17:43.981
it exists in persons.

336
00:17:43.981 --> 00:17:47.885
And the question I have
is, what personal knowledge

337
00:17:47.885 --> 00:17:50.743
do we bring to the
conduct of psychotherapy?

338
00:17:50.743 --> 00:17:53.644
And this, he makes a
distinction between tacit

339
00:17:53.644 --> 00:17:56.545
or implicit knowledge, this is know-how.

340
00:17:56.545 --> 00:18:01.435
Like riding a bike,
playing a piano. Know-how.

341
00:18:01.676 --> 00:18:05.132
A lot of what we do in
relationships is tacit.

342
00:18:05.132 --> 00:18:06.827
We don't know how we do it.

343
00:18:06.827 --> 00:18:10.006
I remember, in thinking
about talking to you tonight,

344
00:18:10.006 --> 00:18:13.355
I remembered when I was a graduate student

345
00:18:13.355 --> 00:18:15.328
we were really lucky.

346
00:18:15.328 --> 00:18:20.133
We had a seminar with a
very seasoned psychoanalyst.

347
00:18:20.160 --> 00:18:22.176
And the unlucky bit was we had to bring in

348
00:18:22.176 --> 00:18:25.685
tapes of our sessions and
play them in the group.

349
00:18:25.685 --> 00:18:29.695
And so, he would, you
know, say, "Stop the tape.

350
00:18:29.695 --> 00:18:32.767
"Okay, so what were you
thinking when you said that?"

351
00:18:32.767 --> 00:18:36.874
So one of my peers, he
would come up with this

352
00:18:36.874 --> 00:18:41.874
beautiful eloquent stuff
about why he said what he did.

353
00:18:42.303 --> 00:18:44.504
Pardon me; it was bullshit.

354
00:18:44.820 --> 00:18:46.462
(audience laughs)

355
00:18:46.462 --> 00:18:49.875
It was rationalization.

356
00:18:49.875 --> 00:18:52.915
You don't-- you know,
occasionally we will think,

357
00:18:52.915 --> 00:18:56.104
"Gosh," you know, like I did
about the contempt remark.

358
00:18:56.104 --> 00:18:59.624
Sometimes we think, "Okay,
I need to say this, okay."

359
00:18:59.624 --> 00:19:01.811
And even sometimes if we're really quick,

360
00:19:01.811 --> 00:19:04.477
we might even think in the
session what we need to say.

361
00:19:04.477 --> 00:19:08.317
But most of the time
(audience laughs) we're not,

362
00:19:08.317 --> 00:19:11.538
most of the time we're kind of responding,

363
00:19:11.538 --> 00:19:15.436
and a ton of what goes on in
the therapy, it's beyond words.

364
00:19:15.762 --> 00:19:19.500
It's, you know, how to
help a person feel safe.

365
00:19:19.826 --> 00:19:23.377
But it's not something
that you're talking about,

366
00:19:23.377 --> 00:19:26.449
it's something in your
bearing and your manner

367
00:19:26.449 --> 00:19:30.182
and your affective state,
and this is beyond control.

368
00:19:30.182 --> 00:19:33.393
If you try to control it,
you've got a total mess.

369
00:19:33.393 --> 00:19:37.030
So there's something that
needs to be natural and safe.

370
00:19:37.030 --> 00:19:39.355
And of course it's not
always gonna be like that,

371
00:19:39.355 --> 00:19:41.186
by any means, you're gonna get tense,

372
00:19:41.186 --> 00:19:43.831
you're gonna get frustrated,
all of this stuff.

373
00:19:43.831 --> 00:19:45.361
And it's out there.

374
00:19:45.505 --> 00:19:48.033
But in general, so there's
a ton of this stuff.

375
00:19:48.033 --> 00:19:51.628
It's like the tip of the
iceberg, is the language

376
00:19:51.628 --> 00:19:52.822
and the narrative.

377
00:19:52.822 --> 00:19:55.606
This thing that I read, this
is the tip of the iceberg.

378
00:19:55.606 --> 00:19:58.646
It's a big tip, but it's
still the tip of the iceberg.

379
00:19:58.646 --> 00:20:03.646
Most of what we know in
living is not explicit,

380
00:20:03.776 --> 00:20:06.400
and there's a wealth of knowledge,

381
00:20:06.400 --> 00:20:09.162
and a lot of it is culture and so forth.

382
00:20:09.162 --> 00:20:13.322
So the explicit is what we're
focusing our attention on,

383
00:20:13.322 --> 00:20:16.257
but it's a small part of the process.

384
00:20:16.455 --> 00:20:17.341
I like this.

385
00:20:17.341 --> 00:20:20.338
This is a comment about
enlightenment, actually,

386
00:20:20.338 --> 00:20:22.492
focusing exclusively on science

387
00:20:22.492 --> 00:20:26.375
as the exclusive knowledge
needed to conduct therapy

388
00:20:26.375 --> 00:20:30.182
as a form of scientism,
and what Polanyi says,

389
00:20:30.182 --> 00:20:33.244
"which fetters thought as cruelly as ever

390
00:20:33.244 --> 00:20:36.241
"the churches had done. It offers no scope

391
00:20:36.241 --> 00:20:39.419
"for our most vital
beliefs, and it forces us

392
00:20:39.419 --> 00:20:43.136
"to disguise them in
farcically inadequate terms."

393
00:20:43.259 --> 00:20:44.544
How about that.

394
00:20:46.640 --> 00:20:50.704
Okay, so here's my thought
about the kind of knowledge,

395
00:20:50.704 --> 00:20:55.280
personal knowledge, what
we know as individuals,

396
00:20:55.280 --> 00:20:57.839
highly individual, that might go

397
00:20:57.839 --> 00:21:00.463
into how to conduct psychotherapy.

398
00:21:00.463 --> 00:21:03.524
And science, yes, is a part of it,

399
00:21:03.524 --> 00:21:05.754
and a pretty important part of it.

400
00:21:05.754 --> 00:21:08.335
But I don't know what the proportions are,

401
00:21:08.335 --> 00:21:09.327
and they're gonna vary.

402
00:21:09.327 --> 00:21:11.321
For me it's probably quite important

403
00:21:11.321 --> 00:21:15.225
because I'm OCPD and I like
science and all that stuff.

404
00:21:15.225 --> 00:21:18.755
But this is only a piece of it.

405
00:21:18.755 --> 00:21:22.030
And I think you could do quite
well as a psychotherapist

406
00:21:22.030 --> 00:21:25.624
without knowing much
science at all, frankly.

407
00:21:25.624 --> 00:21:27.512
Some people just have a knack,

408
00:21:27.512 --> 00:21:29.944
a natural knack for psychotherapy.

409
00:21:29.944 --> 00:21:31.992
By the way, one of the things I like about

410
00:21:31.992 --> 00:21:34.221
the idea of plain old therapy is that

411
00:21:34.221 --> 00:21:37.325
you do not need to be
gifted as a therapist

412
00:21:37.325 --> 00:21:38.978
to do good therapy.

413
00:21:38.978 --> 00:21:41.602
We can't have psychotherapy that

414
00:21:41.602 --> 00:21:45.484
requires gifted people to do it.

415
00:21:45.484 --> 00:21:47.682
We need people, ordinary people need to

416
00:21:47.682 --> 00:21:51.052
be able to do it using
their ordinary human skills.

417
00:21:51.052 --> 00:21:54.326
And for better or for worse,
I did make a statement

418
00:21:54.326 --> 00:21:58.060
in a recent book that,
actually, therapy requires

419
00:21:58.060 --> 00:22:02.593
skill in being human,
which is kind of daunting,

420
00:22:02.593 --> 00:22:04.033
(audience laughs)

421
00:22:04.033 --> 00:22:08.192
but you can't get it from science.

422
00:22:08.192 --> 00:22:12.277
But I think the benefit of science is

423
00:22:12.277 --> 00:22:16.010
that it-- this is, I'm
anticipating myself.

424
00:22:16.010 --> 00:22:18.453
But basically the benefit of science is

425
00:22:18.453 --> 00:22:22.026
that it shows, I think quite conclusively,

426
00:22:22.026 --> 00:22:24.714
that plain old therapy is
actually helpful to people.

427
00:22:24.714 --> 00:22:28.340
And it helps us understand
why it is helpful to people.

428
00:22:28.340 --> 00:22:29.940
And a bit about how to do it.

429
00:22:29.940 --> 00:22:32.265
So we have a technology.

430
00:22:32.265 --> 00:22:36.702
I like better than the term
"art", I think, "craft".

431
00:22:36.702 --> 00:22:39.305
Jeremy Holmes, who's a
British psychoanalyst,

432
00:22:39.305 --> 00:22:41.038
said he likes the word "craft,"

433
00:22:41.417 --> 00:22:43.192
that doing therapy is a craft,

434
00:22:43.192 --> 00:22:47.043
it's something that you
learn through apprenticeship.

435
00:22:47.043 --> 00:22:51.554
And certainly there's a
lot of art in any craft.

436
00:22:51.554 --> 00:22:55.479
But I think craft is the
right word, better than art.

437
00:22:55.479 --> 00:22:58.513
But we have, you know, the
technology, the manuals,

438
00:22:58.711 --> 00:23:00.780
therapy techniques and so forth,

439
00:23:00.780 --> 00:23:02.775
and we have structured clinical interviews

440
00:23:02.775 --> 00:23:05.697
which I actually find very helpful.

441
00:23:05.697 --> 00:23:08.507
So we need some technology.

442
00:23:09.462 --> 00:23:14.462
Here's my grandiose sense of what,

443
00:23:14.966 --> 00:23:19.350
the scholarly resources,
which is only a part

444
00:23:19.350 --> 00:23:21.462
of what we need to know,

445
00:23:21.462 --> 00:23:25.696
but this is what I think is
pertinent to doing therapy,

446
00:23:25.696 --> 00:23:28.911
and that's a bundle.

447
00:23:30.730 --> 00:23:32.981
So why do we need plain old therapy?

448
00:23:32.981 --> 00:23:37.461
When I wrote that paper in Smith Studies,

449
00:23:37.461 --> 00:23:42.015
the art of therapy, it came back to mind

450
00:23:42.015 --> 00:23:44.543
an experience I had as an undergraduate,

451
00:23:44.543 --> 00:23:46.889
and I've written about this
and talked about it since

452
00:23:46.889 --> 00:23:48.767
because it was so instructive.

453
00:23:48.767 --> 00:23:51.273
So believe it or not, when I was a senior

454
00:23:51.273 --> 00:23:53.716
I was in my final semester as a senior,

455
00:23:53.716 --> 00:23:55.508
I was gonna go to graduate school.

456
00:23:55.508 --> 00:23:57.545
I'd taken a couple graduate courses

457
00:23:57.545 --> 00:24:01.193
in clinical psychology, and
my supervisor said, "Well,

458
00:24:01.193 --> 00:24:04.115
"why don't you see a patient
in the psychology clinic?"

459
00:24:04.115 --> 00:24:06.739
I don't think anybody would do this today.

460
00:24:06.739 --> 00:24:09.021
But this was a while ago.

461
00:24:09.021 --> 00:24:11.133
Okay, so I said "Okay."

462
00:24:11.133 --> 00:24:13.501
And the thing that made it not crazy was

463
00:24:13.501 --> 00:24:17.117
that I was gonna do
systematic desensitization

464
00:24:17.117 --> 00:24:19.186
with somebody who had a phobia.

465
00:24:19.186 --> 00:24:21.415
And that's pretty easy;
you develop a hierarchy

466
00:24:21.415 --> 00:24:24.850
of things that are scary
and the person relaxes,

467
00:24:24.850 --> 00:24:27.410
you teach them how to
relax, and they imagine

468
00:24:27.410 --> 00:24:30.193
all these situations while
they're feeling relaxed.

469
00:24:30.193 --> 00:24:32.977
And it works, which is
pretty amazing in itself.

470
00:24:32.977 --> 00:24:35.900
So this was fine, I did it, it went fine.

471
00:24:35.900 --> 00:24:38.438
But something, the insidious bit was

472
00:24:38.438 --> 00:24:41.318
that the guy actually
wanted to talk to me.

473
00:24:41.318 --> 00:24:42.545
(audience chuckles)

474
00:24:42.545 --> 00:24:46.864
And I finally realized that
he wanted to talk to me.

475
00:24:46.864 --> 00:24:48.934
And then I was screwed.

476
00:24:48.934 --> 00:24:50.971
(audience laughs)

477
00:24:50.971 --> 00:24:53.104
How do you talk to somebody

478
00:24:53.104 --> 00:24:55.642
to help them with their problems?

479
00:24:55.642 --> 00:24:58.245
I had no manual for that.

480
00:24:58.245 --> 00:25:01.370
So it was funny that came back to me,

481
00:25:01.370 --> 00:25:02.949
and it's sort of, you can see,

482
00:25:02.949 --> 00:25:06.458
I'm still trying to work
through that experience.

483
00:25:06.458 --> 00:25:08.036
(audience laughs)

484
00:25:08.036 --> 00:25:12.569
So here's, I was teaching
a patient education group

485
00:25:12.569 --> 00:25:17.569
as I've done lots of them,
and this woman who was

486
00:25:17.764 --> 00:25:22.179
brilliant and quite
psychotic, came up to me

487
00:25:22.179 --> 00:25:24.569
and she handed me this
little slip of paper

488
00:25:24.569 --> 00:25:26.841
at the end of the session.

489
00:25:26.841 --> 00:25:29.678
And it was a quote from Chekhov's
play "The Cherry Orchard"

490
00:25:29.678 --> 00:25:33.112
and she had paraphrased it,
but the gist of it is this:

491
00:25:33.112 --> 00:25:36.109
If many remedies are
prescribed for an illness,

492
00:25:36.109 --> 00:25:39.736
you may be certain that
the illness has no cure.

493
00:25:39.736 --> 00:25:43.330
Now this is a very wise statement, right?

494
00:25:43.330 --> 00:25:46.679
It's, to me, it's logical.

495
00:25:46.679 --> 00:25:51.679
So Peter Fonagy counted, very carefully,

496
00:25:51.810 --> 00:25:54.540
the number of current therapies

497
00:25:54.540 --> 00:25:59.073
and he's convinced that
this is an underestimate.

498
00:25:59.073 --> 00:26:02.604
This is why I said earlier,

499
00:26:02.604 --> 00:26:05.761
the field of psychotherapy is nuts.

500
00:26:05.761 --> 00:26:10.761
There's something crazy going on here.

501
00:26:11.072 --> 00:26:14.656
And I'm gonna amplify that bit.

502
00:26:17.966 --> 00:26:20.057
(audience laughs)

503
00:26:20.225 --> 00:26:25.225
So one thing you may have noticed,

504
00:26:26.934 --> 00:26:29.558
that if you don't have an acronym

505
00:26:29.558 --> 00:26:32.096
you are nobody.
(audience laughs)

506
00:26:36.756 --> 00:26:38.948
Enough said.

507
00:26:39.094 --> 00:26:41.786
(audience continues to laugh)

508
00:26:42.699 --> 00:26:46.923
So, in preparation for this talk

509
00:26:46.923 --> 00:26:51.923
I reread that paper published
in the Smith Studies,

510
00:26:52.032 --> 00:26:55.093
and I thought that I had come
up with plain old therapy

511
00:26:55.093 --> 00:26:58.186
when I wrote this blog post.

512
00:26:58.186 --> 00:27:01.482
But actually, then I
discovered, lo and behold,

513
00:27:01.482 --> 00:27:03.103
it was in that paper.

514
00:27:03.103 --> 00:27:04.873
And I like this.

515
00:27:04.873 --> 00:27:07.199
We now have guidelines,
manuals, algorithms.

516
00:27:07.199 --> 00:27:09.727
I find one facet of this development

517
00:27:09.727 --> 00:27:13.748
to be immensely perplexing:
why is plain old psychotherapy

518
00:27:13.748 --> 00:27:17.737
not considered to be an
evidence-based treatment?

519
00:27:17.737 --> 00:27:20.361
(audience applauds)

520
00:27:20.361 --> 00:27:24.659
This is what I mean about
re-thinking psychotherapy.

521
00:27:24.659 --> 00:27:27.635
If you stand back from this, the thing is,

522
00:27:27.635 --> 00:27:31.166
it's nuts that we've
got all this going on.

523
00:27:31.166 --> 00:27:33.320
What are we doing here?

524
00:27:33.320 --> 00:27:36.595
Frankly, I think it's narcissism because

525
00:27:36.595 --> 00:27:38.408
you've gotta have your own thing,

526
00:27:38.408 --> 00:27:40.381
and you know, Freud said, what was it?

527
00:27:40.381 --> 00:27:43.656
The narcissism of small
differences or something,

528
00:27:43.656 --> 00:27:46.205
you know, you gotta
be...everybody's gotta have--

529
00:27:46.205 --> 00:27:48.594
and I got my own acronym,

530
00:27:48.594 --> 00:27:52.402
so I'm guilty of the same old thing. Okay.

531
00:27:52.402 --> 00:27:56.145
So, just a little bit about Menninger.

532
00:27:56.145 --> 00:27:59.143
The challenge of this, we moved

533
00:27:59.143 --> 00:28:02.204
from Topeka to Houston in 2003.

534
00:28:02.204 --> 00:28:05.062
We had, it was part of managed care

535
00:28:05.062 --> 00:28:06.961
that, you know, we used
to do very long-term

536
00:28:06.961 --> 00:28:10.470
inpatient treatment, which
frankly didn't really

537
00:28:10.470 --> 00:28:14.555
make total sense, but anyway,
we did it for a long time.

538
00:28:14.555 --> 00:28:17.019
So we moved to, quote, short-term,

539
00:28:17.019 --> 00:28:19.920
but four to eight weeks
is luxuriously long

540
00:28:19.920 --> 00:28:22.917
in hospital psychiatry.

541
00:28:22.917 --> 00:28:26.049
So we have, I think the luxury here is

542
00:28:26.049 --> 00:28:30.567
we can do what I call
psychotherapeutic hospital treatment.

543
00:28:30.567 --> 00:28:33.394
That we can really do
psychotherapeutic work,

544
00:28:33.394 --> 00:28:35.346
individual, family, group therapy,

545
00:28:35.346 --> 00:28:37.180
in the context of hospital treatment

546
00:28:37.180 --> 00:28:38.993
which is a great luxury.

547
00:28:38.993 --> 00:28:41.223
We have a very heterogenous
patient population

548
00:28:41.223 --> 00:28:44.678
and very eclectic interventions, see,

549
00:28:44.678 --> 00:28:47.185
because we used to be a
psychoanalytic hospital

550
00:28:47.185 --> 00:28:49.531
and, you know, we've
modernized like everybody else.

551
00:28:49.531 --> 00:28:54.203
We've got CBT and DBT and
all the other things going.

552
00:28:54.203 --> 00:28:56.731
We have a lot of educational groups

553
00:28:56.731 --> 00:29:00.912
and I've done, for many years
with various colleagues,

554
00:29:00.912 --> 00:29:04.325
groups focused on
attachment and mentalizing

555
00:29:04.325 --> 00:29:07.290
which we'll talk about, basically as a way

556
00:29:07.290 --> 00:29:10.778
to try to get some coherent framework.

557
00:29:10.778 --> 00:29:13.263
And actually we try to help

558
00:29:13.263 --> 00:29:15.748
the patients understand the treatment,

559
00:29:15.748 --> 00:29:18.468
cause the treatment is wildly complicated

560
00:29:18.468 --> 00:29:21.764
with all these acronym
therapies we've got going,

561
00:29:21.764 --> 00:29:24.569
so you have to try to help
the patients understand,

562
00:29:24.569 --> 00:29:27.566
okay, but bottom line,
what's helpful here?

563
00:29:27.566 --> 00:29:29.998
And that the point is
the therapeutic community

564
00:29:29.998 --> 00:29:32.025
and relationships.

565
00:29:32.025 --> 00:29:34.809
Attachment theory is a
really good theory, I think,

566
00:29:34.809 --> 00:29:36.899
for kind of plain old therapy,

567
00:29:36.899 --> 00:29:38.851
although you could do others.

568
00:29:38.851 --> 00:29:42.445
Now, with allegiance to
research, we also have done

569
00:29:42.445 --> 00:29:44.888
a ton of outcomes research,

570
00:29:44.888 --> 00:29:48.301
so we have demonstrated
to our satisfaction

571
00:29:48.301 --> 00:29:51.341
that our treatment is very effective,

572
00:29:51.341 --> 00:29:53.015
and, you know, the place wouldn't exist

573
00:29:53.015 --> 00:29:54.871
if the treatment weren't effective,

574
00:29:54.871 --> 00:29:57.356
but we have very, very good solid data

575
00:29:57.356 --> 00:29:59.447
and some recent follow-up data

576
00:29:59.447 --> 00:30:01.186
that it's also durable,

577
00:30:01.186 --> 00:30:03.969
so I'm not for a moment
dismissing the importance

578
00:30:03.969 --> 00:30:06.924
of having evidence for the
effectiveness of treatment.

579
00:30:06.924 --> 00:30:09.057
I just don't think the horse races

580
00:30:09.057 --> 00:30:14.057
of one brand against
another make any sense.

581
00:30:15.137 --> 00:30:18.230
This is amazing to me, this is prescient.

582
00:30:18.230 --> 00:30:20.182
50 years ago.

583
00:30:20.182 --> 00:30:22.518
This was before we had a ton of research

584
00:30:22.518 --> 00:30:25.909
that has demonstrated this
point quite convincingly.

585
00:30:25.909 --> 00:30:28.491
So we gotta figure out what's going on

586
00:30:28.491 --> 00:30:30.954
that is helpful in psychotherapy.

587
00:30:30.954 --> 00:30:35.157
And I think we do bring
science to bear on that.

588
00:30:35.157 --> 00:30:38.634
Now what I want to say
to put this in balance,

589
00:30:38.634 --> 00:30:41.194
this is one thing.

590
00:30:41.194 --> 00:30:45.652
Actually, it's very hard to demonstrate.

591
00:30:45.652 --> 00:30:48.713
By the way, same is true with medicines.

592
00:30:48.713 --> 00:30:51.806
That any one antidepressant
is any more effective

593
00:30:51.806 --> 00:30:54.196
than any other, extremely hard.

594
00:30:54.196 --> 00:30:56.446
They have different side effect profiles.

595
00:30:56.446 --> 00:30:58.142
But the effectiveness
and the new medicines

596
00:30:58.142 --> 00:31:02.366
are mainly, not more effective,
they're mainly more benign.

597
00:31:02.366 --> 00:31:07.366
But there's not, it's very
hard to demonstrate that any

598
00:31:07.731 --> 00:31:11.720
therapy is more effective
than any other good therapy,

599
00:31:11.720 --> 00:31:14.344
where it's very easy to demonstrate that

600
00:31:14.344 --> 00:31:18.567
relationship factors have a
major impact on the outcome.

601
00:31:18.567 --> 00:31:22.151
Now there is some evidence
for brand specificity,

602
00:31:22.151 --> 00:31:24.935
and this is the point I really wanna make.

603
00:31:24.935 --> 00:31:29.935
I think about the state
of the art in therapy.

604
00:31:30.204 --> 00:31:32.764
See, we've had the battles forever

605
00:31:32.764 --> 00:31:35.270
between the academics and
the clinicians, right?

606
00:31:35.270 --> 00:31:36.870
We're all aware of that?

607
00:31:36.870 --> 00:31:38.705
The academics do their
research and they have

608
00:31:38.705 --> 00:31:41.254
sort of, relatively
pure cases and so forth,

609
00:31:41.254 --> 00:31:43.601
and the clinicians are
out there in the trenches

610
00:31:43.601 --> 00:31:46.299
trying to work with a whole
bunch of different people,

611
00:31:46.299 --> 00:31:48.966
different kinds of problems
and complicated problems,

612
00:31:48.966 --> 00:31:51.472
and there's this battle between the two.

613
00:31:51.472 --> 00:31:53.680
And the academics say,
"What you're doing is

614
00:31:53.680 --> 00:31:57.274
"not scientific and not good scientism,"

615
00:31:57.274 --> 00:31:59.557
and the clinicians say,
"Yeah, but you're in

616
00:31:59.557 --> 00:32:01.711
"your ivory tower, and
you know, you're doing

617
00:32:01.711 --> 00:32:03.663
"all this fine research
and you oughta come out

618
00:32:03.663 --> 00:32:05.594
"and work in the trenches."

619
00:32:05.594 --> 00:32:07.567
So that battle's been going on.

620
00:32:07.567 --> 00:32:10.863
Another version of that
battle is psychoanalysis

621
00:32:10.863 --> 00:32:13.252
and psychodynamic therapy versus

622
00:32:13.252 --> 00:32:15.972
the other acronym therapies.

623
00:32:15.972 --> 00:32:17.849
And I don't think that's the best way

624
00:32:17.849 --> 00:32:19.705
to draw the battle lines.

625
00:32:19.705 --> 00:32:21.731
I think a better way to
draw the battle lines

626
00:32:21.731 --> 00:32:24.654
is the specialists and the generalists.

627
00:32:24.654 --> 00:32:28.206
And see, the specialists have procedures

628
00:32:28.206 --> 00:32:30.808
for dealing with symptoms.

629
00:32:30.808 --> 00:32:33.731
And these are great.

630
00:32:33.731 --> 00:32:37.858
They are studied, they are
careful, and they work.

631
00:32:37.858 --> 00:32:40.536
The trouble is us generalists,

632
00:32:40.536 --> 00:32:43.042
like the GPs of psychotherapy,

633
00:32:43.042 --> 00:32:45.847
are out there dealing with people who have

634
00:32:45.847 --> 00:32:49.036
complicated life problems,
multiple symptoms,

635
00:32:49.036 --> 00:32:53.164
complicated diagnosis,
and you can't just say,

636
00:32:53.164 --> 00:32:56.396
"Great, well let's work
on this one symptom here."

637
00:32:56.396 --> 00:32:59.041
Well, maybe you could, and if
it were a terrible symptom,

638
00:32:59.041 --> 00:33:02.380
do it, by all means, or refer somebody.

639
00:33:02.380 --> 00:33:07.051
But I think we need a way
of thinking about therapy

640
00:33:07.051 --> 00:33:10.763
for the generalists, and that
they need not be defensive

641
00:33:10.763 --> 00:33:13.547
about what they're doing because it works.

642
00:33:13.547 --> 00:33:18.547
Tons of research over a half
century have demonstrated

643
00:33:18.816 --> 00:33:21.397
that good therapies work.

644
00:33:21.397 --> 00:33:23.530
And it's very hard to demonstrate

645
00:33:23.530 --> 00:33:25.717
that any one is better than any other.

646
00:33:25.717 --> 00:33:28.362
This was a careful review of this sort of

647
00:33:28.362 --> 00:33:33.362
symptom-focused treatment
versus the other treatments,

648
00:33:33.514 --> 00:33:37.215
and actually they found
there was a slight advantage

649
00:33:37.215 --> 00:33:42.215
for the symptom-focused,
the CBT, et cetera,

650
00:33:42.313 --> 00:33:46.270
with regard to the outcome of the symptom.

651
00:33:46.270 --> 00:33:48.499
Which makes sense.

652
00:33:48.499 --> 00:33:51.561
Even then, the advantage wasn't huge.

653
00:33:51.561 --> 00:33:53.832
But if you're a person with a symptom,

654
00:33:53.832 --> 00:33:56.019
and there's a bit of an advantage,

655
00:33:56.019 --> 00:33:59.805
you should do the thing that
has a bit of an advantage.

656
00:34:00.036 --> 00:34:01.804
And I think we need specialists.

657
00:34:01.804 --> 00:34:03.404
It's just like medicine.

658
00:34:03.404 --> 00:34:05.537
But we need generalists,
and the generalists

659
00:34:05.537 --> 00:34:08.812
have plenty of evidence
behind what they're doing,

660
00:34:08.812 --> 00:34:11.414
it just doesn't come from the horse races

661
00:34:11.414 --> 00:34:15.243
and there's definitely
no Triple Crown winner.

662
00:34:15.243 --> 00:34:19.350
The other thing is, there's
this broad spectrum.

663
00:34:19.350 --> 00:34:23.051
We have, you know, hundreds
of psychiatric diagnoses,

664
00:34:23.051 --> 00:34:26.208
but the fact is running
through all these diagnosis

665
00:34:26.208 --> 00:34:29.194
is a broad spectrum of severity,

666
00:34:29.194 --> 00:34:31.957
and it is very interesting to me

667
00:34:31.957 --> 00:34:36.957
that this severity factor
reflects commonality

668
00:34:37.887 --> 00:34:41.226
in etiology including
family history of illness,

669
00:34:41.226 --> 00:34:43.892
genetic risk, childhood maltreatment,

670
00:34:43.892 --> 00:34:46.356
and compromised brain function.

671
00:34:46.356 --> 00:34:48.607
This is a pattern that goes together.

672
00:34:48.607 --> 00:34:51.785
And childhood trauma
is a major contributor

673
00:34:51.785 --> 00:34:56.062
to the severity of
disturbance, which we all know.

674
00:34:56.062 --> 00:35:00.542
So in a sense, this is,
see, for the generalist,

675
00:35:00.542 --> 00:35:03.400
I mean, this is the package
that we're working with

676
00:35:03.400 --> 00:35:06.088
with severe psychopathology for which

677
00:35:06.088 --> 00:35:10.941
there's not a rule-based treatment.

678
00:35:10.941 --> 00:35:15.941
So this is basically a summary.

679
00:35:16.057 --> 00:35:18.820
So the bottom line there,
generalists should use

680
00:35:18.820 --> 00:35:21.102
specialized treatments or refer patients

681
00:35:21.102 --> 00:35:23.726
for specific symptoms,
and there's no reason why

682
00:35:23.726 --> 00:35:26.372
this can't go together, plain old therapy

683
00:35:26.372 --> 00:35:28.430
with specialized treatment.

684
00:35:28.430 --> 00:35:31.662
But see, what I discovered
as an undergraduate,

685
00:35:31.662 --> 00:35:36.024
I'm convinced that even if
you used manualized treatment,

686
00:35:36.024 --> 00:35:39.277
it's very important to be good at POT,

687
00:35:39.277 --> 00:35:44.248
because you're gonna need
to talk to the person.

688
00:35:44.248 --> 00:35:47.194
And you might need to get
to know them, actually.

689
00:35:47.194 --> 00:35:49.335
This would be a good thing.

690
00:35:49.335 --> 00:35:54.335
Because this is the
context in which anybody,

691
00:35:54.487 --> 00:35:58.930
a physician, anybody working
in the healing professions

692
00:35:58.930 --> 00:36:02.337
needs to develop a therapeutic
relationship with the person

693
00:36:02.337 --> 00:36:06.326
for that intervention, whether
you're prescribing medicine

694
00:36:06.326 --> 00:36:10.430
or providing general medical
care or doing psychotherapy.

695
00:36:10.529 --> 00:36:13.100
Or doing some symptom-focused therapy.

696
00:36:13.100 --> 00:36:18.100
So if you can't do POT you
really can't do specialized work.

697
00:36:19.979 --> 00:36:21.857
And this is a point that we make

698
00:36:21.857 --> 00:36:25.899
in teaching our patients about treatment.

699
00:36:25.899 --> 00:36:28.843
It's really important that the,

700
00:36:28.843 --> 00:36:32.789
a lot of our treatments, if you go back

701
00:36:32.789 --> 00:36:35.509
to this first patient I talked about,

702
00:36:35.509 --> 00:36:40.202
see, a lot of the treatments
promote self-regulation

703
00:36:40.202 --> 00:36:44.010
of emotional distress. CBT, mindfulness.

704
00:36:44.010 --> 00:36:47.308
A lot of things, they're what you can do

705
00:36:47.308 --> 00:36:49.697
to decrease your distress.

706
00:36:49.697 --> 00:36:54.667
This is fine, and it's perfect
for avoidant attachment.

707
00:36:54.667 --> 00:36:58.961
Right? This is what is learned
in the first year of life,

708
00:36:58.961 --> 00:37:03.275
is, "Okay, I need to manage on my own."

709
00:37:03.441 --> 00:37:05.414
Well, welcome to psychotherapy.

710
00:37:05.414 --> 00:37:07.046
We'll help you do that.

711
00:37:07.046 --> 00:37:10.709
But see, this is not what's
powerfully important.

712
00:37:10.844 --> 00:37:13.510
It's interpersonal regulation of distress

713
00:37:13.510 --> 00:37:17.211
is the most powerful way
to regulate distress.

714
00:37:17.211 --> 00:37:20.337
And if you look at the first year of life,

715
00:37:22.717 --> 00:37:27.056
self-regulation comes
into play in the infant

716
00:37:27.056 --> 00:37:30.544
when the interpersonal regulation fails.

717
00:37:30.544 --> 00:37:33.402
When there's a failure of connection

718
00:37:33.402 --> 00:37:36.346
and a disruption in the attachment,

719
00:37:36.346 --> 00:37:39.247
then the infant turns to self-regulation.

720
00:37:39.247 --> 00:37:42.597
This is like a back-up strategy.

721
00:37:42.597 --> 00:37:46.127
There's a beautiful
concept of self-dependence,

722
00:37:46.127 --> 00:37:49.119
quote unquote, this is Joseph Lichtenberg

723
00:37:49.119 --> 00:37:51.231
using attachment theory, he says,

724
00:37:51.231 --> 00:37:54.303
"Self-dependence is the capacity

725
00:37:54.303 --> 00:37:58.313
"to bridge the gap between
separation and reunion."

726
00:37:58.313 --> 00:38:00.756
This has it perfect.

727
00:38:00.756 --> 00:38:05.756
Because we have to
manage emotional distress

728
00:38:06.163 --> 00:38:09.022
on our own a fair amount of the time,

729
00:38:09.022 --> 00:38:11.624
because we can't always
be connected with somebody

730
00:38:11.624 --> 00:38:14.312
in a trusting, safe relationship.

731
00:38:14.312 --> 00:38:16.819
But there's no substitute, ultimately,

732
00:38:16.819 --> 00:38:18.867
for that trusting, safe relationship

733
00:38:18.867 --> 00:38:21.608
as the best way to regulate distress

734
00:38:21.608 --> 00:38:24.253
from the first to the last year of life.

735
00:38:24.253 --> 00:38:27.826
So I think this is a kind of a c-chain,

736
00:38:27.826 --> 00:38:30.546
and our patients are kind
of shocked when we say,

737
00:38:30.546 --> 00:38:32.658
"You know, it is really good to

738
00:38:32.658 --> 00:38:35.143
"depend on other people emotionally."

739
00:38:35.143 --> 00:38:38.247
This is what attachment
theory demonstrates

740
00:38:38.247 --> 00:38:41.756
throughout the lifespan;
it is really good.

741
00:38:41.756 --> 00:38:45.009
And in fact, if you
want to be independent,

742
00:38:45.009 --> 00:38:47.398
autonomous, successful and so forth,

743
00:38:47.398 --> 00:38:50.139
being able to depend on
other people emotionally

744
00:38:50.139 --> 00:38:52.390
is exactly what you need.

745
00:38:52.390 --> 00:38:54.832
When you need it, you need it.

746
00:38:54.832 --> 00:38:57.008
And this was, this patient I talked about,

747
00:38:57.008 --> 00:38:58.501
this was the problem.

748
00:38:58.501 --> 00:39:01.563
The avoidance strategy
works until it doesn't.

749
00:39:01.563 --> 00:39:04.816
And when it doesn't, you need
to depend on other people.

750
00:39:04.816 --> 00:39:09.669
What really is, this is
where people get suicidal.

751
00:39:09.669 --> 00:39:12.826
They are suffering,
they're in terrible pain,

752
00:39:12.826 --> 00:39:16.282
and they're out there trying
to manage it on their own.

753
00:39:16.282 --> 00:39:18.788
They cannot rely on other people

754
00:39:18.788 --> 00:39:20.921
and they can't rely on themselves,

755
00:39:20.921 --> 00:39:25.316
and you can see this, sadly,
in the first year of life.

756
00:39:25.316 --> 00:39:27.748
In attachment research.

757
00:39:29.308 --> 00:39:33.774
So, this wonderful book by Sidney Blatt,

758
00:39:33.774 --> 00:39:35.864
Polarities of Experience, and this is

759
00:39:35.864 --> 00:39:38.200
fairly straightforward attachment theory,

760
00:39:38.200 --> 00:39:41.645
just very briefly, secure attachment,

761
00:39:41.645 --> 00:39:45.571
there's a balance between
relatedness and autonomy.

762
00:39:45.571 --> 00:39:46.914
It's in balance.

763
00:39:46.914 --> 00:39:48.749
The secure base of attachment is,

764
00:39:48.749 --> 00:39:51.064
when you can count on
the attachment figure's

765
00:39:51.064 --> 00:39:55.127
availability and responsiveness,
then you can be autonomous.

766
00:39:55.127 --> 00:39:56.994
Cause you know when it hits the fan

767
00:39:56.994 --> 00:39:58.540
you can do something about it.

768
00:39:58.540 --> 00:40:00.983
If you don't have that
confidence in attachment,

769
00:40:00.983 --> 00:40:02.881
you're on shaky ground.

770
00:40:02.881 --> 00:40:05.996
If it doesn't work, you
can, the ambivalent strategy

771
00:40:05.996 --> 00:40:09.644
is basically, "Okay, I need
to make more of a fuss.

772
00:40:09.644 --> 00:40:13.078
"I'm not getting my needs
met, turn the dial up."

773
00:40:13.078 --> 00:40:15.094
And you do it by, you know, protesting,

774
00:40:15.094 --> 00:40:17.750
angry whinging if you will.

775
00:40:17.750 --> 00:40:21.782
You can do it by alarming
people and so forth,

776
00:40:21.782 --> 00:40:23.546
that's the ambivalent strategy.

777
00:40:23.840 --> 00:40:25.643
And it's a good strategy because

778
00:40:25.643 --> 00:40:28.459
it's trying to get the connection to work.

779
00:40:28.459 --> 00:40:30.634
The avoidance strategy,
a lot of our patients,

780
00:40:30.634 --> 00:40:34.393
we have a program,
Professionals in Crisis.

781
00:40:34.730 --> 00:40:38.463
This is like people like us, and they're

782
00:40:38.463 --> 00:40:41.876
masters at avoidant attachment.

783
00:40:43.436 --> 00:40:45.325
But they run into trouble.

784
00:40:46.024 --> 00:40:48.552
And one thing, of course,
if you can't rely on people,

785
00:40:48.552 --> 00:40:51.528
what's a great substance...substitute?

786
00:40:51.528 --> 00:40:53.266
I said it. Substance abuse.

787
00:40:53.266 --> 00:40:54.888
(audience laughs)

788
00:40:54.888 --> 00:40:58.930
It's just, you know, this works
on the same brain circuits

789
00:40:58.930 --> 00:41:02.972
as attachment does, and
so no wonder they get--

790
00:41:02.972 --> 00:41:06.087
I didn't do this.
(audience chuckles)

791
00:41:08.407 --> 00:41:11.921
Okay, so, avoidant-- but the trouble,

792
00:41:11.921 --> 00:41:14.588
and this again, all these strategies,

793
00:41:14.588 --> 00:41:16.561
the amazing thing is, infants,

794
00:41:16.561 --> 00:41:19.046
by the time they're one year of age,

795
00:41:19.046 --> 00:41:21.115
they've figured out which strategy works

796
00:41:21.115 --> 00:41:22.992
in a given relationship.

797
00:41:22.992 --> 00:41:25.062
By one year of age, before they can talk.

798
00:41:25.062 --> 00:41:27.963
These are strategies
to do the best you can

799
00:41:27.963 --> 00:41:30.096
in a particular relationship.

800
00:41:30.096 --> 00:41:31.536
So you know, if you need to make

801
00:41:31.536 --> 00:41:33.211
more of a fuss in the relationship

802
00:41:33.211 --> 00:41:35.461
to get your needs met, go for it.

803
00:41:35.461 --> 00:41:37.530
If you need to keep distance in order to

804
00:41:37.530 --> 00:41:40.154
maintain the relationship, go for it.

805
00:41:40.154 --> 00:41:42.362
And ideally, you know, you can make use

806
00:41:42.362 --> 00:41:44.655
of the relationship when you're suffering.

807
00:41:44.655 --> 00:41:47.076
The disorganized attachment pattern

808
00:41:47.076 --> 00:41:49.487
is not an effective strategy.

809
00:41:49.487 --> 00:41:51.737
That these infants, they're in a daze,

810
00:41:51.737 --> 00:41:54.020
they're profoundly ambivalent,

811
00:41:54.020 --> 00:41:56.132
they just can't work out a way

812
00:41:56.132 --> 00:41:59.268
of relating to the
caregiver that is effective

813
00:41:59.268 --> 00:42:02.585
in reducing suffering; again, evident.

814
00:42:04.225 --> 00:42:07.937
Now I'm gonna throw in just
a little bit of ethics here.

815
00:42:08.082 --> 00:42:10.092
I love this idea.

816
00:42:10.471 --> 00:42:13.649
This is from Kant, who was writing around

817
00:42:13.649 --> 00:42:18.524
the end of the 18th century, and he said

818
00:42:18.524 --> 00:42:20.945
there are two great opposing moral forces,

819
00:42:20.945 --> 00:42:23.377
I love this: love and respect.

820
00:42:23.377 --> 00:42:24.934
Love is obvious, coming close,

821
00:42:24.934 --> 00:42:28.181
but he said respect is
keeping your distance.

822
00:42:28.624 --> 00:42:32.315
Now if you think about
attachment, this is perfect.

823
00:42:32.315 --> 00:42:35.941
Because it involves a
balance of love and respect,

824
00:42:35.941 --> 00:42:37.514
closeness and distance.

825
00:42:37.701 --> 00:42:39.397
Cause the way things go wrong,

826
00:42:39.397 --> 00:42:42.629
and I'm talking about, this
is a clear in infant research,

827
00:42:42.629 --> 00:42:45.647
too much intrusiveness,
too much connection,

828
00:42:45.647 --> 00:42:48.666
kind of hypervigilance in
the attachment relationship,

829
00:42:48.666 --> 00:42:51.172
does not make for security.

830
00:42:51.172 --> 00:42:53.913
What you need to do is allow for distance,

831
00:42:53.913 --> 00:42:58.319
allow for disconnection, and
then establish reconnection.

832
00:42:58.319 --> 00:43:00.712
That's what promotes resilience.

833
00:43:00.825 --> 00:43:04.168
Is being able to manage
disconnection and reconnect.

834
00:43:04.825 --> 00:43:07.033
I hope with that patient
that I talked about

835
00:43:07.033 --> 00:43:10.862
there's an example of that,
disconnect, reconnect.

836
00:43:10.862 --> 00:43:13.838
That's what makes for effective learning

837
00:43:13.838 --> 00:43:16.365
about how to deal with
conflict in relationships,

838
00:43:16.365 --> 00:43:19.101
which is absolutely universal.

839
00:43:19.288 --> 00:43:21.400
Gosh, the computer didn't like that slide

840
00:43:21.400 --> 00:43:23.000
but I really like it.

841
00:43:23.000 --> 00:43:24.493
(audience laughs)

842
00:43:24.493 --> 00:43:26.647
So if you think about relationships,

843
00:43:26.647 --> 00:43:31.223
really this is just so simple
and it is really wonderful.

844
00:43:31.223 --> 00:43:34.775
So you see, the thing
that we were talking about

845
00:43:34.775 --> 00:43:39.775
in the video today, that I have
all this complicated stuff,

846
00:43:40.204 --> 00:43:43.276
but there's some basic, simple stuff

847
00:43:43.276 --> 00:43:48.276
that I think, really, is what
I really gravitate toward

848
00:43:49.099 --> 00:43:54.099
to keep us anchored and with
some sense of what we're doing.

849
00:43:54.230 --> 00:43:56.965
And we use this concept of mentalizing.

850
00:43:57.973 --> 00:44:00.651
This comes from the work of Peter Fonagy,

851
00:44:00.651 --> 00:44:05.642
and it is an enormously helpful idea,

852
00:44:05.642 --> 00:44:10.642
and basically mentalizing
is a sense of connection

853
00:44:11.114 --> 00:44:12.927
psychologically with what's going on

854
00:44:12.927 --> 00:44:15.732
inside the other person and yourself.

855
00:44:15.732 --> 00:44:20.265
Attachment-- mentalizing is
like the glue of attachment.

856
00:44:20.265 --> 00:44:23.465
Because the infant is not
gonna attach to somebody

857
00:44:23.465 --> 00:44:25.513
who's not psychologically connected

858
00:44:25.513 --> 00:44:27.838
with what's going on with the infant.

859
00:44:27.838 --> 00:44:29.225
It just doesn't make sense.

860
00:44:29.225 --> 00:44:31.113
They're not gonna attach securely.

861
00:44:31.113 --> 00:44:33.875
So awkward as the word mentalizing is,

862
00:44:33.875 --> 00:44:37.256
it's essential because it's
the psychological attunement

863
00:44:37.256 --> 00:44:40.819
to the other person and to yourself.

864
00:44:40.819 --> 00:44:43.923
So we have, as I was saying earlier,

865
00:44:43.923 --> 00:44:47.709
we have a few basic domains here

866
00:44:47.709 --> 00:44:51.218
that a lot of this stuff
is going on non-verbally.

867
00:44:51.218 --> 00:44:54.183
And it's beyond words
and it's beyond control.

868
00:44:54.183 --> 00:44:58.439
And it has a profound
influence on our relationships.

869
00:44:58.439 --> 00:45:00.924
This is what's going on in the baby world.

870
00:45:00.924 --> 00:45:05.607
This is all nonverbal, but babies are

871
00:45:05.607 --> 00:45:09.279
very sophisticated
socially, and as I said,

872
00:45:09.279 --> 00:45:11.902
they're very sophisticated with regard

873
00:45:11.902 --> 00:45:14.014
to attachment cause they figure out how

874
00:45:14.014 --> 00:45:16.499
to relate individual by individual

875
00:45:16.499 --> 00:45:20.856
depending on the way they're responded to.

876
00:45:20.936 --> 00:45:23.816
Then what we do consciously in therapy

877
00:45:23.816 --> 00:45:26.803
is mentalizing reflectively,
and this is where

878
00:45:26.803 --> 00:45:30.173
Socrates and his followers come in.

879
00:45:30.173 --> 00:45:33.737
This is thousands of years we
have been trying to figure out

880
00:45:33.737 --> 00:45:37.736
using reflection, and I
don't wanna downplay it

881
00:45:37.736 --> 00:45:40.030
for a moment, I mean, this narrative,

882
00:45:40.030 --> 00:45:41.651
we all appreciate the importance

883
00:45:41.651 --> 00:45:43.139
of this coherent narrative.

884
00:45:43.139 --> 00:45:46.136
It's crucial, and so
that's the reflective part,

885
00:45:46.136 --> 00:45:48.205
again, that is venerable.

886
00:45:48.205 --> 00:45:51.064
But what we emphasize very explicitly

887
00:45:51.064 --> 00:45:53.378
is from an ethical stance,

888
00:45:53.378 --> 00:45:56.610
because mentalizing
without the ethical stance,

889
00:45:56.610 --> 00:45:58.765
none of this is worth anything.

890
00:45:58.765 --> 00:46:00.887
I mean, psychopaths, in their own way

891
00:46:00.887 --> 00:46:03.319
are very effective mentalizers.

892
00:46:03.319 --> 00:46:05.335
This is not what we're talking about.

893
00:46:05.335 --> 00:46:07.266
We mentalize for all kinds of reasons.

894
00:46:07.266 --> 00:46:09.473
We mentalize to compete with other people.

895
00:46:09.473 --> 00:46:11.959
This is not what we're
talking about with attachment.

896
00:46:11.959 --> 00:46:13.932
So we have this ethical frame,

897
00:46:13.932 --> 00:46:16.694
and I think we should be
very explicit about it

898
00:46:16.694 --> 00:46:20.459
and that our values are
hugely important here,

899
00:46:20.459 --> 00:46:24.544
and that the best we
can do is own up to them

900
00:46:24.544 --> 00:46:28.630
and be as explicit as
we can about our values.

901
00:46:28.630 --> 00:46:31.232
And I'll say to people,
"Well, I can tell you

902
00:46:31.232 --> 00:46:34.112
"from my value system..." x.

903
00:46:34.112 --> 00:46:35.946
So I will just say it.

904
00:46:35.946 --> 00:46:37.984
Here's what I, I made an intervention.

905
00:46:37.984 --> 00:46:40.309
You might find this a little weird.

906
00:46:40.309 --> 00:46:42.378
But you might find me a little weird.

907
00:46:42.378 --> 00:46:44.138
(audience chuckles)

908
00:46:44.138 --> 00:46:46.666
So anyway, I was working
with this patient,

909
00:46:46.666 --> 00:46:49.108
this was a person who
was hard to appreciate

910
00:46:49.108 --> 00:46:50.868
because, as I was talking about,

911
00:46:50.868 --> 00:46:54.121
she was among the ilk of people who really

912
00:46:54.121 --> 00:46:59.121
are quite arrogant and quite
contemptuous and devaluing.

913
00:47:01.086 --> 00:47:05.641
And she was challenging to appreciate.

914
00:47:05.641 --> 00:47:08.104
But I said to her at one point,

915
00:47:08.104 --> 00:47:12.019
I was very frustrated and I said to her,

916
00:47:12.019 --> 00:47:17.019
"You know, I find myself
appealing to your self-interest."

917
00:47:18.450 --> 00:47:21.245
And I said, "I don't
like it. I would rather

918
00:47:21.245 --> 00:47:23.933
"appeal to your goodwill."

919
00:47:23.933 --> 00:47:25.927
Cause, see, I was trying to work with her

920
00:47:25.927 --> 00:47:28.882
around treating people more decently.

921
00:47:28.882 --> 00:47:30.738
And it was crucial for her treatment,

922
00:47:30.738 --> 00:47:32.520
she was gonna wreck her treatment.

923
00:47:32.520 --> 00:47:35.187
And I was trying to, you
know, go for prudence.

924
00:47:35.187 --> 00:47:36.819
"Well, it would be in your own interest,"

925
00:47:36.819 --> 00:47:38.973
that, you know, you'd get what you want.

926
00:47:38.973 --> 00:47:43.688
And I realized that and I said
I didn't like it, actually.

927
00:47:43.688 --> 00:47:45.959
I mean, I was doing it and I, you know,

928
00:47:45.959 --> 00:47:47.239
and this really hit home.

929
00:47:47.239 --> 00:47:49.116
She came back to that concept.

930
00:47:49.116 --> 00:47:51.954
And actually I discovered
in the course of the work

931
00:47:51.954 --> 00:47:54.855
that she could be very
caring and empathic,

932
00:47:54.855 --> 00:47:56.903
and I could appreciate that.

933
00:47:56.903 --> 00:47:58.524
But, you know, this was hard for her

934
00:47:58.524 --> 00:48:00.870
to get to that stance.

935
00:48:00.870 --> 00:48:03.420
So I'm just very explicit about this.

936
00:48:03.420 --> 00:48:08.155
And I've learned a lot about
people by reading philosophers.

937
00:48:08.155 --> 00:48:11.893
It's a, gosh, I'll tell
ya, here's a great example.

938
00:48:12.176 --> 00:48:15.402
We say you should be nonjudgmental.

939
00:48:15.472 --> 00:48:18.186
Right? Well, that's a complicated idea.

940
00:48:18.373 --> 00:48:21.392
Because we're always making
judgments about people.

941
00:48:21.392 --> 00:48:22.623
Always!

942
00:48:23.184 --> 00:48:27.642
We're not remotely
without making judgments,

943
00:48:27.642 --> 00:48:30.703
moral judgments, I would say,
judgments about character,

944
00:48:30.703 --> 00:48:32.932
judgments about what's right
and wrong, good and bad.

945
00:48:32.932 --> 00:48:34.607
We're doing it all the time!

946
00:48:34.607 --> 00:48:37.465
We couldn't relate to people,
including our patients

947
00:48:37.465 --> 00:48:40.937
if we weren't engaged in
that evaluative process.

948
00:48:41.551 --> 00:48:46.094
So, nonjudgmental, I read,
this is Christine Swanton,

949
00:48:46.094 --> 00:48:50.510
a New Zealand philosopher,
wrote about nonjudgmental.

950
00:48:50.510 --> 00:48:53.624
She said, "Being nonjudgmental is like

951
00:48:53.624 --> 00:48:58.403
"not being too quick to find fault.

952
00:48:58.403 --> 00:49:02.787
"And moreover, looking
for the good in a person."

953
00:49:02.787 --> 00:49:04.578
See, this is a beautiful idea.

954
00:49:04.578 --> 00:49:07.224
It's like Kant. These are beautiful ideas.

955
00:49:07.224 --> 00:49:11.245
That's the best thing I ever
read about being nonjudgmental.

956
00:49:11.245 --> 00:49:12.706
And so when patients say,

957
00:49:12.706 --> 00:49:14.444
"Well, you should stop
talking about nonjudgmental.

958
00:49:14.444 --> 00:49:16.866
"Don't we criticize and
we need to criticize?"

959
00:49:16.866 --> 00:49:19.927
Yes, we do. But it's not fault-finding.

960
00:49:19.927 --> 00:49:24.481
And I think that some of us are trained

961
00:49:24.481 --> 00:49:27.798
to be pathology hunters.

962
00:49:27.798 --> 00:49:32.182
And that really, if we were
trained to look for the good,

963
00:49:32.182 --> 00:49:35.766
this would be better to work from there.

964
00:49:35.766 --> 00:49:38.870
And I think that's what Swanton is saying.

965
00:49:38.870 --> 00:49:43.870
Just read the personality
disorder criteria in the DSM,

966
00:49:44.608 --> 00:49:49.608
you're gonna find this
language throughout.

967
00:49:50.229 --> 00:49:53.935
This is clearly evaluative language.

968
00:49:54.314 --> 00:49:57.561
And I've been using it. Arrogant,
contemptuous and so forth.

969
00:49:59.092 --> 00:50:04.092
So we have said, if
mentalizing is the most common

970
00:50:04.873 --> 00:50:09.470
and fundamental common factor in therapy,

971
00:50:09.470 --> 00:50:12.884
which it is, it's also
gotta be the least novel.

972
00:50:12.884 --> 00:50:15.928
And it clearly goes back 2,000 years.

973
00:50:16.329 --> 00:50:18.776
So it is not novel.

974
00:50:19.507 --> 00:50:24.077
Peter Fonagy said, he
backpedaled a little bit there.

975
00:50:24.872 --> 00:50:29.602
May contain traces of originality
but those are byproducts.

976
00:50:29.864 --> 00:50:31.735
(audience members laugh)

977
00:50:32.626 --> 00:50:35.783
So, I'd like the mentalizing
approach to therapy,

978
00:50:35.783 --> 00:50:38.109
I think of it as a style of therapy.

979
00:50:38.109 --> 00:50:40.839
And there's one word there: transparency.

980
00:50:40.839 --> 00:50:44.679
This is really important, and
if you take the stereotype,

981
00:50:44.679 --> 00:50:47.601
and it is a stereotype of
psychoanalysis, you know,

982
00:50:47.601 --> 00:50:49.084
where you're not even
looking at the person

983
00:50:49.084 --> 00:50:51.388
much less saying anything or responding.

984
00:50:51.388 --> 00:50:55.057
So, that's a stereotype,
but it's more true

985
00:50:55.057 --> 00:50:57.877
of some than others.

986
00:50:58.491 --> 00:51:02.250
But this is the opposite
end of that continuum.

987
00:51:02.395 --> 00:51:04.522
Being transparent.

988
00:51:05.179 --> 00:51:09.189
And see, this is crucial if you
look at the infant research.

989
00:51:09.189 --> 00:51:14.189
Is the transparency, the
responsiveness, the spontaneity.

990
00:51:15.365 --> 00:51:19.151
Again, this is just allowing
yourself to be with the person,

991
00:51:19.151 --> 00:51:21.033
to respond to the person.

992
00:51:21.551 --> 00:51:25.754
So if somebody said something
that I think is nuts,

993
00:51:25.754 --> 00:51:29.327
I would just look...what?
You know, why not?

994
00:51:29.327 --> 00:51:31.849
"This doesn't make sense."

995
00:51:31.993 --> 00:51:35.123
I have even done, got out of my chair.

996
00:51:36.388 --> 00:51:38.474
(audience laughs)

997
00:51:38.474 --> 00:51:40.398
I don't do it all the time.

998
00:51:43.418 --> 00:51:48.418
(laughing) One of my, I
really like this intervention.

999
00:51:50.529 --> 00:51:52.385
This young man I was working with,

1000
00:51:52.385 --> 00:51:56.960
he was really, he sort
of gradually let me know

1001
00:51:56.960 --> 00:51:59.552
you know, how out-there his behavior was,

1002
00:51:59.552 --> 00:52:02.208
and I said, "You know,
I've got a diagnosis

1003
00:52:02.208 --> 00:52:04.298
for what you're doing."

1004
00:52:04.298 --> 00:52:06.607
I said, "It's crazy shit."

1005
00:52:06.752 --> 00:52:09.049
(audience laughs and applauds)

1006
00:52:09.290 --> 00:52:10.730
He loved it. He loved it.

1007
00:52:10.730 --> 00:52:13.493
But you see, if you're
gonna do that kind of stuff,

1008
00:52:13.493 --> 00:52:17.802
you have to have demonstrated in spades

1009
00:52:17.802 --> 00:52:22.004
to that person that you really
appreciate them as a person.

1010
00:52:22.004 --> 00:52:24.628
You care about 'em,
you're tryin' to help 'em,

1011
00:52:24.628 --> 00:52:28.329
and if you don't have that
going in the relationship

1012
00:52:28.329 --> 00:52:30.366
and you do something like that,

1013
00:52:30.366 --> 00:52:32.435
it's just gonna, you know,
they're gonna walk out

1014
00:52:32.435 --> 00:52:33.971
and they are not gonna come back

1015
00:52:33.971 --> 00:52:35.944
and they should not come back.

1016
00:52:35.944 --> 00:52:40.024
So you really, you've
got to have that frame.

1017
00:52:40.190 --> 00:52:43.901
But once you do have that frame, I think

1018
00:52:43.901 --> 00:52:47.826
being upfront, facially,
vocally, in your posture

1019
00:52:47.826 --> 00:52:49.960
and in what you say to people,

1020
00:52:49.960 --> 00:52:53.725
they need...the beauty of this approach,

1021
00:52:53.725 --> 00:52:56.786
and this really comes
from Bateman and Fonagy,

1022
00:52:56.786 --> 00:53:01.462
is that you share your
mind with the patient.

1023
00:53:01.462 --> 00:53:04.455
And it's not like you're
coming from a dogmatic stance,

1024
00:53:04.455 --> 00:53:07.548
like, "Let me tell you,
now, I've figured you out."

1025
00:53:07.548 --> 00:53:09.681
Now you might think that
this is a bit like this,

1026
00:53:09.681 --> 00:53:12.299
but this is collaborative.

1027
00:53:12.401 --> 00:53:16.177
This is simply explicating
what you've understood

1028
00:53:16.177 --> 00:53:18.059
together with the patient.

1029
00:53:18.128 --> 00:53:21.360
So you're not coming as
the expert from on high,

1030
00:53:21.360 --> 00:53:24.607
but you're saying, "Let me
tell you what I'm thinking."

1031
00:53:24.891 --> 00:53:27.205
If you just preface what you say by,

1032
00:53:27.205 --> 00:53:29.524
"Let me tell you what I'm thinking,"

1033
00:53:30.181 --> 00:53:33.754
it's not declaring some
truth from on high,

1034
00:53:33.754 --> 00:53:37.029
you're simply making
what your experiencing

1035
00:53:37.029 --> 00:53:40.676
available to them, for
their consideration,

1036
00:53:40.676 --> 00:53:43.966
and that's exactly what you
want them to do with you.

1037
00:53:44.026 --> 00:53:45.107
It's sharing.

1038
00:53:45.156 --> 00:53:46.969
And this is, if you
look at what's going on

1039
00:53:46.969 --> 00:53:50.404
on the nonverbal level, in
these very early relationships

1040
00:53:50.404 --> 00:53:52.772
where attachment gets established,

1041
00:53:52.772 --> 00:53:56.441
it's that transparent
connection that is crucial.

1042
00:53:56.441 --> 00:54:01.198
So the baby knows what
the caregiver is feeling,

1043
00:54:01.198 --> 00:54:04.131
and the caregiver knows
what the baby is feeling.

1044
00:54:04.131 --> 00:54:06.915
When this goes wrong, either
the caregiver is shut down

1045
00:54:06.915 --> 00:54:09.277
or the baby is shut down, and then

1046
00:54:09.277 --> 00:54:13.030
there's no way of
influencing the relationship.

1047
00:54:13.175 --> 00:54:14.849
And another thing, I think, that is--

1048
00:54:14.849 --> 00:54:16.780
I'm just preaching now, so.

1049
00:54:16.780 --> 00:54:17.708
(audience laughs)

1050
00:54:17.708 --> 00:54:19.660
Another thing that I think is crucial

1051
00:54:19.660 --> 00:54:23.269
is we therapists, we need
to trust our patients.

1052
00:54:24.182 --> 00:54:27.499
Because to be transparent and spontaneous,

1053
00:54:27.499 --> 00:54:30.123
you need to trust that that other person

1054
00:54:30.123 --> 00:54:34.187
is not gonna respond to you
by jumping down your throat,

1055
00:54:34.187 --> 00:54:36.533
treating you with contempt and so forth.

1056
00:54:36.533 --> 00:54:39.855
Otherwise you can't do this.

1057
00:54:40.106 --> 00:54:42.901
So you need to feel safe with them.

1058
00:54:42.901 --> 00:54:47.695
Which is hugely important,
and not always really easy.

1059
00:54:47.796 --> 00:54:49.844
And if you don't, you're just constrictive

1060
00:54:49.844 --> 00:54:52.804
and you're not doing very good work.

1061
00:54:53.300 --> 00:54:54.990
So, okay.

1062
00:54:56.436 --> 00:55:00.382
Now here's this, I keep coming
back to attachment theory,

1063
00:55:00.382 --> 00:55:05.139
which just seems to me like
if you're gonna use science,

1064
00:55:05.139 --> 00:55:08.291
this is good stuff.

1065
00:55:08.393 --> 00:55:11.294
And you know, there are
thousands of experiments here.

1066
00:55:11.294 --> 00:55:15.981
This is just really robust
knowledge in our field.

1067
00:55:15.987 --> 00:55:17.719
So, anyway.

1068
00:55:18.557 --> 00:55:22.114
So here's the amazing bit.

1069
00:55:22.557 --> 00:55:24.413
Peter Fonagy did this study.

1070
00:55:24.413 --> 00:55:27.431
It followed work done by Mary Main,

1071
00:55:27.431 --> 00:55:29.191
but he took it to another level.

1072
00:55:29.191 --> 00:55:32.210
So what he did, nobody in their right mind

1073
00:55:32.210 --> 00:55:34.945
would try to do this study,
but he did it, thankfully.

1074
00:55:35.580 --> 00:55:38.870
So you interview the parent for an hour.

1075
00:55:39.665 --> 00:55:43.036
This was moms, and it's
been done with dads,

1076
00:55:43.036 --> 00:55:45.148
but he started with moms who were

1077
00:55:45.148 --> 00:55:47.189
pregnant with their first child.

1078
00:55:47.654 --> 00:55:51.185
So an hour interview about
their attachment history,

1079
00:55:51.185 --> 00:55:53.904
and from this interview,
very sophisticated,

1080
00:55:53.904 --> 00:55:56.198
developed by Mary Main, you can actually

1081
00:55:56.198 --> 00:55:59.077
gauge the quality of
the parent's attachment

1082
00:55:59.077 --> 00:56:01.023
and their valuing of attachment.

1083
00:56:01.072 --> 00:56:03.376
So whether they're secure or preoccupied,

1084
00:56:03.376 --> 00:56:05.978
ambivalent, avoidant, or disorganized,

1085
00:56:05.978 --> 00:56:08.479
flummoxed and kind of traumatized.

1086
00:56:08.805 --> 00:56:11.109
Now, what he discovered is that this,

1087
00:56:11.109 --> 00:56:13.124
again, before the baby is born,

1088
00:56:13.124 --> 00:56:18.020
this predicts a year
after the baby is born

1089
00:56:18.020 --> 00:56:21.999
in a 20-minute laboratory situation,

1090
00:56:21.999 --> 00:56:26.334
whether the infant will be
securely attached to the parent.

1091
00:56:26.478 --> 00:56:28.424
This is amazing.

1092
00:56:29.145 --> 00:56:31.235
From a one hour interview you predict

1093
00:56:31.235 --> 00:56:36.235
to 18 months later to a
20-minute lab situation.

1094
00:56:36.696 --> 00:56:40.589
So the question is,
okay, so how do you get

1095
00:56:40.589 --> 00:56:43.405
from the parent's sense of security

1096
00:56:43.405 --> 00:56:47.629
to the baby's reaching out to the parent?

1097
00:56:47.629 --> 00:56:49.810
This is called the transmission gap.

1098
00:56:49.858 --> 00:56:51.687
What's happening in this gap?

1099
00:56:54.551 --> 00:56:56.742
Well, thankfully, there is an answer.

1100
00:56:58.892 --> 00:57:00.668
Mentalizing interactions.

1101
00:57:00.727 --> 00:57:02.977
In other words, again, what's happening

1102
00:57:02.977 --> 00:57:07.756
in these interim months since
the baby was born is that

1103
00:57:07.756 --> 00:57:11.148
the parent is psychologically
engaged with the infant.

1104
00:57:11.148 --> 00:57:14.715
This does not mean perfect attunement.

1105
00:57:14.742 --> 00:57:16.043
This doesn't happen.

1106
00:57:16.043 --> 00:57:17.995
If you look at secure attachment,

1107
00:57:17.995 --> 00:57:21.686
good relationships,
synchrony, being in sync

1108
00:57:21.686 --> 00:57:24.986
is going on about a third of the time.

1109
00:57:25.099 --> 00:57:29.045
But what's going on about 70% of the time

1110
00:57:29.045 --> 00:57:32.207
is the repair of disruptions.

1111
00:57:33.066 --> 00:57:35.733
In sync, out of sync,
back in sync, out of sync,

1112
00:57:35.733 --> 00:57:39.199
back in sync, that's what
going on in these secure--

1113
00:57:39.199 --> 00:57:43.876
and they have to do with
allow-- this is the respect bit.

1114
00:57:43.977 --> 00:57:48.977
Allowing the distance,
allowing the baby to disengage,

1115
00:57:49.044 --> 00:57:52.792
or the mother to disengage,
and then reconnecting.

1116
00:57:53.129 --> 00:57:55.241
That's what establishes the confidence,

1117
00:57:55.241 --> 00:57:57.283
that you can reconnect.

1118
00:57:57.374 --> 00:58:01.790
And this requires a sense of communication

1119
00:58:01.790 --> 00:58:04.499
that the infant is expressing a state,

1120
00:58:04.499 --> 00:58:06.920
the mom is responding to that state.

1121
00:58:06.920 --> 00:58:08.680
Whether it's the wish to engage,

1122
00:58:08.680 --> 00:58:12.264
the wish to disengage, the
response to protest, all of this

1123
00:58:12.264 --> 00:58:17.036
is going on in what turns out
to be a secure attachment.

1124
00:58:17.085 --> 00:58:20.733
And the icing on the cake is that

1125
00:58:20.733 --> 00:58:24.402
these securely attached
infants turn out to be

1126
00:58:24.402 --> 00:58:27.100
more empathic, better
at peer relationships,

1127
00:58:27.100 --> 00:58:32.100
and actually function
better in a host of domains.

1128
00:58:33.830 --> 00:58:36.032
Now this is common sense.

1129
00:58:36.433 --> 00:58:38.859
Think about it from a
learning perspective.

1130
00:58:39.377 --> 00:58:43.739
Okay, so the parents had
a good attachment history;

1131
00:58:43.739 --> 00:58:45.552
this doesn't mean that everything

1132
00:58:45.552 --> 00:58:48.016
went well in the parent's
life by any means.

1133
00:58:48.016 --> 00:58:50.149
But the parent has come to terms with it

1134
00:58:50.149 --> 00:58:54.149
so can value attachment, seek attachment

1135
00:58:54.149 --> 00:58:57.578
and establish attachment
even with a trauma history.

1136
00:58:57.861 --> 00:59:01.641
Now how does that happen?
Through mentalizing.

1137
00:59:02.042 --> 00:59:03.615
Through a good relationship.

1138
00:59:03.898 --> 00:59:05.886
It's the same thing for the parent.

1139
00:59:05.988 --> 00:59:08.745
But if you think about it,
it's very common-sensical.

1140
00:59:08.772 --> 00:59:11.023
Why would this, infant secure attachment

1141
00:59:11.023 --> 00:59:12.996
means that the infant is distressed,

1142
00:59:12.996 --> 00:59:15.758
the lab situation is that
the mom leaves the playroom

1143
00:59:15.758 --> 00:59:18.436
and comes back, you look at the reunion.

1144
00:59:18.436 --> 00:59:21.379
The infant's distressed by
it and reaches out to the mom

1145
00:59:21.379 --> 00:59:24.473
and communicates the
distress and they reconnect.

1146
00:59:24.473 --> 00:59:26.808
So you've got the repair
of the disruption.

1147
00:59:26.808 --> 00:59:28.323
This is logical.

1148
00:59:28.323 --> 00:59:31.715
Why would the infant
confidently go to a parent

1149
00:59:31.715 --> 00:59:34.733
who is not psychologically connected?

1150
00:59:34.733 --> 00:59:36.882
There's no mystery here.

1151
00:59:37.101 --> 00:59:40.098
But see, this is my idea
about psychotherapy.

1152
00:59:40.098 --> 00:59:42.114
Mentalizing begets mentalizing.

1153
00:59:42.114 --> 00:59:44.621
So this is the way we
get people connected,

1154
00:59:44.621 --> 00:59:47.852
is to try to provide that
kind of relationship.

1155
00:59:47.852 --> 00:59:52.852
Quite belatedly, actually,
in individual psychotherapy.

1156
00:59:53.079 --> 00:59:55.489
So I'm not gonna go through this,

1157
00:59:55.489 --> 00:59:57.047
but this is just some of the work

1158
00:59:57.047 --> 01:00:00.364
that goes into clarifying
that transmission gap,

1159
01:00:00.364 --> 01:00:03.030
and I emphasize Beatrice Beebe's work,

1160
01:00:03.030 --> 01:00:05.195
this brilliant work, and again

1161
01:00:05.195 --> 01:00:07.051
I'm not gonna go through this,

1162
01:00:07.051 --> 01:00:10.106
but basically she's looking
at the nonverbal bit.

1163
01:00:10.560 --> 01:00:12.272
This is four months old.

1164
01:00:12.416 --> 01:00:14.827
This has to do with watching videotapes

1165
01:00:14.827 --> 01:00:18.149
about how they're interacting;
none of this is verbal.

1166
01:00:18.197 --> 01:00:20.704
The mom might be talking to the infant,

1167
01:00:20.704 --> 01:00:23.050
but the infant is not
understanding the words.

1168
01:00:23.050 --> 01:00:26.713
But more that's a marker
of the mom's connection.

1169
01:00:27.039 --> 01:00:29.716
So this transmission gap is getting filled

1170
01:00:29.716 --> 01:00:34.175
with really great research, and of course

1171
01:00:34.175 --> 01:00:36.745
we've got the counterpart here

1172
01:00:36.745 --> 01:00:39.679
to the secure attachment, this is the

1173
01:00:39.679 --> 01:00:42.388
disorganized end of the spectrum

1174
01:00:42.388 --> 01:00:47.358
where you have a history of
insecurity in attachment,

1175
01:00:47.358 --> 01:00:51.816
non-mentalizing interactions,
disorganized attachment,

1176
01:00:51.816 --> 01:00:53.928
and then this is actually predictive

1177
01:00:53.928 --> 01:00:56.648
of later psychopathology.

1178
01:00:56.648 --> 01:01:01.648
So, lemme see, I think I'm
gonna go on to another.

1179
01:01:06.682 --> 01:01:10.301
See, actually what I discovered
in this interview with Phebe

1180
01:01:10.301 --> 01:01:14.582
is I like simple stuff,
but I like a lot of it.

1181
01:01:14.962 --> 01:01:16.652
(audience laughs)

1182
01:01:19.217 --> 01:01:24.217
So this is the simple
idea I have about trauma.

1183
01:01:29.425 --> 01:01:33.979
It is the recurrent
experience in a relationship

1184
01:01:33.979 --> 01:01:37.760
of feeling disconnected and invisible.

1185
01:01:38.064 --> 01:01:41.104
And the patients who come to us

1186
01:01:41.104 --> 01:01:43.781
are out there in these states where

1187
01:01:43.781 --> 01:01:47.626
they are in unbearable emotional pain.

1188
01:01:47.792 --> 01:01:50.906
And they just feel like they're alien,

1189
01:01:50.906 --> 01:01:55.198
and nobody gets it, and they've
withdrawn, they're passive.

1190
01:01:55.268 --> 01:01:58.052
And again, the thing
that's really disturbing,

1191
01:01:58.052 --> 01:02:01.284
you can see this at four
months, six months of age

1192
01:02:01.284 --> 01:02:05.480
in an attachment relationship
that's really going badly.

1193
01:02:05.924 --> 01:02:09.668
Kind of withdrawn, passive,
and literally dissociative,

1194
01:02:09.668 --> 01:02:13.731
if you read these descriptions,
they're dissociative states.

1195
01:02:13.731 --> 01:02:16.654
The infants are not
connected with the caregiver,

1196
01:02:16.654 --> 01:02:19.043
and they're not connected
with the environment.

1197
01:02:19.043 --> 01:02:21.944
They're not connected with toys, objects,

1198
01:02:21.944 --> 01:02:25.176
they are literally glazed, spacey,

1199
01:02:25.176 --> 01:02:28.839
sometimes literally walking
around the lab in a daze.

1200
01:02:29.026 --> 01:02:31.586
And I think our patients, a lot of them

1201
01:02:31.586 --> 01:02:34.728
are akin to that, where
they're just out there.

1202
01:02:34.728 --> 01:02:38.099
And the one word, I could
summarize the whole talk

1203
01:02:38.099 --> 01:02:41.907
with one word, or my total
understanding of trauma,

1204
01:02:41.907 --> 01:02:43.059
is "invisible".

1205
01:02:43.059 --> 01:02:45.576
And you'll actually hear
patients use that word

1206
01:02:45.576 --> 01:02:47.474
or words like it.

1207
01:02:47.474 --> 01:02:51.442
It's the feeling of invisibility in pain

1208
01:02:51.442 --> 01:02:53.671
that is what's traumatizing.

1209
01:02:53.671 --> 01:02:54.994
And again, we're not talking about

1210
01:02:54.994 --> 01:02:57.276
an isolated experience,
we're talking about

1211
01:02:57.276 --> 01:03:00.498
recurrent experiences that establish

1212
01:03:00.498 --> 01:03:04.007
a fairly predictable sense that, you know,

1213
01:03:04.007 --> 01:03:05.841
"If I'm hurting, I'm on my own

1214
01:03:05.841 --> 01:03:07.654
"and I can't deal with it."

1215
01:03:07.654 --> 01:03:11.691
And that's where people get suicidal.

1216
01:03:14.246 --> 01:03:16.475
So we have the counterpart, and this is

1217
01:03:16.475 --> 01:03:21.475
a very rich research, meticulous research.

1218
01:03:21.979 --> 01:03:24.187
And again, maybe this
is impressive because

1219
01:03:24.187 --> 01:03:29.187
she looked at, I think it was
20,000 seconds of videotape.

1220
01:03:33.722 --> 01:03:37.385
20,000 seconds analyzed meticulously.

1221
01:03:37.903 --> 01:03:40.126
So pretty compelling data.

1222
01:03:40.324 --> 01:03:42.756
And essentially what she found

1223
01:03:42.756 --> 01:03:45.199
is the essence of these relationships,

1224
01:03:45.199 --> 01:03:48.910
let me get to-- you can
look, you've got the slides,

1225
01:03:48.910 --> 01:03:51.577
thankfully, but here's
the point I want to make.

1226
01:03:51.577 --> 01:03:55.203
She says that these mothers are
not generally less empathic.

1227
01:03:55.203 --> 01:03:59.267
But something very
specific, when the infant

1228
01:03:59.267 --> 01:04:03.192
is in a state of
distress, they disconnect.

1229
01:04:03.192 --> 01:04:05.144
So a simple way of thinking about this

1230
01:04:05.144 --> 01:04:07.693
if you take the
intergenerational perspective,

1231
01:04:07.693 --> 01:04:10.083
again, this is very simple:

1232
01:04:10.083 --> 01:04:14.024
if the parent has been traumatized

1233
01:04:14.364 --> 01:04:18.745
in her or his attachment relationship,

1234
01:04:18.745 --> 01:04:23.745
when the infant is distressed
and needs her or him,

1235
01:04:24.707 --> 01:04:27.267
this is distressing to the parent.

1236
01:04:27.267 --> 01:04:29.400
It's like a reminder of trauma.

1237
01:04:29.400 --> 01:04:32.739
"Oh my god, I'm needed. I'm needed.

1238
01:04:32.739 --> 01:04:34.467
"I need to respond."

1239
01:04:34.467 --> 01:04:37.987
And then the parent has
not had that experience

1240
01:04:37.987 --> 01:04:40.664
so this is like a reminder of trauma

1241
01:04:40.664 --> 01:04:43.885
that causes a lot of
distress in the parent

1242
01:04:43.885 --> 01:04:48.226
and so they avoid
re-experiencing that distress

1243
01:04:48.226 --> 01:04:50.961
by turning away from that pain.

1244
01:04:51.223 --> 01:04:53.388
Now to some degree I think most of us

1245
01:04:53.388 --> 01:04:56.977
are liable to turn away from pain.

1246
01:04:57.495 --> 01:04:59.649
This is not, and we're
faced with a lot of it,

1247
01:04:59.649 --> 01:05:03.206
and it's hard to keep focused on it.

1248
01:05:03.489 --> 01:05:06.288
But this is our job.

1249
01:05:06.550 --> 01:05:08.342
So I will read through this,

1250
01:05:08.342 --> 01:05:11.616
this is Beebe putting into words

1251
01:05:11.616 --> 01:05:13.696
what the infant might experience

1252
01:05:13.696 --> 01:05:16.043
in the context of disorganized attachment.

1253
01:05:16.043 --> 01:05:17.856
"I'm so upset you're not helping me.

1254
01:05:17.856 --> 01:05:20.107
"I'm smiling and whimpering.

1255
01:05:20.107 --> 01:05:21.824
"Don't you see I want you to love me?

1256
01:05:21.824 --> 01:05:24.917
"When I'm upset you smile
or close up or look away.

1257
01:05:24.917 --> 01:05:26.421
"You make me feel worse.

1258
01:05:26.421 --> 01:05:28.309
"I feel confused about what I feel

1259
01:05:28.309 --> 01:05:30.741
"and about what you feel.
I can't predict you.

1260
01:05:30.741 --> 01:05:32.042
"I don't know what's going on.

1261
01:05:32.042 --> 01:05:33.343
"What am I supposed to do?

1262
01:05:33.343 --> 01:05:35.594
"I feel helpless to affect you."

1263
01:05:35.594 --> 01:05:37.225
This is the crucial thing.

1264
01:05:37.225 --> 01:05:40.820
Think about efficacy, or agency,
whatever you wanna call it.

1265
01:05:40.820 --> 01:05:43.284
Really, I mean, great,
it's great that we can

1266
01:05:43.284 --> 01:05:45.278
build stuff and make stuff and of course

1267
01:05:45.278 --> 01:05:47.721
we blow up stuff, too, but...

1268
01:05:47.721 --> 01:05:50.547
so that's a kind of efficacy.

1269
01:05:50.547 --> 01:05:53.448
But the most important kind of efficacy

1270
01:05:53.448 --> 01:05:56.520
is influencing another person.

1271
01:05:56.520 --> 01:05:59.400
And especially when you
think about the baby,

1272
01:05:59.400 --> 01:06:01.299
being able to communicate distress

1273
01:06:01.299 --> 01:06:04.061
in a way that evokes some responsiveness,

1274
01:06:04.061 --> 01:06:06.568
reasonable responsiveness,
that's the efficacy

1275
01:06:06.568 --> 01:06:08.332
that really matters.

1276
01:06:08.541 --> 01:06:11.559
So I think that I should highlight that,

1277
01:06:11.559 --> 01:06:13.469
"I feel helpless to affect you."

1278
01:06:13.469 --> 01:06:16.508
This is what leads to
learned helplessness,

1279
01:06:16.508 --> 01:06:20.726
passivity, depression,
suicidality and so forth.

1280
01:06:20.807 --> 01:06:22.940
"And I feel helpless to help myself."

1281
01:06:22.940 --> 01:06:27.142
Cause these babies are not good
at self-comforting, either.

1282
01:06:27.142 --> 01:06:28.902
So they're not getting comforting,

1283
01:06:28.902 --> 01:06:30.833
they're not doing the
things that babies do

1284
01:06:30.833 --> 01:06:33.809
to comfort themselves when that comforting

1285
01:06:33.809 --> 01:06:37.122
isn't responsive, "and I feel frantic,"

1286
01:06:37.162 --> 01:06:39.996
and I think that
summarizes a lot of people

1287
01:06:39.996 --> 01:06:42.790
before they come to see us.

1288
01:06:42.998 --> 01:06:46.171
Now you might say, "So what's
all this stuff with babies?"

1289
01:06:46.924 --> 01:06:49.313
Well, actually, there's
really good literature,

1290
01:06:49.313 --> 01:06:51.595
and this is a terrifically good book,

1291
01:06:51.595 --> 01:06:54.262
recent, by Beebe and Lachman,

1292
01:06:54.262 --> 01:06:57.515
where they're explicating the connections

1293
01:06:57.515 --> 01:07:00.320
between all this wonderful research.

1294
01:07:00.320 --> 01:07:02.037
And Beebe's one of many.

1295
01:07:02.037 --> 01:07:05.386
Daniel Stern's work is
just absolutely brilliant.

1296
01:07:05.386 --> 01:07:07.264
And Stern and his colleagues have

1297
01:07:07.264 --> 01:07:10.122
applied this to adult therapy,

1298
01:07:10.122 --> 01:07:15.122
but basically, this
nonverbal communication,

1299
01:07:15.370 --> 01:07:17.290
this stuff that's going on with babies

1300
01:07:17.290 --> 01:07:19.242
goes on with us all the time

1301
01:07:19.242 --> 01:07:21.844
and it certainly goes on in
the therapy relationship.

1302
01:07:21.844 --> 01:07:25.534
And so we can use this to
become a bit more aware.

1303
01:07:25.534 --> 01:07:29.833
But where is this, "It is not,"
the second to bottom line,

1304
01:07:29.833 --> 01:07:34.125
"It's not to our advantage
to become self-conscious."

1305
01:07:34.867 --> 01:07:39.867
The paradox is that it has to be natural.

1306
01:07:41.277 --> 01:07:45.011
So if I command you, "be natural,"

1307
01:07:45.011 --> 01:07:47.543
I mean, this is all, this is paradoxical.

1308
01:07:47.549 --> 01:07:49.960
You can't, this is beyond your control.

1309
01:07:49.960 --> 01:07:52.327
But we might become somewhat aware of it,

1310
01:07:52.327 --> 01:07:56.231
and we might, you know, if
you're sitting there like this,

1311
01:07:56.231 --> 01:07:59.250
or if you're having trouble
looking at the patient,

1312
01:07:59.250 --> 01:08:03.729
or whatever, you know, you
might become aware of it

1313
01:08:03.729 --> 01:08:05.681
in a way that you can
detect, "Wait a minute,

1314
01:08:05.681 --> 01:08:08.188
"something's going awry here."

1315
01:08:08.188 --> 01:08:11.345
But you can't try to
regulate it all that much.

1316
01:08:11.345 --> 01:08:12.764
And again, the bottom line,

1317
01:08:12.764 --> 01:08:16.267
"High levels of coordination
are not optimal."

1318
01:08:16.337 --> 01:08:19.490
The mid-range is optimal,
and I think it's interesting

1319
01:08:19.490 --> 01:08:22.912
that that fits with what Kant said.

1320
01:08:23.601 --> 01:08:24.704
So...

1321
01:08:26.225 --> 01:08:28.864
Here's a good idea.

1322
01:08:29.382 --> 01:08:31.925
One of many coming from Peter Fonagy.

1323
01:08:32.208 --> 01:08:34.907
So he and Mary Target in '97 published

1324
01:08:34.907 --> 01:08:37.968
a terrific paper on trauma, and they said

1325
01:08:37.968 --> 01:08:41.285
there's a dual liability.

1326
01:08:41.285 --> 01:08:44.357
And this is again one of
these many, many, many

1327
01:08:44.357 --> 01:08:46.725
simple ideas, that the trouble,

1328
01:08:46.725 --> 01:08:49.530
if you take maltreatment
as an extreme case,

1329
01:08:49.530 --> 01:08:50.692
but if you look at the research

1330
01:08:50.692 --> 01:08:52.964
we're not talking about
blatant maltreatment,

1331
01:08:52.964 --> 01:08:56.313
we're talking about
something much more subtle,

1332
01:08:56.313 --> 01:08:58.345
and that is this disconnection.

1333
01:08:58.351 --> 01:09:00.814
But the dual liability is pretty simple,

1334
01:09:00.814 --> 01:09:05.209
that if you're, say, abusing
and neglecting a child,

1335
01:09:05.209 --> 01:09:10.209
you are evoking distress and you are

1336
01:09:10.307 --> 01:09:12.771
undermining the development of the

1337
01:09:12.771 --> 01:09:15.672
capacity to regulate that distress.

1338
01:09:15.672 --> 01:09:18.712
So this is the dual liability.

1339
01:09:18.712 --> 01:09:22.317
Now Peter has an idea
that he and George Gergely

1340
01:09:22.317 --> 01:09:23.565
have latched on to.

1341
01:09:23.565 --> 01:09:26.327
This is also from
philosophical literature,

1342
01:09:26.327 --> 01:09:30.114
and it's another mouthful,
"epistemic trust".

1343
01:09:30.114 --> 01:09:32.439
But the idea is extremely important.

1344
01:09:32.439 --> 01:09:36.503
Epistemic trust is that
the patient needs to,

1345
01:09:36.503 --> 01:09:39.500
we all need to in close relationships,

1346
01:09:39.500 --> 01:09:41.750
they need to trust that you are a source

1347
01:09:41.750 --> 01:09:44.556
of valuable information about them,

1348
01:09:44.556 --> 01:09:48.385
about relationships and
about living in the world.

1349
01:09:48.385 --> 01:09:51.830
They have to trust you as credible.

1350
01:09:51.830 --> 01:09:54.422
And I think this is really important.

1351
01:09:54.422 --> 01:09:57.909
And what happens in
disorganized attachment

1352
01:09:57.909 --> 01:10:00.213
is that you get not only the distrust

1353
01:10:00.213 --> 01:10:02.762
that you don't feel safe with the person,

1354
01:10:02.762 --> 01:10:06.986
but the distrust that, "I can't
learn something from people.

1355
01:10:06.986 --> 01:10:11.146
"I can't trust people to lead
me in the right direction."

1356
01:10:11.146 --> 01:10:13.887
So it's the closing off to influence.

1357
01:10:13.887 --> 01:10:15.530
Giving up on people.

1358
01:10:15.530 --> 01:10:17.322
"I can't get anything
out of relationships,

1359
01:10:17.322 --> 01:10:19.529
"I can't benefit from relationships."

1360
01:10:19.529 --> 01:10:21.823
And so they're closed off.

1361
01:10:21.823 --> 01:10:25.310
I think a good formulation
actually does go

1362
01:10:25.310 --> 01:10:29.651
a way toward establishing epistemic trust,

1363
01:10:29.651 --> 01:10:34.651
that you have some valuable
knowledge about them.

1364
01:10:35.198 --> 01:10:38.701
Even, ironically, if it's
all come straight from them.

1365
01:10:39.496 --> 01:10:42.573
But something about articulating it.

1366
01:10:43.251 --> 01:10:47.725
A patient said to me recently,
this was very wonderful,

1367
01:10:47.725 --> 01:10:50.999
she said, she read it, she said,

1368
01:10:50.999 --> 01:10:53.388
"You're listening to me."

1369
01:10:53.388 --> 01:10:58.388
And she said, "Also, you see as important

1370
01:10:59.052 --> 01:11:01.926
"what I haven't seen as important."

1371
01:11:02.582 --> 01:11:06.174
And this was very valuable, actually.

1372
01:11:06.457 --> 01:11:08.153
Nothing, there's nothing in this

1373
01:11:08.153 --> 01:11:12.099
that we hadn't talked
about, but explicating it

1374
01:11:12.099 --> 01:11:16.344
is often quite helpful.

1375
01:11:16.344 --> 01:11:21.344
So...this is just a summary slide

1376
01:11:21.986 --> 01:11:24.525
of what I was saying a bit ago.

1377
01:11:24.525 --> 01:11:28.279
I like Bowlby's, this is from a 1990,

1378
01:11:28.279 --> 01:11:31.202
1988 book, which is, you know,

1379
01:11:31.202 --> 01:11:33.719
Bowlby wrote these big three-volume,

1380
01:11:33.719 --> 01:11:35.916
this three-volume set?

1381
01:11:35.916 --> 01:11:40.097
Well, I came across by
luck, this short book.

1382
01:11:40.097 --> 01:11:41.377
(audience chuckles)

1383
01:11:41.377 --> 01:11:44.603
A Secure Base. 1988.

1384
01:11:45.142 --> 01:11:47.436
And I read it, and I thought,

1385
01:11:47.436 --> 01:11:51.984
"Wow." It was like, oh my
god, attachment, this is it.

1386
01:11:52.310 --> 01:11:53.963
So that was my introduction,

1387
01:11:53.963 --> 01:11:55.328
and then I read the long ones,

1388
01:11:55.328 --> 01:11:57.509
but you start with the short one.

1389
01:11:57.974 --> 01:11:59.701
But this is wonderful,

1390
01:11:59.701 --> 01:12:01.973
basically that you explore
the various unhappy

1391
01:12:01.973 --> 01:12:05.365
and painful aspects of his
life, this is of course

1392
01:12:05.365 --> 01:12:09.237
written enough ago so
that it shouldn't say

1393
01:12:09.237 --> 01:12:10.794
his or hers, but anyway,

1394
01:12:10.794 --> 01:12:12.554
past and present, many of which

1395
01:12:12.554 --> 01:12:15.434
he finds it difficult or perhaps
impossible to think about

1396
01:12:15.434 --> 01:12:17.966
without a trusted companion.

1397
01:12:18.548 --> 01:12:21.076
I mean, this is a statement
about plain old therapy.

1398
01:12:21.076 --> 01:12:23.220
This is the statements I made about

1399
01:12:23.220 --> 01:12:26.260
the personal conception of
psychotherapy, that's it.

1400
01:12:26.260 --> 01:12:28.809
I said in a trauma group one day,

1401
01:12:28.809 --> 01:12:30.878
"The mind can be a scary place,"

1402
01:12:30.878 --> 01:12:31.667
and the patient said,

1403
01:12:31.667 --> 01:12:34.445
"Yes, and you wouldn't
wanna go in there alone."

1404
01:12:34.729 --> 01:12:37.779
Now this statement that she made,

1405
01:12:37.779 --> 01:12:42.779
this is the best idea about therapy,

1406
01:12:43.581 --> 01:12:47.112
trauma therapy, certainly, this is in one,

1407
01:12:47.112 --> 01:12:49.661
this was a young woman
who made this statement,

1408
01:12:49.661 --> 01:12:51.447
this is it.

1409
01:12:52.520 --> 01:12:54.535
So this is the idea.

1410
01:12:54.535 --> 01:12:58.316
This is what psychotherapy is about.

1411
01:12:58.674 --> 01:13:01.532
You see, and the infant
research is very consistent.

1412
01:13:01.532 --> 01:13:05.543
You don't wanna be in those states alone.

1413
01:13:05.543 --> 01:13:08.700
And this is where
attachment goes badly awry,

1414
01:13:08.700 --> 01:13:12.305
when consistently you're
in those states alone.

1415
01:13:12.305 --> 01:13:17.305
So she nailed it, and,
this is as good as it gets.

1416
01:13:19.217 --> 01:13:21.653
(audience laughs)

1417
01:13:25.072 --> 01:13:29.019
I'm gonna give you one
other clinical example here

1418
01:13:29.019 --> 01:13:31.103
that's not in your...

1419
01:13:34.544 --> 01:13:38.309
I think I'm gonna stop there

1420
01:13:38.309 --> 01:13:41.551
so we have a bit of time for discussion,

1421
01:13:41.551 --> 01:13:46.551
comments, questions, disagreements.

1422
01:13:47.087 --> 01:13:51.070
(audience applauds)
Thank you.

1423
01:14:00.569 --> 01:14:01.885
Thank you.

1424
01:14:03.267 --> 01:14:04.882
Free for all.

1425
01:14:07.565 --> 01:14:09.533
Just don't throw things.

1426
01:14:11.512 --> 01:14:13.154
- [Voiceover] Hey there.

1427
01:14:13.154 --> 01:14:16.028
This is the most fabulous thing ever.

1428
01:14:16.837 --> 01:14:18.506
(audience laughs)

1429
01:14:18.702 --> 01:14:20.718
(mumbles) I'm a doctoral student here

1430
01:14:20.718 --> 01:14:22.254
and I'm working on issues of philosophy

1431
01:14:22.254 --> 01:14:23.950
and the philosophy of social work,

1432
01:14:23.950 --> 01:14:24.942
so hearing you talk about this

1433
01:14:24.942 --> 01:14:26.147
I'm wondering what your thoughts are

1434
01:14:26.147 --> 01:14:28.078
about why it feels so hard to get

1435
01:14:28.078 --> 01:14:30.446
therapists on the philosophical bandwagon.

1436
01:14:30.446 --> 01:14:33.138
(mumbles)

1437
01:14:37.176 --> 01:14:41.944
- Um, I think, let me th-- I don't know,

1438
01:14:41.944 --> 01:14:46.652
first of all, it's a huge project.

1439
01:14:46.765 --> 01:14:49.698
If I say, "Go read Martha Nussbaum."

1440
01:14:49.698 --> 01:14:51.714
Okay, Martha Nussbaum is great.

1441
01:14:51.714 --> 01:14:53.826
But she's gonna be referring to all these

1442
01:14:53.826 --> 01:14:57.100
philosophers who you're
not gonna have a clue

1443
01:14:57.100 --> 01:15:00.908
who she's talking about, how
this fits into the history,

1444
01:15:00.908 --> 01:15:03.905
so this is something, it's a huge project,

1445
01:15:03.905 --> 01:15:07.734
really, to get even a kind
of modest acquaintance

1446
01:15:07.734 --> 01:15:09.921
with the literature.

1447
01:15:09.921 --> 01:15:13.355
But I think there's a
historical problem here

1448
01:15:13.355 --> 01:15:16.694
that, really, I can whinge now about this,

1449
01:15:16.694 --> 01:15:20.064
that philosophy-- now
I'm not talking about

1450
01:15:20.064 --> 01:15:22.528
social work, so forgive me,
cause I'm a psychologist,

1451
01:15:22.528 --> 01:15:27.375
but philosophy and psychology
split up a century ago.

1452
01:15:27.541 --> 01:15:29.418
The psychologists said,
"Oh, we don't want this

1453
01:15:29.418 --> 01:15:32.138
"armchair stuff, we want
empirical research,"

1454
01:15:32.138 --> 01:15:34.484
the philosophers said,
"Look, we're interested

1455
01:15:34.484 --> 01:15:38.356
"in logic, don't try to
turn us into psychologists,"

1456
01:15:38.356 --> 01:15:40.564
and they divorced each other.

1457
01:15:40.564 --> 01:15:42.905
I think this was a disaster.

1458
01:15:43.519 --> 01:15:47.252
Because then the psychologists
turned to science

1459
01:15:47.252 --> 01:15:50.317
and they close off.

1460
01:15:50.409 --> 01:15:52.595
The reason I like philosophy, I mean,

1461
01:15:52.595 --> 01:15:54.057
we've got literature, we've got art,

1462
01:15:54.057 --> 01:15:56.126
there's a lot to learn.

1463
01:15:56.126 --> 01:15:58.488
Tons of information about life.

1464
01:15:59.187 --> 01:16:01.971
But I like philosophy
because it's systematic,

1465
01:16:01.971 --> 01:16:05.570
and in that sense it's
parallel to science.

1466
01:16:05.714 --> 01:16:09.676
And the two were one
up 'til a century ago.

1467
01:16:09.896 --> 01:16:13.277
So I think that it's a
symptom of the divorce,

1468
01:16:13.277 --> 01:16:16.545
and I think scientism may be the answer.

1469
01:16:16.551 --> 01:16:18.247
That, you know, we think,

1470
01:16:18.247 --> 01:16:20.647
"Well, philosophy, that's
soft, armchair stuff,

1471
01:16:20.647 --> 01:16:23.409
"There's nothing substantial in it."

1472
01:16:23.409 --> 01:16:24.907
And it's ignorant.

1473
01:16:25.148 --> 01:16:28.700
But so it's a combination
of the cultural attitude

1474
01:16:28.700 --> 01:16:30.769
and the so-called culture wars.

1475
01:16:30.769 --> 01:16:34.043
It's, I mean, the whole of the humanities,

1476
01:16:34.043 --> 01:16:38.794
I think, should be of massive
interest to psychotherapists.

1477
01:16:38.939 --> 01:16:42.325
But it's not part of the culture.

1478
01:16:42.491 --> 01:16:46.762
But the effort is ridiculous, frankly.

1479
01:16:46.832 --> 01:16:50.106
But, I mean, it's true, our
knowledge is so specialized.

1480
01:16:50.106 --> 01:16:53.381
The infant research. It's a huge project,

1481
01:16:53.381 --> 01:16:56.063
to learn about that
stuff. Attachment theory.

1482
01:16:56.399 --> 01:16:58.804
I mean, so, effort.

1483
01:17:00.303 --> 01:17:03.012
But if you just pick up philosophy

1484
01:17:03.012 --> 01:17:06.223
sort of without knowing
what you should look at

1485
01:17:06.223 --> 01:17:09.950
it also can be profoundly boring.

1486
01:17:10.052 --> 01:17:11.806
(audience chuckles)

1487
01:17:12.324 --> 01:17:14.254
See, what I discovered is that

1488
01:17:14.254 --> 01:17:17.059
if you read philosophy that's really good,

1489
01:17:17.059 --> 01:17:21.682
it is immediately relevant
and the writing is fabulous.

1490
01:17:22.478 --> 01:17:25.693
Fabulous writers in philosophy.

1491
01:17:25.795 --> 01:17:30.339
But there's a whole huge boring tradition

1492
01:17:30.339 --> 01:17:33.602
of contemporary, or
recent, modern philosophy

1493
01:17:33.602 --> 01:17:36.050
that's just obsessive.

1494
01:17:36.983 --> 01:17:38.951
So that's some thoughts.

1495
01:17:39.074 --> 01:17:40.583
Good luck to you.

1496
01:17:40.770 --> 01:17:43.014
(audience laughs)

1497
01:17:45.111 --> 01:17:46.033
Yes.

1498
01:17:46.082 --> 01:17:47.553
- [Voiceover] I really loved what you said

1499
01:17:47.553 --> 01:17:51.265
about ethics and what
you were talking about

1500
01:17:51.265 --> 01:17:55.841
really reminded me of
Ivan Boszormenyi-Nagy,

1501
01:17:55.841 --> 01:17:58.017
who was a very early family therapist

1502
01:17:58.017 --> 01:18:00.641
who invented what's
called contextual therapy,

1503
01:18:00.641 --> 01:18:03.798
and he talks about giving or receiving

1504
01:18:03.798 --> 01:18:08.672
and this personal, this
kind of philosophical

1505
01:18:08.672 --> 01:18:11.371
dimension in relationships.

1506
01:18:11.371 --> 01:18:14.432
And I think you were
seeing it and relating it

1507
01:18:14.432 --> 01:18:16.693
very much to attachment,

1508
01:18:16.693 --> 01:18:18.570
which is kind of the
intrapsychic dimension.

1509
01:18:18.570 --> 01:18:23.029
But I don't think it's really being taught

1510
01:18:23.029 --> 01:18:25.204
in social work school anymore, but he was

1511
01:18:25.204 --> 01:18:27.274
a very profound influence on me,

1512
01:18:27.274 --> 01:18:32.274
and I think it is something
that's not necessarily

1513
01:18:32.500 --> 01:18:36.212
just philosophical (mumbles),

1514
01:18:36.212 --> 01:18:39.348
but it's something that clinicians

1515
01:18:39.348 --> 01:18:42.691
can easily grasp and can
actually use in treatment.

1516
01:18:42.921 --> 01:18:44.414
- Yes, well, good, thank you,

1517
01:18:44.414 --> 01:18:46.174
so we're on the same wavelength in that.

1518
01:18:46.174 --> 01:18:47.774
It is useful, that's the thing.

1519
01:18:47.774 --> 01:18:50.195
It is immediately applicable, I find.

1520
01:18:50.195 --> 01:18:51.699
But you've mentioned something

1521
01:18:51.699 --> 01:18:53.608
that I really neglected, and Phebe and I

1522
01:18:53.608 --> 01:18:55.816
talked about it in the
interview this afternoon.

1523
01:18:55.816 --> 01:18:58.088
Family work.

1524
01:18:58.088 --> 01:19:00.434
See, I think if you go into
the attachment literature

1525
01:19:00.434 --> 01:19:03.058
what you realize is that

1526
01:19:03.058 --> 01:19:06.471
the current attachment relationships

1527
01:19:06.471 --> 01:19:09.234
are where the action is.

1528
01:19:09.234 --> 01:19:12.529
And so, really, the work
that I think frankly

1529
01:19:12.529 --> 01:19:15.431
is most important is family work.

1530
01:19:15.431 --> 01:19:18.289
And in our clinic, this is the blessing,

1531
01:19:18.289 --> 01:19:20.860
I have as an individual therapist,

1532
01:19:20.860 --> 01:19:24.902
is that we have fantastic
social workers who are doing

1533
01:19:24.902 --> 01:19:28.848
what I think is the most
difficult work in the clinic,

1534
01:19:28.848 --> 01:19:31.210
although other people might disagree.

1535
01:19:31.547 --> 01:19:34.448
But working with very difficult families,

1536
01:19:34.448 --> 01:19:37.744
and so when the treatment
really goes well,

1537
01:19:37.744 --> 01:19:40.784
the individual therapy is
kind of helping the patient

1538
01:19:40.784 --> 01:19:43.898
make use of the therapeutic community

1539
01:19:43.898 --> 01:19:46.821
and especially the family work.

1540
01:19:46.821 --> 01:19:49.285
And when the individual therapy

1541
01:19:49.285 --> 01:19:52.420
and the family therapy are in sync,

1542
01:19:52.420 --> 01:19:55.247
I think that's when the
treatment goes best.

1543
01:19:55.247 --> 01:19:57.615
I realize now, I'm, you
know, pretty much done

1544
01:19:57.615 --> 01:19:59.481
with my career; well, not totally

1545
01:19:59.481 --> 01:20:02.126
but I've still got
another 10 minutes, but,

1546
01:20:02.126 --> 01:20:03.769
(audience laughs)

1547
01:20:03.769 --> 01:20:06.841
I mean, really, individual therapy is not

1548
01:20:06.841 --> 01:20:09.011
the most potent thing to be doing.

1549
01:20:09.927 --> 01:20:12.779
But it's easier than doing family work.

1550
01:20:12.779 --> 01:20:15.931
So I don't totally regret it.

1551
01:20:16.512 --> 01:20:21.512
But I think the family work
is really the crucial thing,

1552
01:20:23.552 --> 01:20:26.240
and this was Murray Bowen,
I think, really said this,

1553
01:20:26.240 --> 01:20:29.237
work with the current
attachment relationships

1554
01:20:29.237 --> 01:20:31.818
and try to get them going, and there's

1555
01:20:31.818 --> 01:20:33.439
a lot of wonderful work there.

1556
01:20:33.439 --> 01:20:35.018
Sue Johnson is somebody who's doing,

1557
01:20:35.018 --> 01:20:37.716
really using this theory,

1558
01:20:37.716 --> 01:20:40.244
but the other thing is the most hopeful

1559
01:20:40.244 --> 01:20:42.793
intervention literature in the field,

1560
01:20:42.793 --> 01:20:45.119
in the psychosocial realm, I think,

1561
01:20:45.119 --> 01:20:47.508
is the early attachment work,

1562
01:20:47.508 --> 01:20:49.534
where they're working
with moms and babies,

1563
01:20:49.534 --> 01:20:50.996
they work with moms in groups,

1564
01:20:50.996 --> 01:20:53.086
they videotape, they sort of, they look at

1565
01:20:53.086 --> 01:20:55.539
each other's interactions with the babies

1566
01:20:55.539 --> 01:20:58.099
and then they, they actually get help,

1567
01:20:58.099 --> 01:21:01.805
you know, connecting and
reestablishing connection.

1568
01:21:01.823 --> 01:21:03.155
- [Voiceover] People
can now see (mumbles),

1569
01:21:03.155 --> 01:21:08.155
you can just Google it
on YouTube and see it.

1570
01:21:08.829 --> 01:21:11.564
- Yeah. Circle of Security
is another thing to Google.

1571
01:21:12.032 --> 01:21:14.976
They're doing just wonderful work.

1572
01:21:14.976 --> 01:21:17.365
So I'm really glad,
too, that you brought up

1573
01:21:17.365 --> 01:21:21.103
the family dimensions. That's crucial.

1574
01:21:21.802 --> 01:21:23.007
- [Voiceover] Hi, Jon.

1575
01:21:23.007 --> 01:21:23.871
- Yes.

1576
01:21:23.871 --> 01:21:24.842
- [Voiceover] Thank you so much.

1577
01:21:24.842 --> 01:21:26.538
I really appreciated your presentation.

1578
01:21:26.538 --> 01:21:27.561
You made a comment though, early on

1579
01:21:27.561 --> 01:21:30.047
that you saw people with avoidant styles

1580
01:21:30.047 --> 01:21:32.201
being excellent at self-regulating?

1581
01:21:32.201 --> 01:21:32.809
- Yes.

1582
01:21:32.809 --> 01:21:34.110
- [Voiceover] And it's been my experience

1583
01:21:34.110 --> 01:21:35.806
working with people
with that kind of style

1584
01:21:35.806 --> 01:21:38.238
that they're often more dissociating

1585
01:21:38.238 --> 01:21:41.214
(mumbles) experiencing (mumbles).

1586
01:21:41.214 --> 01:21:42.558
And I guess I'm curious to hear

1587
01:21:42.558 --> 01:21:44.226
your thoughts about that.

1588
01:21:45.182 --> 01:21:47.507
- Yes, when you're...yeah, see,

1589
01:21:47.507 --> 01:21:49.085
when you're in there,

1590
01:21:49.085 --> 01:21:53.192
you can think of two different
patterns of avoidance.

1591
01:21:53.192 --> 01:21:55.752
The avoidant attachment in infancy,

1592
01:21:55.752 --> 01:21:59.367
is the infant is managing fairly decently.

1593
01:21:59.367 --> 01:22:02.525
It's stressful, but they're managing

1594
01:22:02.525 --> 01:22:04.178
without relying too much on

1595
01:22:04.178 --> 01:22:07.431
close, comforting contact
with the attachment figure.

1596
01:22:07.431 --> 01:22:12.431
Disorganized attachment is
the extreme of avoidance,

1597
01:22:12.487 --> 01:22:15.462
where they are no longer able to manage.

1598
01:22:15.462 --> 01:22:19.334
And I think dissociation would be a clear

1599
01:22:19.334 --> 01:22:21.937
indication that you're at least likely

1600
01:22:21.937 --> 01:22:25.233
to be in the realm of
disorganized attachment.

1601
01:22:25.233 --> 01:22:30.233
Where there's no reasonable
way of regulating emotion.

1602
01:22:30.779 --> 01:22:34.661
So that's how I would
think about that problem.

1603
01:22:34.661 --> 01:22:38.490
So this is quite straightforward
with our patients,

1604
01:22:38.490 --> 01:22:42.213
they're very effective,
they handle a lot of stress,

1605
01:22:42.213 --> 01:22:46.266
but they move from, in
effect, the avoidant,

1606
01:22:46.266 --> 01:22:48.079
where they can manage on their own,

1607
01:22:48.079 --> 01:22:50.703
they move into the disorganized state

1608
01:22:50.703 --> 01:22:54.323
where they're at sea and adrift.

1609
01:22:55.161 --> 01:22:58.270
So that's how I'd think about it.

1610
01:22:59.182 --> 01:23:04.182
And it's a gray area between
the relatively successful

1611
01:23:04.238 --> 01:23:06.819
avoidant strategy and disorganization.

1612
01:23:06.819 --> 01:23:08.440
And in the infant literature,

1613
01:23:08.440 --> 01:23:11.672
and for that matter in the
adult attachment interview,

1614
01:23:11.672 --> 01:23:15.570
the disorganization is
something that's not pervasive.

1615
01:23:15.736 --> 01:23:18.285
It's sort of, you see it in bursts.

1616
01:23:18.285 --> 01:23:19.938
But when you see it in bursts,

1617
01:23:19.938 --> 01:23:22.876
it's an indication of
some very serious trouble.

1618
01:23:24.994 --> 01:23:29.500
And dissociation is the clearest
example of it, actually.

1619
01:23:32.706 --> 01:23:35.718
We got a few more minutes. Please.

1620
01:23:36.513 --> 01:23:40.155
Sorry, what...okay, up there.

1621
01:23:40.396 --> 01:23:42.806
- [Voiceover] When you were talking about

1622
01:23:42.806 --> 01:23:47.806
the intergenerational (mumbles)
of (mumbles) attachment,

1623
01:23:48.279 --> 01:23:53.279
I think you were talking
about (mumbles) mentalization,

1624
01:23:54.775 --> 01:23:59.775
you made one comment about
the dangers of overattunement,

1625
01:24:01.718 --> 01:24:06.550
and I wonder if you can clarify where,

1626
01:24:06.550 --> 01:24:11.550
what overattunement is, kind of like,

1627
01:24:12.075 --> 01:24:14.511
is that over-mentalization?

1628
01:24:14.581 --> 01:24:17.813
- Yeah. There's a term for this

1629
01:24:17.813 --> 01:24:20.042
that Bateman and Fonagy use, actually,

1630
01:24:20.042 --> 01:24:23.381
they call it hypermentalizing.

1631
01:24:23.381 --> 01:24:25.823
Hyperment-- too much of a good thing.

1632
01:24:25.823 --> 01:24:28.682
So we have a term that actually

1633
01:24:28.682 --> 01:24:30.516
my daughter came up with,

1634
01:24:30.516 --> 01:24:32.511
which is "excrementalizing".

1635
01:24:32.511 --> 01:24:34.361
(audience laughs)

1636
01:24:35.295 --> 01:24:36.895
I couldn't refrain from that.

1637
01:24:36.895 --> 01:24:39.796
And if you Google "excrementalizing",

1638
01:24:39.796 --> 01:24:43.188
a friend of my son's who's a
guitarist in New York actually

1639
01:24:43.188 --> 01:24:47.838
performed a piece which she
titled Excrementalizing.

1640
01:24:47.838 --> 01:24:49.843
She was looking for a title, anyway,

1641
01:24:49.843 --> 01:24:53.986
that's a little bit off
topic, but it is connected.

1642
01:24:54.545 --> 01:24:57.670
And in our book, one of 'em,

1643
01:24:57.670 --> 01:25:00.688
yes, I think it's a book
on plain old therapy,

1644
01:25:00.688 --> 01:25:03.685
well, anyway,
excrementalizing is in there.

1645
01:25:03.685 --> 01:25:07.237
Excrementalizing means
that you're mentalizing

1646
01:25:07.237 --> 01:25:09.258
but you're doing a crappy job of it.

1647
01:25:09.328 --> 01:25:10.954
(audience chuckles)

1648
01:25:11.184 --> 01:25:15.183
So the hypermentalizing,
the way this gets going

1649
01:25:15.183 --> 01:25:19.049
is that you're so, it's hypervigilant.

1650
01:25:20.015 --> 01:25:23.545
See, you're so worried
about what's going on

1651
01:25:23.545 --> 01:25:26.809
in the other person's mind that it's like

1652
01:25:26.809 --> 01:25:28.537
you're glued to them and you're making

1653
01:25:28.537 --> 01:25:33.405
all kinds of inferences about
what's going on with them.

1654
01:25:33.827 --> 01:25:36.253
So it's like too much and distorted.

1655
01:25:36.654 --> 01:25:38.659
The too much is the "hyper,"

1656
01:25:38.659 --> 01:25:42.066
and the excrementalizing
is the distorted part.

1657
01:25:42.254 --> 01:25:44.109
But see, what that doesn't do,

1658
01:25:44.109 --> 01:25:47.085
an example in the infant literature

1659
01:25:47.085 --> 01:25:50.936
is that the infant
turns away from the mom.

1660
01:25:50.936 --> 01:25:54.972
Now let's say the mom is very
insecure about her mothering.

1661
01:25:56.119 --> 01:26:00.572
So the infant turning away
from her is threatening to her.

1662
01:26:00.759 --> 01:26:03.516
It may threaten her sense
of herself as a mother.

1663
01:26:03.596 --> 01:26:06.636
So what does she do? She looms in.

1664
01:26:06.636 --> 01:26:09.489
She follows the infant.

1665
01:26:09.559 --> 01:26:11.574
And then the infant doesn't have--

1666
01:26:11.574 --> 01:26:14.902
see, a big part of how we
regulate in interactions

1667
01:26:14.902 --> 01:26:17.035
is turning away, looking away.

1668
01:26:17.035 --> 01:26:19.265
Just stare at another
person for a long time;

1669
01:26:19.265 --> 01:26:21.050
it'll drive you nuts!

1670
01:26:21.259 --> 01:26:23.211
And so, you know, we gotta regulate

1671
01:26:23.211 --> 01:26:26.837
by turning away and withdrawing
and then coming back.

1672
01:26:26.837 --> 01:26:31.221
So that hyperattunement
or hypermentalizing,

1673
01:26:31.221 --> 01:26:34.656
whatever you want to call it, interferes.

1674
01:26:34.656 --> 01:26:36.330
That's the failure of respect,

1675
01:26:36.330 --> 01:26:38.165
that's why I love that,

1676
01:26:38.165 --> 01:26:40.490
to give the other person space.

1677
01:26:40.490 --> 01:26:43.135
It's a kind of possessive way,

1678
01:26:43.135 --> 01:26:46.474
and it's possessing the
person's mind, in a way,

1679
01:26:46.474 --> 01:26:49.369
just not letting 'em have their space.

1680
01:26:51.444 --> 01:26:53.016
Yes.

1681
01:26:53.140 --> 01:26:53.972
- [Voiceover] I guess I'm curious

1682
01:26:53.972 --> 01:26:56.372
what the term "mentalizing"
is referring to

1683
01:26:56.372 --> 01:26:59.411
mental and then mind and then brain,

1684
01:26:59.411 --> 01:27:01.225
which feels a little bit dissociated

1685
01:27:01.225 --> 01:27:02.665
from the more somatic way that I

1686
01:27:02.665 --> 01:27:04.979
experience an attunement, you know?

1687
01:27:04.979 --> 01:27:06.835
And so I'm wondering if you would speak to

1688
01:27:06.835 --> 01:27:08.584
the choice of that word and how

1689
01:27:08.584 --> 01:27:12.429
that's a somatic experience
in connection with (mumbles).

1690
01:27:12.712 --> 01:27:14.962
- Yeah, that's why in that slide

1691
01:27:14.962 --> 01:27:17.170
I have the sort of nonverbal part,

1692
01:27:17.170 --> 01:27:20.914
which is, and then reflective mentalizing.

1693
01:27:20.914 --> 01:27:23.303
And I think, and Peter Fonagy
and I agree about this,

1694
01:27:23.303 --> 01:27:25.874
you need all three of these going.

1695
01:27:25.874 --> 01:27:28.711
And to only focus on the
reflective mentalizing

1696
01:27:28.711 --> 01:27:30.705
is to miss a ton.

1697
01:27:30.705 --> 01:27:33.383
And the word "mentalizing",
the problem with it is

1698
01:27:33.383 --> 01:27:36.721
it's too intellectual, it's too mental.

1699
01:27:36.721 --> 01:27:37.905
People hear "mental".

1700
01:27:37.905 --> 01:27:39.420
Well, what about emotion?

1701
01:27:39.420 --> 01:27:41.990
This whole, everything
I've been talking about

1702
01:27:41.990 --> 01:27:46.310
is about emotion, and so that's a problem

1703
01:27:46.310 --> 01:27:49.403
with that word, it's kind of dehumanizing.

1704
01:27:49.403 --> 01:27:51.461
And now since you mention the brain,

1705
01:27:51.461 --> 01:27:56.461
I'm gonna plug one other,
this is one last whinge, okay?

1706
01:27:57.274 --> 01:27:59.423
Is about biomania.

1707
01:28:00.314 --> 01:28:03.311
See, if you take the
technological approach

1708
01:28:03.311 --> 01:28:05.626
where you got manualized things and rules

1709
01:28:05.626 --> 01:28:07.951
and procedures and all of this,

1710
01:28:07.951 --> 01:28:12.951
and then you get into the
biological psychiatry,

1711
01:28:13.081 --> 01:28:14.799
which I'm not complaining about,

1712
01:28:14.799 --> 01:28:17.284
we need it, there's no question about it.

1713
01:28:17.284 --> 01:28:21.252
But exclusive focus on the brain, I think,

1714
01:28:21.252 --> 01:28:25.625
is the far end of that
scientism continuum,

1715
01:28:25.625 --> 01:28:29.565
where you literally lose the person.

1716
01:28:29.656 --> 01:28:34.656
And the life of the person
is just not in your purview.

1717
01:28:35.651 --> 01:28:39.597
And I mean, this is a
caricature, but it's out there.

1718
01:28:39.597 --> 01:28:44.450
Where, really, you've lost the mind

1719
01:28:44.450 --> 01:28:47.767
and, you know, you're
just totally fascinated

1720
01:28:47.767 --> 01:28:50.903
with the brain and the
images and the medicines

1721
01:28:50.903 --> 01:28:53.937
and the neurostimulation
and all of this stuff.

1722
01:28:54.082 --> 01:28:57.217
And so I think this, it is a problem

1723
01:28:57.217 --> 01:29:00.119
that the humanism in our field,

1724
01:29:00.119 --> 01:29:03.745
which is the guts of it,
you know, fades from view,

1725
01:29:03.745 --> 01:29:06.939
and guts, of course, is
what you're talking about.

1726
01:29:09.110 --> 01:29:09.936
Yes.

1727
01:29:10.529 --> 01:29:12.544
- [Voiceover] Most people who
perform therapy these days

1728
01:29:12.544 --> 01:29:14.912
seems to focus strongly on the body.

1729
01:29:14.912 --> 01:29:17.216
I'm wondering how you
integrate those ideas

1730
01:29:17.216 --> 01:29:19.695
with plain old psychotherapy.

1731
01:29:19.787 --> 01:29:22.208
- Yeah, well, I think it, what this shows

1732
01:29:22.208 --> 01:29:26.724
is that plain old therapy
is not all we need.

1733
01:29:27.658 --> 01:29:30.581
I think plain old therapy
is really important,

1734
01:29:30.581 --> 01:29:32.159
I think we're gonna need it forever

1735
01:29:32.159 --> 01:29:34.346
no matter how many other therapies

1736
01:29:34.346 --> 01:29:36.671
and medicines we have, but I think

1737
01:29:36.671 --> 01:29:39.476
work on the body is really helpful.

1738
01:29:39.476 --> 01:29:41.961
I mean, we're lucky, we
have going at the clinic

1739
01:29:41.961 --> 01:29:44.212
trauma-informed yoga,

1740
01:29:44.212 --> 01:29:48.489
which is helping people in a very safe way

1741
01:29:48.489 --> 01:29:51.309
who are, you know, they
live from the neck up.

1742
01:29:51.849 --> 01:29:54.846
And, you know, helping
them get more in touch

1743
01:29:54.846 --> 01:29:57.150
with what's going on in their body.

1744
01:29:57.150 --> 01:29:58.792
So I don't mean for a moment to say

1745
01:29:58.792 --> 01:30:01.883
well, all we need in the
therapies is plain old therapy.

1746
01:30:02.363 --> 01:30:06.338
There are lots of reasons
for other things that we do.

1747
01:30:07.624 --> 01:30:10.898
I just want to, what my goal is,

1748
01:30:10.898 --> 01:30:14.119
people who are out there
just muddling through,

1749
01:30:14.119 --> 01:30:17.330
trying to help patients by talking to 'em,

1750
01:30:17.330 --> 01:30:21.436
that they shouldn't be made defensive by,

1751
01:30:21.436 --> 01:30:23.708
"Well, you're not doing
evidence-based practice."

1752
01:30:23.708 --> 01:30:26.449
I think the whole attachment field

1753
01:30:26.449 --> 01:30:31.449
has generated a half-century
of fabulous evidence

1754
01:30:32.027 --> 01:30:33.531
for what we do.

1755
01:30:33.531 --> 01:30:37.414
That's basically what I'm saying.

1756
01:30:37.414 --> 01:30:39.195
Not that that's the only thing.

1757
01:30:39.195 --> 01:30:40.987
(audience applauds)

1758
01:30:40.987 --> 01:30:45.987
Okay, enough. Thank you.
Thank you. Thank you.