A Therapist Can't Say That

As humans, we tend to like answers a lot more than we like questions. When we believe we have found answers, re-examining what we think of as truth is inherently destabilizing.

In a relatively young field like neuroscience, paradigm shifts, misconceptions, corrections, retractions, and foundational remodels are inevitable. We already have more questions than answers, and each answer spawns a thousand more questions. 

That ever-unfolding feedback loop of curiosity, seeking, and finding is beautiful. However, it also causes problems when the paradigms we’ve adopted as true turn out to be mistaken.

Do we throw out therapeutic interventions that work because the neuroscientific explanation becomes irrelevant or outdated? Or do we twist the evidence to make it fit to keep using these interventions? The former seems wasteful, the latter disingenuous.

So what do we do? 

It's a daunting task, but acknowledging the vastness of what we don’t know or understand with certainty is a crucial step. This honesty and humility might just be the key to becoming better therapists.

Listen to the full episode to hear:

• The high stakes of re-examining accepted paradigms for ourselves and our clients
• Why the therapy field’s longing for legitimacy makes us so prone to cling to neuroscientific concepts
• Why even rock-solid science probably still won’t erase therapy’s “weird” reputation
• Why it’s worth asking ourselves how we would explain what we do if we couldn’t rely on our favored neuroscientific explanation
• How over-adherence to neuroscientific explanations is fueling the toxic intraprofessional culture of therapists
• Why approaching neuroscientific concepts with humility and a grain of salt and maintaining a healthy skepticism with your clients isn’t going to kill your credibility

Learn more about Riva Stoudt:

• Into the Woods Counseling
• The Kiln School
• Instagram: @atherapistcantsaythat

If you’re a therapist in 2024, odds are you have given a client a neuroscientific explanation for a symptom they’re experiencing or an intervention you’re using. You’ve probably done it sometime in the last week. So have I. Neuroscience-based language is the lingua franca of our field nowadays.

As a field, we have largely abandoned the languages of behaviorism or psychoanalysis, though there are still therapists who use those frameworks. But if you asked most therapists right now why they think what they do works, you would get an answer about the brain and nervous system.

This would be fine, except that at this moment, as our scientific knowledge rapidly grows, so do our claims about what that knowledge means, sometimes outpacing real understanding of the emerging research and its practical implications.

So when I encountered an article in The Washington Post titled “The Body Keeps the Score offers uncertain science in the name of self-help. It’s not alone” by writer and cultural critic Kristen Martin, I was intrigued by the way she shed light on some of the neuroscience that we increasingly use to justify what we do as therapists. 

I invited Kristen to join me to unpack some of the all-too-common misrepresentations and over-interpretations and the wide-ranging implications for our field and the people we treat.

Kristen Martin is a writer and cultural critic. Her debut narrative nonfiction book, The Sun Won’t Come Out Tomorrow, will be published in winter 2025.

Listen to the full episode to hear:

• Why we are so compelled to seek out neurobiological explanations for human experiences
• The significant limitations of the research that routinely gets cited to justify neuroscientific models of mental illness and trauma
• How poor communication, low science literacy, and social media exacerbate the spread of “folk neuroscience.”
• How neuroscientific explanations for mental health struggles are being co-opted and exploited by bad-faith actors and systems
• How biologically-based explanations for mental health issues can increase stigma
• How neurobiological models let us bypass our collective responsibilities to mitigate systemic issues associated with trauma

Learn more about Kristen Martin:

• Website
• Twitter: @kwistent

Learn more about Riva Stoudt:

• 
  Into the Woods Counseling
• The Kiln School
• Instagram: @atherapistcantsaythat
  
  

Resources:

• ‘The Body Keeps the Score’ offers uncertain science in the name of self-help. It’s not alone.
• Scanning Dead Salmon in fMRI Machine Highlights Risk of Red Herrings | WIRED
• Caitlin Shure, PhD 
• Fundamental challenges and likely refutations of the five basic premises of the polyvagal theory, Paul Grossman

How Emotions Are Made: The Secret Life of the Brain, Lisa Feldman Barrett

Since the last episode’s conversation with hannah baer about the Jewishness of therapy, I’ve been thinking a lot about lineage.

When I first decided to do an episode on the topic, I was primarily motivated by wanting a deep sense of admiration for the Jewish pioneers of the field. Their contributions, which, like any minority group, tend to get erased as they are absorbed into the dominant culture, are invaluable and deserve explicit recognition.

But our conversation and hannah’s original article also helped me connect to something more than claiming therapy’s Jewish roots and contributions to global culture.

The American myth of being self-made or self-determined tends to alienate us from our lineages, but we are part of them whether we consciously engage with them or not. The history and context of our field matter, even when those histories are messy, ugly, and problematic. Contending with therapy’s history opens a dialogue between ourselves and our forebears in ways that move the profession forward and bring us together in solidarity and kinship. And that is a project worth taking on.

Listen to the full episode to hear:

• How the American fantasy of being self-made teaches us to ignore the lineages of our practice
• The importance of pushing back against ahistoricism and divorcing concepts from their context
• How we are in relationship with our lineages, whether we are conscious of it or not
• Why critiquing and rejecting what you don’t like about the field’s lineage isn’t enough
• How acknowledging our lineage opens the door to deeper camaraderie and kinship

Learn more about Riva Stoudt:

• Into the Woods Counseling
• The Kiln School
• Instagram: @atherapistcantsaythat

Raise your hand if this sounds familiar: In a group of leftie social justice therapists, someone says that therapy is a profession founded by white men. Everyone else in the room nods along and acknowledges the white male hegemonic roots of the profession, then moves on to discuss other things. 

The problem with saying that white men founded therapy and is part of a white hegemonic legacy is that it just isn’t true.

If you go down a list of the founders and early theorists of therapy as theory, discipline, and practice, you’ll find that many of them were Jews. Even now, many of our theory heroes and celebrity therapists are Jewish.

And that’s not incidental or coincidental; it is consequential. Therapy is foundationally and elementally Jewish.

To dig into therapy’s Jewish roots, I invited writer and therapist hannah baer to join me. We also talk about therapy’s relationship to Jewish mysticism and esotericism and delve into the ways in which therapy follows the Jewish tradition of marking and understanding the past.

hannah baer is a writer and therapist based in New York. She is the author of the memoir trans girl suicide museum. 

Listen to the full episode to hear:

• The conflation of survival and accumulation of privilege that has happened in many Jewish families as they have been assimilated into whiteness
• How the rejection of psychoanalytic therapy is tied to the drive for assimilation into white culture and the rejection of mysticism
• Why it should be okay for therapists to accept that the magic that happens in the room can’t always be explained by science or reduced to an insurance note
• The Jewishness of verbalizing and analyzing trauma, and reinterpreting historic theory
• The radical promise of therapy to help people metabolize and contextualize their trauma so they don’t repeat it on others
• The American insistence on focusing on the now or the future at the expense of grappling with and understanding the past
• The impact of consumerism on how patients approach mental health treatment

Learn more about hannah baer:

• trans girl suicide museum
• Instagram: @malefragility

Learn more about Riva Stoudt:

• Into the Woods Counseling
• The Kiln School
• Instagram: @atherapistcantsaythat

Resources:

• Wikipedia: Who Is a Jew?
• Therapy Was Never Secular
• The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients, Irvin Yalom
• The Case for God, Karen Armstrong
• Hannah Arendt
• Building a Life Worth Living, Marsha M. Linehan
• Standing Together

Co-conspirator and friend of the podcast, Dr. K Hixson, returns to share some exciting news about a true labor of love.

We’ve joined up to create The Kiln, a comprehensive supervision and training program for pre-licensed therapists in Oregon. The Kiln will also offer continuing education to practicing clinicians.

This venture was born out of our mutual frustrations and concerns with the direction, trends, and tendencies in the current state of our field, and our deep dedication and commitment to our work.

Today, we’re going to get into why we are bringing an apprenticeship lens to postgraduate supervision, pushing back on current paradigms in trauma treatment, and how you can join our trainings or become part of our very first cohort.

Listen to the full episode to hear:

• Why many grad schools and supervision programs fail to train great therapists
• The two fundamental philosophies that define our approach with The Kiln 
• Why we teach exposure-based trauma therapies and push back on anti-exposure bias
• Why therapists need to be able and willing to confront themselves
• Trauma processing modalities that we are excited about working with and teaching

Learn more about The Kiln:

• Website

Learn more about Dr. K Hixson:

• Website

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Resources:

• Trauma and Recovery: The Aftermath of Violence--From Domestic Abuse to Political Terror, Judith Lewis Herman
• Brain Talk: How Mind Mapping Brain Science Can Change Your Life & Everyone In It, David Schnarch

To wrap up season two of A Therapist Can’t Say That, I’m continuing my reflections on my ten years as a therapist.

I’ll be back in April with interviews on some juicy topics, but for now, here are lessons six through ten that I’ve learned over the last decade of doing this work. 

Listen to the full episode to hear:

• Why being overly passive for fear of screwing up might be the biggest mistake of all
• How courage is the true gatekeeper of all my clinical skills
• What it really means to take responsibility for what happens in the therapeutic space
• What I’ve come to deeply appreciate about the siblinghood of being a therapist, cardigans included

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Every therapist remembers their first client. 

Many look back and cringe at what a bad job they think they did. But for me, I look back and remember the magic I felt in the room with my very first client. 

Which isn’t to say I’ve never done a bad job with clients. I have, just like we all have.

But after ten years of being a therapist, when the work I do has become part of the mundane fabric of my day, I still remember so clearly the magic of being so in it with my first client.

So today, I’m reflecting on ten years of being in this field. 

Listen to the full episode to hear:

• Why I believe that empathy is crucial to our relationships with our clients
• How making a new therapy with every client is about more than what tools we use
• Learning to have faith in the emergent process of doing therapy while confronting the unfixable
• The realities of balancing the amount of relational energy I have between clients and loved ones

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Resources:

• Slapstick, Kurt Vonnegut
• Season 2 Ep 9: Immediacy in Therapy: Breaking the Fourth Wall with Dr. K Hixson
• Standing by Words, Wendell Berry

In the last episode with Dr. K Hixson, I said that our field is defined by the wish fulfillment fantasy of the parentified child. The parentified child wants nothing more than to get it right, manage the relationship, and have the parental figure be healed and available to you

If you are a therapist and you think that you were not, in some way, a parentified child, you’re probably wrong or in denial, or you’re one of the very, very few exceptions to this trend.

I stand by what I said that grown up, parentified children make up the bulk of this field, which means that knowing someone is a therapist means knowing something pretty significant about a dynamic that shaped them.

But when we name it, there can be a sense of residual shame that comes up.

Today, I’m digging into where that shame comes from, why so many parentified children end up in this field, and how the drives of the parentified child help and hinder us in this work.

Listen to the full episode to hear:

• How being a therapist can actually be an impediment to personal healing
• The fine line between interpersonal hypervigilance and interpersonal hyperattunement
• How this work can reinforce patterns of relational perfectionism and imbalanced caretaking roles so common to parentified children
• How using immediacy with our clients can actually help us heal these patterns and tendencies
• The difference between self-validated intimacy and other-validated intimacy and how it applies to immediacy and self-disclosure

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Resources:

• Constructing the Sexual Crucible: An Integration of Sexual and Marital Therapy, David Schnarch

Immediacy may seem like a stale topic, but I truly believe that it has the capacity to be the primary tool of magic in the therapeutic relationship.

Immediacy is risky. Immediacy is counter-cultural. Immediacy is a disruption to our people-pleasing tendencies. Immediacy challenges us to stretch our tolerance for uncertainty. Immediacy is a key to unlocking difficult clients.

Immediacy invites us to do therapy by taking off the therapist mask and being seen. Immediacy is the mediator of therapeutic intimacy that can change lives.

It’s not trendy, influencers aren’t posting about it, but it is incredibly powerful and effective.

Today, my dear friend and colleague K Hixson returns for a conversation about immediacy and why we believe that it is such a potent tool.

Listen to the full episode to hear:

• How immediacy lays the groundwork for intimacy and trust in the therapeutic relationship
• How we’ve confused therapy with customer service, and how immediacy breaks down our people-pleasing tendencies
• How immediacy can teach us to repair ruptures in a way that strengthens the relationship
• Why immediacy is so effective with clients with interpersonal trauma histories
• The role of self-disclosure in using immediacy
• Why over-attachment to protocols is really just wish fulfillment
• Why it’s vital to broaden our understanding of the history of the field and not just chase the latest trends 

Learn more about Dr. K Hixson:

• Website

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Resources:

• The Theory and Practice of Group Psychotherapy, Irvin Yalom
• Negotiating the Therapeutic Alliance: A Relational Treatment Guide, Jeremy Safran, J. Christopher Muran

Inspired by my conversation in the last episode with Dr. Andrea Celenza, today I want to talk about tolerating paradoxes and about love in the context of therapy.

In our conversation and in her book, Sexual Boundary Violations, Dr. Celenza discusses the concept of the “multiple irreducible levels of reality in the therapeutic relationship.” 

None of those multiple realities is more or less real than the others and it’s essential that we, as clinicians, maintain our awareness of them. Yes, it’s hard. These multiple realities evoke a whole range of relationships and power structures that often contradict each other. Of course it’s hard. 

But when we try to collapse these realities, that’s where we get into trouble. I want to unpack what that means for us in our therapist-client relationships, and how it requires us to hold and tolerate those multiple realities.

Listen to the full episode to hear:

• Three essential layers in the therapeutic relationship
• How the relationship dynamics that arise out of transference and countertransference are both real and useful, even when they contradict each other
• The paradoxical axes of power in the therapist-client relationship 
• How multiplicity and power bump up against each other and why we have to tolerate the tension
• How collapsing the paradox of multiple realities in the dyad creates problems with intimacy–being either exploitative or superficial
• Why too little intimacy in the therapist-client relationship is a significant problem
• How love and grief show up in therapeutic relationships

Learn more about Riva Stoudt:

• Into the Woods Counseling
• Instagram

Resources:

• Season 2 Ep 07: Let's Talk About Sex: A Humane Approach to Sexual Boundary Violations with Dr. Andrea Celenza
• Lynda Barry
• Season 2 Ep 4: What Happens When Our Clients Encounter Our Humanity?
• Sexual Boundary Violations: Therapeutic, Supervisory, and Academic Contexts, Andrea Celenza