Translator: Tanya Cushman Reviewer: Peter van de Ven
My name is Leslie Carr.
I'm a registered clinical psychologist in private practice,
and I'm here today to talk to you about therapy.
I really love what I do for a living.
It's truly what gets me out of bed in the morning.
But I have a dilemma in my work, which is that, from my vantage point,
it seems that therapy isn't very well understood.
Even though I think we've come a long way in this regard,
there's still a fair amount of stigma that surrounds psychotherapy.
And even more signficantly,
it seems to me there are many misconceptions about it
and that it is something that is generally mysterious to most people.
It seems to me that these misconceptions keep many people from trying therapy
even if it would benefit them,
which is a travesty, to me.
So, I really see it as my mission
to increase our collective understanding of what therapy is and how it works
so that we can start to change the way the world looks at it.
Now, first of all, I should explain that the kind of therapy that I practice
and the kind that I am going to talk to you about today
is the kind that is traditionally referred to
as psychodynamic or psychoanalytic psychotherapy.
I know that it can be confusing
because there are a lot of different kinds of therapy out there these days,
but what I'm talking about
is what I'll refer to as the "old-school" kind of therapy;
the classic kind, where you talk
and another person listens and asks questions and reflects.
It's something called insight-oriented therapy,
and I think that in many ways it's gotten a bad rap in recent years.
One of the single biggest misconceptions about this kind of therapy
is that there's no scientific evidence that it works,
which is actually not true.
Research in this field has demonstrated, not only that it works,
but that it works really well.
So, I'm going to dig into this a little bit.
Now, my talk today is not going to be super data heavy,
but this stuff is actually really interesting,
so if you don't mind, I'm going to run some numbers by you.
For those of you who speak research -
and if you don't, don't worry, I'll come back to you -
a meta-analysis of 23 randomized control trials
found an effect size of .97 for overall psychiatric improvement
and 1.51 for follow-up studies conducted nine months after the therapy ended.
This study is one example of hundreds that have been conducted in this area.
For those of you who don't speak research,
effect size is the statistical measurement of how much something works.
An effect size of .2 is considered small,
.5 is considered moderate,
and a large effect size is .8 or above.
So, to give you a frame of reference,
the effect size for Prozac, according to studies conducted by the FDA, is .26.
I'll just let that sink in.
Because these numbers -
.97 for overall improvement and 1.51 at follow-up -
are really off the charts, actually; it's pretty astounding.
Part of what that also means
is that people continue to benefit from therapy even after they stop going -
which is pretty cool.
Now this kind of therapy helps people
who are experiencing psychiatric symptoms or are suffering in some way, of course -
I do want to make that clear -
but it also helps people in the name of personal growth,
and it works according to the same principles.
It helps us to gain insight into how we relate to people,
to identify and change recurring patterns.
It increases our consciousness and improves our decision making.
And we reap all these benefits whether we have a mental illness or not.
Excuse me.
So, let me tell you a little bit about me.
I chose to become a therapist
because I was once, many times in fact, a therapy patient myself.
I was blessed to grow up in a family
that valued therapy and that didn't buy into the stigma.
So, when we encountered challenges in my childhood,
namely, the potentially terminal illness of a family member,
my parents did what they thought was best, and they sent me to see a therapist,
for the first time when I was ten years old.
I think they made that decision largely out of being proactive,
but it was also really clear that I was struggling,
and most of that was manifesting in my experiences at school.
My grades were slipping;
my teachers were reporting that I seemed distracted.
The anxiety and sadness that I felt about what was going on at home
was making it hard for me to pay attention,
and I was falling behind my peers.
Now, I have to tell you that I consider that, to this day -
the decision that my parents made to send me to a therapist -
as being one of the best things that has ever happened to me.
I really do.
I liked it so much that it made me want to become a therapist myself.
So, clearly I got a lot out of it.
But I also have to admit that I really didn't want to go, at first.
It would be hard to say what I was so afraid of, exactly,
because I was so young at the time, but I was terrified.
And I literally, at first, refused to even go into the woman's office.
We spent the first two or three sessions in the waiting room.
And that was what therapy was for me at first,
just trying to get comfortable enough to go into the woman's office.
And the funny thing about that, for me, is that having had those early experiences
really removed any sense of stigma from therapy, for me,
but I also clearly would be lying through my teeth
if I were to say that I don't know what it's like to be afraid at first,
to give it a try.
Now, I know that it's different with adults from children -
after all, I only work with adults
so my only point of reference for child therapy is my own -
but I do think, on a fundamental level, the feeling is the same.
And I think it really just has to do with fear of the unknown.
I just didn't know what that lady was going to do to me.
I felt like she had some magical power and I didn't know what it was,
but I felt like she was going to get in my head or something,
and it just kind of freaked me out.
And it reminds me of how sometimes - today, now that I am a therapist myself -
I'll get this feedback from people sometimes,
that they think I can read their minds or something.
And it always makes me laugh a little bit because that's not how it works.
But I suppose on some level, I can identify
because I have a vague recollection of having felt that way myself.
I do think that for many people
there's a lot of fear of the unknown about therapy.
You might consider giving it a try,
but we avoid it just because we don't know what it's going to be like.
I think there's also some fear and trepidation that comes up
around sharing our thoughts and feelings and vulnerabilities with a stranger
and perhaps some concern that we are going to be judged for what we reveal.
I think that's a really natural concern.
Honestly, I think it's very common and very human.
I personally don't think there's any room for judgment in therapy,
and I know that's a sentiment I share with many of my colleagues,
but nonetheless, I always recommend
that people treat first therapy sessions like interviews of sorts.
Because a lot of the fear that comes up around unloading to a stranger
goes away once we establish a connection with a real flesh and blood human being.
And this brings me to something really significant
that I want to make sure that I impart to you today,
which is how vitally important it is
to really be discerning about the therapist you choose to work with.
This could be a whole separate talk, in and of itself,
but the single most important factor in any effective therapy
has to do with the relationship
that's built between therapist and patient or client.
The relationship of the therapy
is actually what accounts for most of the change that occurs -
it's a complex process.
But studies show us again and again
that it is the single most important ingredient in therapy - the relationship.
So, I really want to empower you to be discriminating.
If you're wondering how to pick the right therapist,
it's really just about trusting your gut.
Because the most important thing is that you find the person who's right for you.
But if you tried therapy in the past and you've had a bad experience,
please know it can be better the second time around
if you find the right person.
Now, I do have a reason why I think that we should all see a therapist
at least once in our lives.
And my hope is that hearing this will spark a little curiosity in you
and perhaps help you to look at yourself and the world around you
just a little bit differently.
It certainly isn't the end-all be-all to what people get out of therapy,
but it's fascinating to me
because it is something that applies to all of us.
I think that most of us have a sense of appreciation
for how our life experiences can impact our emotional lives,
but I want to suggest a subtle shift here,
that our life experiences shape not just our emotional lives
but our very understanding of what reality is.
Different branches of psychology have different names for this -
schemas, relational templates, scripts - but regardless of what we call it,
what it means is that our early childhood experiences
create our understanding of how the world works.
In fact, all of our experiences throughout life do -
these relational templates, as I'll call them -
are always shifting, at least slightly.
But this is particularly salient when we are children
because when we're young, we don't have a sense of what's normal or abnormal.
There's no objective standard that we can compare our lives to,
and children's brains are like sponges.
So every early experience that we have when we are children
works to create this internal script
of how we think the world works and how we expect people to respond to us.
Part of why this happens -
this might help in your understanding of what I'm talking about here -
has to do with how we learn as humans.
To use a very basic, but kind of funny, example:
If every time you got behind the wheel of a car
you had to learn to drive all over again, it would be hard to get by in the world.
Right? But, no.
You get behind the wheel, and you expect,
assuming that the ignition is turned on and that the car is in gear,
that if you put your foot on the gas pedal, the car will go forward;
or backward, depending on which way you are headed.
But you make that assumption because your past experiences
dictate your expectations of how the world will work in the future.
The tricky part is what happens when we apply this theory of learning
to our emotional lives or to human relationships.
To give you an example that I think will resonate easily for everybody:
If we take a child - let's call him Joe -
and raise him in a combative, hostile environment -
imagine that he is physically and emotionally abused -
he's likely to grow up with an unconscious expectation of the world
as a violent, angry place,
and that he needs to be aggressive to get by in it.
The problem here
is that because Joe's expectations are that people aren't trustworthy,
because the psychological world that he lives in is an aggressive one,
he's probably going to operate in a manner that is generally combative.
And you can bet
that if his manner of being in the world is generally combative,
that most people are going to treat him with a fair amount of hostility.
And so it goes.
Joe's unconscious expectations of how the world works have been confirmed.
This is the essence of self-fulfilling prophecies.
Now, the slightly dramatized example is probably easy to imagine for everybody,
but what might be more surprising
is that some version of this is also how all of us learn to function in the world.
We all think that we see the world very clearly,
despite the fact that we are looking at it through specific lenses
which have been created
by all of the experiences that we've had in our lives, to date.
The unconscious beliefs and expectations we have about life can be very subtle.
They can be as relatively simple as not going after what we really want,
because we believe, deep down, that we are unworthy,
and they can be as complex as staying in relationships
with people who hurt us because that's what our understanding of love is.
Put them all together,
and they create the very fabric of our individual universes.
So to use an example that is probably closer to home, here:
Our relational templates have a lot to do with the people we attract into our lives.
Our romantic partners especially.
If we have a hard time finding a partner,
or if we feel incredibly frustrated with the one we've got,
at some point, we have to recognize
that we are the thing that all of our experiences have in common.
And this is the reason why we can all benefit from therapy.
It's also part of the reason why talking to a therapist
is not just like talking to a friend.
What a trained therapist does, among other things,
is help us to explore the role that we are playing in our own lives.
Because if you can't see the role that you're playing
in the circumstances of your own life,
you're powerless to change them.
The beauty of this kind of therapy
is that it carries with it a deep respect for the human condition.
Because it isn't about sickness versus health;
It's about expanding consciousness.
It isn't a sign of weakness, but a sign of strength,
because it takes courage to look at the parts of ourselves we'd rather avoid.
For anyone who's experiencing psychiatric symptoms,
this therapy can help - I just want to repeat that.
The aims of psychoanalytic therapy don't stop there.
Because psychological health isn't defined by the absence of symptoms.
It's defined by the presence of inner resources
that help us to lead more fulfilling, satisfying lives.
If you're struggling or suffering in some way,
I hope I've said something today that will help you to feel less fearful
of reaching out and getting the help that you need.
But, even if you aren't,
it's time for us to change this conversation.
We owe it to ourselves to explore our inner worlds
and to take control of our destinies.
And therapy helps us to do this.
I believe this with every fiber of my being.
And I believe that you are someone who is worth getting to know.
Thank you.
(Applause)