The Biggest Mistake People Make When Seeking Therapy - Jonathan Shedler

Evidently so.

I'm a clinical psychologist. I'm a professor of psychiatry, clinical professor of psychiatry at UCSF, University of California, San Francisco. I'm one of a pretty small handful of people who's lived in the research world, the academic world and the research world, and also the clinical practice world. So, I have a bit of a different perspective on things, perhaps.

Because in the psychology and psychiatry professions, it's a very bifurcated world. You have clinical practitioners who treat patients, and they live in one silo, and you have academic researchers who conduct research and publish studies, and they live in another silo. They don't have the same training, they don't have the same background, they don't talk to each other. They know very little about one another's worlds, and, you know, often what they're doing is at cross purposes.

You don't have to get a license in each one of those things, but I honestly don't know how the average person possibly finds their way to a qualified, competent therapist. I got curious about something going on on Twitter and I started looking — people would show up with different letters after their name and I started looking at what are the different kinds of designations for kinds of licenses in different states, and I mean I think I found something like 60 different kinds of licensure credentials. And then just to take it even further, a lot of therapists — or people, I would say therapist with quotations, because it's not clear what therapist even means anymore — but a lot of therapists have listings on Psychology Today and they have drop-down menus and you get to indicate in the drop-down menu what's your profession, and there were I think 70, 75 or more different choices.

And by the same token, when somebody introduces themselves as a therapist, or that's how they list themselves in some directory, they're hiding something, because somebody with legitimate credentials tells you the credential. Right. You know, we've got what I call psychological illiteracy in this culture about what psychotherapy is and what it should be and what you reasonably have a right to expect.

Well, there's a lot of different kinds of psychotherapy and that's one of the problems. Just like you said, things are fragmented into a lot of different camps. There are a lot of people in the field who have a very minimal and often very questionable training. You just have no idea what you're getting. I would distinguish between psychotherapy on the one hand and two things: crisis management. Let me start the other way. To me, real psychotherapy is fundamentally about changing something about ourselves. It's about coming to know ourselves more fully and more deeply, right? So that we can create the freedom to not have to keep doing things the same old way. You know, when people come to therapy because the way that they are operating, who they are, how they function in the world is causing difficulties for them, right? So, what we're trying to do through deeper understanding and self-knowledge and self-awareness is create the option to be able to do things differently, right? In a way that allows life to be easier or, you know, more satisfying, more rewarding. But then there's an awful lot of other things that people call therapy that really have relatively little to do with that.

Well, there's been a trend in the therapy professions, plural, in recent years that people think of therapy as going in and, you know, getting some good feels. They'll get comforted, they'll get care-taken, they'll get soothed, they'll get validation and empathy. But it's completely divorced from the understanding that the purpose of the work is psychological change. It's to change something about ourselves, right? It's not empathy, understanding, support, validation for its own sake. It's with the idea that when the person comes out of therapy, something about them has changed for the better, right? They're a different and better version of themselves. So, one version of what happens in therapy is a sort of endless affirmation and validation without the idea of change being front and center. Another version is, well, you go in for a very specific problem, right? These are often promoted as evidence-based therapies is the term, and we can talk about that. But the idea is you're there to manage or alleviate certain very specific symptoms. And that's divorced from changing something more fundamental about who we are and how we function in the world. That's divorced from deeper self-understanding or self-awareness. So, it's a much more sort of medical approach, right? You have this symptom, you're going to come, we're going to do these procedures, these kind of standardized procedures, and make the symptom go away. The truth of the matter is these kinds of therapies in the long run actually fail most people most of the time. They call them evidence-based as if they're scientifically demonstrated to work for most people, and that's not true either.

Yeah, so there's the PR of it and the reality of it. I mean, evidence-based sounds like — I think if the average educated person hears the term evidence-based, I think what they think it means is, oh, there's scientific evidence that this is the most effective way of approaching my problem, and that there's evidence that I'll actually get well. Right, that's the PR, right? That's the narrative. But the PR isn't the reality. And so really, there's a group of therapies that are actively marketed and promoted under the banner evidence-based. And what it almost always really means is that these are very, very brief therapies. You know, like typically 8 to 12 sessions. They're not about getting to know you or understand yourself more deeply. They're literally conducted according to instruction manuals, right? So, the evidence-based really means uniform, standardized procedures that are decided on before you even walk in the door, right? And it's very brief. And actually one of the things we know from research is we have some — everybody's different, everyone's an individual — but we can say some time parameters about how long it really takes for meaningful psychological change to start to happen. And it doesn't happen in 8 weeks. So, the therapies that are promoted as evidence-based therapies actually are over before meaningful, lasting psychological change even starts.

Yeah, almost all of the therapies that are promoted — well, no one even knows what cognitive behavioral therapy is anymore. It's a very, very big umbrella. But yeah, pretty much all of the therapies that are most often promoted as evidence-based are variants of CBT.

It has a lot to do with that, but it's actually more complicated than that, right? So, there's a kind of an unholy alliance. It's not a conspiracy. They're not in cahoots with each other. It's more of an accident. But right, health insurers are in the business, of course, of not paying for anything more than they absolutely have to. So, they have a powerful financial incentive to steer people to the most minimal kind of treatment, right? I mean, if they have a choice between — we can make an analogy to other areas of medicine, there's treatment and there's immediate first aid, right? They're not the same thing. You might need to start with first aid. If they can steer people toward first aid, a quick band-aid, rather than dealing with the real psychological issues, they have a powerful financial incentive to do that. That's only part of the equation, right? But they have a lot of clout to steer their members in one direction or another, to get out a certain PR message, a certain narrative about what therapy should be. And the other half of this goes back to the very first thing we said about the bifurcation in the field between academic researchers and clinical practitioners. Most of the research that drives this whole narrative about that there's such a thing as evidence-based therapy is done by people who don't know very much about psychotherapy. They're not in the business of doing therapy. They're not treating patients day in, day out. If they're an academic psychologist, it's literally true that they may never have treated a patient in their lives. Or they may never have treated a patient beyond very brief treatments as a graduate student. They are not experts in therapy. But journalists and public policy makers always go to the researchers. Published an article, you are the expert. And they're making recommendations about what therapy should be like that are just bizarrely divorced from reality. I mean, it's really going on in a parallel universe. And we say 8 to 12 sessions, we know that meaningful change doesn't happen in 8 to 12 sessions. We have a lot of research that tells us this. So, why are researchers studying therapies of 8 to 12 sessions? Well, because they have issues regarding their own career and professional advancement that actually have nothing to do with answering meaningful questions for therapists or patients, right? So, there's a publication cycle. You live and die in the academic world based on publications and research grants funding, right? And it would be professionally suicidal for a non-tenured faculty member to study therapies of realistic duration, you know, 6 months, 12 months, 18 months, when their colleagues are racking up publications based on 8 or 12 session therapies and getting grants on that basis, right? So, we have an incentive system within the academic world to study things that really have very little to do with the clinical reality on the ground.

It never is. And the person — see, I mean, this is kind of the fallacy of this, you know, diagnose and then follow an instruction manual approach. It takes a while for somebody to — you know, someone who comes to therapy to begin to reveal themselves to us. It takes trust. It takes trust in the therapy relationship. That trust doesn't happen on somebody's timetable, right? There's no single event that creates it. Trust develops out of hundreds or thousands of little micro interactions over time. And it's not just that it takes trust for someone to increasingly reveal themselves to us, the therapist. It takes some doing, some work for them to be able to begin to reveal themselves to themselves. I mean, people come in, we go to therapy because things are causing difficulties that we don't fully understand. We can't come in on day one and say, 'Yeah, well, this is what's wrong and this is the problem.' All we know is kind of the surface level of what we experience as cause. We know the effect, not the cause. And if it's meaningful therapy, what I call meaningful therapy, we're not providing first aid for the effect. We're in the business of trying to understand causes and address causes. And that's what we're trying to help the person change.

I have — it's the wild west out there. I wish I had a good, clear, simple answer. Even I don't — I mean, unless it's somebody I personally know, I know their work, even I don't know how to go about finding someone that I know, really trust that they're going to do right. I did — a friend of mine, friend and colleague of mine, did a kind of an informal survey a while ago. We were thinking about writing a book about, you know, what does really good therapy look like. And we had the idea of surveying our colleagues who are PhD-level psychologists and professors of psychology and psychiatrists, you know, MDs and professors of psychiatry. Right? So, these are people at the — we were asking people at the highest level of qualification. And the question was, 'What percentage of your professional colleagues would you really want to treat, you know, a loved one or a family member, someone you care about?' And the answers ranged from a low of 1% to a high of about 10%. This seemed to converge around 5%. So, we came up with the title of a book that we never ended up writing, but the book was going to be called 5% Therapy. How to be that therapist, how to get that therapy.

So, for one thing, there's an understanding that we don't fully know ourselves. There's layers of experience. And, you know, the problem that you see on the surface isn't necessarily the problem. It's a symptom of a problem or it's the effect of something, not necessarily the cause. And that really good therapy is a process of working to understand what's going on psychologically beneath the surface of things, right? How can we understand what's giving rise to the difficulties? So, I mean, in just a very pragmatic way, suppose you have like a pretty common symptom like depression or anxiety or an eating disorder. You know, think about the things that are the — we call the presenting problem that bring people in.

Addiction, that would be another. A good therapist doesn't say, 'Okay, well, we're going to treat your depression. Here's what we're going to do to treat your depression. Here's what we're going to do to treat your anxiety. Here's what we're going to do to treat your addiction.' That's really not how it works when it's good therapy. What a good therapist says in one way or another is — let me say it a little differently. If we're going to use a medical analogy at all, depression, anxiety, addiction, eating disorders, I think it's a lot less helpful to think about these things as disorders or diseases in their own right, but as what we call non-specific symptoms like fever. So, for example, fever is a non-specific symptom of an enormous range of underlying disorders, right, from the common cold to Ebola to Ewing's tumor. Right. It's non-specific. It's the most readily observable manifestation of a huge number of possible difficulties. And when you go to a good doctor, it's not like they say, 'Well, here's some aspirin, call me in the morning, that'll bring down your fever.' That's not the job. The job is to figure out what's the cause of the fever. Maybe it's something that's not serious, maybe it's passing, maybe it's a common cold. Maybe the answer is, 'Well, go home and take two aspirins, you'll be all right.' Maybe you have a bacterial infection and an antibiotic. Maybe you have some kind of serious systemic condition. The job is not treating the fever, but understanding what's causing the fever and treating that. And when a patient or a client first goes into therapy, the truth is neither they nor the therapist knows yet about what's going on under the surface of things that's giving rise to the difficulty. So, really good therapy begins with some version of, 'Talk to me. Let me learn about you. Let's see if we can arrive at some understanding that makes sense to both of us.' And so you have to articulate or define what is the purpose of the work of therapy? What are we trying to accomplish here? And, you know, sorry if I'm being a little redundant, but that's not immediately obvious at the start to either person, and neither one of them can figure it out by themselves. If the patient could come in and say, 'This is the problem. This is what's wrong. This is the underlying cause,' if they could do that, they wouldn't need us. And we're not mind readers, therapists. We can't just look at someone or give them a questionnaire or talk to them for 20 minutes and say, 'Oh, well, this is the problem. This is the cause.' It's a job for two minds together. Right? We have to collaborate together mutually around a shared task. And the shared task is to understand one of the people, the patient, more deeply, right, in the service of figuring out what's going on that's giving rise to their difficulties, what would need to change to make a real difference. Is it something the person desires to change about themselves? And is it something that's realistically possible or likely to change in psychotherapy? And only when we are able to articulate answers to those questions do we really have a foundation for proceeding. So, I guess to bring it full circle, to answer your question, how do you find a good therapist? A good therapist is someone who works like that. They don't move from your presenting symptom or your diagnosis to a treatment. They don't say, 'Oh, well, this is your symptom, therefore we do this, or this is your diagnosis, therefore we're going to do that.' Right? It's someone who's willing to engage in this process with you.

What's your understanding — this isn't a question from the get-go, this is a question that emerges after you've spent some time — but what's your understanding of what's causing difficulties for me? And the answer should not be in theoretical words. The answer should be in very immediate, experience-near, relatable words that speak to you and your experience. You know? And how would therapy work? What would we do here that would help me to change those things? And if the therapist is worth their salt, they damn well better have an answer. And it's not some prescripted answer that comes from their school of therapy. You know, 'Here's how therapy works, it's the same answer for everyone.' It's an answer for you specifically, but based on the shared understanding that the two of you have arrived at and agree, 'Oh, yeah, this is going on, this is causing difficulties.' Right, the patient should be able to say, 'I see that.' And the therapy world is so fragmented and so divisive, I'm going to get into trouble for saying this, but I would want to know — right, there are three kind of central pillars of what goes into the training of a therapist. And I think the most important of the three pillars is personal therapy for the therapist. I would want to know, you know, how much personal therapy have you had? And the answer can't be, 'Well, you know, I've been in therapy for 2 years.' No, like in hours. How many sessions? And the answer should be in the hundreds at least. And there's a reason for that. Whatever we learn in our books and courses, academic study, if we don't see it, if we don't experience it in ourselves, it's just theory. It's just academic. We as therapists have to change first. We have to develop ourselves. Because what we're really saying to the person is, there's an awful lot that you've never really talked to anybody about. There's an awful lot that you don't even talk to yourself about. And what we want to do here is create a relationship where it becomes increasingly possible to talk about all of these things. And these things are things that are unpleasant, uncomfortable, painful, sometimes flat out terrifying. We have to be able to go there with them. Be able to go into the darkest recesses of somebody else's mind. Well, that requires that we have to be pretty damn comfortable in those dark recesses. It means we have to have gone there ourselves.

Well, it's true. And you said it exactly right. There's a lot of lip service, but not a lot of quality care. And I think there's a lot of reasons for that, but one of them is there's just an unpleasant and hard truth at the center of this: that for meaningful psychotherapy to happen, first and foremost, that requires a meaningful relationship and time. And what people now call the therapy space — everything has become a space for some reason these days.

Well, I'm talking about the industry.

That's a pet peeve of mine. Don't even get me started. Everybody's on their journeys. But look at all the players we've got here. We've got pharmaceutical companies, the pharmaceutical industry. We've got the health insurance industry. By the way, those are the two biggest industries in terms of the money spent on paying for lobbyists and paying for political campaign donations. So those industries are shaping the landscape of mental health. Then we've got tech companies, right? Startup companies. We've got matching you up with a therapist. We've got companies coming out with AI chatbots. We're already moving in the direction of chatbot therapy, AI therapy. There's all kinds of industries that are springing up. There's going to be psychedelic therapy. Well, this turns out — there's been ads going around on social media. It looks like it's a physician group. It's actually funded by a tech company, a big tech company. And they're just springing up like mushrooms, these clinics everywhere, you know, go in and then psychedelic therapy.

Yeah. The harsh truth at the center of this is real psychotherapy is a relationship. It takes time. And it doesn't scale. You can't scale a human relationship. All of these companies that are in it for the business of profit, all these startups and tech companies that are entering into the so-called therapy space, obviously they're in it for the profit, but the holy grail — how do you make something profitable? The holy grail is to do something that can scale, right? So, if you can do it once, you can do it a thousand times. If you can do it a thousand times, you can do it a million times or 10 million times. They want to scale, and a human relationship doesn't scale. So what happens? They don't say, 'Oh, you know, our bad. We misunderstood how therapy works. We're going home. We're going to take our VC capital and invest it in something else.' So because everyone's looking for something that scales and a therapy relationship doesn't scale, what in fact is happening is everybody that's coming to this sort of wild west of what the therapy landscape has turned into is selling something other than psychotherapy and calling it psychotherapy. And the harsh reality at the center of this, right, it's a relationship and it's time, and time is money. Right? And if people or society aren't willing to invest in that, but they're determined to get therapy anyway, well, they're going to get something else that goes by the name of therapy, but is not psychotherapy.

It's everywhere. But the thing is — and people think this is about therapy — none of this is about therapy. Right? This culture of therapy speak has nothing to do with actual psychotherapy. And we could talk about it if you want to. I would actually argue it's completely at cross purposes with what real psychotherapy is. Right? It's just speaking in jargon and buzzwords that sort of make the claim that we're doing real psychological work, you know, we're examining ourselves, we're looking at ourselves, we're growing. It's like the language makes the claim to self-examination and psychological work, when in fact more often than not the language actually takes the place of the real psychological work. It's like we all want credit for doing this difficult work of examining ourselves and developing our character and growing as people. It's like we want credit for it without actually doing it.

Taking action — there's something in it that misses the point, that misses something fundamental about the essence of psychotherapy. So, one thing that we have to understand, right, being humans, we have the longest period of helpless dependency of any species on the planet, right? A human infant is literally helpless. And for years. And who we are and who we become is shaped and forged in the context of our relationships, our attachments, our sense of how we see other people, how we see the world, how we see and experience ourselves is forged in the context of our relationships. And when people develop emotional problems, mental health problems that may eventually lead to therapy, right, we have to understand not only are those problems forged in the context of relationships, they also play out in the context of relationships, right? We try to have relationships with people and things go wrong. Right? We find ourselves recreating certain kinds of painful or self-defeating patterns in our relationships. Or we find ourselves unable to create relationships to begin with. And so we could say what gets broken in a relationship actually has to be repaired in a relationship. It takes...

Your therapist said that?

Yeah, you can't, right? You don't know what you don't know, and you can't really see where you are separated from the trajectory of how you got there and where it's taking you. But I would say it — I agree, I would say it just a little bit differently. That none of us fully know our hearts and minds. None of us fully know ourselves. It's not a disorder. It's not pathology. It's not a diagnosis. This is the human condition. And let's bring it back to — because I think maybe I mean something a little different by 'relationships heal' than what your therapist meant, maybe. The things that we don't know about ourselves become manifest in our relationships with other people, or a lack of relationships with other people. Right? This isn't something we can do in isolation, in a vacuum, solipsistically. 'What do I not know about myself? Well, I'm going to figure it out. Here's this course I can sign up for to heal myself.' The things that we don't know about ourselves show up and get played out in our relationships with other people. That's where they become manifest. That's where they become visible. And we all, by virtue of being human, live out certain patterns, certain relationship patterns. We all do it all the time. It's just how we're built. And we're getting a better answer to your question, what's good therapy. And this is how the therapy works, right? So, we have these relationship patterns that we live out all of the time. Another way of saying it is we look at the world through certain lenses, and these lenses are forged in the context of our earliest relationships. Psychotherapy is also a relationship. We go into psychotherapy, and we bring those lenses, we bring those patterns with us into the psychotherapy relationship. And if the therapist is actually skilled, right, what the work is about is recognizing how these patterns play out in our lives, in our relationships, but starting with how they're playing out right here, right now, in the room. Right? So, one way of saying it is, as a therapist, we count on the patient to [__] up the therapy relationship in the same kinds of ways that they [__] up their other relationships. And that's what makes it possible to recognize it, to see it, to discuss it, and hopefully to rework it so that the person doesn't have to keep repeating the same painful and self-defeating patterns. So, when we say the relationship heals, it doesn't mean the therapist is going to be nice to you, you have this warm connection, they're empathetic, they're supportive. I mean, all of that is part of the therapy, but that in and of itself is usually not enough to bring about the kinds of changes we're really after. It's not that. It's that we create the patterns that cause difficulties for us in the therapy relationship, and that's where it becomes possible to recognize and understand them. So, very different meaning when we say really the relationship heals — it's much, much more specific.

But what you're describing — I know you're kind of laughing at yourself as you say it, but in fact, being able to understand things in that way really takes a lot of insight and emotional maturity. Right? It's an understanding that the way we see or experience something just right now isn't necessarily the whole truth, that we're more complex and nuanced and layered than that. That things are rarely black or white. Right. Well, you're kind of backing into a fundamental understanding of psychoanalysis, which is, you know, the mind isn't a unitary thing. And people are not unitary. We are not of one mind about things. We are of many minds about things. And not necessarily immediately consciously accessible either. So, it gives rise to a certain openness and a certain humility about our own thoughts and feelings.

Right. Yeah, I mean, he has a little piece of the truth there, but again, this is the kind of mental and emotional flexibility and sophistication that I'm talking about. It's recognizing — I mean, when it comes to matters of the heart, when it comes to the things important in our lives, there's often not one truth. There are often many truths. And the problem with people like him who make these declarative statements, 'this is the way it is,' sometimes what they say is true or partly true, but it's one truth among other truths. And your instincts are right — or the instincts that you've developed over time, you earned them — are spot on that when somebody speaks with a sort of categorical certainty about our inner experience or about how we live our lives, it's just automatically suspect because it's already denying our multifaceted nature and the complexity and nuances of experience. Right? So, this happens in therapy all the time. Another way to think about defense — I don't tend to use the word defense mechanism, but let's use it for the moment — it's not that the patient comes in and they tell you something that's not true. Right? So, a common example is somebody comes in and you talk about their relationship with their parents and their childhood. And they paint a picture like Disneyland. 'I had a great childhood. I had a happy childhood. My mother, she was wonderful. I love my mother.' And as you work over time, you discover — the person discovers — well, it's actually not that simple. Right? Maybe they're furious with their mother, angry, spiteful, resentful, whatever. It's not as simple as saying when they say, 'I love my mother, I have these good feelings about my mother,' well, that's not true, that's a defense, what you really feel is furious at your mother. Right? What is more often the case is they're both true. It is true that the person loves, cares for their mother, has positive feelings about them. And the issue where it starts to serve a defensive purpose is that they're using one truth to exclude or negate another truth. So that we end up, hopefully in the end, saying, it's not either-or. It's not that you have either these feelings or those feelings about your mother or your father. You have these feelings and those feelings.

I mean, it's not so much the word or the phrase, but there's a kind of a subtext to it, and it's what you just said. That this is beyond questioning. This is so. You can't question it. It's my experience. It's beyond question. And that's a psychological dead end. Because what we know through every single lens we look through, whether it's neuroscience, whether it's experimental psychology, whether it's psychoanalysis — the one thing we know is that our experience is multifaceted, complex, often contradictory, that the hallmark of psychological maturity is that we have the ability to call our experience into question, to reconsider it, to revise it, for our understanding to evolve and unfold and perhaps change. And this continues for a lifetime. Right? That's what growth and development is, or at least it's a big part of what growth and development is. And the moment you take something and you set it apart from that, and in one way or another you signal to the world, to other people, but also internally, what you're telling yourself is this is how it is, this is not open to question. Right? Then our experience becomes...

crystallized and development stops. And there's theoretical concepts that, you know, we use in psychology and psychoanalysis. One of them is one of the concepts is called mentalization. But it refers to the ability to shift perspective, to take perspective, right? To take the other person's perspective. You know, to recognize that what we think, what we feel, what we do is, you know, sort of motivated by internal experiences, right? Different states of mind. And those experiences are complex. And what other people do is motivated by internal experiences. And we can make some reasonable, you know, often get a reasonable sense of what that experience is, but we don't have any direct privileged access to it. Right? So, what we're trying to do in psychotherapy is expand mentalization, space for mentalization, which is another way of saying expand the space to reflect, to reconsider, to question, to look from another perspective, to understand differently. We're trying to expand the space to think and feel and experience things beyond, you know, where we start from. And when somebody says, you know, often that phrase, you know, my truth — this is no, no. You know, we're not going to reconsider, we're not going to reflect on, well, we're not going to be open to the possibility that we might end up understanding things differently. This is fixed. This is so. Right? This is set aside outside of questioning. And then growth and development stops.

Well, and that's an important distinction, really. It was so because it is — for every incident, you know, there are five people witnesses that witness it. There will be, even in a family, everybody has a different recollection of a similar incident. Even the same person has a different recollection on different occasions, depending on their state of mind and their mood. And this is actually an empirical fact. You know, you think — I did some research on this as a grad student, but I mean there's voluminous research on this. That our subjective experiences, you know, events happen and, you know, we remember them. They're stored, you know, kind of like a recording. You can access it. That's actually not how it works. That memories, what we experience in memories, are actually reconstructed. They're not stored there, right? They're reconstructed in the present and influenced by our present state of mind. And that, you know, so for example, you can ask people about, say, their earliest childhood memories, and there's like certain core memories that, you know, that stand out as like, you know, this means something. And you can do this with people who are suffering from depression and have them write down their memories of the event. And then they, you know, either they work in therapy and they get better, or maybe just time passes and the depression runs its course. Anyway, they're now in a different frame of mind, functioning differently psychologically, and you ask them to write down the same memory. And it's changed. Same event. I mean, there's a, you know, nucleus, you know, the facts, this happened, but the memory changes. People who study, you know, eyewitness testimony in, you know, courtroom settings understand this. Right. So, you know, what your sponsor said — you know, there's, you know, what happened versus, you know, how you experienced it happening. This is directly relevant to that concept I just used, mentalization, right? Mentalization is the ability to consider, reflect, you know, recognize that — so when mentalization collapses and we can't think freely, you know, fluidly, like allow our understanding to develop and evolve, one — it collapses in different ways. One way it collapses is something called psychic equivalence. And what's a fancy word for what it means is the person acts as if what they think or feel, right, in their mind is synonymous with external reality. Right, they don't draw a distinction between their perceptions and, you know, what may be happening in the external world. So, a really, you know, common and straightforward example of that is, you know, somebody said or did something, whatever, and it hurt you. Right, mentalization is what was going on with that person? Why might they have said that? What's the range of reasons about why they said it, what they might have meant, what they intended, where they were coming from. That's mentalization. The opposite of mentalization, psychic equivalence: they hurt me. They meant to hurt me. They're, you know, they're out to hurt me. They want me to suffer. They, you know, their goal was cruelty. And we don't make a distinction between our perception versus, you know, the much wider range of possibilities of what might be going on. Maybe the person didn't even know how what they did affected you. And maybe there's, you know, there's an infinite maybes.

In recent years, there's something going on in the culture that, you know, almost seems to invite and encourage this way of thinking — a certain, you know, kind of black-and-white thinking rather than, you know, rather than holding complexity and nuance and ambiguity. Like, you know, if we're talking about human beings, human beings don't come in, you know, categories of, you know, black and white. Human beings come in, you know, complex, nuanced shades of gray. You know, I mean, with I think some pretty rare exceptions. You know, people are good and bad. You know, the world doesn't divide into, you know, heroes and villains. And like in the past, I think, you know, people who thought that way, you know, who thought in this very sort of categorical black-and-white way, you know, I think the world would sort of nudge them in the direction of, you know, it's not so simple. There's more to, you know, there's more to understand here. And I feel like, you know, now often the world nudges them in the direction of, yes, you're right. There is good and evil, and you're on the side of good. The people who think like you are on the side of good, and the people who think differently, well, they are evil, and they're on the side of bad, and, you know, we must — you know, the good must defeat the bad. And it's like, you know, this is like — you know, this is like the script of a B movie. This isn't how — this doesn't reflect the complexity of the world.

I read reviews of it. I didn't actually read the book, so I, you know, I mean, I can't — you know, I can't speak to it. I can't say I have strong feelings about what he wrote, because I didn't read what he wrote. But I mean, based on, you know, what I'm gathering from what other people have said about it, I mean, it seems like he's on to something. Like the premise that the internet is bad for us, and that it's making everyone anxious and crazy.