0:00:12.908,0:00:14.958 My name is Leslie Carr. 0:00:14.958,0:00:18.080 I'm a registered clinical psychologist[br]in private practice, 0:00:18.080,0:00:21.301 and I'm here today[br]to talk to you about therapy. 0:00:22.761,0:00:25.671 I really love what I do for a living. 0:00:25.671,0:00:28.160 It's truly what gets me out of bed[br]in the morning. 0:00:28.160,0:00:32.389 But I have a dilemma in my work,[br]which is that, from my vantage point, 0:00:32.389,0:00:35.570 it seems that therapy[br]isn't very well understood. 0:00:35.580,0:00:38.270 Even though I think we've come[br]a long way in this regard, 0:00:38.270,0:00:41.820 there's still a fair amount of stigma[br]that surrounds psychotherapy. 0:00:41.820,0:00:43.480 And even more signficantly, 0:00:43.480,0:00:46.290 it seems to me there are[br]many misconceptions about it 0:00:46.290,0:00:50.010 and that it is something that is [br]generally mysterious to most people. 0:00:51.610,0:00:55.431 It seems to me that these misconceptions[br]keep many people from trying therapy 0:00:55.431,0:00:57.909 even if it would benefit them, 0:00:57.909,0:01:00.749 which is a travesty, to me. 0:01:00.749,0:01:03.140 So, I really see it as my mission 0:01:03.140,0:01:07.759 to increase our collective understanding [br]of what therapy is and how it works 0:01:07.759,0:01:11.051 so that we can start to change[br]the way the world looks at it. 0:01:11.681,0:01:16.131 Now, first of all, I should explain[br]that the kind of therapy that I practice 0:01:16.131,0:01:18.730 and the kind that I am going to talk[br]to you about today 0:01:18.730,0:01:20.841 is the kind that is[br]traditionally referred to 0:01:20.841,0:01:24.621 as psychodynamic[br]or psychoanalytic psychotherapy. 0:01:24.621,0:01:26.359 I know that it can be confusing 0:01:26.359,0:01:29.944 because there are a lot of different kinds[br]of therapy out there these days, 0:01:29.944,0:01:31.390 but what I'm talking about 0:01:31.390,0:01:34.510 is what I'll refer to as[br]the "old-school" kind of therapy; 0:01:35.290,0:01:37.510 the classic kind, where you talk 0:01:37.510,0:01:42.103 and another person listens[br]and asks questions and reflects. 0:01:42.493,0:01:45.921 It's something called[br]insight-oriented therapy, 0:01:45.921,0:01:49.962 and I think that in many ways[br]it's gotten a bad rap in recent years. 0:01:51.322,0:01:55.041 One of the single biggest misconceptions[br]about this kind of therapy 0:01:55.041,0:01:58.651 is that there's no scientific[br]evidence that it works, 0:01:58.651,0:02:01.221 which is actually not true. 0:02:01.651,0:02:05.042 Research in this field has demonstrated,[br]not only that it works, 0:02:05.042,0:02:07.372 but that it works really well. 0:02:07.372,0:02:09.481 So, I'm going to[br]dig into this a little bit. 0:02:09.481,0:02:13.002 Now, my talk today is not[br]going to be super data heavy, 0:02:13.002,0:02:15.445 but this stuff is[br]actually really interesting, 0:02:15.445,0:02:18.432 so if you don't mind,[br]I'm going to run some numbers by you. 0:02:20.402,0:02:22.791 For those of you who speak research - 0:02:22.791,0:02:25.903 and if you don't, don't worry,[br]I'll come back to you - 0:02:25.903,0:02:30.122 a meta-analysis of 23[br]randomized control trials 0:02:30.122,0:02:36.552 found an effect size of .97[br]for overall psychiatric improvement 0:02:36.552,0:02:43.151 and 1.51 for follow-up studies conducted[br]nine months after the therapy ended. 0:02:43.741,0:02:47.943 This study is one example of hundreds[br]that have been conducted in this area. 0:02:47.943,0:02:50.202 For those of you who don't speak research, 0:02:50.202,0:02:56.533 effect size is the statistical measurement[br]of how much something works. 0:02:56.903,0:03:01.143 An effect size of .2 is considered small, 0:03:01.323,0:03:04.663 .5 is considered moderate, 0:03:04.923,0:03:08.943 and a large effect size is .8 or above. 0:03:09.333,0:03:11.593 So, to give you a frame of reference, 0:03:11.593,0:03:19.053 the effect size for Prozac, according[br]to studies conducted by the FDA, is .26. 0:03:20.453,0:03:23.613 I'll just let that sink in. 0:03:24.243,0:03:25.702 Because these numbers - 0:03:25.702,0:03:30.112 .97 for overall improvement[br]and 1.51 at follow-up - 0:03:30.112,0:03:34.164 are really off the charts, actually;[br]it's pretty astounding. 0:03:34.914,0:03:36.532 Part of what that also means 0:03:36.532,0:03:41.094 is that people continue to benefit[br]from therapy even after they stop going - 0:03:41.094,0:03:43.601 which is pretty cool. 0:03:44.591,0:03:46.396 Now this kind of therapy helps people 0:03:46.396,0:03:51.044 who are experiencing psychiatric symptoms[br]or are suffering in some way, of course - 0:03:51.044,0:03:53.175 I do want to make that clear - 0:03:53.175,0:03:56.132 but it also helps people[br]in the name of personal growth, 0:03:56.132,0:03:58.985 and it works according to[br]the same principles. 0:03:59.445,0:04:03.335 It helps us to gain insight[br]into how we relate to people, 0:04:03.335,0:04:06.905 to identify and change recurring patterns. 0:04:06.905,0:04:11.104 It increases our consciousness[br]and improves our decision making. 0:04:11.104,0:04:15.350 And we reap all these benefits[br]whether we have a mental illness or not. 0:04:17.783,0:04:19.144 Excuse me. 0:04:23.644,0:04:26.584 So, let me tell you a little bit about me. 0:04:27.124,0:04:28.754 I chose to become a therapist 0:04:28.754,0:04:34.726 because I was once, many times in fact,[br]a therapy patient myself. 0:04:35.886,0:04:37.644 I was blessed to grow up in a family 0:04:37.644,0:04:40.895 that valued therapy[br]and that didn't buy into the stigma. 0:04:40.895,0:04:43.396 So, when we encountered[br]challenges in my childhood, 0:04:43.396,0:04:46.486 namely, the potentially[br]terminal illness of a family member, 0:04:46.486,0:04:50.215 my parents did what they thought was best,[br]and they sent me to see a therapist, 0:04:50.215,0:04:52.435 for the first time[br]when I was ten years old. 0:04:53.435,0:04:56.516 I think they made that decision[br]largely out of being proactive, 0:04:56.516,0:04:58.896 but it was also really clear[br]that I was struggling, 0:04:58.896,0:05:02.466 and most of that was manifesting[br]in my experiences at school. 0:05:03.476,0:05:05.175 My grades were slipping; 0:05:05.175,0:05:07.884 my teachers were reporting[br]that I seemed distracted. 0:05:08.514,0:05:11.866 The anxiety and sadness that I felt[br]about what was going on at home 0:05:11.866,0:05:14.117 was making it hard[br]for me to pay attention, 0:05:14.117,0:05:16.487 and I was falling behind my peers. 0:05:18.287,0:05:21.375 Now, I have to tell you[br]that I consider that, to this day - 0:05:21.375,0:05:24.228 the decision that my parents made[br]to send me to a therapist - 0:05:24.228,0:05:27.137 as being one of the best things[br]that has ever happened to me. 0:05:27.137,0:05:28.187 I really do. 0:05:28.187,0:05:31.525 I liked it so much that it made me want[br]to become a therapist myself. 0:05:31.525,0:05:33.596 So, clearly I got a lot out of it. 0:05:33.596,0:05:38.548 But I also have to admit [br]that I really didn't want to go, at first. 0:05:39.348,0:05:42.126 It would be hard to say[br]what I was so afraid of, exactly, 0:05:42.126,0:05:46.027 because I was so young[br]at the time, but I was terrified. 0:05:46.027,0:05:50.756 And I literally, at first, refused[br]to even go into the woman's office. 0:05:51.106,0:05:54.217 We spent the first two or three sessions[br]in the waiting room. 0:05:54.217,0:05:57.106 And that was what therapy[br]was for me at first, 0:05:57.106,0:06:01.377 just trying to get comfortable enough[br]to go into the woman's office. 0:06:02.117,0:06:07.317 And the funny thing about that, for me,[br]is that having had those early experiences 0:06:07.317,0:06:12.836 really removed any sense of stigma[br]from therapy, for me, 0:06:12.836,0:06:15.346 but I also clearly would be lying[br]through my teeth 0:06:15.346,0:06:18.878 if I were to say that I don't know[br]what it's like to be afraid at first, 0:06:18.878,0:06:20.638 to give it a try. 0:06:21.488,0:06:24.647 Now, I know that it's different[br]with adults from children - 0:06:24.647,0:06:26.787 after all, I only work with adults 0:06:26.787,0:06:30.508 so my only point of reference[br]for child therapy is my own - 0:06:30.508,0:06:35.057 but I do think, on a fundamental level,[br]the feeling is the same. 0:06:35.227,0:06:38.497 And I think it really just has to do[br]with fear of the unknown. 0:06:39.387,0:06:42.527 I just didn't know what that lady[br]was going to do to me. 0:06:42.527,0:06:46.508 I felt like she had some magical power[br]and I didn't know what it was, 0:06:46.508,0:06:49.398 but I felt like she was going to[br]get in my head or something, 0:06:49.398,0:06:51.658 and it just kind of freaked me out. 0:06:53.288,0:06:58.508 And it reminds me of how sometimes -[br]today, now that I am a therapist myself - 0:06:58.518,0:07:00.667 I'll get this feedback[br]from people sometimes, 0:07:00.667,0:07:03.847 that they think I can read[br]their minds or something. 0:07:03.847,0:07:08.228 And it always makes me laugh a little bit[br]because that's not how it works. 0:07:08.228,0:07:11.148 But I suppose on some level,[br]I can identify 0:07:11.148,0:07:15.119 because I have a vague recollection[br]of having felt that way myself. 0:07:16.339,0:07:18.699 I do think that for many people 0:07:18.699,0:07:22.018 there's a lot of fear[br]of the unknown about therapy. 0:07:22.018,0:07:24.778 You might consider giving it a try, 0:07:24.778,0:07:28.138 but we avoid it just because[br]we don't know what it's going to be like. 0:07:29.778,0:07:32.860 I think there's also some fear[br]and trepidation that comes up 0:07:32.860,0:07:37.310 around sharing our thoughts and feelings[br]and vulnerabilities with a stranger 0:07:37.310,0:07:42.010 and perhaps some concern that we are[br]going to be judged for what we reveal. 0:07:42.010,0:07:44.489 I think that's a really natural concern. 0:07:44.489,0:07:48.658 Honestly, I think it's[br]very common and very human. 0:07:48.658,0:07:51.888 I personally don't think there's[br]any room for judgment in therapy, 0:07:51.888,0:07:55.630 and I know that's a sentiment I share[br]with many of my colleagues, 0:07:55.630,0:07:57.399 but nonetheless, I always recommend 0:07:57.399,0:08:01.369 that people treat first therapy sessions[br]like interviews of sorts. 0:08:01.369,0:08:04.850 Because a lot of the fear that comes up[br]around unloading to a stranger 0:08:04.850,0:08:09.929 goes away once we establish a connection[br]with a real flesh and blood human being. 0:08:11.639,0:08:14.090 And this brings me to something[br]really significant 0:08:14.090,0:08:17.060 that I want to make sure[br]that I impart to you today, 0:08:17.760,0:08:20.139 which is how vitally important it is 0:08:20.139,0:08:24.669 to really be discerning about[br]the therapist you choose to work with. 0:08:25.699,0:08:29.010 This could be a whole[br]separate talk, in and of itself, 0:08:29.380,0:08:34.919 but the single most important factor[br]in any effective therapy 0:08:34.919,0:08:36.861 has to do with the relationship 0:08:36.861,0:08:41.679 that's built between[br]therapist and patient or client. 0:08:42.610,0:08:44.090 The relationship of the therapy 0:08:44.090,0:08:47.030 is actually what accounts[br]for most of the change that occurs - 0:08:47.030,0:08:48.960 it's a complex process. 0:08:48.960,0:08:52.130 But studies show us again and again 0:08:52.130,0:08:56.953 that it is the single most important[br]ingredient in therapy - the relationship. 0:08:56.953,0:09:00.060 So, I really want to empower you[br]to be discriminating. 0:09:01.200,0:09:04.272 If you're wondering how to pick[br]the right therapist, 0:09:04.272,0:09:06.908 it's really just about trusting your gut. 0:09:06.908,0:09:10.730 Because the most important thing is that[br]you find the person who's right for you. 0:09:11.650,0:09:15.277 But if you tried therapy in the past[br]and you've had a bad experience, 0:09:15.477,0:09:18.242 please know it can be better[br]the second time around 0:09:18.242,0:09:20.698 if you find the right person. 0:09:22.898,0:09:27.621 Now, I do have a reason why I think[br]that we should all see a therapist 0:09:27.621,0:09:29.907 at least once in our lives. 0:09:29.907,0:09:33.831 And my hope is that hearing this[br]will spark a little curiosity in you 0:09:33.831,0:09:36.932 and perhaps help you to look at yourself[br]and the world around you 0:09:36.932,0:09:39.271 just a little bit differently. 0:09:40.181,0:09:43.801 It certainly isn't the end-all be-all[br]to what people get out of therapy, 0:09:44.351,0:09:45.652 but it's fascinating to me 0:09:45.652,0:09:48.670 because it is something[br]that applies to all of us. 0:09:50.250,0:09:52.708 I think that most of us have[br]a sense of appreciation 0:09:52.708,0:09:56.253 for how our life experiences[br]can impact our emotional lives, 0:09:56.253,0:09:59.293 but I want to suggest a subtle shift here, 0:09:59.613,0:10:03.582 that our life experiences shape[br]not just our emotional lives 0:10:04.382,0:10:08.133 but our very understanding[br]of what reality is. 0:10:09.473,0:10:12.791 Different branches of psychology[br]have different names for this - 0:10:12.791,0:10:18.303 schemas, relational templates, scripts -[br]but regardless of what we call it, 0:10:18.303,0:10:21.151 what it means is that [br]our early childhood experiences 0:10:21.151,0:10:24.483 create our understanding[br]of how the world works. 0:10:25.103,0:10:28.091 In fact, all of our experiences[br]throughout life do - 0:10:28.091,0:10:30.301 these relational templates,[br]as I'll call them - 0:10:30.301,0:10:32.818 are always shifting, at least slightly. 0:10:32.818,0:10:35.551 But this is particularly salient[br]when we are children 0:10:35.551,0:10:39.553 because when we're young, we don't have[br]a sense of what's normal or abnormal. 0:10:39.553,0:10:43.162 There's no objective standard[br]that we can compare our lives to, 0:10:43.162,0:10:46.802 and children's brains are like sponges. 0:10:47.582,0:10:51.593 So every early experience that we have[br]when we are children 0:10:51.593,0:10:54.263 works to create this internal script 0:10:54.263,0:10:59.723 of how we think the world works[br]and how we expect people to respond to us. 0:11:00.283,0:11:02.123 Part of why this happens - 0:11:02.123,0:11:05.512 this might help in your understanding[br]of what I'm talking about here - 0:11:05.512,0:11:08.774 has to do with how we learn as humans. 0:11:08.774,0:11:11.974 To use a very basic,[br]but kind of funny, example: 0:11:11.974,0:11:14.243 If every time you got behind[br]the wheel of a car 0:11:14.243,0:11:19.114 you had to learn to drive all over again,[br]it would be hard to get by in the world. 0:11:19.114,0:11:21.023 Right? But, no. 0:11:21.023,0:11:23.654 You get behind the wheel, and you expect, 0:11:23.654,0:11:27.134 assuming that the ignition is turned on[br]and that the car is in gear, 0:11:27.134,0:11:30.763 that if you put your foot[br]on the gas pedal, the car will go forward; 0:11:30.763,0:11:34.433 or backward, depending on[br]which way you are headed. 0:11:34.433,0:11:37.184 But you make that assumption[br]because your past experiences 0:11:37.184,0:11:40.992 dictate your expectations[br]of how the world will work in the future. 0:11:42.132,0:11:45.745 The tricky part is what happens[br]when we apply this theory of learning 0:11:45.745,0:11:49.074 to our emotional lives[br]or to human relationships. 0:11:50.164,0:11:54.404 To give you an example that I think[br]will resonate easily for everybody: 0:11:54.404,0:11:58.114 If we take a child - let's call him Joe - 0:11:58.114,0:12:01.785 and raise him in a combative,[br]hostile environment - 0:12:01.785,0:12:04.764 imagine that he is physically[br]and emotionally abused - 0:12:04.764,0:12:07.953 he's likely to grow up with [br]an unconscious expectation of the world 0:12:07.953,0:12:10.375 as a violent, angry place, 0:12:10.375,0:12:13.876 and that he needs to be[br]aggressive to get by in it. 0:12:14.716,0:12:16.095 The problem here 0:12:16.095,0:12:19.964 is that because Joe's expectations[br]are that people aren't trustworthy, 0:12:20.534,0:12:24.494 because the psychological world[br]that he lives in is an aggressive one, 0:12:24.934,0:12:29.115 he's probably going to operate in a manner[br]that is generally combative. 0:12:29.935,0:12:30.935 And you can bet 0:12:30.935,0:12:35.035 that if his manner of being in the world[br]is generally combative, 0:12:35.035,0:12:38.524 that most people are going to treat him[br]with a fair amount of hostility. 0:12:39.415,0:12:41.205 And so it goes. 0:12:41.205,0:12:44.946 Joe's unconscious expectations of how[br]the world works have been confirmed. 0:12:45.366,0:12:48.625 This is the essence[br]of self-fulfilling prophecies. 0:12:49.905,0:12:54.195 Now, the slightly dramatized example[br]is probably easy to imagine for everybody, 0:12:54.195,0:12:56.275 but what might be more surprising 0:12:56.275,0:13:02.595 is that some version of this is also how[br]all of us learn to function in the world. 0:13:03.245,0:13:06.448 We all think that we see[br]the world very clearly, 0:13:06.448,0:13:09.686 despite the fact that we are looking at it[br]through specific lenses 0:13:09.686,0:13:10.815 which have been created 0:13:10.815,0:13:14.855 by all of the experiences[br]that we've had in our lives, to date. 0:13:16.235,0:13:20.827 The unconscious beliefs and expectations[br]we have about life can be very subtle. 0:13:21.817,0:13:25.806 They can be as relatively simple[br]as not going after what we really want, 0:13:25.806,0:13:28.526 because we believe, deep down,[br]that we are unworthy, 0:13:28.976,0:13:31.587 and they can be as complex [br]as staying in relationships 0:13:31.587,0:13:35.685 with people who hurt us because[br]that's what our understanding of love is. 0:13:36.835,0:13:37.976 Put them all together, 0:13:37.976,0:13:42.086 and they create the very fabric[br]of our individual universes. 0:13:42.656,0:13:45.477 So to use an example[br]that is probably closer to home, here: 0:13:45.477,0:13:49.707 Our relational templates have a lot to do[br]with the people we attract into our lives. 0:13:49.707,0:13:52.238 Our romantic partners especially. 0:13:53.248,0:13:55.326 If we have a hard time finding a partner, 0:13:55.326,0:13:59.687 or if we feel incredibly frustrated[br]with the one we've got, 0:13:59.687,0:14:01.477 at some point, we have to recognize 0:14:01.477,0:14:06.277 that we are the thing that all of [br]our experiences have in common. 0:14:06.697,0:14:12.097 And this is the reason why[br]we can all benefit from therapy. 0:14:12.097,0:14:15.157 It's also part of the reason[br]why talking to a therapist 0:14:15.157,0:14:18.596 is not just like talking to a friend. 0:14:18.596,0:14:22.338 What a trained therapist does,[br]among other things, 0:14:22.338,0:14:26.237 is help us to explore the role [br]that we are playing in our own lives. 0:14:27.357,0:14:30.869 Because if you can't see the role[br]that you're playing 0:14:30.869,0:14:33.288 in the circumstances of your own life, 0:14:33.288,0:14:35.928 you're powerless to change them. 0:14:38.748,0:14:41.156 The beauty of this kind of therapy 0:14:41.156,0:14:46.059 is that it carries with it a deep respect[br]for the human condition. 0:14:47.539,0:14:51.959 Because it isn't about[br]sickness versus health; 0:14:51.959,0:14:54.978 It's about expanding consciousness. 0:14:55.698,0:14:59.688 It isn't a sign of weakness,[br]but a sign of strength, 0:14:59.688,0:15:04.267 because it takes courage to look at[br]the parts of ourselves we'd rather avoid. 0:15:05.747,0:15:08.329 For anyone who's experiencing[br]psychiatric symptoms, 0:15:08.329,0:15:12.600 this therapy can help -[br]I just want to repeat that. 0:15:12.600,0:15:16.908 The aims of psychoanalytic[br]therapy don't stop there. 0:15:16.908,0:15:21.990 Because psychological health[br]isn't defined by the absence of symptoms. 0:15:22.180,0:15:25.689 It's defined by the presence[br]of inner resources 0:15:25.689,0:15:30.509 that help us to lead[br]more fulfilling, satisfying lives. 0:15:32.889,0:15:37.068 If you're struggling[br]or suffering in some way, 0:15:37.658,0:15:41.058 I hope I've said something today[br]that will help you to feel less fearful 0:15:41.058,0:15:43.700 of reaching out and getting[br]the help that you need. 0:15:43.700,0:15:45.608 But, even if you aren't, 0:15:45.608,0:15:48.799 it's time for us to change[br]this conversation. 0:15:50.039,0:15:53.599 We owe it to ourselves[br]to explore our inner worlds 0:15:53.599,0:15:55.908 and to take control of our destinies. 0:15:56.738,0:15:59.557 And therapy helps us to do this. 0:16:01.857,0:16:06.210 I believe this with[br]every fiber of my being. 0:16:07.710,0:16:10.880 And I believe that you are someone[br]who is worth getting to know. 0:16:11.230,0:16:12.441 Thank you. 0:16:12.441,0:16:15.521 (Applause)