The Taproot Podcast - Therapy Roundtable: Challenging Mental Health Orthodoxy and The Evidence Based Paradigm

Episode Date: May 6, 2025

Tired of mental health podcasts that just tell you to breathe deeply? Discover + Heal + Grow from Taproot Therapy Collective brings you honest, sometimes irreverent conversations about the real challenges in psychology and therapy today. In this episode, Joel Blackstock, James Waites, Alice Hawley, and Hailey critique evidence-based practice and the research status quo in psychology. They explore why academic publishing paywalls limit access to knowledge, how profit motives influence research, and why the biomedical model falls short in understanding human consciousness. The therapists examine why CBT has dominated the field despite its limitations, why qualitative research deserves more respect, and how clinical wisdom often outpaces published research. They advocate for a psychology that values both scientific rigor and the subjective experience of individuals, making space for newer modalities like brain spotting, EMDR, and somatic approaches. Whether you're a mental health professional questioning the orthodoxy or someone interested in the deeper workings of therapy, this episode offers a refreshingly authentic critique of how psychological knowledge is created, shared, and applied.   The Future of Therapy: Navigating the Tensions of Our Time - Published January 2025 This article examines the growing mismatch between hyper-specialized, manualized approaches favored by clinical research and the actual needs of patients. It critiques the "cognitive revolution" in psychology, which despite promising a more humanistic alternative to behaviorism, has perpetuated many mechanistic assumptions Gettherapybirmingham. Evidence Based Practice is Bul$*%!@ , Let's Fix It! - Published February 2025 A provocative critique of evidence-based practice, especially in trauma treatment. The author challenges the dominance of CBT and medication-based approaches, arguing they often fail to address the root causes of trauma Gettherapybirmingham. When Evidence Based Practice Goes Wrong - Published October 2024 This piece discusses how commercial interests can negatively influence psychiatric research and practice, compromising scientific integrity and patient welfare Gettherapybirmingham. Evidence Based Practice and Research Psychology Archives The archive section of their blog dedicated to evidence-based practice, which explores the scientific foundations of mental health treatment through integrative lenses of depth psychology and trauma neurology Gettherapybirmingham. These articles collectively offer a thoughtful critique of current evidence-based practice models while acknowledging the importance of scientific rigor. They advocate for a more holistic approach to therapy that values both empirical evidence and the subjective, lived experiences of clients and clinicians. Keywords: evidence-based practice, psychology research, clinical wisdom, CBT critique, biomedical model limitations, qualitative research, academic publishing, psychotherapy, trauma therapy, depth psychology

Walk slow and I'll catch up. Let's hear the stars do their talking. All right, so today we're talking about evidence-based practice and some of the problems with research, some of the things we like about it, some of the things we don't, like how research could be a little bit better. I've got a bunch of articles about that on the blog, so I'll try not to repeat myself and kind of write about those things. But I think while we probably have different experiences with kind of the Institute of Research and like the way that that affects clinical psychology, which is our expertise is just going to be around psychology generally. We all feel that the scientific method is good,

studying cause and effect is a helpful thing to do. But there are places where the incentive structure around research is not terribly scientific. Because if you look at incentive structures, one of the things that they do is that they reward you or punish you. And most people tend to follow those incentive structures. So if the incentive structures are, even if the rules are going a certain way,

if the incentives are pushing people in one direction, I think it's likely that most people are going to do that thing. One of the things that I've written about a lot is that for a while, and I think that this is moving in a better direction than even five years ago when Teprid opened, is that clinical psychology and academic psychology, research psychology, were kind of going in two different directions. And one of that is, one of those reasons is that, you know, clinical psychology is more likely to follow the market, what people will pay for. And then also what works in a sort of like clinical

and embodied way, because you're in the room with somebody and you gotta get them better. Whereas academic psychology is gonna kind of cling to the biomedical model and try and make everything, even maybe things that we shouldn't be very objective and empirical, and turn them into a number in a way that I would argue that a soft science like psychiatry or psychology, you probably can't. A lot of the things that I critique are probably true if you want to study a vaccine or cancer research or which one of the antidepressants makes this pill

smaller, which kind of radiation makes the tumor,, not pill, germs less, which kind of like, you know, radiation makes the tumor smaller. You know, those are kind of like if this than that types of knowing. And the way that I don't know that psychology works that way. I think that it should be more centered on kind of the study of consciousness. on kind of the study of consciousness and not just what somebody comes into a room saying like I want to change but kind of like who are you what are you how deep is that it's a deeper way of knowing the self and I think that the biomedical model has kind of lost that so I'll go ahead and let James start his his thing if you have questions or anything about any of this please feel free to to email James and let him know. Maybe you're listening to this and you wanna say, oh, that was great, except it wasn't.

I didn't like any of it. And let me tell you what I learned in my clinical psychology when I was in class. Please email James that. Maybe Nancy Pelosi put a penny backwards at your McDonald's for you to find. James would be a great person to email about that happening to you. All those

emails that normally I get. Yeah, I'll fill them. That's okay. All right. Yeah. Well, I'm gonna start off. Anybody do that hack in college where you you could you ran into a paywall with a any type of article or anything like that doing research? You're like, crap, my university, academic setting, like, doesn't pay for that subscription to that journal. And so you're like, how do I get around it? You just like you skirt by just reading the abstract and using that as kind of your reference point and still referencing. I did that in undergrad a good bit. It took me till like, graduate school to kind of say,

oh, I need to have access to these full articles. Oh, wow. And. That's OK. For me, I certainly had access to the robust research in my undergrad and through grad school and was required to pull the whole article. And we had access to all the massive

databases all the but you have to be a person who's going to the institute the catches here is that you have to be a person who's going to the institution or like working there in order to be able to access this stuff like you can't get a membership at a at a like an educational institution library like if i call like the call call our local colleges in town or whatever, you can't get a membership at those institutions. So you can go to University of Alabama at Birmingham and go into their library physically and sit there and go through, but you can't,

there's no other way to do it besides to access all that stuff through these subscriptions that cost these institutions thousands and thousands, I mean, I don't know how much they pay for all this stuff. But yeah, but nobody else. But then the, yeah, how much you said? I think that it's like $600 a quarter for an individual

and then organizations get a break, but it's a chunk. Yeah. And then we have this thing of like the average everyone in the peanut gallery is suddenly aware of something called peer review and that we need to be using robust source and sources and but they don't have the you have to have gone through like a background of science to even understand like what we're talking about when we're talking about peer review what we're talking about when we're talking about peer review, what we're talking about when we're talking about robust research. It's not just like a what like a, I don't know, WebMD, like page or you know, there, there are plenty of there's plenty of like research that you can find via Google. That's not like peer reviewed researchviewed research. It might look like research, or it calls itself research. And people, you know, people like kind of reference these things. But in reality, like, there's this huge

gatekeeping thing that happens where most people are not allowed to act, not given access to whatever the, like the cusp of science is giving us. It has to be filtered through other people's sources, like people who might write books on this stuff or reporters who don't have the academic background to understand what they're reading in terms of research. So, you know, we're getting most, the average person is getting the news of like what science is doing through the public media. The public media has not gone to school

and trained in how to read these things because it's complicated. Like what needs to be there? What constitutes a good study? When is, when do you need like a participant, you know, level at certain, you know, when does it need to be thousands of people? When is it appropriate for it to be 15 people? Because there's all kinds of ways of doing research that are like statistically sound, but there's so much knowledge that has to go into that and in order to like be able to interpret it. And so we have people who work at you know all of these very respected institutions like you know like the New York Times or anything like that, but even the best like most expert people in there are not like at the pinnacle of whatever the,

you know, the newest like physics research, like people in that field barely understood it, might understand it at that outset, much less like the person who's trying to report on it, who like has to catch on that there even is something so, you know, groundbreaking, and then tries to report on it from like, nobody understands it yet. And so same with, you know, that's, and with psychology, that's kind of, that's kind of what we get. And so it's like these practices,

like when I started my practice back in, in like, or started practicing in 2010 or something, it was like EMDR was, like that was like woo woo, like nobody did it. But then in graduate school, you know, we were learning like that had to be an extra thing to that you trained in. But in my in my education, I was turned on to that as being like, Oh, my gosh, this is this is this is huge. But that's 15 years ago, and it had been around for a few years before that.

So it feels like everybody's just now catching on to EMDR as being this thing. And now those of us who have been, and now for me, I'm like, okay, no, but like brain spotting, let's like divert and kind of like move this. But people are just catching on to EMDR being kind of a standard model of care, even

though the vet has been saying it's the first, the best treatment of trauma that there is for years and years. The public is just now catching on. So there's just this lag. I just talked a lot. Sorry. Two of those points are really important, Alice. And one of them is the bigger the study, the bigger the readership is going to be the press. And the press is not really trained to read science. So one of the things that they're likely to do is take something that has a political implication or kind of a not controversial, but exciting social implication, and then take the whole study out of context

and then write one long paper about a little clip from research. And I think, you know, as the first point you're talking about, that feedback loop is part of what makes people not trust science and feel manipulated. And also the press seem kind of slimy or controversial, because, you know, if you look at the people that are researching these huge drugs that a

ton of people are on, you know, if they start saying, Hey, it looks like this drug doesn't work very good, your doctor gave you the wrong thing or something at a national level, they're aware of the implications of that. And so they're more likely to kind of try and change science, which I don't think you should do, in order to soften the impact of that. And then when people read it, I think they feel manipulated. They feel kind of messed with. I mean, you see some of that kind of happening around COVID with Fauci and the things like Obama were saying where, I mean, it was a good idea to wear masks. But at first, like they were worried about a surplus of like, there weren't enough like, there weren't enough like there weren't

enough equipment so they kind of downplayed how much non-professionals needed masks and then had to walk it back and I think if they had just said hey masks are a good thing but don't panic please leave some for the please leave some for the health care workers and then later as supply comes back or you know that they were just there were too much kind of dual intentioning there and you and you see that feedback loop of the press being afraid of how a study is going to be received, or the scientists are afraid of how the press is going to receive the study.

They start to change the wording or the way that it's released or control information, and the people feel kind of messed with. And then, like, go ahead. Go ahead there. Is that kind of what you're saying? Because that's what I hear from academic. Yeah, totally. I'm just I'm totally vibing. And

yeah, and I was I think you're getting at it's like the other huge part of what I'm what I'm talking about is that is that where does the money come from? Because the research follows the money? Like, and where and where does that come from? And so all the best research is from these, like really great institutions, like I went to you, Mercer, Colorado, all the there's tons of great research, but where does the money come from? And so all the best research is from these, like really great institutions, like I went to University of Colorado, all the, there's tons of great research, but where does the money come from? You know, when I was there, it was like Coors and then who owns Coors and like, go on, go on up and

that dictates like what, what is like being studied, like what might benefit what parties. And if you're going to do a PhD, like people who've done academic, you know, done, you have to, like, what you want, you can't just say, Oh, I hear people just throw away all the time saying, Oh, if I went back to school, but you have to find a very specific other professor who's being funded to do related research, and then get that person to agree to do that study with you, which is probably not going to do because it won't, it's not like a publicly, you know, it doesn't follow like the money of big pharmacy, you know, that's kind of what I'm talking about. But I mean, a big part of what I'm talking about, but I mean, a big part of what I'm talking about. But- Well, and I think there's a, like to that point, Alice, like I think that there is a perception that like Pfizer goes and writes a check because they make this antidepressant and they like want people to prove that it works. Like in the same way that like the cigarette companies put a bunch of money into like trying

to prove that cigarettes like didn't cause cancer, there was some confusion about it, like in the 70s and the 80s. And sometimes that happens and that you've got these huge organizations. But I think the majority of the corporate influence isn't even like, we're paying for this study. So, you know, cloak and dagger, like we want you to go find this outcome. It's that there's because a lot of times what pays for this is the taxpayer, like it's socialized research. But the problem is like a lot of that research pays for this is the taxpayer, like it's socialized research. But the problem is like a lot of that research is just given to

these private corporations to go do things with. If I pay for something as a taxpayer, I want to own it. If I pay for something, I want it. But when you give Pfizer, when you give these specific companies money, and then they go invent a drug, they own the rights to that drug even though they didn't pay for the research to get it so you know I think a

lot of the thing that that is kind of more at issue than you know the the kind of secret influence in the back room it's this kind of like weird crony capitalism of like yeah the taxpayer will make them a thing but then you can charge whatever you want and then we'll try and buy it back and subsidize insurance to try and get some of the thing. And it's like, whoa, whoa, whoa, whoa. Like we invented the drug. Like we gave you the money. You invented the drug with our money. Why are you the one that now owns the drug? But that's been the arrangement for a while. And that colors, that colors the way that a lot of at least psychopharm research functions. that colors the way that a lot of at least psychopharm research functions.

Yeah. Yeah, I wanted to just add. So I have my doctorate from University of Alabama and have seen a lot of this up close. And there are a lot of ethical dilemmas and issues that you run into, particularly around publishing, even from a student or academic side.

The model is so very capitalistic driven. But what's interesting to me about that is, these organizations that house, warehouse, all of these journals and the ones that you're subscribing to or paying for, either your university does, and then you get access as a student, or maybe you work for a large company, and they do research, and sometimes they have access.

But for the most part, it's not access for everyday people. And then even if you can get access, it's hard to understand or to read. Even someone who's academically trained, there's so many articles that I'm like, I don't understand what this is saying or what it's doing. A lot of times too, articles aren't always written well. I think, you know, we, there's this assumption,

well, you're published, it's peer reviewed, so it's a really good article. It's not the case. Peer review is literally two volunteers who are academics who don't get paid to do this, we're just expected as academics to peer review is literally two volunteers who are academics who don't get paid to do this. We're just expected as academics to peer review. We peer review each other's articles blindly. We don't know who does it.

And it's almost without a doubt you will get a peer review publication back and they will have two complete opposite perspectives and opinions. So as the writer, you're like, how do I satisfy these two opinions but still keep the integrity of my work? So a lot of times, papers get stripped down because that's what it's not going to get published if you don't.

And so the academic structure of that is, again, capitalistic in nature, where you as an academic are required, if you're wanting to be tenure track, you're required publish but you do not get paid to publish you do not get paid to peer review, but you are required to do those things. publications a year for a total of 15 to 20 publications At the five-year mark when you go up for tenure, so that leaves a lot of space where people are having to Churn churn churn out these articles because they're also teaching they're also in committees

They're also doing like a you know, they might have a life outside of this like there's so many other things going on but it becomes the driving factor because that's what drives kind of the the this capitalistic model for this for these publications and then the Databases are the ones that have all the funding Well to your point Haley, you know, the the quality of a journal is determined by something called impact factor for those not familiar, which is kind of what the readership and citation count is how many people are reading this and

counting it. So in psychology, you know, the way that the some of this stuff functions a little bit different. And then also you're a lot of times your, your pay or the quality of your work is via do something called an H index, which is how many people are reading articles that you wrote, and then citing those articles in their research, which doesn't on its face sound like a bad system. But when you take all of the qualitative variables, and you only leave quantitative variables out of the incentive variables and you only leave quantitative variables out of the incentive structures of these institutions about who gets promoted, who gets paid the

most, who gets hired, which we've kind of done as we've turned these public colleges into private corporations. And we quit paying professors, you know, they're not getting the money. It certainly costs a whole lot more. If you look at where that money's going, it's administration. They basically have these boards of CEOs now. But what happens is that you could open a research journal in psychology from the 70s, even from the 80s, and there would be clinical techniques that somebody noticed, hey, if you're doing

aerosinia hypnosis, if you want somebody to go into trance state, you should maybe look at oppos, like to remind them of both parts of self or multiplicity, start off by saying, you know, you can be a good mother and you can be tired. You can be, you know, you can love your children and you can be angry. You know, somebody would publish a paper saying that, you know, opposites or antonyms are a good way to start trans state, something that you could use in the room. If you open an academic journal now that's a high impact factor, you look at the people that have a high H index, they're like writing stuff the way you write a website when you want Google to see it. It's garbage. Like you do a ton of information, you do a giant

meta analysis, you cite a billion things and you're like, hey, when you go back and you control for competence and three other variables, you can extrapolate across like these 17 studies, because you want to cite everything because you want everybody to have to cite you. And it's kind of turned research into this thing that is career making, but like is not useful, which is the point of what science is supposed to be. And so when when Haley, you're talking about like the way that the way that people are basically incentivized when they love this stuff and they go into do science to write in a way that isn't helping anybody do clinical psychology better, which I think is a sad place for us to have disconnected those things so much. I don't know.

And James, you have some experience with that in the hospital too. Yeah, I was actually gonna say I had like well I got a have a buddy. Dr. Burke. He's a pharmacist that Organization He wouldn't mind me talking about this But I he let me be a part of a just a write-up just a case study write-up recently. Well about two years ago and saw this process firsthand that I well, about two years ago, and saw this process firsthand that, I mean, we saw something that worked in the hospital and we're like, we researched it, did, you know, has this happened before,

can we use this again, can we replicate it, and all these things, which turned into a case study. But after, after Senate done, we, you know, we reviewed it ourselves submit it to a couple journals Journals decline Uh one picks us up. It's just like yeah the reviewing starts So you get like these get these red marks on your page You get and this is recent because I was like this is a three page just case study What are like this is the simplest thing to write? Why are people, you know dictating about what we put in here? Like, this is the simplest thing to write. Why are people, you know, dictating about what we put in here? Anyway, this 3, 3 to 4 pages, I forgot what it ended up being, cost us about $4,800 to, so we went the, with the route of basically open access, which is, you know, kind of where universities and big establishments can actually open, you know, get,

where universities and big establishments can actually open, you know, obtain this case study, case report without having to, you know, behind a paywall, except they are part of an organization that's probably paying for it. Open access just means that if you have, if someone's paying for a subscription to these journals, you're gonna pull it up, you know, if you work at UAB, things like that.

Something that you probably couldn't pull up if you're just a lay person, again, going back to, people who actually are inquisitive and want to know these things about different niche things, which is a story I'll get to in a second about sleep psychology. Anyway, so I felt guilty. I mean, I remember there's an email chain of like all these, some of the professors, doctors, and Brad Burke were just like, how are we going to settle this? How are we going to settle all this money? Like we got to pay 4800 just to get this little thing published. And I felt guilty. I was like, Oh my gosh, this is, this is, you know, so small. And you start thinking about that. Like if you're out there and you have something

that is like, not necessarily groundbreaking, but can be utilized and you need more people to kind of see One do you have access to that type of money just willy-nilly to send your your paper? You know the review process went really well, and they're like okay We're accepting it you just have to pay this money, and that's it like the hold-up is you paying this money I'm thinking if I was just by myself and not in this institution This was not that I mean the institution wasn't paying for it. This was actually going to come out of these doctors' pockets and things like that. So if you're your own person and you're still, you know, you're a therapist and you discover these things, just like these old journals back in the day of somebody

actually doing the work and seeing some progress, are you going to pay, that's the open access type where you do have to pay up front because again, the published the company is losing money every time somebody is just getting a free article, which is the hack that I kind of got around in in in grad school, which is if I if I found I was looking up sleep psychology stuff, doing a lot of sleep psychology, doing all these things. And it's a lot of weird stuff out there. But I would get articles that I could not have access to. And I was, I went to University of Alabama, and these databases didn't have access to these articles, which is wild. And they were great and interesting articles. I would read the abstract and like, I really need it. My buddy, who's an astrophysicist was just like, just email the, just email the writers. And so what I would do is I would just email the writers

on that, find the organization that they were at and when they wrote it and email the writers to those articles. And I would have them, they would just email, email me back the PDF of their article, which is what, you know, big, big journals don't want you to hear is that, you know, some of these, because again, a lot of these, a lot of people who are very excited about their work don't really, they're not going to make money off of it

unless it's like something big. And so they're just like, Yeah, if it's useful for you, do it. And I had a lot of great responses. What I emailed about 10 people and got about, I think, out of those 10, about 7 people responded with their articles, which like, Here, please! Because I would explain, it's like, Hey, I cannot get this. I'm, you know, at University of Alabama. I'm not able to access this. Is there a way you could help me out? And they're like, Hell yeah! You know, and they're like, Please! But that was crazy that I had to do that on my own. I didn't have access to that. But just imagine if I, I mean, that's one thing that you can do is kind of look at those writers and see if they'll be willing to, you know, give you their stuff now, but that can go why even why even like have to do that. I mean, that's the question that, you know, we since used to be that, like, if you look at like EBSCO, which is a giant academic library, they started as a magazine company in Birmingham. They sold magazines and part of those magazines were-

I'm fascinated by this. But you used to have to have a printing press and all of these things. And there was some sort of cost proposition for academic libraries. And a ton of what you're talking about is to pay for access for those academic libraries that, I mean, so for me to go out and just get it,

like if I paid for you guys to have academic access through Taproot to all of it, through like Psych Info, one of the big ones, like it would be $600 every quarter, you know, times each one of these. And is that just for Psych Info? No, that would be- Or would that be like Psych Info, Medline, EBSCO Post?

No, like EBSCO. EBSCO is what I priced basically. So like if I got EBSCO- Okay, but you wouldn't get all of them. No, you would get- But you don't get the literature- You'd get a big, it's like- You'd get a majority of them.

Yeah, you would get a big chunk of the biggest psychology publications, but not all of them. You wouldn't get the junior. But you don't have like physics. No, no, no. Because like when I was in school, like we'd have access to, you know, everything. The university. And so that's what I think we all should have access to everything. Well, especially if you pay. Well, I mean, that's the thing is like people make it create this thing of like, oh, well, there's no such thing as a free lunch or something.

But my question is like, what are these companies doing? Like, if you look at that, so the biggest like the biggest like academic publishing hosting company in the world is I think Elsevier. I'm not sure how you say that they're European But they make more money. They make more profit than Google not gross But actual profit just because their their overhead is nothing Like these companies are basically Google Drive like when you to give them the PDF of your research They host it on a server and then they charge everybody $800 to read it. But what you've done as an academic is you've waived your right to any of the intellectual property in that. You've paid for all the research, they didn't pay for it. You've paid to peer review it,

or your colleagues have done that for free, they didn't pay for it. And then you give it to them, which makes your readership of all the people that we want to know about science. We're always talking about like scientific literacy in the public. Well, how are they going to, how are they going to not get their data from Facebook if they don't have access to this stuff? And you've made your readership zero because the people who can afford it are probably in school where the college is paying these astronomical fees to access

it. But what is the company providing? I mean, a Google drive server, where these PDFs float there, what are they doing? Like, they're not curating it, they're not creating it, they're not collecting it. They're not really making it terribly searchable. If you've ever used an academic library, like they're not they're not user friendly. Yeah, like, why the hell is this the system? And if you had anything in there that you could have copyrighted, no, now you don't they own it. So

the the whole proposition of will more people see it or I mean, I don't. They own it. So the whole proposition of will more people see it or I mean I don't see the benefit at all and a lot of times the research again is being paid for by the taxpayer and this is just another private company you know harvesting all this stuff and making a lot of the problems associated with research work. I think it's so hard on the on the researcher side as well because kind of like what you were saying, James, is that you can reach out to a lot of people and get that information, because they've spent all this time doing the research.

They want people to have access to it. Like, researchers can be just as frustrated with the process, because here we've done all this work for free and no one's ever gonna read it. And we want to try, you know, we're trying to move science forward or, you know, look at different things, but it's just,

it's not accessible. And then also you're kind of stuck in the spot where you have to publish. If you do not publish, you do not get tenure. And tenure, you would get one chance. If you do not get tenure at your university, it's not like you can leave and go to another university. That's it. You get one chance your university, it's not like you can leave and go to another university. That's it.

You get one chance your entire career to make tenure. And so it's like you have to publish all of these articles. And if you don't do that, this is not going to be your career path. And so it's really unfortunate because that's the structure. It's very capitalistic. It's very driven by profit, and it is not accessible to the general population

or sometimes even researchers. Kind of what you were saying, Alice, where there's just, there are times where even being at a university, you hit a paywall or you still don't have access and then you have to like go to enter library loan and you request it from the librarian and then the librarian tracks it down but it's like takes all of this effort just to get access and then you get the article and you're like actually this is not really what I need. So I mean it's just there's so it is so much red tape

it is so many hoops to jump through and if you if you can't jump through all those hoops it's just there's so, it is so much red tape. It is so many hoops to jump through. And if you can't jump through all those hoops, it's just not possible to do it. It's just so, so difficult. And the people who say, well, you know, I don't want to pay for this or something. I mean, to a certain extent, like you're already paying for it. I mean, the NIH and these giant like endowments for science,

they, the government provides, you know, basically re-hosting libraries for a ton of the research that is public, I mean, at a lot of expense. If something comes out later that it's not good, they'll remove it, you know, if you question the methods of some of these things. So, like, to a certain extent, the redundant infrastructure is already there.

It's just that, you know that we like the profit motive. There's a lot of lobbyists there. And a lot of my point when I write articles about things are not that I don't like science or evidence-based practice. It's that I think you have to pick between a profit motive for corporations and science. Which one do you like more? And the people that kind of pretend that you can square both circles, I don't see that. I see those things on a collision course in a lot of places that we just don't wanna look at. And like to me, this is sort of bipartisan. I mean, you're dealing with institutions

when you talk about research. And so when you're dealing with institutions, you're gonna get political friction because traditionally left-wingers are more likely to kind of like fetishize institutions and pretend like, well, this tradition in hierarchy is like great. Where are you picking between the institution and what it does or actual science and evidence-based practice? Because if you're avoiding problems to

say, no no no I'm gonna set a good example and say that I like the you know the trappings and the cosplay of science, do you like science itself? Whereas you know I think traditionally right-wingers when it comes to institutions they're more likely to kind of have narratives of oppression and distrust institutions and feel like they're exploitive. But really, I don't think this system is working for anybody. And more scientific literacy would be a really good thing. I'm wondering if we, because Alice started talking about EMDR, could we switch maybe to talking about directly the way that the biomedical model and the kind of like objective and empirical driven research

is sort of at odds with clinical practice or at the very least, you know, maybe not helpful to it. I mean, Alice was pointing out that by the time we have the randomized controlled trials that people say, okay, we can see that for these conditions, EMDR works really well. Clinically, we've moved on. Like if you had waited till

1985 till now to adopt EMDR, I'm sorry, there's better stuff out there. You know, EMDR is fine. Like I'm trained in it. I don't really do it anymore, because there's more effective things that are now in the process of getting evidence based. And if you wait 20 years, that system to validate things, I don't feel like I would have helped as many people as I have, or treated as many conditions as I have. That's also, sorry, I'll say one thing.

And it's also part of the structure of being, what am I trying to say? Go ahead, Alice, I'm gonna think about it. Go back to me. I'm trying to say. Go ahead, Alice, I'm gonna think about it. Go back to me. Yeah, I think, sorry, I'm just, you put me on this spot.

Yeah, I think it's, and I think it's, it's, it's very interesting, like, because we're, because one of the things we're talking about, too, is that, like, like, just to pull it together, like, the people who are, you know, that we're talking about that don't have time to get tenure and all this stuff, it's like, those are also the people who are training the therapist and supposed to be, I mean, there are, you know, institutional, like instructors who don't have tenure, but like, the best people like are made by the university to be like, paying attention to research. And so then likewise, like in, in, you know, they are not tuned into what is actually happening, like people doing research are not tuned into what's actually happening on the ground, like feet on the ground in the field and like what everything is really, you know, how everything I

mean, and you can have like, I had, I had a really excellent master's program that I think did a really good job of this. But like, but it's still like within all of the confines that I'm talking about, you know, and I think in practice, it's, we kind of, yeah, we can just just like how research works. I think I hate I hate the term like ivory towers, but it kind of turns into like we kind of get into our ivory towers of. And then not recognizing like cross referencing different different modalities and things like that that can really be. modalities and things like that that can really be, it's more useful to bring in that stuff and kind of weave it together. But that's kind of where we get into like,

okay, it kind of turns into an art, or you have to have like, it's like this is where our emotional sensitivity and that quotient and our discernment that we've learned from all the experience that we have makes us the best ones at being able to tell, or, you know, some of the best at being able to tell, like what's really working, what are we seeing,

things like that. But we're not, we as therapists aren't really given the chance to like report back to the team. It's like they send us off and then nobody, you know, and assume that you're doing whatever, continuing education, but even that it's just like, it's just checking a box. Like most people aren't pursuing, I don't know.

Yeah, I got you. You're talking about clinical experience and clinical wisdom from seasoned professionals being a part of peer review in journals of psychology, which it largely right now isn't. And a lot of those researchers, when you meet them, they'll tell you, oh, no, I'm a practicing therapist because I work at the Student Counseling Center one day

a week or something. I think that's different. I think that's different than really having to go out and take anybody who comes in and treat a wide variety of conditions. And I don't think that's the same thing. And not to mention like, you know, along those lines of big CBT and what.

Yeah. I mean, again, I know, I mean, I worked with a lot of psychiatry residents that they, all of their classes are CBT focused and they have one guy dedicated to just nailing that, you know, into them. And it's great. But then you start talking about all these other modalities and things that, you know,

expand. It's in the 80s. Like, it's great, great in the 70s. Like, and it's, I mean, it still is, but like, yeah, keep going. It's great. But where do you, well, it's just like, where did it begin? And then, again, and then who trained under CBT over time, and then going back to researchers who made money off, well, sorry,

InfoWars is coming out. A lot of people made money off these modalities, because it was something that they, I mean, I, I, obviously, we all practice CBT, if you're a therapist, to some degree, but not all the time, but you're, it's ingrained for a reason, because I think it's kind of lazy and that's just that's just my opinion. Again, and I think there's a little bit about why that is maybe James and why like research prefers CBT so much because it's where most people are going to start most people are going to start by being like, you know, do you understand that your behavior affects your emotions? Do you understand the role? that your behavior affects your emotions. Do you understand the role of things you do? I mean, most therapists are not going to leave that out. But I think to me, like you're saying, to make that all psychology is, is behavior and symptoms. And that are measurable with a number that is incredibly lazy. I was going to say it's lazy in the fact that it also doesn't, it doesn't treat the underlying trauma and the way that trauma is formed. And that's the thing that I think

we're seeing a lot of now is a lot of, again, a lot of these behaviors spawn from how our brain was rewired in trauma. And, and I think the lazy aspect of it, CBT, and again, we all practice it to some degree, but it's, it's casting a net on some of these behaviors and not necessarily targeting a specific species. Just like fishing, you cast a net and you're going to grab up a billion fish, but what if you just want tuna? And tuna is trauma. And so you have to find, there's different ways of getting that tuna fish. And there a lot of you know there's a specific way of you can't really just cast net over and I think that's one reason that it works is because they saw a lot of this population it trickled down and it worked for a lot and people can change their behavior by thinking

about it or changing some patterns in the behavior changes but that doesn't solve the thing the behavior or they're changing something again they're fixing the symptom and not necessarily the actual problem with it and go saying root cause or saying like emotion You avoid or saying like insight I mean all of those like, you know Certainly when you start talking about somatic energy all those are things that cannot be turned into a number for a study But patient satisfaction and patient self-reported, did I get more out of this than the other one? That can't. And we tend to not try and publish those things, because I think a lot of people do want to protect, they want to pretend that all these

models of therapy are the same way in ways that they aren't. Like, if you look at a lot of cross comparisons where somebody did, you know, depth analytical work versus CBT in the study, they'll say, Hey, how do these 50 models of therapy treat migraine headaches or something? Well, when you look at the study, the person who's doing relational psychoanalysis or, or something that is a little bit more emotion focused, a lot of times those people are saying, oh, my gosh, I realized that this pattern goes on forever. My relationships are better and more creative. And then the researchers like, Yeah, but did

the migraine headaches go down? And they're like, yeah, that happened too. And they're like, all right, moderately effective. And that's the raw data is that, whereas the CBT person is just saying, when I don't eat sugar, when I drink water before bed, when I exercise in the morning, my headaches went down. But the candidate in the study is telling you,

I got more out of this model. And the researcher's discarding it to turn that into a number to publish a paper. Yeah I think you're really hitting on this idea around quantitative versus qualitative research and quantitative research is the highest at the very top of the research tower driven by medical biomedical, and also because they can be published quickly and turned out quickly. And that's also part of the problem of why we see all these modalities taking so long,

you know, to like to catch up to what's going on clinically versus research, because it takes so long to publish research. After you've done, you know, written the article and you've gone through IRB and you do your study, it takes years to get work published sometimes. So by the time it comes out, it's, you know, clinically, people have already figured a lot of that out. And so it's just very hard and qualitative study take so much more time. And you're right, you cannot quantify people's experiences in that way all the time.

Qualitative research is so important and I'm a huge proponent of it for that reason because we're able to capture lived experience. We're able to get, instead of saying, did you experience one to five, what was your scale versus like, what was your actual experience? Use your own words and being able to use that. I think that often more closely aligns with clinical work because that's what we're doing.

We're talking to people and engaging with people and hearing their stories and their processes and how trauma is directly impacting them. So research is also not motivated to do qualitative work as much. It is completely quantitative driven and that has been the way it's been since the beginning and it's still like that now. Well, and I think that when you go back to why does that exist, I mean there's there's two things is like why do we think that way as humans and then to like why did that happen to American politics and British politics around the same time. You know, the Why Do We Do It as Humans? Theodore Porter has a really interesting book on the critique of quantification. And he goes through like human history. And he says like, why did we start to think objectively? Could you go back to the earliest writings? It's all subjective. It's all just even things that are objective now, like history are pretty subjective when when somebody is watching, you know, Vesuvius erupt, and they're like, I saw this thing, it was hot, this is what happened.

They're not saying, on this date, this thing, it's not objective data. So he's looking at why does that happen? There's a couple of theories and he tries to go through all the theories we have and then kind of disprove them and say that's actually not it. What it is, is when you get civilizations that get to a certain size,

people don't trust each other. And so objectivity is this way of in low trust systems trying to validate things. Like if I just go next door to James's office and I'm like, hey, I wanna buy some milk from your cow. And James is like, okay, here you go. I just kind of trust, cause I have this relationship that that milk is gonna be good milk.

But when you get larger systems, the bronze age carving about the copper merchant is the one that like all the anthropology students are going to learn. Is this guy complaining about, you know, don't buy from Ahmed? His copper, it sucks. It's not good. It's mixed with lead. You know, it's when we need these outside organizations to come in and say, a third party has verified that this is what you're getting. It's usually around markets and it's usually around lack of trust. And what it does is it says that nothing can be self-evident. And I think that, you know, on that first point of our human need for objectivity, we should really be able to have more trust that some of these things like somatic psychology, even if we can't turn it into a perfect variable, that there's a somatic relationship to emotion, let's stop researching that.

Because I think that most people who practice things, you know, and clinically have seen that, that there are kind of somatic carriers of emotion. There's markers and a lot of neurology is looking at that. The second thing is like, the reason that CBT takes over in the 80s is because when Reagan and Thatcher come in, that's part of their promise, is that they're going to only fund things that are effective

that tax money is not going to be wasted. So schools are going to have to prove that the kids get smarter with all this academic, with all this standardized testing. Hospitals are going to be subjected to these metrics. Well, that doesn't ever really work. When you look at the hospitals that were effective and got all that federal funding in the 80s, a lot of them were just reclassifying chairs as hospital beds to say, yeah, all the patients were in the beds.

Like literally, that's the thing that happened. You see those metrics getting moved around, but it doesn't actually make progress better. But you do see CBT become the preferred modality because it's something that lets you reduce everything down to a number so it can pass randomized controlled trials, which good models of psychotherapy have a subjective element that you can't turn into a number. So we don't prefer it. And that's like why that takes over, I think in a way that that is not great. And when you look at why CBT has like worse and worse returns every year,

that clinically it's showing that this is supposed to be the best model. But then you look at patient outcomes in the real world and they actually are getting worse the more that's adopted. And that's for a couple of reasons. I mean, one is that you can do things in a lab, you can't do in a clinic. But I think more broadly, a lot of those people that were trained in CBT and said they were doing CBT, like one of my favorite providers locally, Winn-Scheps, is, you know, he says he's a CBT guy. But when you look at him and his therapy and run cases with him, he's a lot more relational and kind of psychodynamic. But those guys were learning that stuff in the water, even though they said they were

CBT practitioners. And as that stuff quit being taught in colleges, they didn't have any skills other than CBT. So you really are seeing the effect of it in a vacuum. When you have people in the 90s and the 2000s that are graduating from school, and they don't know anything about the history of thes and the 2000s that are graduating from school, and they don't know anything about the history of the profession and the way that even somebody in the 80s who says, I do CBT, they really did.

They got a lot of that embodied wisdom from the 60s and 70s, just in the water of their training. So I think those are two variables that are important to kind of sit with when you're looking at how the industry moved there. Yeah. And I think too, we can kind of, you can kind of zoom out to the macro level of like the collective moved there. Yeah. And I think too, we can kind of, you can kind of zoom out to the macro level

of like the collective and everything. And it's like, that's sort of just evident or shows us like where I think it's like the common denominator or like reduction to the mean of like what the public, what the collective consciousness is able to even like process and understand. And it's like this like Cognition plus behavior is still this like touch point that's not that like science is grappling with it's like the other ivory towers

haven't caught up and so even psycho, you know while psychology is like 60 years down the road, or you know 50 years down the road from CBT. It's like You know where know, 50 years down the road from CBT, it's like, you know, we're, we are far beyond it. And so, but then like we're saying, there's this echo, you know, it's kind of in this vacuum. And so at the outset, when CBT was first being practiced, these were people were innovators who were doing something new. And it was on the cusp of what the collective was

like, putting together and thinking about. But when we churn out people people 30 years later doing the same thing, it's just totally stripped of what was innovative about in the first place. And we're telling counselors, no, you need to do this exact thing in this like very neutered stripped down way from back then. And we're just taking the practitioners are the artists the practitioners are the artists are the ones who like

interpret are the interpreters of the research, you know, just like lawyers are interpreters of the law. Like the, we are the, we are the interpreters and the practitioners of it, but we're being held back by like the collective, not being able, it's just like quite hasn't caught, like it just like, like it's like the neurologist and the physicists Can't really get their hands around how cognition and behavior would be connected because they can't understand consciousness

And so it's like creates this like anchor where it's like No, the public isn't gonna let us move on from like what is this with cognition and behavior until all the other like quote-unquote Ivory towers like have caught up and start to understand what we're talking about every year. That's a fantastic point, Alice, because you're talking about re-centering psychology as a response to the environment of the world, which changes. And it's not 1988.

And so to say that there's a best model of psychotherapy, we've found it. It passed a randomized controlled trial, so let's do this one forever. I mean, one, you're going to get people that are deeply curious that like hierarchies that like tradition more so than they like innovation, or maybe helping people that navigate towards a system like that. But two, it just isn't honest. It's like saying we should do Victorian, you know, education in schools, like. Yeah. I mean, so well. Big CBT took Joel out.

Big CBT. Yeah. No, it does feel like that. And this gets to I mean, I I I harp about that. There's like a big pyramid scheme and within the world of therapy, too, about like what you're even, you know, you can say you practice CBT coming out of school, but there are all these other modalities like EMDR, you have to pay a few more thousand dollars to get the training for to do EMDR after you've gone to school, even though in school you learn like this is like a standard thing, you know, and like we're saying that's 20 years ago, but, but, you know, you have to come out of school and then pay, you know,

$500 or $1,000 to do the basic training. But then you really need the second level training too. And then after you've done that, then you can say that you practice it when you're advertising. Then you can say you practice it when you have it on your description, but only after you've done these things and jumped through all these hoops. And then there's like the next, you know, and you're supposed to have multiple of these. I mean, and then they make you, tell you that, but the way to really make money with this modality is if you are a supervisor of people who are trying to train for it. And so then you do that extra training, and then you're just charging other

therapists to like spend an hour with you talking about that modality. And that's, that's where you're really supposed to make the money. I mean, I felt like that, and I don't know if y'all have this in your experience, but a lot of the like trainings and things that I'm really passionate about, you sort of get behind the curtain. And then that's like the, that's always the takeaway, like kind of at the end, it's like, I mean, and it makes sense to turn us into trainers, but it's, but it also just starts having this ring of like, like, wait a minute, but we're charged, so we're supposed to, our paycheck is supposed to come from other therapists

who barely make any money, and we know how this goes. That's, I don't know, it's parasitic or cannibalistic. Yeah. Like looking at you, Peter Levin and Richard Swartz, I mean, you're gonna have $15,000 in SE by the time you're done. Right. And which. I mean, you're going to have $15,000 in SE by the time you're done. I mean, this kind of, I know James has some thoughts on this, but I mean,

this gets me to one of the other points is we're bad at being able to figure out why something works and that it works separately in research. If research doesn't have a neurological description of something, it's very hesitant to say, hey, this works. People are liking it. I was talking to Matt Hongoltz-Hetling on one of the last podcasts about Anton Franz Mesmer, the guy who invented hypnosis, and he thought it worked because of Yeah, like he thought it worked because of animal magnetism and these things that are not objective that can't be seen, you know, it turns out magnets don't really do that much to animals. But all of those techniques of like energy and noticing somebody and matching their energy and regulating them semantically and

mirroring, those were the real reason why mesmerism was effective and later became medical hypnosis, which is a very valid thing. But the reason that he thought that it worked, that neurobiological reason, was not actually right. Same with EMDR. I mean, Shapiro made a perfectly good guess about why EMDR worked. Turns out that's not right, you know, 40 years of neurology later. But the technique is effective in some ways

that were taken by people like Dr. Vazquez and Dr. Crand and innovated on to create these other things. And a lot of times, if we just figure out that something works, I think research is very hesitant to say, hey, this is effective. Let's go find out why. Because they want to understand the root cause. And that just isn't how we discover things. I don't think I think innovation is a more squishy energy than that. Which is crazy, like going to anesthesiology, like they don't know why

that works like anesthesia, they don't know why that works like anesthesia They don't know, you know, so there's no root cause of why when you get put under with any type of anesthetic They don't know why you just go. It's not a real sleep. It's not you're numb. You're not awake They have no they have Western medicine doesn't know like if you get into like go talk to Eastern medicine Then they can explain to you why consciousness works that way. But we don't acknowledge it here, because the ivory towers haven't caught up with that. Like, yeah, when nobody connects the dots, people don't understand, like, what, what that is. Yeah. But going with other modalities is, we don't trans, it doesn't translate well when you get into psychology and things like that. And again, going back to

a bias of a revier in articles and what you want to publish, that, that blind revier, the one that we can't, you know, we don't know who they are, they might be, they might be a modality elitist of some different modality or some different thing, and have a different opinion and kind of, they're not supposed to, but there's always an innate bias within in in the human aspect. So they're going to look at this, whatever this new research in there and be like, ah, that sounds kind of weird, like, can they replicate this or just like this goes against CBT, you know, this is not what this is not at all. And that reviewer is going to mark up your research and gonna say, Yeah, that's not it. And then a lot of publications, a lot of journals are going to say it has to meet these requirements that it matches our reviewers perfectly. And, you know, but again, it's blind for you. So you don't know if you're going to get somebody that's going to be beneficial for you or detrimental. One of my guys, Dr. Burke, he says that he knows all these, a lot of these journals and what they look for. And so he literally formats his writing to those things, which I'm like, that's great.

You get published pretty easily, but what are you sacrificing for that? And it's a little deeper discussion with him, but yeah. Yeah, I mean, the quality is just totally different in having to, and if you want to, which I think the purpose of a big purpose of research is to bring forth new information and find new things and discover new things that we don't know,

but we are so comfortable with, well, if it doesn't fit the standard, if we can't randomize control trial, or if it's not already published a million times prior that's already supported, then we don then we don't want to do it. There's a lot more fear in that to be able to do go in that direction. Well, I mean, so one of the things that I'd like to get y'all's opinion on, and some of you guys have a lot more experience directly with it than I do, but you know, when you say I have a problem with evidence-based practice,

or what's the point of academic libraries, or. I mean the first thing that I get usually from psychology, clinical psychology students that have just taken their first research one-on-one class and googled me and decided that I'm a crank because I use brain spotting. That's the most frequent email that I get. They'll say oh well it's because it's peer reviewed, it's peer reviewed. So the content, again the concept of peer review that you would have people who know how to read science sit down and look At your article and not know who you are and not know their relationship to you or not Know you at all so that they can do that in a way without bias. I like that as an idea

As a practice, I don't think that the way that we do peer review right now does much and we have data on that I mean, what is it Alan Sokol in 1996? And then I think in like the 2010s Bohannon, you know These guys would just publish garbage to kind of it ends your career to do that. Like you have to kind of be academically Antagonistic which means that academia is not gonna like you but they would basically just put in like Sokol put in a whole bunch of Biases that he knew that people had And like Sokol put in a whole bunch of biases that he knew that people had about certain cultural ideas and then just published something that was just complete nonsense. Like he said that if you were transgressive and push boundaries, then it affected quantum gravity on this molecular level that they had seen like within cells or something.

And it got published over and over again. These organizations pick it up. So when people defend these things as like, well, this is what they do. We kind of have data, you know, evidence through science of people seeing if that process does anything. And time and time again, it doesn't really do much because the person who is just a burned out researcher who's having to do this for their job and not getting paid and then also like not even really aware of the thing that you're doing or sort of like in the same waters that

you're in even if you're in the same field being like yeah okay this is scientific is that really a peer review of a group of your actual you know ideological peers challenging and improving your thought process and your kind of scope of practice there i I don't know. I mean, what's y'all's experience with that? I will say my experience, because I've gone through peer review and have peer review publications, you typically do not have more than two individuals that peer review that article and then the editor will look over it. But they like the editor unless they just see a glaring red flag is going to go with whatever the peer review person said. And you think, oh, peer review people,

they're like trained, they like, no, it's just other academics in your field. And so depending on the topic, a lot of times if you're in a small, very specific research community, you can tell who's peer reviewing your work because there's only those people who can peer review it because they are the only other ones that write about it and study it.

So sometimes it really isn't blind. And I think, you know, the idea is good. But the reality is you're just getting two individual people's perspectives on your article and they're calling that peer review. Well, I think like a more equitable model too might be to make these things public for a period of time. Like if you're going to build a road in your town, you have to post it publicly and see who has objections, who has feedback. And yeah, you get some cranks, you know, in that process. But you also maybe get some good ideas. And I think that if these things were a little bit more

public, a little bit more transparent, then we grabbed two burned out adjuncts from our university, you may get a better thing because the incentive structure, I think what it rewards, especially in psychology, is that if you've got a ton of money, you can just spend enough to ram one of these things through into publication. And I thought about when we were planning for this episode, um,

like getting some of the research that's from like really big name people who I personally dislike. And I decided not to be that petty and like read their research on here. Um, but there's a ton of people who like really went after analytical psychology in the, in the nineties and talked about how CBT was wonderful and like it fixed everything. And like, we didn't need relational psychoanalysis. We didn't need anything that had any kind of like spiritual or deeper emotional element

like emotional transformation therapy or Jungian therapy. Basically that the unconscious wasn't real. This was this thing that was just made up for analysts to suck up all the patient's money and take all this time, which sometimes psychoanalysis is a waste of time, but that doesn't, just because you prove that doesn't mean that you prove the unconscious isn't real. And they published all this stuff.

Now it's trendy to be like, oh, trauma in the deep brain or whatever. So the same people, they didn't retract anything. They're now after publishing about the subconscious not being real, they now have these papers where they're like, well, their primary, secondary and tertiary, tertiary levels of cognition and the bottom levels contain more of a symbolic less literal component

and also somatic reactions that budget emotional, you know, releases of energy. And you're like, oh, you mean a fucking unconscious is what you're trying to say. None of these people had to say they're wrong. They didn't have to take anything back. I mean, they're able to publish those things. There's a guy that particularly just likes brain spotting. And so he'll publish stuff every once in a while, but there's very big name journals, but there's nothing of merit in the article. Like there's one of them where he says, I heard about this brain spotting thing. I've not trained in it. I've never done it.

But the one of the theories of it is that it's somehow engaging the subcortical brain. And I remember when I went to medical school in 1980, this is like in an academic publication. All of the memory in the brain is not in the subcortical brain, so there's no memory there. Like where memory is in the brain is one of the most complicated questions

in all of cognitive science. And you've got somebody who's publishing something saying that they remember their textbook from when they became a doctor in a different field that's somehow publishing in academic psych publications. So if you wanna say peer review and specialization and whatever, why are these guys allowed to publish?

It's because they're rich. It's because they can ram these things through by spending money. There are a lot of predatory publishing groups. I mean, that's just part of the capitalistic model of this, where there's a lot of expectation to pay thousands of dollars to get your article published. Or if you have tried to publish multiple other places where

you say you don't have to pay, they won't accept it. But you can always find one that will take it if you pay enough money. And so how is that peer reviewed if you're just buying your article to be published? I mean, I think that's a big part of the problem, too I think that one thing that may be helpful is because one of the questions that you're gonna get because you know I do respond to a lot of the emails that I get from people that you know, I think are genuine, you know even if some of its kind of misguided.

And I remember that, like, I learned a lot of kind of like Jungians and somatic psychology when I was in undergrad when I was doing comparative religion. And then when I went to go get my degree, I was like, Okay, time, that's all for D&D and world building and creative stuff. Now I'm going to be a serious therapist to do science. And I learned that CBT was the best thing. And I read all these books on it and kept being like, but this seems kind of obvious, you know? Like you snap a rubber band and tell the anxiety to stop.

Like this doesn't seem like it goes. When I was trying it with patients, when I was first working and patients weren't resonating with it. And so I just followed what I found to be effective, which I ended up, you ended up learning to trust myself, going somewhere that was totally different than where I was kind of told to go

or where the incentives pointed at me. So I don't think that people send those emails because they're stupid or because they want to be aggressive or something like, I think that they're in school, they're in the same place that I was and I relate to it So I'm not I'm not judging it But like the the big question that they always have is like, okay, so how would you do it? All right, I guess we should just get rid of licensors just get rid of boards and we treat everything with crystals and rainbows

And you know, of course, that's not what I'm saying So if we go back to the impact factor system the h H index system, the academic publishing industry, what are like really easy and probably, I don't want to say bipartisan, because it's not political, but just universally accepted solutions that anybody who's willing to kind of sit creatively with this stuff would be like, Oh, yeah, that's a good idea. What could we do to change it, fix it, you know, tomorrow? That's a big question. But I think that at least the first thing for me is like,

it cannot be capitalistically incentivized. Like the pay structure, the way that it's set up, the structure of the academy in general. I think these are systemic larger issues of how the academy is set up and it's very elitist and it's very, and it's meant, you know, it's become that and academics, a lot of academics wanna keep it that way.

And so I think that's a big part of figuring out how to support people in the Academy and also be able to get people that research to the general population or also to therapists or anyone who works in any kind of specialized field that there's research being done. Well, and a lot of these complaints are not things that like I make up in my head because I don't have like a ton of overlap with research. They come from conversations with doctors, with researchers

who are also complaining about these things because they want to discover stuff. I mean, that's where a lot of my perspective comes from is talking to people who are making things that are interesting that I call up and see if they'll talk to me. You know, I probably read more research than most therapists because I'm really interested in this stuff. And that's why it makes me angry when I feel like it isn't as effective as it could be So, I mean I think just listening to the people in the field and I mean, you know Haley when you're saying that like a lot of the people like in that Academy are not are not Open to it

Well, you're driving out everybody who's not just gonna have this intuition and kind of creative impulse and like being in it for the lack Of a better word the right reasons you drive all all those people out what are you left with? I mean you have a PhD and you're not doing research because you felt like you were going to help more people in therapy. I'm going to speak for you there but you had some problems with it. Can you tell us about those things? Yeah absolutely. I mean one I'm a qualitative researcher in the social work field and even within social work. I really had the rose colored glasses on going into it because I didn't go back to get a PhD. I went back because I wanted to be a good practitioner.

I wanted to be able to use research and clinical work together to be able to address some of these systemic issues that we were seeing. But when you get in there, you are a cog in a machine is really what it felt like for me. And I was like, well, yes, science is important, but it's science and art. It's art and science together.

I think that is such a big piece of it. And that's like where that creative side and that exploring and research side of what is going on, the social phenomenon that we see going on socially, culturally within our communities, or we're hearing feedback from therapists, like this is happening, but nobody's studying it. And then you're like, OK, well, we'll just study it.

And then you get in the academy, and it's like, ooh, we don't want to talk about that. That's too politicized you know there is a structure that the expectation of how you will perform is Very strong a lot of times it's unspoken But it's made pretty evident pretty early on that if you want to do qual just just know it's going to be twice as hard for you. You are more likely to get a tenure track job if you are quantitative, which again is distilling everything down to numbers and people aren't numbers.

Everyone's experience is different. We're not computers. So much of the biomedical model has been this attempt to prove that if you just get all the data, all the variables, you can really just sort of crack the code of this and have the perfect model of therapy that is completely turned into a formula, completely without provider insight,

completely without patient subjective experience, and completely without quantitative variables. It can't just be reduced down to a number. And I don't think you're ever going to solve that problem. And one of the things that bothers me, James, you were talking about how psychiatrists are trained. If I'm a nurse, my boss is a nurse, right? The boards or the people that do billing, they're medical.

If I'm an engineer, my boss is an engineer. If I'm a therapist, why is somebody who's probably never been in therapy, who's not really ever been trained in therapy, the one who's deciding whether or not insurance claims go through, if what I'm doing is real, you know, like what I should be trained in to be on the, an insurance panel, it's not a therapist who's making that call. It's a biomedical doctor who may know a whole lot about well, butrin and antibiotics, but it's very rare in my experience to find any

of those people that's ever been in therapy as a patient which is part of understanding how it works and and ever been in therapy training beyond you know six sessions of CBT tells the person to change their behavior and then if that doesn't reduce the symptom then you go ahead and do drugs you know that's what I see. I don't know if that's something I'll encounter. Well, I was gonna say that I think that it's gone to the cookbook model, you know, where everything is just, yeah, a formula or recipes to kind of get you this product. And there's a doctor that I worked with that was just like, I hate the cookbook model, nobody could fit in this specific thing over and over again. Which is, even in school, like, you get, you get hammered out and learn CBT, because that's the thing that's going to make it in the field. And it's easy to teach, it's easy to replicate in the person, you can be a great therapist, but a terrible CBT practitioner. And I think that and vice versa, you could be a great CBT practitioner, but not a great therapist.

And I think we've lost our inquisitive minds to kind of fit things that work. I remember my eye-opening in grad school was learning crisis intervention. What is not CBT at all? Like there is, you're not, in a moment of crisis, you're not you're not changing a baby, you're trying to change an outcome of what's going to happen in that crisis. And so you're not even but that's it. That was a huge thing going through school was like, what is crisis intervention look like. But you know, when I learned what mindfulness based stress reduction can do and saw the so the research on that,, I mean, that's I was I had to, that was after school, where I was like, Oh, this, this is awesome. Why didn't I know this when I was going through grad school and

have free training, basically, in it? They don't, you know, it's free training and CBT. Why take up for can I just really quick take up? I think it's also different, like, depending on what kind of grad program you're doing. Yeah, cuz y'all are all social workers But like within the field of counseling like your are the structure of what we're learning is so different like CBT was big and undergrad And my psycho, you know in my and which I went to University of Colorado at Boulder. It's the Boulder model It's all about there's a major research emphasis there So CBT was like baked into just my psychology grade and undergrad level. But once I got to grad school, it was really like, this is like very beginning of what we talked about. And

then it was all, all other types of modalities like that, you know, like mindfulness and somatic stuff and trauma based perspectives. So it really, I mean, it does really depend on like what program you're going to and what you're, you know, what, what the perspectives are and that is dictated by like who the, you know, it gets back to like who the professors are, what the research is and what's getting funded. But I know, you know, they're just different little subtle differences and in like how counselors and MFTs are trained versus social workers versus psychologists versus psychiatrists. And we kind of don't acknowledge that like some of us might have like, I went to a KCREP counseling psychology and counselor education, where you actually learn to educate other counselors. And so there's this whole meta level,

but there's totally tons of different types of education and like types of therapists that are out there. But what we are talking about is like kind of therapists that are out there. But what we are talking about is like kind of the anchor of the field. What's really like still like holding us. It's like this touch point of which is kind of creating this, you know, it's just it zaps the creativity from the field and it zaps the independence of the practitioners. And it's boring. You know, it's boring because it's not at this point innovative. It does seem like it's absolutely independent of the practitioners. And it's boring. You know, it's boring because it's not at this point innovated.

It does seem like it's like, you know, CBT and stuff like that. It feels like it's just intuitive knowledge by this point, but. Well, and if we could talk a little bit about what the biomedical model is, because I don't really think that the biomedical model is a bad thing.

I think it's always gonna be a part of care. You know, if somebody comes in and they don't know that if they don't get sleep or if they don't know how to get sleep, that their, you know, depression or anxiety is not going to come down. If somebody comes in and they're using too much alcohol or they're using illegal drugs and you just say, all right, we don't have to worry about all this pesky intellectual knowledge and skills. I'm just going to cure this with yoga and meditation.

Well, I mean, yeah, maybe drinking a fifth a day is the more important thing first. That biomedical model is something that is something that you're always going to be in conversation with and we should be. I just, I don't think that it's something that can contain all of consciousness, that can contain all of therapeutic work,

because at its heart, what it's doing is saying, here's a list of check boxes. And when we check these boxes, then you now have this disorder, and this disorder, we're gonna study which treatments it responds to. And so when all these other people in the study checked those boxes and we gave them this disorder,

let's see, you know, which models made that go up or down. And now we know that if you have generalized anxiety disorder, if you have bipolar one, that, you know, this is the kind of therapy that works. This is the kind of therapy that doesn't. Broad strokes, I think that's fine. But even when you take them at their word,

it's like, they don't want to use that model. They don't want to go ahead and go all the way with it. We know that something like ADHD, like we've known for a really long time. I mean, I think Dr. Amin said this in the 70s or maybe the 80s. You can look at a QEG brain map, and you can see that there are six different things that

can happen in the brain that result in the same boxes being checked for ADHD and respond to the same medication. But they're not the same thing. So you're treating them like they're the same disorder. And if you go back and you point something like that out, they're just going to be like, oh, well, it's not realistic or effective or cost effective to go ahead and do a QAG brain

map for everybody to see which disorder they actually have. So I mean, that seems like it's the biomedical model being like, Oh, well, the model itself is kind of too inconvenient. So we're just going to do it this way. I mean, even if you want to do it the way that they're saying that they want to do it, um, then there's places that you could do that better that they still don't want to go. Does that sort of make sense?

Or James, do you have any kind of, have you seen those catch 22s in the hospital? Oh, all the time. Obviously in consult psychiatry, you're going to wrap into on the medicine side. There's a lot of things that go on, um, that are just not the things that you're not able to replicate out anywhere else. Um, outside of the hospital hospital obviously, but there's there's Yeah, the those things exist and it's I'm kind of drawing a blank. I just got an email about something but um Yes, we did have those a lot I mean you see you're gonna see that

They things outside of our control play a big role like as a therapist with the people that we work with. And it's whether or not, if the person that we're working with is doing the things that we want them to or not, it is hard to kind of set the space. Well, and like, let's just set a little bit, cause I think that one thing we're not acknowledging and maybe the most important thing is that our clients

are the experts on themselves. Yeah. And every individual you work with is an expert on themselves. They don't have to know about what is in the research to know what their experience of themselves is. And so as long as we're putting somebody else, we have this whole hierarchical thing happening over here.

And we're sitting here feeling like humble therapists. we have this whole hierarchical thing happening over here. And we're sitting here feeling like humble therapists, like why won't anybody pay attention to us? But really like people who are suffering are our clients. And they're just screaming out like even more so and beating their heads against the wall. I mean, sometimes literally trying to like find a therapist who's not just gonna like just motivational energy interviewing and like CBT, like it's in who will actually relate to them as like a real human and meet them where they are and like be responsive in their treatment instead of just prescriptive.

Haley, have you seen anything like that, where the biomedical model is sort of in tension with these newer ideas they're trying to tack on? Like, oh, everything should be person-centered, or we should maintain a concept of person in the environment, or we should have more of that. Because I see people coming back and being like, oh, yeah, we trained y'all on CBT, but now the industry is saying trauma, so we're going to do CBTTF or something. We're going to attack a spoiler on the Civic to make it a different car. Do you see things like that? Because you have probably more experience in the PhD world than any of us. Yeah. And surprisingly enough, being a PhD, even in social work is not really social work or therapy or therapeutic.

I mean, you do learn if you study certain things, but the PhD model is very much driven by the medical model. And so whatever medicine does, it's kind of the standard for other research programs. Whatever medicine does, that's what everybody else wants to do. Because that's how they've seen it's been successful. That's how I see it's profitable. And I think there is like, this tension, right, between we want an answer to fix things, and we want to know that it works before we do it. But that's just not how humans work. You know, that's just like what you were saying, Alice, like it just really takes all the creativity, all your ability to use your own intuition and to listen and to engage with the client. And it's, it's really putting all the oneness on the therapist to be the expert in the room. And not to mention, that's a lot of pressure on a therapist, but that's also not how it should be. This, you know, we, it's so top down. The model is so driven that way, that even if you are trying to do a their ability to jump keep jumping through the hoops than necessarily just being smart. Like if you

can figure out the system and learn how to jump through the hoops you can be successful but at what cost you know and each researcher has to really ask themselves is this what you can't be a researcher and not be in it's just it's almost impossible to be a researcher and not be set within this model. It's very hard to break out of it. of where if you took these models at face value and you looked at everything that objective research wants to research about psychology where you would be kind of missing the real point of, I think, a lot of what we do. Because to me, when you take anxiety and you turn it into a diagnosis, when you take depression and you turn it into a diagnosis, you're cutting these things off from the real root of where they come from, which a lot of times we wanna think about this stuff

like genes, and you don't get anxiety like you get cancer. You don't get anxiety like you get the flu and then you take this retroviral or you take this antibiotic. Like you get anxiety because there's a lack of balance in your life, maybe you're outgrowing like an older identity and you need to let go of parts of that identity to hear a greater whole of you that you need to remember. You get depressed maybe when you're making yourself fit a box that you never even knew was a box, but you mistook the box for who you were or all that you could be. You get anxiety and depression and all of these things as part of dynamic forces that it takes a certain amount of subjectivity and a certain amount of things that can never be a formula to really sit with and help someone hear who am I, what do I want to be. And so many times

those goals that somebody comes in with of I want to bite my fingernails, I don't want to drink alcohol anymore, I can't sleep. When you really listen to that, what happens is that you go a whole lot deeper into a person and into a problem. And the people who are going to the oncologist, they know what the problem is. And the way that the people going to therapy know the beginning of this pathway,

but it's not the end and it's not the whole thing in a way that I think we've we've are in the process of kind of losing as a profession in a way that's scary to me. Can you all have kind of examples in your work where the I don't know I mean we we all are kind of in the same world but we work differently. Are there places where you know you get somewhere with subjectivity you never would have gotten with kind of an empirical objective method alone? Yeah. I mean, I still think everything to me, and the field is moving in this direction a little bit, but how trauma does inform

pretty much everything that I see. And I think therapists on the ground, more so than psychiatrists, I mean, psychiatrists are still out there diagnosing everyone with borderline. And I think that that's sort of a, I have opinions there, but it's sort of a made up thing. And it's really complex trauma that we're seeing. And then among that population, the interface between trauma symptoms and ADHD symptoms, trauma symptoms and autism, and then the compounded,

like because you grow up with autism, that is traumatic to be a, to have like the world like set up not for you and like not reflecting back what your experience is. But so everything and so trying to differentiate whereas like psychiatry wants to throw everybody in the same boat of like, okay, this person is just emotionally erratic. It's like just a modern way of saying hysterical, hysteria. But there are so many subtle aspects

and we get into autism and there's like, I mean, we could do episodes and episodes, but about differences in consciousness and how that works and like what we should be pathologizing and what really is like a higher method or a higher way of being in a lot of cases. But trying to differentiate that when it's like I'll get these patients and it's like they've been just like labeled borderline since they were 13 and it's like okay what what are we actually seeing here?

Like did you cut one time and somebody gave you a borderline diagnosis? That's automatically what I hear. And again not to beat up on the on the researchers and the doctors, because, you know, if you are a woman and you try to like, you know, have a suicide attempt or you you present in distress and you get sent to the ER, you're probably going to get a diagnosis of borderline personality disorder on that discharge. And I think that's wrong because they don't have time to assess that. They don't know if your reaction was a normal or understandable reaction to the environment that you're coming out of. And a lot of times they a normal or understandable reaction to the environment

that you're coming out of. And a lot of times they miss problems in the home and the environment, which, you know, they're in the ER, they don't have time to play detective. But if you, that doctor is required in order to get paid and to use your insurance so that you don't have this bill to give you a diagnosis, and that's the best one they can come up with in the 30 minutes while you're there. If they weren't required to do that, if that was a system that was rethought I mean a lot of those providers probably don't want to have to do that anyway

I mean we do the things in our job that we have to and when you make that one of them you're gonna continue to Get that result even if the provider is good and well-intentioned and understand these concepts and a lot of times when you talk to them They do And a lot of times when you talk to them, they do. James, you do a lot of the kind of mindfulness stuff and then brain spotting with more kind of executives and doctors. Can you explain some of the ways that you get to a place that is, I don't know,

more of an energy or a subjective realm that doesn't quite fit into a number, but is the root of a lot of the effectiveness of some of those things? Well, first off, it's funny that and I don't know how this is going to be taken, but I get a lot of those that type of population coming in that kind of had said, you know, talk therapy just doesn't work for me. You know, I have not had success with talking.

And it's like, well, what is talk therapy to you? Because that could be a lot of things, you know, that's just a sounding board or and they're like, well, you know, it's kind of CBT. They try to make me rethink this and that. I get to a place where a lot of these, especially a lot of these high functioning, well, I guess high functioning is a weird term. People have this idea that I need something more, something actionable, something not necessarily physical, to kind of get me into this space that is very beneficial for myself. And you get to a point that they offer, I mean, you just go with the flow. It is, it is the person that is in front of you, again, that you are paying attention to, and not necessarily the cookbook of options to kind of you. I allow my individuals to kind of, again, not be the professional in what I provide, but professional of themselves. And

then they'll offer up some stuff. I'm like, That's it. That's what we're gonna go. We're gonna do Brainspotting. This would be perfect for you, and things like that. I've dived into a lot of shadow work recently because a lot of people are having, which is a very, you know, it's very woo-woo in the sense of like, no one wants to talk about what the shadow is. And that's happened naturally to a lot of my, a lot of the people that I've seen come through. Yeah, it's a collective. It's a thing happening in the collective. And, and it's people, and it's, that's where we're kind of coming back around to the field has kind of moved into like trauma trauma trauma and this is where the collective and the peanut gallery are kind of catching up and the language that they're that we're using that's more accessible to everybody is like is shadow work i mean that's a perfect you know and it

does bring back in like the original like you know union um union terminology so makes, you know, it's basically like our patients are now showing up saying we want to do that. We're here to do the work is what that means to me. You know? Yeah. That's what I was trying to talk about when I was like, not physical. They just, they want to do something.

Yeah. Yeah. I think what you're talking about, James, is the ability of the intellect to avoid emotion that a lot of times, I mean, because I've had very skilled talk therapists that were really able to stop me from being able to deflect and entertain and like push me into the thing that I'm avoiding feeling. But to my, my experience with therapy, I mean, that's what works. And brain spotting does that pretty quickly, in a way that we may not even really fully understand how it works, but it's

reproducible. And we know that it does. But, you know, one of the reasons why on this podcast, like I like to sit with the kind of kind of crazy, new age, woo, concepts, and also, you know, a lot of these kind of like Eastern wisdom traditions and perennial philosophy, and then also state of the art neuro neuroscience is that when you when you do that, I think there is kind of a synthesis in how a lot of these things are saying the same thing, like something like shadow work, like you're talking about, which is, you know, Jungian. Yeah, there's a lot of mysticism and things that people

may want to discount because it scares them or they're not familiar with those concepts if you crack those books. But look at what it's saying. It's saying that there are huge emotional reactions that you avoid, feeling those implicit emotions. I don't want to feel trapped. I don't want to feel out of control. Or that you're enmeshed with, that you feel all the time, I have to be disangry. I have to be disaware.

I have to understand how everything works or else I'm not safe. And that going into the shadow in a Jungian sense is challenging your relationship to those things. What if you can go back and feel that without dying? What if you can let go of this and you can still be okay and you can still feel safety without anger? I mean, that's shadow work and polyvagal theory and a whole lot of the interesting work that people like Gazaniga and Demacio and many, many more are doing are noticing those same things in neurology and cognitive sciences in a way that those professions seem to be comfortable with. And for some reason,

academic psychology is less comfortable with them than neurology and cognitive science. I mean, I don't know. I mean, Haley, you work with women and mothers a lot. Do you see places where that their experience or the factors that are influencing them just don't fit perfectly into a diagnosis or sort of clash with the randomized controlled trial model for figuring out how to help? I mean, yeah, just short answer. Yeah. I think my experience with that really, a lot of that is, again, research or model, a lot of models or interventions are top down, and that's what's being used.

Again, birth has now become hypermedicalized, and so again, we're throwing back kind of into that medical model. But yeah, I think there is a huge disparity around women not being able to have a voice or share their experiences or know what, you know, they just have these expectations of, oh, well, this is just what I'm supposed to do because this is what everybody else has done or what my mom told me would happen versus like what the actual experience was. So I think there's just such a disconnect, particularly around birthing, but even more, just because you're forced to wanna fit into this medical model that it doesn't work because it's a very intense, it is a traumatic experience.

It's a life-changing experience. And again, check boxes don't you can't quantify that. And I think women have a hard time. There's that expectation to be like, How was your birth? How did it go? Did it do do do you know, and women can't even verbalize that it's like, Oh, because it's not that way for them. And so even just holding space for women to be able to have those opportunities is really important. I found that is such a critical piece, like doing all of this, doing research. What I studied, my PhD, is we have

a lot of quantitative data. We don't really know what women are experiencing. And for me, that's a really important place to start. Instead of assuming that we know or doctors know what's best for women. And are you saying there, Haley, that a lot of times we're not maybe aware of our emotional experience

or the way that our environment's affecting us. So even if we do the screener in the hospital and we check for traumatic birth or we check for something, we still, you know, maybe you're missing something because we haven't made room to consider kind of a deeper embodied or I don't want to speak for you. But yeah. I'll just share my own personal experience of like, when you get one six week postpartum checkup and they give you the depression form, they don't really talk about it, it's just like in your paperwork.

And even as someone who I felt like I advocated for myself, I was so embarrassed that I was experiencing like postpartum depression that I just kind of, I don't know, I try to mark things a little bit higher because I didn't want to bring it up with my doctor. But then she was just flipping through and was like, oh, it looks like you're good. No depression.

And I was just on the verge of having a complete breakdown. There is just no space for that. There is very little room to be able to hold space and to feel safe. Safety is a huge thing. Safety is a huge thing and I think there's very little space within those, you know, you see your doctor once six weeks postpartum and that's it. To be able to, you know, address a lot of things that are still going on physically, emotionally, mentally, spiritually,

that are, they're getting missed. Yeah. Well, I think we're coming to the end of our episode. Is there anybody that has, you know, anything else that feels like a good place to share something before we end that we don't get to? I don't have anything, but we could spend forever talking about birth. I'm just like holding my tongue out here.

We can talk about. Yeah, I'm sure we will again. Attachment and birth and everything. Yeah, I think, you know, for me, one of the things that I'd like to see is separate, you know, how something works from does it work? And to see is it reproducible first and then figure out all of the different smushier variables about those things and then you know as a pathway to that maybe make room for things that are just self-evidencing that we just say we know these things are

true even though maybe they're not directly provable in a way that would let semantic psychology and other things be more a part of medicine than they are. Well, I appreciate you guys getting on today and we will see you next week. Alrighty. Hey guys, I wanted to pop in here to give you a quick reminder that we do this podcast for free and there are significant expenses associated with it, including the biggest resource in my life right now, which is time. One of the things that would really help us, and hopefully would help you, would be to check out

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