Hello! I am back from vacation and wishing I never left! In all seriousness, I had a great time. But now I’m back with another great episode for you. This episode is a recording of a live stream that I did on Mxiety’s Mixer stream. She interviewed me and we cover a lot of ground.
The birth of Hardcore Self Help
To open, Marie asks me about my Hardcore Self Help book series and the inspiration behind them. I talk about my normal “day job” as a practicing neuropsychologist where I do in-person and online psychotherapy as well as neuropsychological assessment testing things such as memory, attention, and reasoning in patients with dementia and/or brain injury etc. I speak about how this is very different, and much more formal, compared to the approach that I take in my work and writing under the Duff the Psych brand – “Certainly, none of my colleagues have books like mine out!”
To set the scene, I talk about the educational path which saw me do an undergraduate degree in Psychology followed immediately afterwards by a PhD program, through all of which I always felt a bit different to everyone else – I have always put a high value on being a ‘real’ person and not just having everything be related to study, academia or research. It’s important, but it’s also important to be a person, hang out with friends, do things you like and experience life!
It’s really hard to be empathetic if you can’t empathize with what it’s like to be a real person.
I describe how the clinical psychology Ph.D. program generally works and how this saw Joelle, my wife, and I head off to San Diego in Southern California for me to do my final year pre-doctoral internship. We’d been living together already but Joelle put many of her ambitions on the back-burner for a while to help support me in pursuing my career. Although the move wasn’t drastically far, it was far enough to take us away from most of our family and our normal support structures. I open up about how this became a period of time that was really hard for us. We were living in a tiny one-bedroom apartment with no natural light in it, I was overworked and underpaid (the nature of a pre-doctoral internship!) and Joelle was also struggling with anxiety and what we would later come to learn was Bipolar II. Things progressively got tougher for us and Joelle was eventually hospitalized due to having thoughts of suicide. I talk about the series of events that took place which saw Joelle hospitalized voluntarily after an emergency appointment with her Psychiatrist.
Joelle stayed in hospital for 72 hours. After she came out, we talked and talked about how we had arrived at this point. One of the things we realized was how a lot of the resources Joelle was given and people she worked with were very unapproachable and often over-complicated…when you’re already dealing with a mental health problem and elevated in some way, there is no way you’re going to read or take in information which is essentially a textbook broken up into sections in an attempt to try and make it more digestible. I realized at that moment that a lot of the content psychologists and therapists put out are really not produced with ‘real’ people in mind. As psychologists, we strive to be empathetic but we don’t show that through the content that we make because we don’t consider what it’s actually like to be in that frame of mind – to be in the midst of depression or to be overrun with anxiety – and that really sucks. There was no helpful, actionable resource that took these complex psychological issues and broke them down into plain language for everyone. It was in these chats with Joelle that she suggested I should create that missing resource and that marked the birth of the Hardcore Self Help book series – within a month, F**k Anxiety was on Kindle!
We chat more about my books, the approach they take and why it’s important to try and find humor in these moments of despair to help pull you through. I also talk about the feedback I’ve received, both positive and negative, along with how there has been a movement in recent years towards including humor into the self-help genre and mental health genre – it is becoming more accepted that self-help books may have an element of humor in them.
Thinking about such a public use of swearwords in the Hardcore Self Help series, Marie asks about my thoughts on how your decisions and behaviors can shape the opportunities you are given (i.e. you might miss out on some opportunities if you act, behave or create content in a certain way). While I think there is some truth in this, I feel it’s not that you’re missing out on those opportunities, it’s more that your screening opportunities. If something’s not going to be a good fit for you then it’s not going to be a good fit, and if you’re being your authentic self and that doesn’t fit then perhaps that’s a sign that it’s an opportunity that isn’t right for you.
Thinking traps, anxiety and CBT
Marie talks about a personality trait she feels she has where she needs everybody to like her all of the time. I explain how buried behind this is the assumption that there are people who don’t like you. However, it’s just that…an assumption…and I would not assume that somebody doesn’t like you without trying to figure out the truth. And if it turns out they really don’t like you? Then they’re not good fits for your life. But it’s important to take a step back when you have these thoughts as anxiety can take a grip and the next thing you know you’ve spun an elaborate story in your mind which may or may not be true. Then anxiety convinces you that it’s keeping you safe from the event you’ve created in your head by encouraging you to avoid the situation. That avoidance feeds your anxiety when in reality there wasn’t anything to be saved from. Understanding that this is a common occurrence which falls into the realm of thinking traps, or cognitive distortions, can help you pick them out when they happen around you or to you. As you become more aware and notice these traps, you can subtly retrain your attention to be less biased towards those things while also allowing you to notice the other evidence in the situation and not just that which supports your false belief.
We talk about cognitive behavioral therapy (CBT) and I explain how the process and application vary depending on each individual’s situation. For example, if you have a phobia, CBT can effectively cure it, but if you suffer from more generalized anxiety, the goal will be very different. That is how I prefer to look at each situation, by looking towards the goal for each individual. In the case of generalized anxiety, the goal would be to take some control back from anxiety. I describe how anxiety is basically trying to drive your boat, telling you where to go and how to behave, trapping you in a cycle…
Something happens — you think about it a certain way, which makes you feel a certain way — you act.
Unfortunately, the phase in the middle is where anxiety has a lot of influence which is inevitably going to alter the way you act and behave in many ways. Therefore, the goal of CBT is to essentially put a buffer there so you can pay attention to what’s happening and what that process is, but you make the choice about what’s happening and you’re not compelled to do, or not to do something because of anxiety – you are in control.
You’re trying to get better at being an anxious person
And as you adapt a happy bi-product might be that you generally become a less anxious person because you are more confident in being anxious – the goal isn’t to get rid of anxiety completely, it’s to take control back. Therapies like CBT, along with self-help advice and other resources all aim to provide you with the tools to give yourself the mental space needed to evaluate the situation using all information, not just anxiety signals, and make the decision yourself.
What is a Psychologist?
Moving on, Marie asks what difference it makes when you become licensed and how this differs from someone who has a bachelor’s degree in psychology. I describe how a psychologist as a term means somebody with a doctoral-level degree in psychology. They may or may not practice therapy – some psychologists concentrate on teaching or research, some therapy, and others on a combination of these. When a psychologist becomes licensed, it means they are allowed to carry out independent clinical work like testing or therapy. Before you get licensed you are not legally allowed to do these things independently and you would have to work under somebody else’s license, such as working as a psych assistant.
Psychologist vs. Life Coach!
We talk about the concept of being a ‘life coach’ rather than a psychologist or therapist and how in reality you need no qualifications or licenses to become one. There are many who call themselves ‘life coaches’ who in reality have little to no credible experience or qualifications. That’s not to say there is no such thing as a good life coach. I talk about how some psychologists and therapists choose not to go down the route of getting licensed because it can be so unapproachable – a lot of work, effort, time and money is required to get licensed – and so some choose to use their psychology qualifications to work as a coach or advisor and do it extremely well. So there are some great examples out there but the problem is it is unregulated and so life coaches don’t have the same law and ethical standards that apply. We talk about this in detail and draw an analogy from the use of health diet supplements where there may be one fantastic product amongst a tonne of rubbish!
We chat about how people, in general, seem to be more open to the term ‘life coach’ rather than therapist…for example, it seems easier to admit that you are seeing a life coach rather than attending psychotherapy. This is still much to do with the stigma that surrounds mental health. I talk about how the term ‘therapist’ has become a lot more acceptable – you see it online much more now – but there is still some way to go. Hopefully, as time moves forward the positivity around therapy will continue to grow and the stigma will fade away. I explain how one of the issues is the fact that there are psychologists and therapists etc. who aren’t that great and the negative stories to do tend to travel more readily than the positive ones. We talk about this in detail and how it isn’t always cut and dry – sometimes personalities or therapy types just don’t match. Unfortunately, however, there are those who are jaded which can happen for varying reasons. For example, in some fields, you have to work through excessive amounts of clients in order to make a living, which is ultimately going to impact the service you give. Personally, I tend to work well with clients who have had negative previous experiences, and these clients often gravitate towards online therapy as the threshold of effort and time appears to be lower. I chat about the use of online therapy in a little more detail and my interest in seeing how it progresses in the future.
Making Psychology Accessible
Next, Marie and I chat about the accessibility of psychology and psychological services in general. We discuss how there are no shortcuts to good care and how there does appear to be something not right within the care systems around the world. Online services attempt to bring the cost down, particularly in the US, but consideration has to be taken to ensure a good level of care is still provided. Following this, I describe how many of the clients who work best with me actually found me through my resources, books or the podcast. This is because they already ‘know’ me and the way that I work. They’ve seen the content that I produce and so they know what to expect and have already begun to build the trust needed between therapist and client – it’s important in this day and age that mental health professionals have an online presence. We talk about this in detail and I explain how more therapists and mental health professionals should put content out into the world or have platforms to showcase themselves in order to enable people to make a more educated decision when choosing who they want to see. This would reduce the amount of trial and error in finding a therapist as well as the number of missed opportunities that occur. Ultimately, personality match matters and if therapists and mental health professionals put out content, potential clients are going to be able to gauge if they will be a good fit, reducing the treatment gap that may prevent some from accessing the help they need.
With creating and sharing content and resources comes a level of care and responsibility. We discuss this in detail and I talk about how that responsibility largely lies with the person who creates the content to ensure they are producing resources that are informative, useful and responsible. Furthermore, there is also an element of responsibility on the consumer, who must do their own research and vet any resources and/or information that they come across to make sure they are not a fraud before diving into their product, or at least compare it with other sources and information. We also talk about Marie’s responsibility as a mental health advocate and her role in sharing content made by others. I outline how it’s important to share content and be mindful about the way in which you share it (i.e. not being exploitative or trying to pass as a mental health professional yourself) – as long as you’re making it clear that you are not the professional here then that what we want to aim for. When people start crossing that line and calling it ‘therapy’ or ‘life coaching’ and start offering direct advice, that is when it starts to turn more sinister.
I talk about how it’s just not feasible to help every single person, no matter how much you want to, and sometimes the best thing that you can do is to point an individual in the direction of another resource. We chat about this in more detail and Marie highlights how it is important for people to remember that when reaching out to someone, that one person may not be the last person to help you and that’s okay.
Marie closes by highlights some of the resources I have available (many of which can be found here) and asking me a couple of final questions taken from the online audience.
Q: Do you think younger therapists tend to be drawing away from traditional therapy techniques and are generally more relaxed? How do you think that’s affecting people receiving therapy?
It’s hard to say on the whole, but my perception is probably. What’s interesting is there is this line of research called the ‘master therapist model’ which basically says if you’ve been doing therapy for long enough and you’re good at it then you tend to converge (i.e. no matter what perspective of psychology you take in your approach, at a certain level they all operate in a similar way as there are aspects of talking and empathizing with people that just work). The training is essentially still the same today, but besides their take on technology, I think that one great thing the younger generations have that potentially the older generation overlook is intersectionality (i.e. there are other factors involved that contribute to every individual’s situation). The younger generations are doing a great job of bringing the large body of training and research forward into the modern world and making it work, being realistic with things and meeting people where they are, which is going to be a really important thing to continue doing.
Q: Is there any way to remove the guesswork out of mental health medications?
Great question, but tough question! A lot of times, unfortunately, it does take some trial and error – There are so many different medications, even just within the category of SSRI’s. One thing I always suggest is to try and see a psychiatrist if you can rather than seeing your primary caregiver as they will hopefully be much better equipt to recognize and assess the situation. My answer would hopefully be very different in 5-10 years from now as a large amount of research is being done into genetic testing etc. to help identify what medications may or may not work for you, but there are not a lot of ways at the moment to make sure you are getting it right on the first try and there is an element of trial and error. Then it’s about keeping the line of communication open with your provider and giving things a shot and not giving up on a medication too quickly (unless you’re having side effects). Most medications can take a month to start working so you should keep that in mind.
Q: How do you feel about the body of research building that suggests we should ditch the meds and focus on holistic methods that work on increasing gut and body health in order to combat mental illness?
I think it’s an important line of research, but it’s way to early to ditch the meds. We know we have a microbiome that affects us, but we don’t know how to manipulate that in a way to fix everything. The area I’m more interested in is actually Psychadellic research. Things like psilocybin mushrooms and Ketamine. I’ve done a couple of podcast episodes about ketamine infusions which are an amazing tool that I wish were a first-line treatment as they are not addictive and make massive change for people in a very un-risky way. There is so much research that is coming to light now and I think the next decade is going to be really interesting and exciting!
That’s it! Thanks to Marie @Mxiety for having me on – Mxiety is part of an amazing group of streamers that talk openly about mental health. Please go and support her at the following links:
This episode of the Hardcore Self Help Podcast is sponsored by Kencko organic smoothies. For 10% off your first order, use the coupon code “duff” at checkout when you visit Kencko’s website.
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