How do we know therapy is working?

There's reality, which is loving awareness,

unconcerned by the arising and passing away of phenomena.

And then there are the 10, 000 things.

Welcome to the 10, 000 things. My name is Sam Ellis.

I'm Joe Loh.

And I'm Ali Catramados.

Today on the show, how do we know if therapy is working? Uh, I propose this topic. I've been doing a lot of work in the last three years in psychoanalysis. And sometimes as I speak, to my psychoanalyst about, it's a bit, unclear if it's working. Ali, Sam, also both in therapy, uh, what are your thoughts?

I think Sometimes it's impossible to tell and other times you really feel like you've just aced it and you walk out. Going, Oh, mate, I'm cured. I'm there.

Oh, no. See, I always feel good afterwards, but what's not clear is what's changing.

Hmm. I have like, so I'm like, Sam, sometimes I come out and it's like, Oh, I really feel, you know, like positive. And then sometimes it's not so

Yeah, that's right. If you're trying to measure progress against some sort of ideal image of the self that's gonna be, you're not gonna see it that much of it. You might see some, um, and yeah, it might be good to have high aspirations and high expectations of yourself sometimes, but if you are, one of the big problems with the human mind is that it's very good at, healing over the scars of its own changes that it's had to make over time. So neuroplasticity, which is like good news.

I've done it every day since March.

Yeah. So yeah. Can you, can you say

like, I had to look back the other day, actually, I'm a bit scared to look back.

Yeah. It is. It's horrifying sometimes.

Uh, yeah, I mean I, there's stuff, there's obsessive thoughts that are stuck in my head and I actually use, I've been using prayer actually to overcome one of those, uh, which has been incredibly effective and an atheist could say, oh well you're just rewiring your neural pathways. Yeah. I would say I'm asking them high power to help remove an obsessive thought from my mind and finding that it's 80 percent.

If it works, it works.

That's what my therapist would probably say. I mean, she said that she feels like when I came in three years ago, I had small boy's fears and a small boy's mind in a lot of ways and that I've matured in the last three years. But what you said is really interesting is that if I haven't matured in the previous month, I'm only referring to myself two weeks ago or whatever. I'm not, it's very hard to access January 2020 Joe.

Yeah.

I still say boo to that therapist though. What they should be saying instead is, okay, mate, maybe you don't understand what like. Actually, no, the Sopranos is not a bad example in some ways, but you know what that therapist should be saying in my unprofessional, but nonetheless expert opinion, damn it. I've earned the right to talk about this. That therapist should be saying, this is more like a personal trainer.

I really love that metaphor. Yeah.

Yeah. And if you, yeah, if you don't want to do the reps, that's okay,

but don't don't expect results.

Don't

Here's a question for you. Yeah. Is there a 40 year old who doesn't need therapy? Uh, I, I, I would say no, no.

Yeah.

I would say you've had enough trauma. Even if you don't have a mental illness, you've had enough shit go on, by the 40, and also you've got death looming.

You're at the halfway point, probably.

If you're lucky, if you're really lucky. I think if you've

got, yeah, for, for, where was my train of thought with this? Sorry. Um. Take your

time. We'll cut it out, Ali, so you seem really switched on. Always sharpen you up, mate. So what, what did you say? Is there a 40 year old who doesn't need therapy?

No, no, like I think you, It's in the same way that I see going to the doctors regularly, going to the dentist regularly going to, you know, it's the brain

person that doesn't need to go to a GP?

No, exactly. Yeah. It's a part of our body that has a huge part of, you know, like our brains have a huge impact on our day to day. You should keep on top of that in the same way that you would get your car serviced, that you would get, you know, like a lot of responsibilities. And I think mental health is just one of those things we need to add into that needs to be maintained and updated and. You know, and stay on top of,

yeah. I mean, so I guess for me, it's like a, it's like a teeth cleaning. It's a, it's a brushing the teeth. It's like a, it's, it's a high frequency, uh, for other people. And maybe it's like, you know, that super duper clean you get every 12 months at the dentist. But I would suggest, even if you don't take it up as a weekly thing, um, some people even go twice weekly, God knows how they afford it, but you may not need that, but I would definitely recommend like a good stint. And then a break.

reality is in Australia, incredibly privileged, you can get 10 sessions basically for free. And so, so, so people say it's too expensive. It's like, well, it's not if you're an Australian citizen. I'm not going to take the bait. No.

But that's a rebate though. So the thera what the therapist charges might be considerably in excess of what that rebate is. You get most of it back.

You're gonna get most of it back. It's not, it's not, it's not a financial, it's not a financial problem for the first. 10 sessions

also, you have to look at the savings that ultimately you're gonna be experiencing some major financial savings because it's probably, it close

my mind that we, we do that here, but we do it, you know, we do do it. And it's amazing. So there's no financial reason really for most people not to get 10 sessions with a, with a therapist. There's a stronger aversion and I'm mostly talking to men to going to therapy. Yes. So I guess what I want to lay down is concrete. So, there's a lot of stuff Sam, like how do you know therapies working?

there were times when it wasn't, there were times when it wasn't working and a good therapist will confront that and they'll get you through it. And so it's like, I, you know, I've noticed a pattern in like the last three sessions, you've done a lot of this. And then right before we're about to finish up, you'll get started on the thing you really want to talk about. Here's, you know, here's your homework for next week. Why don't you give a bit of thought to,

I prefer to work these things out myself. Yeah. Good one. Good one. I prefer to work them out myself. How's that been working out

Yeah, Bill Burr said therapy was bullshit and oh yeah, you go in and just talk about the few big things that have happened and then you don't, there's no need to keep going.

Uh, no, no, he does it. No, he does it. And well,

that's what I, I saw a video of him and this is a deep fake Sam. Oh,

it might be an old one though. No, no, no, no. He's, he's, he started it a while ago and I'm pretty sure. And more importantly though, like he quit drinking like four times and then it's stuck on the last time. And he does. Two weekly, two weekly shows, which, I know he's on to three or four now, where he's actually constantly examining himself, like you see it, and so like, uh.

is.

But this show is, I don't know for you guys, for me, it's incredibly therapeutic, but it's also not formal therapy. It's not. Uh, like you talk about the end of an email, I hit the end of a therapy session. We're flying by the end. By the time we get to 50 minutes, it's like. Like, there's like fucking fireworks going off, you know, like there's so much flowing out from my whole life and it's like, and that's the end of the session.

It's a bummer. I was reading about the castration thing, the castration complex or castration anxiety and where that really originally came from. And it was Freud's observation that people always felt like they were making the most progress right when the session had to end and that there would be this fear and resentment

Make it weird and about balls though, didn't he? Yeah, he did.

Isn't that Freud though? Yeah, yeah, yeah. He's very genital focused man. Like where's the balls coming. And the bum and the bum as well, all about the bum. But like, I think there's something in that that like you have to place limits on things and it was his observation, we don't like that.

And then you focus for next week. But like, yeah, I don't take drugs, but I would love to do like, uh, The an MD M D M A six hour therapy session. Yeah, so M D M A first came about and this is how it's used now with That's right. It was used clinically at first. It's, it's used now with people with ptsd. Ts

ptsd, TS d Yeah, I'm, I'm gonna sign up, could

handle like six to eight hour M D M A therapy session where I talk about my relationship with my parents or whatever.

I wanna do the ketamine actually. But yeah,

just take ketamine. I can get you some. Just fucking take it. Something really weird will happen. Time will stop working. You'll feel like you literally spend eternity in there and then you're like, time kicks back in. You're like, oh my God. I was in there for eternity and like my hand was giant and like it's stressful as fuck, you know? But you feel maybe good the next day.

I would, you have to get the exact right dose,

but yeah, you are not talking. Can it mean you're not doing talking therapy? Oh, no, no, I mean, I'm interested in doing both. For MDMA, your emotions are protected and opened up, right? So, but leaving with it, I would do seven hour caffeine therapy where I just drank coffee and talked more and more and more and more and more with my therapist.

Twice a week. I'd go

twice

Yeah, we're here to talk about you, there's a tip from the top, uh, yeah, if you're not entirely sure what to go in there and talk about, just Just pick any significant childhood memory and start there. Like it'll, it'll lead you somewhere.

Yeah, but they won't tell you to do that. You can decide to talk about whatever you can go in and just talk about what you have for breakfast if you want. Yeah, it's your time. It's your money.

Also, I think a lot of people hesitate to go to therapy because they don't want to go in there and walk away hating their parents and blaming their parents for everything. It's actually the opposite of that. Yes. It's about letting go of blame and hate. Yeah, it really is.

Oh, that's a good one, Sam. forward. Yeah, I've certainly experienced that with, when it comes to my family and any resentments and things like, and being able to move really positively forward with that. Like that's, that's been huge

for me last week that she feels like we're, our relationship's so much better since I've been going to therapy.

Yeah, it should be. Yeah.

And I've processed a lot of stuff to do without my relationship with her. And it's like, You think that you're going to be prosecuting your parents in the, but yeah, it's exactly what you just said. I think.

Work on yourself, man. That's it. Yeah.

I think it's a big misconception. And we also have the dead parents, Sam.

Yeah. It seems especially unfair, doesn't it? But it's like

they're sainted. Yeah. Right. That's right. The sainted dead parent. But it's. It's still worth looking at your relationship with them

and it's through like that exploration

to, in fact. Like yourself and then, you know, and seeing yourself as a complex and flawed person and then seeing your parents as...

In the same light.

In the same light as complex and flawed people who made mistakes and then, yeah, that understanding and forgiveness and going, okay, I know. Yeah, this might've been a mistake and it's also acknowledging, okay, this really hurt me. I, my feelings are valid around that, but also similarly, they were doing the best they could with what they had and you know, it wasn't a malicious, you know. Thing. It was just, you know, they've made a mistake and it doesn't minimize the impact it's had on you.

which is fundamental to growing up. Yeah. Yes, exactly. That's actually what growing up is. Yes. Giving your parents, yeah.

Yes. It's brilliant. It's 90% of it, I reckon, and, and it because, and not to understate it, because it's like, oh, well great, well fine. I'll just forgive my parents. Done. It's like, eh, actually, yeah. You haven't gone into it yet. Yeah. Yeah.

You've been very clear that in hindsight, your parents shouldn't have sent you to a martial Hare Krishna boarding school. Yeah. It was a big mistake. The weirdo that you ended up becoming is. Yeah, in large part due to the trauma of that time.

Yes, there's a lot of manure here that's turning into roses hopefully, but the truth is it's and as much as like I've made So they fucked that up? They did. They fucked it up.

it's going to feel like. I asked my therapist last week, I said, can I resolve this stuff? And she said, no, no, but you can carry it much more lightly than you have been. We

have to carry these things lightly, Adam says. I was going to say,

Ali, what... How do you know that therapy is working for you?

Well, like even like this last week, um, I opened up to Joe about some stuff that had happened to me when I was younger, which I'd always. Historically, what one did not speak about at all, I couldn't even verbalize it, I got to a point where I could start to verbalize it, but I would get myself into such a state of extreme distress, like we're talking like throwing up, crying, like it was really extreme. And so I just, it became a thing like, I can't talk about it, I can't talk about it.

But without being detached from

it either. Yeah, it's not detached from it because it's still very hard and painful to talk about. But, I haven't... Yeah, I mean, I don't talk about that openly with many people at all. Um, or at all, really, I mean, mainly in therapy, but yeah, just being able to, you know, as my, and I, I did say to my therapist this week, I was like, Oh, I was actually able to speak to a friend about, you know, some of this stuff, like for the first time.

that's the thing about friends who are all doing therapy Which is us on this podcast is that you shared that with me. It was horrific Maybe one of the worst things I've ever heard from someone I know but and then it stayed with me for a couple of days and disturbed me but because I'm doing therapy That's okay Because I got my own shit floating around and it's always kind of disturbing me. Focus on someone else's.

stuff. I think you're ready for a relationship after all, Joe. Because

it's, it's interesting, like, I've always been very much... It's not with Ali. It's a

wonderful thing you two have got, don't mess it up. Um,

yeah, but like being able to share, yeah, sharing that information and knowing that yeah, it is. Yeah, I don't want to expose anyone to any sort of vicarious trauma. It's quite, it's quite, it's not a, like, yeah. And feeling comfortable that, yeah, Joe would be able to like, to handle it. And him also reassuring me that you can tell me or that, yeah, I can, I can handle it. And, and knowing that, okay, he's, you know. Yeah, he's not going to take this on personally.

it. I just get really curious as to like why people are the way they are. Yeah, and until they explain to me their trauma. Yeah, it's very, it just becomes, if you get close enough with a person, there's a certain point where the stuff that's hidden behind Yeah, the black wall or whatever. You need to know that stuff because it's hinted at all the time. Completely agree. And... Once you know the extent of it,

It's so much easier to forgive that person for

things. Or just an understanding of like, oh, I can understand why they're behaving the way they are now. It is, it's that understanding of like, why on earth would that person do that? But in the context of, well, they've experienced all these things and this is the patterns of behavior that are a result of that. Oh, that makes

sense. And the, the, the, the part, the, the way that I didn't like to get that information was working on a psych ward. You could look up people's file, and you could see what their trauma was, as in the criminal stuff, or stuff that had happened to them, and I used to never look up patients files, because I only ever wanted them to tell me, as a peer support worker, what they wanted to tell me, and not be defined by it was Whatever horrible things that happen to them.

them. And the same thing often happens in education. Yeah.

Yeah, because it's yeah You're looking at it through the lens of okay Well, these these traumatic events have potentially created a series of personality disorders or like diagnosable things And so I mean from a clinical point of view that they would need to know that information Whereas your role as a peer support worker is different in that you don't have to have that lens clouding, what you're providing to that

But the wonderful thing about my therapist, and I would broaden it out to say about psychoanalysis, and she's a Lacanian trained psychoanalyst, also a clinical, clinical psych who's worked in hospitals, and maybe still does, because she's mysterious, doesn't tell me anything, but like, The refreshing thing about her, I had psychologists in the past who kind of gave me a bit of a pat on the back and said, Oh, you're not doing so bad. Oh, we all worry about stuff like that. Don't worry about it.

can't, They're not so much interested in the reason why,

Whereas

Peter was willing to step right back and be like, I don't even care about your bipolar diagnosis. I'm not going to... It's neither here nor there for me. It's neither here nor there. Let's work out why you are the way you are. And if some of that involves some bipolarity, she almost approaches it like a literary device. Like she was talking to me the other day about two tracks of thought, my father and my mother, and they're on separate tracks.

hmm.

Therapists, they I mean, there's a lot of evidence with bipolar that there's obviously a genetic component. There's a genetic factor, but it's actually a traumatic event, not necessarily drug use. It's actually trauma that then triggers it into becoming, to be expressing those traits as genetic traits. 25

years since, 30 years since Dolly the sheep or whatever, and we still don't. Have strong genetic correlates for a lot of mental illness. Like it's really pretty poor, but it suggests that nurture is playing a huge role here.

I would suggest Sam, I'm going to do a Sam impersonation. Yeah. Right. You ready? Yeah. To any bipolar people out there, I would suggest you have both a psychiatrist and a psychologist. Yes. Now the psychiatrist will keep you functioning in capitalism and paying your bills and rent or mortgage. That's true. That's true. 'cause they'll medicate you correctly. Yep. So that you can be functioning, be functional, functioning.

what I would say though. Yeah. Yeah. Yeah. I think, no, I think, I think it was a fair impression. It was very complimentary to me. Thank you.

I think it's because you're a teacher. You're quite comfortable just being like, I think you should try this. It's more than comfortable. I get very uncomfortable trying to suggest to anyone that they should.

It is. It's not just comfort. It's a, it's a goddamn awful habit that I have, yes, of being didactic, Joe, I do apologize, but so

it sounds corny, but it's as simple as, tell me if I'm wrong. Yeah. It was horrible. Yes. But you left the boarding school? Yes. You're never going back there? No. And it's like, that's in the past now, Sam. You're never going back there again, Sam. And it's like, some of this stuff we're walking around, I can't, a psychologist might be able to explain why you are certain ways because of those childhood boarding school experiences.

Well, it's not hard to see, yeah.

I struggle to see some of that stuff. That's why I wouldn't be a very good therapist. But I can understand from doing therapy that they're gonna... The part of the job for you is to close the door for one last time on that boarding school and really feel in your body that you're now safe and you're not being trained to be a paramilitary Hare Krishna kid, you know? That's right. Only you can do that. The therapist can't do it. I can't do it.

They can say it. Like they can suggest like, yeah. They can't say it in the first session. Not in the first session. No. They've got to hear you

for

years. You've got to, yeah, you've got to really feel it. And then like, yeah, they can direct you towards you are safe now. I certainly have had my psychologist tell me, yes, but like if I'm, you know, talking about a perceived threat, yeah, but you're safe now you're here in an, in a very grounding way. It's like you're in this room with me. You are safe now. Even though this person, you know. He's not here anymore or whatever, you know, you are safe right in this moment.

that's right. They have, they have to avoid editorializing as much as possible, but, but it's like, for example, to hear from Adam was very affirming, you know, recently he just, he really didn't want to say it, but he kind of eventually felt the need to do it. That C. You are a competent pair of hands. You, other people can trust you. You can trust yourself. You

don't get that out of them easily.

No, no, no. I get quite a bit

of that.

Like yours is a much more of a booster than mine and Sam's. Cause you're not doing psychoanalysis,

are you? Oh, no, there's, that's, there's an element of that, but it's more, but he definitely does. Cause so much of mine is self doubt and, you know, and criticism and, you know, imperfectionism and where, and he's, you know, sometimes I just objectively need somebody to take a step back and go, here is the evidence. Yeah. No, like when I'm going on about something that I've done wrong or fucked up or whatever, he's like, yeah, but you've got to show me the evidence.

It sounds like a very workable method for the particular circumstances you're dealing with. Whereas I couldn't even, I found it very hard to access the self blame at all. Like it took, it took a long, well, I mean, no, it would come and go, but it was, it was often neurotic and kind of too much in the self pity area and not enough in the truth area.

Yeah. Like, yeah, that's, that's my default. Like program is okay. What have I done wrong? How have I fucked this up? You know, like, yeah, yeah. How can I make this right? Yeah. That's the default. That's not the resolution. The default is that. And so it's then actually, okay, well. Is that really RA based in any sort of rational That's right. You know, thought process and it's, it's not, most of the time it's not. No, it's never, yeah.

adjusting the, you know, like I, I heard a Jungian say on a podcast that, you know, Jungians will put a lot of work into deconstruction and they tend to see that as their main or even only priority a lot of the time And you got to remember that some of the Jung's original patients a lot like Freud's middle class women who badly needed Deconstructing they were too constructed. They were too put together.

think we should wrap it up, but I think it comes down to what I would call the final level boss. Yeah. So I'm, when I met my therapist, I was 40 full of fear and The last thing I needed was another pat on the back. Yeah, there's a huge back,

there's a back pat trend at the moment. I wanted to say this Joe, I nearly, nearly got to it earlier. I keep coming across references to the pat on the back in therapy, and I think, yeah, there might be too much of that going on at the moment. I had those

therapists in my 20s and 30s. Um, all women, like, you're doing okay. You've got it. Isn't it hard? You've got bipolar. Yeah. And I just sat down. How do

you feel about that? And I'm like, I know I feel like shit. I just want someone to practically tell me how to live my life. That was my huge argument for, yeah, with why I didn't think historically that therapy worked for me. I knew what had happened.

Don't tell me it's okay. I'm being a disaster. I don't want to be a disaster. Yeah. Yeah. It's

more the day to day. I'm really struggling with it. So I know all the, I can rationalize. It's everything horrible thing that I can understand very quickly. Okay. Yeah. This, this came from my childhood. This pattern of behavior has developed from that. I can put those bits and pieces together quickly. And as my psychologist would say, almost too quickly to my detriment,

I was struggling Yeah. So

whereas I can put it all together and have the understanding of it really quickly. It's just, it doesn't translate into really functional behaviors as an adult.

Intellectualized feelings. I can't feel them. Mm. So I can turn them into words. Yeah. I do this, I'll do it on this show a lot, but I don't feel anything. That's right. That's a tough one. But yeah, I'll, yeah, I'll finish up. But like the final level boss concept for me and with me and Peter is, You finally get into the room and you sit down and you say, Hi, how are you? And she says, it doesn't matter how I am, Joe. And then sits there and just stares at you.

Picaresque

escapades.

I'll finish on that. Yeah, makes a lot of sense to me. Go on Ali. I was

gonna say three years is about the mark, like I went in after my hospitalization and I was like Very optimistically, I'll get this done in six months. Right. And my psychologist laughed at me. And he's just, he's like, he's like, well, look, you can be as diligent as you like, but you know, that's, that's pretty, that's optimistic. He goes, I'm not saying it can't be done, but like, you know, and I said, well, how long? Like, you know, I don't want to be doing this for like 20 years.

but almost. So final thought. Yeah, man. Uh, look, I, I wish someone had said it's gonna take more than three years. You know, I think I needed to hear that at an earlier point.

Yeah. I mean, I keep saying, we'll finish on this. Yeah. But, uh, look, the childhood stuff. Yeah. It's a cliche. We spoke about it in my last session. Yeah. It's a cliche for a reason. It is. And the one thing I learned in addiction recovery, things are cliches for a reason.

And the same themes keep occurring in that work.

There's a reason I don't pick up a drink one day at a time. Now that's a cliché, there's a, it's incredibly helpful for me to remember that one cliché. That's right. Uh, and in Diction Recovery there's hundreds of them. In therapy the one big cliché is it's all about your childhood or it's all about blaming your parents.

Yes. That's right. And please, if, if, yeah, anyone's listening, going to therapy next, just, yeah, get into some childhood stuff. You know, like there was a thing that I'd be wanting to tell Adam and I'd told my, and I've been putting it off for weeks, right? And I told myself, Oh, this thing's just a little curiosity that he might be interested in, right? I, look, here's a little curio, a little knick knack I found, a little object for your mantel shelf, Adam.

dunno what that was for you. Yeah. Yeah. You dunno what the citizen Kane Rosebud sleigh is, but you probably have got one. Yeah. Right. Alright, let's finish up. Yep. See you guys. See you next week. See you. Love your work.

See you. Bye

Bye. Bye.