Why We Don’t Change (and what you can do about it) with Dr. Ross Ellenhorn

Hey, everyone. Welcome to Being Well. I'm Forrest Hansen. If you're new to the show, thanks for listening today. And if you've listened before, welcome back. We've recorded roughly 400 episodes of Being Well, and we have talked about a lot. during those episodes. But you could argue that all 400 of them come back to a fundamental question. What helps us change? Particularly, what can we develop inside of ourselves that supports us in changing in the ways that we want to?

I'm joined today by a very special guest who has spent their career exploring that question, Dr. Ross Ellenhorn. Ross is a psychotherapist and sociologist, the owner and CEO of Ellen Horn, a community integration program offering services for individuals experiencing addictive behaviors or extreme and complex states of mind and mood.

and the author of three books, including How We Change and 10 Reasons Why We Don't. So, Ross, thanks for joining me today. How are you doing? Good, good. It's good to be here. I'm so glad to have you for this. I want to start by saying that I personally find your work really fascinating. I appreciate it a lot.

Because I feel like you kind of poke out a lot of conventional wisdom about what really helps people change. For example, as we'll talk a bit later, how some people can have a fear of hope, which we tend to think of as a purely positive emotion.

Another thing you do is you tend to encourage people to focus a bit on contemplation before action, when a lot of self-help content focuses on really moving people into action, you know, behavioral activation, all of that kind of stuff. And you have an extensive background in social work. And I'm curious how working with people in that context influenced how you think about change. Yeah. Well, real social work is about thinking about a person's context.

And there are psychological events in that context. So real social work is applied social psychology. And that has a strong influence on me as a sociologist practitioner, right? can't seem to figure out how we can talk about a brain as not a social organ. And so the stuff that you're describing is kind of out of the mainstream that I talk about. It actually comes from a bewilderment about the other group.

who acts as if our experiences are skull bound and something that are just individual. I can't quite figure that out. I can't figure out how we can think about people that way because. We are the most gregarious animal. In other words, we are the most social animal. We depend less on instinct than any other animal and more on collaboration and cooperation than any other animal.

And so it's really hard for me to figure out that world of talking about people as individuals. I mean, not that we're not individuals, but our change and our suffering typically has to do. with what's happening around us, our response to what's happening, our idiosyncratic response to what's happening around us. So I'm wondering about that, Ross, because a huge part of your work is focusing on personal responsibility.

You talk about like the individual really finding within them. I think the word that you use is faith most of the time, like a faith in their own ability to create a kind of change in their life. But here, just in what you kind of first said, you're really situating it contextually and socially and interdependently. So I'm wondering how you square that circle. Right, right. That's a really great question.

It's not as if I don't think that we don't have our own traits and our own strengths, but our attainment of those things always have to do with what's happening to us socially. You build a sense of what's called self-efficacy.

Self-efficacy, the other term for that is self-belief, which is very similar to faith. You don't build that anywhere but accomplishing things, which means that you're doing it in the world. You don't build self-efficacy by thinking about self-efficacy. You build it through. action to actually getting competent in something mental health system has all of these conversations about life skills about training people about life skills

I don't think that the people I work with at least have problems with life skills. I think they have problems with being afraid of applying those skills. It's the struggle over who am I in the world if I can actually make this happen.

I think most people can figure out how to clean an apartment, sign a check. I mean, not that we do sign checks anymore, but anything like that. I don't think that we have to learn life skills. What we have to learn is having some faith in ourselves because every social interaction.

has the potential for some sort of failure or disagreement or discomfort that we now have to deal with and and that means having some faith in ourselves but that's developed through social things through making something happen in the world

And through like those kinds of positive interactions with other people where you're getting that kind of feedback and you're getting encouragement from them. Yeah, totally. Right. The other thing is there's a theory in social psychology called threat appraisal theory. And it basically says that a challenge is something difficult in front of you. A threat is something difficult in front of you where you don't feel like you have the resources to meet that challenge.

You're walking in your shorts and a t-shirt. A snowstorm hits. That's a threat. You put on a jacket. It's a challenge, right? And there are social resources that make us feel as if we've got that jacket on. So one is social support. Another is a sense of purpose. Another is this thing we were talking about, self-efficacy. The ability to talk to people about your experiences has this profound effect. All these things.

are like that jacket. They give us this ability to see challenges in the challenge mode, not the threat mode. If we don't have those things, everything looks like a threat, including looking at your own problems.

That's a challenge that becomes a threat. I don't want to look at that problem. Now, in the psychotherapy world, in the mental health world, we call that denial, resistance. We start blaming the person's qualities instead of noticing that they're living without enough resources to be able to do that.

And you know that in your own life, that the points when you're willing to look at yourself are the points when things are going okay. And the points when you're not willing to look at yourself are the points when things are kind of not going okay. And we don't afford people that idea.

that really what's going on for you when you resist changing or you're kind of not wanting to look at your problems typically has to do with the fact that you don't have enough of those resources around you. This is another soft poking of the bear.

that I feel like you do in your work, where most of the time when people are, certainly me, listen to this podcast, frequent listeners will know, we focus a lot on essentially developing change energy of different kinds. What are the resources that a person can build that can support them? achieving the things that they want to achieve in life. You really kind of flip it upside down and you tend to focus on what essentially makes people want to stay the same.

So rather than thinking about, you know, we're in this painful circumstance right now. I have this bad habit that I don't like. There's this good thing that I'm not doing. You're really looking at, oh, actually, what is it about the quote unquote bad habit? that has an allure, that has an attachment to it, and what's kind of perpetuating that situation. The act of change means watching yourself have some accountability for your experience.

And the emotion that goes along with that is what's called existential anxiety. I'm, oh my Lord, I'm driving this bus called my life. And so in many ways, we're not changing because we're looking at that. And that's not something that is a disease. That's an anxiety we all have. This idea that basically I've got to kind of figure this out on my own on some level with help, but I got to figure it out. And so.

We stay the same because we want to resist that, and especially if we've been through multiple, multiple experiences of trying something and it didn't work. What we're doing when we're staying the same is really eloquent and beautiful. We're taking care of ourselves. We don't want to have that experience of something bad happening. We don't want to get our hopes up again and then have them dashed. There's all these things we're doing that's profoundly understandable.

And if we don't understand that, we don't understand that we're acting out of self-love when we stay the same, it's really hard to contemplate changing because you really have to be able to look at, well, this is why I'm doing it.

Bless me for staying the same. I'm just taking care of myself. I'm just looking for some comfort. That's all I'm doing. And if you can start looking at that, then you can begin to think about whether you want to change. If all you say is I'm being an idiot because I'm not changing, you're not going to get anywhere.

And that's sort of the classic mode in our societies. Why aren't you changing? Why aren't you just doing it? You know, there's only five steps in this book. There's 12 steps in that book. Just take the steps and you'll be there. Yeah. If you're in a place where you could take those steps. In other words, you have enough motivation to take those steps. Guess what? You don't need the steps, right? And so we're in this advice culture.

Instead of looking at how do I get myself or help another get into that place where I'm able to kind of contemplate and then make the decision on some level to face my accountability and move forward. In a coaching context, working with people, that's the work that I do. I'm not a therapist, but I do some work as a coach. What often kind of pops out of a person in that discovery process is that they come into the room, to your point,

with a lot of self-criticism about whatever behavior it is that they are doing, that they don't like, that they're not doing, that they want to move toward, whatever it is. We try some interventions. We noodle around. We figure out what could help that person. Nothing works, nothing works, nothing works. What usually pops out at some point is that they discover that they actually like what they're currently doing. Yeah.

that they like the smoking, that they like the drinking, that they like the getting into the arguments, that they like scrolling through their ex's Instagram feed to see what they're up to. And when we can identify that kind of feeling of like, oh, I actually like that. Then I'm like, great, tell me what you like about it. And we can kind of investigate that in a weird way. It becomes almost like a person who was sort of fractured. Like they had these two different parts that were at war.

that work kind of calms down and they can experience themselves as like a whole individual and then from that stance they can make a lot of progress with stuff at least that's my experience with it well that that's that's exactly right and what you're describing there it's a little different than

slightly different than what I'm saying in the book, which is it's not just the behavior again. It's the staying same, the same part that's comforting, just keeping things the way they are independent of the behavior. But what you're describing is basically the roots of what's called motivational interviewing.

So motivational interviewing is really about a nonjudgmental approach to help a person get to the place where they can contemplate. And you can't get a person to contemplate if you don't help them appreciate why doing the behavior is something they're actually enjoying. And it's, in a sense, good for them.

it gets them through the day or whatever. If it's just the secret that they like it and it's not told, it just stays that secret and stays shameful instead of, no, this is, this is you doing something to look after yourself.

And what that also means is you're speaking to the part of them that's going to help them change. The same part of them that's going to help them change is the part of them that's keeping them the same, which is the part of them that's looking out for them, that's trying to make sure they're okay.

All change has to do not with looking at the problem, but looking at what is the courage and what is the power within the person to make it happen. You can't have a conversation about this is just a problem you have or brokenness in you that you got to fix. It's got to be. where can we find the places where you're already working on it? So I'd love to spend kind of a minute here looking at that. I think the phrase you have for it is the allure of sameness.

things that tend to kind of keep people that way. You have this list of 10 points that actually came from much earlier work that you did. But just to give some examples of here, why might somebody not want to change? Why might they actually enjoy staying the way that they are? Yeah. Well, I think the way to get to that is probably to talk a little bit about the fear of hope research, because it kind of fits with that. Basically, let's start with the idea of what is hope. Hope is not optimism.

It's kind of a cheap emotion. Everything's going to be okay. Hope is a really profound spiritual event on some level that gets you through uncertainty to something you yearn for. So hope is a process. If you can't hope, you can't move through uncertainty. It is the tool to get you to uncertainty to something you want. But when you hope for something, you make that thing more important than before you hope for it. It becomes the target, the thing you're heading towards.

Yeah, no, for sure. So then you're setting yourself up for the experience of not getting a thing you hoped for, which makes you feel like you can't get your needs met, which is a profoundly... powerful experience because it is exactly what's going on for you in infancy all the way up through childhood is, can I get my needs met? Are these people around me going to meet my needs? All that, because you're having that experience every time you don't get hope.

And if you want later, I'll talk about that a little bit more because I actually believe that we can think about infancy not as an attachment period, but a hope period. Yeah, I thought that was such an interesting parallel just when you mentioned it there, Ross. Like, that would be really cool, like, putting it inside of that developmental framework the way that you're thinking about it. Yeah. Yeah. But basically, in attachment events, what is going on is...

The infant or child is hoping for milk, hoping for a hug. Yeah. Hoping for affection. Totally. Yeah. Co-regulation, whatever it is. Yeah. Exactly. Exactly. It's all hope. It's all, it's uncertain, but I want to get to that thing. And you can think about attachment trauma or attachment problems as being about that hope not being fulfilled and then the powerful sense of helplessness because of that.

And kind of like the disappointment, essentially, that you're describing. That like internalized, deeply internalized feeling of disappointment, like my needs can't be met in this way. Totally. Right. And now you're sitting there going, I didn't get that milk. I didn't get that hug. I didn't get all those things. So the feeling is the worst human emotion, which is helplessness. I'm not able to control myself. So that resonates every time we try to lose weight.

It doesn't feel as powerful as an infant not getting it. But we still have that feeling like, oh, man, I can't get my needs met. I can't make that happen. I'm helpless. I'm helpless in making my life work. And so one really smart way to not have that happen. is to not change. Sure. To just not have the hope in the first place. Yeah. Yeah. And not act on it because, you know, especially if you've been through a lot of disappointment, it's like, oh my God, do I really want that hope thing?

Or worse, oh my God, I'm feeling hopeful again. You know where that takes me? That takes me to this massive sense of helplessness. I don't want that thing in my life. You've had a lot of bad experiences with it. Yeah, totally. Yeah, you just want to back off on that. So that's what I think is going on in change.

in is this powerful relationship with hope and this this feeling like i don't want to feel like i'm helpless and i can't control my life i want to avoid that feeling and the remarkable beautiful thing you do when you stay the same, is you're protecting something. And weirdly, what you're protecting is hope. I've got this hope in me. I don't want it messed with. I can't let it get hurt again.

That's really interesting here, Ross. And you're making me think of actually an interaction that I had with somebody very, very recently where they're dealing with a significant problem inside of their life. They're highly motivated around it for a whole bunch of different reasons. And there is kind of this one intervention that they haven't done yet that most people point to as like, this is the intervention that you do for this kind of a thing.

And they're very resistant to do this intervention. And I was kind of, there's somebody I have a close relationship with. I was talking with them like, well, why don't you want to do this intervention? It's what people say is the intervention you do. And we really explored it for a little while and what eventually popped out. is they said some version of honestly, I want that to be the last thing that I try. Because I feel like if I do it and it doesn't work, I'm just sunk.

And I'm going to feel so disappointed and so just defeated by that. So I want to kind of keep that as like a last resort here. And I think that just totally is like such a poignant version of what you're describing. That really is. That really is. That really is. I want to be careful not to go on tangents, but I just want to say that there's a real slightly cruel thing going on right now. I'm engaged on some level. I've got a business that's in the psychedelic world. And there's a really...

Yeah, there's a real cruel thing going on right now, which is people are being told psychedelics are kind of the last resort. They're the miracle drug for intractable depression. People are going. They're not getting better. Because it turns out the miracle drug is human connection and therapy, things like that. And they're feeling like that's it. There's no more hope. I did the thing that you do when it's intractable and it didn't work.

That's how cruel our profession can be, because that really is just our profession entering the psychedelic world. It really is just a classic psychotherapeutic kind of narrative and the classic psychopharm narrative, which is, this will fix you. So it really is about sort of... this event where you're trying to protect hope. It's as if you're afraid of heights and you're on a cliff and everybody around you saying, Oh, it's obvious. Just, just jump. It's just, it's obvious. Like just jump, man.

You read the book, you do ABC, you're on C, C is when you jump. You got the parachute on. Yeah. Yeah. Just do it. And the person is like, but I'm terrified, not I'm terrified of hope. I don't want to be pulled into this again. And so then they begin to resist. And then we say, oh, they're in resistance. They're in denial. Right. We start labeling them instead of saying, no, they're they're really worried about this really important event harming them.

making them feel worse about their ability to hope. And that means that staying the same makes some sense. It's not good for us most often, but it doesn't mean it doesn't make sense. We'll be right back to the show in just a moment. This might seem surprising, but I have always struggled to eat enough vegetables. Ever since I was a kid I just didn't want to eat them. And although I've worked on that in my adulthood, it's still not my favorite thing to do.

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Now back to the show. And I think that you're describing a pretty deep level of self-awareness, I would say. Like when you can get down to that layer, you can really get very aware about what's going on inside of you, what's going on.

in the systems that you're a part of, what's happening in other people, all of that. And that requires a degree of, hello, thinking about yourself, contemplation, which is something that you encourage a lot of here. When, again, like I was saying in the intro, a lot of the typical advice...

move into action, start doing stuff. But the truth is that doing is often a way for us to relieve our own anxiety about just being the way that we are or engaging with something in a certain kind of way, whether it's when you're working with people or just how you talk with people about this.

What tends to support people in doing that kind of contemplation? There's a lot that I do that's related to this guy, Kurt Lewin, who's really the person that invented social psychology. Shout out. And then as a coach, you must know, he's also the guy that...

created national training laboratories in Maine. So he was doing all the teaching at organizational consulting. He created organizational psychology too, really. I mean, remarkable. And he believed that we live in these fields. And in those fields, fields of social interaction.

fields around us that affect, like I was talking before, our motivation, and also fields that are filled with our strengths and weaknesses. In every act of motivation, everywhere we are in life towards a goal is when things in that field that are holding us back.

are hitting things in that field that are pushing us forward so every place we are it has to do with whether one is stronger than the other where they're matching each other so staying in stasis is i'm just there with these two tensions hitting each other

And I think that's actually already can be an insight for people because when things are staying just the way they are, it can feel like nothing's happening. A lot of the time, a lot is happening. It's just kind of hidden or it's in balance. Yeah, totally. Exactly. Exactly.

Exactly. A lot of, in other words, they're already on the way to change. Just the burden is so powerful, but it's not as if they're not pushing up against that burden. If somebody shows up in your office, they've already done something courageous.

are we going to respect that if someone says i'm completely blown away by depression are we just going to have a conversation about how do we fix your depression are we going to have a conversation about their courage you're completely blown away by your depression what got you in my office today what got you to be able to do that totally right

Exactly. And then it's really focusing because we live in a culture that's basically problem saturated. It's basically telling everybody they're broken. I mean, it really is. Our arguments now begin with.

oh yeah let's have a let's have a let's have an argument but let's start with the fact that you're an idiot now let's start the argument like basically that this is a society we live in and then we've got yeah so we have to kind of break through what society is telling people what people are feeling about themselves

and get to where the courage is and where the resilience always is. Even the talk of resilience has a problem because it acts as if there's some perfect state of it, that more people have more of it than other people, and it doesn't respect the burden. a person might be experiencing. In other words, their conation, which means the ability to kind of move forward, might be just as strong as someone who's moving forward. But the burden is greater. Yeah, totally. Totally. Yeah.

There's some like stress diathesis stuff in here too, and like all of that. Yeah, totally. Yeah, yeah. So it's that element that I think is really important. And then it is focusing on their context. What are the social resources around you? that give you the strength to push through. So I mentioned those social reasons before, right? The threat and challenge, they really are important at the point when you face fear of hope because am I capable of handling if this falls apart again?

And that's where faith comes in. How do I build what's called self-efficacy? How do I build the sense that even if things fall apart, there'll still be a me there holding it together? And that's why faith in oneself, you can't actually improve a person's hope.

you can improve their faith in themselves and so how do we get to that place where they have some sense of self-belief and faith so they can face hope i would love to ask you about this ross because i think it's applicable both for the work that coaches teachers therapists do with people but also just applying these ideas and our own lives. So you mentioned there that you can increase the kind of faith in the self, but it's difficult to increase hope in an external thing.

one of the things that I've been playing with a lot and that we've been talking about because we've been doing content recently focused on like making good decisions we have a new year's episode that's going to be coming out which is about

connecting with an individual's wants and needs and using that as a way to guide future decision making. Very consistent with some of the stuff in your book actually. Something I've been really thinking about a lot is like how can we make the big bright light of the thing that like is out there that you're moving toward as big and as bright as possible this like aspirational idea for a person something down the stream to connect with call it values orientation whatever you want

That to me kind of feels like making hope big, if that makes sense. Like trying to give them a big target that they're aiming at. They're like, yeah, that's good. And I feel like when I work with people... I can help them really pump up about that big shiny light in the sky. It's actually much harder to help them pump up about the faith aspect.

Give them that feeling of self-efficacy or self-belief, really to develop that in someone, that's tough. And I'm just wondering how you think about that. There's two different things. We can either create change by giving something

bigger to go toward or by sort of pumping up the faith of it. I don't know how you think about it. Yeah, no, no. I think it requires both because what you're talking about on some level is giving them a dream and we don't change without a dream we're heading towards, you know?

And the dream is realistic because it's about meaning and connection. Typically, it's about expressing your values. It's not a ridiculous dream. Almost always it's social in nature. Almost always you want more of some kind of social input. Right. And you have to have that. And dreams are opiates because they make us feel good. I'll be there someday.

Gotcha, gotcha, gotcha. Little achievements along the way are insults. Totally. Yeah, little achievements along the way. And that's one of the 10 reasons not to change. But little achievements along the way are insults. Oh, I'm only here? Oh, I'm so far from that goal? Like every time you make a little change. You're recognizing how far you are to that thing that really makes you happy. And so our job is to actually always frame the little change as how closer you are to the other thing, right?

and to always keep it within that frame for the person and you also need these little changes because to hope you have to have a time perspective you have to have a sense of where things are and so hope has to be sort of dealed out in small increments, like six months from now, where do you want to be in relationship to that larger dream? And then heading towards that, you have to have that time perspective. That's Kurt Lewin too, but you have to have the sense, my hope's connected to something.

I can actually achieve sooner than miles down the road, right? Where it's unclear when it'll happen. Right. One place where I want to spend another minute or two here is the self-criticism and self-compassion aspect of it.

Because you were talking about the two pressures model, the pressures to change, the things that are holding us back. And the perception if we're looking at somebody or somebody's looking at their own life and they're going, why haven't I changed in these ways with a lot of self-criticism?

a lot of the time what's lost in that is a sense of all the work that they've already done to get where they currently are. There's not that appreciation of the movement forward, there's just a perception of the things that are holding them back. But even that perception is often internally loaded for people. They're seeing all the problems inside of themselves.

Right. Kind of stopping them without appreciating the larger like systemic forces that they're dealing with or where they came from in life or all of that. And so just appreciating that can help us both evaluate ourselves and frankly, like be kinder to other people. Yeah. Yeah, absolutely.

If somebody's listening to this and they're thinking something like, okay, that sounds nice in theory, but that's not me. I really am problematic in these ways or whatever it might be. Yeah. I mean, I got a couple of responses. Yeah. purely problematic, you wouldn't be listening to this podcast. For sure. For starters. You'd be gone. You wouldn't be able to feed yourself. There's something there driving you.

And if you're not respecting that somewhere driving you, you're in a state of distortion. You're not seeing the whole you. Your problem is the self-criticism. The thing you're criticizing yourself isn't the problem. The problem is an orientation that only sees problems. because that's inaccurate it's untrue so there's a distortion there and so how do we focus on what's driving you what is the conation what is the thing getting you where you want to go is sort of a vital part of

of helping somebody. And then also, and this is the stuff that gets interesting in what's called narrative therapy, which is also how do we have a conversation about the things you call problems? in a way where you begin to see them also as solutions you're doing, also as things you're doing that sometimes have worked for you. And what is this thing in your life? Can we give it a different name than this problem?

Can we call it something that belongs to you so that you can build a relationship with your suffering? You can build a relationship with these events instead of seeing them as just sort of in you and defining your brokenness.

Because that's what gets us to contemplation is how can we have a conversation where we're actually contemplating that this can actually change, right? Yeah. Let me give you an example. Yeah, this would be great. Brand new idea. Maybe 50 years old. This is a 50-year-old idea. It's radical. You want to hear it? Want to hear it? Brand new. Okay. Anxiety is a disease. In the span of human history, it's only been 50 years when we decided it's an illness.

There's about 100 years of philosophers saying, that's what we feel when we feel like we can't be in charge of our lives. That's what we feel when we do something courageous, and then we recognize that we're in charge of our lives. It is the message to us that we're dealing with our own autonomy. They went out. It's only been 50 years for this disease idea. Existential anxieties from Nietzsche on.

is all about this anxiety issue, about accountability. So when you're looking at your anxiety, there's a way to look at it as, that's me still wanting to be independent. That's me struggling. with how I'm going to be a person in the world. And bless me for having the courage to keep trying. But I'm going to feel anxious by it. The anxiety is going to get overwhelming. It still is horrible. It still ruins my life. But until you look at it as...

a symbol of your struggle regarding your autonomy, you're not going to be able to change it. It becomes just something to work on as a problem, as a source of brokenness. I know that you don't give a lot of advice here, Ross, but I got to wonder from your extensive history here. What do you think? I mean, God, maybe we should.

call Yalom or something. But what do you think helps somebody grapple with that kind of existential anxiety, that sense of deep personal responsibility? Kind of get over the hump of it. Because once people are sort of moving, it's kind of one thing. that first landing moment of end of the day, it comes back to me, can be really tough for people. I think that there's a bunch of things.

I mean, anti-anxiety medications are awesome. They're one of the ones that just has this massive effect right away. But you can't just look at it as a thing you're medicating. It's got to be something more than that. And one is what I just said. having conversations with somebody where you're recognizing that sometimes it's sometimes it's a result of your your courage you're anxious because you're trying you're trying to be an individual another is to kind of

to witness it in relationship to what's going on around you, to say, yeah, of course I'm anxious. This is a tough, tough world I'm living in. This is this thing that's playing out. I've got to kind of take hold of it, but it's also understandable. It's this experience I'm having.

that lots of people have and that i'm experiencing another is disclosure so disclosure is pro it's like a profound medicine to talk about your experience to another fully Even to write down your experience to another makes you less prejudiced, makes you less stereotyping of people, has an effect on your health, has an effect on your mood.

So having places where you can actually just talk about it, this is what psychotherapy was built for, not for saying we're here to fix your anxiety, but a place where you can bring this to light and have a conversation with somebody about it. And then not to feel ashamed by the anxiety, not to see it as when it comes about, I got to get rid of it, but to see it as something that you're going to live with. It won't destroy you, but that.

The goal is to have it so it's not taking over your life. The goal is not to get rid of it. And those might sound like sort of soft approaches, but we got a problem, which is the stronger approaches that focus on anxiety. they don't have a great they don't have a great track record anxiety is a tough one for the field as a whole like we yeah actually really struggle with with treatments for anxiety broadly speaking and absolutely yeah yeah

But I also think it's true that you're describing it as a soft process, but I think it is a soft process. It's a process that feels big and overwhelming, but it is one of those funny things where when I was able to come out of the woods around some of this stuff. it was like the slow movement through 100 different steps. It was the accumulation of a lot of little thoughts, a lot of little interactions over time that

led to me experiencing less existential dread or led to me kind of, I mean, for me, a lot of that was through the lens of Buddhist practice, which is a whole other thing. But, you know, people find their way into this stuff, I think. You know,

The other thing, I don't know how long you want to stay in anxiety and just let's, you change the subject when you want to, but I got to say, like I was meeting with one of my teams last week who's doing just a great job morale wise. And I said to them, you guys realize. You're working with the most complex cases in the community, not locking them up. You're a diverse group, which is brand new to sit around with the diverse group. It's kind of brand new in human history.

to not be with homogeneic groups all those things are happening and you're able to have morale of course we're anxious we are without customs or traditions any longer we're at without a sense of neighborhood We're out a sense of fellowship. All the things that used to wrote, we're out a sense of an agreed upon deity that we can all say is there.

All we're left with is our accountability. All we're left with is we're driving our own buses. So of course we're anxious. And some of us are anxious in a way. that is out of control and ruins their lives. And some of us are anxious, anxious. We're just anxious. It's a sign of our existence in modern life.

So that's one of the maybe the biggest one of the in some ways is like 10 reasons not to change that first one that you talk about, which is kind of the allure of say miss, staying the same protects us from is that shape. all of these 10 reasons take, if I'm remembering correctly. And an awareness of that, that aloneness, that existential anxiety, all of that is one of them. We've talked about a couple of others. You mentioned the insult of small steps, this idea that

even as you approach that big sun of the gold, the smallness of the movement toward it can itself be like, okay, I just moved this far. Among the other ones, or among the list as a whole, do you think that there are any that when you say them to people, they're just really surprised? by or they tend to struggle with them or it's like it's a little unexpected? I've been writing recently about the shock of recognition. So recognition is to recognite.

something strange seems familiar because you kind of know it. And what I have with the experience of the 10 reasons not to change is typically when it works, the person's sort of in shock of, yeah, that's exactly it. No one's ever told me that. I never thought of that, but that's exactly what's going on. And I don't want to sound like I'm selling this thing, but the fact is, is that it's the language that's not being used around them. Existential language is not being used around them.

And so then when they hear it, they're usually like, yeah, that's, that's, and then they sometimes say, yeah, that doesn't apply to me, but this one does, you know, it's liberating for them to know that they're, first of all, engaged in something that's normal that we all deal with. Right.

And that this doesn't have to do with brokenness. It has to do with dealing with expectations, dealing with their own expectations and the fear of being disappointed. It usually holds people. They feel they feel comforted by it. Yeah. So something that I kind of mentioned this for a second, but I would love to go back to it with you because there's this little section of the book that I really liked. I'm actually just going to read it really quickly here.

the strongest enabling factors and the strongest restraining factors this is in that model we were talking about earlier pushes forward pulls back often reside in these sorts of underlying very unique very personal goals how-to instructions don't get at meetings-based goals and don't tell you how to negotiate them because they aren't informed by you and why you want to achieve what you want to achieve.

So you really emphasize a person's unique motivations, essentially, for wanting to either pursue something or not pursue it, saying exactly the same way that they are. We've been talking about this a lot on the podcast recently. I talk about wants and needs all the time. inside of it because they're so deeply motivated. One of the pieces of feedback we always get when we post something about this is, this sounds great, but I can't figure out

fill in the blank. I can't figure out what I want. I can't look inside of myself and find those motivations that you're describing. I don't know what you mean by these very unique, very personal goals. What do you find tends to help people connect with that? Well, first of all, the way to fix that

So that they feel satisfied that you gave them direction is to tell them what to do. It won't work. But they'll feel like they'll feel like you were an expert that gave them really good advice that was worth their money. But but it doesn't work. I got to look smart. Yeah, totally. Yeah, it doesn't work. So they're complaining about something they think is going to work that doesn't work. You know, just tell me how to do this thing.

I think there is a teach a man to fish in this in terms of being able to explore the interior, though. That's the aspect of it where I think there's some mileage. What do you mean? Like helping somebody learn how to interocept, essentially. Helping somebody learn how to connect with. We were talking a second ago about the developmental injury of disappointment, essentially. I think for a lot of people who have that kind of developmental injury, they have a...

a touchy time kind of connecting with their own wants, needs, desires, all of that. Because there's so much pain associated with it, you can kind of help somebody work through that a little bit. Does that make sense? Is that sort of fair? Yeah.

to get to that. You're talking about kind of insights. Yeah, yeah. Great. How do you help somebody develop insight? Better way to put it. Yeah. There's only one way. It's through dialogue. It doesn't happen through telling them what to do. Yeah. It happens through... the give and take of dialogue. And so people leave therapy with skills that they apply, but it's because it came out of the dialogue.

It emerged out of it has a lot of meaning to them and a lot of vitality to it because it emerged out of the conversation, out of the back and forth. And so the number one thing is for people to be in a state where they're having a decent, connected dialogue with somebody.

It's not do this. It's like, you'll get there if you have that dialogue. This is the psychotherapeutic ethos has been lost. This is what it was talking about before it became best practice as you apply. Yeah. Yeah. And this is some like Rogerian stuff and totally. Yeah. I find in general people can get some mileage out of essentially trying to do not technical voice dialogue or something like that, but they can go through kind of an internal process.

of writing things down or trying to explore that and develop that insight over time. But I think you're totally right, Russ. So much of it is about having somebody that you're bouncing this off of and particularly who is reflecting to you in a positive way.

what they see and what you're saying. Who's giving you that kind of reinforcement that helps you air out some of the shame that can emerge as we engage with this kind of stuff. Yeah, yeah. And I talk in black and white terms too much just because I'm- trying to be efficient but but you can be in dialogue with a book yeah if you're able to yeah so a person a person who's able to read and feel like they're having a conversation with the self-help book

First of all, it's pretty far along in their ability to change. Like they're just about there. If they can do that, they're just about there. But you can have a dialogue with advice and feel like I'm taking this wisdom from an elder and applying it to my own life. and in my own way that belongs to me and it's working. You can do that. It's just, that's pretty far along. You're in pretty good shape if you can do that. I would love to ask you a little bit about

in part the kind of injury of small steps, I think it kind of relates to this, this idea of managing disappointments along the way. When a person decides on something, when they look at things, they go, okay. There are a lot of factors in this system. Things are complicated. Sure, all of that's true. Everyone's got these pushes and pulls on them. Everyone's situation is unique. End of the day, what I can influence most is my own.

is my own effort, my own sense of agency, my own accountability, all of that kind of existential stuff. So they've kind of taken the leap around there. Maybe they've even built up that big shiny sun of the dream, the whatever that they're kind of moving forward. They understand that, you know, the only way I'm going to get there is by kind of putting in these various forms of effort. Okay. Yeah. We all feel disappointed along the way.

You know, we all have those moments where it didn't go the way we wanted it to or we tried it on and we feel really defeated like it, particularly for a person who has experienced a lot of that disappointment in the past. That's very reactivating. It's very painful.

And there are even models of addiction recovery that incorporate relapse as a stage in the recovery process because it's trying to build it in as, I don't know what you think about that, but it builds it in as the idea that everyone relapses eventually. The question is, what do we do after relapse occurs?

To me, that can be a kind of disappointment. A ton of shame can come out of that experience for people. I'm wondering what you think helps people kind of manage that and then stay on track with whatever it is that they're trying to do. The concept that a relapse is a therapeutic event can be.

is a really good one it's it's kind of new you know and the older models gave people so little capacity to make choices at the point of a relapse it was just basically your back yeah and there was no language about no you're you're in another state where Your competency is needed. So what if we made relapse an event where you could be competent and you could build your sense of faith in yourself, right? That it is part of the road. And there's an opportunity here.

for you to build faith in yourself at that point too, not to lose faith in yourself. Another example is, and this probably doesn't match a lot of your listeners, but when we help one of our clients take a class, we say to them, can we work out a plan for your exit strategy in this class?

So that if they get demotivated in that class, they don't just start not showing up and then feeling shitty about themselves. They're writing the professor. They're saying, hey, just like anybody would, this class isn't for me. Thank you very much. I'm not coming to class anymore. So then they did the hard work of taking the class, but they didn't erase that hard work by having an experience as a failure.

It was actually the competent act of taking the class and the competent act of ending the class. And so for me, it's always about how can you actually get the person in a position where the disappointment becomes another thing where they build faith in themselves. It's not always possible, right? But that's...

That's what we should be looking at, you know, and people don't want to do that. They don't even consider that there could be a disappointment, but we kind of have to help people get prepared for it. We'll be back to the show in just a minute, but first a word from our sponsors. Now, back to the show. We're sort of wandering into some potentially social work-y kind of topics in a good way, related to relapse and recovery and supporting people through these experiences.

Before we started recording, I was telling you about one of my housemates who works in crisis work in response. And I was talking with him a little bit about this conversation because you know he has such a rich background in working with those populations of people and supporting them really through like the worst experiences of their life you know worst day of somebody's life that's the guy who shows up

And he's a great guy to show up for that. He's very good at it. Yeah. And one of the questions that he had that I kind of got from him is like, what do you wish that people knew about? mental health or like mental health, the way that change works, any of that, that might help improve like our broader mental health infrastructure in support of people, particularly people who do policy. What do you wish they kind of understood about all this?

I wish, I really do wish they would understand the powerful impact of the social experience of having a psychiatric event. That it's the thing that gets in the way of a person then changing. It's rarely the diagnosis that's getting in the way. It's the sense that I'm broken, that I need to be fixed, which are the same thing. Someone's telling you you need to be fixed or telling you you're broken. Mental illness.

You know, if you translate that, it's sick in the head. That's like deeply shaming. It's a total shame. Yeah. Yeah. Personality disorder. Have you met any ordered personalities? So I haven't. So. And I wouldn't want to. It'd be horrible. Good point. Yeah, it might not be fun, you know? It'd be the worst form of insanity. An ordered personality would be the worst form of insanity. So we've got all this languaging of people that just, it's got to stop. It's got to be about...

Other things about having a meaningful life. It's about that struggle. How do we get you to a meaningful existence? I know in my program, a person who hears voices, but has a meaningful existence is much. more of an achievement than a person who doesn't hear voices and is on the tranquilizing effects of an antipsychotic and not doing anything. You can get rid of that mental health issue and not achieve what...

which should be achieved, which is how do you feel connected and part of the world? You know? So I think that, you know, and that message actually isn't mine. That's what's called psychosocial rehab. It's also called the recovery movement in.

In mental health, not recovery from substances, but recovery of hope movement, which was started by ex-patients. There's a lot of that in community mental health right now. And community health is so poorly funded. Yeah, I mean, that's something he talks about a lot too. Yeah.

Yeah, yeah. So we emptied out these hospitals in the 60s and then we didn't spend the money on how to make it happen in the community because we know what to do. We know it's about people living not in congregate settings and residential programs, but living on their own. helping them get jobs, supporting them with a group of people that will keep them in those jobs or back in school. All those things are the things that help a person not only recover but be willing to engage in their treatment.

They have enough social resources to look at their problem, to have a conversation about it, to figure out which meds work and which don't, to have a more fluid conversation with their psychiatrist. All those things matter for a person's recovery. The external triggers for psychosis, I mean, there's probably something genetic going on for people with psychosis, with schizophrenia. The external triggers are stress and isolation.

The United States has this wonderful model where what we do with someone who's psychotic is stress and isolate them. If you're hearing voices, you need a team around you who's holding you in the community. So we go to hospitals because we don't have a strong enough team for the person in the community.

And that's expensive a lot of the time. It's expensive. It's more expensive than going in the hospital. On some level it is, right? Exactly. You know, it's relatively easy to stick somebody in a car, put them in a psych unit. hit him with a tranquilizer. That's a very straightforward, that's a very medical model. Also, one of the things that he talks about a lot is how people really misunderstand what happens in those hospital settings.

If you're going into a psych ward or something like that, they think that you're receiving real therapy and treatment, and that's not what's happening most of the time. No, no. they're actually doing what they should be doing on some level, which is figuring out, getting the person away from anything that's unsafe to them. Yeah, it's very safety-oriented, totally. Yeah, which is what addiction programs are. I mean, we have this weird system where we say,

we're going to get you sober and celebrate your sobriety in a place where you can't have access to the thing that you're using. I don't even know what that means. What does that get you? The person's going back to the thing they're using. It's not.

of course they're sober they don't have access to the thing they're using there are no choices to be made here yeah totally right so sometimes somebody needs to detox they need to be away from the substance and let's just admit that's what we're doing we're not doing something therapeutic necessarily

right? Because therapeutic is how do I help this person build a sense of purpose and connectedness? I mean, I'm really convinced that addiction is an event of estrangement and disconnection with the world. A lot of people agree with you. I mean, Gabor Matei and yeah, totally. Absolutely.

so how do we treat people with addiction in the community how do we keep them connected to things because the system is doing this odd thing of removing people from their lives i think i didn't tell you i have a fancy word for enabling that i've worked on for the last 30 years Okay. When parents enable their kids, I came up with this word. It's called love. I see where you're going. Yeah. And then I came up with this word for addiction that I'm really proud of.

That took me a long time to get to it. The word I use for addiction is addiction. It's a process in our own lives, in all of our lives that can remain its own without it being a disease, without it being a story. of the being diseased it's something we all do and it's something we do that's great i'm addicted to my kids i'm addicted to my wife i'm addicted to creative endeavors

It becomes a habit I don't want to give up on. It takes over my brain. So it's a process that ends up in areas that are bad for us, but it's also a process we all should be like that we have it in our lives. You know, since I got to get back to my work and these sort of things. So we have this process where we tell people it's a disease. We convince them it's a disease. And then we tell them, oh, by the way, if you're experiencing symptoms of this disease, I can't treat you.

That's insane. If you're using, you can't be treated. Oh, yeah. Yeah, yeah. No, this is a huge issue in the field. Yeah. Yeah. You can only get help from the thing we've said is a disease. Once you stop using. Yeah. So it's like saying to somebody, I'm a flu expert, but don't come to me if you got the flu. Come to me when you're healthy. Yeah. And we've got that throughout the mental health system. We've got this thing called.

for borderline processing we got this thing called dbt dialectical behavioral therapy which is basically um a form of therapy for people who have borderline experiences who can make it to a group which means That's a pretty mild borderline experience. Oh, that's interesting to think about it that way. I mean, DBT, as you know, it's like super validated as a treatment, but just like the whole idea of the person is...

is currently in a state of functioning where they can access that as a resource. Kind of like what we were talking about earlier, where if you can be in dialogue with the book about your own process, you're pretty far along the path. That's a really interesting point, Ross. I hadn't really thought about that.

And you tell me if I'm going on a tangent, you stop. No, I think it's interesting because we're talking really about like what supports people in their process at this point. We're going up to the systems level of like, okay, how can systems be more attentive to how people change?

and use that as the framework for the work that they're doing. Yeah, totally. Yeah, I will talk for you just really quickly. DBT is good at stopping certain behaviors. It hasn't been shown to have much of an effect on borderline processes. It hasn't. It stops behaviors. And if we think that...

borderline experience is an attachment event somebody who can actually be part of a group and deal with all those attachments in that group is in pretty good shape there's plenty of people out there that get called treatment resistant treatment interfering behavior they're being called that they're called in denial about their problem who just can't do that kind of care because they're so dysregulated yeah yeah

Understandably. I mean, there are significant injuries that can come along that can lead to a person not feeling comfortable in a group setting. I mean, we've had people on podcasts in the past to talk about group, and it's one of those interventions that like… When it's a fit for a person and when it works for them, it's incredible because it's all of the social support aspects that you've been talking about so far. It really gets people in touch with that. When it's a bad fit, it's a disaster.

That's right. And so group tends to be very, people either love group or they hate group. It's very, very rare that I've talked to somebody and they were like, oh, I had an okay experience. You know what I mean? Yeah. The curative event of AA, if you ask most people in AA, it's the meeting before the meeting and the meeting after.

Yeah. And it's the, it's the fellowship. It's the fellowship that's having the effect and not just that. I mean, that's a kind of a beautiful process AA, but, but that fellowship aspect. I think you're totally right. Yeah. Yeah. It's the thing that's drawing people through, you know?

So groups are great, but let's face it. Most groups are because of money. Most groups are, it saves money. Yeah. Yeah. You can't do individual work or you can't see all the 10 people individually because it takes 10 hours and so on and so on. Yeah, totally.

One of the things we talked about for one second that I want to loop back to here is psychedelics, because psychedelics are one of those things that a lot of people, like you were saying, are holding up as, oh, maybe this is the direction that treatment is going for people who experience.

treatment-resistant, fill in the blank, which is just our way of saying we haven't yet figured out how to serve that population in an effective way. And we're hoping that psychedelics will kind of fill that void. Yeah.

Maps is one organization that does a lot of work in this area. There are a lot of organizations that are trying to get... I could futz some of the details of this, but essentially psychedelics decriminalized for medical usages in different kinds of approved therapeutic settings so that they can be used by therapists with

individuals. That took like a big hit in the United States earlier this year when the FDA was like, I don't know if I believe these studies that you're doing effectively. Or like, the results here are not so great. in part because they were thinking about it in terms of that very classically medical model. And psychedelics just don't work that way, as near as we can tell. They're not something where you can just inject somebody with a given dosage of psilocybin or MDMA or whatever it is.

and expect them to respond to it in an extremely consistent way where we can be prescriptive about it. You had a great- piece that I think that you co-wrote for The Guardian about this. And I was wondering if you could talk about it maybe a little more. Yeah. Yeah. It's been a fascinating world to be sort of part of it, but on the outside, you know, I start to get a little...

irritated by the whole thing. Well, and also you work with populations that theoretically could be really potentially served by this kind of stuff. Yeah. Yeah, I actually think like ketamine would be great for more of my clients at Ellenhorn. I haven't gotten there at that other company because I think it's a great medication for institutionalization, for fear of hope and this sort of thing. Yeah, I've had friends who've done ketamine therapy and yeah, totally. Yeah.

Where to start? Basically, there's been this movement towards what's called best practices, which is all these little technique-y things we do that supposedly fix people. right? I love that phrase, this movement toward, quote unquote, best practices. That was a great phrase. Yeah. Okay. Yeah. But it is this sort of idea, like you got this one tool for this one thing. Totally. And it's removed anything that's about the relationship on some level.

And psychedelics just sort of entered that sphere. It became part, it became all about, let's do family, let's do this technique with psychedelics. And psychedelics became kind of a best practice for these things. So it became...

It became, like I said, profoundly anti-psychedelic. It was all about like fixing people, right? And creating a lot of disappointment for people and also just participating in a world that's telling everybody they're broken, you know, that this is going to fix your brokenness.

You have this problem, here's how you solve it. Yeah, totally. Yeah, yeah, yeah. What most people believe about something like MDMA is it facilitates a better relationship with your therapist, which is a good thing. Deepens connection, yeah. And you can't sell that to the FDA. It has to fix the problem. Now, what MAPS will say is that they know that, but they had to sell the other broken version to... To get FDA approval, yeah. Yeah, yeah, yeah.

But go to a psychedelic conference. Everybody's talking. It's not some Trojan horse. Go to any psychedelic conference and everybody's talking about the miracle of fixing depression. It's not a Trojan horse. This is how people are thinking. They are thinking in a way that they found a way to fix these things.

Yeah. Not everybody, but there is that kind of cultish kind of this is we found the answer. No, for sure. I mean, you can watch clips on YouTube or whatever of these various conferences. They're kind of wild. There's a little cultiness about some aspects of it, I got to say. Yeah, totally. Yeah.

And then it gets even crazier because people talk about how it's going to make the world a better place. Yeah. And often opening people up to like a certain kind of progressive ideology, like all of that. Yeah, yeah, yeah, yeah, yeah.

We have such evidence in that now because look what it's done just so beautifully for Elon Musk. It's just changed him in a way where he's just this generous, caring person who wants to save everybody. Oh, yeah. Yeah. When I think of Elon, that's what I think of first. Yeah. Yeah. Yeah. And so that's kind of like this other story. And they're all stories that removes our humanity. We change the world through direct action. We change the world through protest. We change the world by doing things.

We don't change it by changing our consciousness. We do change the world. It's an action. And it's removing that when it makes that promise. And the same is true with therapy. Therapy is a doing event. It's work. It's not putting some pill in your mouth like snake oil. And the next day you're not depressed. And so psychedelics can help with therapy. What they're helping with is the number one way in which people change, which is through dialogue with someone.

who's focused on caring for them. They just help that process. That's the number one thing. And so when they talk about people holding space for someone in a psychedelic experience, and everybody's now a space holder, everybody seems to think they can do it. There's one way to say that what you're doing is you're holding space to keep the person safe, right? To contain them. I think that's sort of true, but I think that there might be something else going on, which is that...

You're enriching the person's sense of being held by you. Yeah. No, it's like the warm container. Yeah. Yes. The main event is I'm being held by you. I'm in dialogue with you. The person might not be thinking like, oh, it's just. The space holder and me are having a conversation, but they're feeling this sense that they're part of something with them and in collaboration if it's working. And so the event is so important as far as the human factor.

And then we've got these, you know, we got basically a Botox. It's serious. It is like a Botox model where we basically have you go to a ketamine clinic. You don't see anybody. You sit down to give you an IV and then you leave. and it's it's basically doctors making extra money just like in botox doing something that doesn't require any labor superficial treatment yeah yeah it is yep and it's like these factories factory care you know and people don't get better than that

I don't know why this was coming to mind for me, but I was thinking a little bit about the difference between the words that you say to somebody and the landing event, like the emotional landing event of the way that it kind of connects with how they feel.

And that can be something that psychedelics are really good at. They kind of open people up to the full experience of the warmth of another person if it's done in the proper setting, proper environment, proper substance, all that kind of stuff.

that can be extremely therapeutic for people. But again, it gets back to that connective aspect that you're talking about. It's not so much about the words. The words matter, but it's not so much about the words. It's about how the words are said and how the words are received by the other person.

And I think that's also the gap in a lot of people's relationships, frankly. If something's gone sideways in a relationship, it's often because that landing event has gone sideways. People are often saying the right things, but it doesn't feel that way anymore. I agree. And I think if psychedelics were to land well for me. Yeah, what would that look like? It'd be assisting good psychotherapists, not people that went to a six week training on psychedelic assisted psychotherapy, which is.

It would be an aid within good psychotherapy. And it would also be something that would help people spiritually. Sometimes they go and they do a psilocybin retreat, and it does help. And the other thing that psychedelics do is they get us to a state of... What I think of as fathoming. So you could say, my parents didn't treat me well. Psychedelics can bring you to the experience of what that was. The unnameable. So much of our existence is not wordable. Yeah.

where you're just fathoming it. You're like, okay, that's what that was. That's, oh, oh, that's it. And from that usually comes self-compassion. It's like, oh, that's why I did that. That now makes sense. God bless me for figuring out a way to build a life considering what happened. That stuff can happen too. It can last. It can last better if it's brought back into a therapy. I don't want to claim it can't change a person's life. it'll have a better effect if it's brought back into the therapy.

I think you're totally right. And then whatever is revealed, I mean, there's a reason that like good kind of psychedelic processes that people have mapped out include a lot of before and a lot of after. And at that point, you got to start asking yourself, how much of it is?

substance and how much of it is the good therapy that this person is doing before and after. Yeah. Yeah. And the answer is, you know, it's probably both for people with more, with less tractable challenges that they've been dealing with in their life. Yeah. I'm feeling right now not fully. me isolated from you, but me in a state of sharing with you an experience. That means my brain is working to understand what's happening in your brain.

And also to capture who I am in your brain, in my brain, figuring that out. Now, you want to tell me psychedelics are miraculous? No, that's miraculous. That's miraculous. It's right there, baby. We already got it. But that is like mind-blowing that we do that as human beings, that we communicate in ways where we feel connected.

Because we're able to see a person's other intentions and thoughts on some level, guess at it, and see ourselves in their eyes. That we're not appreciating that, that we're not in love with what humans do. to be with each other that we don't we don't make that our snake oil and we make it something you put in your mouth that really that's what pisses me off about psychedelics that they're they're downplaying the human element as the profoundly psychedelic thing

In the sense that it's playful, it's novel, it's always creating something new if you let it. And we can do that through art, through conversations, all those sorts of things. It's why I rarely do them. I don't. I rarely do. I don't want to leave this. Yeah. Why would I want to leave this? Because you're very connected with that aspect of your experience. Totally. Totally. Yeah. I got no interest in going somewhere else. This is freaking wild.

But it does help when you feel stuck. And especially people that feel like their lives are just no novelty to them. It's just habit. It can really shake the snow globe. That's for sure. And then it's about what are we doing to help that land in a meaningful way before? Absolutely. Absolutely. And that's where you see it. People who are radically habitual, they're like, oh my God, they're like blown away because they're so radically different. Yeah, you got to break it up.

This has been so great, Russ. It's been just so great to talk with you. I've really enjoyed this conversation. Thanks again for taking the time to come and talk with us today. And is there anything that you want to be sure that people know about your work, any place they can find you, any other projects you've got coming up?

I would love it if people would read my last book because it touches on these things in a more poetic way. And that's Purple Crayons. I'm really proud of that book. And it touches on what it means to live a creative life. in our times and i mean not to be grandiose but what it means to to be so afraid of your own autonomy that you you give up your freedom i'd like to give a plug to that thanks so much for doing this ross i really appreciate it absolutely man

We've recorded almost 400 episodes of Being Well, or right around there. It's a wild milestone to look back on and to think of all the people that we've talked to. And I have to say, out of all of those episodes, all of those guest interviews, man, this was really one of my favorites. I really loved talking today with Dr. Ross Ellenhorn about how we change. And I just really appreciate Ross's perspective here.

which is quite different from the more traditional, procedural, dose-ized medical model that therapy, psychology, personal change has really fallen into in the last 20 to 30 years. And I just want to say for a second, there are some benefits to that model. A lot of people are really served by it. But when it comes to personal change, I think that so much of it comes down to a couple of things that Ross has really identified and focused on.

as major variables, major questions for a person. And we just don't talk about these things enough most of the time. He really focuses, for example, on the power of sameness. Like, what are the things that keep a person the way they are? Why is there an allure to that? What are the benefits that they're getting out of their current behavior?

And particularly, what are the kind of pains that they're avoiding by staying the same? How is staying the same a kind of nurturant act to who they are right now? And dropping into that perspective on it. can really help us become so much more compassionate about our behavior. We talked for example about the push-pull model, the things that are holding us the way that we are, and then the energy that we're trying to put into change.

And a lot of the time, people feel like they're kind of stuck in that model, right? I'm not moving. I'm not changing. Nothing's happening for me. But that's just a fundamental misunderstanding of what's going on. They're seeing that stability, the stability that's been created. but they're not appreciating that that stability is coming, at least in part, based on an enormous amount of effort that they're expending to try to make things better already.

And sure, they're facing equally great headwinds. They're facing equally great pressures on them that are trying to keep them the same or even move them backwards in life. And it's their own good effort that's allowed them to come as far as they have. Obviously, two people can be in similar circumstances. and have spent radically different levels of effort in order to get there based on just providence, good luck.

whatever else is going on inside of their social system or their family system all of that kind of stuff and once we start from that stance change becomes so much more possible we develop more of an appreciation for the part of ourselves that is resisting that change

and often the good explanations that part has for why it's doing what it's doing. Then we develop that empathy, that sense of connection, and that can really help us move forward. And that gets to one of the big themes of today's conversation. which is just the role of relationship in any kind of a meaningful change process. And this could be a relationship with a lot of different things. This could be a relationship that you experience with me.

as you listen to this podcast or as you watch a video like this on YouTube. For some people, it's a relationship that they have with a therapist, counselor, coach, somebody who's directly helping them out. A lot of the time for people, it's a relationship with friends, social support. If they have a positive relationship with parental figures or their children, something like that, that can really carry them along. For people who don't have those things,

there are often other ways that they can connect, other ways that they can experience social support. Reading a book and exploring how they feel about it. We talked about that a little bit on the podcast today. And this then connected to the conversation that we had about social work and about supporting people.

who are experiencing really extreme and complex states of mind and mood, how a lot of the time those people are put into situations, often against their will, that are completely disconnecting. And the experience of a psychotic episode is itself incredibly disconnecting.

And Ross really pointed to that as something that he wished that people understood more about this kind of work or this kind of treatment, how that episode itself is this profoundly shame-inducing, profoundly intense experience for a person. So they don't need...

A lot of other people come into the system and telling them, oh, by the way, you're messed up now. They're already doing plenty of that to themselves. So the question is, how can we be more supportive, more compassionate, more understanding of that person's experience?

And how can we move them into situations where they can get more social support from others? One of the ideas that came up during the conversation that I'm going to get a lot of mileage out of both in my personal life and in my practice with other people. and I hope has some value for the people listening to this podcast, is the idea of the fear of hope. Hope is an emotion that we think of as being this purely positive experience, but hope's got a lot of downsides to it.

Once you start hoping, you open yourself up to intense disappointment. And I loved the connection that Ross drew between adult forms of hope, that experience, and the fears that we have around it. and how that might exist in a more developmental model. What's a kid doing? What's a baby doing a lot of the time? It's hoping. It's hoping the parent shows up. It's hoping it gets the milk. It's hoping the parental figure is really nurturing toward it, holding it, co-regulation, all of that stuff.

And a lot of people have developmental injuries in that space. It's actually pretty uncommon for people to have the truly good enough parent in their life for a lot of complicated social reasons. That's an unusual experience. And so because of that, most people are carrying around some kind of attachment injury, some kind of a feeling of hope and then loss and then intense disappointment.

So these experiences come along in adulthood, we start seeing something out there in the field that we could hope for, that we could long for. Well, what happens? We cut ourselves off from that hope so we don't have to risk that kind of disappointment.

And that's how a fear of hope can build in a person. Hoping is a risk. It's a scary emotion. But in order to really change, you need a combination of different things. One of them is hope. You need to see, like I was saying to Ross, that big, bright, shiny sun. that you're kind of moving towards or that you feel pulled towards or, oh, I have this value that I'm going to try to achieve in my life. Okay, whatever it might be. And then you also need faith.

You need belief in yourself. You need self-efficacy, a sense of yourself as an individual who can get things done. And good therapy, good work, is really focused on developing both of those things at the same time. We're seeing the thing that we're being pulled toward that more values orientation. And we're seeing the ways in which we can increasingly rely on ourselves based on evidence out in the world.

And hey, bringing it back, a great way to develop a sense of that self-reliance is by appreciating all of the pushing factors that you have applied in your life. to push back against the resistance that you faced in order to get to where you are right now. I didn't actually name Russ's 10 reasons that people don't change during the podcast. I'll just do that now. They all take the form of staying the same protects you from.

And then there's something that comes after that. So the first one, which we talked about at some length, is existential anxiety, an awareness of aloneness, and soul accountability for life. I wish that I'd asked Russ a little bit more about the idea of soul accountability.

in a broader conversation that was so about connection and so about finding social support and so about the impact of circumstances on somebody's life. Just because I'm interested in kind of how he squares that circle, that was the very first question that I started with. I thought he gave a good answer to it.

But I sort of wish we had spent more time there as well. Then we've got staying the same protects you from the unknown, from your own expectations, the expectations of others, seeing where you are. the insult of small steps. In other words, a perception of the fact that that big shiny goal is like a long ways away. And oh, I've only made this little step here. You're really telling me that that's, that doesn't feel like enough.

And here's one that's really interesting. Staying the same protects a monument to your pain. Staying the same protects you from changing your relationship with others. And then finally, changing your relationship with yourself. And appreciating all of this, appreciating all of the understandable reasons a person might have for not changing, can really help us exit this kind of change, good, same, bad paradigm, this black-white dichotomy that we've set up in people.

in the broader mental health space. And I think what a lot of this just keeps on coming back to is self-compassion, frankly. And I know we talk about self-compassion a lot, and some people can really struggle with it. It can be a difficult experience to access. But I'm focusing on it because it is essentially the opposite of shame. And shame is what comes up for people. Shame is really the experience, I think, that gets in the way of change a lot of the time.

Because shame is what stops us from looking at all of this clearly, from looking at the motivations to not change, from looking at the way our life is right now, from looking at the things that we've done and things that we haven't done. Shame's at the root of all of this, right?

And that's why I think Ross's approach here is so novel and so powerful, because it helps you essentially get on the same team as the parts of you that have really resisted change. And that getting on the same team-ness of it all... is what tends to really help people out. We talked about a whole bunch of other stuff during the conversation. We got into a really interesting conversation about

mental health systems and what Ross wishes people understood about them a lot better. We talked about psychedelics in some detail. I thought that was a really interesting conversation. I could have talked with Ross for easily another hour about all of this stuff. He's just such a thoughtful guy. And I hope that you enjoyed today's conversation.

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