Reconsidering psychotherapy | Dr. Leslie Carr | TEDxFiDiWomen

Although therapy is often stigmatized in our society, data shows it is much more effective than Prozac, even after it is over. It is human to fear talking to a stranger, but Dr. Carr has seen the fear disappear once we find the right therapist. She believes that we all would benefit from being in therapy at least once in our lives; that therapy is not just for those who are struggling, but for any of us who want to live more consciously.

Dr. Leslie Carr is a registered clinical psychologist in private practice, where she works with adults. She has a physical office in San Francisco, CA, as well as a virtual office where she meets with people via Skype who are not in the Bay Area. Dr. Carr is a regular contributing writer for the online wellness magazine CrazySexyLife.com, and she serves on the board of directors for the Northern California Society for Psychoanalytic Psychology (NCSPP). She is committed to showing the world that therapy is cool.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

My name is Leslie Carr.

I'm a registered clinical psychologist
in private practice,

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

I really love what I do for a living.

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

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

it seems that therapy
isn't very well understood.

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

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

And even more signficantly,

it seems to me there are
many misconceptions about it

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

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

even if it would benefit them,

which is a travesty, to me.

So, I really see it as my mission

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

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

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

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

is the kind that is
traditionally referred to

as psychodynamic
or psychoanalytic psychotherapy.

I know that it can be confusing

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

but what I'm talking about

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

the classic kind, where you talk

and another person listens
and asks questions and reflects.

It's something called
insight-oriented therapy,

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

One of the single biggest misconceptions
about this kind of therapy

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

which is actually not true.

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

but that it works really well.

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

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

but this stuff is
actually really interesting,

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

For those of you who speak research -

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

a meta-analysis of 23
randomized control trials

found an effect size of .97
for overall psychiatric improvement

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

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

For those of you who don't speak research,

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

An effect size of .2 is considered small,

.5 is considered moderate,

and a large effect size is .8 or above.

So, to give you a frame of reference,

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

I'll just let that sink in.

Because these numbers -

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

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

Part of what that also means

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

which is pretty cool.

Now this kind of therapy helps people

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

I do want to make that clear -

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

and it works according to
the same principles.

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

to identify and change recurring patterns.

It increases our consciousness
and improves our decision making.

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

Excuse me.

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

I chose to become a therapist

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

I was blessed to grow up in a family

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

So, when we encountered
challenges in my childhood,

namely, the potentially
terminal illness of a family member,

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

for the first time
when I was ten years old.

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

but it was also really clear
that I was struggling,

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

My grades were slipping;

my teachers were reporting
that I seemed distracted.

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

was making it hard
for me to pay attention,

and I was falling behind my peers.

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

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

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

I really do.

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

So, clearly I got a lot out of it.

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

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

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

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

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

And that was what therapy
was for me at first,

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

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

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

but I also clearly would be lying
through my teeth

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

to give it a try.

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

after all, I only work with adults

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

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

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

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

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

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

and it just kind of freaked me out.

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

I'll get this feedback
from people sometimes,

that they think I can read
their minds or something.

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

But I suppose on some level,
I can identify

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

I do think that for many people

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

You might consider giving it a try,

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

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

around sharing our thoughts and feelings
and vulnerabilities with a stranger

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

I think that's a really natural concern.

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

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

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

but nonetheless, I always recommend

that people treat first therapy sessions
like interviews of sorts.

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

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

And this brings me to something
really significant

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

which is how vitally important it is

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

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

but the single most important factor
in any effective therapy

has to do with the relationship

that's built between
therapist and patient or client.

The relationship of the therapy

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

it's a complex process.

But studies show us again and again

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

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

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

it's really just about trusting your gut.

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

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

please know it can be better
the second time around

if you find the right person.

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

at least once in our lives.

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

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

just a little bit differently.

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

but it's fascinating to me

because it is something
that applies to all of us.

I think that most of us have
a sense of appreciation

for how our life experiences
can impact our emotional lives,

but I want to suggest a subtle shift here,

that our life experiences shape
not just our emotional lives

but our very understanding
of what reality is.

Different branches of psychology
have different names for this -

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

what it means is that
our early childhood experiences

create our understanding
of how the world works.

In fact, all of our experiences
throughout life do -

these relational templates,
as I'll call them -

are always shifting, at least slightly.

But this is particularly salient
when we are children

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

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

and children's brains are like sponges.

So every early experience that we have
when we are children

works to create this internal script

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

Part of why this happens -

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

has to do with how we learn as humans.

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

If every time you got behind
the wheel of a car

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

Right? But, no.

You get behind the wheel, and you expect,

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

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

or backward, depending on
which way you are headed.

But you make that assumption
because your past experiences

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

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

to our emotional lives
or to human relationships.

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

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

and raise him in a combative,
hostile environment -

imagine that he is physically
and emotionally abused -

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

as a violent, angry place,

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

The problem here

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

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

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

And you can bet

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

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

And so it goes.

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

This is the essence
of self-fulfilling prophecies.

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

but what might be more surprising

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

We all think that we see
the world very clearly,

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

which have been created

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

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

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

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

and they can be as complex
as staying in relationships

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

Put them all together,

and they create the very fabric
of our individual universes.

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

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

Our romantic partners especially.

If we have a hard time finding a partner,

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

at some point, we have to recognize

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

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

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

is not just like talking to a friend.

What a trained therapist does,
among other things,

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

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

in the circumstances of your own life,

you're powerless to change them.

The beauty of this kind of therapy

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

Because it isn't about
sickness versus health;

It's about expanding consciousness.

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

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

For anyone who's experiencing
psychiatric symptoms,

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

The aims of psychoanalytic
therapy don't stop there.

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

It's defined by the presence
of inner resources

that help us to lead
more fulfilling, satisfying lives.

If you're struggling
or suffering in some way,

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

of reaching out and getting
the help that you need.

But, even if you aren't,

it's time for us to change
this conversation.

We owe it to ourselves
to explore our inner worlds

and to take control of our destinies.

And therapy helps us to do this.

I believe this with
every fiber of my being.

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

Thank you.

(Applause)