The Peter Attia Drive - #146 - Guy Winch, Ph.D.: Emotional first aid and how to treat psychological injuries

Episode Date: January 25, 2021

Guy Winch is a psychologist, author, and co-host of the Dear Therapist podcast. In this episode, Guy speaks to the commonality of the human condition with relatable stories from his decades of therapy sessions as well as his own experience with incessant rumination in the early days of his private practice. He shares insights on what he sees as an epidemic of rumination that leads to career burnout, the consequences of social comparison heightened by social media, and the psychological impact of not recognizing success. He emphasizes the need for a “psychological medicine cabinet” and provides concrete and practical tools for treating emotional injuries. He concludes with a discussion about the widespread impact of the coronavirus pandemic on emotional health and how we can use experienced psychologists in a time when it’s especially needed. We discuss: The unique format and impetus for Guy’s podcast with Lori Gottlieb (3:00); How Guy pieced together the many different schools of thought in psychology to develop his own unique approach (7:45); The most important component of successful therapy, and why it sometimes makes sense to “break the rules” (19:30); Insights extracted from Guy’s own battle with extreme stress and anxiety around finishing his education and starting his private practice (28:15); The epidemic of rumination, burnout, and the inability to psychologically leave work (34:15); Antidotes to incessant rumination, and tips for transitioning from work to home to avoid burnout (41:15); The psychology of complaining: The hidden cost of complaining incorrectly and benefits of learning how and when to complain (52:30); The consequences of social comparison, and the impact of “failure” on emotional health (1:02:15); How Guy helps people who struggle to acknowledge any level of success (1:07:30); Emotional first aid: The importance of a psychological medicine cabinet for treating emotional injuries (1:19:00); The role of therapists in normalizing the discussion of emotional injuries and illuminating the commonality of feelings (1:27:45); The widespread impact of the coronavirus pandemic on emotional health (1:35:15); How to properly use affirmations—a tool for treating psychological injuries (1:42:00); The importance of nuanced language and the stories we tell ourselves (1:47:30); Peter’s favorite episode of the Dear Therapist Podcast (1:53:15); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/guywinch Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Hey everyone, welcome to the Drive Podcast. I'm your host, Peter Atia. This podcast, my website, and my weekly newsletter, I'll focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, full stop, and we've assembled a great team of analysts to make this happen. If you enjoy this podcast, we've created a membership program that brings you far more in-depth content if you want to take your knowledge of this space to the next level. At the end of this episode, I'll explain what those benefits are, or if you want to learn

more now, head over to peteratia MD dot com forward slash subscribe. Now without further delay, here's today's episode. My guest this week is Guy Witch. Guy is a psychologist, an author, a speaker, and now recently a podcast host. Guy received his PhD in clinical psychology from NYU, where he also did his postdoctoral work at the medical center. He's been in private practice in New York for nearly 30 years. And as we learned on this podcast, he shares office space with my therapist, and that probably speaks to the state of mind. I'm in when I walk in for therapy, and that I haven't noticed the names of anybody else on the wall there.

Guy has authored three books, The Squeaky Wheel, How to Fix a Broken Heart, and Emotional First Aid. We get into a pretty good discussion on two of these three. He's also the co-host of one of my favorite podcasts, Dear Therapists, which he hosts with Laurie Gottlib, a previous guest on this podcast. He's given three fantastic TED talks and a number of great Talks, all of which I recommend highly. I wanted to talk with Guy after I had a chance to get to Nolore a little bit and obviously since their podcast came out which was late July, I've been pretty obsessed with it and I think getting to familiarize myself with the style with which Guy and Lorie worked together. I realized he'd

be just a fantastic guest. In this episode, we talk a lot about his journey to the path he's on now through psychology and what he learned along the way, both about himself and perhaps more interestingly to the listener what he's learned about the human conditions. We get into a lot of things that he later acknowledged he doesn't get asked a lot of during his frequent interviews. And so I'm grateful that we were able to have kind of that nuanced discussion. I could have spoken with Guy for many hours, but before I knew it, we were nearly two hours into a discussion. And he was already in Israel, and it was getting late at night. So where we did end though was I think a really interesting discussion around

emotional health, specifically vis-a-vis the challenges that many people have experienced through the pandemic. And Guy would actually actually say, during our interview, that he thinks it is the biggest sort of seismic shift that's probably impacted our ability to recognize the importance of psychological and emotional health. And so if you've found yourself interested in other episodes we've done that have covered mental health, emotional health, I think you're going to find this one very interesting.

And without further delay, please enjoy my conversation with Guy Wage. I'm gonna be here. Guy, it's fantastic to be speaking with you here today. I almost feel like I know you because I have been listening to your podcast, yours and Lori's podcast, pretty religiously since it came out, which I think wasn't

about August, is that right? Correct. You like 30th, actually. Okay. And I don't know. Well, you can probably imagine the fondness I have for Lori that probably came across in the interview I did with her. And so now by extension, I see you too, as left in right hand, and I've really just enjoyed

listening to you guys. I do have to ask you a quick question about this. When you read the letter at the beginning of each episode, actually, before I do that, explain to people the format of the podcast, and then I'll ask my question, how do you guys set it up? Because you have a pretty specific format. Right. Well, Laurie is the advice columnist for the Atlantic, and I write an advice column for Ted. So our initial concept was, hey, advice, But we wanted to do something different because number one we're both therapists, which is not always the case when it comes to advice. And number two, the thing

that's always frustrated me about advice is that you can give the most brilliant advice, but you never find out what happened. Sometimes people will write and tell you, but even then it's very curated. So our format is such that we bring a letter each week. We start by reading the letter to one another and we do a very brief case consultation like we would in a therapy office and that gives you a little bit of a fly on the wall and a therapy office perspective.

And then we immediately bring in the guest and we do a session with them. And then after the session or at the end of the session, we jump in to give them very actionable advice that they have to do within a week. And then we give some predictions about what we think will happen. And then we hear back from the guest. And here what happened when they implemented the advice, how they felt about it, how it went, what they took from it. And after that, we give our closing thoughts as therapists to the situation.

So it's a really complete and satisfying, or not depending on the resolution arc, that you get, and you get to find out what happens. And that's what I really like about it. You get to find out how therapists think, and you get to find out what happens after the session. One question I have guys, it's usually you trading off. Sometimes you will bring the letter and read it to Lori and sometimes it's the reverse. And immediately upon doing that, the two of you have kind of a back and forth banter before you have the consultation with the client before they zoom in. And

that'll be three to five minutes, I guess, is about what it seems as I'm not actually timing it as I'm listening, but that's about what it feels like. Are you guys doing that cold or is that scripted? We're doing that entirely cold, completely cold. The only thing we say to one another before practically every taping of that section is, okay, but let's keep it short because we can't go on too long. So that is as warm as we go, and I don't know what she's thinking about this letter. She doesn't know what I'm thinking about this letter. We might be thinking different things. And when we agree to do this podcast

together, you know, I'll just say this one, I met Laurie once in June of last year. That's the sum of our acquaintance before we started doing this. So it's not as if we've been working together for years on end and I know how she thinks and she knows how I think. She doesn't and I don't or I didn't. Now I do. So we're entirely cold and that's and the idea there was let's keep it organic Let's keep it spontaneous because that will be more interesting than getting all our ducks in a row and then sounding like the same person Well, you answered another question which is kind of amazing to me Which is how do you have that pretty apparent chemistry without a long track record together? That's not a simple thing actually. That could have flopped

That could have gone badly so many ways. And I think what saves us is that I have tons of respect for Laurie as a therapist. And I think the same goes for her. And what that means is that I see her leading in direction A, and I want to go in direction B. I'm assuming direction A is not going to be bad. So yes, let's explore A for a bit and then we'll get to B. It is not happened. We've taped a whole season of 20 episodes. It has not happened that Laurie went in a direction that I'm like, oh my goodness, why are we doing that? It's all valid because she's a very good therapist. Then I think she feels the same. And so we indulge one another because we haven't come across something that's making us win some kind of,

you know, start to hit the panic pattern. Well, let's back up a little bit and kind of talk about you and how you got here. You've written about, spoken about the fact that you kind of wanted to be a therapist from day one. So just as the way that some little boys want to be firefighters or professional footballers or whatever, you sort of wanted to be a therapist. When did you realize that? I wasn't sure when I realized that, but I think when one of the first articles that I was interviewed in came out in the press, I got a message from, I think it was pre-internet, so it was a phone message, actual phone message, with rotary phones, you know, and things. What other things? With a cradle.

Yeah. And the person said, and it was a high school friend, and she said, oh my goodness, I remember you talking about wanting to be a psychologist when you were 14 years old. Now to any psychologist, ding, ding, ding, what was going on with him, that he wanted to be a psychologist at 14 years old. But that aside for a minute, apparently very young, is when I wanted to be a psychologist at 14 years old. But that aside for a minute, apparently very young is when I wanted to be a psychologist. You grew up in Israel or you grew up in the United States. I was born in England and you know had some years there and then some years

formative ones in Israel. Okay. You have a twin brother. Is he an identical twin or he's an identical twin? What other siblings do you have? That's it, it's just us. It's just the two of you. How close were you? Which sounds like a dumb question perhaps, but I don't know. I've met twins who are not that close, so. Yeah, as of I, we were always very, very close.

We were one of the lucky ones, or I guess. My philosophy is if you can't get along with a person that's most like you in the world, then you have some work to do to figure out why you don't like yourself. Really, I mean, I think it's just because twins, especially identical ones, this is your carbon copy practically. If you love yourself, you should love them. We always did get along. We always had a very strong bond.

So did you finish high school in Israel or in the United States? In Israel. I came to the United States after my undergraduate degree with two suitcases and maybe a thousand bucks in hope. Okay, so you went to NYU if I recall and you did both your graduate degree and post-doctoral work there, is that right?

Yeah, I did a Master's in PhD at NYU and then I did a post-doc at NYU Medical Center. God. And during that process, how did you refine your interests? So I assume at 14, when you're thinking, I want to be a psychotherapist or I want to be a psychologist or I want to be some sort of therapist that helps people's minds and emotions, it becomes a lot more nuanced by the time you're writing your dissertation. So what was that journey as you went from a 14-year-old to a high school or two, an undergraduate

to a graduate student? How did you refine your objectives? The good thing about an undergraduate degree in psychology is that if you do it right, it gives you a lot of exposure to different areas of psychology because psychologists is a general term, but you can be a psychologist who runs rats through maces or you can be a psychologist that does consulting for organizations, you can be a clinical psychologist and do therapy, which is what I do, you can work with children, et cetera, there's just, it's psychology is very broad. So you do get the exposure and it was very clear to me from the beginning of my education because really before then I didn't have that exposure, that I am thoroughly disinterested

in severe psychopathology. In other words, everyone that I was studying with were fascinated by schizophrenia, for example, and hallucinations, because people that were so wild to see and people are fervorantly believing in delusions and having paranoia and all those things. It just never interested me. It did seem a little bit like a side show rather than and I felt I wanted to help regular people deal with regular life. That was always my interest and I don't know why or when I had that interest. I think my interest in psychology all along was because I was looking at the adults around me, probably at age 14 and going,

I'm not sure you guys are communicating very well, or I had other notes probably for them, and thought, you know, I need to study this to understand this, because I'm really interested in, you know, because I could see mistakes and I could see things and I just didn't have a framework with which to understand them, or categorize them, and so the interest probably started there. But it continued in that I was always interested in just working with regular people, improving their quality of life. Now, when I think back to my undergraduate, which was in engineering, my girlfriend for at least half of my time in college was in the psychology department, but she overlapped with the business school and

ultimately went on to do her PhD in organizational behavior. And she never stated this, but my impression was that the superstar people in the psych department were the ones going off doing these other things. And there was fewer people sticking around to do the, how do I help regular people suffer less? Now, is that true? Was there something less sexy about wanting to do what you wanted to do? I will tell you, and if that girlfriend's around, she will confirm, the sexiest thing you can do with a PhD is finish it. And there is a point at which you just don't care about anything else except just finishing it.

And so really everyone is really oriented toward how do I just get done. That aside, my program at NYU for graduate school was just clinical. So it was just 10 people studying clinical psychology undergraduate. I split between psychology and film. So I was in the film school. And the feedback I got from the psychology department was, oh, you're good at this. And the feedback I got from the film school is they love you in psychology. So I took a hint. How do you think about your undergraduate tour? Because I only took probably two courses in psychology and I remember thinking, wow, there's a lot here. I mean, there are so many different schools of thinking.

There are so many great thinkers in this space and they're often at odds with each other. So it was less like physics, which was where I spent much more of my time, where Schrodinger is building on the guy before him. And in other words, there's a continuity of the science and a new discovery can upend an old one, but there's general agreement about it. You know, relativity built upon Newtonian mechanics and people could understand where the Newtonian laws broke down. I didn't feel that way in psychology. I really felt like there were different camps. Does that sort of resonate? Did you sort of experience that as you went through it?

Oh, yes. I mean, you can't not write. I mean, you mentioned Schrodinger because that's one of the few areas in physics where there is uncertainty, but psychology is all about uncertainty. We don't have that grasp of the human mind. We don't have that grasp of the brain, we don't have that grasp of emotions, we don't even have that grasp of consciousness yet at all. And so we're very much in the infancy of understanding how we tick and how we operate. I mean, I'd love to be at the point where we have an operator manual for the human mind that we can all use to maximize our potential, but we're very, very far from that. So you approach a science like that with like, I'll take what we, you know, any certainty feels like an oasis because there's so much of uncertainty.

Right. We don't have a unifying set of theories or principles the way we do in physics and mathematics. And I guess that just speaks to how much more complicated humans are than the natural world around us. Well, also how much newer psychology is a science than physics or mathematics, right? Physics and mathematics have a couple thousand years or several thousand years on psychology. Do you think that as you're going through your training, your impressions of which camps you tend to be in as students is potentially influenced by the people who present the information to you and the affinity that you have for, hey, the way that professor teaches that resonates with me or alternatively like an experience that you've had where that school of thinking actually fits with my personal experience. I guess what I'm trying to

ask in a clumsy way is how do you think a young student slash therapist creates the scaffolding that is going to become their mental model and more importantly how malleable is that over time. I can tell you about my scaffolding and it's such a such an interesting question. I've never been asked that and I'm already enjoying this because it's really good that you get to ask me to think about things that I haven't thought about necessarily in that way. But here's my answer to that. When you go somewhere and you're presented with ten different religions that everyone

presents them, each one is presented fervently, My response to that was to be an agnostic. My response to that was not to believe in any of them, but to cure it and say, what there can I take, what in that one can I take, what aspect of this resonates with me. And that's from the beginning was how I treated it and how I thought of it. These are all ideas from which I get to pick what seems right to me, but I don't need to endorse or embrace fully any of them and I never did.

You know, the highest compliment I can pay somebody in that scenario is to compare them to Bruce Lee, but that's effectively what is referred to as G'd Coon Do, which is the way of No Way, which was his sort of model of martial arts, which was every one of them offers things that are useful, and every one of them has things which are useless. What if you could dissociate yourself from being a student of one exclusively?

And so he created this technique, which actually the privilege of studying for two years and you study it one-on-one with one teacher. It was very, very interesting. He spends three months interviewing me to confirm I'm worthy of learning this by the way. Oh wow. Yeah, but it was beautiful and it was true to how it was presented which was it was never about being wed to one style. So that's, that's an amazing kind of way that you described it. Did that ever put you at odds with your colleagues who couldn't understand why you didn't fit in one box?

Yes. My program back in the day was pretty psychoanalytic. It was a very New York kind of thinking. And so in that approach, for example, when the first patient I ever had, because you have to start somewhere, right, union, that they don't know you're there, you're first, but you do. Ask me where I'm from. And my supervisors said, somebody asked you where you're from, you can't tell them. And I'm like, well, I can't tell them. I said because it's, it's

your introducing extraneous material, you should just ask them what their thoughts and feelings and associations are about where you might be from and what that means to them. And I had a really hard time with that. And I said, if my accent were more obvious, then I wouldn't have to go through that charade. And it just seems with holding and irrelevant because I don't know if they're there to spend their time discussing where I might be from.

It just makes me the center of something that I don't think I should be the center of. So I had issues with some of the techniques that I was presented with from the beginning, but I was very fortunate because the professors there, at least the ones I interacted with, were very open-minded. They didn't assume that you had to buy things, locks, or can barrel. They assumed that you get to wrestle with these things and reach your own conclusion. The students were sometimes a little bit more, should I say, devout. But the professors typically were more flexible.

You know, I remember, I think it was even Laurie wrote about it in her book, and I'm sure many have commented to this effect because it seems like such an important finding that it's probably been out there for some time, which is the training of the therapist, the credentials of the therapist, all of these things probably don't matter as much as the rapport that is built between the therapist and the client. Maybe I'm stating that slightly incorrectly, but what I took away from it was it's at least as important how much of a rapport the client and the therapist have is how voluminous the knowledge is of the therapist. Is that an accurate statement? It's very accurate.

In fact, my dissertation back in the day was about what are the aspects of the therapist, their experience, their gender, their age that might influence therapy outcome. But since then, it's been very clear, and the research is very, very clear about it, that the most active ingredient in therapy is that fit between the therapist and the patient. And specifically, a patient, if you're going to therapy for the first time, what you want to feel is that the person you're, that stranger that you're spilling your gods out to, gets you, that they're responding

and saying things and asking questions that shows that they get it. We have a very clear, it's like a bullseye, it's a bullseye or a miss, you either feel that person gets me or they don't, either they don't allow it or they don't, a little bit it doesn't matter. The ding, ding, of gets me is very very specific. That's what you want to feel when you go to speak to a therapist that at least they get you now. The work starts from there but without that it's going to be a slogger. Yeah maybe maybe it may be an easier way to say it I guess is it's a necessary but not necessarily sufficient criteria for great therapy. That's been my experience in my own journeys of therapy. And I think it comes,

the reason I ask the question, of course, it comes back to your original point, which is if you sit down for the first time with a therapist who has an accent and you ask them where they're from and they dodge the question, it becomes awfully hard to feel you have some rapport with them. and they dodge the question, it becomes awfully hard to feel you have some rapport with them. When instead, if you can spend two or three minutes having a relational discussion about where someone is from, and oh, wow, you're from there. What a beautiful place. I've been there. Oh, that's lovely. It strikes me as a non-therapist, at least, as an elegant way to at least try to capture some of that relationality. Absolutely. I mean, I remember when I graduated and I started my practice, and for the first time I could absolutely just do what I wanted, and I went on vacation.

And one of my patients said to me, where are you going on vacation? And I answered the question, and I beamed not because of where I was going, but because I could just answer it. And the minute I answered it, all the curiosity about it evaporated. Because who cares where your therapist is going on vacation, unless the therapist is making a big deal out of it. Yeah, that's funny. There are parallels in medicine as well.

I remember being scolded for something when I was in my third or maybe for fifth year of residency. A young boy came in, this is a sad story, but you'll understand the parallel. So a young boy was in a car that was T-bonged. So he was in the passenger seat, it was hit on his side, someone had run a red light, and he was killed. It was just unbearably tragic. And so I was the senior resident that received him in the ER and tried in failure for 30 minutes

to to resuscitate him. And that meant I was the one that went and spoke to his mom after and explained what had happened. And I don't think there's a harder scenario than telling a mom who just saw her son two hours earlier, perfectly normal and healthy that now he's dead. Through that experience, I became close to the mom. I went to the funeral three days later, and for years I stayed in touch with her and would speak with her on the

anniversary of her son's death and such. I really took a shit kicking for that from one of the senior fellows. When he found out I went to the funeral, he said, that is an absolute mistake. You had no business going to that funeral. You must draw a line between you and the patients. You cannot. And again, I don't think he was saying this to be malicious. I think that was his way. I guess I never probed enough to understand what he was saying. Was he saying you have to protect yourself from that, or you have to protect the Institute of Medicine from that. I've never fully understood it, but I don't think his view was alone.

I think probably a number of people would have thought I made a mistake by doing that. Again, in Laurie's book, I think she talked very eloquently about going to her patient's funeral. Now, that's a different situation. She had such a long relationship with that patient and the patient insisted that she go to the funeral, but I guess there are just different ways of thinking about it. You know, it's interesting because I've been in both experiences I've gotten the lecture that I shouldn't go when I started out my practice You know, how do you feel of practice when you're in New York City and there's

Four therapists for every resident roughly it seems that way maybe not but so how do you distinguish yourself when you're young and just out of school? And so I would take on the cases that people didn't want and some of them tended to be kids with terminal illness. And so I've had that experience of being told by a, not a supervisor at that point, because I was, I graduated, but by a senior colleague that I really should not go to the funeral. And what they said was, I graduated, but by a senior colleague that I really should not go to the funeral. And what they said was, A, you'll find yourself that the more time you spend in practice,

the more funerals you'll have to attend. And at some point, there'll be a point where you just can't attend all of them because of the years you'll have met many people. You can't keep going to all the funerals. But don't think that meant I had to go to all the funerals, but I then later on, somebody died and they left me a letter that I got after they died in which they said I would like you to go to my funeral and speak at it. So now it's a lift because now fine I can go who knows who I am, but they want me to speak and they're hippolos, so I actually can't say anything about anything. And so I went and I was surprised that almost everyone knew who I was. Not from the internet or anything, just, you know, I was the only one unfamiliar and it was, oh,

it's a therapist, it's a therapist. You know, so that's a fun room to go into. And then when it was my turn to speak, what I decided to do was to say, you know, I can't talk about him because of privacy laws, but I can talk about you because I knew all those people. These are the people that the sessions were about and obviously I spoke about the good part of it because these are people that is funeral and I just spoke about how this one was meaningful and this one was meaningful and this one and this one and that's how I chose to handle it at the time and it was it gave me so much closure it it it was so meaningful to me I'm assuming it was meaningful to the people who were there I there was a lot that I got out of it I remember it

as a very important experience. I'm curious about whether you feel the same about funeral you went to. I absolutely do. I just think it's a privilege to be in the position you're in or the position that I was once in where obviously the most delicate situations of a person's life you can sometimes be a part of. And sometimes it's very unpleasant. I mean, I had another patient who I had connected with very closely. He developed a pulmonary embolism. We tried to resuscitate him and couldn't. And he basically suffered a catastrophic neurologic injury.

So he was now basically on life support, and he was brain dead. Very young, he was my age. So I was in my, probably early 30s at the time as was he. And after a few days, his family decided to withdraw support. But his mom asked, they said, look, we can't be here when you take the ventilator off. But we would like you to be the one that stays in the room with him because we know how much he liked you. And we remember the first day we walked in the hospital.

How much he just connected with you and he was so happy that you were going to be part of his team. That's another one of those asks, which is, boy, ordinarily, I would not want to be in the room, having to watch a person take these, what are called, chain stokes breaths, which are, you know, not real breaths, but look like real breaths as they're sort of gasping and dying. But I also thought, like, that's the responsibility that comes with this. And I think that that's you know, not real breaths, but look like real breaths as they're sort of gasping and dying. But I also thought like that's the responsibility that comes with this and I think that that's a reasonable ask of the family. Yeah, I'm sitting here thinking,

and this is why I didn't go into medicine because I don't know if I could do that. Well, but I think what you did is harder. I mean, I wanna go back to something you said a moment ago, talk to me about the early part of your practice when you're taking children with terminal illnesses. I mean, at that point, you have two clients. You have the child and you have the parents, right?

Yes, and I was doing a lot of family therapy for that reason. I mean, my training in graduate school, I had published some research before as an undergraduate and that exempted me for some research courses in graduate school and that was enabled me to double up on practicone to really study couples and family therapy from year one. And so usually you get to take that as a module at some point, but I had four years of intense practicone and seeing patients.

And the way we teach couples and family therapies with one-way mirrors, you know, as opposed to coming in and saying, this is what I said, this is what the patient said. Is that what the patient said or is that you're a collection? You don't know. But when you're doing it and the team and the supervisor are actually watching you and calling in with suggestions, if they have them, et cetera, it's a great way to study because you really, you can't hide number one. So you learn more.

And so I did that and I had a lot of qualifications with that and so that's part of why I got that gig as a word of working with these families because I could do family therapy as well as see the parents for consultations individually. And so it was a lot of that. When I started out, it was couples, for example, where the husband was deemed aggressive. And so if it was a female therapist, they felt uncomfortable, I was fine with it. Bring me these aggressive husbands. Now they were not aggressive.

They were upset or angry, sometimes a little, maybe with other issues that triggered the anger, but they want violent people, at least not the ones I worked with. So I would take the cases that people would kind of fub off. And the other trick that I learned was that stay in town in August when you're starting out, especially in New York. And then there's no therapists in town and people will come to you. What year did you begin your private practice? 92. So I love to find out of toes and fingers. You're going to run out of toes and fingers. I love the idea of stay in town in August.

I mean, that is, yeah, New York is a ghost town. I guess the only thing that could be better is go out to Long Island in August and then you'll be overrun. Well, yeah, you can go to Mount Isvenia. That's where all the therapists used to be apparently. I don't know. I never went. Why did you decide to go into private practice versus stay in academia?

It's very simple. The dissertation was traumatic. You know, it is for a lot of people. It was for me. I had a difficult situation. I was on a five year visa. I had to complete. I'm an immigrant, essentially, to the US.

So I was on a visa that allowed me to study and stay for five years, but I had to be done by then. You were on a J1? I was on a J1. And when I was done, I was allowed to stay for another 18 months for practical training. But if I wasn't done, I would actually have to leave. So the average of graduation in my program was eight years. And I didn't have eight years. I had to do it all very very quickly, you know, as soon as possible. And so, you know, just that just impacted everything in terms of, you know, just how I did things, what I did, the dissertation I did, and I had a dissertation advisor who was difficult, little difficult to work with. And there were moments I thought, if I have to do this, I'm not going to finish. She just gave me so much to do.

And it was objectively an unusual amount of the study she wanted me to do was way too big. So it was very stressful. And it took me, literally I'm telling you this, it took me three to four years after graduating before I could walk into a library without feeling a real surge in anxiety. That's interesting. How did you help yourself through that? I mean, did you have a therapist at this point that you could process that with?

I did, but A, I just stopped going to libraries for a while. I was really traumatized. I mean, I was really like, it's just truly anxiety, like you heart starts racing when you walk in. Library's don't usually do that to most people. They usually consider boring rather than activating. Because when you everything you have and every investment you've ever made, talking about emotionally and intellectually, you're not financially, might go down the tube if you don't finish and someone just is making it very

difficult to finish. It was very difficult. And it's very difficult for many people, many people are traumatized by the dissertation process. academia is a very difficult place. But nonetheless, it took me some recovery time. The therapy was extremely useful at the time. But it was very useful to also be able to start my private practice. And at that point, it was like, I don't want to do research. It was associated. I have to have to go to libraries. I don't want to do that anymore.

It just soured me on something that I'd been very interested in. It's unfortunate. Now, why did you decide to stay in the United States versus, for example, returning to Israel or going to Europe where you had spent some time? You still had a fondness for New York? I had a phone call from New York from my first time I visited New York. The first time I visited New York, I said aloud to several people who remind me of it, I'm going to live here. I was captivated by New York. And so yes, to me, New York was where it was at number one, but number two,

when you go through five years of school, then you do a postdoc, then you do a year and a half of practical training, all your contacts are there. So I could start a private practice because I had enough contacts to do it. If I was going anywhere else, even if it were Israel, that's not where my professional contacts were, I would really have to start from scratch plus not Quote Frankie too much, but really if you can make it there I wouldn't you want to make it anywhere else I read once that you I don't know where I read this but in some of my preparations for a discussion

One of the things you struggled with when you went into practice right away was sort of endless remination and an inability to turn it off when you went home. Can you tell me a little bit more about that? Yeah, that was my third TED Talk, so that's probably where you saw it. And it was about that exactly. It was, that talk was actually about remination.

It was about that we experience work stress, most of it actually outside of work, because when we're at work and working, when you're absorbed in your work, you're not conscious about whether you're stressed, you're just doing it. It's when you stop and you're driving home, or in my case, walking home, or you're sitting at dinner or you're trying to fall asleep at night, that all those worries and, you know, ruminations come. And if you're not diligent about managing them and limiting them, they can really take over.

And ruminations actually really harmful psychological practice. What I find interesting about it is that the assumption is that psychologists would welcome any kind of self-reflection, like, oh, reflect away, that's a great thing. Well, no, there's healthy, in adaptive self-reflection, and there's unhealthy, and maladaptive, self-reflection. Then it's very clear what's useful and what isn't. If you're thinking about things in a way that's trying to gain insight or understanding, or meaning, you're trying to problem-sob, something, you're trying to problem-sove something, you're trying to tackle it, that's adaptive. If you're just replaying the same upsetting memory or idea over and over again,

if you're just walking around your house in the evening, muttering, oh my, so much to do tomorrow, I have so much to do tomorrow, it's not useful, you're stressing yourself out, because when you do that, actually, you activate your stress response, so you're really stressing yourself out. It's associated with lack of sleep, with eating unhealthy foods, with irritability. You're checked out with your family. It's bad in all kinds of ways, but it's not something we pay enough attention to. So that talk was about stress from work, happens outside of work. So you need to control it because you like your job much better if you're not burnt out.

So how did you start coping with that? How did you begin to treat yourself as you realized this thing was happening? And I guess, before I ask you that question, let me start with another question, which is, do you think that this remination was the natural consequence of now being the final person? In other words, you didn't have a superior or a supervisor. The buck stopped with you. Do you think that was really the source of the remination? Absolutely. Because you, you know, I opened a private practice and suddenly the responsibility of that sits on you.

You know, you're advising people and again, half my practice has always been couples and families. Those are very active, live, sometimes intense situations, right? This couple has had an affair, this couple is dealing with this, this family is fighting about that. Individuals don't go nuts in a session usually by themselves, but a couple, you take your eye off the ball for one second, it can go very wrong very quickly. And people were coming to me with their kids who were dying with their husbands who they were afraid of, whether, you know, like you're responsible for helping and for having an impact. And that is a huge responsibility. And I think it's just a process of adapting

to get used to that, to the enormity of it and to the responsibility of it. And that's what was, and if you're conscientious, which I tend to be, then you ask yourself, whether you're doing the best you ask yourself, am I experienced enough to do this yet? Am I qualified enough to do this yet? You seek help. You're trying to do the best you can, but if you're conscientious, it's stressful. Yeah, and I imagine that, again, to your point about adaptive versus mal-adaptive, a certain amount of stress is actually very adaptive, right? Without it, you become so complacent. But it's really an inverted U, and at some point you go beyond it, and it becomes quite maladaptive. And it sounds like for you in the early years, you probably

went a little too far on the rumination. Did you recognize it at the time, or is this more of something you now see in retrospect? Well, part of the story I tell in the TED talk, and I'll just tell it briefly because it's a quick one, was the moment that made me realize it was Friday night, it was July, it was very, very hot. I was coming home from my office, and I lived in Manhattan, my office was there, I was walking, and I get into the elevator in my building with a neighbor who was a doctor in an ER. And the elevator, you know, rose a a couple of floors then shutted and stopped. And the man who manages emergencies for a living started banging on the door and poking all the buttons going, this is my nightmare, this is my nightmare. And instead of being compassionate,

which I would have been in any other circumstance, I found what came out of my mouth was, and this is my nightmare, which was funny to my ears at the time, not so much to his, and really horribly obnoxious, and really unkind, and plus to remind you, this is a neighbor, I'm going to see them again, it was just not wise, but it was so unlike me, and I felt so bad about it, I mean, those words left my mouth, I literally said what is going on with me with that's not me at all. And that's when I started realizing I am burnt out, but I've only been in practice for a year, how is that possible? And that's when I started thinking about, well, how many hours are my working,

and that's when I started realizing it's not the hours that I put in my office. It's the hours that I'm working in my head afterwards. Those don't stop. And that's when I started realizing I need to get a handle on it. This is really an epidemic, isn't it? I think this concept is probably not appreciated by... I certainly don't think I've appreciated it as much until kind of recently, and I think certainly in the era of non-stop electronics, it's only harder to detach yourself from work. You're more tethered to it even when you're not there. I mean, look, these days most of us are working from home, which is kind of nice, but also

means you're kind of at work all the time. I think that distinction is a really good one, right? Which is burnout cannot just result from how much time you are at work, but how much time you're thinking about work when you're not at work. And that's the part you can control, right? That's the part you have control of. And yes, to amplify your point, the pandemic has been terrible for people in that way, because it's not that you home all the time. It's that your boss is no you are. So, and you know they know you are. Like, why didn't you respond to the email? It's not like you were anywhere.

It's not like you had something to do. Is the kind of subtext of a lot of that. Right, you weren't changing for an hour and unable to respond because you were proud. You weren't out of the movies, because most of them don't exist. You wanted a Broadway show. You weren't doing anything important.

Yeah, so it's been a real problem, because it's difficult enough to make a separation when you don't have that physical space door to close and you have to do it psychologically. But then when you keep getting bombarded with emails and requests and all those things, and it's actually unless you create firm guardrails for yourself, unless you have the discipline to really determine I finish at this hour, then you're going to struggle with it. What do you think are some of the antidotes to rumination?

What would you say to, like you just give you the case study, right? I have many patients that fit this description, very successful, man or woman professionally, right? So by any external measure, whatever the world could bestow upon them as a measure of success, financial company building, entrepreneurial spirit, you name it, they look like they've done it all. And yet, when they're home, they can't interact with their kids

because they're constantly lost in thought or their spouse. They struggle to sleep. They don't have a hard time falling asleep But once they wake up they can't go back to sleep and that's usually somewhere around one or two in the morning They tend to numb that behavior with maybe a little more alcohol than they should What I just described is like Sometimes that's me sometimes that's my fate like I mean, I think we all fit in this description, right? Just we can all put pieces of fit in this description, right?

Just we can all put pieces of us in this description. How do you start helping that person? So the first thing that person has to realize is that this is not gonna happen naturally. It's not that you can set yourself, yes, and I'm working too much. I'm gonna do better. That doesn't work because the intentionality

will be good for day or two and then it will fade. You can't direct yourself to not think about something. You can redirect your thoughts to think about something else and that will work to the extent that the other thing that you're thinking about is requires concentration and is absorbing. If you're trying to drown out work thoughts by watching television, you won't get through the first commercial with knowing anything about what's happening in that show, because your mind will drift immediately, the same with reading, unfortunately. So it has to be something active,

where you're actually engaging your head and doing something that requires concentration. That's one thing. So if you're really caught in a loop, distracting yourself by doing something that requires concentration, whether it's a memory task, a puzzle, or what have you, the research is two to three minutes

of a distracting task that requires concentration, should be enough to make that initial urge or the craving to ruminate go away. The other thing people have to understand is that it feels very satisfying to ruminate because it feels like you're doing something important here, something that's troubling me. I am thinking about it. What possibly could be wrong with that? Well, you're not thinking about it. You're just replaying it. You're just obsessing. You're in an emotional hamster wheel and just spinning your wheels. You're not trying to figure anything out. So the second key is take whatever it is that's troubling you. It's usually one or two things. People tend to ruminate on a day or one in the morning about the same thing that's troubling them. Whatever

that is, pose it as a problem to be solved. Because when you pose it as a problem to be solved, let's say the really common rumination of hype so much work to do or when we're going to do this, when you pose that as a problem, it's a scheduling problem. It's when in my schedule, I'm going to have time to deal with this. What can I move to make that time? And if you actually think about it in that way, and you put it in your schedule, move things around to do so, the stress you'll feel about it will ease, and the urge to ruminate will ease with it. The other thing you can do, and I think this is the most important, is these guardrails. You need, and it's not just about that one night, it's about at what point can your family, or you, if you're a without one, rely on you to show up and not be at work mentally,

and you have an obligation to them. So when you think about it that way, what you should do is if you decide that's eight o'clock at night or seven o'clock at night or nine o'clock at night, whatever it is, then that's the time you let everyone know. And then you have to create rituals of transition, which make you feel like you're no longer at work. So you have to change your clothes out of work clothes and you have to put on some music and change the lighting. And if you have kids, you have to get into the ten-year-old mode or the four-year-old mode or the four-year-old shouldn't be able to do that. But anyway, you know what I'm saying? You know, you

really have to kind of, or if you have a spouse, you have to get into romantic mode, you have to get into the mood and really engage with them. You can't just sit there possibly engage with them, which means you plan the evening, you organize the game, you organize the outing, you curate dinner. You really have to purposefully mark out territory to have a life and if you don't, you won't. How often do you collaborate with psychiatrists where they incorporate also pharmacotherapy that can help with that? You know, medications that can help with sleep by easing some of these circuits, you know, things like trasidone or thorazine, things like that where

you can sort of start to short circuit it a little bit and it becomes kind of a creative with that process that you describe. I work with psychiatrists all the time. My first instinct would not be to refer someone, would not be to refer someone to a psychiatrist when they're ruminating in this way simply because there are so many things they need to try. I give a few examples. I can give you formal examples of techniques and things you can do to limit ruminations that will work. So if there's one of those things that you can do without meds, you should. If it's difficult to do without meds, I'm actually four meds, and I work with a scientist all the time, but this thing specifically, it will be more effective to change the habit that sets you up to ruminate rather than just medicate the rumination away

because the habit is setting you up to do it so much. Yeah, I completely agree with that. It's more durable, of course, and it's a lot harder. I mean, that's the reality of it. To have the durability of the response comes at a price, which is you have to work harder up front. It's much more difficult to change the habits as you describe them to take a pill. One of the things from me, from a ritual perspective that I have found to be so helpful, you touched on it briefly, is the ritual of playing with kids. So if you're lucky enough to have kids, which doesn't always feel lucky sometimes, playing with them in a truly engaged way.

So that means, at least for my two youngest, that's on the floor, like they're now sitting. On the floor. Yeah, you have to be on the floor. Yeah, you have to be on the floor and you have to be doing exactly what they're doing. You can't be half doing it. That is a real antidote to sort of rumination in that negative loop. But it's also not easy to do initially. It turns out to be a bit of a shock to your system because we, I think, lose this ability to play pretty quickly.

It fades from us, you know, but the time we're adults, we've sort of lost. We don't know what that means anymore. So it's actually a beautiful thing. I don't know, I'm sure there are other ways to capture that if you don't have children, but that, for me, at least, that's been a very powerful tool in that toolbox. Let me tell you how to capture that if you don't have children. There are many aspects of everyone's identity. You're not just a professional. You're an individual, you're an amateur tennis player, perhaps you're an amateur cook, perhaps you have this hobby or a sports fan, perhaps you can access any one of those aspects of your identity and bring it forth in that moment because when you're

screaming at the television because your team is doing something you really wouldn't like them to do, you're not thinking about work. You're just thinking about just get the ball down there. That's where your mind is. So you can access that. You sign up for a race and go train. And then the question is can you improve your time? Can you put in the miles you need to put in?

Or if you're an artist, then go into the studio because that's where you'll create best or create a studio like atmosphere. So, the many aspects of our identity that we can access that actually get short-trift when we're too preoccupied with work, and we will suffer from not accessing these parts of ourselves that are meaningful or to the extent that they're meaningful to us, that they make us feel like us and they make us feel important, we do need to give them stage time. And by doing so, it's a good way to, you know, to birds with one stone in the sense of give that stage time, access that part of your creativity or personality, whatever it is. And at the same time, if you're doing one thing, there's not room in there for the other.

So how long did it take you to undergo this transformation at the beginning of your career? Well, it's a long story, so I'll just give you some highlights of it because I went through an exploration. It didn't take me long to limit the hours and to limit the rumination. But what it brought up for me was, okay, here I am, a year or two, now into my private practice. I have been full steam ahead since my undergraduate days, undergraduate degree, then post-doc, then practice, hadn't stopped to consider how I feel about what I'm doing.

And when I did at those times, in addition to limiting roominations, I realized I cannot do psychology 50, 60 hours a week. It's too much for me. I need to do something else. I need to balance that. It can be related to psychology, but it has to be different. And then I went through a two-year exploration of what that would be, that exploration took me through some unusual, perhaps, stations. There was a point where I was in conversation with the head of behavioral science at NASA because I wanted to be an astronaut. I'm not saying that was a wise tangent on my part because actually I did not become an astronaut.

But I was curious, then I decided to maybe I should enroll in the Space University again, astronaut dreams. Then I realized, you know, there's not a lot of behavioral science going on in space. That's not maybe the best place. Plus I heard about this idea of floaters, which is, you know, the problem with bathrooms in space that you end up with. Sorry.

So that turned me off. These small things sometimes make a difference. And so I ended up realizing that I end up with. Sorry. So that turned me off. These small things sometimes make a difference. And so I ended up realizing that I wanted to write. And at that point, I decided to limit the hours of the week and of the day in which I see patients and create space for writing. And that's what I did for many years. How good were you at writing when you started? I'm going to answer you this way. I did that for 14 years. I didn't publish a word.

I didn't get paid a penny. That might hold within it some hints about my skill set at the time as a writer. Now, to be clear, I was writing screenplays at that time. I went back to, I had a rapprochement with film and I was writing screenplays a couple of them did get options, so I wasn't completely on a fool's errand. But you know, there's the luck of the jaw, I was in New York, I wasn't in Hollywood, and it was in 2008 that this one screenplay got optioned for a second time and started looked like it was it might happen. And I got my hopes up and I was working with this company and then the financial collapse happened and that went by the wayside and that was when I was like oh my goodness it's been 14 years.

Oh my goodness, it's been 14 years. And then an agent I knew already said to me, like, I've been telling you just write psychology. And I didn't want to write psychology, right? The whole writing thing was to not do psychology. And then I'll tell this very briefly just because it's so stupid, but it's like how life... Don't tell it briefly, just tell it. I love the story.

I went to Best Buy to buy earphones. And I tried to get the attention of someone there to help me and three people walked by and didn't help me and so I got annoyed and I left the store and as I'm leaving the store there's a big picture of the manager like I'm talking about like a four-foot picture of the manager smiling and saying how was our customer service? Email me and let me know. So I emailed them and let them know. And the surprising thing was that I got a email back the next morning saying, I'm so sorry that happened. Here's my personal phone number. Let me know when you're coming

by. I will make sure someone helps you in whatever you need. And that email made me think, wow, if I would have gone to a customer service hotline or stood in a customer service line, I would have taken forever it and really made me think that the squeaky wheel gets the grease. And that gave me an idea. I'm like, huh, what's this psychology behind that? And I started doing a search to see what books have been written about the psychology of complaining, and there weren't any. And a week later, I saw that agent at Christmas party and I said, no, I had this idea for a psychology book, but she goes, finally, what is it? I said, no, no, I'm not even sure it's a book. It's just an idea. It's about

the psychology of complaining, and I would call it the squeaky wheel. And she looked at me, she goes, I can sell that. I'm like, there's not enough to sell, you know, and she looked at me and she goes, I can sell that. I'm like, there's not a that to sell. And she said, I'm telling you, do the research, write a proposal, I can sell it. And it sold at auction. So let's talk a little bit about the book. I've watched your Google talk, I think, from back in 2011, where you presented this. I love the story, by the way, of when you walk into the bookstore

ready to sign your copies. I'm going to let you tell that. But where did your research take you? How did you begin to uncover what was known? And more importantly, what the downside of complaining was. Because that, to me, is what you take away from that talk. Right. There's a hidden cost of complaining incorrectly.

Right. Well, at that point, I was cured from my anxiety-related libraries. I could enter a library without having a panic attack, which was super useful when you're researching a book. So back to the libraries I went. And I started looking to research, but most of the research was actually in the customer service domain, or in couples therapy domain, but very little bit about our individual psychology, but from I started interviewing people, I started thinking a lot about it, and the thing that came up over and over again was that complaining is a form of expressing empowerment to the extent that we're trying to get a result.

But the research was, for example, that 95% of people who have a customer service complained with a product don't voice it, even though they're very upset. Why? Because they feel and they fear that it will be too difficult and too time consuming and too aggravating to do that. Instead, and this is the part that's fun, they will tell 12 to 16 people on average about that incident spending way more time getting aggravated each time all over again and getting zero result. And that fascinated me. I'm like, wow, our complaining psychology is really broken.

We just don't, you know, it used to be a transactional tool, and now it's just a venting thing that we do. And the problem is that when you tell 16 people about how you are wronged and you don't do anything about it, you're going to feel like a victim. You're going to feel powerless because that's the story you're telling. Here's a story of my getting aggravated not being able to do anything about it. Is the subject of the story or telling whether you realize that or not? Because it really reinforces it, right? I mean, it would be, it's one thing to not complain to the entity who could write the wrong. And if it stopped there, that could be problematic

enough. But to then go and tell the story to 16 people who are not empowered to fix it. Boy, that really, I'm using the term myelination loosely, but that almost, you know, myelinate's excessively a whole new set of pathways that create a narrative that's probably quite unbearable, right? Yes, and I love that phrase, so we should be using it from here on. But yes, it does. And especially when you think about how many complaints we have on a daily basis, it's not one. So that's one thing. The other thing is when you work with people in psychotherapy

and individual psychotherapy and they bring up issues with a sibling, with a sister, with a brother, with a friend, with a mother, with a partner, whatever it is. And you ask the with a sister, with a brother, with a friend, with a mother, with a partner, whatever it is. And you ask the most obvious question was, and did you discuss that with them? The alarming amount of time is in which you hear, no. And the stupifying amount of time is in which you look at you like, why would I discuss it with them? That's just going to cause an argument. I'm not stupid.

It's really powerful when you think about it. People are absolutely convinced that to voice something that's really important for them, meaningful for them, is an impossibility. Now, they're right. They're right because the vast majority of people express complaints so poorly, it actually does get the wrong result. It actually does get the wrong result. It actually does cause the argument. It actually does piss off the customer service representative.

It turns out that when strangers scream at you on the phone and curse at you and threaten you, you're not necessarily moved to try and help them as best you can. Wait, wait, just let me confirm that. So all kidding aside, do you get the sense that this is a process that has changed over time? So let's take a very extreme example. What did complaining look like when we were hunter-gatherers? Obviously we don't have data, but can we rely on any insight to say when we walked around in tribes of 18, if you know, Johnny was supposed to go out and get dinner that night and didn't. And the tribe doesn't get to eat. Do we have any sense of how that was handled? And then what has been that evolution to where we are today? So how did we get to the point where we're at today where 19 out of 20 people won't

voice the complaint to the entity that can address it, but we'll go and spend an average of 12 to 16 times, you know, lamenting it to the wrong people. Like, I want to understand that transformation through our history and as much as you think it's understandable. I can't say much about how together is in in that domain except to say that what happened with hunter-gatherers is that the research on ostracism and rejection tells us that the risk you took as a hunter-gatherer of offending your tribe mates was severe because the implications were that if you go to ostracized from the tribe,

you weren't going to make it. So to really piss off your fellow tribemates was something you probably did very judiciously. So I don't know how that was expressed at the time. I can go back 150 years to the origin of the term in the squeaky wheel. It came from a poem by a guy called Josh Billings, who was a humorist in the days of Mark Twain, and the poem was something like, whatever, I know I forget it, but it's something about, I hate to be a kicker, and I always long for peace, but the wheel that does the squeaking is the one that gets the grease. It's something like that. The issue there is the word kicker. The word kicker was the very insulting word associated with the people who complained too much. In

other words, as a society, at that time, 150 years ago, complaining was frowned upon. And because it was, it was used mostly transactionally, if the blacksmith didn't put the horseshawon correctly, you'll go and say, you know, my horse is limping, but if your horse was only limping slightly, you might not, because you didn't want to be a kicker. So it was frowned upon back then. And now you're going to become a reality TV star if you complain enough for if you, you know, voice something on social media. In other words, the idea today, and I think it's really developed because culturally, complainers, the squeaky wheel did,

I'm not sure if they got to Greece, but they got attention. And sometimes the attention was better for them than the Greece. And the Greece is supposed to quiet the wheel, and they weren't looking to be quiet, and they were looking to actually get a megaphone and be louder. A lot of people, and culturally, they were rewarded in that way, number one. Number two, we are expectations have grown over the

industrialization of society such that we would never complain about discomfort, but when we were sharing four people to a bed and going to the outhouse to go to the bathroom in the snow. But today, you know, if there's anything slightly wrong with something, we're going to make, because we are expectations are so high. And complaining in general gets triggered when there's a big gap between expectation and reality. And because expectations of risen, the gap is risen and complaints get triggered, and then they get reinforced by culture and society. complaints get triggered and then they get reinforced by culture and society.

How much general discontent do you think can be attributed to what you just said, this gap between expectation and reality? I mean, what percent of this is probably an unanswerable question, but just directionally, how much human suffering, psychological suffering, comes down to that single delta? A lot, right? I mean, you're asking for numbers. I don't know, but a lot. human suffering, psychological suffering, comes down to that single Delta. A lot, right? I mean, you're asking for numbers. I don't know, but a lot. And more so because of social media, because if your expectations were that, you know, you could see what you enabled it was all about, right? I mean, keeping up with the Joneses was keeping up with the people next door because you could see what car they had. But now you don't have to be next door. You can see that that

person you grew up with lives very far away. Now they have this car, and they have this house, and their wife looks like that. In other words, social media has, and because it's so curated, right, it's a highly curated, best of, in most cases, set very poor expectations, or very wrong expectations for what we should expect out of life and how much work we should be expected to put in to get that. So that's not helped. Do you think that people say of your generation who didn't grow up with social media and now as adults experience social media have one set of potential downsides from that, from

what you just described, but say a 10-year-old today who's never known a world without social media by the time they're your age is going to be in a different situation. How would you compare the experiences of someone like you versus the person who's going to be you some years from now who's never known in any other way? And I guess what I'm trying to get at is if there's a harm to someone as an adult today, will it be greater to someone who's didn't have some sort of a grounding at least without social media? I think so because for me, I grew up without social media.

So for me, what stands out about the internet, social media, apps, all of those things are the convenience of them. Because I remember that before social media, I actually had to call people to see what was going on with them, or write to them and post it in a mailbox. And now I just need to look at my phone. And so that convenience of being able to keep in touch with so many people at a distance, and see what's going on with them and enjoy the pictures here and just knowing what's happening or reach out if I see something not great is happening. It's very, very convenient.

But for someone who grew up with it, it's not about convenience, it's about image curation, it's about comparison, it's about how everyone else has more followers than I do. Why does he get more followers? Or why did you know, it's just a very, it's looked upon very, very differently. It's looked upon as a way to measure your worth, rather than as a way to get something done. You've talked about it, and I want to talk about it with you. You've talked extensively about the impact of failure on our emotional health. A lot of what you just described can

be viewed as a failure, right? By definition, if you're willing to compare yourself to a broad enough array, you're a failure. I mean, there's always someone who is smarter, better looking, richer, more popular. There's no metric by which I couldn't in 30 seconds come up with 10 people who are better than me. So what is the antidote to that misery that comes from comparison? First of all, it's a true misery and the issue is that for example, I work with a lot of successful people. They don't think of themselves as failures. It's more painful.

They just don't think of themselves as successful because they've only made 20 million and they're looking at the person who made 50. And there's something extraordinarily tragic about someone who went from nothing to 20 million dollars and doesn't think of it as a success. Right? I mean, that's just unfortunate that you would spend so much effort to get somewhere and have zero appreciation

for the fact that you're there. I work with somebody once who tried to climb Everest and only made it to Basecamp. And I was like, oh my goodness, you made it to Basecamp. And they were like, but I didn't get to the top of Everest. I'm like, again, you made it to Basecamp. In other words, that's actually impressive. It's not that simple. It's not that easy. And if you keep looking up, you will never, ever be satisfied. You will never, ever be happy. And one of the things I say to my patients all the time is if you just pause and celebrate

these stations along the way, it doesn't mean you're done. This idea that I only celebrate when I reach the top of a heap that doesn't have a top is such a bad life plan because you will never be satisfied, you will always feel envious, you will always feel envious, you will always feel insufficient, even though you've done so much, how unfortunate. And it is very difficult to get people to look down or look sideways rather than keep looking out. Was it ever difficult for you to find empathy within yourself for patients of yours who by any objective metric were enormous successes, but who couldn't appreciate it.

For example, when that person comes in and says, I started with nothing, I'm worth $100 million, but I don't feel like a success because, you know, my peers are all worth five times that one could take a very jaded view and say, I mean, shut up. I can't even relate to what you're complaining about. I'd give anything to have a fraction of what you have, but I don't sense that in you. I sense a genuine empathy for that person is actually suffering as odd as that might sound to someone on the outside.

Was that it was that natural for you to be able to have that empathy and to be able to communicate what you just said? Yes, it was natural for me. The job of a therapist is I see it. I'm not saying it for all, but as I see it is my primary job is to see the world through that person's eyes. the world through that person's eyes to really understand their experience. And if they're saying to me, I am ridiculously successful financially, but I don't feel like a success. My job is not to react to that as I would if I'm hearing it from stranger. My job is to really try and understand why, what's going on? Why can't they allow themselves this? What happened in their childhood Why can't they allow themselves this? What happened in their childhood that put them on this path of just keep barreling forward

and don't pause to celebrate anything? Because if you dare take your eye off the goal or your foot off the pedal, you will come to a shuddering halt and never get going again. Is usually some kind of fear there. It's very old that fear. It's obviously not something from their adult lives.

But once I find that once you really understand someone, once you really see the world through their eyes, two things happen. Number one, you have compassion for them. And number two, for me, again personally, you like them because when you really get someone, there's a fondness that gets triggered, at least for me. And one of my, and I discuss this sometimes with people and they look at me like, I don't understand these terms, for me, customer service as a therapist is very important. And customer service, what does that mean? It means that because I have those feelings, it's important for me that when I go to see you in my waiting room these days, when you shop in my Zoom, I'm genuinely happy to see you. You're going to see that in my face. And I think there's something very powerful about that for people who come to see you and you look like you're genuinely happy to see them, that you're genuinely interested in how they've been and what's going on, and that you're genuinely compassionate for the things that are not going well for them.

And to me, that's a natural outcome of using empathy to gain understanding, to be able to do your job. I love what you said earlier, and I actually want to go back to it and even come up with some of the kind of thoughts and behaviors that one can use because I certainly see this a lot in my patients and I see it a lot in myself which is an inability to simply acknowledge something done as being successful. And certainly what you said resonates with me, I suspect that also would resonate with anybody who's going to be honest with themselves. There is a fear that if I stop and acknowledge this,

I will lose it. I'll give you even the most trivial example. People who listen to this podcast know how much I love archery and race car driving. And so I'm driving my simulator almost every day. And so I'm driving my simulator almost every day. And, you know, when you take a new car onto a new racetrack, you'll start to set goals. Like, I want to achieve this. I want to break a minute and 14 seconds on this circuit in this car. And it could take me months to achieve it. Invariably, guy, Whenever I finally achieve my goal, the happiness

lasts for maybe 13 milliseconds. And then I immediately think, well, how much faster can I go? It's almost like I'm afraid to just say, wow, Peter, that was amazing. Look at that. You literally, it took you six months to shave two seconds, which is a big deal, right? Two seconds off a minute, you know, a minute 16 to a minute 14 is a big deal. But what, you know, what are we afraid of? Like what, what are we afraid of losing and why? And, and instead, wouldn't it be, I like the way you said it, which is how about doing both? How about saying, that's a wonderful achievement, Peter, you should be really proud of yourself. Yes, by all means, try to take more time off, but not at the expense of appreciating what's going on. How do you help people do that for things that are much more important and

much less trivial than what I just described? For example, building a business or achieving financial security or mending a relationship, like, you know, things that actually matter in life. Okay, so we'll trade secrets. Fine, I'll tell you. Here's one of the things I do. There are many avenues that you can take, but here's one of them. What I would do, and it's difficult,

maybe a little difficult to do with a race car example, just because it's a short timeframe, but if you take somebody who's been working on something for a long time frame But the person who just finally made their first million dollars or whatever it is Or made the first exit would have you is I will take them to a visualization exercise Now the key about visualization exercises is the detail the more detail the visualization the more you'll connect to it emotionally.

And so you actually, you're not just quickly thinking about, you're actually in the therapy session, you're going to spend time really painting the picture. So I want to take you back to when this was a dream, a hope. Where were you? Let's find a time where you were thinking about this. Where were you? What was the weather like? When were you wearing? Who were you with? How are you feeling back then? What was the context for you? What did this mean to you that idea of one day? You know? And if you can really help connect people to what it felt like at the point where they were just dreaming of it, thinking of it, wishing for it, and hoping but truly not knowing if they will ever have it. And then you have them insert into that visualization, that present selves that comes to give the news to their past selves about the

success, and you have them really visualise and imagine that entire conversation. How do you say it? How do you reveal? And what does that younger version of yourself think when you're the bit old? Yes, this is not just a dream you do achieve it. How would they react? How amazing would they feel? How excited would they feel? So that's one way that you can really try and connect someone by giving them the perspective of the person who hasn't achieved yet, them at the younger age, and looking at the achievement from that point, rather than from the point of the person who the day before was close to achieving and now they just did. So what? So that sounds an unbelievable amount like EMDR

But that sounds an unbelievable amount like EMDR and trauma work where you take the adult version of you and you go back to the child version who's been traumatized and you experientially go back and almost sort of help them and rescue them. I mean, it's pretty profound exercise you just described. It is very profound and it's very, very moving for their man, me, truly. Those are the moments that I remember very strongly in certain treatments of when the person really connected and you could see on their face that they were experiencing it from that perspective rather than the present one. But it doesn't have to be about trauma, right? We don't, you know, I'm not necessarily as opposed to the MDR, not as

a sort of... Oh, no, that's my point. Yeah, yeah, yeah. Just to an earlier perspective. And you're right, because from any one day to the next, it's very difficult to appreciate a change, but over a decade, I mean, it could be a step function. Right, now the other thing that's very, very useful is a lot of the times these people who don't want to celebrate have people around them who do. And what I'll sometimes say is that, and I'll say this because it's going to sound silly

but it does work. I'll say, you know, if you don't want to go and have a celebration for you, do it for them. They want to celebrate you and dullage them. And the thing is that they might start out thinking that they're indulging them, but they will get swept up most likely in that moment when they're actually out celebrating that thing that they did really didn't want to, but their family or friends really thought was important to, they get caught up in it and they can connect to it at some point. So actually sometimes from the outside in works to just start celebrating your connect at some point to what it is you're celebrating. So how was your book received?

Which one? The first one. Sorry, yeah, going back to 2008, so the squeaky wheel book. And how much of an itch did that scratch for you, vis-a-vis, you are now your author. It's a new part of an identity, right? Well, remember those 14 years, right? So it was, yeah, well, now you're a published author, right? So there's like your name is on the page for the first time, you know, and when somebody says, Oh, what do you write? I can actually point to something and say, it's a thing. Here it is. The book was received not well in the States and rather well, internationally. That book sold in internationally. That book sold in 12, I think, to 15 countries and did rather well in their most funny to me. So the first country was South Korea. And my agent said, oh, we just sold that book in South Korea. And I said, why? What a book about complaining. And they said, well, I'll send you the email. And the email said, oh, this is great. Koreans are the biggest complainers.

And then we sold it in China. And we got the same email. Oh, this is great. Chinese are the biggest complainers. And then the French were the biggest complainers, the historians, too, the polls are biggest complainers. Every territory that bought that book announced that they consider themselves the biggest complainers as if it was some kind of title worthy

of having. But my perspective is that it just touched a nerve with people. It didn't do that well here, primarily I think, because the book is a mixture of psychology and business, and it's difficult when it's not quite one thing or the other would be my guess. I think the book is quite well written actually, but if you're looking for the psychology parts you have to get through the customer service parts and if you're looking for the customer service parts then what's this thing going on about couples? So I think it was a difficult book to market, but what happened was because it didn't do well my agent said to me book in Latin January of 2011 by March it was clear that it's not taking off. And my agent said to me, if you want to sell another book, you have to do it now.

And I'm like, excuse me, the book just came out. She goes, yes, but it's not doing well. And I can convince editors that it will do much better in paperback. But it's going to come out in a year in paperback. And if it doesn't do well, no one's going to be interested in the second book. So you have to sell one before that one comes out and paperback. I'm like, I'm still doing publicity for this one.

Like, can I take a break? She goes, no, you can't if you wanna have another book. And again, 14 years taught me that, let's take the opportunities when we can. So I put everything aside and started working on a second book. Now, was that the emotional first aid? Notional first aid.

Oh, yeah. What was the motivation? How did you decide that that was going to be the next? I mean, it's an unbelievably important topic and something I want to discuss with you now. But how did you decide that that was the next book? I decided that I definitely wanted the next book to be just full on psychology. I wanted it to be about emotional health.

And I wanted to really reflect the work I was doing with patients in which I was at that point, you know, for quite a few years at that point, because I recovered from the dissertation, regularly reading research articles and trying to find ways to apply findings in my practice, because research articles in psychology are not written for practitioners, they're written for other researchers, but they might actually have a lot of information that's very relevant to practitioners, you just have to translate the research finding into an intervention. So I would do that when I found it necessary, and I would try things out with my patients, and let them know there's this research, and it implies that this might be useful,

try it out. And if it was, I would recommend it to other people. And over the time, I had curated a lot of different little tricks and tips and techniques for people to manage common emotional wounds like failure of rejection, guilt, self-esteem, low self-esteem and such. And I always had this idea, it would always piss me off, that, you know, medicine cabinets were such a thing, but there was none for emotions, there was no psychological medicine cabinet. And so I had this idea, like I want to write a book that's in essence, the psychological emotional medicine cabinet you should have in every home. And so I started doing that. Let's contrast three types of injuries and I want to better understand why it is we struggle so much with emotional injury. So case one, a broken femur. And let's make it really juicy and it's a spiral fracture that's open. And you can literally see the femur sticking out of the thigh bone. Injury two or illness two type two diabetes, but really see anything from the outside.

But you know, we have a blood test that can tell us you have it. Injury number three, rejection. Nobody sees it, and the point I think you make is we're far less likely to even acknowledge it. Help me understand that spectrum and what it is about us as a species that is very quick to acknowledge case one as an injury. And frankly, despite the fact that we don't really see case two externally, we don't seem to have a hard time accepting type two diabetes as an illness that warrants treatment and can't

be left alone. And yet, for many people listening to this, the idea that being rejected or failing at something or in treatment is going to sound stupid and you're going to have to do some convincing. Is it okay if I answer by way of a story? Please. Okay. So, this is a true story. I'm sitting with a very, very senior executive in a financial institution.

And I'm talking about emotions and the importance of emotions and he immediately shuts me down, waves his hand and says, yeah, I don't believe in feelings. And I do what most psychologists do in their court of guard, you just repeat the statement in the form of a question. I said, you don't believe in feelings. And he said, you know, I know people have them, but it's not as if they're real. They shouldn't matter. Now, he said this in the first few minutes of a couple's therapy session with his wife sitting next to him, dabbing her eyes with a tissue because she was having feelings. So it was an interesting time to make that statement that didn't believe in feelings when his wife is crying beside

him in the first few minutes of a therapy session, but so many people feel that way. And when he says, you know, they're not real, it's not unicorns or aliens that you have to have proof of sightings or something, in other words, but he really didn't think feelings mattered. And so what I did is I turned to the wife and I said, did you know your husband doesn't believe in feelings? And she stopped crying, she looked at me and she said this, no, but it explains a lot. And I started laughing really hard because I thought it was really funny.

And I laughed so hard that she started laughing. And then she laughed so hard that he did not start laughing. He actually looked really irritated. So I looked at him and I said, what, you don't believe in laughter either? And then he was literally about to get up and I said, you look angry. He goes, I am angry. Like, well, there's one feeling you believe in. Now let's talk about some of the others

and how they might be impacting your marriage. And he sat down because I've made the point. You can't just cure it. If you believe in anger, there are other feelings. You have to believe in as well. But many people think that feelings are not worthy of attention. And to be honest with you, when we were early on in our development, societally, industrially, when it really was about just keep alive,

you know, roof shelter, the hierarchy of needs as it were, your emotional well-being was very much at the bottom of that hierarchy. Actualization was at the bottom of that hierarchy. And so we had to reach a certain level of industrialization was very much at the bottom of that hierarchy. Actualization was at the bottom of that hierarchy. And so we had to reach a certain level of industrialization and comfort and safety and self-sufficiency as a society as individuals to be able to start looking at higher order needs, beyond safety, shelter, et cetera, food.

And that's when we started paying attention more to emotions. It's a very recent development relatively speaking. And if you go even today to certain war zones, no one's going to be listening to podcasts about how to self-actualize and be the best you. They're going to look at podcasts about what to do and your FEMA is shutting out of your leg, or you have type 2 diabetes and no insulin. So that's going to be a bigger concern, fair enough. But for most of the industrialized in Western world,

probably we are at a point where we need to think about our emotional well-being, even because it has a huge impact on our physical well-being and our longevity and our health. So even if that's the priority, just staying alive, we know there are many emotional psychological conditions that can actually contribute to you dying much more quickly than you might otherwise. So that would be who view in that way. But we are finally at the point where our emotional

will being our happiness, our life satisfaction, is something that's on our agenda and then we're starting to pay more attention to it, but not everyone is. By the way, I think, guys, that is probably one of the most eloquent explanations, both in terms of the story, but also I think drawing on the hierarchy of needs is a great point I hadn't considered, which is you could argue since the domestication of crop and cattle we've had the only then, only since then have we had the luxury we've been thinking about stability with respect to food and infrastructure. And that would have started the clock on when having the luxury of thinking about this began,

whereas physical injury, we've had our entire evolutionary history to worry about. Right. And that industrial revolution was 11,000 years ago. It's just not that long. And you know, like writing's only in around 5,000 years or whatever. In other words, yes, we're pretty new. And it's only very recently that,000 years or whatever. In other words, yes, we're pretty new and it's only very recently that we can attend to this. Yeah, I mean, even go one step further. Language might only be

50,000 years old, and yet clearly prior to language, we still had to concern ourselves with a physical injury. There's no animal that isn't concerned with a physical injury. I guess the one thing that would draw some concern is, I don't think we have another 50,000 years or 10,000 years or 5,000 years to figure out how to deal with emotional injury because we probably won't survive it. That's been my conclusion as a person who has come to this from the lens of the physical side, right? The longevity side of things.

I think it hasn't taken me my whole life only half of it to figure out that if the emotional piece is not working, at best you will continue to do okay physically and just be miserable, which strikes me as the definition of torture, or at worst you'll have all of that plus an impaired physical existence. So either way if you're emotionally broken, I think you're in for a very difficult life. So how do we shave 5,000 years off the next 50? And how does your work and the work of people like you start to change this mindset? One of the reasons, Laurie and I decided we want to do this podcast is because we sat there and spoke about wow if we can really show people by doing this work and putting it out in a

podcast that people who you know so we have this episode about heartbreak an episode about parental alienation episode about this and that but within those episodes there are a lot of insights that we're offering that are nothing to do with it and that are very transferable. And in the reviews that we have and the letters that we get, it's the point that people emphasize the most. That, wow, nothing to do with me and I learnt so much about myself regardless. And I think we, and I've said this before, I think any mental health professional these

days has to think of themselves as an ambassador because there is such ignorance that we have about our emotional and our psychological states and how we operate and what matters and any professional needs to be able to talk about that and to let people know and to educate because we are so in need of that education. One of the things I sometimes do in a session, a lot of the sessions that I do from people who are foreign, they find me they want to do sessions obviously by a Zoom way before the pandemic. And usually have an hour, say. And for me, if I have one hour with you, I'm going to come in guns blazing right in the beginning, because we're going to get something done. And so it's going to be a little headspinning for the person, because I'm not holding back here. I'm not

doing the, well, I don't need to do that now. We'll get to that in week 10. Mm-hmm. Oh, now. So I am this point, experience enough that I can fill in a lot of gaps. I don't need to do that now. We'll get to that in week 10. Mm-hmm. Oh, now. So I am this point, experiencing up that I can fill in a lot of gaps. I don't need to hear a lot before I can figure out where the problem is and where the issue is. And what people find really interesting is that, well, wait, how are you able to articulate what I'm feeling better than I can when you just met me? And this is the thing that makes me sad. It's something we should all be able to do if we were better educated in how psychology and feelings work because there's a lot we don't know, but there's a ton we do.

We know for example that rejection hurts even if the person who rejected you is someone you rejection hurts, even if the person who rejected you is someone you absolutely despise and would never want to be associated with ever, but if they rejected you, it's going to sting. Now if you don't know that we are wired to respond that way, you're going to have a lot of other ideas about what kind of loser you are or, you know, like, why is this hurting? Knowing our basics and we have some basics about our emotional responses, understanding that if something happened to you and you feel this way about it, anyone else that happened to is going to feel similarly they might not show it, they might not display it, they might not confess it and they might not feel it to that extent, but feel it they will. Our emotional DNA is global, it's universal, it's evolved. We're all very, very similar in our emotional responses. In our experiences, our responses might differ, but our experience is the same.

So there's so much we can teach, there's so much we can inform, and there's so much that if we did, we'd feel unifying as humans, would make us feel more connected to one another, because we're all so the same under the skin. You said something there that really resonated. It's a bit tangential, but I think it's worth mentioning, and I think you'll agree, but if not, please, please tell me. I remember at one point I was saying something to one of my therapists, her name is Esther Peral, you I'm sure no, Esther, you both in New York.

If I may be the Esther and I have shared offices for 27 years, we have been office mates for 20, 70. I don't think I knew that. Okay. Yeah, yeah, yeah. If you've been to her office in person, I have many times. So no one at the bell, you know, we're, I, so I've been in your waiting room then. I don't have some amazing that I didn't realize that. So, as you said something to me once, when I was explaining to her a thought pattern I was having, and I was explaining it to her as though I was the only person in civilization that has probably ever had this. So, of the 10 billion people or whatever number of people who have lived to date, Peter Tia is the first one that has ever had this pattern of thought. And as I start to explain it to her, she finishes the thought for me.

And I said, how do you know that? And she said, Peter, I hate to tell you this. And I'm not saying this to minimize you as a person, but this isn't a very uncommon thing. Your mind, when it's poisoned, is staggeringly unoriginal. Lots of people have the exact same poisonous sets of thoughts that you do. And unfortunately, there's a very common set of beliefs that are maladaptive, that people like you have, and I've heard every one of them. And it's basically what you just said. It's the pattern recognition that allows people like you, and Esther, and Laurie, to be so good at what you do. And I actually took great comfort in that, right? I mean, she said it to me in a way that was like, hey, I don't want you to not feel special because everyone wants to be special. But at the same time, Peter, please realize like, you're actually not that special.

And that's good news in this situation. You're not alone. Yes, you're not alone. And it should be comforting, right? Because, and the upsetting thing is, you're not alone on the one hand, on the other hand, because you probably hadn't expressed that to many people before, other than to a therapist, as many others haven't, that's why you didn't know that it was common, because people don't

talk about it. And that's again why I believe that it's the duty of therapists to be ambassadors in some way, because even if it's a dinner table discussion, and by please, by all means, I'm not trying to say walk into a room therapist and start taking over with your drowning on about your work, please don't do that. But if you have an opportunity to point to a generality, to point to research, to say, yeah, this is how this works. This is a truism. This is something that's always the case. Then do so because you can educate people. We can crowdsource this. We can really let people know. I have the podcast, I write books, I give a lot of talks, I do consulting. I am trying in these years of my practice to really get the word out.

Because I do feel a certain sense of mission, because when you do, it's kind of upsetting that we know so little and that people know so little and for you, that's a moment of insight and therapy, where for Esther, she could complete the thought and she could probably have completed it even before she told us she could complete it. If it's that clear to her, it should be clear to everyone, but we just don't have any platforms by which we can disseminate that information. It should be high schools, obviously, because that's when we have people captive, and that's, we should be teaching life in school, not whatever is a terror information people will soon forget when they graduate.

We don't, it's unfortunate. But that's where it should happen. Do you think the tide is changing? You know, you've been in practice for nearly 30 years. When you think about where we're going to be 10 years from now, versus where we were as a society, 10 years ago, specifically with respect to the seriousness with which we take emotional injury, what does the derivative look like? The most important event in that regard, the event that moved the dial more than anything

else by far is the pandemic, by far, because there are very, very few people untouched. And I don't mean by illness, I mean by stress, by anxiety, by grief, by loss, by loneliness, by tension, by relationship, rupture, by fear, by depression, very few are left untouched. And I know that, not just because that's how we are and that's how we respond. But because I have been getting calls and talking with entities who would never have contacted me before because there would have been like, well, this is just not something I can saddle my employees with listening to and now suddenly it's a necessity. Now suddenly I need the people who work for me to know how to deal with this or with that or how to understand this and that.

And all kinds of very specific kinds of organizations who truly would have been at the bottom of my list of who will ever call me have called. It is something everyone is very much aware of. And I wrote an op-ed for the Boston Globe about this in April in which I said, this pandemic is going to leave a legacy of mental health crisis that is going to be years to address. And we should start thinking about it right now because we cannot, as therapists, address the needs of people, with not enough of us. Therapy is not a practical solution for everyone. We need to start working on online mass interventions

that can be deployed psychologically and emotionally because we're going to have masses of people with trauma. What about all these nurses and doctors in the front line who are truly traumatized? I give a call, I give a talk to 7,000 nurses in the Duke nursing system in May I think it was. And one of the questions I had was, it was a very simple one, but it was just, it stayed with me. This nurse said she was very emotional and she said, what do I do when I am risking my life and my family's life every day?

And then I go on social media and my own best friends. My own immediate family members are out there than not wearing masks, they're not social distancing, every image is a stab in my back. What do I do with those feelings? And that's what we're going to have after this is all over. A Hulk, Hadre of nurses and doctors and physicians assistants and all of it, healthcare workers, frontline workers who are truly traumatized. What do we have in place to help them? Nothing. Nothing. And we'll need it.

And not just them. What do we have for the kids, for the adolescents, been dying to like socialize, because that's what life is about and prevented from doing that, for the parents who don't have a break because they're remote learning this and this people are going through extremely hard time emotionally. And while most people are unscathed physically, emotionally, everyone is a little bit damaged now. So the one thing it's done though, yeah, we don't have interventions, I can go on about that for a while, but I'll get off the soapbox.

What I really mean to say is that people actually paying attention to it now. They're more receptive to it now. They're more interested in it now. And I think they will listen more now. How can the work that you do that best or does that Laurie does? How can it be scaled? Because every time I meet a therapist, they don't have room for more patients. There's just very difficult to get in

to see a great therapist. And I know sometimes people will say, look, I can do a one-off consultation, but I can't take a new person on as a regular. And so how do you scale this given that it's not a widget, right? You can't just tell the factory to make more. It takes years to, like even if at this moment guy, you know, thousands of people were listening

to this as undergraduate students and felt, you know what, this is an amazing calling. Rather than, you know, go and do X, I'm going to go and do this. I mean, we're still a decade away from those people being on the front lines. So what do we do between now and then? The answer is not make more therapists. That's not the answer because it's just not practical. The answer is they are already all kinds of studies going on about online interventions for things like loneliness or anxiety. There are all kinds of protocols and they are just being used in like regular research but they're not

you know this this vaccine effort that was a global vaccine effort if a fraction of those resources were allocated to finding useful interventions that truly can be put online and anyone can do in the privacy of their home in their own time. Will it be as effective as one-on-one therapy? No. Will it be effective and actually helpful to a lot of people? Yes. Not everyone needs the therapy. We have nothing and we have therapy or read an article or read a book. There's a lot in the middle that we can do that can be deployed and scaled Really on a mass level and then once you do it in one place you just translate it and you know You have to adapt things for cultural ways, but that should not be that heavy a lift And it can be really

popularized in the sense that people can find these resources to at least triage at least do some first aid Emotional first aid, the book I wrote, it's a book, I don't come with it. And yet, that book is done really well. It's in 27 languages. And people write to me all the time saying, oh, I keep dipping back into it as needed. And it's very useful because it is that medicine cabinet. And if you can do it in a book, you can do it even much better with interactive online tools, with apps, with, you know, AR, with whatever you need to use. But if the efforts were going to that, you can scale and you can actually do things that are really,

really helpful for people on a male scale. You can't do that with medicine because a femur has to be set, a broken femur, individually. You can't look at an online thing and do it yourself. But some of this you can when it comes to psychology and emotional health. One of the things you've written and spoken about that I can speak to from personal experience and initially I would have never believed it is the use of affirmations.

I was challenged at one point to come up with an affirmation for every year I've been alive. So, I'm 47 and that meant I had to come up with 47 affirmations. And my experience with it, which I think you will understand because of the way you've spoken about it, is, and this was during a very intensive therapy. This was three weeks of residential care, right? So this was 10 hours of therapy a day. For the first two and a half weeks, I couldn't come up with two. I just refused to write anything down. And I wasn't

pushed to because I think the therapist understood I had to come up with these on my own. I had to believe them. And then I had an enormous breakthrough at the very end of that experience, and in one sitting, wrote them all out. And the important part here is believe them all, right? Talk a little bit about the importance of believing in affirmation that you come up with versus going to an affirmation website and downloading some posters. So positive affirmations are defined as those typical sayings that you get on refrigerator magnets and the bottom of calendars. I am going to be a great success.

I am beautiful and worthy of great love, etc. That kind of thing. What the research shows and by the way, these are a multi-multimillion dollar industry, these positive affirmations. What the research shows is that there is a very specific group that benefits from them and a very specific group that is harmed by them. The people who are harmed by them are people with low self-esteem. The very people, these affirmations, target why they harm by them, because when you're feeling very unbeautiful or very unsuccessful, looking in the mirror and telling yourself that you're going to be a great success, when you feel like a massive failure is not going

to register as believable. And because it's going to register so unbelievable, it's going to remind you that in fact, you feel like a failure. Same with saying you're going to register so unbelievable, it's going to remind you that in fact you feel like a failure. Same with saying you're going to find great love when your immediate experience is been that you're not. So who they do help is people with high self-esteem because it doesn't contradict their internal beliefs, which is horribly ironic, right? That the thing it's supposed to help, the people it's supposed to help get harmed, the people who don't need it can benefit from it. But there's a way to change affirmations into useful and the way you do that is, as you said, you individualize them so that they sound believable to you. So don't say, I'm going to be a great success. You can set yourself, I'm going to persevere until I succeed. That's believable. Don't say, I'm worthy of great love.

Oh, I'm beautiful and I'm worthy of great love. Say, I have amazing eyes and an amazing personality, and I'm going to keep putting myself out there until I find the person who appreciates them. Individualize the affirmation so that it sounds believable to you and yet is hopeful and optimistic and sets a goal. That's the key to making them useful and those versions don't usually come on refrigerator magnets because they're too long, they don't fit. That's exactly right. I mean, it took a couple of pages to write them all out. And I went through a phase of my sort of recovery slash journey where every single day I would take five minutes out and I pegged it to getting dressed in the morning so that it would never be missed.

So I had a ritual that said, when you're getting dressed, you're going to also stand in the mirror and you're going to read these and not too quickly, you're going to read them and sort of reflect on what they mean. And truthfully, guys, there were days it was hard to read them. There were days I didn't fully believe them when I was, you know, having a bad day. You know, when one of your affirmations is, I am a good father and you just yelled at your kid over something that you shouldn't have yelled at them for, it actually becomes a little hard to read that. But it also reinforces that you are a good father who just made a mistake.

And that's, that's okay too. And you get to read it again tomorrow and come to it with a different light. But, you know, when I heard you speak about that, which again, I think was in one of your other Google talks, I found it to be an amazingly insightful view of something that I felt a little hokey about having done, but personally found very valuable. And again, if you'd told me a year earlier, Peter, you're going to find this valuable. I would have said there's zero chance. I'll find that valuable. Right, because what you would have associated was Stuart Smolley, looking the mirror and sat at a night live and doing it, or some kind of trite thing that to you sounds trite because it is, to you

doesn't sound personal because it's not. So yeah, you were thinking of that version, but that's the whole point. You can individualize and I would even say to you that on the day that you just yell at your kid before you're about to say, I am a good father, adapt it. And that day don't say, I am a good father. You can say, I am trying to be a good father. And I am learning from my mistakes. Say, you can always, always tweak it so that it has the same sentiment, but it matches the reality that you're living in that moment. That's a fantastic point. Do you think that there's something to be said, by the way, for the fact that as a writer, it makes you a better therapist. I mean, I sort of, obviously,

there's an enormous selection bias because we're more familiar with people who are out there doing other things besides their clinical practice. And often it's their writing and speaking that brings them to our attention. I mean, I sought out Esther years ago, but in part, it was because of her work, right? And that's how I sought her out. But that said, do you think that, for example, like you and Laurie, when you're doing your podcast, are able to do what you do because of the discipline that writing has brought to your thought process?

It's an interesting question. I'll answer it two ways. One thing that's very important to me, I'm sure to Laurie and I know it's important to Esther, is language. Because, you know, sometimes a lot of people will say to me, oh, I'm really empathetic. I'm an empath, some people say, I don't like the word, but they'll say it anyway. I'm an empath, and I'm like, what does that mean? Like, I really know how people are feeling. I'm like, how do I know you do? In other words, if you aren't able to express it in language that truly captures it, I have no idea if that's what you know or not.

It's one thing thinking that you know how someone feels, but it's not able to articulate it very clearly and very accurately. And so language is a very important tool for therapists because, for example, our emotional language is very limited, tends to be its primary colors. We're angry, we're sad, we're upset, there's no nuance, but there's tons of nuance in language. We have dozens of words for certain levels or kinds of upset. And I try and choose mine very, very carefully because I want to make the point that you're not just angry. You're also quite frustrated and you're also quite resentful.

And in that way, you feel a bit of rage too. And you can start teasing out the nuances. And when I start going through that with someone in that context, they'll get it. It'll be, yeah, that's true. That's true. That's just would never be how they would have described it. They would just be like, I'm annoyed, you know, but no, no, it's very nuanced. You're also a little bit relieved because you've been waiting to vent and yell at that person. It's very complex, our emotional experience, except we tend to think of it in just like one thing,

which is not so language actually is very important tool for therapists because when you're describing emotions, which you have to do, you really want to be able to do so. But the other way it's very important for a writer is that I and I know, Esther, I know Laurie, a lot of, you know, most therapists I know use narrative psychology to a degree in anything that we do because when somebody comes to me for a first session, that's not a one up. So,

what my duty is in a first session is you will tell me your story and then I will tell it back to you at the end of the session or midway at some point. I will tell your story back to you and it will be a different story. And in my version of the story, why you feel the way you do or why you're stuck in the way you do will become abundantly clear and What you need to do in basic rough terms will also become clear because in your version of the story your stuck in my version of the story You're not and I can explain why but that means that I have to be able to describe your narrative Take the data points that you presented to me. Shuffle the order, look at some of them from a different perspective

and tell a different story. The simple example I always use just to illustrate this is if you're a survivor of a horrible plane crash and you lost a limb in that plane crash, what is the story you have about that? Are you a horribly unfortunate person who became disabled in a plane crash, or are you the luckiest person alive? Because you're the only one who walked away, albeit maybe hopped, which is to say those different perspectives are going to make you recover in a very different way, feel very differently about yourself, and very feel very differently about the life you go forward to live.

It'll be much more adaptive to think of yourself as a very fortunate survivor, rather than have the self-pity of, think, you know, you've been horribly, horribly victimized. And we have choice in the stories we tell ourselves. We don't have choice about the facts. We have choice about our organization, our perspective, and the narrative we create around them. And as a therapist, you have to be able to create and present a different narrative. And writing is certainly helpful. You bring up such a great point. And as I think about it, you know, I can think of examples

of people who don't write, you know, or haven't published books, but yet have this. I have a friend, his name is Jim Kachalka, who's an amazing psychologist. Now, he's a colleague of mine, a friend of mine, not a therapist of mine, but anytime I've sat down with him to have dinner, unfortunately, I just suck up all of his time because I end up, you know, it's always a one-sided discussion, but he's just so giving. And I come away from these discussions, appreciating what you've said, which is, Jim's ability to articulate things is unbelievable.

And I could go in with a narrative that says, I'm upset about X and come out of that discussion with 12 more layers of complexity to that onion. So maybe that is the sincwanan of a great therapist is that ability to say, you showed me an onion. I showed you there were actually 12 layers to it. Right. I do think it's a very important aspect

that you have to be able to master at some point. Guy, I could continue this discussion with you for hours, but we've been at it for quite a while. I guess I could continue this discussion with you for hours, but we've been at it for quite a while. I guess I want to conclude by just letting the listeners know that if they haven't already done so they really need to listen to the podcast you do with Laurie. I absolutely love it. There's one episode in particular. I'm just going to make a make a shout for for people to start with. It's the one called Molly's Father's Suicide. where it's the one called Molly's Father's Suicide. I found that to be a very, I don't know why,

I just wanted to hug Molly to pieces. Like, I wanted to jump through my phone and just grab that woman and squeeze her till tomorrow. Peter, can I tell you how I have to restrain myself? I am, I said this to my brother. I said, I am so dying to see how she's doing. I want to email her, I want to call her, I want to give her a hug. And we've gotten those responses. We've forwarded her. A lot of emails and texts of people going like,

Oh, please, it hugs to Molly, please, it hugs to Molly. I haven't done that because I'm respecting her privacy and her distance. But oh, my goodness, you feel for this woman. Yeah. So I would say folks that haven't heard the podcast, start with that one and that'll give you a sense of the kind of work you guys are doing. Guy, thank you very much. Peter, thank you very much. It's been so interesting.

You've asked me things that have never been asked and I've been doing interviews for many, many, many years. And when you get me to start thinking about things and going, oh, that's it. I appreciate that so much. So thank you very much. Oh, it's been a pleasure, and I'm sure this won't be the last time.

Thank you for listening to this week's episode of The Drive. If you're interested in diving deeper into any topics we discuss, we've created a membership program that allows us to bring you more in-depth, exclusive content without relying on paid ads. It's our goal to ensure members get back much more than the price of the subscription. Now, to that end, membership benefits include a bunch of things. One, totally kick-ass comprehensive podcast show notes

that detail every topic paper person thing we discuss on each episode. The word on the street is, nobody's show notes rival these. Monthly AMA episodes are asking me anything episodes, hearing these episodes completely. Access to our private podcast feed that allows you to hear everything without having to listen to spills like this. The qualities, which are a super short podcast that we release every Tuesday through Friday, highlighting the best questions, topics, and tactics

discussed on previous episodes of the drive. This is a great way to catch up on previous episodes without having to go back and necessarily listen to everyone. Steep discounts on products that I believe in, but for which I'm not getting paid to endorse. And a whole bunch of other benefits that we continue to trickle in as time goes on. If you want to learn more and access these member-only benefits, you can head over to peteratia-md.com forward slash subscribe. You can find me on Twitter, Instagram, Facebook, all with the ID, Peter Atia MD.

You can also leave us a review on Apple Podcasts or whatever podcast player you listen on. This podcast is for general informational purposes only. It does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical

advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take conflicts of interest very seriously. For all of my disclosures in the companies I invest in or advise, please visit peteratiamd.com forward slash about

where I keep an up-to-date and active list of such companies. you