Mind Dive Episode 74 Transcript: The Importance of Therapeutic Relationships

Welcome to the Mind Dive Podcast, brought to you by the Menninger Clinic, a national leader in mental health care, where your hosts, Dr. Bob Boland. 

 

And Dr. Kerry Horrell. Monthly, we explore intriguing topics from across the mental health field and dive into hidden realities of patient treatment.

 

We also discuss the latest research and perspectives from the minds of distinguished colleagues near and far.

 

So, thanks for joining us. We are excited today to have, I think for the first time ever, a repeat guest. I think this is our first time we've had.

 

It's definitely our repeat guest.

 

And quite frankly, it makes the most sense because we have anyone, the incredible Dr. Jon Allen with us today. Um, we will go through a bit of his bio here. Dr. Allen spent more than 40 years at the Menninger Clinic. That is four-zero, four decades with this hospital where he taught, supervised, and helped shape the next generation of clinicians, though retired from practice. That's hilarious. That's even written that way because I know, I know of Dr. Allen that he, I don't think, will ever retire. I don't think you have that in you. Um, but yes, technically retired, he still teaches, consults, and writes extensively about trauma, attachment, mentalizing, and what makes therapy work. Currently, Dr. Allen is a clinical professor and volunteer faculty member of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston. He's an honorary faculty member of the, excuse me, at the Center for Psychoanalytic Studies in Houston, and an adjunct faculty member of the Institute for Spirituality and Health at the Texas Medical Center. Dr. Allen has written several, many, I would say, influential books, including Coping with Trauma, Trusting in Psychotherapy, and Mentalizing and Clinical Practice. And today we are going to be talking about his latest book, Bringing Psychotherapy to Life Through Caring Connections, which I am just so thrilled to talk about. And I think this is just an incredible piece of work. But welcome, Dr. Allen. Thank you so much for coming back.

 

Thank you so much for joining us again.

 

Well, thank you. Yeah. Actually, I've spent 10 additional years in my retirement connected with Menninger. So, I'm calling it half a century, half the Menninger Clinic. Right.

 

 I didn't say this in the bio, but I have been incredibly lucky to have Dr. Allen as my consultant.   I had him as my consultant for many years and feel like truly one of the people I look up to the most as a teacher and as a thinker.

 

And absolutely. So, I think a lot of people here feel that way.

 

I think this is fair to say that the years in which  I was your consultant actively, you were writing this book.

 

Yes, that's right.

 

And you shared some chapters with me and some pieces of it as you were writing it, and it felt very much alive and like the spirit of what you were thinking about when writing this book and what we were talking about with our cases.

 

Yeah. Yeah. So, I obviously we're going to be talking about the you know your career too, but really about the book today and focusing on that. So, could you just tell us a little bit about what inspired you to write this book?

 

The point of the book is almost absurdly simple. What I'm saying is the way the field of therapy has moved, the emphasis, especially in the healthcare system, is on developing procedures to treat psychiatric disorders and symptoms. Now, I think that we should give equal attention to what a lot of patients want to do and a lot of therapists are doing, which is talking about trouble in the patient's life. This is a blindingly simple point. Now, you should be saying immediately, and I'll say it for you,  wait a minute, can't you do both? And I would say, yes, you can do both. We need to integrate therapies, procedures, methods, theories, and so forth with getting to know the patient, talking about the trouble in their life. And in a way, these are inextricable because it's trouble in the person's life -- stress -- that creates and perpetuates psychiatric disorders. So these are entangled, really. So all I'm trying to do is kind of tip the scales back to okay, let's focus on getting to know the patient and develop a therapeutic relationship with the patient. So that's the blindingly simple point. Now, I'm going to be very blunt and I'm going to make a lot of realizations today. But the bluntness is I think it is absurd that we have collectively developed hundreds of therapies. I can see it would be good to have different types of therapy. I get that. But do we need hundreds of them? Now, what I'm saying is it's hard to show that these therapies, one of them is more effective than the others. Right. Right. There's decades of research showing that, roughly speaking and over-generalizing, these different kinds of therapy are similar in their effectiveness. So it's hard to get one to stand out, but that's competitiveness. You know, mine is better than yours.

 

I was going to say the buzzword usually is evidence-based therapy.

 

Yes, exactly. Evidence-based. Now, what I want to say is that there is an evidence-based for talking to people about trouble in their life. I want to emphasize that it is easy to show that the quality of the therapeutic relationship contributes a huge amount to the effectiveness of the therapy. Sure. Now, science is  a problem here. Now, I must say that I love science, and I did research. Yeah, I was working on developing evidence for the effectiveness of many Menninger treatment for decades. Yes. And it came to its greatest fruition, actually, in Houston, where we, for the first time in the clinic, we were collecting data hospital-wide on the effectiveness of treatment. So, I'm all for research, I'm all for effectiveness, but science has the prestige in our culture.

 

Yes.

 

Science, I love science and protest scientism, which is scientism means that you view science as the only pathway to knowledge and truth. Anything else, you know, doesn't really count. It doesn't have the kind of power of science. Now, here's what I came up with for my attitude towards science. Science's majesty does not entitle it to a monarchy. And I think that's what's happened. Science, it has to be scientific. And if I'm saying, look, what do you how do you talk with patients about trouble in their life? Is science helpful? Yes, but science alone, there's no way that can be your sole guide to do this. Now I'm really saying, and the book is the last two books actually, both make a lot of use of philosophy. I just happened to be really interested in philosophy. And it was about 20 years ago I  got back into reading philosophy. Ethics is the domain that pertains to life. What I realized is, wow, this is really, this stuff is really helping me think about trouble in human life more than the sort of scientistic technical language drives me crazy.

 

I so associate that with you because I think, again, in our work together, if I said something overly jargony, you would say, stop, stop, stop, say that differently. Can you say that in a way that's a little bit more like human? Um, and I really appreciate it. It's such a we can get stuck in that sometimes of just putting out words and then we don't actually, we're not describing what we're actually trying to say.

 

It's usually hiding behind them.

 

Yes.

 

Yeah, when we don't exactly understand what we're saying.

 

Yes. Well, thank you for saving me so bluntly. I'll tell you an anecdote. There's a great lecture series run out of London called Legacy Interviews. And one of my friends and colleagues, Arietta Slade, she did work at the Yale Child Study Center, she does mother-baby interventions, which are very powerful. So, she gives this talk. At the end of the talk, somebody asks her, Arietta, what is the basis of your expertise? So, she pauses, she thinks about it and says: “I know a lot about people.” That is genius. Yeah, I know a lot about people. Yes, so with her reluctant permission, in this book, I refer to that as the Slade Test for concepts. Does this concept increase your knowledge of people? Do you I mean not just patients, people, yourself, other people that really does this concept, mentalizing would be a great example. The research on mentalizing is fabulous. The word suggests something esoteric. Actually, mentalizing refers to how do we understand each other and ourselves?

 

Yes.

 

Yeah. And you know, then Peter Fonagy and Anthony Bateman and hordes of others created a scientific study of mentalizing and a treatment based on it. But it's common-sense psychology, folk psychology. So mentalizing for me does pass the Slade Test. But you know, to projective identification, object relation, all this stuff. If it passes the Slade Test, go for it. If it enriches your actual, you understand people better.

 

But that's something I associate with you, and I think is something I care a lot about. And I imagine you're putting language to something so many therapists experience and maybe even who are listening are thinking about, which is that you put words to these things that perhaps feel really simple, as you're saying. Like this is a simple idea. This is a concept that's actually quite human and like not jargony and not over the top, but you also give it like credence of like how intense it is. Like, for example, I know as you wrote this book, you sifted through extensive philosophy. I remember, I remember us having conversations because of our shared interest in like feminist theory, feminist philosophy. And like you take this idea of well, we'll get to this in a moment, but like care. And you're saying, let's really sink our teeth into like the depth of what that is, while also honoring the simplicity and the normalcy and the everydayness of it. And I think that's a balance that you're talking about, like between like the rigor of scientist, science, period. Um, I wanted to say scientism there, but I think that's actually not what you're saying. The balance between science and human and like giving credence to both. And I think that's actually really important. And I just want to say that. I think that's a really good thing.

 

Yes. I and getting it right is tricky. I want to make another point here that I think is crucial. Okay, so we know that the quality of the therapeutic relationship is very important in the effectiveness of the work, right? And most people know that, whether they go with it or not is another thing. Right. I mean, Rogers figured it. Go around Carl Rogers. He's come on, positive regard, genuineness, you know. I mean, these things, okay. Now, I do want to say something else so I don't lose it. The benefit of the therapeutic relationship, there will be intrinsic benefit to it for the patient, but the ultimate benefit is that that relationship paves the way for generalization to other relationships in the patient's life. That the crucial benefit is not they have a good relationship with a therapist, but can they learn something from that that will enable them to relate to other people? I once said this was a couple decades ago, I said to a group of patients, I said, you know, the therapy is like uh therapy should be a bridge to get to a bridge to other relationships. And I said, and it can be very hard to get on the bridge. And a patient wisely said, it can be harder to get off the bridge. And I think that and one thing I will say that I loved about Menninger is you  bring other people onto the bridge, right? Group therapy, therapeutic community, family work. So, you  sort of actively foster those other relationships and the generalization in the work. Therapeutic communities are unbelievably powerful. So, preaching to the local choir here, we know that there are dramatic individual differences between therapists in their effectiveness. This is less well appreciated. But some therapists are way more effective. Sadly, a fair proportion of therapists, I'll say a quarter, this is from research, are having trouble in their life and in doing therapy. Now, what I'm saying is okay, let's cool it with developing hundreds more brands and think about the development of the therapist. Now, the development of the therapist starts in infancy. That's where the capacity to develop relationships that are trusting and caring, to take a couple of favorite examples, starts developing in infancy. Now, by the time you become a therapist, often in young adulthood, you have had a lot of development that bears directly on your capacity to develop therapeutic relationships with patients. Now, one thing I think from a developmental perspective, and I will say that psychoanalysis is the domain of therapy where this is taken most seriously. So, if you're a dynamically oriented therapist, you're going to be thinking about different domains of relationships, family of origin, current personal relationships, the relationship you have with the patient.

 

Now, there's a guy named David Orlinsky, who's a quite a well-known therapy researcher. He and his colleagues studied 12,000 therapists. Wow. Multiprofessional, multinational sample of therapists. And they did exactly this. They looked at the therapists' relationships with their family of origin, their current personal relationships, and their sense of their relationships with patients. And 80% of them had been in personal therapy. So, they also looked at their quality of their relationship with therapists. So, the bottom line, this research is wildly complex. But the bottom line is all these domains intersect family of origin, personal current relationships, relationships with your own therapists, and the satisfaction and sense you have about developing a caring relationship with your patients. And about a quarter of those therapists were having trouble, either kind of burned out, highly stressed, or just kind of detached. So, this is very serious stuff because presumably this relates to their effectiveness at psychotherapists. So, my idea was that we should cool it with developing more therapies and think about the development of therapists from this kind of developmental perspective. We need to think of the professional development as superimposed on the foundation of, you know, a bit of a lifetime of personal development. And the personal development continues and is influenced by the work you do as a therapist because it's a unique opportunity to get to know the Slade Test, to get to know a lot of people with a lot of serious trouble. And then to develop, I don't want to say, you know, we the whole century of psychiatry really is not much help. I don't want to say that. Like we learned a lot. I could never have done the therapy at Menninger  with people with serious mental illness if I didn't know a lot about psychiatric disorders. So I'm not dismissing all that. But it has to pass the Slade  test. Does the diagnosis of BPD help you? Do you know more about people after understanding that? Dissociation, all those.

 

Well, and I'm thinking about, okay, so if I were to kind of summarize some of what you're saying here, I'm thinking back to like my first class as a therapist in grad school, which was like, all right, let's talk about the basics, trust and care and therapeutic relationship. And then it's sort of almost like paid lip service. Um, like, yeah, so those are obvious and do those. And then it's like, and now we're going to send semesters learning DBT and semesters learning CBT and psychodynamic therapy. And that's the real stuff. And the lip service that gets paid to this thing that I think you're saying is like, this is what holds so much of the weight. We can't just pay lip service to it. These are actually skills and practices that account for scientifically a lot of how people do better in therapy. And it actually does take thinking about it in a very critical way.

 

Okay, that is a perfect segue to what I want to talk about now. And that is that we have this, I think it comes out of short-term therapies. We have this thing you need to therapeutic alliance. Tens of thousands of patients have been studied therapeutically. The idea is, okay, it's just what you just said, Kerry. Okay, what you need to do is develop a therapeutic alliance, you know, and then you can do the real work. Right. Come to do therapy at the Menninger Clinic and see how that goes. Right. Developing a therapeutic alliance is the work of the therapy, a cooperative relationship. Now, there are canonical common factors, therapeutic alliance, the Rogerian factors, positive expectations, a bunch of these have been studied and researched. That's what I'm basing the evidence on. But I'm interested in what I'm calling “uncommon-common factors.”

 

Ooh, I like that.

 

Yeah. The uncommon common factors, one of them is the therapist. The therapist is a weird one because it's unique and universal at the same time. Right. So, we got to deal with that common factor, the development of the therapist. Okay, but trust and care are examples of other ones. Now, what you said, Kerry, is I think it's the crux of what inspired me to write these late last two books. One is we take our understanding of trust and care for granted.

 

Yeah.

 

But we think, okay, So first of all, let get a trusting relationship going here and then we can really do the thing of the therapy.

 

And there's no suggestion of how to do that. It's like, you know, do that thing. Yeah, be trustworthy, period.

 

You know all about trust. You know all about care. We that's ordinary, obvious stuff. Let's get on to the real thing. But the developing trusting and caring relationships, if we think of it with people who see, I'm coming from the trauma background that we developed years ago, a specialized trauma treatment program. This is the work of the therapy. By the time the patient is trusting, responsive to care, and cooperative, you know, that's the work. And then the generalization of that to other relationships is also a lot of work. So, Kerry made the point that we take our understanding of things like trust and care for granted. Yes. And as if, you know, of course, we can get a trusting, caring relationship going, and then we do the real work of therapy. But my point is that developing a capacity to be trusting, to be trustworthy, to be caring, to be responsive to care is the work of the therapy. And  that work can take years. We think of, you know, trust, therapeutic alliance care as instrumental to the work of therapy. Rather, we should say these are intrinsically important in the person's life and relationships, and patients with a history of trauma, which has been my focus for decades now. This is why I'm so interested in these things because these patients have enormous difficulty. And I discovered there's relatively little in the therapy literature written about trust and care. And there's a lot written by philosophers. I discovered this for both the domain of trust and the domain of care, that there are very rich literatures in philosophy.

 

Say more about this. Like what did you find in there?

 

Well, let me just give two. There are two people that I know of who take trust seriously. One of them is John Gottman writing Pebbles. Late in his life, he said, “Oh, now I get it, trust.” You know, beautiful book about trust. Peter Fonagy  and his colleagues write about, quote, epistemic trust.

 

Yeah.

 

That is a fancy word for do you trust the knowledge that's being conveyed right now, right? I'm talking to you. Right. Well, I would like it to have epistemic trust. Um, you know, that what I'm saying is valid and useful.

 

Yes.

 

So now I think I wrote the book about trust. I wanted to emphasize basic trust, Eric Erickson, which is trust in care would be a way to think about basic trust. There is a big literature, and what is missing in the trust talk in therapy, to the extent that it exists, is what makes the therapist trustworthy.

 

Yes.

 

See and you know, this is dealt with in the philosophy literature. Now, patients who have been injured in relationships repeatedly are distrusting. That is because they are sane.

 

Right, right. Why should they trust me? Right.

 

They have learned that they need to be distrusting to protect themselves. Yeah. So, it is not a problem per se that they are distrusting. The problem is that they are missing opportunities to trust people who are trustworthy. And guess who might show up as trustworthy? One would hope, a therapist. Let's hope. Right. And then, you know, learning that other people can be trustworthy. And you see this in the therapeutic community, that these patients are alienated, distrusting, and they learn, lo and behold, this is the beauty. I just can't say enough about the therapeutic community. They learn, yes, I can trust other people, not just therapists, not just professionals, but peers, you know. So, this is huge. So, this is the irony that we all say, yes, trust is important, but we don't think about it. So full court press in the book on trust. Now, I said in that book I wrote, okay, so trustworthiness for a therapist comes down to two basic domains: care and competence. Think about going to a physician, right? Care and competence. You like both. If you're just having surgery, you know, the care maybe you know. Really? But you, you know, you want both of those. See, then I realized after I finished this trust book, I thought, care. I did the same thing with care that I complained about with trust. I took my understanding of care for granted. And discovered soon after I finished the trust book, there's this rich literature and philosophy under the rubric ethics of care. And so, this inspired me to write the next book. And as Kerry alluded to, it's a feminist literature. The authors are mostly, not entirely, but mostly, unsurprisingly, women. And care is highly gendered in our culture.

 

Yes.

 

So, I would say that caring is underdeveloped in men. And it's not that men are incapable of care. There's a great book I'd love to plug by Sarah Hrdy, H R D Y, called Father Time, brand new book. And she's written all about the biology of care, gender differences. It's a fabulous, fabulous book. That sounds like an excellent book. Yeah, yeah. I mean, the gist of it is that if you study men who have primary responsibility for the infant, and lots of literally hands-on intensive contact with the infant, and you look at the neurobiology, men look very much like women in their caring capacity. It's an amazing thing. And of course, the to say the least, these gender troubles are massive in our culture. Absolutely. The other thing that hit me over the head in writing about care is our current political social situation is massively problematic when it comes to the cultural political value of care.

 

Yeah, I mean, right. You want to say more right about the fact that we don't value it any as much, or not everyone. It's not always you know, the notion that we're supposed to care about our fellow man.

 

Yeah, yeah.

 

Yes. Yeah. Yes, right.

 

The women are supposed to care about their fellow men.

 

Yeah. Sounds kind of glib when you say it like that.

 

It's uh yeah. So I think the health care system  is , you know, it's  problematic to say the least. Despite your being a good title.

 

Yeah, yeah.

 

Yes, health care and system. Right. People have argued that it's neither focus on health nor care, nor in order to much of a system integration.

 

Yeah.

 

Yeah. So that's a whole thing. I just want to mention it without getting bogged down in it. Yeah. Yeah.

 

Well, and I gosh, you've touched on a lot around that, but I  think that is like that is something that readers can anticipate from your book, is like getting into this idea of like, what does it mean to care? Yeah. And what does that look like? And what are the struggles in our current world we live in as therapists trying to offer care? And it reminds me of, I remember one time when I was a fellow and I was being supervised by George Bombell, and I was really struggling with a patient who I really didn't like. And you, he was so like, Carrie, it's okay that you don't like this patient. And I was like, no, I have to like all my patients. And I remember really struggling with this. And he said, you do not have to like all your patients to care for them. And he we really like taught thought about this idea of like, what does it mean to have your patient in your care and to care for them? And again, I think this is something that I'm I remember, even as a postdoc fellow, I was like, whoa, these are all things that blended as one thing in my head care and trust and like and you know, affection. And like to really like get into the weeds of it is something that I think makes us more precise and effective therapists. And again, I think that's at your core what you're getting at. How do we be effective in this work that is so often taught as like this diffuse? I call it like the chapter one stuff. Chapter one, be caring. Next, like, you know, and maybe we could we could think a little bit more about you made a point in your title to talk about connection and about the idea of really like relationship. And why, when we're thinking about care, do you also feel like there's such an emphasis on connection and again, life, people's struggles? Like, can you say more about this?

 

Yes. I just want to amplify something you said. What the main thing I learned about care was that the problem, and again, thinking about trauma is unresponsiveness to care. And I make a point in this book about therapy being moral work, which is a really tendentious point. And I make a case for it, but the thing is, we as humans naturally expect that if we give conscientious, competent care, that it will be received, and that people might even be grateful for it. This is a natural human expectation. So, what happens when the patient is persistently unresponsive to care, rejecting of care, which is what we face, because it's scary to really welcome care when you've been disillusioned, disappointed, and hurt. Okay, so we need to, as you were saying, implying, we need to provide care, care giving. I distinguish between caring feelings, caregiving actions. We need to give care when we don't feel caring. In fact, we may feel resentful, frightened, so forth. And that is a huge, huge challenge.

 

I had a I had a supervisor once tell me, and when I this was when I was in grad school, and it was so remarkable to me because I was going on about how if the patient was less resistant to the treatment, we'd really get the treatment done. And my supervisor said, Kerry, resistance doesn't get in the way of treatment. Resistance is the treatment. And just making this point that like if the patient was not if the patient was able to take in everything you're saying, they wouldn't need to be here.

 

Exactly. Yeah.

 

Um it was so like it was so foundational to me that it's like, that's right. That's right. The thing that's they're getting stuck in is that this is the tough stuff.

 

There was a guy who discovered that a while ago, Freud. Oh, I think we've heard him.

 

Yeah, we should get him on the podcast sometime.

 

Yeah, right. Yeah.

 

Get them to talk about civilization and its discontent if while you're talking about connections, which seems really central to this idea of why should they trust us and care. Yeah.

 

Yeah. The target of my book is feeling connected. I want uh I'm emphasizing actually, I'm contrasting language with experience and feeling, especially. And that what I want to work up to in the book is feeling connected, because we're working with patients who are alienated and that it's scary to feel connected. And we that's what we need to achieve is the feeling of connection. Now, I think again, I'm going to credit psychoanalysis with its interest in mother-baby work. Arietta Slade's a great example. She's a spectacular recent book, which I will just plug. So, on her  career. What's happening in psychotherapy? It's tremendous issues around connection that we start developing that capacity for connection in infancy. And attachment literature is beautiful on this. And the research is meticulous. And that's really how we're developing trusting, caring relationships, starting in infancy at the pre-verbal level.

 

Yes.

 

And the research is spectacular. The thing I want to emphasize is I did talk therapy, right? Well, talk is valuable. I will accept that. It helps us to try to understand. But the real action is at this pre-verbal level for adults as well as children. Yes. And it's this, so I like the word ineffable. It is a terrifically good word. It's ironic. I'm talking about words. Words fail to capture the feeling of connection. I have a section on meeting of minds. Where do the minds meet? How do we think about that? It's not something we can actually capture with words, it's ineffable, but we can feel it.

 

Yes. Yes.

 

And that feeling is the crucial thing, I think. And so, I'm talking about feeling connected. And there's a lot of psychoanalytic language for this. And you know, intersubjectivity recognition. There's a whole literature on the third. You know, the third is kind of where the signs meet. It's ineffable. I actually came to appreciate it in playing jazz. I just want to put in a plug for jazz. Jazz pianist and composer.

 

You can find Dr. Allen's work on YouTube.

 

That's right.

 

Yeah.

 

Yeah. So that's where I got it. The feeling of connection is this inevitable sense in either playing jazz or listening to jazz. You just have this sense of something that transcends the individuals. The language I like is the creation creates the creators.

 

Yes.

 

It's the creation.

 

John, I feel like you're doing something so important too, because even though you're using a lot of words to describe this other wordy thing, you're helping therapists mentalize a thing that the therapists often don't mentalize, I think. That like there's this thing happening that is beyond what we say. It's happening in the room.

 

Yes, right. Yeah. There's a wonderful irony in this. Neither the therapists nor the patients know how the therapy worked.

 

Yes. And yet it worked for something.

 

And yet it works. Yeah.

 

Something you're speaking to. And again, maybe we can, I know we're running a little short on time, but I would be remiss if we didn't get to this. What you're talking about with music is reminding me of several presentations that I've seen from hospital chaplains and people who work with people in more of like a religious spiritual way who are sick, who show up and like let's say someone's dying and they aren't able to speak, but they show up with music. They show up in a way that's like, I see you and I hear you. And it's been really profound to hear these presentations of what this means to people when people show up, even when it's without words. And so that's a bit of a segue, but I know you did you spend some time in this book talking about religion and spirituality. And you included in this book as somebody who obviously is very in invested in understanding religion and spirituality, but I think it'd be fair to say it's not a you're not a particularly religious person yourself.

 

That's right.

 

That's fair to say. And so, I'm interested that you included this. And I wonder if you want to say more about why this felt like it needed to be included in a book on care and relationships.

 

Yes, I do want to say one other thing about jazz. What I like about jazz as the metaphor is improvisation. Yeah. Learning to improvise. And I think you can rely on manuals, say, give me the score. I don't like this improvising bit. Just give me the score and I'll play the score. We need to have structure. Jazz has a lot of structure, but it's improvising around themes. So on to the relation between what I'm talking about and religion and spirituality. What I want to say is that we, a lot of us, are in the psych professions, right? The three of us are in the psych professions: psychotherapy, psychiatry, psychology, psychoanalysis, psych. What does psych refer to? Soul and spirit. And when we talk about the feeling of connection, I think a good word among all the psychoanalytic words is spiritual. It's a fine word for this ineffable spiritual connection. And there's some wonderful literature, a lot of really wonderful literature. And I do that, you know, spiritual but not religious, I guess applies to me. Frankly, that seems kind of wobbly to me. I mean, you know, spirituality emerges in religion. So, to separate them, this whole history. Yes, right. But I confess a lot of ignorance. I just read the book Job, which I love. That's brilliant, brilliant, wonderful book.

 

Yeah, I mean, it's you cover so much in the book, and I'm hoping people are very intrigued as they're I imagine they are as they're hearing this, but you know, how does this affect clinical practice? What are you hoping clinicians take from this and how it affects their practice?

 

Yeah, thank you for that question. I answered this in the beginning of the book. I'm not going to tell anybody what to do. Oh, darn it. Yeah, darn it. I uh I really think uh, you know, that's the CE question. Okay, now you've had this CE thing. Yeah, on the questionnaire you get, you know, you how's this going to change your practice?

 

Right. I always pick, I don't know.

 

Yeah. I say I'm talking about how to think about therapy, maybe affect how you feel about therapy, maybe affect what you pay attention to, and what you do with this is up to you.

 

Yeah. I hope it also affects your ability to not take things for granted.

 

And I feel like we can't overstate as you've talked about, there is research to support that your growth as a therapist in regard to how you as a person show up and consider these things and pay attention is actually an intervention, if you will. That's a little too overly simplistic, but to fit into the structure that we talk about things, it is part of how we treat patients. And so, it does turn into, I think, this very practical way of how we become better therapists.

 

Yeah, I want to say I like the word craft. I think of therapy as an art, but I like the word craft. And what I would say is that they do say the mastery of a craft is the work of a lifetime. So that you need methods, you need a lot of knowledge about psychiatric disorders. And you're going to use some techniques. Techniques, you have a way of thinking about so you need all that stuff. But the development of the therapist includes learning as you go. And everybody's going to have a different path from everybody else. But you need some methods, but it's pretty hard to say you need this one. Yeah, you need mine.

 

John, I find the way that your mind works, because I think you are this interesting combination of somebody who is pushes against over rigidity and jargon and getting in the weeds of things that are missing the point. But you're also incredibly specific and a little fussy about language and how things all fit together. It is really I think it's actually incredibly useful. I shouldn't say actually there. I just find it to be fits with how I think very well. And I think this book is probably, and my reading of it so far, um, it at the time we're recording, this book has only been out for a couple of weeks, if I'm not mistaken. But it really does something, again, I think that's really critical, which is to give credence to some topics that we don't always give credence to, gives language to it and helps us mentalize it, but then leaves us with a very practical feeling of like, this isn't a to-do list. This isn't like, okay, so do X, Y, and Z. And now you're going to be doing care. It is giving the sense of like you have this thing you're going to keep cultivating in your life, and it's worthy to look at and think about and it's complicated. And let's do the mentalizing work of it.

 

Wow. Well, well said.

 

John, as we begin to wrap up for today, again, I think we could spend so much more time talking about a lot of the different things that you cover in this book. But if you were to have our listeners kind of walk away with something, what would you want them to walk away with today?

 

Well, I think that personal development of the therapist is really, really important. And we're privileged to learn a lot from patients who confide in us. And it's that personal development that I think is so crucial and the need. It's like I used to talk with patients about  attachment, and the mothers in the group would worry, you know, oh my gosh, you know, have I done it right? And you know, the anguish about it. And I would ask people, well, what does a mother focusing on mothers, what does the mother need to provide secure attachment? Secure attachment. That we need care; we need trusting relationships. And I think that that, you know, we're in the same boat with our patients. That's what I would want people to think.

 

Great. Well, once again, we've been talking with Dr. Jon Allen. Thank you so much for joining us. So when's your next book coming out?

 

That you can find this book, which is bringing psychotherapy to life through carrying connections on Amazon, I believe.

 

The usual yeah.

 

And yes, we've been so lucky to talk to you, Dr. Allen. , thank you.

 

Thanks so much. And once again, this is the Mind Dive Podcast. I'm your host, Bob Bowland.

 

And I'm Kerry Horrell. Thanks for diving in. The Mind Dive Podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.

 

For more episodes like this, visit www.menningerclinic.org.

 

To submit a topic for discussion, send us an email at podcast at meninger.edu.