Head Inside Mental Health
Todd Weatherly, Therapeutic Consultant and behavioral health expert hosts #Head-Inside Mental Health featuring conversations about mental health and substance use treatment with experts from across the country sharing their thoughts and insights on the world of behavioral health care.
Head Inside Mental Health
Thinking About Thinking with Dr. Kerry Horrell
Feeling overwhelmed, reactive, or stuck in cycles that don’t make sense? We sit down with Dr. Kerry Horrell, staff psychologist of the Compass Program for Young Adults at the The Menninger Clinic to map a clearer path: learn how to “mentalize” in everyday life, reduce shame, and rebuild trust in your own mind. Carrie breaks down the neuroscience of big emotions—why your survival brain can hijack thinking—and shows how simple practices during calmer moments help you keep access to choice when it counts.
We dig into the difference between logic and experience. If a fear response was learned in your body, new experiences reshape it. Kerry explains how exposure, done safely and gradually, provides the fresh data your nervous system needs to update its predictions. Along the way, we explore why many therapies work for the same reason: the human bond. Research on common factors shows alliance, empathy, and collaboration drive most of the change, while techniques amplify what trust has already made possible.
The conversation widens into meaning and spirituality, not as doctrine but as direction. When life becomes a checklist of symptom control, hope shrinks. Asking Why stay? What do I live for? reconnects us to what’s sacred—love, belonging, creativity, nature—and gives pain a purpose to lean against. We discuss practicing self-compassion, and thinking about thinking can turn reactivity into reflection and isolation into connection. By the end, you’ll have a grounded way to understand your mind, tools to calm your body, and questions that help you build a life that feels like your own.
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Hello, folks. Thanks for joining us on Head Inside Mental Health, featuring conversations about mental health and substance use treatment with experts, advocates, and professionals from across the country sharing their thoughts and insights on the world behavioral health care. Broadcasting on WPBM 1037, the voice of Asheville, independent commercial-free radio. I'm Todd Weatherly, your host, therapeutic consultant, and behavioral health expert. It is my pleasure to welcome to the show today Dr. Carrie Horrell. Dr. Horrell is a staff psychologist on Mineger's Compass Program for Young Adults, as well as the coordinator of the youth division. In addition, she's a co-host of Mind Dive Mineger's podcast for mental health professionals. She is also an associate professor in the Minegar Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, DCM. Dr. Horrell earned a bachelor's degree in psychology and social behavior from the University of California, Irvine, and her doctorate from Rosemead School of Psychology at Biola University. She completed a predoctoral internship and a postgraduate fellowship at the Mininger Clinic at BCM, and they just wouldn't let her leave. Carrie's clinical expertise includes the treatment of shame, trauma, and attachment issues, and with a particular focus on self-compassion, mentalizing, and psychodynamic psychotherapy. Her research interests include experiences of gender and sexuality, as well as religion and spirituality and how they relate to mental health and well-being. Her research has been published in the Journal of Psychology and Theology and has been shared at the annual conference of the Association of Psychological Science. Dr. Carey, welcome to the show.
SPEAKER_00:Thank you so much for having me, Todd. I'm excited about this.
SPEAKER_01:Oh my gosh. Me too. Thanks for joining us. Well, you know, I think it's really funny that um the when you and I have met, which spent a couple of times now, the last time we met, you know, we're always sitting with a group of people. That's right. I didn't invite anybody else onto the podcast. I just happened to invite the other podcaster in the room to the show.
SPEAKER_00:That's right. You just we we find each other in this way.
SPEAKER_01:We jived, right? Exactly. And uh I I take it in addition to the interests that are listed in your your profile there on Maniger's site, you also have um an an interest in in very young, young people. So very young people, like the new the new young people that you have in your home. You're applying all your science.
SPEAKER_00:Oh my gosh, being a psychologist and a new parent is terrifying. You have all this way too much about it, attachment and all this, and then you're just actually still just being a normal human with a child. And luckily, my husband is not in the mental health field, and he has such a practical way of just saying, Hey, I think it's fine, chill out.
SPEAKER_01:We don't need to worry too much about this.
SPEAKER_00:So we make a nice one.
SPEAKER_01:Yeah, I think we're just gonna do this now.
SPEAKER_00:You're you're overthinking this.
SPEAKER_01:I I agree with you being in being in behavioral health and knowing as much well, seeing all the things that you see, you see the most terrible thing, right?
SPEAKER_00:Yes. I you know, sometimes mentors of mine have had to remind me of this. I'll say something like, Well, this is kind of a common occurrence among young adults, and they'll say, Hey, just as a reminder, the young adults you interface with are in psychiatric care, that might not be an absolute representation of all young adults. And I'm like, Well, that's actually a reminder. I I I don't always hold on to that, yeah, we we interface with people who are in psychiatric crisis. Um, and that's not there are a lot of people in psychiatric crisis, but it's not always the full representation of everybody out there.
SPEAKER_01:Oh, I know, I know, and um I I you know maybe we can get into this a little bit. I I really try to be careful when when I talk to wide groups of people, and you know, not everything's a crisis, not everything's the most horrible thing you've ever seen. And yet, and I think that this is what's this is what's cool about it, a lot of the principles that we use in treatment feel really really good for everyday life. Like you know, absolutely finding your center, creating balance in your life, um, being able to process things from a from a broader and objective perspective, getting help when you feel like you need it. Like there's there's just all these principles that I think we carry with us all the time. Uh and you know, your your background here, of course, doing research and um going through your doctoral uh work. Uh you sent me a you sent me some of the material that you have on mentalizing. Can you tell me what that is?
SPEAKER_00:You know, it's one of the things I'm really passionate about. And yet I I'm just even gonna say at the forefront, it's also one of those things that I'm like, this word sounds like it's a jargony, like, oh, what is mentalizing? When in reality, it is this really simple concept of something that we do every day. It's actually a really nice segue from what you were just saying, which is like, this is not something that's a a coping skill or thing that's particularly used for people who are going through a crisis or going through a struggle. This is for everybody. And it's not even just for everybody, it's we're all doing it whether we know it or not. But mentalizing at its core can be thinking about thinking. It is, it is the process of being explicit about what goes on in our mind. And it's particularly thinking about how the ways in which we show up in the world around us, whether that's our behaviors, our reactions, the way that our mood lands on our bodies, our facial expression, our body language, but there's stuff that underlies that for ourselves and for other people. And so at the core of mentalizing, is thinking about the fact that we have a mind, that other people have a mind, and that our minds work differently, and they influence how we show up.
SPEAKER_01:As you were saying that, I was thinking about my thoughts about thinking about those thoughts.
SPEAKER_03:Yeah.
SPEAKER_01:You're you're you know, it's um median said this, and I think it's really true, is that um you know the there's a there's a lot of the public. I mean, there's a lot of people just you know, have day-to-day, very busy day-to-day lives, you know, people working two jobs and people they're trying to make ends meet and live in month to month and everything else. And they don't have the luxury to reflect. And I think what you're talking about is that in addition to not having the luxury of reflection, they don't have the luxury of being able to examine how the way they think influences the way they behave. Because they don't get to see these this underlying piece. They don't get the chance to mentalize. Not really. Not not deeply.
SPEAKER_03:Yeah.
SPEAKER_01:You know having worked with I mean you you your team served clients buyers of everything else, and a lot of the work there at Miniger, especially, you know, on the assessment end and stabilization end, is really giving some of the clients that are showing up who've been hijacked by their by their behavioral process or by their you know, their activation, maybe it's anxiety, it's like, hey, let's let's slow down and let's think about how you're getting to this place. Um and and maybe consider shifting it a little bit. What does that process look like when like when you're getting somebody to kind of step into a space obviously we're all mentalizing, maybe we don't realize it, maybe we're not doing it deeply, and maybe it's something that we need to use as a tool. How do you get people to step into that space and start, you know, being, if you will, more aware?
SPEAKER_00:I think one of the first pieces that comes to my mind is letting people know that it's a practice because I think that like mindfulness is a very similar related topic, right? That it's bringing just non-judgmental awareness. Mentalizing is incorporates mindfulness, but it it maybe also includes sort of this explicit thinking about how your your thoughts are and where they come from. Um again, but similarly, it's like we have to learn how to do that and we have to practice it. It's a bit of a muscle. And so whenever I talk to patients about mentalizing, one of the first things I tell them is like, if you feel like I'm bad at this, I can't do this, I'm bad at it. It's like, well, if you're not in the practice of doing it, of course you're not good at it. And so early, like picking up these as a practice. And then I think the other thing that comes to mind, especially in the early parts of letting people work on mentalizing, is understanding the connection between our brain and our brain's capacity to think and emotion dysregulation. I tell patients, you know, it doesn't matter, you know, if you have a mental health condition or not, if you've been working and thinking and doing mentalizing for years or not. Um, any of us, when we are either really dysregulated, overwhelmed with an emotion, or we are shut down, we're numb, we're dissociated. Anyone who ends up in those emotional extremes is not in a position to think well. Um, we don't have the skills, literally at a neurobiological level, to think because our brain and the part of our brain responsible for thinking our cerebral cortex, our uh, you know, prefrontal protect, it's not, we don't have as much access to it when the middle parts of our brain that are more responsible for survival are going off. So again, when we when our amygdala and other parts of our limbic system, which again are in that lizard brain, you know, the part of our brain responsible for survival, really connected to emotional processing, when it's going off, the part of our brain that's responsible for language and memory, cognition, again, like this higher level thinking, it just shuts down. So when people come in and they're like, I'm terrible at mentalizing and I get into these crisis states where I'm just I am feeling at a 10 out of 10 and I can't mentalize, I'm like, yes, that's correct. That is correct. You cannot mentalize that that that place. And there's no criticism of that. That like that's why we work on mentalizing when we're not at a 10 out of 10, and that that we we work on building up that muscle so that it's easier to get to that um as we're moving through these kind of like big emotional waves.
SPEAKER_01:Well, vigilal hijacking, of course, uh, one of these kind of culprits that exist in people, but you're talking about Maslow's hierarchy as well. Um, you know, where like except for the fact it's not quite as simple as this diagram. You know, we got people that live in a world where they may not be in danger, but because of their level of activation, it may be rooted in a stimuli, but the stimuli itself is not dangerous. They feel like they're in danger. Therefore, the brain engages in this hijacking, like you've got to escape and you've got to go away now, and everything's terrible, it's gonna fall and crash, and the sky is falling, and you know. And in that state, you can't do any of the other layers, you can't work on like self-acceptance, you can't think about how you might be calm or whether or not you're safe. You don't have the capacity, the brain only can only do one of those things at a time.
SPEAKER_00:I tell my patients a lot that, you know, if you imagine that you were being chased from a bear in the woods, you know, like all the things that you would want your body to do, if you had to imminently survive a physical attack, you would want to be able to run, you'd want to therefore get more blood to your extremities, you want to get more oxygen in your body, you want your pupils to dilate so that you can see more. You don't want to have to stop to go to the bathroom. So your GI track needs to kind of stop up. All of that is super helpful if you needed to survive a bear attack and run from a bear in the woods. Now, when you need to get up in front of your classroom and give a presentation, almost every single one of those things is really not helpful to you. And yet that is what your body's gonna do if it feels like it's under threat. And so I also feel like just helping patients know that like there's a reason why your body responds this way, why your mouth dries up, why your heart starts racing, why it's hard to recall information that when you're not stressed out, it's easy to recall. It's like all of this has this biological underpinning. There's nothing wrong with you or weird about you that your body does that. It's it really is just unfortunately uh an evolutionary problem that now the things that we experience as threat, whether it's a stressful text message, getting up in front of a class and doing a presentation, our body is not responding in ways that are actually uh usually super helpful to us in that moment.
SPEAKER_01:Yeah. It believes that it's the thing it's supposed to do, but it's not the thing that's gonna be helpful to you in that situation. Uh you know, and when you the thing that I that I learned from someone um when I was I was talking to a research neurologist. His name is escaping your one of the things he mentioned, which I thought was really interesting, is that you know, we used to think of the amygdala as this kind of rapid response system, which it is. Um, you know, it's like fixed and stimuli. You need to swerve to you know avoid the deer that's you know cutting across the road. There's a there's a reflex mechanism in the brain that's located in located in the parasympathetic nervous system that allows you to do that and not think about that region of the brain has memory, it's not a lot of memory, it's not what we refer to as long-term memory, but like things like your accent and the way you say hello to your mother, and what you call, you know, your sibling, or whatever it is. There are things like this that are located that are memory stored in that region of the brain. One of the things that people who getting up in front of a group of people feel traumatized, one of the things that they have is that now every time they get up in front of a group of the people a group in front of a group of people, the response that they generated to that scenario gets lodged.
unknown:Yeah.
SPEAKER_01:And it's very hard for them to get it out. So how do you how do you help people get it out? Like how do you how do you take that material out of the out of the amygdala and put it somewhere in long-term memory and separate, you know, make the mechanism stop triggering the way it's triggering. What is the bonus process for clients to be about that?
SPEAKER_00:You know, something that I I say to my patients a lot is if logic didn't get you into that system and that belief and that way of responding, logic will not be the thing that gets you out. So if if something happened to you and you have begun to have a response because it's based on something you've been through and it's held in the body as this experiential thing, it's not going to be any of us sitting here and telling you, hey, you're gonna be okay, that's gonna really get you out of it. It's gonna be an experience. It's we we need these new experiences and for our body to actually go through something different in relationship, in again, a stressful, you know, a stressful similar experience, um, for us to actually be able to trust and believe and for our body to be like, okay, I have another data point now to respond with. Um, right, right. Like again, like it, you know, if you you had a really stressful time, you gave a presentation and it went terrible. Again, you can practice and you can work on coping skills, but ultimately to be able to do a presentation and not feel that level of anxiety again, you're gonna have to have given one. You're gonna have to do another one and work your way through that and have it feel better for your body to trust that, okay, actually I can do this. It's why so much of trauma work ends up being experiential and exposure in nature. I I wish it wasn't. I wish I had a magic wand or some intervention where I could say, hey, you don't have to feel your way through this. We could just kind of zap it away. And unfortunately, that's just not the case. Like people have to have these kind of new emotional experiences to have things feel different in the long term.
SPEAKER_01:If you use, I'm sure you do at times use film, but you know, your the story that you're telling reminds me in the in the film Finding Nemo, where they, you know, the Mount Wana Hakaluy and he has to he has to go through the fire. The fire is is just bubbles.
SPEAKER_03:Yes.
SPEAKER_01:You know, but they've made it really scary.
SPEAKER_03:Yeah.
SPEAKER_01:They've given, they've built it up and everything else, and he's like, I can do it, I can do it. And like he goes through, he's like, but like he's not harmed at all.
SPEAKER_00:I know.
SPEAKER_01:And I feel like that's the experience, right? You know, that's what you're talking about with being absolutely and it's gotta go through the bubble fire.
SPEAKER_00:Exactly. And I think that's it speaks to like the power of our emotional memory that like for for so many people to even allow themselves to like get into their feelings and to feel with the again, like in their full body, it can feel so overwhelming, like something really scary is happening. Um then I think one of the things that we're we're talking about, but haven't quite named yet, is like the idea of shame. Shame is one of the things that like I don't think anyone can talk to me without me bringing up shame because I think it's such it's I know me and and and Queen Brene. Um, but like it just it's one of those things where so many people who've gone through mental health struggles and they're wrestling with their mood, they're they have problems with dysregulation, or even they maybe they have problems with just like they have ADHD. It's hard to concentrate, they're struggling in school, you know, they're they're this is someone maybe who is going through a major depressive episode and they feel suicidal. I think so many people end up wrestling with like, is there something wrong with me? Is there something wrong with me? Not again that this is an illness or a struggle or an experience, but is there something wrong with who I am at my core, that I'm having this thing? And I think that's so often where the mentalizing work comes in and is so important is that I think as people are learning that, okay, the mind does work a certain way and the body responds to emotions in a certain way. And this is actually all very understandable that it can help reduce that that that isolated and very lonely feeling of like, oh, I there's just something wrong with me that I'm struggling in the ways that I've been struggling.
SPEAKER_01:Well, this is maybe not a not the best word to use here, but the level of separation, objectivity from their experience. It's like you're the things that you've experienced up to now. They don't have to define you. You don't want them to, you would like to take on a definition. You've got choices. And that kind of brings me to this other piece, um, which I'm you know super curious to hear from you about, which is the the whole linkage of spirituality therapeutic process. You know, Eckhart he experiences this awakening and he he asks himself, Who is it that's saying this to me, witnessing the experience? Is it one person? Is it two people? Who is this person that's observing this experience? Um you know, launches from there into you know how to be present and powered now and these other pieces we don't go too far down that road, but it's a very spiritual um kind of approach. How does that play a role in your work? Like what is that what fascinates you about that? How do you use it?
SPEAKER_00:Oh, there's so many directions I could go with that question. Um I will just start. Let me just and this I I think is only tangentially related to what you're talking about, but I I decided to go go to a doctoral program that specifically uh trained people to consider religion and spirituality and how those things play a role in people's experiences, their psychology, if you will, because I wanted to study the intersection of religion and religious trauma and gender and sexuality. And some of the people who were doing that work were at Biol University. Um, and so my dissertation was on sexism and kind of the proliferation of sexism in uh many religious ideologies and how that is not very good for people.
SPEAKER_01:Um, and so and I think it's not good for people. What?
SPEAKER_00:I know it's mind-blowing. Um and also looking at things like uh sexuality and gender identity and people who've experienced religious trauma around those parts of their identities. So again, that was what that was my like entryway into this. And I'll be honest, I don't know that I would have been somebody before I landed at that program that would have been super kind of gung-ho on the spirituality stuff. Like I think I I was like, yeah, no, that sounds good. If you're into that, you know, if you're a yogi, go off. You do you. But I don't think it felt like I didn't feel as connected to it. And again, I was like, I want to study religious trauma and I want to study how people's experiences of their identity interface with religious ideology and how that might influence them. So I go to this program. But I think uh what's interesting is I have really landed as somebody who is deeply kind of like pro-spirituality. Um, one of my little isms, I have a lot of these little sayings that I throw around, but one of them is like, we we should try not to throw out the spiritual baby with the religious bathwater. And it's specifically for those, I'm thinking of people who've had religious trauma and they've had experiences where they feel like they're really uninterested in religiosity and they're really uninterested in getting it involved with organized religion. You can also find people saying in the same breath, they're like, Yeah, so I don't want to have anything to do with spirituality. And it's like, oof, well, look, can we think about what that is? What is spirituality? What is the idea that we have things in our life that are sacred, that are important to us?
SPEAKER_01:Um, that's contemplating your existence, you know?
SPEAKER_00:Yeah. What does it mean? And and ultimately, I think that when you work with people who are going through crisis as a mental health professional, there's just no shot you get out of the questions of spirituality because try to talk to somebody who is suicidal, like contemplating their own life and not end up in some level of existential spiritual-minded conversations. What is the purpose of life? What is the nature of suffering? Why do people persevere through pain? Is there hope? What is hope? Um, why stay alive? Like these are questions that are so inherently more than just like symptoms and clinical and like these are questions about life and meaning. And so again, as somebody who specifically works with people who've had trauma and people who are suicidal, like it just is such a part of the like, it's it's in the texture of the work that people who are wrestling with bad things have happened. I struggle now. Is it all worth it? Like these are questions about, I think, like the human spirit. And I am really passionate that that's one other thing, and then I'll I'll I'll end this answer. One of my mentors and people I really look up to is Dr. Lisa Miller. Um, she's out of Columbia University. She's one of the people who's really doing this work. And um we're both on we're both faculty of the Institute for Spirituality and Health. And so I've got to meet her and know her, uh, which I'm very lucky for that. And they really pioneered, they're one of the institutions that puts on the conference for medicine and religion every year. And they really, again, like um campaign a lot of like understanding how our health is related to spirituality and our spiritual wellness. So Lisa, Dr. Lisa Miller, you know, she wrote this book called The Awakened Brain and one, and she really looks at the neuroscience of spirituality. And again, say so much about this, but what I wanted to say here about her is that like she really has pioneered thinking about how we are currently seeing some of the most like up-and-coming generations who have the least levels of spirituality, and we're seeing that run tandem to having some of the highest levels of mental health problems and really trying to think about like, how do we, at least in part? I don't think it's the full solution. We use spirituality as one of the ways that we help combat just mass levels of anxiety and depression, hopelessness, fearfulness, polarization, division. Like, how do we use our our common shared values of what we find sacred? Love, connection, nature, life, how do we use these things to connect?
SPEAKER_01:Well, it sounds terrible. No, I mean I've got to say, I know, right? I've gotta say that um pretty much across the board when supporting parents and talking to clients who are needing treatment and usually advices um Though I may not talk about it explicitly the nature of spirituality and the questions that reside therein are always present. I'm always asking something like, Well, what do you want? What is what does this mean? And like, you know, the this kind of big questions. I mean, the the the great grandmother and grandfather of of psychology and psychiatric practice, of course, philosophy. Um, and you know, the all of that rose out of asking the big questions of life, why does it matter? Well I mean, I I think that it makes a lot of sense that people who don't have who haven't spent any time asking these questions. I and I don't know about you, but my initial experience, and I can remember even as a young child, because my dad was very pontificative, he's very much a philosopher and loved to ask big questions, but to asking them big questions like what does this mean? Like it was a very comforting experience to have to like reflect on that question to think about these things. I can remember it being some of the warmest and comforting times of my life to be in a space where I'm able to contemplate those questions. If I didn't have that, I think I would be have struggling greatly as well. Um, you know, how do you introduce this to the people that you're working with? Like, where's the bridge?
SPEAKER_00:Well, I actually appreciate what you're saying, that sometimes there is no bridge to like explicitly saying we're talking about things in the realm of spirituality. Um, but actually, I so similar to your story with your grandfather or your father. Was it just your father?
SPEAKER_01:Um father, yeah.
SPEAKER_00:Uh I find people in therapy, you can just kind of watch them take a sigh of relief when you ask them these questions about life beyond symptoms and beyond like their current struggles. It's like, well, what do you what do you want to do with your life? Or a big one, and again, I I particularly work inpatient and I work with folks who are suicidal a lot, which I know is not what everybody's doing in clinical work, but you know, when I'm working with patients, when I just ask them like, well, why do you want to die? And is there another why would you stay alive? You I think you can watch on their faces and like, well, no one's asked me that before. Everyone's like, you need to stay alive, you have to stay alive, we have to figure out well, how do you stay alive? And I think even just the slowing down of like, well, why do you want to be dead? What, what, what, what drives that want? Why would you want to stay alive? Where does that come from? Like, and just helping people talk about these things, like there's such a sense of like, oh, yeah, this is the stuff I want to talk about. And I have to say, I feel like I'm I'm plugging this book, even though I have absolutely no reason to, because it's not my book. But one of my mentors, uh John Allen, who is a he's a psychologist of many, many years. Um, he's at Menninger for over, I think, 40 years. He just came out with a book called Bringing Psychotherapy to Life. And his like whole thing, if you're not familiar with John Allen, is like a real pushback against the he calls it acronymania, which is that we have we have uh CPT for PTSD and we have DBT for BPD and we have CBT for MDD, and just like we have all these manualized treatments for specific disorders, and that sometimes we miss the force from the trees of the actual person. And so he wrote this book to like really kind of think about that. And he he actually uh, who is a man who is not religious, I should say, and I don't think he'd mind me sharing that. He has a whole chapter in your own religion and spirituality, and just sort of the idea that, like, as people are recovering from painful things that are behavioral or mental struggles, there is this quality so often of like these bigger questions of life and the meaning of it all and the purpose of suffering and the meaning making we do through the stuff that's been hard that happens in the therapy room, whether we're talking about it or not. Like it's happening. Like our patients are coming in and they want to talk about like the nature of their suffering and how to make sense of it as much as often at least, they want to talk about their symptoms and like the clinical you know, ways of managing those symptoms.
SPEAKER_01:You can't you can't dodge it.
SPEAKER_00:No, it's so human. And what like truly, what is spirituality if not like our experiences of being human? Like that it is what it is.
SPEAKER_01:Um I mean, absolutely. I um I just think that it's impossible it's impossible to, if you will, strike a therapeutic alignment, align alliance with someone if you don't have some toe at least in the water. Of what we're talking about. Spirituality and the nature of you know why we're here and existence in general. Like these are the big questions they've been asked for centuries. Um and we continue to ask them because they are the big questions. So if I were and they are unique to each of us.
SPEAKER_00:If I were to kind of crap on psychiatry for just a second, though, and psychiatry psychology. Right. I think that as a discipline, we're really, we really focus more on like, here is the baseline of just a neutral life, and here are the things that make life bad. Let's get those bad things up to neutral. And it's really only been in the last several decades that we've had more and more people being like, you know, there actually might be more to life than just like, and then what we do as a field, than just getting the bad things up to neutral. Like there actually might be stuff above that, the stuff that brings us pleasure and joy and meaning. And again, I think the field is actually like that's the positive psychology of the field is only like several decades old. Um, and it's still just a yeah, way of thinking about it. That we we have more to offer than just like, let's get rid of your symptoms and let's have a live life that feels nice and exciting.
SPEAKER_01:We're we're smart people. We think that we can do more than symptom management.
SPEAKER_00:Yeah.
SPEAKER_01:You know, my I've been in I've been in behavioral health for 30 years at this point a long time, but really came into the you know what we often refer to as the private pay side when we started working at Cooker Reese. Um and Virgil Virgil was always just like, I don't want to know what your illness is. I want to know what your dream is. And it was it was always you know, and I mean to this day the the man's in his middle seventies and he like he he's as strong a voice about it these days as it is as he ever has been. Um and I talk to him regularly, but you know, honestly nobody's ever asked someone to dream. But you know, what do you want to do with your life? Why would you want to live? If you were gonna live, what would you live for? And they're just I don't I don't know if you're familiar with uh Dr. David Cooper and Pre ship inquiry. The question's important You know, change happens from these like poignant questions that cause the brain to focus in a place that's not about a problem, not much diagnosis, about why you're here in an inpatient facility, but why you might want to live in the first place. Um and and that's the question that all of us are trying to answer all the time. And in that way, the person's no longer alone. It's such a it's such a joining kind of experience, I think.
SPEAKER_00:Um It's also again, and I gotta say, I always go back to shame. Because shame, I think shame is this like experience of feeling like there's something wrong about you, and and nobody else is like this. Like if people really found out about you, they'd really shun you because like you're different and and in a broken way, right?
SPEAKER_01:Terminally unique, right?
SPEAKER_00:Yeah, like not good. Um, and I think that like so often, like one of the ways we we burst through that is through connection. Like it is not a coincidence that the like the thing that Brene Brown herself has really championed is that the antidote to shame is vulnerability and connection and being seen. And I think that like shame doesn't exist, that that isolated, very lonely feeling of there's something wrong with me just really ceases to fester and have as much power when we share our stories and we're able to say, like, yeah, I do have dreams, or I have this thought, or this is the thing that's keeping me from that. And it and again, I I think there's again, there's to me, there's spirituality in all of that. The human connection and and the the role that that plays and how we recover and build a life worth living is is so based in our capacity to connect with each other and connect with our story, own our story. Yeah.
SPEAKER_01:Well, you know, you you probably heard this before as well, but if you if you measure modalities, their efficacy, um they all they all come out, they all at least in the study that I've seen, many of them come out at the same level of efficacy. And the thing that makes it successful or not successful is the practitioner's ability to have to gain trust with the client.
SPEAKER_00:Yeah. Yeah, the common the common factors research that looks at, and and again, statistics is so odd that they can actually like we call it factor analyze and look at like, okay, how can we actually tell which parts of interventions and treatment account for change? Or yeah, and like actually like hold the like the punch, if you will, like this is what what we really are doing. Yeah, they they find that when you account for the common factors, which is like therapeutic alliance, you know, empathy, like also therapist skill and knowledge, that's in there too. Um, but like our our capacity to connect and like feel with our patients, it accounts for so much of why any therapy works that like the actual intervention only holds like, I think it's like 15, 10, 15% of the variance in why people get it's a really small percentage, which is part of the reason why I'm so drawn to again John Allen's work. And he's very again, like he he doesn't he doesn't crap on anybody's like modality or intervention, but just definitely is like there's something that's going on with no matter what you're doing, usually in therapy, or whatever whatever manualized protocol or or you know process you use, there's something we're all doing that we should name. And again, it's these these common factors.
SPEAKER_01:It feels like it should be more complicated, doesn't it? It's like actually it's not. Do you know it's all the science and all the research?
SPEAKER_00:To like full circle it. Uh what John Allen would say is the closest thing to this, like if we were to put words like a common factors kind of therapy, it's mentalization-based therapy. It's doing mentalizing. It's this work of like sitting with another person and saying, I mean, because that's what we're doing as therapists, right? It's like, I want to understand what it's like to live in your mind. And I want to help you understand why you do the things you do. And I want you to not feel like you're alone or bizarre or crazy for it existing that way. And it's blocking this together and figuring it out together that I think so often helps people to feel like, oh, this makes more sense. And I actually then have a sense of what I can do about it to have it look different.
SPEAKER_01:He had a term for what I think we're referring to as mentalizing. Um what a therapist does. He calls he called it intellectual midwifery.
SPEAKER_00:Oh, I like that.
SPEAKER_01:I know, right? Um, basically, uh, you know, somebody somebody had reached conclusions and had done things that were because their belief systems were out of alignment. So they're how they how they saw themselves or what they believed was out of alignment with values, so there's misalignment thought structure. And then he would proceed to ask questions that reveal the the you know incongruities, and so that the person would start to realize that there was corrective work to be done and that they were capable of doing it, intellectual midwifery.
SPEAKER_00:I'm obsessed with that. I've never heard that phrase, and I think that's an incredible phrase.
SPEAKER_01:I will send you the quote. You'll love it. Um Yeah. I you know, I could um I could really spend a great deal of time, and it's it's probably what you and I are are just ultimately scratching the surface on here is one of my favorite topics of all time. No wonder we found each other in the room. But um I really would like to spend a little more time talking about this, and I would love to have you back on the show so that we could engage in some of these deeper topics and everything else. Maybe get get a little vulnerable, possibly. I don't know. Oh, I would be if you're willing.
SPEAKER_00:Oh, I'd be delighted. I sign me up, and then I would, yeah. That would that would that would sound so good to me.
SPEAKER_01:Well, I just want to say thanks for joining us today on Head Inside Mental Health with Todd Weatherly, Dr. Carrie Horrell with the Mineger Clinic in Houston, Texas. This has been a treat to be with you.
SPEAKER_02:Thank you.
SPEAKER_01:Join us next time on WPBM 1037, the voice of Asheville. Take care.
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SPEAKER_02:I need to find my way on their so lonely and last in the need to find my way home. I feel so lonely, you'll last in the need to find my way home. I want I feel so lonely, you last in the ask. I need to find my way home, oh my way home.