Getting some comments about my brief list of evidence-based therapies. I should have been even more explicit that this was NOT intended as a complete list! My list was the therapies that both:

1. Immediately occurred to me, and
2. Have a VERY strong evidence basis.

There are many other therapies that either:

1. I'm aware of but didn't occur to me at the time (e.g., EMDR and mentalization-based treatment are two examples of this)
2. I wasn't aware of (e.g., I only learned about Accelerated Experiential Dynamic Psychotherapy [AEDP] recently)
3. Have preliminary evidence, but may or may not tip the scales into full-on Stamp of RCT Approval territory (somatic experiencing, existential therapies, brief psychodynamic therapy, etc.)

My goal here was to help people think about these issues more deeply, and hopefully give a starting point if you're interested in learning more about evidence-based treatment. It was NOT to recommend specific treatments - both because I'm not a doctor, and because I don't know you.

Any therapy is only as good as the therapist.

This is a really difficult episode to process. I've had so many bad experiences with therapists and 'evidence' based approaches. If someone came to me and said they feel really depressed, like the scenario Forrest set up, I would listen to them without interjecting any of my opinions. And then ask them what they think they need. They probably need to be listened to first, and the answer will reveal itself from the space that the listening, without interruption, provides.

I see a therapist for cptsd and anxiety, and our work is centered around IFS. I've found it immensely useful and life-changing. Unlike everything else I've tried, it has given me the ability to actually have perspective about my life, and to understand how the trauma has influenced my general behaviors even to this day. It helps me feel a lot more centered and in control. All of the work I have done with my therapist is around understanding the various parts, why I was compelled to create them in the first place, and using that knowledge to build a life where I can trust myself to deal with tough issues (instead of some of the more maladaptive behaviors I learned from my trauma). It helps me take actions that are in line with my values and feel more at peace inside. Now, all of that said, I think it probably takes an extremely good therapist to do this... I've been lucky to find the right therapist, and I cannot imagine her ever engaging in the various scary things that article describes... that article seemed a lot like fear-mongering based on the bad actions of a few people. My therapist essentially is walking me through how to be there for myself - she never puts ideas in my head, never tells me how to solve particular problems, never suggests that I randomly create new parts or cause chaos with people I know, and she lets me be the leader of my own journey. She's also certified in a lot of stuff and is malleable as to how we go about therapy. Most importantly (and it's sad, but true), I do not rely on insurance to pay for any of my therapy - I pay for her out of pocket and it's a night and day difference from when I tried to get therapy from those who accept insurance. So I feel for anyone who has had bad therapy with bad therapists, but I'm here to say it can be done right if you find the right person to help you (and that sadly means you almost always need substantial resources to make that happen)

Just when I feel I could not appreciate Forrest and his father more; then I do with each episode. My heart and mind are tremendously grateful for these two gentlemen. Great respect!

I appreciate this conversation. It’s rare to see such a genuine attempt to hold nuance between evidence-based therapy and personal growth, and I think that effort deserves credit. Where I think the discussion goes off track is around Castlewood. To me, this was not primarily a failure of modality. It was a failure of containment, power, and responsibility inside an institutional setting. When authority overrides agency, almost any approach can become dangerous. Not the modality.

To be clear, the patients are not responsible. Period. If harm occurred, responsibility sits with the clinic and the practitioners who created or tolerated coercive dynamics.

I also think this debate is limited by a Western, medicalized lens. The U.S., Canada, and Europe have some of the most highly regulated healthcare systems in the world, yet the U.S. in particular has extreme costs and relatively poor outcomes. Regulation does not automatically equal safety or wisdom.

There is also a cultural tendency in the U.S. to externalize responsibility upward rather than examine power, agency, and accountability at the institutional level. I live in Mexico now, and the orientation toward responsibility is noticeably different, and that contrast matters in conversations about therapy and risk.

Finally, on the self-help side, I don’t believe the degree to which an adult explores personal growth on themselves should be regulated. That is distinct from institutional or medical treatment, where power and responsibility are not equal.

I appreciate the care you brought to this discussion. My hope is that future conversations focus less on policing modalities and more on power, agency, and context.

I've benefited from IFS personally, I've "unfrozen" stuck past trauma, child grief that I've never processed for years and the first time I came in contact with what in IFS it's called "exile" or my inner wounded child was in an IFS session. However IFS is not the only thing that I did. I also did expressive self journaling + research on (attachment, trauma, ptg, neuroscience, and a lot more)

I tried IFS and read No Bad Parts. It was helpful to me and I still use one technique (asking my parts to step aside so my Self energy can lead) which does wonders at times when I am overwhelmed with negativity and/or anxiety. I did feel the need to step away from it though because it felt like I was going down a path towards learning about my parts that I don't think I was prepared to do alone. If I had open access to a IFS certified therapist with lots of experience, I would continue to work with my parts because it seems to help with understanding yourself so that you can help yourself when you need it but I became fearful of my firefighters as they lead me to actual physical problems/pain. I think IFS could be dangerous for people who don't have good therapists or access to therapists in between sessions if you have a lot of trauma. Once a week, where you are potentially activating parts of you that feel threatened is no fun.

ABA has long been touted as the best evidence-based “treatment” for Autism, but when you look at the horrific origin of it and actually listen to Autistic people who went through it and learn how traumatizing it was for them, you can see that ABA isn’t good for Autistic people at all. The “evidence” is all about compliance and helping caregivers by keeping the Autistic person in line.

My therapist showed me a recent study that revealed ABA doesn’t improve Autistic people’s mental health or experience of the world. So, even though I’m a pretty hardcore believer in the scientific method, it’s so important that we look at the origin and intention of these therapeutic and behavioral treatment plans. Most importantly, if you find it’s not working for yourself or your loved one, it’s best to try something else.

More than enough common sense in this episode. I honestly think you both are the least offensive speakers out there.

The IFS approach was a big help for several friends of mine. So I gave it a try during some years, with a horrible outcome. It didn't only not help - it caused problems I didn't have before, so my situation got a lot worse.
Maybe the problem of the therapists is the lack of capacity to differentiate. Either they think that working with the IFS is marvellous, or they say it's humbug.
I wish, professionals would be more neutral, and that scientific evaluation would focus not only on if something helps or not, but also on how to know who could try it and who not at all. This applies to lot's of therapeutical approaches, both in psychology and in medicine.

Well, as for myself IFS took me on a wild ride, but I think it was necessary and has been for my higher good. When I've felt like the work has been too heavy for me to do alone I've turned to IFS certified therapists to help me do the heavy processing. I don't think IFS alone is a complete treatment approach but I've combined it with a number of supports that are more grounded and that has kept me going on the healing journey. When I started IFS I was in a very dark place that looked "normal" on the outside, and part of waking up to the reality of my situation was some very heavy work that utterly shattered my marriage and my old way of life. My ex blames IFS for ruining our lives together, but sticking with the process has brought me to a progressively more stable and healthy state of mind and integration. I wish everyone personal growth towards peace, self acceptance, and love.

As a non american its great to listen to americans that display such logic and humane and open hearted reasoning when discussing complex ideas. Sadly we don't see enough of this from america in these awful times of the glorification of narcissism and the worship of false prophets selling snake oil.

Thank you both for not avoiding to face how complicated all that is.
"What do we mean by evidence? " is something professionals really disagree about.
To be aware of your own biases is very important for being able to judge.
If something was used since a very long time, it doesn't mean, that something new couldn't be better. And if something new works, it doesn't mean that ancient ways of treatment are all wrong. Different cultures have different impacts on everything, including health and the efficacy of treatments.
Science and technology make it possible to evaluate subjects of which existence  we didn't even know not so long ago. It's important not to forget, that when we don't find evidence, it might be, because we don't have the means for evaluating it yet.
And so on...
I think we all should be more humble, aware of the fact that there's more that we don't know, than what we do really know.
At the same time it's important to accept this calmly. Trusting our eyes and questioning them, without getting insecure.
It took me more than 50 years to get there 😄
Again: thank you!

Lol!  Tell the clinician what's not working?!!  Tried that on for size and 1) Got dumped by the therapist who had NOTHING to say that what we were doing wasn't working, 2) Was told, "Sorry, that's all I got.  Can't help you.", 3) Was chastised for having "strong emotions" for having panic attacks, 4) Was talked to death with no treatment plan, 5) Got left hanging by a therapist for 7 weeks with no alternate therapist to stand in while I was in the middle of a medical crisis.  This is why no one speaks up and we ghost in therapy.

Whenever you guys have genuine fun and are able to be playful while exploring these complicated topics, it is a true delight to learn from the both of you.  Thank you.

I just started IFS.. incorporating it at least. It is one of multiple modalities the therapist uses. I like the parts concept but I don't name them or think of them as separate identities. More like motives or a way to reveal schema or core beliefs behind behaviors & thoughts. I think alot therapists use concepts from different modalities these days. This therapist also uses emotion focused & psychodynamic therapy. I am used to CBT

After listening to the entire episode, I appreciate not only the sincerity and honesty of intent but also the comprehensive and nuanced treatment of this complex subject.  In addition, I applaud the courage to address an often overlooked issue, even though it is so important to so many, whether they realize it or not.  Well done.

I'm a clinician and a postgraduate researcher, and someone who continues to invest a lot in my own therapy and personal growth journey. And I have to say this episode is exceptional well researched and discussed, and the reason I decided to hit the subscribe button. Thank you, Forrest and Rick for this rich, well researched and nuanced conversation. Look forward to more episodes such as this one.

I love a nuanced take. The ability to hold two conflicting ideas at once is a skill that many people would benefit from more of.