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My name is Leslie Carr.

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I'm a registered clinical psychologist
in private practice,

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and I'm here today
to talk to you about therapy.

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I really love what I do for a living.

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It's truly what gets me out of bed
in the morning.

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But I have a dilemma in my work,
which is that, from my vantage point,

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it seems that therapy
isn't very well understood.

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Even though I think we've come
a long way in this regard,

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there's still a fair amount of stigma
that surrounds psychotherapy.

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And even more signficantly,

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it seems to me there are
many misconceptions about it

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and that it is something that is 
generally mysterious to most people.

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It seems to me that these misconceptions
keep many people from trying therapy

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even if it would benefit them,

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which is a travesty, to me.

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So, I really see it as my mission

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to increase our collective understanding 
of what therapy is and how it works

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so that we can start to change
the way the world looks at it.

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Now, first of all, I should explain
that the kind of therapy that I practice

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and the kind that I am going to talk
to you about today

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is the kind that is
traditionally referred to

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as psychodynamic
or psychoanalytic psychotherapy.

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I know that it can be confusing

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because there are a lot of different kinds
of therapy out there these days,

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but what I'm talking about

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is what I'll refer to as
the "old-school" kind of therapy;

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the classic kind, where you talk

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and another person listens
and asks questions and reflects.

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It's something called
insight-oriented therapy,

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and I think that in many ways
it's gotten a bad rap in recent years.

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One of the single biggest misconceptions
about this kind of therapy

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is that there's no scientific
evidence that it works,

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which is actually not true.

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Research in this field has demonstrated,
not only that it works,

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but that it works really well.

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So, I'm going to
dig into this a little bit.

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Now, my talk today is not
going to be super data heavy,

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but this stuff is
actually really interesting,

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so if you don't mind,
I'm going to run some numbers by you.

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For those of you who speak research -

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and if you don't, don't worry,
I'll come back to you -

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a meta-analysis of 23
randomized control trials

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found an effect size of .97
for overall psychiatric improvement

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and 1.51 for follow-up studies conducted
nine months after the therapy ended.

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This study is one example of hundreds
that have been conducted in this area.

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For those of you who don't speak research,

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effect size is the statistical measurement
of how much something works.

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An effect size of .2 is considered small,

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.5 is considered moderate,

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and a large effect size is .8 or above.

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So, to give you a frame of reference,

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the effect size for Prozac, according
to studies conducted by the FDA, is .26.

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I'll just let that sink in.

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Because these numbers -

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.97 for overall improvement
and 1.51 at follow-up -

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are really off the charts, actually;
it's pretty astounding.

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Part of what that also means

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is that people continue to benefit
from therapy even after they stop going -

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which is pretty cool.

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Now this kind of therapy helps people

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who are experiencing psychiatric symptoms
or are suffering in some way, of course -

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I do want to make that clear -

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but it also helps people
in the name of personal growth,

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and it works according to
the same principles.

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It helps us to gain insight
into how we relate to people,

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to identify and change recurring patterns.

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It increases our consciousness
and improves our decision making.

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And we reap all these benefits
whether we have a mental illness or not.

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Excuse me.

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So, let me tell you a little bit about me.

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I chose to become a therapist

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because I was once, many times in fact,
a therapy patient myself.

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I was blessed to grow up in a family

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that valued therapy
and that didn't buy into the stigma.

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So, when we encountered
challenges in my childhood,

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namely, the potentially
terminal illness of a family member,

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my parents did what they thought was best,
and they sent me to see a therapist,

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for the first time
when I was ten years old.

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I think they made that decision
largely out of being proactive,

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but it was also really clear
that I was struggling,

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and most of that was manifesting
in my experiences at school.

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My grades were slipping;

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my teachers were reporting
that I seemed distracted.

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The anxiety and sadness that I felt
about what was going on at home

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was making it hard
for me to pay attention,

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and I was falling behind my peers.

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Now, I have to tell you
that I consider that, to this day -

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the decision that my parents made
to send me to a therapist -

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as being one of the best things
that has ever happened to me.

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I really do.

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I liked it so much that it made me want
to become a therapist myself.

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So, clearly I got a lot out of it.

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But I also have to admit 
that I really didn't want to go, at first.

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It would be hard to say
what I was so afraid of, exactly,

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because I was so young
at the time, but I was terrified.

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And I literally, at first, refused
to even go into the woman's office.

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We spent the first two or three sessions
in the waiting room.

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And that was what therapy
was for me at first,

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just trying to get comfortable enough
to go into the woman's office.

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And the funny thing about that, for me,
is that having had those early experiences

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really removed any sense of stigma
from therapy, for me,

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but I also clearly would be lying
through my teeth

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if I were to say that I don't know
what it's like to be afraid at first,

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to give it a try.

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Now, I know that it's different
with adults from children -

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after all, I only work with adults

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so my only point of reference
for child therapy is my own -

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but I do think, on a fundamental level,
the feeling is the same.

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And I think it really just has to do
with fear of the unknown.

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I just didn't know what that lady
was going to do to me.

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I felt like she had some magical power
and I didn't know what it was,

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but I felt like she was going to
get in my head or something,

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and it just kind of freaked me out.

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And it reminds me of how sometimes -
today, now that I am a therapist myself -

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I'll get this feedback
from people sometimes,

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that they think I can read
their minds or something.

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And it always makes me laugh a little bit
because that's not how it works.

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But I suppose on some level,
I can identify

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because I have a vague recollection
of having felt that way myself.

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I do think that for many people

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there's a lot of fear
of the unknown about therapy.

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You might consider giving it a try,

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but we avoid it just because
we don't know what it's going to be like.

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I think there's also some fear
and trepidation that comes up

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around sharing our thoughts and feelings
and vulnerabilities with a stranger

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and perhaps some concern that we are
going to be judged for what we reveal.

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I think that's a really natural concern.

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Honestly, I think it's
very common and very human.

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I personally don't think there's
any room for judgment in therapy,

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and I know that's a sentiment I share
with many of my colleagues,

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but nonetheless, I always recommend

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that people treat first therapy sessions
like interviews of sorts.

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Because a lot of the fear that comes up
around unloading to a stranger

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goes away once we establish a connection
with a real flesh and blood human being.

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And this brings me to something
really significant

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that I want to make sure
that I impart to you today,

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which is how vitally important it is

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to really be discerning about
the therapist you choose to work with.

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This could be a whole
separate talk, in and of itself,

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but the single most important factor
in any effective therapy

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has to do with the relationship

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that's built between
therapist and patient or client.

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The relationship of the therapy

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is actually what accounts
for most of the change that occurs -

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it's a complex process.

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But studies show us again and again

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that it is the single most important
ingredient in therapy - the relationship.

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So, I really want to empower you
to be discriminating.

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If you're wondering how to pick
the right therapist,

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it's really just about trusting your gut.

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Because the most important thing is that
you find the person who's right for you.

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But if you tried therapy in the past
and you've had a bad experience,

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please know it can be better
the second time around

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if you find the right person.

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Now, I do have a reason why I think
that we should all see a therapist

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at least once in our lives.

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And my hope is that hearing this
will spark a little curiosity in you

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and perhaps help you to look at yourself
and the world around you

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just a little bit differently.

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It certainly isn't the end-all be-all
to what people get out of therapy,

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but it's fascinating to me

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because it is something
that applies to all of us.

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I think that most of us have
a sense of appreciation

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for how our life experiences
can impact our emotional lives,

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but I want to suggest a subtle shift here,

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that our life experiences shape
not just our emotional lives

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but our very understanding
of what reality is.

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Different branches of psychology
have different names for this -

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schemas, relational templates, scripts -
but regardless of what we call it,

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what it means is that 
our early childhood experiences

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create our understanding
of how the world works.

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In fact, all of our experiences
throughout life do -

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these relational templates,
as I'll call them -

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are always shifting, at least slightly.

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But this is particularly salient
when we are children

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because when we're young, we don't have
a sense of what's normal or abnormal.

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There's no objective standard
that we can compare our lives to,

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and children's brains are like sponges.

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So every early experience that we have
when we are children

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works to create this internal script

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of how we think the world works
and how we expect people to respond to us.

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Part of why this happens -

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this might help in your understanding
of what I'm talking about here -

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has to do with how we learn as humans.

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To use a very basic,
but kind of funny, example:

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If every time you got behind
the wheel of a car

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you had to learn to drive all over again,
it would be hard to get by in the world.

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Right? But, no.

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You get behind the wheel, and you expect,

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assuming that the ignition is turned on
and that the car is in gear,

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that if you put your foot
on the gas pedal, the car will go forward;

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or backward, depending on
which way you are headed.

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But you make that assumption
because your past experiences

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dictate your expectations
of how the world will work in the future.

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The tricky part is what happens
when we apply this theory of learning

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to our emotional lives
or to human relationships.

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To give you an example that I think
will resonate easily for everybody:

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If we take a child - let's call him Joe -

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and raise him in a combative,
hostile environment -

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imagine that he is physically
and emotionally abused -

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he's likely to grow up with 
an unconscious expectation of the world

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as a violent, angry place,

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and that he needs to be
aggressive to get by in it.

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The problem here

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is that because Joe's expectations
are that people aren't trustworthy,

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because the psychological world
that he lives in is an aggressive one,

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he's probably going to operate in a manner
that is generally combative.

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And you can bet

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that if his manner of being in the world
is generally combative,

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that most people are going to treat him
with a fair amount of hostility.

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And so it goes.

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Joe's unconscious expectations of how
the world works have been confirmed.

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This is the essence
of self-fulfilling prophecies.

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Now, the slightly dramatized example
is probably easy to imagine for everybody,

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but what might be more surprising

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is that some version of this is also how
all of us learn to function in the world.

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We all think that we see
the world very clearly,

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despite the fact that we are looking at it
through specific lenses

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which have been created

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by all of the experiences
that we've had in our lives, to date.

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The unconscious beliefs and expectations
we have about life can be very subtle.

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They can be as relatively simple
as not going after what we really want,

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because we believe, deep down,
that we are unworthy,

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and they can be as complex 
as staying in relationships

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with people who hurt us because
that's what our understanding of love is.

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Put them all together,

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and they create the very fabric
of our individual universes.

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So to use an example
that is probably closer to home, here:

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Our relational templates have a lot to do
with the people we attract into our lives.

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Our romantic partners especially.

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If we have a hard time finding a partner,

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or if we feel incredibly frustrated
with the one we've got,

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at some point, we have to recognize

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that we are the thing that all of 
our experiences have in common.

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And this is the reason why
we can all benefit from therapy.

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It's also part of the reason
why talking to a therapist

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is not just like talking to a friend.

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What a trained therapist does,
among other things,

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is help us to explore the role 
that we are playing in our own lives.

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Because if you can't see the role
that you're playing

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in the circumstances of your own life,

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you're powerless to change them.

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The beauty of this kind of therapy

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is that it carries with it a deep respect
for the human condition.

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Because it isn't about
sickness versus health;

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It's about expanding consciousness.

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It isn't a sign of weakness,
but a sign of strength,

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because it takes courage to look at
the parts of ourselves we'd rather avoid.

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For anyone who's experiencing
psychiatric symptoms,

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this therapy can help -
I just want to repeat that.

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The aims of psychoanalytic
therapy don't stop there.

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Because psychological health
isn't defined by the absence of symptoms.

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It's defined by the presence
of inner resources

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that help us to lead
more fulfilling, satisfying lives.

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If you're struggling
or suffering in some way,

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I hope I've said something today
that will help you to feel less fearful

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of reaching out and getting
the help that you need.

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But, even if you aren't,

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it's time for us to change
this conversation.

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We owe it to ourselves
to explore our inner worlds

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and to take control of our destinies.

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And therapy helps us to do this.

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I believe this with
every fiber of my being.

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And I believe that you are someone
who is worth getting to know.

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Thank you.

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(Applause)