Episode 146 - Patreon Selects: Carrie-Ben Therapy (aka CBT 2.0)

Carrie and Ben create their own model of therapy. Goal setting! Psychoeducation! Exploitation and worrisome sales tactics! What does it say about psychotherapy when our progressively cynical efforts to develop a modality end up mirroring some of the norms in our field? This episode is evidence-based and supported by neuroscience.

Introduction: 0:00 – 5:13

Part One: 5:13 – 1:08:54

Part Two: 1:08:54 – 1:11:44

Show Notes:

• Mental health clinical exams’ evident adherence to industry standards for testing

• How to Spot Hype in the Field of Psychotherapy

• The efficacy of non-directive supportive therapy for adult depression: a meta-analysis

• Insight Exchange: Guide to Selecting a Counsellor

• The Radical Therapist #094 – Response-Based Practice w/ Dr. Allan Wade

• Organized Abandonment and Systemic Harm: A Conversation with Therapist & Educator Kimberly Chiswell

• Transcript

  Carrie Wiita [00:00:00]:

  Welcome to Very Bad Therapy, a closer look at what goes wrong in the counseling room and how it could go better as told by the clients who survived. From Los Angeles, I'm Caroline Wiita.

  Ben Fineman [00:00:11]:

  And I'm Ben Fineman legally encouraged to say that this podcast does not constitute therapeutic advice.

  Carrie Wiita [00:00:16]:

  But it will get interesting.

  Ben Fineman [00:00:18]:

  Let's get started.

  Carrie Wiita [00:00:25]:

  Ben, I kinda wanna, like, throw out a little disclaimer ahead of, re airing this particular Patreon episode.

  Ben Fineman [00:00:32]:

  Is is the disclaimer that if you don't like Cynicism and a rapid descent into, nihilism that this is Serving as a trigger warning for people with much more optimistic

  Carrie Wiita [00:00:50]:

  perspectives. Yeah. Oh my god. Okay. We literally just then like, do you wanna start this one, or do you want me to? And I was like, well, hey. I think I know how to start this. I'll I'll go. And all I said was that that's exactly what I was going to say.

  Carrie Wiita [00:01:03]:

  This particular Patreon episode, it does we go very quickly and, like, real hard off the rails, into full blown cynical, yeah, nihilism, just wallowing in cynicism as as it pertains to our field.

  Ben Fineman [00:01:22]:

  And it started very genuine and It did. Very earnestly.

  Carrie Wiita [00:01:27]:

  Yeah. We were it starts out by us talking about all the things that we really love about therapy and think, like, should always happen in therapy. And then it by the end of it, we're multimillionaires with, like, an MLM therapy scheme.

  Ben Fineman [00:01:39]:

  Yeah. And I guess in retrospect well, 2 things in retrospect. 1 is, I think we've been doing this podcast for way too long because we just think exactly alike at this point.

  Carrie Wiita [00:01:47]:

  That's So

  Ben Fineman [00:01:49]:

  true. But, also, when when we start talking about things like how therapists are educated and trained, continuing education, The fact that there are people out there with completely unscientific theories selling multi $1,000, if not, like, Five figure trainings Mhmm. To people who just want something to grasp onto to feel grounded in our field. I think it's hard not to get Cynical when you realize that these things don't actually make you a better therapist. They just make other people a lot of

  Carrie Wiita [00:02:18]:

  money. Yeah. Yeah. It's tough. It's it's depressing. And I think that that's how I handle things that are really, like, depressing and demoralizing is I just laugh about it really hard.

  Ben Fineman [00:02:29]:

  Cynicism and humor?

  Carrie Wiita [00:02:30]:

  I think so.

  Ben Fineman [00:02:31]:

  Mhmm. Well, let me throw out one more thing that is in some ways, depressing about our field. Oh. But this comes with a big shout out to the wonderful doctor Ben Caldwell who has an article that's in the process of, being peer reviewed, but it's, still put out. Would this be called pre publication, Carrie? Is that the right terminology?

  Carrie Wiita [00:02:50]:

  I think yes. I think that's true.

  Ben Fineman [00:02:52]:

  So it's on a research gate, and we'll link it in the show this is an article, that's titled mental health clinical exams, evident adherence to industry standards for testing. And shout out to doctor Caldwell because he is doing a great job really shining a spotlight on the fact that many of the clinical exams here in America that people are required to take to get licensed, in various fields, really don't adhere to, like, industry standards for these kinds of tests, And not just in industry standards within our field, but broadly speaking, specifically that there is significant racial disparities in the exam outcomes. So, Carrie, if our trainings and the way therapists get educated and certified don't really mean anything as we get into, in this episode, And if the clinical exams that serve to gatekeep certain people out of the field more than other people don't necessarily improve the Quality of service is provided within our field. What are we doing?

  Carrie Wiita [00:03:50]:

  It's a great question. It's a great question, Den. You know and I'll be honest with you. So when you and I talk about it, as as all the listeners who stick around, We'll soon find out. It gets it gets real dark real fast. But somehow, Ben Caldwell maintains this, like, optimism And this kind of these conclusions and this kind of really honest look at the reality of the field, Somehow that inspires in him, greater advocacy. And so if you are depressed about the field. I encourage you to go check out Ben Caldwell's stuff anywhere you can find it because somehow he maintains his Hopefulness, and it is very inspiring.

  Ben Fineman [00:04:39]:

  You yes. You're making a very good point that I don't think I realized is that you and I, I think we had Some of that when we started out in this field and started out making this podcast but now I think it's just cynicism and snark.

  Carrie Wiita [00:04:51]:

  Right. No. That's that

  Ben Fineman [00:04:52]:

  was That's where we end up at.

  Carrie Wiita [00:04:54]:

  We became, like, the peanut gallery.

  Ben Fineman [00:04:56]:

  Mhmm.

  Carrie Wiita [00:04:58]:

  And and Ben Caldwell is, like, in the trenches, like, we can make this better. Yeah. And we're in the back of the theater just throwing shit.

  Ben Fineman [00:05:09]:

  Well, let's go throw some

  Carrie Wiita [00:05:10]:

  shit. Great.

  Ben Fineman [00:05:18]:

  Harry, are you ready to get super rich And famous. And this is the origin story of our future keynote at the Evolution of Psychotherapy Conference.

  Carrie Wiita [00:05:29]:

  I feel like everything we've ever done, Ben, is build been building to this.

  Ben Fineman [00:05:33]:

  Mhmm.

  Carrie Wiita [00:05:34]:

  I also feel like I really want a mimosa right now. Like, I need one for this.

  Ben Fineman [00:05:37]:

  You want a what? Mimosa. Oh, momo why a mimosa?

  Carrie Wiita [00:05:42]:

  Because it has alcohol in it, and it's 10 AM on a Saturday

  Ben Fineman [00:05:44]:

  morning. Oh, okay. It would make this episode more interesting, I

  Carrie Wiita [00:05:48]:

  think. I think so.

  Ben Fineman [00:05:50]:

  Should we should we describe what this potentially life changing idea is?

  Carrie Wiita [00:05:56]:

  Yeah. Yeah. Are we are we going with the names CBT 2 point o?

  Ben Fineman [00:06:01]:

  I I think CBT 2 point o is great.

  Carrie Wiita [00:06:03]:

  I love it because it's because it's Yeah.

  Ben Fineman [00:06:05]:

  It implies that we're we're just 1 upping the CBT.

  Carrie Wiita [00:06:10]:

  It's a little, it's a little, misleading, but I think that's fair. I think that's fair. CBT deserves it.

  Ben Fineman [00:06:17]:

  I have to be honest. Like, looking at my shortlist here Yeah. I think I may have just Come up with CBT again. We'll see how this

  Carrie Wiita [00:06:24]:

  goes. Oh my god. Wait. Really? Well, then I wanna, like, remove if if I know now I now that I know that, I wanna remove one My five things and bring something in off of the wait list that didn't make the cut because, now I have a feeling one of mine, you will be covering.

  Ben Fineman [00:06:39]:

  We'll find out. I think the fun of of CBT 2 point o, aka carry bend therapy, is that we will either have some redundancies, Which will be interesting because it'll highlight Yeah. How you and I think in terms of what is necessary for a good treatment.

  Carrie Wiita [00:06:56]:

  Yes.

  Ben Fineman [00:06:57]:

  Or there will be some ridiculous contradictions that can't possibly fit together coherently.

  Carrie Wiita [00:07:02]:

  Right.

  Ben Fineman [00:07:02]:

  And so that is what we're gonna do. For those of you listening, we are going to take Five ideas that we've come up with independent of one another in terms of ingredients that we feel are most important for an effective treatment of therapy, And then we are going to Frankenstein them together into a coherent treatment model that we are calling CBT 2 point o. Except we don't know if it's gonna be coherent because some of this may just directly contradict each other.

  Carrie Wiita [00:07:28]:

  It might. It really might. And particularly, like, I I feel like I went with, like, my favorite things or things that I think are really important in therapy, like, transtheoretically. So So although I did when I was just telling you this before we started recording, like, what I found myself doing to come up with this list was I I knew how easy it would be for me to be like, the the theoretical home that I've landed at personally. I'm I'm just gonna pick from that bucket because that's obviously why I picked it. Right? That's all my favorite things to do. I believe in it. Whatever.

  Carrie Wiita [00:08:03]:

  So I was like, alright. I'm gonna go look through all the other approaches that I don't really fundamentally agree with and see if I you know, is there anything they have contributed to that I think, hey. This is super This is super important. And as I went through, I did find something almost out of every single approach to therapy. But in all my notes, I'll, like, write down their thing, and then I'll be like, but not for the reason they say. I I did have. I I have since dropped this out, but I did have from person centered Therapy, I I had the qualities of a therapist, genuineness or congruence, unconditional positive regard, and empathic understanding. And I said, but not because it's a change agent.

  Carrie Wiita [00:08:47]:

  So that didn't make my top five. I'm excited to see what's in your top five.

  Ben Fineman [00:08:51]:

  I think I took a bit of a different approach.

  Carrie Wiita [00:08:53]:

  Mhmm.

  Ben Fineman [00:08:54]:

  I thought of things that I believe From what of the research I can make sense of Mhmm. That I believe to actually be correlated with increased, effectiveness. Yeah. And then I sprinkled in a few things that I just think are generally important, maybe not even for effectiveness purposes, but for ethical or Just quality of service purposes. So in theory, it sounds like you and I have ticked a lot of important boxes. We'll just see how this plays out.

  Carrie Wiita [00:09:21]:

  Yeah. I think so.

  Ben Fineman [00:09:22]:

  So do you wanna do you wanna start? We can trade off presenting our our ingredient of CBT two point o and then maybe why Yeah. This ingredient was chosen. And then after we get all 10 on the board, we can structure it into a a nice Crisp, sellable approach?

  Carrie Wiita [00:09:44]:

  Yeah. Yeah. Yeah. I really like that. I love that you have, like, come so far over to the dark side of capitalism. This makes me so happy. Alright. So I'll start.

  Carrie Wiita [00:09:54]:

  I'm gonna start with, like, my most amorphous one. I am bringing from the constructivist therapies, the constructivist therapeutic stance, which incorporates The idea that, like, you have to, like, buy into the idea that reality is constructed and that there is no objective truth to be mined out of or uncovered out of your client, and that the therapist is seen as and this quote is coming from collaborative therapy specifically. Therapists is a conversational artist who is an expert in the therapeutic process, but not an expert in the client.

  Ben Fineman [00:10:35]:

  So this is?

  Carrie Wiita [00:10:36]:

  This is a it's a therapeutic stance that is specific to this, like, approach to therapy.

  Ben Fineman [00:10:42]:

  Okay. Okay. So I wanna skip ahead to 1 of my 5 then.

  Carrie Wiita [00:10:45]:

  Oh, shit.

  Ben Fineman [00:10:45]:

  Okay. Because this is where I mean, it's already funny to me. So, I see your constructivist therapist dance, and and I raise you. One of my ingredients is exposure therapy.

  Carrie Wiita [00:11:01]:

  Well, that's okay. Okay.

  Ben Fineman [00:11:03]:

  So the reason I chose exposure therapy is because in in the baffling conversations we've had over the years with each other, with experts in the field, it Seems like and correct me if you feel otherwise, Carrie, but it seems like the one thing that nobody really denies

  Carrie Wiita [00:11:21]:

  Mhmm.

  Ben Fineman [00:11:21]:

  Is that exposure therapy for Specific phobia Mhmm. Is a legitimate empirically supported treatment that is demonstrated conclusively to be more effective for that specific diagnosis of phobia than any other approach. So if you have a client who has specific phobia, you should be doing exposure therapy with them As at least a 1st option or presenting it because it's more likely to be effective than anything

  Carrie Wiita [00:11:45]:

  else.

  Ben Fineman [00:11:45]:

  Yeah. And I buy into that. It seems like credible research or or more accurately, the people who have said it's credible research, I trust. Right. So I want that in here because at the very least, it's Something that has been demonstrated to be more effective than other things. Now if we're manualizing this, the question is, are we just shoehorning exposure therapy into Everything the clients are bringing in, and I say yes. It doesn't have to be the entirety of treatment. Doesn't just have to be exposure therapy, but there has to be some exposure therapy in it because and here's my rationale, Carrie.

  Ben Fineman [00:12:22]:

  In some ways, everything is a phobia. Right? Anything that a client is talking about in therapy, there is some kind of avoidance or fear. If a client is anxious, They are phobic of something happening in the future. If a client is upset about a breakup, they are Phobic about not being with the person they're they've broken up with. Uh-huh. I think phobic is a word, and I think I'm using your credit. But if not, We're gonna introduce it as part of CBT 2 point o. I'm sure you could challenge this idea that everything is a phobia in some way.

  Carrie Wiita [00:12:59]:

  I'm sure.

  Ben Fineman [00:13:00]:

  I don't care. I am the expert in CBT 2 point o.

  Carrie Wiita [00:13:03]:

  Fuck yeah. You

  Ben Fineman [00:13:04]:

  are. So if a client is depressed, maybe they're afraid of being happy. I don't fucking know. We're gonna come up with jargon to sell this as experts. So that is the 1st ingredient I will introduce, and I don't know how it fits With the constructivist stance because it does require the therapist declaratively saying, you have a fear, and we are going to fix it. Yeah. But There you go. Exposure therapy.

  Ben Fineman [00:13:27]:

  No.

  Carrie Wiita [00:13:28]:

  I'm excited to find out. You know what my favorite part of this is? It's, like, to manualize this, which is what we're gonna do At the end of this, you are gonna have to explain to me exactly what exposure and response prevention therapy looks like, like, what that Technique looks like it. I'm very excited because now off I will learn. Sure. Okay. Alright. Should I throw it out there? Right. Okay.

  Carrie Wiita [00:13:53]:

  This is completely what wait. Should I do oh, you know what? I'm gonna kind of actually know. Okay. So in here, I'm gonna go with a different one. This is actually as we will find out when we start Frankensteining, This is how I think that, your exposure, intervention can absolutely be done in a constructivist stance. I am now, introducing appropriately unusual comments and questions.

  Ben Fineman [00:14:26]:

  Wait. Is this like, there's a term for this, like Carl Whitaker?

  Carrie Wiita [00:14:30]:

  It's Tommy Anderson.

  Ben Fineman [00:14:32]:

  Oh, so you're back to, like, collaborative language stuff?

  Carrie Wiita [00:14:34]:

  Uh-huh. Yeah. This is not now but, see, this is exactly what I'm saying, Ben. Like, this is exactly what I'm saying. If you then go back Through all of the different approaches, there's probably something to this like, to speak to this in for sure, like Whitaker. That's, symbolic experiential. Right? Miss Whitaker?

  Ben Fineman [00:14:52]:

  Oh, I don't know. He was he he was the family systems therapist who sat on his clients.

  Carrie Wiita [00:14:56]:

  Yeah. Yeah. Symbolic I'm pretty sure it's symbolic because I never really understood that particular

  Ben Fineman [00:15:01]:

  approach. So it's what what was the appropriately I'm taking notes so we can, give you

  Carrie Wiita [00:15:05]:

  a call. Great.

  Ben Fineman [00:15:05]:

  Yeah.

  Carrie Wiita [00:15:07]:

  Appropriately unusual comments and

  Ben Fineman [00:15:09]:

  questions. Okay. Great. So So so you're sad. Let's do exposure therapy. Does that count?

  Carrie Wiita [00:15:16]:

  Yes. It can. So here's here's what it here's how the the whole idea between appropriately appropriately unusual is that if comments are too Usual, there's no difference from which can be constructed new meaning. The whole idea in collaborative therapy is that, like, the therapeutic Relationship introduces new possibilities, and you have to introduce difference, right, into the conversation because the therapist the the client is stuck in their own, like, construction of meaning, and that's why they have a problem and that's why it can't get, quote, unquote, better. Right? So the therapist is there to introduce difference into the system, essentially. And so if the comments are Too usual, it just fits right in to the problem system that the client already has. If if the questions or comments are too unusual, The client will not be able to engage in the ideas in a way that promotes a new perspective. If it's too unusual, the client's like, what the fuck? No.

  Carrie Wiita [00:16:13]:

  Not at all. Like, Absolutely rejects the idea that it could have anything to do with them. So I think that this is How, like, we this is how we need to un this is where we need to understand our clients' problems, the way like, what they're bringing in, so that we can introduce something that is appropriately unusual. And this is where I think if you come with a constructivist stance and you introduce exposure therapy, that could be for the get right Client appropriately unusual.

  Ben Fineman [00:16:49]:

  Oh, wait. But now there's a problem. What if a client wants exposure therapy?

  Carrie Wiita [00:16:57]:

  Well, then what you're what you are exposing them to, I think would, By virtue of the nature of the intervention itself have to be unusual. Right? Because if the problem if they have a if they are saying they right? I think we can make We're

  Ben Fineman [00:17:13]:

  saying they have a phobia. So yes. Yeah. They they don't have to say they have a phobia. We're saying they

  Carrie Wiita [00:17:17]:

  have a phobia. We are. We are. Yeah. Yeah. Yeah. That's

  Ben Fineman [00:17:19]:

  okay. You have a fear of not being in therapy. Okay. Alright. So my next one, I think, is very straightforward.

  Carrie Wiita [00:17:27]:

  Oh,

  Ben Fineman [00:17:27]:

  okay. Not particularly interesting, but very necessary to quality therapy. So if we're gonna sell very expensive weekend seminars, we need

  Carrie Wiita [00:17:35]:

  this Yeah.

  Ben Fineman [00:17:36]:

  Yeah. Which is goal setting. So the therapist of the client Yeah. Need to agree on what are the goals for treatment so that all of the things we're talking about are pointed in the same direction. And Yeah. It can be assessed to see, are we meeting the goals? So Nothing groundbreaking, but I think that's that's probably something that's gonna be at the beginning of our our manual where Everything needs to be in alignment between therapist and client in terms of the goal of everything that's happening in therapy. So Yes. Goal setting.

  Ben Fineman [00:18:06]:

  Straightforward.

  Carrie Wiita [00:18:07]:

  Love it. Okay. That's great. I think that's really great. I'm making a last minute substitution. I'm bringing the wonderfulness interview back because I just can't leave it alone. Alright. Let's go with that.

  Carrie Wiita [00:18:20]:

  So that's that's what I'm throwing into the mix now, Fairly straightforward intervention from narrative therapy, specifically specifically, it's for narrative, therapy with children and families, but I am introducing it to CBT 2 point o as an intervention for anybody.

  Ben Fineman [00:18:37]:

  I've actually never heard of this.

  Carrie Wiita [00:18:40]:

  Until I started talking about it on the podcast, like, constantly. I've I've we've talked about it, like, in-depth on the show before.

  Ben Fineman [00:18:47]:

  I don't remember this, the wonderful in this interview?

  Carrie Wiita [00:18:50]:

  Yeah. Tell me god. I I have vividly I I vividly remember talking to you about this. No? Okay. Well, I will I will tell you. The wonderful this interview is, an intervention from, David Marston and, is it It's Laurie

  Ben Fineman [00:19:06]:

  Markham?

  Carrie Wiita [00:19:07]:

  Markham. Yes. Their book, narrative therapy in wonderland, I believe, is which is about working with kids. And So they suggest starting off narrative therapy, with kids and families, with the wonderfulness interview. Because the assumption is, for that family with the children, to have gotten to the point where they are finally in therapy, Probably what has happened is that the child has been problematized, like, identified as the as the problem, and and there's Probably been a lot of discourse around the kid is the problem, whether that's coming from school or babysitters or, you know, whatever. So the kid is probably very, very aware that they are a problem and that They probably probably everybody is steeling themselves when they walk into the therapy room to dig into how awful Whole things are the family is probably bringing in a lot of shame about how how could they have gotten to this point as parents where Their child is so bad, blah blah blah. And so everyone's, like, butthole's real tight about, like, this whole, like, going into therapy. And so then the narrative therapist says, as sure as them and it's great.

  Carrie Wiita [00:20:22]:

  I there's a whole script kind of for it in this book. I highly recommend it. And I and I've used it in session with one of my very few, like, families and small children, and it was unbelievable how this worked in the room. But so you, say, I just want you know, I I know we're here because there are some very serious things going on, and you're very worried and concerned, and we are gonna get to those. But I was hoping to start by getting to know child, And then you turn to the parents, and you ask a parent or caregiver, whoever, is there to please, Explain, like, if they could ask what is wonderful about the child. And I'm pretty sure you actually get you get consent from the child to ask the parent or caregiver, what is wonderful about them. And he just, like, just like the way they describe it in the book is the kids like, I don't I wasn't anticipating this. And then, the parent or caregiver is asked to so they've been preparing, right, this whole monologue, this whole story about, like, all the bad things that are happening.

  Carrie Wiita [00:21:29]:

  And then they're asked to, like, talk about how wonderful the child is, and it really just, like, shifts the whole dynamic. So, yeah, that's what I'm bringing in, but I say apply to

  Ben Fineman [00:21:39]:

  everybody. Okay. So I assume this would happen towards the beginning then.

  Carrie Wiita [00:21:43]:

  Early early

  Ben Fineman [00:21:43]:

  first question. Assessing for strengths.

  Carrie Wiita [00:21:45]:

  It's exact exactly. That's exactly what it is. Yes. Awesome. Yeah.

  Ben Fineman [00:21:50]:

  Okay. My next one is predictable, I think. Some form of outcome monitoring.

  Carrie Wiita [00:21:56]:

  Oh, good.

  Ben Fineman [00:21:57]:

  Why? Feedback informed treatment because we can do all of these things. And as as we are all too aware, our biases will make us see that therapy is working. And because we have created the theory, We will always think it's working because that's apparently what happens when you create a theory. Right. You just assume it always works, and you write books Talking about how it always works. So we need some form of outcome monitoring woven into the very fabric of CBT 2 point o So that on a per session basis, we are checking with the clients about how they're doing, how they think therapy's going, etcetera. It just it just seems like Oh, I love it. We'd be huge hypocrites if we didn't create a modality that included this since we we harp on this incessantly, on our podcast and maybe even in our personal

  Carrie Wiita [00:22:44]:

  lives. Right. Oh, I think that's great. Oh, I'm so glad you brought that in because it didn't it was not on my list, but, again, I think I did this wrong. That's okay.

  Ben Fineman [00:22:54]:

  But no. Wait. Hold on.

  Carrie Wiita [00:22:55]:

  Oh, you're still going? Oh, great. Thank you.

  Ben Fineman [00:22:57]:

  No. I I just wanna challenge the idea that you've done something wrong because we can't Sell this as as, like, a big ex oh, no. Wait. This could be the Francine Shapiro. Like, it just happened. I was walking through the park, and my eyes started fluttering. But the the accidental genius of Carrie is that you forgot to include this, which opened up space to bring in things like The wonderfulness interview. Yes.

  Ben Fineman [00:23:18]:

  And that's why we have our brilliant modality.

  Carrie Wiita [00:23:21]:

  Right. Right.

  Ben Fineman [00:23:22]:

  Yeah. There we

  Carrie Wiita [00:23:22]:

  go. Yeah. That's that's really good. This is, Yeah. We're gonna put that in the, the the the the forward of the book.

  Ben Fineman [00:23:29]:

  Right? And let's say we did this while walking through a park.

  Carrie Wiita [00:23:32]:

  Excellent. I

  Ben Fineman [00:23:33]:

  will resume because that

  Carrie Wiita [00:23:34]:

  sounds better. Right. Yeah. It's much better. Okay. So I'm gonna throw out there, super basic, the cognitive triangle. Bringing bringing the cognitive triangle in from CBT, I think that concept is very helpful for people because whether or not you're acquainted with, like, that specific idea, I do think it is pervasive to a certain extent in the culture. So it's a I think it's like a folk Psychology idea or concept that is very easy for people to be like, oh, yeah.

  Carrie Wiita [00:24:09]:

  I recognize that.

  Ben Fineman [00:24:10]:

  Can you

  Carrie Wiita [00:24:10]:

  define it? The cog yes. Yeah. It's the idea that, like, thoughts Influence your emotions or feelings, which influence behavior, which influences the thoughts that you have, and so it's this process, where your thoughts, your feelings, and your behaviors are all interconnected. And so it it what it does is it asks People to start becoming aware, on a, like, moment to moment, like, current experiencing level. Are they having thoughts about something? What is the feeling that is coming up, and what behaviors are either coming of that or what behaviors were antecedent to the thoughts of feelings. And what? You're grinning, like or you're smirking. No. No.

  Carrie Wiita [00:24:56]:

  Smirking.

  Ben Fineman [00:24:56]:

  It's a good smirk. As As you're talking and as I'm seeing, like, all the things we've put on this list now, I can see a, like No. A step by step Oh, no. Like, I can see it coming to life. I can see the

  Carrie Wiita [00:25:09]:

  phases. Easy.

  Ben Fineman [00:25:11]:

  Yeah. Seriously. Like like, I think we're actually creating a good modality.

  Carrie Wiita [00:25:16]:

  You would think that though because you're one of the developers.

  Ben Fineman [00:25:18]:

  Of course. Yeah. And I'll write a book where, like what was it? The the client has had 50 years of therapy, and within 1 session, they went into convulsions and said, Everything in my life is great, and then they ran for president and also cured cancer. And now, you know, that

  Carrie Wiita [00:25:34]:

  that that. Therapy was a success. Yes. Alright. Alright. So that's my that's my pitch for the cognitive triangle.

  Ben Fineman [00:25:41]:

  Love it. Okay. My next one is Checking in about termination periodically. So Oh. This goes back to our study on my code.

  Carrie Wiita [00:25:52]:

  Concrete on these.

  Ben Fineman [00:25:54]:

  I know.

  Carrie Wiita [00:25:55]:

  Alright. Okay.

  Ben Fineman [00:25:56]:

  Alright. We balance each other out. Yes. I feel like it also reflects our our general, like, ways of being in the world.

  Carrie Wiita [00:26:02]:

  It's probably So

  Ben Fineman [00:26:06]:

  true. So, yeah, the this is something we talked about in our study hall episode on termination That most of the time, clients just drop out or there's no conversation about termination. And I don't know if it necessarily leads to better outcomes per se, but I think it just leads to better therapy, better practices, better peace of mind for all parties involved. And so I think a good modality It should include some kind of manualized approach where every handful of sessions or Since there's outcome monitoring, when there's a noticeable plateau, or since there's goal setting, when the goals have been met, it's built into the fabric of the modality where the therapist will check-in and say, I just wanna see how you're feeling about therapy. Is this something you still need, you still want? Because from my perspective, it seems like either It hasn't been helpful for a while Mhmm. Or we've met our goals, and it's been something where this is a just a part of therapy where every Once in a while, you're talking about termination so that if and when it does happen Yeah. It isn't a surprise to anybody, and you can actually have a nice few session closing that culminates in that, you know, the quote, unquote traditional termination session where you're doing all the stuff Right. Fits with a good termination.

  Ben Fineman [00:27:16]:

  So I think that's helpful, and I'm throwing it

  Carrie Wiita [00:27:19]:

  in there. That's great. I love it. I love it. Okay. So my last one is another Amorphous concept, but which just so everyone listening knows I'd weave my hands in the air in a very amorphous way because that's How I think and exist in the world. Okay. So I am bringing in the concept from feminist therapy, misogyny of mental illness.

  Carrie Wiita [00:27:43]:

  So, this is introducing into therapy the idea that concepts of mental health like autonomy, Individuality and independence are associated with masculinity, and often these are exalted as traits that, like, everybody should have because they're associated with the masculine. And in our culture, we, like, exalt things that are associated with the masculine, But then it simultaneously devalues women's experiences as pathological. And so I think that, again, this goes back to my. And one of the things that I'm finding is, like, really important to me in therapy is I think as therapists, we need to have an awareness and address in the room. The folk psychology shit that people are bringing in as just fundamental assumptions. And so I think that this is baked into a lot of how we talk about mental health is like, for example, the whole concept of codependence. It like, it is such a thing for laypeople to be like, I the problem with me in relationships is I'm codependent. Right? And that is, I think, directly from this idea that, well, independence is good, is what you should have.

  Carrie Wiita [00:28:55]:

  Therefore, if you are not independent, you are codependent, and that's inherently problematic. And so I think The feminist idea of addressing the idea that perhaps things that we take for granted about mental health care, perhaps they are infused with misogyny, And are we okay with that? Which also just invites a bigger conversation about what is the impact of societal structures on what we're identifying as a problem.

  Ben Fineman [00:29:23]:

  I am so eager to hear how we can fit this into my last one. Oh, shit. I think I'm going the opposite direction.

  Carrie Wiita [00:29:32]:

  Oh my god. What? You're all for misogyny?

  Ben Fineman [00:29:36]:

  Are we are we on Twitter? Okay. So do you remember the hype checklist that Yeah. That Grillingfeld and Don Meichenbaum published a while back? Yeah. And for anybody listening, and we'll link this, in the show notes. For anybody listening who's not familiar with the hype checklist, these 2 wonderful people, men, Which Mhmm. Feels relevant.

  Carrie Wiita [00:29:58]:

  Yep. Yep. Thanks for noting that.

  Ben Fineman [00:30:00]:

  Published an article identifying 20 different characteristics of hype In terms of if a modality is presenting itself in the public sphere in ways that are not really meaning anything, But it's just hype designed to get interest, rely on buzzwords, etcetera. So something like EMDR talking about neuroscience was hype because it's not really grounded in anything objective, but it sounds

  Carrie Wiita [00:30:28]:

  great. Right.

  Ben Fineman [00:30:29]:

  So they they had 20 things like this, which I love. So the final addition to my, my 5 for c b t two point o, And we're gonna have to discuss how to operationalize this, is to actually do everything that that was on the hype checklist Because I think this as we sell this treatment to the world, I think it boosts Therapist buy in, it boosts it boosts client awareness of the treatment and the belief in treatment because it increases the placebo effect Because you're playing into people's, you know, like, desire for hype and ability to or Lack of ability to look under the hood. So I think

  Carrie Wiita [00:31:12]:

  part of so cynical.

  Ben Fineman [00:31:13]:

  I know. It is very cynical. So I think part of CBT 2 point o is that therapists have to commit to doing some kind of pro bono advocacy directed at other therapists on the public to increase hype. And and I took, 4 things from the hype checklist that I wanna prioritize.

  Carrie Wiita [00:31:27]:

  You cheated. You are shoehorning 20 things until your last One

  Ben Fineman [00:31:33]:

  item. Okay.

  Carrie Wiita [00:31:34]:

  So so

  Ben Fineman [00:31:35]:

  yes. I well, yeah. I am. Fair. Meh. Deal with it.

  Carrie Wiita [00:31:39]:

  You gave me such Shit before we got on because I had a list of 13 things, and he's like, no, Carrie. Only 5. Cut it down to 5. And now he's like, my number 5 is 1 through 20 of the hype checklist.

  Ben Fineman [00:31:53]:

  Yes. My my 3rd wish from my genie is a 1,000,000 wishes. So we could just distill all this down to, like, promoting hype, but I'd wanna read these 4.

  Carrie Wiita [00:32:03]:

  Yeah. Yeah. Okay.

  Ben Fineman [00:32:05]:

  Because I think If we're starting a modality, there's no choice but to do these for our success.

  Carrie Wiita [00:32:11]:

  Oh my god.

  Ben Fineman [00:32:11]:

  Okay. So use greatly exaggerated and unsubstantiated claims Using model specific jargon and always saying that it's evidence based. So we have to do that right off the bat. Have trainings taught by a, quote, master of the theory, which Carrie is you and I, so we're gonna get rich.

  Carrie Wiita [00:32:28]:

  Oh, a 100%.

  Ben Fineman [00:32:30]:

  And set up an international organization to govern all things related to CVG two point o. My god. That includes certifications that people have to pay for.

  Carrie Wiita [00:32:38]:

  Oh, can we have a board? We Oh, sure. Yeah. Need a board. Okay. Thank you.

  Ben Fineman [00:32:42]:

  Board certified.

  Carrie Wiita [00:32:43]:

  Yeah. Yeah. Board certified.

  Ben Fineman [00:32:45]:

  Talk about neuroscience, And then, conduct poor quality research and only publish what supports our claims. All this is from the hype checklist, And it's not us being cynical. This is, like, how certain modalities gain public influence as they do all this stuff, and it just sounds good and people believe it. So We're gonna steal that

  Carrie Wiita [00:33:09]:

  because Oh my god.

  Ben Fineman [00:33:10]:

  Are being shameless in our in our carry band therapy.

  Carrie Wiita [00:33:13]:

  This is so cynical and one of the funniest things you've ever done.

  Ben Fineman [00:33:19]:

  It's it's the opposite of the wonderful in this interview in every way.

  Carrie Wiita [00:33:23]:

  It is. Alright. Let's do it, Ben.

  Ben Fineman [00:33:28]:

  So before we structure this into stages and steps and make it nice and manualized Yeah. Carrie, I know you said you think it's necessary for us to first define the therapist's role.

  Carrie Wiita [00:33:41]:

  Yes. I do.

  Ben Fineman [00:33:44]:

  How do we do that?

  Carrie Wiita [00:33:45]:

  Okay. Well, in all the well, if you look at, like, all the, like, theory textbook kind of things, they all well, at least dying gay hearts. They break it out into, like, you know, a description of, like, what the whole deal is. And then it starts with the stance of the therapist. Right? Because

  Ben Fineman [00:34:01]:

  Okay. No. I'm just so excited for this. Keep going, though.

  Carrie Wiita [00:34:03]:

  Oh my god. Oh my god. So the stance of the therapist, it kind of infuses everything. The stance of the therapist, it, like, identifies what the therapist's point is. Like, what are they supposed to be fucking doing in this ship. And it it directs it, like, kind of defines, is this gonna be a very active therapeutic relationship? Is this a passive therapeutic relationship? Where, like, where do you fall on the expert to nonexpert, you know, spectrum? So you have to define the therapist role because it defines how the therapist is going to interact with the client, how the therapist is going to introduce things into therapy, how much the therapist is going to kind of lord it over the client, all those good

  Ben Fineman [00:34:52]:

  Thanks. Can I propose the stance that's on that I'm thinking of can't wait? Or float it and see how you feel?

  Carrie Wiita [00:34:59]:

  Yeah. But remember, we have to we have to stitch in. I specifically listed the constructivist okay. Go ahead.

  Ben Fineman [00:35:06]:

  So so you may Disagree, and we can scrap this, but I would like to start by floating that the stance of the therapist is that of a really good car salesman where Deep down, there's a lot of cynicism, and they think they know what's best. And they're using lots of buzzwords and trying to get, in this case, the client To come to the conclusion that they've already arrived at, which is to spend the most money Uh-huh. Because the therapist in in CBD two point o is using lots of hype And knows deep down that exposure therapy is necessary because the client has some kind of phobia, but they can't come across that way because they have to do things like come across in a constructivist way, pretend to have a not knowing stance, To not assume that they know what's best for the client and to do things like a wonderfulness interview, which, you know, a a cynical person could do, but they have to Pretend like they really bought into it.

  Carrie Wiita [00:36:03]:

  Okay. No. I I alright. I think that we can do all of these things, but the pretending can't be there. The pretending to be you I think I think this I think we can make this work. Okay. Okay. Because if you think about it If you think about sales as not being, forcing something on somebody that they don't want, if you think about it terms of cocreation of value Mhmm.

  Carrie Wiita [00:36:28]:

  Where the salesperson is, you know, to some extent, like Like, offering up, like a therapist does, a myth and rationale for treatment and a ritual that's gonna, like, get them to where they wanna go. Right? That's what But that's the car we're selling. Right? And if the client buys into that, then then the car becomes exactly what they want the car to become. So I do think I'm I'm on board with the with the car salesman therapist. As long as that car salesman therapist is genuinely trying to create something of value with the client, like, in good

  Ben Fineman [00:37:06]:

  faith. You and I have had very different experiences of buying cars in the past. That's what I'm learning from this conversation. Patient. Well Oh, yeah. Because Subaru sent you, like, a wedding gift.

  Carrie Wiita [00:37:15]:

  Yeah. They did. But okay. But okay. But see here, that's the thing. Right? So the car salesman's Job is to get you like, to go back to the hype that you're that you're saying we should we should put in there. Right? So this car salesman is gonna be, telling the client that this is evidence bless you.

  Ben Fineman [00:37:34]:

  I'm I'm allergic to car salesman.

  Carrie Wiita [00:37:39]:

  This car salesman therapist is going to be telling the client that this is an evidence based method that has lots of great research behind it. Right? Now if they're doing that deliberately to deceive, that's not okay. That's not a constructive stance. But if they are doing that in an effort to cocreate value and help the client engage in the therapeutic process And if that is what the client needs to be have confidence in the process, then I think you're doing it in good faith. Okay.

  Ben Fineman [00:38:09]:

  So it's like it's an ethical car salesman who genuinely wants To put the customer in the right car for them, but also recognizes that that customer needs

  Carrie Wiita [00:38:22]:

  Yes?

  Ben Fineman [00:38:23]:

  The the increased,

  Carrie Wiita [00:38:26]:

  They need the good sound package, the Harman Kardon sound system. Yeah. Yeah. Yeah. Yeah. But they, but they also need the customer to be overjoyed with the

  Ben Fineman [00:38:35]:

  purchase. So okay. So can we say that the stance of the therapist is that of An ethical car

  Carrie Wiita [00:38:42]:

  salesman?

  Ben Fineman [00:38:42]:

  Yes. Alright. I think we've lost everybody already, but let's go go.

  Carrie Wiita [00:38:47]:

  Thinking that. I was like, if anyone is still listening to this, I love you.

  Ben Fineman [00:38:53]:

  Also, I I think I said salesman salesperson, obviously.

  Carrie Wiita [00:38:56]:

  Yeah. Yeah. Yeah. Salesperson, obviously.

  Ben Fineman [00:38:58]:

  So with the stance in mind, can we pull things from our list of 10 that fits into phase one, which I think we can call something like Like assessment and expectation setting? Yes. Something like that.

  Carrie Wiita [00:39:12]:

  Ding. Ding. Ding. Absolutely.

  Ben Fineman [00:39:14]:

  Okay. So I'm looking at your list and my list, and I think the stuff that could fit in here, the wonderfulness interview and goal setting.

  Carrie Wiita [00:39:24]:

  Yes.

  Ben Fineman [00:39:25]:

  And maybe just those 2 to start, unless you wanna put in

  Carrie Wiita [00:39:29]:

  if we're doing expectation setting, that's where I think misogyny and mental illness Lands. Okay. Because because I think that I think introducing that idea early in the early phases is what helps I I think it would come from the assessment if you are like, for if you're if you're getting to know the client, why are you coming in? And the client Jumps up with, I am super codependent, and I need to be less codependent in relationships. You would introduce that there. Right?

  Ben Fineman [00:39:58]:

  Okay. Yeah. So I think Okay. So so in what order then do we do goal setting, misogyny of mental illness, and wonderfulness

  Carrie Wiita [00:40:06]:

  interview? Goal setting first. Okay. Because that you're you're get your setting the stage for them to direct the therapy and getting like, identifying what their priorities are in the car they're buying.

  Ben Fineman [00:40:19]:

  Mhmm.

  Carrie Wiita [00:40:22]:

  Misogyny of of mental illness will come in, like, if the their, goal setting, if their goals are, perhaps impacted by societal structures that, you know, they feel like they are to, like, have some sort of slavish adherence to. Like No. No.

  Ben Fineman [00:40:36]:

  It it can't be perhaps Because we're selling an an objectively better theory, so we have to tell people this is necessary, which means it's not If the client has goals that are misaligned with with who they are deep down

  Carrie Wiita [00:40:50]:

  This works because the yeah. Introducing it here is an explanation of why all other therapies are wrong.

  Ben Fineman [00:40:56]:

  Great. I I love oh, I love it. We've built into phase 1, explaining the clients why

  Carrie Wiita [00:41:09]:

  Love it.

  Ben Fineman [00:41:11]:

  Love it. And never follow that.

  Carrie Wiita [00:41:14]:

  Life. No. We'll follow that with a wonderful disinterview.

  Ben Fineman [00:41:18]:

  Okay. Great. Okay. So phase 2 then has to be like

  Carrie Wiita [00:41:24]:

  Middle stage treatment.

  Ben Fineman [00:41:27]:

  Just like calling it phase 2 again. Phase 2. But that's, like, where you do the stuff.

  Carrie Wiita [00:41:32]:

  Yeah. Like Just call it that. Do the stuff.

  Ben Fineman [00:41:35]:

  The phase 2. Do the stuff. Okay. So we have here, exposure therapy definitely fits in here.

  Carrie Wiita [00:41:42]:

  Yeah. A

  Ben Fineman [00:41:42]:

  100%. Cognitive triangle fits in here. Appropriately unusual comments and questions fits in

  Carrie Wiita [00:41:47]:

  here. Yes. I don't this is making me uncomfortable that it's slotting in so well. What? This whole thing

  Ben Fineman [00:41:53]:

  fact that, like like, this is just

  Carrie Wiita [00:41:55]:

  that it's working. Yeah. I know. It's really uncomfortable.

  Ben Fineman [00:41:57]:

  We are gonna be the 1st people to ever create, like, a foundational model of therapy Fueled purely by cynicism.

  Carrie Wiita [00:42:05]:

  It's like when it's like what was that 1 therapy the guy developed out of, like, People using, like, passive therapy, like, listening skills as a placebo in in research, And then they were like, oh, fuck. It's working, and then they turned it into an actual therapeutic approach. Which one was that?

  Ben Fineman [00:42:22]:

  I've never heard of this. It sounds

  Carrie Wiita [00:42:24]:

  hilarious. I gotta find it. Hold I'll Google it while you are doing or setting up phase 2 do this stuff. Yeah. I'm gonna phone a friend really quick. Hold on. I'm gonna text, Ben and Kurt. Okay.

  Carrie Wiita [00:42:45]:

  I haven't gotten an answer from the lifeline yet, and I thought there was, like I thought it was given as, like, a brand name. But here is a research article from 2012 published, in the clinical psychology review. It's called the efficacy of nondirective supportive therapy for adult depression, a meta analysis. Of nondirective supportive therapy for adult depression have been examined in a considerable number number of studies, but no meta analysis of these studies has been conducted. So and that's because it wasn't supposed to be a treatment.

  Ben Fineman [00:43:20]:

  It was a control.

  Carrie Wiita [00:43:21]:

  It was a yes. It was supposed to be the thing that wasn't gonna work. Right? And then they would test it against, like, real, quote, unquote, psychotherapies. NDST was less effective than other psychological treatments, But these differences were no longer present after controlling for researcher allegiance. NDST has a considerable effect on symptoms of

  Ben Fineman [00:43:47]:

  depression. So we can't we can't include this as part of our CBT 2 point o because it would undermine all the hype.

  Carrie Wiita [00:43:54]:

  Yes. We can't. Yeah. No. No. No. Definitely not.

  Ben Fineman [00:43:57]:

  We we have to actually seek to discredit This line of

  Carrie Wiita [00:44:00]:

  research. Yes. Absolutely.

  Ben Fineman [00:44:03]:

  So so maybe we need, like, a, like, a hype person to get on Twitter.

  Carrie Wiita [00:44:07]:

  That's absolutely what we need to hire a social media manager.

  Ben Fineman [00:44:11]:

  So while you were digging into this, I I realized we skipped over phase 2. So before do the stuff

  Carrie Wiita [00:44:18]:

  I thought phase 2 was do was do the stuff.

  Ben Fineman [00:44:20]:

  I think do the stuff is phase 3. And here, let me sell you on

  Carrie Wiita [00:44:23]:

  Alright. Okay.

  Ben Fineman [00:44:25]:

  So first, we need to do psychoeducation before we do the stuff. Oh, sure. Like, so we've already done expectation setting as part of phase one. Yeah. But we haven't yet done psychoeducation. We haven't yet told the client about the cognitive triangle, and we haven't yet told the client about neuroscience, about how how this is evidence based, And how, there are gurus out there who have figured out that this is how therapy works. So I think After phase 1, we do phase 2, which is just the psychoeducation

  Carrie Wiita [00:44:59]:

  phase. Put put misogyny in that one. That the it falls under psychoeducation. Yeah. Okay.

  Ben Fineman [00:45:05]:

  So so let me re reimagine this.

  Carrie Wiita [00:45:08]:

  Okay. Okay.

  Ben Fineman [00:45:09]:

  1, which is assessment and expectation setting. We're doing goal setting. We're doing the wonderfulness interview. Great. Sprinkled throughout all of this beginning after the 1st session is routine outcome monitoring, feedback informed treatment. That's just a given. Mhmm. Phase 2, psychoeducation, Where we're hitting them with misogyny and mental illness, a cognitive triangle, and all of this is done with as much jargon as Yes.

  Ben Fineman [00:45:30]:

  We'll allow with our ethical car salesperson stance. Yes. Because we're we're just hyping it up as much as we think the client can tolerate so that they will know that this is what they

  Carrie Wiita [00:45:40]:

  need. Yes. So they have full faith and confidence in the treatment being provided.

  Ben Fineman [00:45:46]:

  Yes. And so I think all this can be done within the first, like, 1 or 2 sessions.

  Carrie Wiita [00:45:50]:

  Jesus. We we blow through phase 1 and 2 in the 1st 1 and 2 sessions?

  Ben Fineman [00:45:54]:

  It is what EMDR does unless the client needs a lot more resourcing.

  Carrie Wiita [00:45:59]:

  Oh, okay. Great. Yeah. Awesome. Alright. Then moving right along. So phase 3 is do the stuff.

  Ben Fineman [00:46:07]:

  Phase 3 is do the stuff, and that's where, and you have to let me know the the way Unusual comments and exposure therapy fits together Yes. Because that is the primary prime that's the primary stuff that we're doing. Like, those are the the things that could be recognized as, like, quote, unquote, interventions that we can Yes. Train people in to do at, like, advanced And super advanced levels for an extra

  Carrie Wiita [00:46:34]:

  $1,000. Okay. Perfect. Perfect. It's like an upsell. Right? Okay. Okay. So So, yes, I think that these fit together perfectly because when you are identifying the fear to which the client needs to be exposed to, It has to be an appropriately unusual fear.

  Carrie Wiita [00:46:52]:

  It it can't be something that, like, they've never thought of, and it can't be something that It's like they're like, oh, no. This is my problem. You know, like, they walked in being like, I'm afraid of being co of, you know, the the codependence is a fear represents a fear. Right?

  Ben Fineman [00:47:09]:

  Yeah? Oh, so so, like, if they come in and say something like, I have a fear of dogs or a fear of flying where it seems like they know what the fear is, we are Because we've already given them the psychoeducation Right. We get to tell them why. That's not the actual fear.

  Carrie Wiita [00:47:23]:

  They think

  Ben Fineman [00:47:24]:

  They have a fear of flying, but in reality, they have a fear of not not flying or something where we're We're unusually explaining what their fear

  Carrie Wiita [00:47:34]:

  actually is. Yes. Yes. What happened? Too unusual what? What

  Ben Fineman [00:47:40]:

  what? What happened?

  Carrie Wiita [00:47:42]:

  Oh, I thought you were typing stuff down. I thought you were taking notes. I was waiting till you were done taking notes. Oh, is it too unusual? No. See no. See, it says too usual. To say you have a fear of dying is too usual. That's existential therapy.

  Carrie Wiita [00:47:56]:

  Exactly. Exactly. But that's wrong. They're wrong because everything that's come before is wrong. So so so if someone who comes in and says they have a fear of flying, fear you have a fear of dying, too usual. What would be too unusual would be you have a fear of airplane food. That's too unusual.

  Ben Fineman [00:48:17]:

  Too unusual.

  Carrie Wiita [00:48:18]:

  Yeah. Because they had nothing that has nothing to do with with the flying. They probably weren't even thinking about you don't even know that for sure that they have food on every flight they go on.

  Ben Fineman [00:48:26]:

  How about this? You have a fear of whatever is happening neuroscientifically within your mind. So it's not the flying. Yes. The food, but there's something that you are experiencing that you are afraid of, and you have misplaced your fear into the flying itself. But we have neuroscience to show That what happens within your mind when you think about

  Carrie Wiita [00:48:49]:

  flying is

  Ben Fineman [00:48:49]:

  what you're actually afraid of, and then those emotions Lead to thoughts and feelings, cognitive triangle, that cause you to avoid flying, and so we wanna get you To do exposure therapy around letting those feelings, I don't know. We're I think we're getting there.

  Carrie Wiita [00:49:07]:

  I hate to say this, but I Think you just described, flight, fight, freeze in trauma informed

  Ben Fineman [00:49:16]:

  therapy. That's fine because every theory is really just repackaging some other theory. So as long as we have new language for it, then we can sell this.

  Carrie Wiita [00:49:24]:

  Right. But, like, what's deeply concerning to me is that we arrived at that actual therapy by virtue of trying to do it, like, incredibly wrong and cynically.

  Ben Fineman [00:49:33]:

  Oh, I'm not surprised by that at all. I I just assumed this was gonna happen.

  Carrie Wiita [00:49:39]:

  Because that would be like so you're oh, You don't have a fear of flying. It's not and it's not a fear of death, and it's not a fear of the food. You you have a fear of Fear. Wish you got it.

  Ben Fineman [00:49:52]:

  I love it. Oh, it's so

  Carrie Wiita [00:49:56]:

  good. My god. Alright. Great. Okay. Great. So now that we've done an appropriately unusual, exposure, We set up a good an appropriately unusual exposure intervention. Now we do it.

  Carrie Wiita [00:50:12]:

  We do the stuff. We do the exposure intervention, and then we just keep going from there. Yeah. So then it becomes like EMDR. Like, okay. Do this and then do this other thing. And if it doesn't work, do it harder.

  Ben Fineman [00:50:22]:

  Yeah. And also like EMDR. So MDR has 8 phases or stages. But once you get through all of them, you go back to Typically, you start back at, like, 3. But if you need to, you start back at 1 to reassess what are the things you wanna work on, and do you need more resourcing. And I think we do the same thing where Once the exposure and the unusual comments have done their

  Carrie Wiita [00:50:45]:

  magic

  Ben Fineman [00:50:45]:

  Yes. We can go back as needed to throw in more psychoeducation, more hype, More goal setting if it's shifted at all, do a new wonderfulness. If, like, you can cycle through these.

  Carrie Wiita [00:50:54]:

  Hell yeah. You can.

  Ben Fineman [00:50:56]:

  And It's funny now because I'm looking at the next part of phase 3, which is checking in about termination. Because as you're doing this and clients are meeting their goals or you're stating. You do wanna check-in about termination, but now I feel like I'm in a bind. Uh-oh. Why? Because we got very cynical very fast as we created this theory. Right. And the checking in about termination is very ethical because you are giving a client a very informed option to stop Attending therapy if it's no longer serving their needs.

  Carrie Wiita [00:51:25]:

  Oh, yeah. No. But it's like the sales technique of Brian? Brian, What's the sales technique where you're like, oh, no. You can't have this? Brian. What's the sales technique where you're, like, selling something and then, like, you're like, oh, no. You can't have it. You take it away. It's called the takeaway.

  Ben Fineman [00:51:49]:

  The takeaway. Jesus

  Carrie Wiita [00:51:52]:

  Christ. It's like when someone's hesitating, and you're like, wait. JK, You can't have it. Oh, wait. Hold on.

  Ben Fineman [00:51:58]:

  I don't think you're

  Carrie Wiita [00:51:59]:

  ready. He says, yeah. I don't think you're

  Ben Fineman [00:52:01]:

  ready. I don't think you're ready. It works. You end treatment? No. I don't think you're

  Carrie Wiita [00:52:06]:

  ready. Think you're ready. So This works so

  Ben Fineman [00:52:11]:

  good. So here's the problem I'm realizing. Well Not not problem, but I think we were kind of in earnest still doing something that wasn't Pure cynicism, but then we got into phases 2 and 3 where we actually do the therapy. And very quickly, we went over the cliff, and now it's pure

  Carrie Wiita [00:52:29]:

  Well, you made pure Cynicism. You made it pure cynicism because you said we have to do all the interventions, Which is fundamentally at odds with the constructiveness therapist stance, which is I'll introduce it, but if you don't want it, we don't have to do it. So you're the one who who shoehorned this down some evil

  Ben Fineman [00:52:51]:

  path. Yeah. That's fair. I also introduced the hype checklist.

  Carrie Wiita [00:52:54]:

  You did.

  Ben Fineman [00:52:55]:

  But but if I didn't do these things, you just wrote a paper on how to combine narrative therapy and CBT.

  Carrie Wiita [00:53:03]:

  Yes. I

  Ben Fineman [00:53:03]:

  that the most

  Carrie Wiita [00:53:04]:

  interesting, I guess, for sure. The best therapy in my Objective opinion.

  Ben Fineman [00:53:13]:

  Oh, I feel I feel shame for having ended up hearing the conversation.

  Carrie Wiita [00:53:18]:

  Okay. But here, think about this, though. Right? So we these very, very elegant therapy we've come up with. Right? And so now we get to the termination section where we're like Phase 4. You are you ready phase 4. Are you ready to terminate? No. You're not ready. And the book, we don't it's we're gonna save money on publishing the manual Because it's gonna be, like, a choose your own adventure, only there's 1 choice.

  Carrie Wiita [00:53:41]:

  You go back to the beginning, and you just keep doing that as long as the client is paying. It's just a constant cycling back, but you've really gotta make the client be the one making the choice to stay in therapy. They're they're the ones who are like, no. No. No. I'm not ready. I'm not ready to leave. I don't wanna leave you.

  Ben Fineman [00:54:00]:

  Is is there a way to to keep everything that we've We've just created and actually make it well intentioned.

  Carrie Wiita [00:54:09]:

  Wait. You why are we now trying to make it well intentioned? Jin.

  Ben Fineman [00:54:14]:

  Shame, guilt. The fear the fear that maybe one of my clients someday will hear this and think That I am just a terrible person, and it will undermine the efficacy of therapy.

  Carrie Wiita [00:54:24]:

  We won't release this on the Made podcast, number 1. And number 2, we have come down this far. Ben, you are going all the way to the dark end of capitalism, my friend. We're going all the way.

  Ben Fineman [00:54:36]:

  So do so does that Very naturally transitioned to how do we take our our wonderful c b t two point o Yes. And reach the masses with it. How how will we certify people in this? How what is the price point, now that we have, what is it, the, international organization to govern all things related to cbd 2 point o, What comes next to take over the world?

  Carrie Wiita [00:55:04]:

  I think our biggest question is, do we want to partner with Pesi or not? Because if we partner with Pesi, we're gonna have to give up some of the of the revenue.

  Ben Fineman [00:55:16]:

  Yes. We

  Carrie Wiita [00:55:16]:

  do. But we are but we are going to access They are they're robust

  Ben Fineman [00:55:22]:

  audience. Yes. I think we have to, and I think I think I'll I will I will pitch that not just partnering with PESI. I think this is one of those we retain 51% kind of scenarios.

  Carrie Wiita [00:55:31]:

  Yes. Controlling share. I love it. I'd love it.

  Ben Fineman [00:55:35]:

  Because no effective model of therapy becomes popular Without some big name guru attached to it who is at the forefront of, like, the topic du jour.

  Carrie Wiita [00:55:49]:

  Right? Yeah.

  Ben Fineman [00:55:50]:

  Back in the day, it was, let's blame the mothers. Right. Then it was, let's blame I forget who. Now it's trauma.

  Carrie Wiita [00:55:57]:

  It's always been blamed on mothers.

  Ben Fineman [00:55:59]:

  And and at some point, probably blaming mothers again.

  Carrie Wiita [00:56:01]:

  I mean, we're still blaming mothers for the trauma. It's all childhood trauma.

  Ben Fineman [00:56:04]:

  I don't know if we're culturally there yet So, like, get Andrew Tate or some horrible, like, public massages to be our our mouthpiece. So we have to find who is the doctor That has captured the current cultural moment,

  Carrie Wiita [00:56:18]:

  the thinking Vanderkolk. You know I'm right because also He probably blames it on the mother.

  Ben Fineman [00:56:26]:

  He's he's a big fan of EMDR, so we know he's not immune to buying into hype.

  Carrie Wiita [00:56:31]:

  I'm pretty sure we need to approach Bessel van der Kolk with a with a very lucrative profit sharing arrangement.

  Ben Fineman [00:56:36]:

  I think we need more. We we need I agree. We need Betel, man, or coke. We need we need somebody else.

  Carrie Wiita [00:56:43]:

  The person has to be a man.

  Ben Fineman [00:56:49]:

  I mean, I would say that goes against our current cultural moment, but then I look at, like, who Are the gurus in our field? They're all men. And I think if if we do wanna be unethical and just, like, Maximize our profit? Definitely some white male

  Carrie Wiita [00:57:04]:

  doctor, because Siegel.

  Ben Fineman [00:57:07]:

  Dan Siegel, investor van der yeah. I could see it.

  Carrie Wiita [00:57:10]:

  Yeah. Alright. Dream team.

  Ben Fineman [00:57:11]:

  We don't have enough mindfulness for Dan Siegel to get on board.

  Carrie Wiita [00:57:14]:

  No. No. He's also, into, inter, interpersonal neurobiology.

  Ben Fineman [00:57:19]:

  Uh-huh. That's, I mean,

  Carrie Wiita [00:57:20]:

  that's a whole scam. That gets our that gets our

  Ben Fineman [00:57:24]:

  neuroscience. Yep.

  Carrie Wiita [00:57:25]:

  Okay. That That's our neuroscience credentials right there. Interpersonal neurobiology.

  Ben Fineman [00:57:32]:

  Yeah. We didn't talk a lot about that. We didn't talk a lot about, trauma. Because I think just using the word trauma is gonna be important here. So Vanderkolk hits the trauma side.

  Carrie Wiita [00:57:41]:

  The trauma. Dan, on the on the neuroscience. Biology. Yep. Yep. Great. We're nailing this. So we give each other we're doing right now 24

  Ben Fineman [00:57:50]:

  a half percent to show for us.

  Carrie Wiita [00:57:53]:

  Yeah. Exactly. Yeah. Okay. So now we're gonna have to maximize the revenue because we are giving away a lot of the pie. Right.

  Ben Fineman [00:58:01]:

  Which means very expensive training.

  Carrie Wiita [00:58:02]:

  It has to be very expensive, And which is good, though, because, according to, like, hype I don't know if this is actually on the hype checklist, but if Something's more expensive. It is perceived to be, like, probably pretty

  Ben Fineman [00:58:16]:

  good. Not just more expensive, but let me take a page. Carrie, this may shock you given that I am A, late thirties white guy who has a podcast, but I I I was once upon a time very into craft beer.

  Carrie Wiita [00:58:30]:

  How you set that up?

  Ben Fineman [00:58:33]:

  And the the foolproof strategy was that breweries would release Limited edition Yes. Bottles, which were

  Carrie Wiita [00:58:41]:

  Oh my god.

  Ben Fineman [00:58:42]:

  Variations of the normal stuff that anybody could get, but it was barrel aged, and they had, like, variants With certain kind of flavorings

  Carrie Wiita [00:58:48]:

  It's just like IFS.

  Ben Fineman [00:58:49]:

  And they would charge

  Carrie Wiita [00:58:50]:

  more can't get in.

  Ben Fineman [00:58:51]:

  But they would cap it at, like, 800 bottles, and so people would line up for days. Yes. So we need to sell very expensive trainings.

  Carrie Wiita [00:58:58]:

  Very expensive with a very limited attendance list.

  Ben Fineman [00:59:01]:

  So it's it's like especially as we're starting out to make it Clear that this is an exclusive, like, special thing. So it's something like I don't know. How does this sound? It's it's a 3 day like, Friday through Sunday weekend training Right. That costs $4,000.

  Carrie Wiita [00:59:18]:

  Oh, too cheap. We're giving away so much of that. Yeah. If we're limiting no. No. No. Yeah. If because if you're limiting how many people that you can bring in, then you need to increase the price above and beyond what it would normally be.

  Carrie Wiita [00:59:29]:

  And I feel Plenty of trainings are $4. This needs to be 9, $10,000.

  Ben Fineman [00:59:34]:

  Yeah. Okay.

  Carrie Wiita [00:59:35]:

  So 10 only, like, 12 people can do it at a time, something like that. $10,000.

  Ben Fineman [00:59:41]:

  Let's say 12

  Carrie Wiita [00:59:44]:

  people? Yeah. I love it. Yeah. That's a meaning that's a a manageable group for a weekend.

  Ben Fineman [00:59:48]:

  Yeah. So 12 people, so we're making a $120.

  Carrie Wiita [00:59:52]:

  And you have to apply to get in. You know, like, all the, like, business coaches that do this, you have to you you can't just buy it. You have to fill out an application and get chosen to give them your 10,000

  Ben Fineman [01:00:04]:

  I'm curious. Can we say because IFS does this. Can we say scholarship's available? But but here's the catch, And I don't know that IFS does this. They probably don't, and I don't wanna get

  Carrie Wiita [01:00:14]:

  sued. Okay.

  Ben Fineman [01:00:15]:

  Fair. But what we should do is say scholarship's available, But never more than 1, whether it's 12 people or a 1000 people. Yes. So so we have the appearance of actually caring about equity? Yes. Oh, at the end of the day, we are just trying to, like, pump the audience for money.

  Carrie Wiita [01:00:32]:

  That is very

  Ben Fineman [01:00:33]:

  important. And we're using the person who gets the scholarship To make us more appealing for PR purposes. So it's it's really actually to to boost our rep

  Carrie Wiita [01:00:41]:

  That's part of the scholarship is you have to be present at the, like, gala dinner where they are awarded the scholarship. And so we get lots of photos of them being, like, fetted by everybody, and it seems like a very big deal. Absolutely. Absolutely. And and To to apply for the scholarship, you have to, you have to fill out the application, and then, like, you can get accepted. Wait. Should we do it like grad schools do it? Like, Pepperdine does this. You are eligible for scholarships, but only after you've been enrolled in the program.

  Ben Fineman [01:01:11]:

  How does that work? So you have to quit before

  Carrie Wiita [01:01:13]:

  knowing if

  Ben Fineman [01:01:14]:

  you can pay for it? Yes. So if you don't get the scholarship, Yes. Convince yourself to pay anyway, and then

  Carrie Wiita [01:01:20]:

  you're screwed?

  Ben Fineman [01:01:21]:

  Yes. Really? That is horrible. I know. That is, like, predatory.

  Carrie Wiita [01:01:25]:

  Oh, it's terrible. They are not the only school that has Lot of the predatory for profit yeah. Woah. Schools do that. Yeah.

  Ben Fineman [01:01:31]:

  Well, I mean, if we're using words like horrible and predatory, we should definitely do it for CBT two

  Carrie Wiita [01:01:34]:

  point o. A 100%.

  Ben Fineman [01:01:38]:

  Jesus. Okay. So, obviously, what we're talking about now, the $10,000 12 person training

  Carrie Wiita [01:01:43]:

  Right. Right.

  Ben Fineman [01:01:44]:

  It's just level 1. I mean, that that goes without saying. So Yeah. Yeah. Happens for people who wanna get level 2 and level 3? At some point, they need to get Extensive paid, in shape or supervision from the certified people. Right. So we need, like, multiple tiers the people in the higher tiers can be a part of the pyramid scheme Yes. Siphoning off money from people trying to get certified Exactly.

  Ben Fineman [01:02:06]:

  Because this is the the this is what a Ponzi scheme is.

  Carrie Wiita [01:02:09]:

  Yeah. Once you've done level 1, then you can become a supervisor. That's gonna be a separate training. It's real cheap. Oh, you

  Ben Fineman [01:02:16]:

  have to get soup Training to be a supervisor so you have to

  Carrie Wiita [01:02:19]:

  pay 1st. Yes.

  Ben Fineman [01:02:20]:

  Yep.

  Carrie Wiita [01:02:20]:

  Okay. But it's like but it's like $1,000. It's it's super easy to become a it's You have to you have to show your commitment, and pay something, but then you become a supervisor. But so then now once you're a supervisor, then You can go do level 2 training. So then once you've become level 2, then you can teach other you start to become a supervisor for people going through level 2 training, And that's the point at which you are now pot committed, and you now your a part of your income now is providing supervision for people getting trained in CBT two point o. So now you have to go market for new people to join the CBT 2 point o family.

  Ben Fineman [01:03:00]:

  Perfect. And especially because if our efforts to raise hype and interest among the public is lagging

  Carrie Wiita [01:03:07]:

  Right.

  Ben Fineman [01:03:08]:

  Our supervisors will be able to make their income if they're only seeing 10

  Carrie Wiita [01:03:14]:

  clients. Yes.

  Ben Fineman [01:03:14]:

  And they have an extra, you know, 30 hours in the week, they can do supervision. Absolutely. So we don't even need a robust client population initially As long as the supervisors have other therapists to sell their supervision to to make

  Carrie Wiita [01:03:27]:

  income. And it cuts down on our marketing spend because now we have Advise these folks who've already bought in to do the marketing for us because now their livelihoods depend on it.

  Ben Fineman [01:03:39]:

  Can I ask how this, fits into the constructivist stance at at the at the misogyny of mental illness?

  Carrie Wiita [01:03:47]:

  Placebo effects? I mean, like, a a good placebo effect is often as good as treatment. So c EMDR.

  Ben Fineman [01:04:02]:

  Man. I have to say this genuinely did not go At at all as I expected. Like, I thought we would take the cynicism and fit it into something that actually felt Good, if not, like, fun and lighthearted. I did not expect us to go, like, truly dark on this.

  Carrie Wiita [01:04:20]:

  No. But, see, this is this is this is what's this is the worst part. This is the darkest part of all of it, Ben. I think it's just a shift. I think you could get back to genuine, like, good faith engagement with this model with just a mindset shift. And the shift is it's what's best for the client. It is best for the client. It's what it's all about the client's healing, and that's what's so terrifying about

  Ben Fineman [01:04:47]:

  So I think I get what you're saying. Are you saying that I mean, what we're joking about is A cartoon, but not that far removed from how a lot of modalities end up getting created and sold blah blah blah, except that the people who are Doing the things we're joking about aren't doing it cynically. They genuinely believe they have stumbled upon the answer, and by, like, structuring these pyramid schemes and all this training and the hype, etcetera, It's not in any way motivated by cynicism. It's motivated by a genuine belief that they have figured out what is needed in the field. Yep. So the only difference between what we're doing and what they do is the mindset shift Yes. Where they believe it, and we are horrible people who See beyond the

  Carrie Wiita [01:05:30]:

  curtain. We are doing this to make fun of that. Like, that's that's that's what's at its core. Yeah. And I think it's so funny, though, how when you put yourself it's interesting because we didn't plan to go down this road necessarily. We joked about how this could end up this way, But we put ourselves in the position of being as cynical and greedy as possible, and look how easily it mapped on to all of these available, like, methods. Like, it was it's like if you are what is that? What am I thinking? It's like If you were going to be as Machiavellian and evil as possible and you make all the decisions to do that and then it ends up looking Like, something else that, like, already exists. Like, what does that tell you?

  Ben Fineman [01:06:18]:

  Boy, this is gonna be interesting to edit and just see our descent. So dark. Really?

  Carrie Wiita [01:06:26]:

  But I think we just real we we are reveling. We're wallowing and all of the things that, like, aggravate us about this field. Yeah. I mean, this is that's that's why we did this was because, you know, we at at our core, you and I both have, like, a very a very cynical attitude towards manualized treatment, And we have a very cynical perspective about folks who are making so much money off of a manualized treatment.

  Ben Fineman [01:06:57]:

  That's it. Like, I I'm actually not cynical about manualized treatments because I think sometimes that's perfectly fine and works and is is good. It's it's the we have this new information that will revolutionize the field Yeah. And we're gonna charge people a lot of money so that only this elite Kabbal of therapists can actually help

  Carrie Wiita [01:07:16]:

  people. Right.

  Ben Fineman [01:07:16]:

  And then they get brainwashed into thinking that's the only way. And it's it's not an exaggeration. Like, to become I think it's like a Certified somatic experiencing practitioner or something cost well over $10

  Carrie Wiita [01:07:28]:

  overall. Jesus.

  Ben Fineman [01:07:29]:

  Not like one training. Was a ridiculous exaggeration, but

  Carrie Wiita [01:07:32]:

  a hilarious

  Ben Fineman [01:07:33]:

  one. But, like, to get from start to finish, it takes lots of time and lots of money.

  Carrie Wiita [01:07:37]:

  Yeah.

  Ben Fineman [01:07:38]:

  But it doesn't make you a better therapist. It just makes you believe you're a better therapist, and that's Well, hold up. We were coming up with with, like, We're not gonna do anything new. We're gonna say it's fear of fear. Right. Tell people that this is, like that's every modality is like

  Carrie Wiita [01:07:54]:

  It is. But we don't

  Ben Fineman [01:07:56]:

  packaged the same old shit in new exciting ways, and we have this guru who can tell you that it's like

  Carrie Wiita [01:08:01]:

  And we don't know that that isn't what works in therapy.

  Ben Fineman [01:08:05]:

  We don't know that it is.

  Carrie Wiita [01:08:07]:

  We don't know that it is, but we don't know that it isn't.

  Ben Fineman [01:08:12]:

  Familiar old nihilism. Here we are again.

  Carrie Wiita [01:08:17]:

  This is oh, wait. Ben, I see your campsite at the edge of the wood.

  Ben Fineman [01:08:21]:

  Oh, yeah. Yeah. It's comfortable here. I've built a nice home. The edge of sanity.

  Carrie Wiita [01:08:30]:

  This was fun,

  Ben Fineman [01:08:31]:

  Ben. This was fun. I feel like I need to process this.

  Carrie Wiita [01:08:38]:

  I desperately need a mimosa now.

  Ben Fineman [01:08:40]:

  Yeah. We did the sober. Well, Thanks, Gary. This was

  Carrie Wiita [01:08:48]:

  Thanks. Thanks, Ben.

  Ben Fineman [01:08:49]:

  This was an experience.

  Carrie Wiita [01:08:50]:

  This is this was yeah. We're gonna have to go think about this.

  Ben Fineman [01:08:59]:

  That was a fun conversation. You know? Going back to the intro, cynicism abounds, but we have some listener mail that is a bit of a palate cleanser from somebody who I think Kind of shares that mentality of of hope and advocacy and not just pure cynicism.

  Carrie Wiita [01:09:16]:

  Oh my goodness. That makes me so happy.

  Ben Fineman [01:09:18]:

  So this comes from, Kimberly Chiswell Who is in Australia. Kai, was our last listener mail also from somebody in

  Carrie Wiita [01:09:25]:

  Australia? Yes. Is it is it just that Australians are, like, Optimistic, wonderful people, like, by and large?

  Ben Fineman [01:09:32]:

  I think we're gonna get some emails from Australians who will No. Correct that call.

  Carrie Wiita [01:09:36]:

  About that. Okay.

  Ben Fineman [01:09:37]:

  I think so. Okay. So Kimberly writes, I've been listening to you guys for years. I actually remember the 1st time I came across your podcast and where I was listening to it from. I'm a therapist, supervisor and educator at several universities and my own and my own private practice in Australia and Mexico, which Sidebar, Carrie, that's a hell of a commute. I assume that's Sure is. That's online therapy. Sure is.

  Ben Fineman [01:10:00]:

  I share your podcast with all my students and supervisees and professional networks. I very much appreciate your deep dive into the abyss of trauma and the body. Thanks so much for exposing some of the taken for granted assumptions about trauma. My passion lies in promoting skills and knowledge and being able to listen, understand, and respond to interpersonal violence and state sanctioned harm slash oppression. I find that this is not taught in our schools and would boldly say that if many of the interviewees on your show had have received a violence informed approach, Then the outcome may have been different. I'd be keen to hear about whether or not your schools teach this at all or well. I'm very much informed by RBP, response based practice and narrative therapy and teach this in the social work courses. I'm also on the international advisory group for InsightXchange.

  Ben Fineman [01:10:46]:

  And then Carrie Kimberly has included Some really wonderful links here, some of her work, some work from Insight Exchange, and then actually, a link to an interview, from Chris Hoff's podcast, The Radical Therapist. So So we are going to put all of those in the show notes, and thank you, Kimberly, for writing

  Carrie Wiita [01:11:02]:

  in. Kimberly, that just made, like, every Saturday morning of podcasting So worth it. Thank you so much for those kind words. Thank you for listening to Very Bad Therapy. The views and opinions expressed do not constitute therapeutic or legal advice, nor did they represent any entity other than ourselves or our

  Ben Fineman [01:11:28]:

  guests. Visit us at very bad therapy.com for more content, ways to support the podcast, Or to let us know if you have a story you'd like to share on the show. If you'd like to join our Patreon community and get access to our monthly bonus episodes, Check us out at patreon.com/verybadtherapy.