A Therapist Can't Say That

Introducing The Kiln Podcast!

Dr. Kae Hixson and I started a new podcast! I wanted to give you a peek into what we’re up to. Welcome to The Kiln, where postgraduate education meets brave, bold, and imperfect therapy. We’re here to shake up professional culture—to make it braver and to help therapists rediscover their excitement for this work. At The Kiln, it’s okay to be imperfect. We’re building a learning community where practicing trauma therapy with courage is just as important as doing it with competence. On this podcast, we’ll share what we’re creating at The Kiln and why it matters. Learn more about The Kiln: * Website [http://thekilnschool.com] Learn more about Dr. Kae Hixson: * Website [https://www.drhixson.com] Learn more about Riva Stoudt, MA, LPC: * Into the Woods Counseling [http://www.intothewoodsportland.com] * Instagram [https://www.instagram.com/atherapistcantsaythat/]

MBNET: Confronting Interpersonal Trauma with Courage

Over the course of three seasons, we have talked plenty about trauma. And yet, somehow, I have never explicitly described or discussed the modality I use with clients, Mentalization-Based Narrative Exposure Therapy (MBNET). MBNET is a methodology that Dr. Kae Hixson and I synthesized from two different approaches that we were independently trained in, and it’s what we teach at The Kiln. On today’s bonus episode, Dr. Hixson joins me to get into how we arrived at this blended model for treating patients struggling with complex interpersonal trauma. Listen to the full episode to hear: * How MBNET builds on existing research and frameworks to create a novel approach designed explicitly for interpersonal trauma * Why complex interpersonal trauma needs an approach that addresses incidents across the lifespan * How MBNET provides tools to intervene in client avoidance of traumatic memories * How the concept of traumatic mind mapping explains and addresses the depth and severity of interpersonal trauma * Why we believe in the transformative power of clients’ stories in processing their trauma  * How the structure and flexibility built into MBNET make it easier to meet clients where they are Learn more about The Kiln: * Website [http://thekilnschool.com/] Learn more about Dr. Kae Hixson: * Website [https://www.drhixson.com/] Learn more about Riva Stoudt: * Into the Woods Counseling [http://www.intothewoodsportland.com/] * Instagram [https://www.instagram.com/atherapistcantsaythat/] Resources: * Season 1 Ep 10: Leave No Stone Unturned: The Healing Opportunity of Exposure Therapy With Allison Aosved [https://www.intothewoodsportland.com/a-therapist-cant-say-that-podcast/episode-10] * Season 1 Ep 14: Growing Into the Light: In Memory of David Schnarch [https://www.intothewoodsportland.com/a-therapist-cant-say-that-podcast/episode-14] * Brain Talk: How Mind Mapping Brain Science Can Change Your Life & Everyone In It, David Schnarch [https://bookshop.org/p/books/brain-talk-how-mind-mapping-brain-science-can-change-your-life-everyone-in-it-david-schnarch/9119226?ean=9781548371531] * Season 3 Ep 5: From Childhood Wounds to Therapeutic Wisdom with Dr. Karen Maroda [https://www.intothewoodsportland.com/a-therapist-cant-say-that-podcast/episode-2-num-9gmy3] * Season 3 Ep 3: Unraveling Popular Ideas: Challenging Neuroscientific Narratives in Therapy with Kristen Martin [https://www.intothewoodsportland.com/a-therapist-cant-say-that-podcast/episode-3-3]

Ep 3.12 - Into the Hall of Mirrors: Deciding What (and When) to Pathologize

As I’ve been trying to wrap up this season of the podcast, I’ve been reflecting, in particular on my conversations about psychiatric diagnosis with Dr. Awais Aftab and Dr. Miri Forbes. I keep coming back to this question: How do we decide what human traits, behaviors, and subjective experiences to pathologize? What makes something about a person a problem that we try to fix? It’s a deeply complicated question, with few, if any, absolute answers. Yet I still think we have to wander that hall of mirrors, and I believe that how we conceptualize and approach the question is actually more important than any conclusions we might make. Because when we are able to articulate the various factors that influence what we pathologize and when, we actually increase our ability to apply those factors across contexts without needing to have an ultimate conclusion that is true for all people, in all contexts, at all times. Listen to the full episode to hear: * How even using suffering as a metric for a problematic trait  is often complicated by context * Why we cannot discount the sociocultural context for an individual’s expression of traits * Why pathologizing states as problematic across the board falls apart in real life * How the medical model of optimal human functioning fails to translate to psychopathology * Why we have to stay open to uncertainty in viewing our clients’ suffering and how we can help ease it Learn more about Riva Stoudt: * Into the Woods Counseling [http://www.intothewoodsportland.com/] * The Kiln School [https://www.thekilnschool.com/] * Instagram: @atherapistcantsaythat [https://www.instagram.com/atherapistcantsaythat/] Resources: * Season 3 Ep 9: Epistemic Justice in Diagnosis: Exploring Borderline Personality Disorder with Dr. Awais Aftab [https://www.intothewoodsportland.com/a-therapist-cant-say-that-podcast/episode-3-9] * Season 3 Ep 10: What We Talk About When We Talk About Diagnosis [https://www.intothewoodsportland.com/a-therapist-cant-say-that-podcast/episode-3-10] * Season 3 Ep 11: Redefining Psychiatric Constructs with Dr. Miri Forbes [https://www.intothewoodsportland.com/a-therapist-cant-say-that-podcast/episode-3-11] * Effective Reaction to Danger: Attachment Insecurities Predict Behavioral Reactions to an Experimentally Induced Threat Above and Beyond General Personality Traits [https://www.researchgate.net/publication/233639393_Effective_Reaction_to_Danger], Tsachi Ein-Dor, Mario Mikulincer, and Phillip R. Shaver

Ep 3.11 - Redefining Psychiatric Constructs with Dr. Miri Forbes

Everyone who has a foot in the world of psychiatric diagnosis seems to agree that our diagnostic system could, at the very least, use some updating, if not burning it down and starting over. So how do we approach developing constructs of psychiatric diagnoses that are more complex, more accurate, more flexible, and more context-specific than what we’ve been taught or what exists in the DSM-V? Today, I’m excited to share my conversation with Dr. Miri Forbes, an expert in psychopathology and one of the authors of the paper, “Reconstructing Psychopathology: A Data-Driven Reorganization of the Symptoms in the Diagnostic and Statistical Manual of Mental Disorders.”  Dr. Forbes and her colleagues are doing innovative research on creating more empirically-supported diagnostic constructs.  This approach to symptoms, categorization, and how we think about and use diagnostic constructs is one that I hope will help us get out of the habit of taking our current diagnostic constructs too literally. Dr. Forbes, an Associate Professor at Macquarie University's School of Psychological Sciences, is focused on improving our understanding of the empirical structure of psychopathology based on the specific patterns in which symptoms of mental disorders tend to co-occur. She is an Associate Editor of The Journal of Psychopathology and Clinical Science,and serves on the Editorial Boards of Clinical Psychological Science and The Journal of Emotion and Psychopathology. Additionally, Dr. Forbes is a member of the Executive Board of the international Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. Listen to the full episode to hear: * How a dimensional model can potentially help decrease stigmatizing and pathologizing of individual human experiences * How the regrouping of symptoms creates potential for more fruitful research into how and why symptoms cluster and how best to treat them * Why reliance on current categorization and diagnostic criteria can cause clinicians to miss or lose vital information about clients * Reckoning with the utility of existing diagnoses like BPD that may lack statistical support Learn more about Dr. Miri Forbes: * Website [http://miriamkforbes.academic.ws/] * Twitter: @MiriForbes [https://twitter.com/MiriForbes] Learn more about Riva Stoudt: * Into the Woods Counseling [http://www.intothewoodsportland.com/] * The Kiln School [https://www.thekilnschool.com/] * Instagram: @atherapistcantsaythat [https://www.instagram.com/atherapistcantsaythat/] Resources: * Reconstructing Psychopathology: A data-driven reorganization of the symptoms in the Diagnostic and Statistical Manual of Mental Disorders [https://osf.io/preprints/psyarxiv/7um9a]

Ep 3.10 - What We Talk About When We Talk About Diagnosis

In my last episode, Dr. Awais Aftab and I explored the controversial nature of Borderline Personality Disorder as a diagnosis. One of the reasons I wanted to discuss BPD is that it opens the door for digging into psychiatric diagnosis itself, and that’s part of what I want to discuss more today. What is our purpose in using diagnosis? How does it benefit us as clinicians and the clients who receive that label? Getting more clear about the constellation of things we may be referring to when we talk about diagnosis, in general, is a crucial prerequisite for using specific diagnoses wisely, especially for using highly controversial and stigmatized diagnoses like BPD. Even if you never use diagnosis, the language and concepts of psychiatric diagnoses are out there. It shapes our professional discourse, past and present, and increasingly impacts our clients’ thinking when they arrive in our offices. Diagnosis is complex, multifactorial, and profoundly impacted by context, and we must contend with it. Listen to the full episode to hear: * Why it is vital that we understand diagnoses and their value–or lack thereof–as constructs and constructs as tools * How holding diagnosis as a lens, not a label, allows for more flexibility and curiosity * The heavy lifting we expect from diagnostic constructs applied across multiple contexts * Why it’s not always necessary to share how you’re applying a diagnostic construct to your therapeutic relationship with a client * Why we have to learn to uncouple “difficult” from “bad” with our clients Learn more about Riva Stoudt: * Into the Woods Counseling [http://www.intothewoodsportland.com/] * The Kiln School [https://www.thekilnschool.com/] * Instagram: @atherapistcantsaythat [https://www.instagram.com/atherapistcantsaythat/] Resources: Management of Countertransference with Borderline Patients [https://bookshop.org/p/books/management-of-countertransference-with-borderline-patients-glen-o-gabbard/7106033?ean=9780765702630], Glen Gabbard