ASM177 Ask Hillary McBride (Week 1)

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ah forget this ask science mike stuff it's time for ask hillary mcbride's [Music] welcome to ask science mike the weekly podcast where i usually answer your questions about science faith in life but for the next three episodes we've got a special guest hillary mcbride the licensed therapist researcher phd candidate and all-around brilliant human being is here to answer your questions about mental health happiness contentment and our feelings so what do you say let's get it [Applause] [Music] started i can't believe it this i'm so excited it's blowing my mind this might be like the most anticipated special edition of ask science mike ever i put out on the podcast feed you've got questions for hillary mcbride we're going to do an ask hillary episode of science mike and people went cuckoo for cocoa puffs this episode has been months in the planning more planning i think that any episode of the podcast i've ever had and it's finally happening ladies and gentlemen and people of non-binary gender identities it is my pleasure to welcome to the podcast the one the only hillary mcbride how are you hilary oh good well i am just i'm kind of blushing over here my cheeks are red um just kind of enjoying hearing hearing this intro and enjoying being here with you i'm so excited to be with you mike and all of the people who listen to your really important work on this podcast i'm guessing there could be literally ones of people who listen to ask science mike who aren't familiar with hillary if you don't know hillary one yes she is a co-host on the liturgist podcast but she's also a phd candidate a therapist a researcher a feminist scholar like just a force for love and justice in the world um and so we we're doing an episode this week i've asked you all for your questions that fit within hillary's expertise and oh my did we get some questions oh we got some questions all right yeah uh so we're gonna do not one not two but three ask hillary episodes because when we narrowed down the questions that's pretty much as tight as we could get it we had over 500 questions submitted for hillary uh so we can't get to all of them i mean that would be that would be like a multi-season podcast that's true we answered all those questions but we tried to pick questions that were uh representative and i actually really like you know one thing that i don't like about assigned spike in some ways is how many people ask me life advice questions and ask me questions regarding mental health and what i always do is say hey i'm not qualified to answer this but here's what i found on google so it'll be nice to have someone with actual education and relevant professional expertise talking about these questions today although i probably also do want to say that um get ready hillary's credentials uh not only make her more qualified to go through some of these questions but also limit her in some pretty significant ways uh so i'll just go ahead and give you the bad news right up front hillary cannot diagnose you over a podcast question hillary can't treat you hilary is not your therapist but she is graciously offering us her insights today in the confines of doing that in a public media format that is in no way making her your therapist is is that fair to say hillary yeah and thanks for saying that that's always something that i i struggle to spit out because it's such an important part of my ethical code and yet it often makes me feel like i can't give people the things that they want so thanks for so graciously saying that for me and i i hope that that works for all the listeners and we've got some doozy so we'll jump right in here's our first question uh it says this might not be a question that can be answered in a short podcast episode but i followed hillary's work both on the liturgist and other people's problems when she's talking to other people she always seems to ask questions that help the person talk about something they either didn't know or didn't know they needed to talk about how could i develop that skill in my own life to help myself and people around me do i need to become a therapist to be able to know how to ask these questions without hurting them and i would just echo this person's question i've noticed that about you as well hillary um and i'm very very curious to hear what you'll say okay well here we go so to the person writing this question i i wanted to start off by saying i'm so glad that you noticed the different kinds of questions that i ask there are actually some kinds of questions and ways of responding to people that are different in a therapeutic context than what shows up in our everyday reactions to people in our everyday relationships so before i answer your question i kind of need to say that certain questions are therapeutic or exploratory in nature and they're not necessarily helpful or appropriate in certain interpersonal contexts i ask questions that are meant to elicit exploration or bring insight and awareness because people have consented to that process like literally we actually sit down and sign a form a legal form that goes through the risks and benefits of engaging in this question answering process with me so i don't ask questions necessarily to peer uh i don't ask questions necessarily to feel powerful or to be a good therapist because sometimes my best therapy is actually done when i'm just with a person looking into their eyes and showing that i'm there with them so to be clear i don't ask the same questions in my friendships or with my family or with strangers because they haven't actually consented to that process and that's not the nature of the relationships also i've got training and skills to know how to do something therapeutic with whatever comes up when they answer the questions so it's inappropriate maybe harmful and maybe even misguided for us if we try to get someone to open up about something when we don't really have the tools to help them close back up again or to create a healing experience or right and this is important if they haven't really agreed to us doing that with them so when we think about the question asking process it's really important to try to not get too deep with someone too quickly when we don't have the skills or when they're not consenting to it therapy i think about sometimes is kind of like surgery for the mind or the soul and a lot has to go into a person being ready or willing to do that exploratory process not including the training we have to do to do that surgery but if i'm hearing the heart behind your question what i hear is that you're actually really interested in helping people and having meaningful interactions with people that feel rich for you and hopefully for them too so if that's the case what i might suggest is actually that you work on becoming a better listener that means really hearing what a person is saying and sometimes when we really hear what a person is saying we ask questions that naturally come up for us when we hear what they're saying and we have a kind of curiosity about what next whenever i'm asking questions in a non-therapeutic context like with a friend or co-worker and neither they nor i are doing therapy at that time i try to be extremely cautious to ask questions in a tentative way for example if it's okay for you i'd love to know a little bit more about that you haven't really told me about that part of your life before and i'm interested in you and hearing what that is like for you but only if you're comfortable sharing so what you could always do if you wanted to be a better listener is read a book on listening or take a course on active listening skills or join something that we call an interpersonal process group where people in a group setting supported by a trained professional consent to ask each other these deepening questions in addition to expressing their own vulnerability when asked those meaningful questions too so instead of thinking about how do i ask better questions to kind of maybe elicit a certain response in someone what i want to remind you to do is that sometimes those questions naturally come up when we listen and we share our honest reactions to people lastly in a therapeutic relationship although as a therapist i really care deeply for my clients they don't ask me the same questions back it's a unique kind of relationship that doesn't really work outside of therapy like maybe in the context of a mentor or a sponsor or supervisor but that means that if we're hoping to deepen our relationships by doing more active listening and then asking questions that come out of what we're hearing we have to be willing to do the same for others and to have other people ask us what we might be asking them for this kind of questioning to work we have to enter into that process of relationship and connection with a kind of mutuality and that's something that you probably don't hear whenever you're hearing me ask these questions it's a one-way street not a two-way street and part of that is because it's within a therapeutic context so i hope that answers your question and i love the heart behind this or what i think is the heart behind this which is about wanting connection and wanting to experience something meaningful with other people mike anything you want to add on that one i've just noticed in my own life um after i went through my collapse of faith and went through a period where i got just as certain in materialism and atheism as i was as a baptist and then that collapsed i was left with no confidence in my beliefs about anything which changed my dynamic conversationally i became very uninterested in what i had to say and started just listening to people and i didn't even have great active listening skills i would kind of sit stone silent as other people talked but i would just focus on giving them signals like eye contact which i'm not super comfortable with but just signs that i'm hearing them and before i became a science mic just just just this is interpersonally and what started happening was people started to tell me things they'd never told anyone before and because i had no confidence in what i had to say in response i had no advice to offer people i had no insights that i trusted i would usually just say thanks for telling me that and i i can understand how you feel which would lead to people telling me even more about themselves and so often for those of us that do not have therapeutic background and therapeutic training simply being a non-judgmental listener for people is a real gift that creates intimacy in relationships and honestly invites people into a space where they desire to be a non-judgmental non-reactive listener in return so gosh hillary that is uh i hope that's a skill that everyone listening decides they want to develop because i think we have a real drought of listening in our culture today and a great cultural impetus towards i want to appear smart and an expert and successful and together which leads us to be really performative and as that happens so often we miss out on on the real joy of relationship one thing that might help people if they're thinking wow yeah you're right i really wanted to become i really want to become a better listener how do i do that i often ask people to to pause between when they've heard someone say something and when they respond and when you're listening not just thinking about what you're going to say next in response to the other person or a story that you're going to share to show indirectly that you understand what they're saying but try to leave space to actually hear what is being said underneath the words hear what is being not said and what that communicates about what's happening in the other person and leave lots of space when they after they answer instead of rushing in to give a comment or some sort of um statement or a shared story well that's great [Music] friends i just got to tell you about kiwi co they are a sponsor of ask science mike and i just love them i've gotten so many pictures and cards and letters from you all showing me your children playing with kiwico crates that you found out about through ask science mike and this has become like the monthly ritual in our house uh we now have kiwi cakes coming for both of our daughters madison and macy one is a tinker crate which is focused on engineering and science and the other is a craft kit uh craft crate which is art projects and they kind of look at them both and then barter and decide who's going to do art this month and who's going to do engineering and they're making really beautiful things this week macy made some decorative lights for her room in the art crate and uh last month madison made a beautiful leather bag um and so this is something my teenage children love but i also know that young children love kiwi co2 because i've seen all of your pictures on social media if you'd like to help your children have so much fun learning in an interactive and tactile way just go to kiwico.com science and kiwico is going to send ask sciencemic listeners a box for free to try out in your family i absolutely believe your kids will love it as much as mine do and heck sometimes i get a little jealous some of that stuff looks really fun again just go to kiwi.co science excuse me kiwico.com science to get your free completely free kiwi coke rate this is says hi hillary i have frequently heard about some of the benefits of meditation but would like to know if there are specific meditative practices that are more suited to people with anxiety depression and or ptsd i know of many people who have who have these conditions that find mindfulness and contemplation does more harm than benefit when they try and remain still with their thoughts or focus on their breathing their thoughts often turn to suicidal ideation self-loathing or they may suffer a panic attack is there a type of meditative practice that has been proven to be beneficial to people with anxiety depression or ptsd in clinical trials that you have also seen individual benefit from in your line of work thanks steve and you know it's an ask science mike question because they asked for clinical trials i appreciate that that's so good so i'm going to speak more generally instead of rattling off a bunch of the results from randomized control trials but i wanted to start by saying steve your question is such an important one particularly as we see a rise in the use of mindfulness in a variety of health contexts and the message is finally getting out to people in more mainstream contexts that slowing down and being mindful is good for your brain and while that's true there are some exceptions for certain kinds of people whose brains might work a little bit differently so to get into a little bit of the nuance of your question trauma anxiety and depression can all be related but aren't necessarily related for some people who have trauma as part of the trauma diagnosis they also present with symptoms of depression or anxiety or both but there are people who experience depression or anxiety who don't have trauma who don't meet diagnostic criteria for ptsd because all these things can be related but are also often separately occurring i want to try and give the best answer that i can in light of the variety of possible clinical presentations or issues that you're talking about first mindfulness is super hard right i just want to say it's really really hard and if we're told to sit down and shut up and stop our thoughts for 10 15 20 30 minutes it can be a lot for the average brain let alone for someone who struggles with any of these conditions that you've mentioned anxiety depression or ptsd so how we're informed about mindfulness and the context within which we practice can make all the difference for example there is such thing as too much too soon and it can leave us feeling overwhelmed and like we failed especially if we have a predisposition towards seeing our failures or feeling like we can't get anything right we want to set ourselves up for success so i always recommend that with any kind of practice especially if we're new to it especially if it's hard that we start small if someone has never done mindfulness in the past i provide lots of education when i'm working with them about what it is and for those of you who are new to it i can't imagine there will be many because i know you talk about it lots on this podcast mike but it involves three things intention attention and attitude and we need to make sure to emphasize that the non-judgment component is actually one of the most important parts of mindfulness not necessarily the absence of thinking but rather the noticing of our thinking and are shifting our awareness back to target that holds our attention and those experiences of noticing that our thinking is going somewhere that we didn't necessarily intend it to and bringing it back and doing that with a kind and thoughtful dialogue is actually part of why mindfulness can be so effective for us not just empty you know blank brain activity but really the the nurturance of this connection and kindness to noticing when something is happening that maybe we didn't necessarily want to have happen then there are different kinds of mindfulness that can be suitable based on what we're struggling with one of my favorite kinds of mindfulness to do with people who experience depression is not actually to try and push against depressive thoughts or to focus exclusively on their breath but actually to help people be a detective for the good things in their life and then when something good happens or comes to mind to try their very best to stay with it and the feeling of it as they experience it in their body without leaving it or intellectualizing it and to stay there as long as possible so mindfulness can also be that we attune to good things and we know that for people who struggle with depression it's super hard to see the good things we have a name for that within the realm of cognitive distortions and we call that the mental filter that we just can't even see the good things or the beautiful things that are happening in us and in life so learning to see them maybe even starting in the moment if you're in a therapy office or in a session or in a moment of connection with a friend noticing those moments as they're happening and trying to stay with them so that's an example of how mindfulness could be used in a way that's helpful for depression that doesn't necessarily involve sitting still or pushing against oppressive thoughts for anxiety sometimes it can be helpful to practice a mindfulness activity that involves sorting so a lot of times people approach mindfulness when they have anxiety and they think i need to get rid of anxious thoughts and actually what happens then is that when we notice those anxious thoughts come up we become more preoccupied with them and often there's a dialogue on the inside about feeling overwhelmed with the new awareness of just how many anxious thoughts there are so instead of trying to get rid of anxious thoughts we could think about sorting them sorting them into categories that help us get better at identifying the nature of thoughts so that perhaps in the future we respond to them differently for example setting aside some time to practice noticing if a thought comes up what kind of thought it is or what category we want to place it in and in that way we're still up in our head and we're still working really hard and the anxiety thoughts are still there but we're changing our relationship to them and we're becoming aware of them so that they're not so automatic again all of those are different ways of practicing mindfulness based on whatever the presenting concern is but i still haven't really got to the heart of your question which is about trauma so for trauma mindfulness can be a bit of a minefield although it can be helpful for you know all of the things that we know increasing heart rate variability activating the rest digest branch of the autonomic nervous system thickening structures in our brain that help us down regulate the fear anger arousal systems in the brain we know all those things but for people who have trauma being mindful can result in an experience that we call flooding that's when all of the sensations and the somatic and implicit memories associated with the trauma get activated they come up as we slow down and pay attention because all of the things that we've been doing to try to get away from them aren't active in that moment so sometimes when people are doing mindfulness they get flooded or they actually just dissociate it's too much too soon to come back to that comment that i made earlier a person can re-experience trauma if they start to tune in and that means that mindfulness or mindful activities need to be administered or practiced very carefully and in the right dosage if we think of mindfulness is almost like a medication we want to start slow and in ways that actually make sense based on what is happening in your brain so here are some of the things that can be helpful for a person doing mindfulness who has a history of trauma one keeping your eyes open often when we're doing mindfulness we tell people close your eyes but for some people going on the inside or being told to close your eyes activates the trauma memories so not only having your eyes open can be helpful but being given a choice about what to do with your body with your eyes with your thinking another thing we can do is not go on the inside but be mindful of the things that are on the outside so noticing what's around us instead of paying attention to the sensation on the inside of our body that might mean that we're less likely to stay with or activate any kind of implicit or somatic memories that are associated with this trauma that's living in our nervous system some people find that having music on is really helpful some people find that having no sound or some songs or sounds can be activating so again it comes back to the choice piece what is it in my context that helps me feel a little bit more present or aware of what's going on it's probably not a good idea to tell a person or to tell yourself to relax for a lot of people who've experienced trauma that was something especially if it was sexual in nature or interpersonal that was a series of words that was used as part of the trauma so saying to someone just relax doesn't necessarily actually help us it could make things worse and before we get into doing mindfulness sometimes or this could be considered perhaps a branch of mindfulness we work on orienting so getting skills at noticing the world around us and becoming mindful of those before going inside so for example for anyone who's listening as long as it's safe to do this because i know some people listen while they're in their cars or out on a walk but if you have a moment right now where you can pause and look around you notice if there are lines moving in a certain direction like horizontal or vertical that your eye is drawn to and see if you can pick out those lines or say if you notice shapes or patterns perhaps you might notice some squares in your field of vision so all of those things are helping us be mindful but in a way that helps our brain know that the context that we're in is actually safe and sometimes going inside is too activating because it means that we access everything that we've been trying to get away from before starting mindfulness i often recommend for people doing groundwork to help build skills around emotional regulation distress tolerance grounding and try to give people lots of psychoeducation about mobilization tendencies in the body and dissociation so if we're told mindfulness is great do it it's good for your brain it's good for your spiritual practices etc etc and then we go inside and all of a sudden we're flooded with fear or we feel like we don't know where we are or we can't feel our body anymore that understanding that that's a very normal response and that there are things we can do about it means that when that happens we're not getting another level of trauma or another level of fear on top of what's already there a few other things when i'm doing mindfulness with people who have trauma i primarily ask them to do it with me in the room and give lots of choice and only incorporate it after a big chunk of trauma work has been done we start really slow and when i'm inviting a person to become aware or mindful of something i'm extremely attuned to their micro expressions their body language skin color and will often bring people out of a mindfulness exercise if i think they're getting flooded or before they could get flooded as a way of helping them learn implicitly that they can do that for themselves how it works and what it feels like the one of the technical or clinical words that we use for that is titration so going towards something and then coming back going towards something maybe even a little bit closer and coming back and it builds this behavioral memory of being able to leave a situation and creates this if you could think of it like a neural track out of whatever behavior or context that we're in for anyone who's wanting to learn more there's a new book a new great book that came out called trauma sensitive mindfulness and for people who enjoy yoga or want to try yoga but have a history of trauma i highly recommend doing a kind of yoga that i have some training in that comes from the trauma center in brookline massachusetts called trauma sensitive yoga which looks at all of these things and how we can still learn to slowly over time be in our bodies and be aware even when our nervous system says it might not be safe to do so that's what i got on that um anything you want to add mike gosh it'd be hard to add anything there that was i mean i've i've studied meditation pretty extensively um but uh when you got into the portions especially how yoga intersex trauma that was all new for me um and if you know me you know there's nothing i love more than new information my goodness i was enthralled and i really appreciate the i get frustrated with meditation teachers who like romanticize the struggle of meditation um because i think when you set this framing of this hard long road to enlightenment or whatever um you shoe people away from the benefits they could get if someone just said hey what if we try to like be aware and non-judgmental for 60 seconds and that's something most people can try and have a good experience with and for a lot of people the the aware might come easily but the non-judgment is going to really be a struggle and i feel like trying to get people into these 30 and 60 minute sessions right up front um it just sets them up for failure it's like taking it'd be like if i went out and tried to run 10 miles right now i would probably literally injure my body that doesn't mean running 10 miles is bad it just means i'm not ready so i really appreciate that that focus and that nuance of you know maybe the popular conceptions we have of meditation all the way into our media um aren't setting us up for success yeah and it means that we have to know what's right for us too that yes one specific thing might generally speaking be helpful for the average brain but as i was saying if it's not dosed appropriately or if we don't have the support around how to do that in a way that works based on how our brain works then it can leave us maybe even a worse off situation so we want to be careful about how we use interventions particularly when an intervention is causing us to go to the place where our trauma resides which is in the body and often in our nervous system which is constantly in the present [Music] this one says for those of us battling mental health demons what does one do when therapy does not work or at the least when therapy results in more harm than benefit i'm frustrated and bamboozled on how to proceed on this journey because everyone treats therapy as the magic pill to make things better and therapy is not helpful when i say therapy i'm referring to anything from cbt to dbt to intensive inpatient treatment daily outpatient sessions and multiple therapists with different focuses and styles as someone who is highly introspective and prefers not to share anything personal with anyone the inability to be vulnerable with or even to physically say truthful words to a therapist results in a further spiral of shame guilt and an overwhelming sense of failure as a person then this spiral is in turn unable to be communicated to the therapist so the spiral gets worse and worse after each appointment so what do you do when therapy doesn't work signed anonymous yeah i feel the weight of that question and i'm guessing from the question that that you writer um or someone you know whoever you're talking about is has tried a lot of different things to heal and i can hear the frustration and the discouragement and man i think my primary response just off the top is i'm so sorry that you're hurting i'm so sorry that the things that you were told would work and and tried didn't help it can take so so so long to change it can take so many different kinds of interventions and when we're hurting i think there is something in us that is just desperate for it to be that magic pill and when people have told us that it is it's even like there's another level of discouragement and frustration when it doesn't work the way that we're told that it will [Music] it may not surprise you or it might i don't know to know that this is something that i've worked with before with my clients um in a clinical setting that you're not the only one who feels that way and that sometimes the ways that we have promised people healing have have disappointed them because our promises haven't delivered and so i'm so sorry on behalf of the profession if we have told you lies or led you to believe things that yeah that weren't true and left you feeling more more hurt but i want you to know that you're not alone and that there are lots of people who feel this way or like this and that it is actually possible to work through it i tell you that not to diminish what's going on for you but to say that that i don't feel hopeless hearing your question that i don't feel discouraged um but i do know that that's how you feel and i can i can hold that with you so in light of that just my heart aching here are some of my thoughts about this more generally sometimes when therapy isn't working it can be because there are other issues kind of like the shame spiral you mentioned that getting in the way of us working on what feels like the real issue that we want to work on in therapy for example someone comes in because they want to work on some relationship issues but they can't even get the words out or it feels so uncomfortable to be across from someone that the shame spiral starts the defenses get activated and then we're left with this feeling of bare a barrier of distance of futility and now we have kind of two problems on our hands so in that case it can be important to work with the kind of therapist and therapy who specializes in working on those issues the shame spiral for example and in that case with in therapy it might be someone who works with attachment traumas that create chronic shame in the first place and sometimes if words are really hard to get out then doing therapy that doesn't actually use words or logic is a really important first step because there's a lot going on that we can work with and i think one of our misunderstandings about therapy generally both within the profession and outside is that therapy is exclusively two people talking to each other about intellectual constructs and most of the beneficial therapy that i've received and done with people accesses the whole person and actually involves very little talking but we have to back up in those cases and and notice the barriers to therapy and work on the things first that might not seem like the presenting concern but actually get in the way of doing the therapy and when those feel like they're smoothed over we can get on with the other things these are often therapies which focus on interpersonal relationships like i was mentioning past attachment experiences as they play out in the moment-to-moment interactions and give us corrective experiences perhaps going in and saying i've got a shame spiral that happens when i try and tell people about my life or i've had people come in and have that written on a piece of paper because it's too hard to say that there are ways of working around that specific thing that might create a corrective experience so that it feels a little bit safer to be in the room so not just talking or sharing information but accessing the parts of the self that carry the most shame one of the kinds of therapy that i recommend for people who have found other therapy unhelpful in the past and not surprisingly it's actually really really useful for some of the things that you're talking about is a kind of newer therapy that's heavily rooted in neuroscience and attachment theory and inner processes and defenses that come up in therapy and it's called aedp accelerated experiential dynamic psychotherapy and i think mike i don't know how much you've talked about that kind of therapy that you're doing on this show but often it doesn't involve a ton of talking more experiencing and shifting things through experience is that correct to say have you talked about it a little bit i have not talked about it on the show yet because it is so prominently featured in my next book so uh i'm i just outed you i'm sorry it's all good okay okay all right um sometimes people who struggle with therapy also find a kind of therapy called act helpful acceptance and commitment therapy because it can help us shift from the how do i get rid of this suffering to it's here how do i be with it how do i be with the shame spiral how do i see that it's present in the room and exist and perhaps learn to work with it in a way it can mean that we can still have meaningful and rich lives while having the anxiety shame or depression but want to work on how we respond to those things as they come up so the common therapies that people prescribe and that people do in inpatient and outpatient treatment centers are not the ones that i'm talking about here this is usually done by people who are not necessarily in the system and people who have the freedom to take extra trainings and work in ways that are on the front line of our understandings of how people change and the neuroscientific evidence therapy though is super hard work and sometimes it's a good idea to consult with a physician or psychiatrist about combining medication and therapy um which can often be extremely effective for people who find that one or the other doesn't seem to be working on their own we've got really good empirical evidence that in a lot of cases for people who are resistant to or whose symptoms tend to still hang around when they've been trying one or the other that doing them together results in in shifts so i like to think about medication as a therapy aid at times um for example imagine that i'm in a hole and that you mike are the therapist and you're dropping down this ladder and you say to me here's the ladder here's the way i just grab it it's right here come on and i'm jumping and jumping and jumping and jumping but i can't reach the ladder so i think of medication sometimes is that footstool it can help us reach the ladder it does not get us out of the hole it might feel nice for a while to to get a little bit more of a view because we're not so far down in the hole but we still have to do the work and climb our way out and that's hard but at least we can reach the ladder now we couldn't before when therapy is hard and seems like it's not working we could also think about trying to create the conditions in our lives under which therapy might be more effective so having connection with others in a sense of belonging or getting exercise getting good sleep eating a healthy diet having hobbies and doing things that are creative and fun paying attention to the things that feel meaningful in our lives and trying to make space for more of that that might set our nervous system up so that when we encounter something hard or frustrating or new that we're going at it with a little bit more in our tank i also recommend books for people that might address the barriers that get in the way of therapy so in this case i might be a good idea to read a book about shame or complex or attachment traumas that might make sense of that inner experience the shame spiral and how that is related to connection and experiences of vulnerability and sometimes insight can bring awareness to what pieces might need work most in therapy and lastly it's not always the right time or the right therapist or the right approach um so there is that that you it sounds like you've done a ton of work and i want to go out on a limb here and make an assumption so bear with me but if i'm making a correct assumption not all hope is gone um you made the effort to reach out to this you you heard the call for questions and you decided to connect with me or try and ask for help ask for some insight so i i believe that there is the part in you that wants to find the answer wants to heal wants to believe that there's something else that has yet to be tried and like a blade of grass growing up between slabs of concrete i can see that there that that in spite of all of the pain and what feels like failed attempts at healing and so much probably money and energy and effort and risk that that there is still that seed there and i hope for you my hope for you is that you can notice that too that you can believe in that and follow it and draw on it as you move forward thank you for saying that hillary as i read the question i was struck at how much courage and energy it took to write all that out yeah and i just want to echo what you just said again just because i want the person asking the question to hear it twice that for someone who says i don't know how to say this to a therapist you communicated it so clearly to us just now that i understood where you were coming from i i felt your frustration um so i would say not as a therapist but as your random friend on the internet uh you have a skill to communicate your needs and where you're at and you used it to reach out to us and i hope that as you hear us talking right now you can take a moment to savor that success that you do have the ability to communicate your needs to others and i believe that that ability will help you find options over time um that are effective in achieving the change you want in your life and in your feelings and i'm so thankful that you were so honest with us just now yeah yeah i really appreciate that honesty [Music] here's our last question for this episode it says hello science mike and hillary a dear friend of mine recently told me her therapist has been interpreting her dreams as part of her sessions citing freud and young her therapist has told her things like all characters and dreams represent parts of your own self and the ocean appearing in your dream represents your unconscious now i'm usually skeptical in general but this sounds like complete horseshit in the same category as astrology and telephone fortune telling i know the unconscious human brain is capable of a lot like lucid dreaming that brain scans have partially confirmed freud's division of the psyche and that dreams serve as house cleaning for our brains and we usually dream about things we've been thinking about all from episode 30 of ask science mike that is an old school listener i'm happy if it's helping my friend in therapy even if it's just a placebo it just seems laughably bogus to me is there any scientific or psychological research that supports such specific interpretation and meaning of the details in our dreams follow-up question what does it mean scientifically and or psychologically that i very very rarely remember even snippets of dreams upon waking and even those are gone within minutes of waking up thanks for all you do keep it up okay do you want me to jump in or do you want to say anything right off the bat um i mean i have all kinds of thoughts but if you want me to swing first i'm happy to sure why do you swing and then i'll i'll share some of my thoughts after yeah um the first thing is when i talk about dreaming i'm always going to be really cautious to stick to what we're confident about and what we're what we're comfortable typically involves some direct measurement of a brain inactivity and those studies are pretty hard to do it's hard to get brain imaging on someone dreaming so the sample sizes are really small and so when we talk about what's happening in the brain while people sleep we're really brushing against far frontiers of what we can know in neuroscience today so when i talk about dreams i talk very conservatively that i know that there are molecules and proteins that move through the brain and there's different cell activity when we sleep that that helps clear out the day's activities and helps deepen connections between neural neurons have been active together we reinforce neural networks while we dream and i've seen lots of neuroscientists talk about how during rem sleep that process uh creates images that our sleeping brain turns into narrative that's what we call dreaming and then i would just stop really short personally of any of the dream interpretation thing although oddly enough there was one thing i read in uh the horseshit portion of the question that says everything in your dream represents parts of you i actually agree with that because your entire dream is happening in your brain and before hillary gets in and answers this question with qualification i'd also say that um whether or not dreams can be rigidly interpreted the act of interpreting dreams can create narratives that help people heal so i'm always reticent even if it's a tool is not i i don't put a lot of confidence in overly specific dream indexes for example but if those tools have helped people heal i'm always reticent to kind of pull the rug out from under them in something that has helped them to grow and to change although i'm with you you know what what specific imagery and dream represents in my opinion is most likely the activity of some neurons well said that aligns really well with what i was going to say there is no science that i'm aware of that can say definitively that specific symbols represent or images represent something conclusively about what's happening in a person and what that means existentially what that means in terms of what's happening in a person's life and of course who knows like maybe there are some things that we'll find out in the future but it's really hard to test dream activity and the content and meaning of that empirically you also can't randomly assign people to conditions where they dream about certain things and then they about you know evaluate what that means for them so it's really hard for us to prove any of this but i do want to say that sometimes there can be some some theories that help us explore our inner experiences and when they're used as tools to elicit curiosity that that can be really helpful so i think about it this way if we have a theory about dreaming or symbols that helps us explore and experience but we aren't necessarily trying to test or prove something we're trying to generate some insight and a lot of the therapy that jung and freud did was insight-based a lot of trying to draw connections between what is happening subconsciously and what's happening consciously and dreamwork is a really big part of that tradition a lot of therapy as we know was originally developed in the days of young or freud by trial and error freud found out that when people talked some of their symptoms went away so therapy was born and only later did the science come around to prove why it works and based on what we now know about the brain so who knows maybe we'll find something out in the future but right now um i couldn't find anything and i can't imagine there would be anything out there that tells us that specific stories or images mean certain things but here's what i will say instead of thinking about something like this empirically often with dream analysis we think about it as a map to lay over an experience that might help make sense of things one popular theory in a variety of disciplines is to suggest that each part of the dream as you're mentioning in this question like a character an element a scene represents a part of ourselves or our lives and if so if that's the case what might that help us understand about the tensions we felt in the dream or the connections we felt in the dream and how it reveals something about what's playing out in our lives around us for those of us who are in tune with what's happening around us and aren't engaging in a lot of defenses or repressing of our inner experiences it might not yield any new information but what it can point out to us is that maybe something needs addressing if we haven't really addressed it in our regular lives it doesn't work though in my opinion to ever say to anyone your dream meant this or this symbol means this but rather i think it can be interesting perhaps exciting perhaps um meaningful to ask what do you think that means or what do you think it reveals about what's happening in your life and and what do you think is coming to the surface that maybe you didn't have some space for in your waking hours while we often dream about the things that we're thinking about before we go to sleep as you mentioned the content of the dream is not as important necessarily as the emotion when we're actually working with dreams in therapy we want to pay attention to the felt experience of the dream particularly because of what our brain might be doing what we think it's doing when we're dreaming so some of the researchers showed us that although other structures of the brain seem to be less active when we're sleeping that the amygdala and some of the limbic structures of the brain can be very active during rem stage sleep leading some to the hypothesis that during rem sleep we're actually reconsolidating processing emotionally laden memory content so one kind of dream work that i do with people is to say what was the main feeling of the dream and how does that feeling make sense based on what's happening in your life right now if there was a big big fear or grief or anger that came up in a dream and someone was disturbed i might say are there things that you feel angry about that maybe you haven't had a chance to feel and again not saying to someone this is what your dream means or do this but as a tool for exploration always approached with curiosity but i don't think that we can rely on these symbols to necessarily tell us information um i don't think we can rely on these symbols definitively across people and say for example that the ocean means this or that but we can be curious about what comes up and then to the second point of the question just really briefly the theory about the difficulty that some people have with remembering their dreams is actually about what's happening with the hippocampus during different stages of sleep so the hippocampus is a structure involved in helping us move things from short to long-term memory and when we're asleep it is relatively asleep so to speak and in fact some people think that the hippocampus is actually the last thing to wake up which means that if we have a thought as soon as we wake up because our hippocampus is um i'm speaking really colloquially here like not up and running yet then very colloquially then it will be hard for us to move a little piece of information that we have in that moment to long-term storage and then retrieve it at another time however during rem sleep the hippocampus can be very active so one theory that i've read about is that it might actually depend on when we wake up and what sleep cycle or stage of the sleep cycle we're in when we wake up and if you want to remember your dreams uh keep a notepad by the bed to pin and when you wake up start writing and you'll you'll let your pad of paper act as memory formation both in that moment literally as you write it down but that can also engage your memory systems faster that act of tactile engagement um and i also want to say something i think that's important based on this question you've got a friend here who's got a therapist and a therapist is helping this person i assume but also communicating some ideas that i would say aren't terribly well based in research and um at the risk of making hillary slightly uncomfortable i need to tell you all why i like hillary so much and how that impacts what therapists you work with okay one thing hillary is my friend and hillary because she is a well-trained and professional therapist always carefully delineates the line between being my friend and being my therapist and something i've noticed is that not all therapists are so cautious even though that is ethically important and necessary some therapists have clients that they begin to treat as friends in the therapy environment and they begin to move across boundaries that perhaps exist for good reasons in between a client and a therapist and and when therapists don't respect the line between friend and therapist to me that's at least a yellow flag if not a red flag of something that is warrants caution or concern the other thing i really like about hillary is in her therapeutic practice she has a clear delineation between what comes out of research and what comes out of tradition there's a lot of things in psychology that are traditional they that doesn't mean they are without value but you know one thing i've learned by being friends with hillary is seeing how much of the therapeutic landscape has been shaped by psychoanalysis and hillary's never said it in those terms but me being exposed to more schools of therapy and the research supporting them has helped me understand really how broad the practices are there and how limited often the tool set people use in therapeutic environments are you can imagine a toolbox that only includes spray paint like spray paint is good in specific conditions but you don't want to drive a nail with it and so the things one of the things i love so much about hillary is she can talk fluently across different treatment strategies understand when they're applicable and when they should aren't and there's no one form of therapy that works for every mental health challenge um and the way we find out what's effective for what groups is research and too often i have seen in therapeutic environments the influence of not just spirituality uh but but positively unscientific and even borderline dangerous ideas being communicated authoritatively so when you are looking for someone in your life to get professional support and you're facing some kind of mental health challenge or just need the the support that comes from a therapeutic environment i would say look for someone like hillary who is clear when they are your friend versus your therapist and when they are speaking from research versus when they are speaking from tradition well gosh mike oh i could i could write a book about how many how many ways i like you hillary that'd be really easy you know your last point um maybe think about something that i had to do as part of a comprehensive exam or like a exam requirement as part of my phd doing and oral exam where we defend our theoretical framework is essential for actually being able to graduate and become a psychologist one of the things we have to do in that what's called a clinical comprehensive exam is identify the ways in which our primary theory or approach is ineffective and for which populations and what we would do for those populations to present their or to work with their presenting concern so it's actually a sign of i think integrity to be able to say i can't do this work or that's not something that i treat or this is the way that i normally like to work but i have to flex so i can meet you where you're at and that means i'm going to be needing supervision and consultation is that all right with you so being able to say where our limits are i think actually builds credibility in our profession and um yeah helps us do better work but thanks for saying all those things i'm glad that that's come through that's really oh loud and clear and to that point one of the first things my trauma therapist said to me was i don't know very much about autism spectrum disorder would you mind giving me the contact information for the psychiatrist who diagnosed you so that i could talk with her and that made me feel much more confident in working with this therapist than someone to say oh i know all about trauma and autism but in fact did not well the bad news is this episode with hillary mcbride on ask science mike is over but the good news is we've got two more to go and uh man you really want to make time for these episodes they are something special of course i want to thank hillary mcbride uh for coming on the program and answering your questions i know i learned a lot just listening to her uh of course i also want to thank andrew golucky for his pre-production work on ask science mike i want to thank greg nordine for editing and sound design and being the producer of ask science mike jeb bodaford wrote the ask science mic theme song which after all these shows is still a ton of fun and of course i want to thank all of my patrons on patreon who make ask science mike possible and i always need new patrons a dollar a month or five dollars a month makes a huge difference in my life and my ability to continue making this program so if you'd like to join my patrons and get behind the scenes access to saints mike as well as picking what shows happen in the future you can just go to ask sciencemike.com and tap to join me on patreon button to become part of the patreon community again every little bit helps thanks for listening everyone and i'll be back with hillary mcbride next week