You Must Be Some Kind of Therapist

Swell AI Transcript: 99. Group Chat FINAL.mp3
Stephanie Winn: Is therapy dead? Is therapeutic neutrality a thing of the past? What even is therapeutic neutrality? And how do we contrast that with informed consent? With the ethical obligation to disclose to our prospective clients that we do have opinions and biases and, you know, a cultural background that of course are going to inform the way we work with a given topic. And while there are certain commonalities we would hope that all members of the public could expect from any given therapist in terms of following the basic ethical principles, there's still a lot of variation.
David Teachout: You must be some kind of therapist.

Stephanie Winn: Welcome back! Today is the second time that we're doing one of these sort of returning guests group dialogues. So for listeners who are just hearing this for the first time, I've basically made a choice to invite back some former guests of the show in various configurations to have group conversations so that I get to deepen relationships with friends and colleagues over time and just sort of explore new topics as they arise. So today I have David Teachout and Christine Seethan with me here. They're both therapists who've been on this show before. And I'll have them each introduce themselves just to sort of remind listeners where you might have heard them before and just sort of who they are and what they're up to. So David, I'll have you go first. Oh, and by the way, I forgot to say, of course, thank you both for joining me.

David Teachout: Happy to be here. Yes, absolutely. So, yes, David Teachout, I believe, is in episode 37. It was Reclaiming Your Mind, Recovering from Religious Trauma. And, you know, I write often at lifeleavings.substack.com and, of course, my own website, lifeleavings.com. I work with a lot of people on issues of identity. from a non-traditional kind of therapy idea in the sense that, you know, you're not reducible to a diagnosis. And we'll often, you know, operate from a far more philosophy worldview with the idea that eventually you don't need to talk to me as often. I am not here to be your guru for the rest of your life. I've got other things to do. So happy to come on in and have a fun chat. Looking forward to it.

Christine Sefein: Christine. All right. I'm Christine Siefen and I'm from episode 51, which was Wokeness versus the Counseling Profession. And for those of you that might have seen it or may not have, I was a professor teaching in a counseling program here in Southern California that was very ideologically captured. And I sort of got to a point where I had to make a decision whether I was going to continue on and infuse some of that into my teaching, or if I was going to take a stand and say, this isn't going to work for me, which I did. So I left or resigned and I hopped around a little bit figuring out what my next steps were, and I stumbled on to critical therapy antidote. which is a network of therapists that's global. So we have members from all over the world that are trying to sort of return back to the healing ethos and practice of therapy and away from the ideological capture. So with that group, we started some peer consultation groups, which have been fantastic and We're talking about perhaps putting a conference together in the coming year and a half or so. We'll see how far we're able to get. And just really trying to expand the network so that therapists feel as though they have a home. A lot of what we hear from therapists that belong to the network are that they felt homeless at some point, not exactly in line with this ideological capture, and also not sure where to find other colleagues who have the same feelings and thoughts as they do. So that's been very fulfilling for me and that's where I've spent majority of my time. I see clients occasionally as well, but developing CTA has been where I put most of my efforts in the past couple years.

Stephanie Winn: The latest developments at CTA are pretty exciting. I love the idea of a CTA conference. And I did make an easy to find CTA link. So if you just go to sometherapist.com slash CTA, that'll take you to the join page where you can sign up for the new membership that you guys have worked hard to create with all those perks like the trainings and peer consultations and all that good stuff you guys are up to. So today we're going to talk about is therapy broken? What about this concept of therapeutic neutrality? In an age of ideological capture, culture wars, you know, everyone having their own bias, what are the limits to the concept of therapeutic neutrality and how do we contrast that? with the idea of informed consent. And we might even get into our own little disagreement because before we start recording, as we were exploring these ideas, we discovered a particular clinical issue that David and I are actually very different about, which is the concept of porn addiction. So listen up, stay tuned for that part where we will explore in real time an example of therapists who actually are pretty like-minded on a lot of issues, but who might approach that issue differently and sort of exploring like, you know, what are our biases? And is that part of an informed consent process? And where do we draw, you know, ethical boundaries to how we can approach different things? So, so David, you had mentioned before we started recording that you've heard a lot of horror stories lately about bad therapy. And of course, most of these stories you're hearing in the context of therapy, so you can't compromise your client confidentiality, of course, but you know, within the limits of what you can share without compromising confidentiality, what have been some of the themes that you've come across?

David Teachout: A lot of it, speaking of to try to keep it within the bounds of the broader conversation around bias, and bias in, to use the therapy word, you know, heuristic, basically how people baseline assume reality works. And in many and quite often, you know, we'll encounter the ideas of, you know, basic ideas around emotions for that matter, or which is that, of course, inevitably tied or quite often tied to CBT, cognitive behavioral therapy. as being, of course, the only means for dealing with fill in the blank, everything, because money is poured into studying it. And therefore, this must be the evidence-based thing, which is another bias as well. Because the question then becomes what is actually meant by even evidence and how you do that. And then you throw in the ideas of the replication crisis and all the problems and how even research is done, and you've got all sorts of extra issues. But to bring it back down to some of the examples, I mean, I've had everybody from, you know, let's celebrate with a 12 days of hatred, because you're not in touch with your inner, you know, anger. So, you know, let's, you know, get rid of that gratitude stuff. That's for, you know, the upper echelons of society, and you need to understand the world is against you. probably going to talk about woke stuff later on with Christine here. So, you know, it's that whole thing of like, you know, you're part of the disadvantaged group. So therefore you need to get in touch with your anger. And, you know, this is, this will help you figure out why your husband is in fact an awful person and you need to just tell him, you know, what's up. So, you know, 12 days of anger to, you know, a, you know, we need to obsessively look at all the nasty things, you know, what's, you know, the common thing is we need to unearth this. We need to delve deep. You know, the number of clients that I have who have said, well, when are we going to talk about my childhood? And my usual rejoinder is, well, let's see, you're 40. Did anything happen in the 30 years between your childhood and this, or are we just kind of skipping over all of that? Like, really? How, how does that, was that meaningless? Did it have played no role whatsoever? Is your brain still exactly the same as it was when you were five? All of the above? No. I mean, this is this notion that, that, you know, which is a common assumption around. We just need to. unearthed in order to, quote unquote, heal, as if, you know, the issues out of Van der Kolk's, you know, Body Keeps the Score is inherently legit, which none of it is.

Stephanie Winn: And so, you know, these things- Oh, you have a lot of controversial ideas.

David Teachout: Oh, yeah, no. You're saying a lot right now, David. Yeah, I don't get invited to therapy picnics, so.

Stephanie Winn: Well, hold on. I feel like you've said a lot right there, and I'm sure there was somewhere more you were going. Please interrupt me. So, I mean, let me say where I'm with you, where I'm not with you, where I'm following along, and then Christine can chime in. I mean, first of all, when you talk about the idea of evidence-based therapy, I think a lot of us who've worked in the field understand how problematic that phrase is. It's misleading, because what the evidence actually points to is that the therapeutic rapport between the therapist and client is the number one factor in determining the outcomes of therapy, more than any given modality, let's say, right? But there are certain modalities that have been studied more than others, they've had more research money behind them. And so then they, you know, there's the money for the studies, the studies come out saying, oh, dbt is effective. And then people take that to mean that it's more effective than other approaches, when that's actually not the evidence truly points to. But gosh, then you got into talking about what is the relevance of childhood and therapy for middle aged people, which is certainly something we could explore You talk about that being sort of an expectation that clients have coming into therapy, and maybe an issue of informed consent there in terms of how the therapist explains their approach, you know? Is a therapist who operates more in the present, in the here and now, with how symptoms are currently presenting in your life? Is this a therapist who's more, you know, sort of behavior-oriented? And then you just came out and said that you disagree with Bessel van der Kolk's work. So, whoa, you put so much on the table with that.

David Teachout: not where I thought I was going to go. But, you know, this has recently been a hot topic in, well, personal conversations, but in professional ones. And then also as I continue to work with religious trauma and, I mean, anything trauma itself, you know, because now everything's potentially traumatic. I mean, there's financial trauma and verbal trauma and And to the point where the term itself is pretty much meaningless, it's used purely as a form of, listen to me, I am therefore accurate in my assessment of a situation because I use the term trauma. Because I felt it as a trauma. And we all are about lived experience these days. whatever that means. And therefore, we just carte blanche accept that one's assessment is somehow divorced from bias, heuristic, biology.

Stephanie Winn: Let's sum it down because, again, you're saying so many different things, right? I am curious about your criticism of Bessel van der Kolk. I never know if I'm saying that name right. of his ideas, but I hear you kind of like leaping to an issue that I think is easier for more therapists to get behind, you know, especially people like Christine, right, which is that, you know, we can talk about the nature of trauma and what can or should be called trauma, lowercase t, trauma, capital case, t, trauma, but then there's the meaning attached to it and the way it's used for let's say secondary gain the way it can be weaponized you know and all of that i feel like i want to separate that from your critique of you know a book like the body keeps the score because i think our concerns about how how these ideas can be used in an interpersonally manipulative way is definitely valid, but if you have a criticism of the idea itself that traumatic memories live in the body, I feel like I want to make sure I hear that idea in and of itself. But before we do, Christine, what are your thoughts?

Christine Sefein: Oh, I mean, no, I'm thinking, sitting here kind of thinking about what The Body Keeps the Score specifically because I used to teach an Intro to Trauma class when I was teaching. And that's one of the books, that's one of the textbooks for the course. So I'm very familiar with it and with the ideas there. And I think that there's A real lack of when talking about trauma and you know, people are sort of identifying everything is traumatic that word gets tossed around. I totally agree with that 100%. But I think also in any good therapeutic experience, the client over time with good therapy intervention should be able to find points of resilience. or they're able to grow through and grow out of that without it being over dominating or domineering their life so that there isn't the sense of being a victim. It's a sense of this is part of the history or story of my life. How do I take this and create a strength or strength through which I can continue to move forward? and be able to live a meaningful life. And I think the part about all of this that, including wokeness that's infused, if we go back to that kind of concept, is that the healing part, the growth, the resilience is completely cut off and divorced from, I would even use that phrase too, the actual events that people maybe are hiding behind or in some way attributing to everything that's going wrong in their lives so that they don't have any responsibility whatsoever in creating the lives that they want or the life they believe they deserve to have. So I think that's where kind of the split happens is that that piece, that resilience part, the growth gets totally lost and it becomes something that's no longer part of the conversation. So those are just the thoughts that I was having as you were talking, David, and specifically about that book and about trauma in general.

David Teachout: I loved it because it goes really big on looking at what are the underlying assumptions and how we kind of narratize, to make up a word on the spot, our experiences and the fact that experience does not come with an automatic, indelible story. It doesn't come with its own defining, you know, what we do in life is completely unconscious. It's not like any of us are sitting around going, I think I'm going to take this piece and that piece and put it together. I mean, they're thoughts ourselves. None of us are choosing them, and at least not initially. We're not sitting there going, I have this 10 possibilities and I'm going to think this one next. Even that example itself doesn't make any sense because we're already thinking it. And so the thing around, you know, and what you talked about when it comes to that healing process, moving on from that traumatic experience is in some ways to recognize that the experience itself was not does not have to be considered intransformatic in a defining way. And we already know this because we already know literally, you know, sizable percentages of people who will experience the same event and do not come out of it. With whether or not you go all the way to the clinical perspective of PTSD or whether or not it has a long-term effect in other ways. We just, we know this already that a lot of people don't. Well, to me, that raises a real big question of like, well, wait a minute. if so much of this is tied to perspective, culture, one's relationship to notions like resiliency, then their notion, ideas that trauma is some kind of force that is indelibly connected with a physical element should at least be questioned, if not jettisoned, and which then goes to the heart of Van der Golden's idea.

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 think it's a question of where these ideas belong, what context in which What are the contexts in which these ideas are helpful, and what are they Where are they harmful? And I think one could easily sway too far in either direction because there are, I would argue, plenty of people going around with unprocessed trauma that's living in their body, that's living in patterns of stress that they are carrying physically, that's manifesting as disease and disability in various forms, and where some healing work would really benefit their health, their happiness, their loved ones, their job performance. And self-compassion is such an important part of that, you know, being able to say, wow, some really terrible things did happen and that hurt and I feel that and here's how I'm carrying that, right? And then that there are limits as well to the usefulness of, you know, one could say dwelling on the past or I think what a lot of people are afraid of is sort of residing in a victim mindset. And I've observed so much, I want to say, hypervigilance around this victim mindset. Because I think there are certain places in society where it's festering and proliferating to a really unhealthy degree. And then there are people who have valid concerns about that. And some of those valid concerns are based in they see their adult son or daughter failing to thrive. Or they see their employees not showing up to work and being able to compartmentalize their emotions on the job. There are people with real concerns about the fragility of this generation and may have the sort of, you know, toughen up mindset. But what I experience is I actually see both sides of this, because on the one hand, I share the concerns that you guys have. On the other, I have my own, quote unquote, lived experience as someone with a chronic health condition. And I've noticed that whenever I speak or write in the great world wide web about my… From one standpoint, you could say disability. I am not disabled from working, but my ability to do a lot of physical things is really seriously limited. There's inevitably a swath of internet strangers that are just ready to pounce on me and criticize the victim mentality that they think they're seeing in me. I get the like, buck up, drink a cup of coffee and get back out there, kiddo, what do you think you are? Snowflake. I get that. My reaction is like, you have no idea who I am. You're obviously projecting. I think it seems maybe like older crowds, maybe boomers who have their frustrations with millennials. They have no idea who I am. They have no idea about my work ethic. They have no idea. how much time and money and research I've spent trying to heal myself, how motivated I am to be well, how much it bothers me to be sick. They have no idea that I should actually have probably been resting more, like I'd probably be further along in my healing if I wasn't working so hard. You know, they just see someone talking about, oh, I have this chronic health condition and it's been really hard for me, and they're ready to pounce. And so it's like this hypervigilance has developed that I think flows both ways. It's like we're all seeing in two dimensions when really it's operating in four. I want to bring a yes and mentality to the whole thing. I wouldn't want anyone to walk away from this podcast thinking that a group of mental health professionals doesn't respect how trauma can hurt people. Or that we think the solution is really just as simple as, well, have another cup of coffee, and lift yourself up by your bootstraps, and get back out there. We do have a few more tools in our toolkit than stop at therapy, right?

Christine Sefein: Well, and I think that's part of what you said earlier to Stephanie, that the most healing aspect or component of therapy, what we know, is the relationship between the therapist and the client. through that, you know, through that relationship, through that avenue. I mean, I think what's important to remember or what's important for me to remember is that there needs to be enough time to have really delved into what these traumatic experiences are, how they've affected the client before we go into a let's heal yourself now and get up by your bootstraps, which we wouldn't do anyway. But the idea of resilience and growth That doesn't happen overnight in the way that I see this, my viewpoint. That's something that takes time. And I think a lot of the relationship building you do with a therapist can lead to developing and seeing the resilience and the strength and the growth in yourself and being able to identify that in yourself. And you are the expert of your own life. I really do believe that. But I think it's important that we don't dismiss the experiences and what people are coming in for. And I relate to you on the illness part as well, Stephanie, because I've had a pretty chronic condition myself for several years now, and that's affected my ability to do a lot of things. So I don't share that with many people. I seem very high functioning. This is kind of the way I present myself, because I don't want it to define me. But there are some real world effects that that has on my relationships, that it has on my work that it has on, you know, time, you know, my time, time for myself time that I, you know, need to figure out how to balance and commit to what? I mean, all of those things. So I think that jumping the gun and just getting to the healing is also not very valuable. The exploration in that relationship, I think, is crucial to being able to get to that next component of healing and resilience. And this doesn't go in like one, two, three, four step fashion. It's something that's always kind of present at any given time and interchangeable and you know, many things are occurring at once in the space of that session. But I think it's the overtime, you know, component of it being crippling, or it being something that you learn to live with and go forward in spite of or despite, but always being aware that, you know, if you have an ongoing, and I can speak for myself, with the health, this is always going to be an issue for me, it's always going to be something that I have to pay attention to. Not that I lean with it. It's not in the forefront of my mind every minute of the day. And it isn't for me because it can't be for me. But something that when it's time to stop, I get notified, my body tells me it's time. I start to get signs that okay, I may be neglecting a little bit. And now I've got to go back and take care of myself so that I can move forward again. Not so that I can be victimized in any way, you know, for it or feel I want people to feel sorry for me, things like that. But anyway, so this is all just to say that I think the exploration part before we even get to that component is super important.

Stephanie Winn: And I have an idea about why it can be so hard for people to treat those of us with chronic illness with compassion, respect, and understanding. I think it's partly that there's this hypervigilance that's developed, especially on the part of the people who are carrying the bulk of the responsibility, the people who have maybe pulled themselves up by their bootstraps or disassociated from pain or stress in order to show up and do the job, who are feeling worried that the next generation is going to be incapable, that dynamic is part of things. But I think there's also, someone pointed out, I was dialoguing about this on social media, the just world fallacy. This idea that people like to believe that bad things don't happen to good people. They also like to believe that they're in control of their own fate. And so for someone who, let's say, has not had a chronic illness, who meets someone like you or I, Where our story is I was actually, you know, healthy, happy, active, really motivated to be productive, and then this unfortunate event happened, for me it was getting COVID, and it created a health crisis, and I have not been able to get myself back together even though I've tried all these things. That story is incredibly inconvenient and scary. If you're somebody who likes to feel in charge of your own well-being and likes to think that as long as I eat this way, sleep this way, do this, that, and the other, nothing bad will happen to me. I would never end up disabled. Just to hear that like, oh yeah, there's actually someone who has a really similar lifestyle practice and orientation to you who ended up in a health crisis. It's like they don't want to face the vulnerability that that makes them feel. So there's, I think that's where kind of the victim blaming comes in, right? That like, oh no, you must be doing something wrong. You know, whether it's that you got vaccinated or that you didn't get vaccinated. That's one reason I don't disclose my vaccination status because people make assumptions and there are ideologically intense people on both sides. So whenever I talk about my chronic illness, there is a camp of people who assume that I must have had vaccines and that must be the reason for my chronic illness. There's another group of people that assume I must have not had vaccines and if only I had been vaccinated, I wouldn't be sick. Now the truth is, there are people with my condition who have been vaccinated and people who haven't. So whether or not my condition is attributable to a vaccine or to having not been vaccinated is actually irrelevant. It's all like a projective test, and I'm not going to get involved with it. Because the ideologues on both sides want to think, oh, it's because I've been vaccinated. That will never happen to me. I'm smart enough. I got vaccinated. And then people on the other side saying, oh, well, I was smart enough not to get vaccinated, so I'm not going to get the vaccine injury. And either way, it's an attempt to emotionally distance themselves. from the very real fear and terror of their own mortality and the fact that this could happen to them too. And I think that's where a lot of it's coming from.

Christine Sefein: The assumptive worldview and the shattering of the assumptive worldview, it's a phrase we used a lot in grad school anyhow, but that's kind of assuming that your world is completely under your control.

David Teachout: Or even assuming that a person is actually even thinking that. I mean, there's a lot of assuming going on here as to what is going on supposedly beneath you know, the person's mind, and we have zero access to it outside of, you know, their verbiage. And, you know, the, you know, is it a way of describing, you know, a person's antipathy to, you know, certain medical science or certain practices or whatever that they want to, you know, avoid, you know, death anxiety? Maybe. It also could just as well be a allegiance to, you know, one's tribe and a declaration of, I belong to this through variations and status games. And if you were to point it out, many people would probably go, what do you mean? I'm not even talking, I'm not even thinking about my mortality. And, and this is where the, you know, in some ways kind of bring it back, bring it into the, the therapy relationship is this where, where often I see the many issues do come up is that we think of ourselves professionally as somehow having access to some secret knowledge and that we need to inform the patient or client, whatever word you're using, you know, to, help them understand what's really going on unconsciously. And what ends up happening is what we're doing then is just simply providing our own perspective and adding in a whole bunch of notions that of course we think are right, because otherwise, why would we share them? We're not actively sharing things we think are wrong. Um, that would, nobody does that. So, I mean, it's just like, so, you know, the, which then goes into the heart of the relationship issue, you know, this, the, you know, I was hit with that, you know, right from my first masters in, in mental health counseling. I was going, well, it doesn't matter what your therapy perspective is. It's all about the relationship. And of course my initial, my immediate question then and ongoing has been, yeah, but what about the relationship? Is going on like we we're just throwing this word out like well, it's the relationship. Yeah, but what does that actually mean?

Stephanie Winn: Like what are the elements of a therapeutic relationship that make it especially beneficial?

David Teachout: Yeah, or even I mean, is it even a special like what what are actually the mechanisms going on? that result in or seemingly result in certain outcomes but again Now we pose the question of, I mean, when you consider the fact that what, within six months, depression, you know, there's like a 50% remission in depression without any interventions. And you're going, well, wait a minute, is it the therapy that did it? Well, I guess it is if they engaged in it. Well, that's an assumption. I mean, what if they didn't do anything? I mean, the fact that placebo effects, you know, are prevalent and by some estimations growing, the fact that people can actively engage in all sorts of, I mean, what, you know, we probably might consider any number of, you know, ridiculous practices, but it's like, did you think it worked? What level of conversation are we having?

Stephanie Winn: I hear you asking so many good questions, David. And I think from one level, the questions themselves could sound kind of cynical about the utility of therapy, but I don't think that's where you're going. I think you're raising questions that maybe we could explore. Like, what are the elements of the therapeutic relationship that make it beneficial to patients? Maybe we could explore some of that. I mean, I think it's For one, I would say the right balance of safety and challenge is an important ingredient and that this is where the woke people that we criticize lean all the way into safety and not into challenge if you belong to a certain population. If you belong to a different population, they think you deserve all the challenge and none of the safety. So I think that's one way that our profession has become polarized, where it's my view that every human needs the optimal balance of safety and challenge. And for someone with a lot of trauma, someone who's really fragile, someone in a certain condition, they might need to really start off building the safety before they're ready for much challenge. Some people are maybe ready to dive in the challenge. And I would say among the people who are ready to dive in the challenge, some of them might need to pay more attention to their needs for safety. Do you guys ever have that experience? Let's just start with that, actually. You ever have that experience where someone comes to therapy and they're like just trauma dumping, just like telling you all the details without any regard for whether they feel safe with you yet. And you're like, wait a minute, hold on. I know I'm the professional and all that, and maybe the license behind my name makes you feel good enough to get started, but I'm a stranger to you, and you're just telling me all this stuff. Can you just check in? How's that feeling? Because I notice people who have a lot of trauma, especially sexual trauma, complex developmental trauma, they never learned to develop a sense of their own boundaries. Or does this feel okay with me? Do I trust this person? And so sometimes that's part of the therapeutic relationship. I know I just said a lot there, but what are your thoughts on that?

Christine Sefein: No, I agree. I was actually thinking of the opposite case, a client I had recently, that every session, I want to keep this as protective as possible, every session was about, we're going to say flying airplanes, and her experience doing that. And it took a good year, even with my very gentle, just a little gentle challenging that maybe there's something else to talk about that is coming up within the context of those stories, that there'd be a line or two in there that I'd catch and think, Hmm, this seems a little significant. We spent about a year with just talking about the airplane, flying these airplanes. Okay. And. At some point after that, and it was just completely out of the blue, we start our session one day and all of the sudden, the trauma and the history of abuse and very severe abuse just comes pouring right out of her mouth. And I'm taken aback. It's not that I didn't know there was probably more going on. But the fact that it the fact that she could be just totally shut off and then turned on like a faucet that just overflows and floods the whole entire area was very fascinating to me. So that became a dynamic and a portion of the therapy, I think, in our relationship is talking about what that was about. She was actually able to eventually say, you know, I felt like I really needed to test you, which in and of itself has its own connotations, right? So I agree with you because I do think that that balance is super important, but I don't think we can rush that process. If it's too fast, it's a problem. If it's not fast enough, it's a problem. We could say there is no rushing of that. So I guess the timing and where we as therapists feel we need to be with the client at a certain point. When do they, when do they need to end therapy? When do they need to open up more? When do they need to be challenged more? We don't really know. I mean, we, we play around a little bit with trial and error and just see how that works because we can't really make any, I mean, if we want to go back to assumptions, we can't make any kind of assumption about how that, how long that's going to last a particular period of time. how long they're going to take to open up, what they're going to do when they report. I've had clients that have dumped their trauma in the second session, and I never saw them again. So there was no ability for us to kind of look at, wait a minute, this is a little bit concerning. Is this how you maybe deal with your relationships in general? That's why there's so much volatility in your relationship, whatever the case may be. But we don't have enough information really ever to know when, and some people thought that the one client I was with, we were going too slowly. Well, we were going at the pace at which she felt comfortable and the pace at which I felt that, you know, she was ready for. But again, I don't, you know, it's all trial and error. I did try some things and some things fell flat and some things didn't. And that's kind of what it was about. But once we got to that point where the floodgate opened, there was an ability to take that and to put some containment around it, to put some boundary around it, and to explore it from a place that wasn't so emotionally flooded, we'll say, or so emotionally, you know, charged that she couldn't even almost speak.

David Teachout: I love the example, actually, because so part of this goes into, because I have conversations about boundaries all the time, often, And in many ways, this conversation, I'm loving it because it's highlighting just how much I don't fit at all in the broader therapy community at this point. You know, so this specifically like boundaries themselves, you know, often we'll hear like, I'm terrible at boundaries. No, nobody's terrible at boundaries. They're terrible at the consequences of maintaining them. you know it's everybody knows you know we begin with a particular coming back to the relationship question like what is the nature of the the the what are the contours or boundaries of the relationship that you have with a client per se and what is being assumed brought in what is being brought in by you i mean by, you know, the psychodynamic perspective would come into transference, counter transference is one way of looking at it. Here and there, it's different wording, but you're like, okay, what, what is each person bringing in and the assumptions around what is and isn't good to perpetuate this relationship? You know, there's that, there's at least a question that comes up of going, well, we've been talking for X amount of time and things are going well. And then the question at least should be coming up, I would think, of going, if they were to suddenly start trauma dumping, then one, yeah, like you said, rightly, like, where was this? And then two, why now? you know, it's, it's that question of like, we all get faced when, when somebody like, all right, we get to that 45 minute mark. And then it's like, and now I really want to talk about this. And it's like, wait, you've got a list. It's no different, I think, in process, because what does the person want to do? They want to perpetuate the structure that says, this makes sense of my world right now, this thing that you and I have. which is what then is happening in all relationships. We don't function in the world individualistically. We're bone deep involved in relationships, and by an infinite number of ways, not to buildings, to the fact that we will think different things if we walk into a hospital, as opposed to whether or not we walk into a school. It's just that the places themselves will incur different associational strategies that our brain tries to go, all right, I'm going to try to make sense of. What do I need to do given the likelihood of certain situations that are going to arise? And same thing in the therapy relationship. It's part of the reason why I will do that line that I did at the intro of going, I don't want to be your guru, because I'm setting up the stage already of going, there is an end point to this. because the professional relationship should serve a purpose. And that purpose is, and it could be wrong, but I don't think the purpose is lifetime management. I mean, it might help me pay my bills, but it's like… It brings up sort of a

Stephanie Winn: a debate in the in our professional community that I certainly know people on both sides of and it's sort of the the depth approach versus the short-term brief therapy that fits better within the medical model, which is like you have a problem, you come to therapy, we help you resolve your problem and move on with your life, which I really see advantages to both sides because, Christine, you bring up this example of someone who had all this stuff that was really buried and something that was getting in the way of bringing any of it to you any sooner than that patient did. And so, you know, that makes a strong case for why some people need to be in therapy even when we're not sure why they're there, right? And I can think of other examples of that, and I feel, you know, since you mentioned, David, transference and counter-transference issues, We're talking about transference here partly. And I think it's important to remember, and the three of us certainly keep this in mind, and a lot of listeners of the show know this, people's prior experiences in therapy are definitely going to have an impact on their transference towards us and the pace at which they unfold. And some of the times that I had similar experiences to you, Christine, of someone staying on the surface for a really long time, and then finally, maybe a year into it, like opening up about some massive trauma that had occurred in the past, sometimes that was very much tied in with previous experiences in therapy. And I think it's just important to remind, you know, anyone who's interested in the subject that there are therapists who have incurred major gross boundary violations on their clients, whether that's having a personal or a sexual relationship with them. There are therapists who have committed suicide and whose patients knew about it or might have been actually in the middle of care. when it occurred or found out about it. There are therapists who have committed crimes and ended up in the news, and patients, you know, former patients have found out about that. And these are just a few of the most egregious examples. There are probably subtler ones as well, but we just never know. If we're seeing someone and it's not their first time in therapy, we never know if their last therapist tried to have sex with them, or if they saw their last, you know, therapist on the 6 o'clock news. I mean, those are relatively unusual, not-so-common scenarios. But of course, doing the type of work I do, where I'm talking to detransitioners, you know, like I just had an interview come out with Leighton Dupart, where, you know, her therapist just committed the most egregious boundary violations, got her, like, working for her, and, like, projected her own dissociative identity disorder on her. I mean, you know, So I think just bearing in mind that we never know if someone has had those experiences, or maybe someone in their life has had those experiences, or similar stories have formed their impressions of therapy. First of all, it's kind of a miracle that they're there, that they're even giving it a shot working with us. And then we just don't know what kind of hoops we're going to have to jump through for them in order to get to a point where they can finally say, yeah, in the back of my mind, I'm 5% worried that you're going to die on me, or whatever that underlying fear is, you know?

Christine Sefein: I did have a client whose previous therapist died, and that was something she actually said to me is, I'm afraid because my last therapist died. It was very, very powerful. But anyhow, again, I just remembered it from you talking about it. So yeah, that was very hard for her.

David Teachout: And she should be. I mean, and that's just it. I mean, based on the previous experience, why did this person decide to bring this up? Are they, in fact, she used that recent example, afraid of that loss? Well, they should be largely because that previous experience did happen. It makes it now possible in the sense that, yeah, how are we dealing with that? Well, now you start going into you know, what I think you were referring to back before, Christine and Stephanie, you know, it's just like, well, what do you process? How do you go about doing that? What is the outcome that we're looking for? To never fear again about it? Well, that seems a little fantasy. To have a better functional relationship with one's assessment, to recognize perhaps that our brains come up with stuff all the time, And really, perhaps we shouldn't take our thoughts as seriously, you know, automatically, at least, you know, without reflection, that, that it's just guesswork on the part of our heads, based on its own, you know, background of, well, this kind of happened. This is kind of similar to what's going on in the present. And now I have an idea of how I'm going to function going forward into the imagined or projected future. And where are the interventions for all of that?

Stephanie Winn: I recently told you about a group called Do No Harm, who's working to do just that. Eliminate the harm that so-called gender-affirming care for minors and political ideologies in medicine are causing. Do No Harm is made up of thousands of members across the country, from doctors to nurses to policymakers to concerned parents who see what's happening at practitioners around the country and are waving a red flag. Membership is free, and you get unlimited access to information from experts, on-the-ground updates from people working in medicine or state houses to take a stand, and collaboration with other thinkers. Learn more and sign up at do-no-harm-medicine.org slash some-therapist to learn more. That's do-no-harm-medicine.org slash some-therapist. So I'm gonna make sure to talk about what I promised we would talk about. I think we have been sort of skirting around it, but, you know, is therapy dead? Is therapeutic neutrality a thing of the past? What even is therapeutic neutrality? And and how do we contrast that with informed consent with, you know, the, the ethical obligation to disclose to our prospective clients that we do have opinions and biases and a cultural background that, of course, are going to inform the way we work with a given topic. And that while there are certain commonalities we would hope that all members of the public could expect from any given therapist in terms of following the basic ethical principles, there's still a lot of variation. And I think I mentioned up front, and I want to make sure to fulfill on this promise that we would give this example. that came up before we started recording that David, you and I differ on the concept of porn addiction. So maybe we can just dive into that.

David Teachout: One, I'm ridiculously Googleable. my opinions on most things pretty easily searchable. I'd imagine, and I'm sure Stephanie, you've experienced this and Christine as well, where you have people who may have encountered you in the past and then assume that you're going to respond in a specific way to something that they bring up. And to my mind, in the way that I look at the nature of how relationships work in all varieties, is to me that's like, to quote Yalom Gris for the mill, it's like, why do you think that? What is being served by, which is a common question I will bring up with clients, even to your own thoughts, what are your thoughts serving What are they seeking to make happen to, you know, parse out the broad reality? Because we can never grasp all of it. So we're always trying to do this piecemeal. And so what is, you know, what's the functional question that it's that any and all behavior, you know, what is it serving? What is its purpose? How is this trying to develop these things?

Stephanie Winn: If I can pause you there, I'm glad that you brought up the things you did before we dive into this specific example of something as contentious as porn addiction, right? Because you talk about being Googleable and how that influences clients' perceptions of you. And this is something that you and I have in common, David, and you as well, Christine, because of your work with CTA, the fact that you've been on podcasts. People can find out what you think. that you've shared on platforms where you're not acting as a therapist in that platform. You're speaking as a person who has the life experience of being a therapist and for whom that has informed your thoughts on various matters, including the practice of our profession, but including other things as well. And there's a huge, I think, ethical debate just around what are the ethics of a therapist having a public presence at all? And I think that that might have been relevant. 20 years ago, before the internet became what it is today. But nowadays, it's just not a matter of if you're going to have some things about you that are Google-able, but the nature of those things and just how prevalent they are and how you carry yourself with that in mind. So for me, I feel like the last few years it's been a rocky process of going from just being a therapist to being a therapist who was extremely Google-able, like you said, and it's shifted who comes to me. And now, like, most people who come to me come to me knowing about my work because of my work, and so… that could be said to be part of the informed consent process. That being said, they still might have some surprises about what it's like to actually work with me. Just because I hold a certain opinion that I state publicly on a certain matter doesn't mean that with regard to the specifics of their life circumstance that I'm going to apply that same thinking. And then there are still some people who come to me who have no idea that I have a podcast. Now, I try, I think, again, for the process of informed consent I try to make it very easy to know that I have a podcast because I'm not trying to hide that from anyone. I don't want anyone to feel like, you know, they're my client for six months and then they discover I have a podcast and they feel like they've been deceived. You know, I don't want anyone to have that experience. So it's all out there, you know, and I try to make the messaging like, if you want to work with me, you're welcome to check out my podcast, my public social media, my blog. You're welcome to check these things out. You're under no obligation to do so. But, you know, I also recently updated my website so that it says, you know, if you go to myname.com, that's where you can find out both about my therapy and my consulting services listed separately. And, you know, it says for helping adults, couples, and people impacted by the gender craze, you can look up my values. I try to have it all very out there. in the open. Now, is that 100% guaranteed to prevent any circumstance where someone's going to be working with me and then be like, oh my god, I can't believe she didn't tell me that she has this podcast or that she has these views? And of course, if people are coming to me as therapy patients and they're disclosing certain values or worldview that I'm going to be operating within their framework. So yeah, it might feel kind of jarring for them to discover whatever they learn about me. And this goes down to the smallest thing. I remember a patient who assumed that I had cats. She just thought she knew I had cats. She had no reason to believe this other than the fact that she liked cats, and she liked me, right? So her Transference was that I must be a cat person because I'm likable to her. I'm not going to be like, no, you're wrong. I don't have cats. Unless she asks. It could be that. It could be where I stand on religion. It could be all kinds of things. If it's not relevant to your therapy, I'm not going to bring it up. It doesn't mean that you wouldn't be surprised if you found out what I thought. But then there's also the process for the patient of navigating. Can I see someone whose views might differ from me in terms of what they express personally? But in the context of therapy, they're able to respect my worldview and operate within that. It's all part of the informed consent process.

Christine Sefein: I mean, I had a client not too long ago who had seen all of these podcast appearances and whatnot, and kind of had me on a pedestal to the point where I felt anxiety, performance anxiety, that I had to rise up I mean, we can spend all day talking about what that triggered in me, but I had to rise up kind of to this point of being this perfect and, oh my gosh, everything that I would say would be the right thing to say. I mean, and that caused me a lot of anxiety. I'll be honest. It really did because I felt like it was very performative on my end that I had to be in that kind of place because it was, but I learned a lot from that experience, what I would do differently next time. If that same type of situation comes along where this kind of idea of perfection is, it's really a fantasy about who I am and about how it's going to go in therapy.

Stephanie Winn: It sounds like there was a projective identification process that happened where she put you on this pedestal and then you unconsciously rose to the occasion of like, oh, I guess I have the answers now. Whereas that, when we're picking up on the transference like that, that can be so rich to explore. Oh, absolutely. What is it that makes you feel like you need someone outside of you to have some authoritative guidebook to life that you don't have, you know?

Christine Sefein: Absolutely. No, that's absolutely correct. It was the first time I'd experienced something like that, but it certainly did bring up a lot of things that, again, I would just probably explore a little bit further in a different way next time. speak, you know, kind of agreeing with what you're saying, Stephanie, on some of the things that could have been explored in the moment. But I don't know, there's never a way to predict. I mean, that's the thing. I guess I just go back to there's it's so hard to predict who's coming through the door or who's coming through the computer. We're all doing telehealth now. But it's hard to predict what that's going to be.

Stephanie Winn: Looking for authority, looking for answers, that's part of why I offer consulting practice instead of therapy for ROGD parents. And one way that this is a gross oversimplification, I don't mean it 100%, but just to bring it into stark contrast, it's sort of like this. If you want to know what I think, hire me for consultation. If you want to know what you think, hire me for therapy, right? The job of a therapist is to help their client clarify their own thought process. But there are people who are coming to me not because they need therapy, but because they're worried about someone they love, and they need to understand the gender craze, and they needed to understand it yesterday because their kid just came out as trans, and they're trying to figure out what to do. And, you know, and that's when I'm like, I'm like, don't read those books, read these books. Oh, you said that to your kid, wrong move. They're actually gonna take it this way. You know, like, if you want to know what I think about how to talk to your kid, It's consulting. It's not therapy because you're asking for me to be the authority figure. And I'm actually willing to do that because I've spent the last few years focusing really intensively on this issue. And I do have information. And I don't want to have to explore your transference toward me as perceiving me as authority figure for for therapeutic relevance. I actually want to help you solve the problem in your life, which is how do I talk to my kid?

David Teachout: Why are people coming to us as therapists like legit like they didn't go to a mechanic? They didn't go to the bartender. Maybe they should have depending on who they're talking to but you know, it's like, you know They came to a designated professional Yeah, there is a entire social apparatus that is geared around we are the The the final arbiters of truth of what happens inside your mind you know, it's just it's And it's complete fantasy it's you know the in fact i love the example christina gave around the the you know perfection until you started asking questions about this person like what are you wanting me to do right you don't actually know what their counter transference is occurring in fact i'm not using that term again you know it's the it's is transference and counter transference the notion of a kind of projected unconscious energy being placed on this other person? Or is it a, because one, we never have access to that. And unless you think that consciousness is capable of being disembodied and put out there as some kind of magic, then what we're really doing is having a conversation around my assumptions about what I think you're thinking. And the other person having assumptions about what they think I'm thinking. and so on and so forth. And until you actually have the conversation around what are you actually wanting.

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David Teachout: So usually I'll ask like, okay, so how are you defining your addiction? Cause I don't want to, you know, one, I don't want to assume cause everybody's coming in. It's kind of like going, well, I feel depressed. I don't know what that means. Like it's going to show up differently. You know, I'm anxious. Yeah. I don't know what that means. Like, well, how is this actually, you know, impacting your life? So I would start with, okay, well, what is, you know, how is this showing up? What are the behaviors that you are identifying as, you know, indicating addiction?

Christine Sefein: Oh, I was going to say, I can even just speak for a client I had. It's my my girlfriend who thinks that I have the addiction.

David Teachout: Mm hmm. Which is so very common.

Christine Sefein: She sent me here. Yeah. Right.

David Teachout: Which is, again, common. So then the the behaviors that, you know, occurred, whatever they may be. So I'm assuming probably, you know, since everything's online these days, I mean, who really gets a Playboy magazine anymore? I mean, I'm already, like, generationalizing myself by referring to even Playboy. Do they even have a publication anymore? Anyway, but you know, it's like, so… Then we would explore like, okay, well then what happened with this? When did she find out that you were doing something that you were, I'm going to assume, hiding from her?

Christine Sefein: Yes. She found out that I was hiding this from her and that I was more interested in watching porn than I was in having sex with her.

David Teachout: Okay, so definitely a couple of things there. One, you were hiding. So there was a, I'm assuming that you don't have as part of your relational agreements to keep secrets. I'm just assuming. You know, so you were violating then a agreement, tacit or otherwise. And then two, You were then using that, you know, porn and I'm going to assume masturbation. It wasn't just the watching of it.

Christine Sefein: Yeah.

David Teachout: So then you were using this sexual release activity as opposed to the, you know, sexual activity with your girlfriend. Yes. Okay. That is correct. Is that the kind of relationship that you want? Mm hmm.

Christine Sefein: Yeah, I love her. And I want to be with her. I don't want her to think that I find them more attractive than her because I don't. I'm literally like role playing an actual. Oh, yeah. Yeah.

David Teachout: So yeah, this is the languaging is so common. It's Yeah, I'm remarkable. Like I'm thinking about half a dozen other clients right now saying the same right, right. So then, so then you don't want to, because you care about her, you want to be with her in, I would assume, an asexual way. Yes. When, you know, we only have a few more minutes. You know, it's like, so we, we go into like, when are you, when did this start happening? What was going on contextually? You know, what do you get out of, you know, what's the function out of finding essentially orgasm through masturbation and then going, okay, well then why, You know, it's often then an issue of ease. It's an issue of non-judgment. You know, often there are issues of even attraction. You know, it's easy to say, well, of course, I don't think of these, you know, pixelate, you know, CGI enhanced, you know, often women online is somehow, you know, we say this thing about we don't find this person as or more attractive. But that's what we started getting into. And let's just be honest, at a certain visceral level, that's the purpose. I mean, it's like sugar in food. Why is sugar added to deli meat? Because we want people to keep eating it, even though there's probably better alternatives. And so then we go into like, okay, well, what's the outcome that we're looking for here? you know, if for that matter, you know, is porn use a issue of, you know, addressing a sexual need that one is perceived as not being able to, you know, do so for various reasons, relationally, or at least in that particular, or is it and, you know, is it one that could be, you know, substituted by having a broader conversation about what this does? Can it is it an issue of enhancement? Like, a sex toy or anything like that? You know, what are the nature of the agreements that the person had with their, you know, significant other or relationship? Because those, of course,

Stephanie Winn: I'm going to have to jump in here because we need to wrap up in a couple minutes. So we didn't have the opportunity to do a sort of an in-depth compare and contrast. What I'm learning is that your approach isn't as diametrically opposed to mine as I initially thought when you made a really bold statement before we started recording, which is that porn addiction doesn't exist. I was like, that could be a full debate in and of itself. Philosophically, we could bring in brain science, we could bring in all kinds of stuff. But what I'm hearing is that you got really specific about the function in this person's life and the motivation. So there's a little bit of sort of motivational interviewing there. looking at the attachment needs in the relationship, which I think is important. And I think where I suppose we might disagree, if we were to explore this further, is some of your framing around this idea of attraction, this idea of sexual needs, and so on. Because it's my belief, from what I've learned about porn addiction, that watching porn creates lower levels of satisfaction with real partners, especially for men, both in terms of the way real real women look, the way real women perform in bed, and all of that, and that, you know, that continuing to watch porn for a heterosexual man in a relationship with a woman is destructive to that relationship for a number of reasons, in my view. That it makes his partner feel insecure, which can drive up attachment issues and conflict all around, makes her feel less appreciated, which is probably going to lower her motivation to show up as her best self in the relationship. And then there's that, again, the unrealistic expectations. And so this sort of thought process, I think I would have used different words than you, David, around the thought process, because I don't think of it as either a man has certain proclivities or he doesn't. And that his porn use doesn't affect that either way. I think that choosing to continue watching porn is going to increase his dissatisfaction with his partner in terms of her looks and what she's willing to do in bed and stuff like that. focusing on the relationship and nurturing his partner's secure attachment is going to result in more satisfaction for both people in the long run. That's all my philosophical framework. It doesn't really necessarily get to how I would approach a client with this issue because, of course, with a client, I'm also building rapport. I'm also gathering their perception of the problem. and all of that. So I think our approaches might be kind of similar up front. But I just want an opportunity to sort of compare and contrast just to give an example of how, you know, even like-minded therapists who are showing up to be on the same podcast together are going to have different philosophies about something that, you know, I think we picked a good one because it's sort of a hot, spicy topic and also a really, really common one that affects so many people's relationships. So I'm glad that we got to explore that. And so since we need to wrap up, let's just sort of recap where people can find you guys and any closing points you wanted to make in one minute. David, we'll start with you.

David Teachout: So yeah, man, that is a whole longer conversation because I definitely don't agree with most of the points. So give me another time. But yes, people can find me, you know, at lifeweavings.com. That's my main website. But all my writing is now kind of shifting over to, you know, Substack platform. So you can, you know, Google my name for that matter, or it's lifeweavings.substack.com. Always love, you know, we're often anymore these days, I'm writing about criticizing some of, you know, the kind of sacred cows or therapy and poking at some of the things that kind of touched on here. And so by all means, you know, if you have questions, I can always use the prompts for, for writing further. So yeah, reach out.

Christine Sefein: It's easiest to find me through criticaltherapyantidote.org. If you go to the About Us page or meet the team, actually, meet the team page, I'm there. And there's also a link to the chapter that I wrote for the book we put out last year. So that gives a little bit more information about me as well. And how to contact me is on there too. So best way to go. Otherwise, I do have an ad on Psychology Today. If you do a Google search or a search on their website, you can find me that way as well.

Stephanie Winn: Well, thank you both so much for joining me. It's been a pleasure. Thank you so much.

David Teachout: Yeah, thank you.

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. Special thanks to my producers, Eric and Amber Beals at DifferentMix. and 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.