Next Level Practitioner

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1 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 1 Next Level Practitioner Week 88: Treatment Specific Advice Day 5: Critical Insights with Ruth Buczynski, PhD; Ron Siegel, PsyD; and Kelly McGonigal, PhD

2 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 2 Week 88, Day 5: Ron Siegel, PsyD and Kelly McGonigal, PhD Critical Insights Table of Contents (click to go to a page) How Simply Following the Client s Lead Sets a Strong Foundation for Therapy... 3 Strategies to Transform a Client s View of Therapy... 4 When Putting Ourselves in a Client s Shoes Can Help Them Change Their Perspective... 6 One Technique to Foster Empathy and Encourage Change... 8 How to Know When to Lead and When to Follow A Case Study... 10

3 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 3 Week 88, Day 5: Ron Siegel, PsyD and Kelly McGonigal, PhD Critical Insights Dr. Buczynski: Hello everyone we re back. This is the part of the week where we re going to focus on synthesizing all the ideas from this week. To jump right in Kelly and Ron, what stood out to you this week? How Simply Following the Client s Lead Sets a Strong Foundation for Therapy Dr. McGonigal: What stood out to me was Christine s example of her 10-year-old client, and how he came up with the idea of using a secret code to talk about how he was feeling and how she was feeling. And two things actually stood out to me One of them was a really good example of what Shelly had talked Be willing to follow where the client is going. about: the importance of letting your client lead. And when your client is leading, be willing to follow where the client is going. This is such a perfect example of that. But I also thought it was amazing that she still remembers the codes. And think about that; part of me wanted to contact that client in midlife and say, She still remembers your codes. There was something very poignant about that, recognizing how clients can actually affect clinicians as well. Dr. Siegel: I also loved that story. I was very touched by it. The other thing that really struck me was the tremendous variation that we have among different individuals and how they think and feel. There s really a kind of clinical corollary to that for me which is a kind of best advice which is that everybody doesn t have my history, my genes, or live in my head, or my experience. I started reflecting, why is this so hard for us to grasp this, even though it s intellectually obvious? As clinicians, people generally don t do interventions that they haven t found personally to work. When

4 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 4 we ve found some way of approaching something, or some way of dealing with a thought or feeling, or some What sticks for us and works for us may not be what works for somebody else. way of thinking about something is personally transformative, that tends to be the stuff that sticks for us. We use variations of it in our ongoing work. The problem is that what sticks for us and works for us may not be what works for somebody else. Really almost all of our presenters were basically telling us, The best advice is don t get caught in that. Christine talked about taking the client s perspective; Michael talked about identifying each client s particular strengths; Ed Tronick understands the meaning that people are making out of their world, even if those people are infants which is another way of trying to see it not from the perspective of our own heart and head; and Joan talked about noticing people s motivations. Of course, we have to consider gender, color, sexual orientation, class, and all those other issues as well. We can t know the degree to which another person has had our experience. So the big take-home point that I got was this: since we can t know the degree to which another person has had our experience, we have to really be careful with assumptions, and really ask. Strategies to Transform a Client s View of Therapy Dr. Buczynski: Let s go into Christine Padesky s story a bit more. That 10-year-old boy helped her realize that therapy doesn t have to be boring. I can imagine it wouldn t be boring if you re talking in code! It might be challenging but not necessarily boring. Can you share a strategy that you ve used to make something otherwise boring into something that s more engaging? Dr. McGonigal: That example is almost an example of gamification, where you use things that we know are intrinsically rewarding to try to jazz up something that s a little more boring. I will say that, in my own teaching and work, I tend to fall on the exact other end of the spectrum I think of it as making something less fun and less of a game, and more deeply serious; I think about turning things into

5 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 5 rituals or almost sanctifying rather than gamifying them. In some of the group programs that I teach, one of the things we do is introduce the idea of intention-setting at the beginning of a practice, and a dedication at the end. So the idea is we say, It doesn t matter what happens in the middle like whether the practice worked, if you re doing a gratitude practice or you re doing a meditation; At the beginning of it, you clarify why you re doing it you re doing it to support your own health and healing, or well-being, or because it s consistent with a value, and you do whatever the work assignment is; and at the end you dedicate it you can dedicate it to yourself, or you can dedicate it to something bigger than yourself. We ve found that that practice you can put almost anything in the middle of it, even some boring practice that people say they don t like to do and it s not fun but you get the right frame for it and it just transforms You re transforming the experience by putting a frame that people naturally find interesting. the meaning of it. It s almost like it s the reverse of gamification but it s using some of the same principles you re transforming the experience by putting a frame that people naturally find interesting. Dr. Buczynski: I love the way you talk about that, and it strikes me your twin sister is an expert in gamification right? Dr. McGonigal: Yes, Jane McGonigal. We re identical twins but somehow, she got the only game gene. I don't know; it didn t express itself. There s epigenetics for you I don't know. Dr. Buczynski: Yes! And it just makes me think, a Thanksgiving dinner with you all must be very interesting because you have such different perspectives. Dr. McGonigal: Well, actually, I don't think that we ve ever talked about this in the program, but I will say the one game that I collaborated with her on is called Super Better. It s actually an app that you can use on your mobile phone that gamifies things that come from the research literature that is it s been demonstrated to be as effective as CBT for people with anxiety, and depression, and traumatic brain injuries. It definitely can be done. Although I did not come up with the fun part of it the game part.

6 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 6 When Putting Ourselves in a Client s Shoes Can Help Them Change Their Perspective Dr. Buczynski: Staying with Christine Padesky, she shared three times once with a supervisor, once with a mentor, and once with a client that she got the same advice, which was to see situations from the client s perspective. Can you share a story or a time when you were able to see something from another person s perspective, and how that might have impacted your work? Dr. Siegel: An example came to mind in which I was seeing something from the other person s perspective, but I was seeing something that they hadn t seen from their perspective, if you will. There s an interesting challenge: can we imagine what may be the unconscious perspective, or at least the unseen or implicit perspective, of a client? Let me tell you what the story was I was seeing something that they hadn t seen from their perspective. Obviously, it s risky. Thinking we know what s going on in somebody s unconscious can lay itself open to a lot of errors, but nonetheless, this actually happened in a therapy session last week. This woman has suffered a lot of physical abuse as a child, and she came in saying, You know, I don't think I ve really talked to you about this before, but I really feel horrible about losing control, and I think I m losing control a lot. I began by trying to understand what she meant by losing control we certainly want to begin there. She said she was really talking about reacting with strong feeling, feelings that was perhaps disproportional to the situation particularly anger. The incident that got her thinking about this was she had been at her hairdresser s, and the hairdresser had moved her head roughly, and she reacted strongly to that. It devolved quickly into a conflict in which the hairdresser basically fired her. This was very painful for her because this particular hairdresser I don't know much about these matters, but understands what she s looking for in the way of a look, and it s important to her and, even worse,

7 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 7 her sister continues to see this hairdresser. So, she was particularly disturbed by having reacted very strongly. But what occurred to me was and this wasn t exactly her unconscious; it was really just seeing the broad picture of human development her reacting too strongly made perfect sense to me. It made perfect sense to me because she had suffered a lot of physical abuse; she was quite sensitized to that; and it also made perfect sense to me because she basically didn t speak for the first 12 years of her life at least, she didn t speak outside of the household; and in the household, she had spoken only very, very cautiously. She was afraid of being beaten, because that was the result if you spoke in a way that irritated her dad. Now, at this stage in her life, decades later, she was beginning to speak up. But when we begin a new skill that we haven t practiced, it doesn t come out in a highly differentiated, highly modulated way. We tend to overdo it or underdo it; we re clunky about it. It makes perfect sense to me that you have had that reaction, and it makes perfect sense that it would come out clunky. And just talking to her about, Well, you know, it makes perfect sense to me that you have had that reaction, and it makes perfect sense that it would come out clunky, she actually found enormously useful. It also led to the association that as a kid she d thought, I will never be like my father. So, anger is quite fraught because when she does connect with her aggression, it is kind of like being like him, in the sense that it is aggression. And she had reason to be very uncomfortable with that. It occurred to me that I was taking her perspective, but not just in the sense of reflective listening it was taking her perspective and putting it in the context of what we know about psychological development. In seeing the factors and forces that brought about her losing control, she actually felt very relieved and comfortable and kind of armed with the kind of enthusiasm of I want to keep practicing this. In seeing the factors and forces that brought about her losing control, she actually felt very relieved.

8 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 8 One Technique to Foster Empathy and Encourage Change Dr. Buczynski: Let s talk about something Michael Yapko said. He got this advice: If you want the flowers to grow, you have to plant them in a soil that s fertile, meaning he should work with a client s strengths to help them grow or, that s what he took that to mean. And he s used that advice in every session since then. Can you share some strategies for uncovering fertile soil or strengths of a client? Dr. McGonigal: This really reminded me of some research that I ve been trying to implement in my own teachings. Some of the strengths that I try to help people to develop are empathy, perspective-taking, and compassion. And there s been a lot of research lately in looking at, how do you convince people to put in the emotional labor and the cognitive labor to develop something that most people experience as not only difficult but also often aversive? People report that it s unfun and hard to try to take someone else s perspective. So, there s been some recent research showing that how you talk about a strength like this like empathy can really influence people s willingness to try to put in that effort. Some of my colleagues at Stanford looked at whether you talked about empathy from an incremental or growth perspective versus a trait perspective you re the kind of person who s naturally empathic versus empathy as something that everyone has to develop, as it s a capacity. So, they had people read an article (all of their articles were fake but they were meant to be like a little New York Times article) that suggests empathy is something that can be trained and cultivated and we all have to work on it and develop it that growth mindset; and they had other people read another article that presented it more as a personality trait, something that s more fixed. In general, the overall takeaway is that people who read an article that suggested empathy was something that could be cultivated were more willing to do hard empathy. The examples they d looked at were How many hours are you willing to volunteer in a social-support group? You re going to be the ones providing the social support. That increased in the growth-mindset manipulation

9 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 9 but not how many hours people were willing to volunteer in a cancer-awareness booth. You re doing something nice, but it doesn t take a lot of empathy. They also found people were more willing to spend time listening to a woman of a different race talk about her personal suffering. They were willing to put in more effort to understand someone who holds a different social or political view from them so, really different aspects of empathy. And again, this was just from being given the perspective that, this thing that you find difficult is something that we all need to develop and can be developed. The other study that I ve been trying to balance with that again was looking at empathy. They found that people will selectively choose not to empathize if you give them the choice how to think about another person s experience. People will choose the easy version, of not having to empathize unless you give them (and this is a little bit tricky) false feedback that they are better than average at understanding other people s perspectives. And they found that, after some practice rounds, people suddenly found it fun and they wanted to play the empathy game rather than this other game where you did not have to try to understand what someone else is thinking and feeling. So I thought about how would you apply that, because obviously we don t want to give people false feedback Hey, you re really good at this thing that we re trying to develop but I thought what s important is to What s important is to give people positive experiences. give people positive experiences. What might really be at play there is someone tried it and, instead of getting criticized, instead of being given the feedback, Wow, you really aren t good at this, they were given the sense that Hey, you tried this. You re doing well. It s so important to give success feedback and celebrate. I often will tell teachers I train to see the strength when it s just barely emerging like Put on your filter and then amplify it a little bit; like this is what I really see in you. As long as there s a seed of truth to it, that often gives rise to a deeper flourishing. Dr. Buczynski: I certainly find that with leadership, with the team or whatever: find some little example and

10 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 10 try to praise the heck out of it. Dr. Siegel: It is so powerful how our tendency for social comparison or concern about self-esteem will affect motivation because both of your examples are about that. You know, if we think of it as a trait, then it s like I m either good or I m bad, and I might be bad so I stay away from it. if I think of it as something I can develop, then, Oh, I can get good at it and obviously the second one was a direct feeding of people s desire to feel good about themselves. So much of what we do is harnessing our basic instincts to move in the direction of sanity and decency if we can do it. Dr. Buczynski: And if you think of Maslow s Hierarchy of Needs, you think about mastery comes after you get some safety and love and belongingness and so forth; mastery is a basic need. How to Know When to Lead and When to Follow A Case Study Dr. Buczynski: Let s go to something that Shelly Harrell said. She said that Les Greenberg taught her about the delicate balance between leading and following. How do you know which you should do lead versus follow in any given situation? Can you share a story to show us how you tease that out? Dr. Siegel: I really appreciated her pointing this out because this is one of those constructs that I hadn t really held very often in my clinical work, but as soon as she mentioned it I realized, Oh, yes. Without labeling it as such or without thinking about it clearly, this is going on organically, and it s actually useful to think clearly about it. I started thinking, So, what is the determinant of when I tend to lead or when I tend to follow in the work? I realized that I unconsciously stumble on one posture, and it s only when it starts to be clear that it s not working that I then shift to the other posture. For example I m with a client and they seem to be going on about some theme, and I find my mind wandering and it starts to feel like it s not just me, it s that this doesn t have poignancy or juice to it. Either

11 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 11 they re stuck in a particularly unhelpful belief, or perhaps they re avoiding moving toward a feeling. That s a time that I ll go from just listening to wanting to do something more active to try to change things, and I ll start engaging them more. But then there s other times when I m going on with some explanation, or some idea, or some piece of psychoeducation that seems to me oh, so valuable, and I notice their eyes are glazing over that s a signal to get me to start listening more and following. There is an interesting dynamic. I ll give you an actual example I was listening to someone who was quite caught in obsessive anxiety. When I notice their eyes are glazing over that s a signal to get me to start listening more and following. This was over buying the right mattress and anybody who s been through that ritual can attest that it s an easy one to obsess over, and particularly if someone s got insomnia, it can really be almost paralyzing. So, I m empathically listening to this thing. She actually got a mattress, but then was thinking it was too hard the mattress that she had now at home and she started to berate herself around it. And when she started to berate herself, I just started having the feeling, here we go again. And this is because this is her habit to get stuck in some obsession, finally make a decision, and then, for some period of time, think it s the wrong decision, until she gets into something else that she s obsessed about and she forgets about the first one. So that s what kicked me into being more active that feeling of here we go again and I found myself pointing out that there are these two very reliable patterns in her mind: one is to get obsessed, and the other is to berate herself for her choice. I listed a few of the other incidents that I could remember what retirement package to take, whether to see a doctor about a problem or not, and how to ask her boss for a letter all of which followed that pattern. But then I realized that I was going on too long identifying the pattern, because it made sense but then clearly, she was starting to glaze over a little bit. So, I went back to just shutting up and listening.

12 Next Level Practitioner - Best Advice Week 88 - Critical Insights - Transcript - pg. 12 And I think it is very helpful to have this leading-and-following construct with this, so it may make us change course a little bit sooner. Dr. Buczynski: Okay folks, that s it for us for this week. Take good care, everyone. Ron and Kelly, thank you very much.