You Must Be Some Kind of Therapist

Swell AI Transcript: 116. Camilo Ortiz FINAL.mp3
Dr. Camilo Ortiz:
My most hated phrase is be careful. It implies that there's danger where there may not be danger or this is generalized. I'm going outside. Okay, be careful. That's one of the hypothesized ways that parents transmit anxiety to their kids is by warping, maybe too strong a word, but their view of the world, of themselves, of the future as things that are to be scared of. I see this more generally when a child is uncomfortable or something and a parent will say, are you OK? There was no indication that she felt like she wasn't OK until you said it. And then you sometimes see kids start crying at that point. You must be some kind of therapist.

Stephanie Winn: Today I am pleased to be speaking with Dr. Camilo Ortiz. He has an impressive list of qualifications, though I'm not quite sure where to start. He is a clinical psychologist in private practice in Long Island, also an associate professor and director of clinical training in the clinical psychology doctoral program at Long Island University Post, He's also the clinical director at Open Therapy Institute, which might sound familiar if you remember way back in episode 24 when I talked to his colleague Andrew Hartz, the episode called Counseling in a Cluster B Culture. Andrew Hartz founded Open Therapy Institute, so Dr. Ortiz is now the clinical director there, and he has a bunch of other impressive qualifications as well. You might recognize his name as well from his affiliation with Let Grow, And I think he appeared in Abigail Schreier's book, Bad Therapy. So today we're going to talk about independence therapy, a term that he coined for helping kids overcome anxiety through giving them age-appropriate responsibilities and freedoms. Camilo, welcome. It's so good to have you here today.

Dr. Camilo Ortiz: Thanks so much for having me.

Stephanie Winn: Alright, so you coined this term independence therapy. Can you tell people about the evolution of this idea from sort of classic exposure therapy for, let's say, specific phobias, to this idea of giving kids independence therapy?

Dr. Camilo Ortiz: Yeah, sure. So a lot of this is borrowed from my good friend, Lenore Skenazy, and she has an organization called Let Grow, and they work with schools to have teachers give out what they call independence homework once a week, or kids do things without parents that people my age used to do all the time. And now kids don't really do that much, like ride a bike to the park or climb a tree or even take the subway. and anecdotally teachers were reporting that kids were getting less anxious as they did more of these independence activities. Now these are just typically developing kids and so I see really anxious kids in my private practice and so It occurred to me that we could turn this into a treatment, but it would have to be more than once a week. Any behavior change takes a lot of practice. And so I thought, well, what if we did this every day and we turn this into a treatment? A short treatment, just five sessions, didn't involve a ton of expertise and is mostly about asking kids, what things would you like to do independently? We pulled out a calendar and made plans for that week of things they would do every day, and then we'd meet the following week. And so my doctoral student and I, his name is Matthew Fastman, tested it on a few families, and we were really happy with the results. We were finding that kids were less anxious, and parents were less anxious, and parents began to trust their kids more, and kids began to trust themselves more. And so we wrote about it in the New York Times. And so now we're applying for a big federal grant so that we can test it on a lot of people to see if it's at least as good as exposure therapy. And I'm hoping that it's better and quicker.

Stephanie Winn: Well, that's so exciting that you're heading toward that level of research. What ages is this appropriate for?

Dr. Camilo Ortiz: So we tested it on kids who are nine to 13. This is sort of the age range where kids, A, start developing anxiety disorders, and B, under the right circumstances, can be out in the world by themselves without a parent looking over their shoulders. But I've gotten lots of questions about whether some of these principles can be used with younger kids than with older kids. And I'm pretty firm that the answer is yes, we just need to change the types of activities that kids would do. But the structure of the treatment really should not change that much.

Stephanie Winn: I talk to a lot of parents of kids just a little older than that, and it seems like so many of them are so bright, so cognitively developed, but maybe stunted in other ways in terms of their emotional and social skills and their practical life skills. So we often talk about just sort of rounding things out by being physically active, helping out around the house, getting outside, and things like that. These age-appropriate responsibilities and freedoms, though, that you're talking about, I know part of Lenore's story, your good friend Lenore Scanese, is the massive amount of blowback that she's gotten, and that other parents who have followed this advice have gotten, and some have even potentially gotten into legal trouble, like Child Protective Services reports, because of how the culture has changed. Now, at the beginning, you said that the types of things that you're recommending children do are things that kids were doing in the past 20, 30, 40 years ago. Or even less. Wow. Okay. So what is your perspective on that cultural shift in norms over time about what children are expected to be able to do independently?

Dr. Camilo Ortiz: Yeah. I mean, when we look at research on a number of things, we see dramatic drops in independent activities. Things like, at what age would you allow your child to walk to school by themselves? Or walk less than a mile to a park by themselves? And at what age were you allowed to do that? We see around And parents who are born in the 70s and 80s, we see about a three year difference in how they answer those two questions. So it's just very clear that the kids are less independent now. And we've seen at the same time, child anxiety rising. Now we can't create randomized control trials to make some kids independent and some kids not. And so all we have are correlations, but I think that they're pretty strong and pretty meaningful. It may not be the whole answer to why kids are more anxious these days, but I think it's a part of the answer. And related to that is also how kids play. And so there's a psychologist named Peter Gray, and he has demonstrated that over the past generation, mixed-age free play has plummeted in kids. And so now kids play segregated by age and they play with adults telling them what the rules of the play are. So lots of sports teams and much less, let's hang out at the park and create a game. And I think, you know, they're both important, but the free play really works on kids' soft skills, negotiations and and distress tolerance. You know, when I was a kid, there'd be a discussion about where was out of bounds and this is in bounds. And what about that tree? And we'd all have to get together without an adult. They're figuring it out. And it didn't occur to me at the time. But that's amazing training for how to actually be an adult and deal with other people who have differences of opinions.

Stephanie Winn: So in the therapy setting, you work with parents and children and you develop a list, is that right, of activities that kids want to do independently. So can you sort of walk us through what that might look like for a family from one week to the next?

Dr. Camilo Ortiz: Sure. Well, we have a list of over 100 things that could be independent activities, but we don't show our hands. We don't show it to the kids. I really just start with a question this simple. What is something that you would like to do independently that you're not doing right now? And every kid I've ever asked that to has some answers. And that's where we start. Now, parents obviously get a veto on anything. I had a kid who wanted to take the Amtrak by himself. And so he started researching which states would allow a 13-year-old to take Amtrak. And his mom said, there's no way we're doing that. And that's fine. You get a veto on that. When kids struggle to find something feasible, then we have ideas that we've seen other kids do. And they typically fall into a few categories. So there are indoor activities. An example of that would be painting a wall in your own bedroom or cooking a meal from start to finish without any help from a parent. But we also can do things, if that's too challenging, we sometimes start with chopping some vegetables by yourself. There are outdoor activities, going to a pizza place and ordering a slice of pizza by yourself, going to a supermarket with a list of things without your parent there and buying them and paying for them. There are activities that involve other people, other kids, no adults, other kids, and preferably, as I just mentioned, mixed age independence activities. So, you know, going to the, riding your bike with friends. to a local park and playing a game of pickup basketball without any referees or adults telling you what the rules are, those sorts of things.

Stephanie Winn: And you find that most of the time when you frame it this way, kids are on board with it. What did you discover about the shift in language or framing that helped kids get on board with this?

Dr. Camilo Ortiz: Well, kids are not the problem. So I really, maybe I've had one One kid who is very socially anxious and didn't want to do things where people might see her doing things, but mainly the people to convince our parents. And then to get to your original question about the culture, the adults that we have to worry about are not adults that have any ill intent toward our kids, but adults that will step in and kind of ruin the independence activity by saying, hey, where are your parents? So let me address those separately. And I'll start with the last one. So in Lenore's program, she has these little ID cards that she gives kids. And they say something like, I'm a Let Grow kid. I have permission to be here. And they sign it almost like a badge. and so we give our kids these ID cards and basically they just like flash them to anyone who might step in their way, any adult. So we had a child take the Long Island Railroad here by himself and we had done our research and we knew that he was old enough according to the rules to be on the train, but the conductor was confused and thought that There's something wrong about this. This child was 10, I believe, being on the train for two stops. His mom dropped him off and his dad is waiting two stops away. And so he showed his card and the conductor let him stay on. But convincing parents is really what we start the treatment with. And again, here, I lean on Lenore because she It was part of this amazing video produced by my friend John Popola, who's a filmmaker, about her story of letting her own son, Izzy, take the New York City subway by himself when he was nine. And it's a beautiful 10-minute documentary of what happened. And part of the first session is just showing parents this documentary. And most parents I show this to start crying. And I think the emotion comes from the disconnect they see from their fondest memories as kids and what they now don't allow their own kids to do. And they know there's something not right about that, but they feel pressure from those around them. And when they watch this video, they see, I think, that there's a way out of this. And then there's me, a professional, telling them that it's OK and they're not bad parents if they allow their kids to do independence activities. And it's really hard for them. But our parents have been really brave. We had a mom who had to take the day off from work the first time her son walked home from school by himself. She was so nervous she couldn't concentrate on her work, but he did an amazing job. And the next day she went to work. And it was easy from from then on.

Stephanie Winn: What's the name of this documentary?

Dr. Camilo Ortiz: It is called Off the Rails, and you can find it on YouTube.

Stephanie Winn: So it seems like this documentary does a good job of highlighting this issue for parents of how much things have changed over the generations.

Dr. Camilo Ortiz: Yeah, that's right. And it ends in a really hopeful way. that there's a way out of this. We don't have to succumb to the societal pressure to over parent and to be over involved. And actually our kids will benefit if we do less. That's the sort of like beautiful sweet spot that if I can get parents to do less, they actually will get better outcomes. And I think most parents are tired of the expectation that there's just never enough time and effort and money spent on their kids. And that's another trend. When we look at the amount of time parents spend physically in the same place as their child, it has just gone up nonstop. for the last 50 years. And when you ask parents if they are satisfied with their efforts, that number is going down. So we're spending more effort and energy on our kids and feeling worse about ourselves as parents. It's just not sustainable.

Stephanie Winn: So you've gotten a reputation at this point. I imagine many of the parents bringing their children with anxiety to know what they're getting into. but not all of them, and maybe not always that many of them have known. So for parents who, let's say, parents of a 10-year-old boy who's very anxious and they're coming to you for, you know, child anxiety specialist, how do you draw the connection for them, if they're not familiar with your work, between their kid's anxiety, which they're seeing as its own problem, And the idea that him walking to the park by himself or getting himself a slice of pizza is maybe the solution.

Dr. Camilo Ortiz: Yeah, so I lead with curiosity. And so I'll just say something like after they describe their child's anxiety, I will say, how independent do you think your child is? What sorts of things can he do on his own? And they often say, not so much. He doesn't really do this or do that. And then I'll say, Is it because he doesn't want to or or are you guys worried about what might happen if he did things independently? And usually the answer is the latter, that he does. He's been asking to do this or to do that, but, you know, he can't even sleep in his own bed. And so we're worried about what will happen if he goes to the park by himself. And this is sort of like the the the beauty of independence therapy, which is that we are finding that kids who become more independent see improvements in anxieties that are not even related, at least on the surface, to what they're coming in to see me for. And so, for example, we had this little girl who, she was nine and she took the bus in Brooklyn by herself to school and had not been able to sleep in her own bed. And that night, when she got home from school on the bus again, marched in her house and announced that she was going to sleep in her bed by herself. And when her parents said, why? Why today? She said something to the effect of, I just took the bus. So I feel really grown up. I don't need to sleep in your bed anymore. And so this is what, to get scientific about it, we call topographical dissimilarity. So on the surface, these two fears, sleeping in your bed, going to school by yourself, might seem unrelated to each other, but they share a lot of underlying pathways or mechanisms. And so the theory behind independence therapy was if we could get kids to be more independent, the other things that they're afraid of would get better, even if we never directly worked on it. And this is the main difference between my treatment and exposure therapy. So If you were, for example, scared of spiders and you came in to see me and we were going to do traditional exposure therapy, we would start playing with spiders until you weren't scared of them anymore. As you can imagine, most kids don't want to do that. After a long day of school, go to some therapist's office and confront the thing that scares them the most. I mean, who would want to do that? Whereas I think they do want to come into my office and talk about what things they can do independently. And so we're finding that there's sort of higher level of acceptance of this treatment. And it also seems to sneakily work on the anxieties without ever really directly confronting them.

Stephanie Winn: It seems like the overarching theme is about developing a sense of competence and in the process learning to trust yourself. You're having that visceral lived experience of, I know I can handle myself and various situations that come up. And the more you're able to trust yourself in various situations, the more a child will be able to generalize from that, that I'm a competent, trustworthy person. I think I got this.

Dr. Camilo Ortiz: So when kids come back to us and they have done something successfully, like taking a bus to school or gone to a pizza place, in order to slice by themselves, we really focus on what the lesson is that they learned. And many kids will have a very specific lesson. So they'll say, I learned I can go buy pizza by myself. But any good psychologist really wants to broaden that lesson. And so I'll say something like, is that all you learned? Or did you learn anything more fundamental about yourself? And at that point, kids will often say, well, I learned that I can do things that are challenging. or I learned that I didn't need an adult around to do challenging things. And so that's really the sweet spot. We want those generalized lessons, and that's why we see improvement to other areas that we never even addressed. Actually, the best thing that can happen is if something goes wrong. And that might seem like a strange thing to say, but I sort of secretly hope that things go wrong when we do these independence activities. And an example is this little girl who took the bus by herself to school in Brooklyn. She actually missed her stop. And her phone wasn't working for some reason. And so there was a woman sitting next to her. And she said something like, Are you okay, honey? You look a little upset. And she said, Yeah, I think I think that was my stop. And the woman said, Oh, okay, you can just get out right here. And then it's just two more blocks that you have to walk. And this is, I think, even extra growth that can happen from independence activities, which is this idea that things don't have to go perfectly. I'm capable of handling challenges. And so that made this particular independence activity, I think, even more powerful. And there are some roots in exposure therapy where you sort of sometimes purposely want things to quote unquote go wrong, because then it really stretches people. So, most people who are anxious have two general beliefs. They overestimate the likelihood of something going wrong, and they underestimate their own ability to handle it. And so, if you do a lot of exposure therapy, you will see that most of the time nothing goes wrong. But you actually want things to go wrong occasionally to test that second belief, that if things go wrong, I can handle it. So, We don't want it to be catastrophic, but missing your stop on a bus and having to walk two extra blocks is probably perfect.

Stephanie Winn: I have some stories coming to mind from my own experiences as a stepmother. So one is that one of my kids just broke a bone recently. And fortunately, I had just read The Anxious Generation and remembered reading something specifically about how kids who have a broken bone at some point in childhood actually have better outcomes as adults because of that resilience and the growth that can come from it. And it's not the first time in my life that something happens. And I think, thank goodness, I just read that book by Jonathan Haidt, where I learned this particular fact that allows me to see the situation this way. And the funny thing is this. Broken bones, Jay. You had that written down on a post-it?

Dr. Camilo Ortiz: I had it on a post-it because that exact example is something that I have been wanting to talk about more. It's funny that you mentioned it.

Stephanie Winn: Well, then we will delve into it now. You can shed some light on this situation, but what I noticed is that this particular kid is so squeamish about pain. So, for example, if there's nice weather and we decide to have dinner sitting outside rather than inside, And a bee comes up and starts buzzing in the area. He freaks out. I mean, he's like attracting attention to himself. He's asking to get stung. He's like, ah, ah. And we're all just like, calm down. The bee's not trying to hurt you unless you're trying to hurt it, you know? So he's normally super squeamish about pain. Then he breaks a bone. And it turns out that the process of treating it – so I stayed home with the other kid and, you know, he went to the hospital with his dad. The process of getting it fixed, they had to put him on ketamine and readjust his arm. So he was totally out of it during the process of having his arm readjusted. Otherwise, he would have been screaming. But what I noticed is that he handled it so well. Like, in the days following that, I mean, he's just been rolling with it, having his arm in a cast. He asked me to macrame him a lanyard to keep his watch on so that he can, you know, because normally his watch would go here. And he's had this really positive attitude about, you know, making sure that he can do everything on his own with his other hand. And I'm really curious to see, not that I want him to be in pain, but I'm curious to see the next time some threat of minor pain, pain less than the pain of a broken bone, comes up. I'm really curious to see if he's less reactive to that.

Dr. Camilo Ortiz: I'm sure he will be. And I think there's lots of ways to explain that. But one thing that comes to mind is that our minds, our brains are really good at filling in gaps with the worst possible outcome. And there are probably evolutionary reasons for that, that the people who imagine the worst are actually more likely to survive. As I tell my clients, there probably were not too many surfer dude cavemen who would look at the sky and look at how beautiful it was and not see where they were walking. They didn't tend to survive very well. But people who fill in gaps with danger, like, I don't know what's behind that bush, it's probably a rattlesnake, will tend to be more likely to pass on their genes. But when we get information about what actually happens when something unfortunate occurs, it often is not as bad as the image that we've imagined. But I also talk about kids really needing experience with distress, with disappointment, with danger, and current contemporary parenting protects kids from those things. And it's actually, I think, pretty bad for kids to not experience those things. what I call the four Ds, who are basically kids, need tons of experience with them, and then they do better. So I think I, did I only mention three of them?

Stephanie Winn: You mentioned distress, disappointment, and danger.

Dr. Camilo Ortiz: And discomfort, discomfort. Yeah, and I'm sure he's uncomfortable with a broken hand. And so he's learning that it doesn't feel great, but I can tolerate it. Super, super important lesson.

Stephanie Winn: I love sleep. Sound sleep is a crucial foundation of good mental and physical health, from mood and concentration to metabolism and cellular repair. And I sleep very well thanks to my Eight Sleep Pod Pro Cover. My side of the bed is programmed to be warm when I get in and cool down to a neutral temperature in the middle of the night so I don't wake up overheated like I used to. How would you customize your bed temperature? Visit 8sleep.com and use promo code SUMTHERAPIST to take up to $200 off your purchase. Even if they're already running another sale, this code will get you an additional $50 off. 8sleep currently ships not only within the USA, but also to Canada, the UK, select countries in the European Union, and Australia. Thanks for considering purchases that support the show. I'm thinking about something related to what we're talking about, which is the experience I'm having with the other stepkid. The one who's had a harder time adjusting to our blended family situation, a harder time trusting me. Because I've often had this intuition about him that what he needs is some kind of high-risk situation with me where he has to depend on me. And that if we can make it through that together, it will help us overcome one of the hurdles to him being able to trust me in the way that I think will ultimately be a more secure environment for him as a kid. And so I've had sort of fantasies of what that might look like, you know, but it's like you don't want to create an endangering situation. It's a very fine line. So in this case, it's not so much about the kid learning that he can handle a situation on his own, but it's in the context of a blended family where there's not that secure attachment from early childhood with a parental figure that the kid still needs to depend on. I've wondered, I've racked my brain for what situation I could put the two of us in where there's no real danger that anything could go terribly wrong, but where he would make it through feeling like, glad I depended on Stephanie.

Dr. Camilo Ortiz: Well, where my mind goes is I wonder if Him feeling like you trust him to do things independently could actually have the same positive effect instead of him needing you.

Stephanie Winn: That's a good point and he's, I will give you an example of that. We've been outside doing yard work, and he's a contrarian by nature. I mean, his automatic first thought in response to everything is, no, you're wrong, which sometimes is hilarious. And there was this one day that everyone could see that there's no use trying to hack a path through this particular part of the yard. But knowing his temperament, he had this idea that he wanted to try it out, you know, with some Shears and his brother was trying to argue with him and I was just like, no, no, go ahead and try it. I knew that it, you know, and sure enough, after one minute, he's like, yeah, you can't make a path through there. But it was, you know, I think he felt so much better with me not trying to get in his way of figuring that out for himself.

Dr. Camilo Ortiz: Yes. Yeah. I mean, one of the main skills that I work on with parents is to make far fewer commands of their kids and as I call it, let the world do your parenting for you. So you could have gotten into a big argument with him there, but that would only probably have made him less likely to want to listen to you. Whereas the natural consequence of it being really hard to cut a path through the yard was a far better teacher for him than any words you would have said. And then you're not the bad guy.

Stephanie Winn: Yeah. And it's so much easier to say, go ahead and try it.

Dr. Camilo Ortiz: Yeah. Yeah. And, you know, that's also consistent with what we were talking about earlier, that independence activities don't always go well. And at least initially, people run into barriers and they're not always sure what to do, but that's where growth happens, where you have to figure it out. And again, I think teenagers are blessed by evolution to be amazing problem solvers. They're really good at figuring it out, but that muscle gets weak over time if parents step in to solve the problem for them. They need lots of practice with solving problems. So, I mean, that's another way to look at this independence therapy is we're giving them practice to handle problems.

Stephanie Winn: You know, I hope this, I don't mean to make this too personal, but now I want your opinion on all these little situations that I can think of. Like, for example, the younger one I was just talking about, we were walking through the neighborhood and there were some kids very close in age to him playing with a soccer ball. They didn't have like a soccer net or anything, but they were kicking the ball around and he loves to kick a soccer ball around. So I was like, Hey, why don't you go introduce yourself to them? And. He was saying that he thinks they're too old for him. I mean, they were, I looked at them and they were maybe a year older than him. And earlier you were talking about how age, you know, age stratified groups. And here I am thinking these kids are so close in age, but all this time in, I don't know, the public school system where you're only allowed to be with kids of the exact same grade, he seems shy. He was also saying that they shouldn't be kicking the ball on the street. It's a perfectly safe place for them to kick it. And I was just surprised by his cautiousness. And I left that thinking, I'm not going to push him. No, no, no. You must introduce yourself. That would backfire, of course. But I was wondering, how do I nudge him?

Dr. Camilo Ortiz: Yeah. So I think most parents in that situation would reassure, nothing will happen. Go talk to them. I'm sure they're really nice kids. that tends to, in many kids, produce a counter response. So they harden their position even more. And so this is a technique that is pretty simple to describe, but actually is quite difficult to do in practice. But the first step of reflecting back what the child is saying, you're worried that they'll say no or something like that. Without saying whether you agree with it or not, you're just reflecting back. So, you know, one of the most important psychotherapists of the 20th century, Carl Rogers, said that a person cannot change if they're not accepted as they are. And so reflecting does that. Yeah, I'm worried that they're going to say no. And then I asked parents to count to five Mississippi in their head before they say anything else, because usually they ruin the very nice reflection with like, no, it's not a big deal or that's silly. Don't worry about it. Go, go talk to them. So reflect what your child is saying, count to five Mississippi to let them think about it, because sometimes a child will say, you know what, maybe I will try before you've said anything. If they still don't, then at that point, you could decide that you want to reassure or problem solve, but at least they have felt heard and had a little bit of time to on their own, come up with a solution. And maybe that time they don't go, play with those kids, but the next time they remember the conversation you had, and they're a little more likely to do it. I just see a lot of parents invalidate. No, that's silly. They're going to play with you. And then get upset when a child won't do something that's actually difficult. It's not easy. Again, if you have not had practice walking up to a group of kids and saying, hey, can I play? That's a really hard thing to do. When I was a kid, we did that literally every day. And so it became quite easy to do that. But if you haven't had that practice, it is asking a lot of a kid to do that for the first time.

Stephanie Winn: It's crazy to think about the idea that some kids' lives are so structured that they are really only interacting with other kids in these very confined and scripted environments. So yeah, that skill of just wandering up to a kid in the neighborhood because They're playing soccer. You like soccer. That's a big leap.

Dr. Camilo Ortiz: My mother tells this story of how I met my best friend when I was growing up. And I was four. And I walked up to his mother. And I said, can I play with your little boy? And that became my best friend for 20 years. And my mother and she became best friends for 40 years.

Stephanie Winn: That's so cute. So I'm thinking about missed opportunities to pick up on these things, because in the type of work I do with parents, which is albeit much different, one thing I notice is that sometimes, ironically, the stress that parents are under and their own worries get in their way of just seeing those little opportunities that crop up in everyday life. Some people are fortunate enough to be able to go to the office of someone like you and be walked through this exercise, but I'm imagining that there are plenty of parents who, you know, their kids don't have clinical levels of anxiety. They can do this at home. They can either explicitly make that list with their kid of, hey, what would you like to learn how to do on your own? Or maybe they can just notice. Maybe there are missed opportunities to pick up on ways that a kid is signaling they're ready to try something new.

Dr. Camilo Ortiz: This is, for me, the best part of independence therapy, that you can do all this stuff for free anytime you want to. Because if you're like a typical parent, you probably will have 100 opportunities every day to step in a little bit less. And so sometimes it's as easy as doing the exact same thing you are going to do, but waiting five seconds. So this is, with really anxious parents, this is where I start. And there's a whole literature on reducing what are called parental accommodations, but these are sort of short-term strategies meant to reduce discomfort or reduce anxiety that actually deprive a child of the practice that we've been talking about. And so, you know, I tell this story of this little girl I saw at the park and she had a sweater on and she was trying to pull it off. She must have been like three or four years old. And she kind of got stuck in the turtleneck of the sweater for a second. And she was struggling a little bit. And I saw her dad race across the park to pull the sweater off. And nobody other than a clinical psychologist would ever notice this. But I was like, right there. a little bit of delay, and I think she would have gotten it off and learned a little something about herself. I don't need someone when I'm uncomfortable to pull a sweater off of my head. Or maybe a more generalized lesson like the one that we learned. And so this is, I think, the simplest place to start is spend 24 hours just noticing every time you step in to reduce one of the four D's for kids. And then the next day, do all those same things, but just wait five seconds before, unless we're talking about, you know, imminent danger, that's where we start. But it also can be having a conversation with your child, like the same one I have. What are some things you'd like to do independently? And then you don't have to say yes, it's just a conversation. And then you can decide whether maybe there's one thing that your child notices or your child, states that you're willing to try. And it's going to be a little bit uncomfortable, but that's part of the benefit for parents as well.

Stephanie Winn: It would seem like also there are, you know, when you talk about the amount of support that parents are providing, sometimes that support involves Maybe giving the child the responsibility or the freedom, but explaining how to do it. And sometimes we can just step back a notch. Like I'll try to give instructions slightly differently. Like I'll say, you know, here's the objective that needs to be completed and then see if they can kind of figure it out their own way. Yeah. And then I'm here if they miss a step or they don't know what order to put steps in.

Dr. Camilo Ortiz: Yeah.

Stephanie Winn: I wonder too if some of the problem with kids having so much anxiety involves a misguided attempt at empathy. And when you were sharing your recollection of this tiny little moment in some family's life where the dad rushed to help his daughter take her sweater off, it reminded me of a tiny little moment I remember observing years ago too, which was a dad with a baby under the age of two And the baby was in a new environment, and the baby was showing signs of fearfulness. And I remember the dad saying, ooh, scary. And I was thinking, no. No, you're – and I saw exactly what was going on. I was like, he's trying to empathize. He's trying to mirror his child's emotions. But in the process, he's telling his child that this environment is scary when there's no danger in this environment.

Dr. Camilo Ortiz: Yeah. I don't know if this is the exact same thing, but my most hated phrase is, be careful. And I think for a similar reason, that it implies that there's danger where there may not be danger, or it's just generalized. I'm going outside. OK, be careful. And that's one of the, sort of hypothesized ways that parents transmit anxiety to their kids is by warping, maybe too strong a word, but their view of the world, of themselves, of the future as things that are to be scared of. I see this more generally when a child is uncomfortable or something and a parent will say, are you okay? And I'm thinking the same, no, There was no indication that she felt like she wasn't okay until you said it, and then you sometimes see kids start crying at that point.

Stephanie Winn: And thinking about what are some alternative approaches that parents can use in situations like that, and one that's coming to mind would be, like, instead of saying, be careful, if there is a particular problem that you anticipate your child could encounter, maybe you as a parent could ask, what are you going to do if this or that comes up? Because then you're getting your kids' problem-solving gears turning, and then they can give you an answer that could reassure you, or you might identify if there is a missing skill.

Dr. Camilo Ortiz: One other thing that comes to mind is this, just how parents think about risk. And I see from parents all the time that they can very easily identify risks of things going wrong, like their child getting kidnapped. or breaking a bone or something like that. They're very good at that. What they have a hard time seeing is the risk of inaction. So when I don't let my child do A, B, or C, there are also risks in that. It feels like that's the safer thing to do because if I have them at home, they can't get hurt. But what we're starting to see now with the increase of anxiety and other problems, loneliness, is that there are real risks at preventing kids from being independent. And so that's another thing, just to go back to your first question of how we get parents to allow some of these things is we alert them to this other risk that they're typically not thinking about. And then the equation becomes less obvious that the good thing to do is to not let kids be independent. Then it becomes debatable. And usually they're willing to allow a little bit more at that point.

Stephanie Winn: It reminds me of this time that we took the kids to a like an outdoor camp where they had a obstacle course of some kind. I'm forgetting. It's not called an obstacle course. It was called something else. And it involved balancing heights, you know, having to navigate tricky physical situations. And our kids were running laps, literally, like going around the course multiple times around some other kids their own age who seemed really fearful and uncertain in their bodies and didn't have a good sense of balance. And we were talking about, you know, maybe that kid spends a lot of time playing video games. So when you talk about the parents overestimating the risks and underestimating kids' ability to deal with the risks in the real world, again, coming back to John Haidt's work, there's also an underestimation of, like you say, the risks of inaction, the risks of being in the online world, the risks of spending that time on video games, the risks of not – whether we're talking about that you're not developing a sense of balance in your body and how to navigate physically challenging skills and the physical grounded confidence that can come from that. Or the exposure, you know, when you feel like as a parent, your kid is fine, because they're just right there in the next room. But you don't know what they're looking at online. There's a whole world of dangers out there. And it's completely disconnected to the process of your kids physically building those resilient skills.

Dr. Camilo Ortiz: There's a whole interesting literature on accident rates in playgrounds. And they actually have gone up significantly in the last 30 years, despite the fact that we now pad every last piece of the playground. And I think it speaks to this lack of practice with assessing and dealing with danger. And that's why danger is one of the four Ds, that kids need practice with danger. It actually makes them unsafe when we do not allow them to be in danger. And this, again, might sound like a strange thing for a child psychologist to tell parents that your kid needs more practice with danger. But, you know, as part of the independence activities, we really like things that have some physical risk. So we'll have kids whittle with a knife or even start a fire in the backyard or boil water, make things in the oven. The best way to learn how not to get burned is to get burned. As long as you don't have a third degree burn, you'll survive it and then you'll be actually much better the rest of your life.

Stephanie Winn: I guess there are probably laws that vary from state to state, but I noticed when I was listening to you speak earlier, just like I've noticed every time I've been part of a conversation like this, I actually don't know what the laws are in any given state about a kid riding public transit alone or You know, like you mentioned that one kid whose idea was to leave the state on a train. Yeah, that's going a little far, but I actually don't know. Sorry?

Dr. Camilo Ortiz: Huck Finn style.

Stephanie Winn: Yeah.

Dr. Camilo Ortiz: At least he wasn't going on down the Mississippi on a raft.

Stephanie Winn: I actually don't know what the laws are in terms of what kids can do and at what point parents are held responsible. I was actually just listening to an interview, I can't remember the woman's name, but she's a lawyer who specializes in defending parents who have encountered the child welfare system undeservingly. So for example, kid fell climbing a tree, parent wasn't there, parent brings the kid to the hospital. And they're like, I don't know, I think this is what happened. And the next thing they know, there's like a child abuse investigation underway.

Dr. Camilo Ortiz: So I mean, this is something that Lenore Scanese does as well, as she has gotten a number of states to pass laws that as long as I believe that the wording as long as the parent has consciously decided to allow some free range parenting that they cannot be held liable. But what I was gonna What I was going to say initially is that I don't even think it's that helpful to know the laws because they are so selectively enforced that, you know, in the exact same behavior in two different situations, one of them will be no problem and the other one will end up with a parent with a child protective services case. And then we also have things that are clearly legal where parents step in and ruin the independence anyway. When we're doing something very specific like riding a train, we will do our due diligence to just make sure we're not breaking laws there, but I'm just not sure how helpful that actually is.

Stephanie Winn: Do you have any sort of list of approximately what a kid should be able to do independently at given ages if they're developing normally, or is it just more kind of a

Dr. Camilo Ortiz: I don't. And the main reason is that it really doesn't matter in some ways, because it's really up to each family and each child what they are willing to allow. Kids are physically capable of doing amazing things. And so We never run into, really never run into the issue of a child saying they wanna do something that is vastly inappropriate given their age. Maybe the kid who wanted to take the Amtrak, but that was easily vetoed by a parent. We just almost always have kids who are clearly not doing things that kids just a couple of decades ago routinely did. So we don't run into the problem very much of kids wanting to do things that they have no business doing based on their developmental level.

Stephanie Winn: Do you have any amusing recollections of unexpected answers that kids gave besides the Amtrak one that come to mind?

Dr. Camilo Ortiz: I don't. And it's actually kind of sad because most kids will say, I want to do things that would seem like fairly obvious that they should be doing on their own. So it's just pretty rare that a child says something that throws me off. You know, it's like, I want to walk two houses down to my best friend, and he can let me in when I get there, and his parents are home. I can't do that now. Or, you know, Lenore talks about kids who have their steak cut by their parents when they're 12 years old, and so they don't want to do that anymore. They want to cut their own steak. So it's, you know, we're really like talking about pretty basic things that people a couple of decades ago wouldn't believe form the basis of a treatment.

Stephanie Winn: Hmm.

Dr. Camilo Ortiz: That's where we are.

Stephanie Winn: Wow. I guess one way, one idea for how a family might think about figuring out what those things could or should be for them is just imagining your kid turning 18 and graduating from high school, and what happens if your kid wants to move out at that point, whether we're talking about college, dorm, roommate situation, whether we're talking about getting a job, having a boyfriend or girlfriend, living with them. if your kid was 18, what skills would he or she need to live independently that your kid doesn't have today? And how many years left do you have to make sure they get those skills? And I think most people, when they start to think about that, it's the work that needs to be done is very rapidly becomes evident.

Dr. Camilo Ortiz: That's right. And related to that, lately I've been talking to parents and tweeting a little bit about not helping kids with their homework. And I think it's generally a pretty awful way to spend your time as an adult and unhelpful to your kids in the end. And that's a good example, because when they go away to college, you're not going to be able to help them with their homework. Or I guess maybe there are parents who still do that. But I think most parents will recognize that that's a trap and will end up setting their kid up for failure when they're getting help with homework every night and then zero help once they're in college. That just can't be a good thing.

Stephanie Winn: Well, that makes it sound extreme when you put it that way. I started having mixed feelings when you said that because I thought, I worry about a lot of the nonsense being taught in schools right now. And so being asked to help with homework is my way of keeping an eye on it. And if they don't occasionally ask me for help with their homework, then I don't have any way of keeping an eye on what kind of nonsense their teachers are telling them.

Dr. Camilo Ortiz: OK, that makes sense. I will carve out an exemption for none.

Stephanie Winn: Yes, but it can't be. I mean, I think the point I hear you saying is that there are probably some families where that is the ritual of the parents sitting with the kid from start to finish of their homework, and I don't know who has time for that, but there are certainly people who could draw back on the amount of support that they're providing.

Dr. Camilo Ortiz: Yes. So many parents routinely spend multiple hours every day with kids doing homework, and I just don't like it at all.

Stephanie Winn: If you're looking for a simple way to take better care of yourself, check out Organifi. I start every day with a glass of their original green juice powder mixed with water. It contains moringa, ashwagandha, chlorella, spirulina, matcha, wheatgrass, beets, turmeric, mint, lemon, and coconut water. 100% organic with no added sugar. It's the best tasting superfood supplement I've ever tried. It's super easy to make, and it makes me feel good. Organifi also makes several other delicious and nutritious superfood blends, such as red juice, immune support, protein powders, a golden milk mix, and even superfood hot cocoa. Check out the collection at organifi.com slash some therapist. That's O-R-G-A-N-I-F-I dot com slash some therapist and use code some therapist to take 20% off your order. So it's been a while since I caught up with my colleague, Andrew Hartz, who you work with closely at the Open Therapy Institute. Tell us about it. So for people who have never heard of Open Therapy Institute, what goes on there? And then maybe an update about what you guys have been up to lately.

Dr. Camilo Ortiz: So, you know, when I was trained as a therapist, it was pretty clear that the therapy room The purpose of it is to help the client and that your own beliefs play no role in what's happening in the therapy room. I am there to help you attain your goals. And other than if your goals violate my own ethics and what I tell my students is if I see a client who tells me that they want to be a better serial killer, that's where I will draw the line that violates my own ethics. And I'm interested in helping somebody do that. But other than that, pretty libertarian about what another person's goals are, and I'm there to help them with those things. And so what Andrew and I noticed, and we're not the only people by any stretch who have noticed this, is that this has changed, and many therapists now believe that it's okay to insert your own political beliefs into the therapy room And some therapists even think that it is an ethical guideline, a necessity for therapists to do this, and you're a bad therapist if you are not pushing clients in one political orientation or another. And this has other corollaries. And so I have heard multiple therapists say that they would not treat a conservative client, or they would not treat a Trump supporter, or they would they wouldn't even treat a liberal who differs with them on abortion. So we're talking about a single issue would now be enough to treat someone. And so, and by the way, this works in both directions, although my field of psychology tends to be very liberal. And so in practice, that ends up usually being that a liberal therapist will have problems treating a conservative or even middle of the road politically client. And so we think this is a bad idea. And we think that it causes a lot of people who actually could benefit from psychotherapy to avoid the whole endeavor, because the last thing they want is to be judged by their therapist and to be told how to live their lives. So we developed the Open Therapy Institute, which right now is a place where we don't have a physical location. But if you reach out to us and you say, I live in Maryland, and I want to see a therapist who will not try to indoctrinate me. We have a list of people who we have interviewed and have vetted. And so we can give you some names and it's free. And we have bigger plans than that. We want to go nationwide with maybe some, some physical locations, but right now we're just offering sort of like a free referral service for people who want to see a therapist who has a client centered. approach. And we're also putting on some interesting talks for professionals and for non-professionals about underserved areas and very excited about where this is going to go.

Stephanie Winn: I'm excited as well, and the last time I talked to Andrew, one of the things we were collaborating on was lists of, like you say, underserved populations or issues that might need proper support and therapy, but where the politicization of our field makes it hard to talk about. So for example, you just talked about a therapist saying, presumably a liberal therapist, saying, I would not treat a fellow liberal if they disagree with me on abortion, which would mean being pro-life in that case. And I just want to highlight that particular issue because I have tremendous respect for my colleague, Robin Atkins, who came on and talked with me in episode 27, Two Therapists Debate Abortion. And also she was part of a roundtable, I believe 108 Babygate is the name, the heretical notion that mothers matter, I believe. So she was part of that roundtable with Amy Sousa and Laura Wiley, Laura Haynes Wiley. And Robin and I have had really great conversations, publicly and privately, about the topic of abortion. And she has expressed how she was not able to find appropriate therapy for her own abortion regret because of this political bias in therapists. And that is so concerning for me because I consider abortion such a huge potential source of trauma, grief, and regret. It's complicated. I'm not getting into the politics of whether it should be legal or not. What I'm talking about here is the psychological, as well as the physical, pain of abortion, and the significance that can have for women in the immediate wake of it, but also years down the line as well. So knowing that a therapist having pro-choice views politically sometimes would even get in the way of being able to acknowledge a woman's grief is just, it's like we have a major problem as a field when it's become that politicized.

Dr. Camilo Ortiz: We do, and our professional organizations are making this far worse because they are actually leading the charge to politicize therapy. This is not a few rogue therapists. the American Psychological Association, for example. So we're up against a big wave of change in our field. And we're trying to push back for the example you gave is a perfect example, I think of what can go wrong, when we think we're helping our clients by guiding them or judging them in a political direction. That's just not how therapy works.

Stephanie Winn: If I can play devil's advocate a little bit. I had a colleague reach out to me who I still need to get back to, and I don't remember his name off the top of my head, but he has a YouTube channel where he talks about the, I think he calls it the seven deadly sins of psychotherapy, and he points out some of the flaws in our field. And I wanted to reach back to him and have a discussion because I mostly agree, but I also disagree with some of his points. And this is tying into that. It's this idea of enemy. which I think Jon Hite talks about in his book, Normlessness. And in a time when we spend so much time online, there are so many micro subcultures. So for example, I'm tying a lot of things together right now, forgive the long story arc, but I swear it'll all come together. We had an event at the house this weekend. We had an escape room. The boys like to put on escape rooms. So it's kind of like a treasure hunt, whodunit. It's a fun puzzle that we create for their friends. And one of the clues involved the Flintstones. And it said, yabba dabba doo time. And it was supposed to indicate people were looking for something with the Flintstones on it. And it came up. that there was a generational difference because their dad and I were able to sing the Flintstones song and explain that when we were growing up, there was nobody who did not know the Flintstones song because there were only like five channels to watch. That's right. Now, we live in a time when there are people who are famous to millions of other people in their corner of the internet and other people who have no idea who they are. And there are shows that are popular amongst some people, and other people have never heard. And so kids are growing up in a different environment where there's no such thing as the Flintstones anymore. There's no such thing as that thing that everybody knows. So there's an enemy there. There's an enemy with our sense of time, with people working remotely on whatever schedules, and us not being synced together in time, having the same days off and things like that. So trust me, I'm looping this in to what you said. When you talk about preserving the sort of classic ethos of the therapy profession and therapists not impacting clients with their political beliefs, I think we have reached a time of such normlessness that I'm not sure if that's possible anymore because there's such a wide range of lifestyles and such huge disagreement about the fundamental basics of what humans need to thrive. So for example, there are segments of society that believe that monogamy, that monogamous marriage is the healthiest thing for society and the best environment for children. And there are people that think the institution of marriage is a sham and should be destroyed and that polyamorous throuples are just as healthy of an environment for children to grow up in, that type of normlessness where we can't even agree on not necessarily what freedoms people should have to live their lives in different ways. Freedom is one issue. But what should we view as the ideal? And so I think our job is tricky as mental health professionals. because we do need to have our compass pointed in the direction of some sense of health, wholeness, and healing. And so in that, do we need to have an opinion about something like, is a child better off growing up in a two-parent home or a polyamorous thruple? And then if you have an opinion on that, does it mean that you're not qualified to treat the polyamorous cripple if they want to be treated in the context of their lifestyle? So that's where I think it gets really tricky.

Dr. Camilo Ortiz: I mean, for me, it's maybe it's oversimplified, but I'm allowed to know facts about things. And so kids growing up in a two-parent household have better outcomes on average than kids growing up in a single-parent household. That is a fact. I don't think anyone would debate that. But I can see a client who decides that they're going to have multiple kids on their own. I don't consider it my job to correct that client. I want to understand their values and I want to help them get to a place where they're living life consistent with their values. So one way that I describe that to clients is I imagine a dartboard. and it has a whole bunch of different parts to it. And so we can imagine that for each one of those slices, that might be a value. Let's say like physical health. There are two darts. One, which signifies how important it is to you. So the closer it is to the bullseye, the more important. And the second dart is how are you living your life right now? And when there are distances or differences between those two, my job as a therapist is to help narrow those And either we can increase the amount of time someone is spending on a value so that it's closer to the importance, or we can actually talk about a value not being as important as the person thought. That's my job. And how we get there, I don't really care. There are a million ways to get there. I don't see it as my job as to correct someone. If they ask me for information, I can give them that, being an expert in different areas. It can be an experiment that we do where you will on your own, go find out some things if we're not sure. But the moment that I tell someone, this is how you should live your life, not that way that you said, I think I have violated a central tenant of psychotherapy, and I'm not willing to do that. Even if that means clients making mistakes and walking into a disaster that I see coming. It is still, in my opinion, not my job to tell them that they shouldn't do that. I can help them see the pros and cons of particular approaches, but I think it ceases to be therapy and becomes more like a friendship, which is not a good idea between therapist and client. If you want advice on how to live your life, go to your friends. If you want help behaviorally on how to get to a certain place, go to your therapist.

Stephanie Winn: As you have entered the public arena, I'm just thinking where it gets tricky is that it sounds like you have clear boundaries around your professional role and boundaries that sound pretty sensible and classic. But here in the 21st century, you're on a podcast with me right now. You've been making the rounds. So it's a different setting, right? Here's a setting where you and I are speaking philosophically. about what we think is generally best for people as a whole, not specifically any individual or family situation. And within that context, we get to have our opinions, which may be more or less professional opinions, you're certainly saying, you know, this is what the evidence points to. And I found that in this era of so many people being so chronically online and having you know, podcasts and blogs and tweets and things like that, that some people get confused in ways that end up leaving them hurt and angry about the role of a professional, where as a psychotherapist or clinical psychologist, as you are, that, you know, it's like, how dare you hold that opinion? Because if I were your therapy patient, and I knew that you had that opinion, I would be hurt by it, or I would take it as a judgment that I'm not making the right decisions for my life. So there's kind of this idea that therapists shouldn't have any judgments ever, including shouldn't have opinions about human nature, about what tends to promote or take away from human thriving. I've certainly encountered a lot of that online, and it can get pretty stifling. I'm wondering if you've encountered it as well.

Dr. Camilo Ortiz: Yes, on Twitter, I talk about lots of things, including what sports teams I like. And I've had people say, how dare you express an opinion about this? You're supposed to be a therapist. And I don't know where this belief came from. There's a really good psychologist on Twitter that I suggest people follow. His name is Jonathan Shedler. And he talks a lot about this as well. It is written nowhere that therapists can't have opinions. It's not in our ethics code. It doesn't even need to interfere with what's happening in the therapy room. Because when you and I are there for those 45 minutes, it doesn't matter what I believe about anything. I am there to help you with what your goals are. And again, other than a goal of yours directly violating an ethical principle of mine, like murdering people or being a a child abuser, I'm going to help you with whatever it is that you want, whether I agree with it for my own life or not. And, you know, if that bothers someone, if they need their therapist to agree with them on everything, then they don't have to see me. There are plenty of people they can see. But, you know, that's also where we cross the line from therapist to friend. Generally, you want friends who agree with you on things. The demand that a therapist agree with you I think is a misunderstanding of what the relationship is. I'm not there to tell you you're doing the right thing or to cheer you on, although that can happen. My goal is to skeptically talk to you about your goals and values and see if that's really the direction you want to go in. And if it is, then I'm going to do everything I can to help you, whether I agree with it or not.

Stephanie Winn: I think it takes a lot of maturity. Well, not a lot. It takes a fair amount of maturity for people who are online and are then, in the context of the online world like Twitter, interacting with people who are known to be therapists in their professional life. You know, to be able to see that as someone who is a whole person whose career is psychotherapist, and who is certainly influenced by that, and they're going to offer opinions that might be more or less professional, and some of those opinions are going to be more personal, like you said, about sports. It takes maturity to be able to see that person as fundamentally human, equal, no greater or lesser than you. I think there's a huge propensity towards idealization and devaluation. You know, when I talked to Andrew Hartz on my podcast, this was more than a year ago now, but the title of that episode was Counseling in a Cluster B Culture. And I think the internet perpetuates that, that tendency to idealize and devalue other people and to see other humans as these two-dimensional cardboard cutouts. So I think for some people in the online world, regardless of whether they've had whatever personal experiences with psychotherapy they may have had, just the mere presence of someone interacting as an equal during our free time when we're not on the clock, as knowing that person's a therapist and being able to see them as just a person whose profession is this, rather than seeing them as someone who needs to be 24 seven, fulfilling my expectations of what a perfect saintly human being is.

Dr. Camilo Ortiz: Exactly. And on the one hand, I can understand that if any of us has ever seen one of our elementary school teachers out on the street, and we've had that very uncomfortable feeling, I think there's some of this going on. They're supposed to be in the classroom.

Stephanie Winn: I thought she lived there.

Dr. Camilo Ortiz: Right, right. But I think it's a dangerous belief that therapists have to be therapists 24 hours a day. I am a therapist with you for 45 minutes a week, and that's all I'm doing. That's all I'm devoted to. Outside of that, I'm a person, and I don't know what to tell people who don't like that.

Stephanie Winn: It just reminds me, when you talked about the elementary school teacher, it reminded me of a cute story. I don't do child therapy anymore, but there was a little boy who I worked with who was in the foster care system. And I worked with him from age three to age six. So by the time we parted ways, he'd known me half his life. And he was accustomed to coming to my office and playing. And I remember one day him asking me, when are you coming to my house to play, Stephanie? And I was like, oh, he thinks this is my house. He thinks he's coming over for playtime.

Dr. Camilo Ortiz: That's very cute.

Stephanie Winn: Well, this has been delightful. Thank you so much for joining me. So tell people where they can find you.

Dr. Camilo Ortiz: They can just Google my name. It's not a common name, but it's Camilo Ortiz, C-A-M-I-L-O-O-R-T-I-Z. And I have a website if you're on Long Island or in New York state and you would like some services, we have a private practice with lots of options, not just me. And probably following me on Twitter is a good way to know what I'm up to.

Stephanie Winn: All right. Thank you so much. It's been a pleasure.

Dr. Camilo Ortiz: I do so much.

Stephanie Winn: I hope you enjoyed this episode of You Must Be Some Kind of Therapist podcast. To check out my book recommendations, articles, wellness products, guest episodes on other podcasts, consulting services, and lots more, visit SomeTherapist.com or follow me on Twitter or Instagram at SomeTherapist. If you'd like to go deeper, join my community at somekindoftherapist.locals.com. Members can dialogue with other listeners, post questions for upcoming podcast guests to respond to, or ask questions for me to respond to in exclusive members-only Q&A live streams. To learn more about the gender crisis, watch our film, No Way Back, The Reality of Gender-Affirming Care, at nowaybackfilm.com. Special thanks to Joey Pecoraro for our theme song, Half Awake. If you appreciate this podcast and want more people to find it, kindly take a moment to rate, review, like, comment, and share on your platforms of choice. Of course, just because I am some therapist doesn't mean I'm your therapist. This podcast is not a substitute for medical advice. If you need help, ask your doctor or browse your local therapists online. And whatever you do next, please take care of yourself. Eat well, sleep well, move your body, get outside, and tell someone you love them. You're worth it.