We were lucky to catch up with Joel recently and have shared our conversation below.

Joel , appreciate you joining us today. Was there a defining moment in your professional career? A moment that changed the trajectory of your career?

Brainspotting Therapy Changed My Life in 40 Minutes

Yellow garden spiders have a fat yellow abdomen slicked with yellow and black stripes. They weave a tiny white squiggle in the center of their webs. I stare at the faintly milky zig zag as it sways when wind moves the web and stirs the iris sepals it hangs between in my mothers garden. I am biting on the seam of injection molded red plastic in a 1980s baby walker. I ponder the way that Alabama red clay cakes in the grooves of my tennis shoe and poke it with a stubby finger and later a small twig. My dreams were a miasma of detailed childhood imagery. I vividly re-experienced half remembered and seemingly insignificant moments from when I was a toddler in photorealistic detail. When I woke up my phone rang. “Did you have weird dreams?” asked a colleague “Everyone is saying their dreams are weird.”.

I had just had my first session of brainspotting on my first day of brainspotting training. You learn brainspotting by having the brainspotting process done to you and by conducting the brainspotting experience on other trainees. The brainspotting training teaches clinicians to “hold” a patient’s experience without analysis or judgment. Clinicians are taught to turn off the impulse to try and teach the patient anything. Instead the patient’s own experience is what the patient learns from when the clinician can “make room” to let the experience unfold. Unlike cognitive models of psychotherapy, brainspotting does not train you to analyze your experience. It teaches you nothing. Brainspotting practitioners are taught to feel instead of understand so that they can “hold” the experience of patients who are doing the same.

Brainspotting began as a branch of EMDR and quickly became its own modality. Developed to treat trauma and PTSD, providers quickly discovered that it works for just about everything else as well. The technique itself is extraordinarily simple; a clinician holds a pointer and a patient looks at it. Despite that, the nuances of the technique can be infinitely complex. Brainspotting helps most people get to know, and get comfortable with the parts of themselves that they are the most out of touch with.

How does Brainspotting work?
In trauma therapy teaching patients to let go of their cognitive “thinky” brain and experience the “feely” body brain is the name of the game. Our subcortical brain is the oldest part of the brain. It rapidly directs our use of energy for survival into fight, flight, and freeze responses. This process takes place before we intellectually or linguistically understand why we are thinking or what we are doing. Teaching patients to feel their unconscious emotions and their somatic reactions to trauma is the only way to get to the root of how trauma is affecting the brain. Our ego defends us against experiencing the unconscious parts of our being. It is threatened by the fact that parts of us that we do not understand can control us so deeply.

The philosopher Martin Heidegger wrote that language was the house of being. He meant to that our words were all we were. Language is implied to be a confining prison. The philosopher René Descartes stated that “I think, therefore I am”. His assumption that cognition was the essence of what made us real underlies most of modern medical science. I wonder how the landscape of existential philosophy would have changed if these philosophers had ever had a brainspotting session. Our ego driven cognition does not want to turn itself off. It does not want to admit that there is a deeper and older part of the brain . Our mid and sub brains are arguably the most important component to our sense of self and understanding of the world. Some times called our lizard brain, they come from our reptilian ancestry and are responsible for our intuitive and unconscious snap judgements. Put simply we are not logic or rational creatures. A large component of our instinctual thinking occurs before we are thinking in words or with intellect.

David Grand, the creator of brainspotting, made the point that our neocortex front brain thinks that it is all of us, but we must teach it that we have a mid and sub cortex that are part of us as well. Our brains feel before we think. It is our cognitive neo cortex brain that sometimes forget to be aware of the powerful energy our feeling and intuition holds. The reason that trauma therapy is difficult for patients and providers is that our ego defends us from the experience of the unconscious feeling and emotion. Teaching patients to let go of what they know is hard. Facing younger and traumatized parts of self in the deep brain is not something that our intellect can help us with. Even though we have an intellectual understanding of trauma and how it affects us, that does not help us loosen its effect on our lives. There is not a formula or even a manual for good therapy. Effective therapy helps you find and face the parts of yourself we avoid.

What does Brainspotting feel like?
Brainspotting is amazingly effective at this. Brainspotting strips away our defenses and plunges our awareness into the deepest and most recessed areas of ourselves. Brainspotting turns our gaze to the places that we most avoid. Brainspotting allows us to repair and rewire the damaged assumptions trauma makes us hold about ourselves, the world and our relationships. Cognitive therapy teaches us to train and flex our intellect. This is one of the reasons that cognitive therapy alone can not take patients to the deep roots of trauma’s effect on the brain. Somatic and brain based therapies can teach us to feel ourselves again.

It is a common phenomenon that patients “lose” language during a brainspotting session and start to feel a deep emotion and intuitive self. It is normal to realize your body and emotional state is shifting and moving without your permission. Put another way our physical and emotional selves are able to be experienced without cognition interfering. This is similar to the way that is similar to how psychedelics reorient our consciousness. Brainspotting can help us feel the emotional states “under” our lives that we often run from and avoid. It can help us confront and repair emotional damage and unremembered pain.
Carl Jung observed that symbols and metaphors are the language of the unconscious. This is perhaps why when we stir the subconscious brain with brainspotting it causes highly mythic or symbolic dreams. The two hallmarks of a brainspotting dream are vividly remembering minutiae from childhood in photo realistic detail and also dreams with highly allegorical narratives. Patients often remember “important” and “deep” dreams that they can’t quite explain or put into words. After the dream images from my childhood in my first brainspotting session I began to have dreams about shadowy wolf-like figures in the woods . They peered through the windows of Vestavia home to eye my children.

During the brainspotting sessions I felt myself dropping down into a terrifying feeling of inadequacy and inferiority that had always underlaid my life. I hadn’t noticed it or confronted the feeling. I realized that wit, education, learning skills and even my career were nothing more than mechanisms for me to turn this feeling off and run from it.

Brainspotting was the first kind of therapy that allowed me to not only identify the feeling that controlled my behavior from the shadows, but also to face it and master it. Social workers are often wounded healers. Therapy can become a crutch when therapists won’t do their own work. Therapists can become, unconsciously, obsessed with giving others the medicine that they themselves need.

Many Brainspotting therapists, like myself and David Grand, began as EMDR practitioners. EMDR takes patients into the deep brain just like brainspotting. The difference between the modalities is that EMDR immediately makes patients analyze and cognitivize the experience of the deep brain. What you get in the room is what you get with EMDR. In a brainspotting session a therapist is simply opening a box in the patients brain. The majority of the processing takes place over several days while the patients brain decides with the experiences in the box that we have decompartmentalized.

Brainspotting changed my life. I had been in many types of therapy for years and nothing else had this effect. After Brainspotting I was able to notice when I was reacting based on emotion while hiding in my intellect. I was able to feel the way that my body was reacting based on how I felt. I didnt need to hunch my back when angry. I didn’t need to twist my spine when I was sad. Instead I noticed the, previously unconscious, reaction and chose to do it or not. I was able to stop avoiding the problems in my life and deal with the deepest part of the emotional root of my own pain. Brainspotting gives us more time and room in our own head to react to how we are feeling. Brainspotting was the inspiration for the name Taproot Therapy Collective and the direction of my career and practice.
Just like the technique itself the effects of brainspotting are subtle but profound. Before

brainspotting, I thought therapy was about learning information or knowing something new. After brainspotting I realized that therapy was more than this. Brainspotting changed my life but afterward I didn’t know anything new. There was no big reveal or discovery. Brainspotting let me feel how big my own soul was and how much work I have to do in the project of finding and becoming that potential. If anything, brainspotting helped me forget. I forgot my ego and saw how much my own intellect was stopping me from experiencing who I really was.

We absolutely do not exist because we think. We exist despite the fact that we are trying to think ourselves into existing. The mystic Simone Weil wrote that “The smart man proud of his intellect is like the prisoner proud of his jail”. Language is not the house of being. It is the house that we are trying, foolishly, to cram being into. We are so much bigger than we can think. Trauma makes us feel and act small but we are all bigger than we are able to know. Outside of our intellect lies a tremendous felt sense of creativity, intuition and a larger more whole self. We do not have to learn anything to find it. All we have to do is stop talking, stop thinking and begin to listen to who we are.

“Behold your thoughts and feelings….there stands a mighty ruler, an unknown sage—whose name is Self.”

-Friedrich Nietzsche

Joel , love having you share your insights with us. Before we ask you more questions, maybe you can take a moment to introduce yourself to our readers who might have missed our earlier conversations?

Joel is a native of Birmingham. Alabama and a licensed clinical social work supervisor. He received his BA in comparative religion from Sewanee: The University of the South and his Master’s in Social Work with adults and families from The University of Alabama. He was awarded the Master’s Scholar award for his education at UA. Across his 10 year career he has run a youth program for adolescents, worked with geriatric memory care patients, and worked with a community mental health program in service of chronically homeless patients with schizophrenia and severe mental illness.

Joel’s academic areas of study include mythology, world religions, depth psychology, trauma theories, philosophy, ancient history, and cultural anthropology; as well as the history and philosophy of psychotherapy practice. Joel uses his diversity of academic and professional experience in therapy through an eclectic integration of many techniques for growth, healing, and meaning. Joel believes that therapy must begin with a genuine appreciation for each patient’s unique story and individuality.

Joel is an EMDR, Emotional Transformation Therapy Level 2 and Brainspotting Phase 2 trained clinician who often utilizes parts-based therapies and existential approaches. These help clients overcome problems in a non-judgmental environment with fast paced progress. Joel specializes in helping clients harness their own creativity and strengths to overcome barriers for growth and healing. When treating trauma, Joel uses a “trauma map” to allow patients to understand how trauma is affecting their emotional reality, physical sensations, somatic feelings, posture, communication style, and unconscious reactions. ​

In his personal life, Joel is an avid reader and home chef. He spends most weekends hiking and enjoying the outdoors with his wife and children. He is passionate about travel and exploring new cultures as well as new ways of being. In addition to working as a therapist, he also works as a photographer and writer.

Putting training and knowledge aside, what else do you think really matters in terms of succeeding in your field?

Innovation is at it’s heart, the ability to see through the cracks in the systems we take for granted in order to blow them up. Genius is very often just boredom. Someone who has heard every guitar solo or self help talk so many times that they blur together A real genius sees the basic structure of these things and deconstructs them into elements that the other professionals stuck on the tracks of the normal cant see. They disassemble the formulas for success at any model of business or artistic technique and create a new thing. Intuition is the key to this process. However dealing with the inevitable trauma behind any innovators shadow is essential to be able to listen to the intuition behind all innovation.

Many artists that I have spoken to describe their artistic process as “tuning into a radio wave”. One artist told me that she did not even know what she was making until it is all done. Many effective creatives explain that it does not feel like they create art. Instead it feels like their art is simply coming through them.

Joseph Campbell used to say that the artist swims in the ocean that the psychotic drowns in. Art, wisdom, intuition, and our unresolved trauma responses come from a place in our brain that is beneath our ego, cognitive, and conscious mind. Older psychoanalysts like Carl Jung called these places the unconscious mind. More recently research calls them “implicit memories” “secondary” and “tertiary” cognitive processes and “somatic memories”.

Intuition and trauma are both have their origin in the subcortical brain. The subcortical brain is the oldest part of the brain that stores information that we can only be partially conscious of. When we feel things the subcortical brain tells us we often call them hutches gut feelings or instincts. Until we deal with trauma we cannot live authentically or trust our intuition. When we are traumatized our gut reactions and changes in mood are problematic and untrustworthy.

For example: Maybe I should have a suspicion of someone that everyone else trusts. My intuition is telling me something that I need to pay attention to to be safe. If I have trauma that makes me unconsciously afraid of men or people who wear red shirts, I might think that this intuition is only a trauma response. Maybe it is a trauma response and I label my aversion to someone intuition when really I am only projecting my trauma response on to them. Until I heal trauma I don not know when to trust my gut reactions.

Intuition:
Intuition refers to the ability to understand or know something without conscious reasoning or evidence. It often manifests as a gut feeling or a sense of knowing that emerges spontaneously. While intuition is not fully understood, research suggests that it involves the integration of various cognitive processes and information stored in the brain.
The subcortical brain regions, particularly the amygdala and the basal ganglia, have been implicated in intuition. The amygdala plays a critical role in processing emotions and detecting potential threats or dangers in the environment. It can rapidly assess incoming sensory information and trigger intuitive responses, guiding our behavior based on previous experiences and emotional associations.

The basal ganglia, a group of structures involved in motor control and habit formation, also contribute to intuition. They are responsible for integrating information from different brain areas and facilitating quick, automated responses. The basal ganglia help us make intuitive decisions by combining learned patterns, previous experiences, and emotional signals.

Trauma:
Trauma refers to an emotional or psychological response to an overwhelmingly distressing event or experience. It can result in long-lasting effects on an individual’s mental and emotional well-being. Traumatic experiences can range from single incidents, such as accidents or assaults, to prolonged situations like abuse or warfare.
The subcortical regions, particularly the amygdala and the hippocampus, are heavily involved in the processing and storage of traumatic memories. The amygdala plays a crucial role in the initial emotional response to trauma, helping to encode fear and stress-related information. It also contributes to the development of hypervigilance, heightened emotional reactions, and the formation of fear-based associations with trauma-related stimuli.

The hippocampus, another subcortical structure, is responsible for memory formation and consolidation. During traumatic events, the stress response can impact the functioning of the hippocampus, potentially leading to memory impairments or fragmented recollection of the traumatic event. This can contribute to symptoms like flashbacks or difficulties in integrating the traumatic experience into a coherent narrative.

The Effects of Trauma:
While both intuition and trauma involve the subcortical brain regions, they arise from different mechanisms. Intuition relies on the integration of cognitive processes, emotional associations, epigenetic memories, and learned patterns, while trauma involves the processing and storage of unconscious distressing memories and emotional responses. Understanding these distinct processes can provide insight into how the brain functions in various contexts.

Trauma can have a significant impact on intuition and hinder access to our authentic selves. When a person experiences trauma, whether it be a single distressing event or ongoing adverse experiences, it can disrupt the normal functioning of the brain and create barriers to intuitive abilities. Here’s how trauma can block intuition and impede connection with our authentic selves:

Hyperarousal and Hypervigilance:
Trauma often leads to a heightened state of arousal and hypervigilance, where individuals are constantly on guard for potential threats. This chronic state of anxiety and vigilance can consume mental and emotional resources, making it difficult for intuitive signals to surface. The constant focus on survival and self-protection overshadows the subtler intuitive insights that arise when we are more relaxed and attuned to our internal wisdom.

Dissociation and Fragmentation:
Traumatic experiences can lead to dissociation, a defense mechanism in which individuals detach from their emotions, sensations, or even their sense of self. Dissociation can fragment the normal flow of thoughts and feelings, creating a disconnection from intuitive cues. When trauma remains unhealed, the dissociative response may persist, making it challenging to access and trust intuitive information.

Trust and Safety Issues:
Trauma can erode an individual’s trust in themselves, others, and the world around them. When trust is compromised, it becomes difficult to rely on one’s own intuition. The fear and uncertainty associated with trauma can lead to a constant questioning of one’s instincts and an inability to discern between genuine intuitive guidance and perceived threats.

Distorted Beliefs and Self-Perception:
Trauma can shape an individual’s beliefs about themselves, others, and the world. Negative self-perceptions, feelings of guilt, shame, or worthlessness can cloud intuition and distort one’s authentic self-expression. These distorted beliefs can create self-doubt, undermine confidence, and inhibit the ability to trust one’s intuitive insights.

Unprocessed Emotions and Traumatic Memories:
Traumatic experiences often involve overwhelming emotions that may remain unprocessed if not adequately addressed. Unresolved emotions can create internal turmoil and make it challenging to connect with intuition. Additionally, traumatic memories, particularly when fragmented or repressed, can disrupt the integration of past experiences, hindering the formation of coherent intuitive responses.

Healing Trauma:
Trauma responses and intuition both have connections to the unconscious or implicit memory, often influencing our thoughts, emotions, and behaviors without conscious awareness. Here’s an elaboration on how trauma responses and intuition originate from the unconscious or implicit memory, and why healing trauma is crucial for accessing our embodied wisdom and authentic self:

Trauma Responses and Unconscious Memory:
Traumatic experiences leave profound imprints on our unconscious memory systems. The unconscious mind stores information and experiences that may not be readily accessible to conscious awareness but can still impact us on various levels. Trauma-related memories, emotions, and sensory cues become embedded in the unconscious, shaping our reactions and behavior even when we’re not consciously aware of their influence.
Trauma responses, such as hypervigilance, avoidance, or emotional triggers, are often automatic and instinctive. They arise from the unconscious memory, triggered by sensory cues or reminders associated with the traumatic event. These responses can occur without conscious understanding or control, making them difficult to manage or modify until the underlying trauma is addressed.

Intuition and Unconscious Knowledge:
Intuition is closely linked to the unconscious or implicit knowledge we possess. It’s a form of knowing that arises without conscious reasoning or explicit awareness of how we acquired the information. Intuitive insights often stem from the integration of various cognitive processes, learned patterns, and emotional associations stored in the unconscious mind.
Our unconscious knowledge encompasses a vast range of experiences, observations, and memories that shape our intuition. It can include implicit learnings from past events, nonverbal cues, body language, and subtle signals that our conscious mind may overlook. Intuitive responses draw upon this rich reservoir of information, guiding us towards insights and decisions that may go beyond logical analysis.

Accessing Embodied Wisdom and Authentic Self:
Healing trauma is essential for accessing our embodied wisdom and authentic self because unhealed trauma can create barriers to trusting and embracing our intuitive responses. Trauma can fragment our sense of self, distort our beliefs, and erode our self-trust, making it challenging to access and rely on our intuitive guidance.
Unresolved trauma can perpetuate a state of hypervigilance, fear, and emotional reactivity, overpowering the quieter, intuitive voice within us. Trust in our intuition requires a sense of safety, self-assuredness, and inner calm that can be compromised by unhealed trauma. By addressing and healing trauma, we can gradually dismantle these barriers, restoring a sense of wholeness and trust in our intuitive abilities.

In Summary:
Now that we have access to QEEG brain mapping technology we can see what is going on in the brain instead of trying to diagnosis it from the outside. Conditions like CPTSD, childhood neglect ADHD and fibromyalgia look the same on a brain map. If a scan can see that these have a correlation on the inside of the brain, can we admit that they are related, perhaps causal conditions? This has validated the intuition of many trauma therapists who long suspected that trauma and PTSD were the fuel under the genetic expression of trauma.

Healing trauma allows us to integrate fragmented experiences, process unresolved emotions, and develop a healthier relationship with our unconscious and intuitive knowledge. It opens up space for the authentic self to emerge, fostering a deeper connection with our inner wisdom, values, and desires. By healing trauma, we clear the path to accessing and embracing our innate intuitive responses, leading to a more authentic and empowered way of being.

Healing trauma is a complex and individual journey, but it can pave the way for reclaiming intuition and reconnecting with one’s authentic self. Through trauma therapy, self-reflection, and supportive interventions, individuals can gradually address the barriers created by trauma, process the emotional wounds, and rebuild trust in themselves and their intuition. As healing progresses, intuitive abilities can reemerge, facilitating a deeper understanding of oneself and promoting a more authentic way of being in the world.

Without healing trauma it is hard to live an authentic life or be comfortable with vulnerability. Intuition is an important ingredient of a whole and actualized life. Clearing the confusion and misdirection caused by trauma can help us to wield intuition as an effective tool in our lives.

What’s a lesson you had to unlearn and what’s the backstory?

I remember going into my first day of research class during my masters program. We sat and learned the evidence based practice system that the psychology profession is based on. Put simply, evidence based practice is the system by which clinicians make sure that the techniques that they are using are backed by science. Evidence based practice means that psychotherapists only use interventions that research has proved are effective. Evidence is determined by research studies that test for measurable changes in a population given a certain intervention.

What a brilliant system, I had thought. I then became enamored with research journals. I memorized every methodology by which research was conducted. I would peruse academic libraries at night for every clinical topic that I encountered clinically. I would select studies that used only the best methodologies before I would believe that their findings had merit. I loved research and the evidence based practice system. I was so proud to be a part of a profession that took science so seriously and used it to improve the quality of care I gave patients.

There was just one problem. The more that I learned about psychotherapy the less helpful I found research. Every expert that I encountered in the profession didn’t use methods that I kept reading about in research. In fact there were actually psychological journals from the nineteen seventies that I found more helpful than modern evidence based practice obsessed publications. They would come up in digital libraries when I searched for more information about the interventions my patients liked. Moreover I found that all of the most popular and effective private practice clinicians were not using the techniques that I was reading about in the scientific literature either. What gives?

Psychological trauma and the symptoms and conditions psychological trauma causes (PTSD, dissociative disorders, panic disorders, etc) are some of the most difficult symptoms to treat in psychotherapy. It therefore follows that patients with disorders caused by psychological trauma would be one of the most studied populations in research. So what are the two most commonly researched interventions for trauma? Prescribing medication and CBT or cognitive behavioral therapy.

One thing that most of the best trauma therapists in the world all agree on is that CBT and medication don’t actually process trauma at all, but instead assist patients in managing the symptoms that trauma causes. As a trauma therapist it is my goal to help patients actually process and eliminate psychological trauma. Teaching patients to drug or manage symptoms might be necessary periodically, but surely it shouldn’t be the GOAL of treatment.

I’m mixing metaphors but this image might help clarify these treatment modalities for those unfamiliar. Imagine that psychological trauma is like an allergy to a cat. Once you have an allergic reaction to the cat, a psychiatrist could give you an allergy medication like benadryl. A CBT therapist would teach you how to change your behavior based on your allergy. They might tell you to avoid cats or wash after touching one. A therapist practicing brain based or somatic focused trauma treatment would give you an allergy shot to help you develop an immunity to cats. The CBT patient never gets to know a cat’s love.

I don’t have time to explore here why therapy that gives patients scripted ego management strategies like CBT took over the profession after the nineteen eighties . If you have any interest in why check out my article Is the Corporatization of Healthcare and Academia Ruining Psychotherapy?. Suffice it to say that insurance and american healthcare companies pay for much of the research that is conducted and they like to make money. CBT and prescribing drugs are two of the easiest ways for those institutions to accomplish those goals.

Many of the MOST effective ways to treat trauma use the body and deep emotional brain system to assist patients in processing and permanently releasing psychological trauma.

Unlike CBT the modalities that accomplish this are not manualizable. They can not be reduced to a “if they say this then you say that” script. Instead somatic therapies often use a therapist’s intuition and make room for the patient to participate in the therapeutic process. CBT on the other hand is a formula that a therapist is performing “correctly” or “incorrectly” based on their adherence to a manual. Right now hospitals are rushing to program computers to do CBT so they can reduce overhead. Yikes! Think of a therapy experience like the self checkout at Walmart.

If myself and most of the leading voices of the profession agree that newer brain based and body based therapy modalities are the future of trauma treatment then why hasn’t research caught up yet? To stop this article from becoming a book I will break down the failure of modern research to back the techniques that actually work in psychotherapy.

1. It’s Expensive – cash moves everything around me, cream get the money
Research studies cost tons of money and take tons of time. Researchers have to plan studies and get the studies cleared with funders, ethics boards, university staff, etc.. They then have to screen participants and train and pay staff. The average study costs about $45,000.

I would love to do a study myself on some of the therapy modalities that we use at Taproot Therapy Collective, but unfortunately I have to pay my mortgage. Studies get more expensive when you are studying things that have more moving parts and variables. Things like, Uh… therapy modalities that actually work to treat trauma. These modalities are unscripted and allow a clinician you use their intuition, conventional wisdom, and make room for a patient to discover their own insights and interventions.

Someone has to pay for those studies and those someones usually aren’t giving you that money without an agenda. Giant institutions are the ones most likely to benefit from researching things like prescribing drugs and CBT. They are also the ones that are the most likely to be in control of who gets to research what.

The sedative drugs prescribed to treat trauma work essentially like alcohol, they dull and numb a person’s ability to feel. Antidepressants reduce hopelessness and obsession. While this might help manage symptoms, it doesn’t help patients process trauma or have insight into their psychology. Antidepressants and sedatives also block the healthy and normal anxieties that poor choices should cause us to feel. Despite this drugs are often prescribed to patients that have never been referred to therapy.

For all the “rigorous ethical standards” modern research mandates, it doesn’t specify who pays the bills for the studies. Drug companies conduct the vast majority of research studies in the United States, and those drug companies also like to make money. Funnily enough most of the research drug companies perform tends to validate the effectiveness of their product.

Does anyone remember all the 90s cigarette company research that failed to prove that cigarettes were dangerous? All those studies still passed an ethics board review though. Maybe we should distribute research money to the professionals wha are actually working clinically with patients instead of career academics who do research for a living. At the very least keep it out of the hands of people who have a conflict of interest with the results.

This leads me to my next point.

2. We Only Use Research to Prove Things that we Want to Know – Duh!
The thing that got left out of my research 101 class was that the research usually has an agenda. Even if the science is solid there are some things that the commissioners of the studies don’t want to know. For example, did you know that the D.A.R.E. program caused kids to use drugs? Uh..yeah, that wasn’t what patrons of that research study meant to prove, so you never heard about it. It also didn’t stop the DARE program for sticking around for another 10 years and 10 more studies that said the same thing.

Giant institutions don’t like to be told that their programs need to change. They wield an enormous amount of power over what gets researched and they tend to research things that would validate the decisions that they make, even the bad decisions.

If you want research to be an effective guide for clinicians to use evidence interventions then you have to research all modalities of psychotherapy in equal measure. When the vast majority of research is funneled into the same areas, then those areas of medicine become better known clinically regardless of their validity. When very few models of therapy are researched, then those few models appear, falsely, to be superior.

Easier and cheaper research studies are going to be designed and completed much more often than research studies that are more complicated. Even when institutional or monetary control of research is not an issue, the very nature of research design means that it is trickier to research things like “patient insight” than it is to research “hours of sleep”. This leads me to my next point.

3. Objective is not Better – People are not Robots
CBT was designed by Aaron Beck to be a faster and data-driven alternative to the subjective and lengthy process of Freudian Psychoanalysis. Beck did this by saying that patient’s had to agree on a goal that was measurable with a number, like “hours of sleep” or “times I drank” and then complete assessments to see if the goal was being accomplished. Because of this CBT is inherently objective and research based. CBT is therefore extremely easy to research.

This approach works when it works, but a person’s humanity is not always reducible to a number. I once heard a story from a colleague who was seeing a patient who had just completed CBT with another clinician to “reduce” marijuana use. The patient, who appeared to be very high, explained that his CBT clinician had discharged him after he cut back from 6 to only one joint per day. The patient explained proudly that he had simply begun to roll joints that were 6 times the size of the originals.

That story is humorous, but it shows you the irony of a number based system invading a very human type of medicine. Squeezing people and behavior into tiny boxes means that you miss the whole person.

Patients with complex symptoms presentations of PTSD and trauma are often excluded from research studies because they do not fit the criteria of having one measurable symptom. Discarding the most severe and treatment resistant cases means that researchers are left with only the easiest cases of PTSD to treat. This in turn, falsely inflates the perceived efficacy of the model that you are researching.

Additionally, these studies usually exclude people who “drop out” of therapy early. In my experience people who leave therapy have failed to be engaged by the therapist and their model of choice. This falsely inflates the efficacy of models that discount patients that don’t continue to come to a treatment that they feel is not helping them. It is my belief that it is the therapists job to engage a patient in treatment, not the patient to engage themselves. Trauma patients often quickly know whether or not a treatment is something that is going to help them or whether or not the information that a therapist has is something that they’ve already heard.

Trauma affects the subcortical regions of the brain, the same regions that newer brain based medicine is targeting. CBT is a cognitive based intervention that measures and seeks to modify cognition. Clinical research stays away from measuring subcortical activation and patients’ subjective feelings in favor of measuring cognition and behavior. Newer models of therapy like brainspotting and sensorimotor therapy are able to deliver results to a patient in a few sessions instead of a few months.

Brainspotting therapy changed my life, but after completing the therapy I didn’t “know” anything different. Brainspotting did not impart intellectual or cognitive knowledge. I was able to notice how my body responded to my emotions. I was also able to release stored emotional energy that had previously caused me distress in certain situations. Brainspotting did not significantly change my behavior and it would be difficult to quantify how my life changed with an objective number.

These kinds of subjective and patient centered results are difficult for our modern evidence based system to quantify. Researchers hesitate to measure things like “insight” “body energy”, “happiness”, or “self actualization”. However it is these messy and human concepts that clinicians need to see in research journals in order to learn how to do a human connection centered profession.

4. People Learn from People not Numbers – Publish or Perish
Once a research study is complete, the way that it is delivered to the professional community is through a research journal. Modern research journals focus on cold data driven outcomes and ignore things like impressionistic or phenomenological case studies and subjective patient impressions of a modality. The decision to do this means that the modern research journal is useless to most practicing clinicians. Remember when I said that I read academic journals from the 70’s and 80’s? I do that because those papers actually discuss therapy techniques, style and research that might help me understand a patient. Recent research articles look more like Excel spreadsheets.

The corporatization of healthcare and academia, not only changed hospitals, it changed Universities as well. The people designing and running research studies and publishing those papers have a PhD. Academia is an extremely competitive game. Not only do you have to hustle to get a PhD., you have to keep hustling once you do. How do you compete with other academics once you get your PhD?

The answer is that you get other people to cite your research in their research. You raise the status of yourself as an academic or your academic journal based on how many people cite your article in their article. The amount of times that a publication has its articles cited is called an impact factor and the amount of times that an author’s articles get cited is measured with something called an h-index or RCR. In my opinion many of the journals and academics with the low scores by these metrics are the best in the profession.

The modern research system focusing on these metrics has definitely not resulted in the creation of some page turner academic papers. In fact this competitive academic culture has led to modern journals being garbage that create careers for the people that write them and not change in the clinical profession. Academics research things that will get cited, not things that will help anyone and certainly not anything that anyone wants to read.

Often the abstract for a modern research paper begins like this “In order to challenge the prevailing paradigm, we took the data from 7 studies and extrapolated it against our filter in order to refine data to compare against a metric…”. They are papers written to get cited but not to be read. They are the modern equivalent of those web pages that are supposed to be picked up by google but not read by humans.

5. Good Psychology Thrives in Complexity – In-tuition is Out
Do you remember the middle school counselor that said “I understand how you are feeling” with a dull blank look in her eyes? Remember how that didn’t work?

Good therapy is about a clinician teaching a patient to use their own intuition and the clinician using their own. It is not about memorizing phrases and cognitive suggestions. The best modalities are ways of understanding and conceptualizing patients that allow a therapist to apply their own intuition. A modality becomes easier to study, but less effective, when it strips out all of the opportunity for personality, individuality and unique life experience that a clinician might need to make a genuine connection with a patient.

Research studies are deeply uncomfortable with not being able to control every variable that goes on in a therapy room. However, the therapy modalities that strip that amount of control from a clinician could be done by a computer. Why is it not okay to research more abstract, less definable properties that are still helpful and observable.

For example let’s say that this is the research finding:

“Clinicians who introduce patients to the idea that emotion is experienced somatically first, then cognitively secondarily in the first session had less patients drop out after the first session.”

or

“Clinicians that use a parts based approach to therapy (Jungian, IFS, Voice Dialogue, etc.) were able to reduce trauma symptoms faster than cognitive and mindfulness based approaches.”

If those statements are true then why does it matter HOW those clinicians are implementing those conceptualizations in therapy? If we know that certain strategies of conceptualization are effective then why does research need to control how those conceptualizations are applied?

If clinicians who conceptualize cases in a certain way tend to keep patients, then why does it matter if we can’t control for all the other unique variables that that clinician introduces into treatment. With a big enough sample, we can still see what types of training and what modes of thinking are working.

Modern research has become more interested in why something works instead of being content to simply find what works. If patient’s and clinicians with trauma all favor a certain modality, then why does it matter if we can’t extrapolate and control all the variables present in those successful sessions. Research has stayed away from modalities that regulate the subcortical brain and instead emphasized more measurable cognitive variables simply because it is harder to measure the variables that make therapy for trauma effective!

This is a whole other article, but the American medical community has become fixated on managing symptoms instead of curing or preventing actual illness. Research has become hostile to variables that contain affective experience or clinical complexity or challenging the existing institutional status quo. The concept of “evidence” needs to be expanded to include scientifically plausible working theories that have been validated by clinicians and patients alike. This is especially important regarding diagnoses that are difficult to broadly generalize like dissociative and affective disorders.

6. The not so Totally Random-ized Controlled Trial
Evidence based practiced posed a problem for the drug industry. However, the industry soon realized that evidence based medicine could work in their favor, as research published in prestigious journals held more weight than sales representatives. Today those same journals have become such a dominant force in clinical practice and are used as a cudgel, leaving little room for clinical discretion. This fueling the problems of over diagnosis and overmedication. Researchers and the profession at large are incentivized to push diagnostic criteria and the amount of diagnosis they confirm to sell drugs. The drug industry has a vested interest in legitimizing questionable diagnoses, broadening drug indications, and promoting excessive pharmaceutical solutions. Furthermore, corruption plagues clinical research. Academics essentially go into debt to do pay for the privilege of legitimizing pharmaceutical companies interests disguised as “randomized controlled trials” designed to have predetermined outcomes. The studies are often run impeccably but they are framed around predetermined conclusions. We must not just look at what research says but who moved the goal posts of what we research and who’s interests that framing prioritizes. Our research should focus on what we don’t know rather than what we think we know. Let’s dig into the natural course of diseases, explore alternative treatments that corporations have no vested interest in.

7. In Conclusion – Results
Psychotherapy is a modality that is conducted between humans and it is best learned about and conveyed in a medium that considers our Humanity. The interests of the modern research conducting institution and research publishing bodies largely contradict the interests of psychotherapy as a profession. The trends in modern evidence based practice make it exceptionally poor at evaluating the techniques and practices that are actually helping patients in the field or that are popular with trauma focused clinicians. If I had never unlearned what was taken as granted in graduate school I never would have built the practice that I built or connected with eh people that I needed to succeed. I also never would have dealt with my own trauma or treated the thousands of patients trauma that I have now in short term effective therapy. Don’t ever think any conventional wisdom is beyond questioning or that there are basic tenants that you have to unlearn in order to innovate.

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