How Psychotherapy Works With Dr. Jeffery Smith

Psychotherapy has a weird problem: it’s supposed to reduce suffering, yet it’s been split for decades into rival schools that often talk past each other. We wanted to know what sits underneath all those theories and techniques. So we sat down with Dr. Jeffery Smith, clinical professor of psychiatry, former president of the Society for the Exploration of Psychotherapy Integration, and a leader in organized psychiatry who’s pushing for a unified understanding of how psychological change actually happens.

We start with the lived side of the work: a formative trauma case that revealed something most training programs barely teach, and a hard truth many clients feel in their bones. Some pain can lift quickly when memory and emotion finally connect in the presence of another, while other struggles like chronic low self-esteem and distorted values can take far longer because they involve different change processes. From there, we move into addiction and relapse prevention, where the conflict between conscious intention and the non-conscious survival mind becomes impossible to ignore.

Dr. Smith breaks down threat processing, emotional alarm signals, and why the brain’s survival shortcuts can misfire in modern social life, fueling phobias, avoidance, and entrenched patterns. We explore affect avoidance, attachment, and the real role of empathy and relationship in effective therapy, including why “punishing the inner child” backfires and how new experiences reshape deep schemas. We also talk about what psychotherapy integration should look like when it’s done well: not blending modalities into a mess, but building a shared infrastructure that clinicians and clients can actually use.

If you care about evidence-based therapy, trauma recovery, the therapeutic alliance, and the neuroscience of change, this conversation gives you a clearer lens. Subscribe, share this with someone who loves psychology, and leave a review with the biggest idea you’re taking from the conversation.

His upcoming book How Psychotherapy Works will be available later this year.

https://www.howtherapyworks.com/

Transcript

Why Unify Psychotherapy

SPEAKER_00 1:02

Today's conversation explores one of the most important developments in modern psychology: the effort to move beyond fragmented schools of therapy toward a unified understanding of how psychological change actually occurs. For more than a century, psychotherapy has been divided into competing orientations psychodynamic, cognitive behavioral, humanistic, interpersonal, each offering partial insight into the complexity of the human mind. Yet beneath these differences lies a deeper question Are there common processes that underline all effective psychological transformation? My guest today, Dr. Jeffrey Smith, has devoted his career to precisely this question. Dr. Smith is a clinical professor of psychiatry at New York Medical College, former president of the Society for the Exploration of Psychotherapy Integration, an organization dedicated to identifying the shared principles that make therapy effective across theoretical traditions. His work, including the affect avoidance model, examines how emotional learning, avoidance, and integration shape the development and resolution of psychological suffering. His perspective brings together clinical insight, neuroscience, and decades of psychotherapeutic practice in an effort to clarify the mechanisms through which meaningful change becomes possible. And he is the author of many articles and um he has uh his own uh Substack and blogs, and um he he has uh many um efforts on many fronts, um, but uh they uh he he is also uh anticipating the upcoming publishing of his book, How Psychotherapy Works. And so I am uh delighted and honored to have you as my guest today, uh the one in the many. Dr. Smith, welcome.

A Life Of Curiosity

SPEAKER_01 3:29

Well thank you very much, Arshak. That that was a a very nice introduction, and it really it really kind of uh sums up a lot, and um uh so I'm I'm really happy to be here and to uh to talk with you.

SPEAKER_00 3:43

Yes, indeed, me too. Um so you know uh as every essay, every story has beginning, middle, and end. And I see every one of our lives as a story that we write as we are alive. So um, living that story, where did your story begin?

Trauma Work And Lasting Relief

SPEAKER_01 4:09

Well, um it begins when I was um I was not old enough to ride a tricycle. Um, one of my earliest memories is I was watching the neighbor kid ride her tricycle really, really fast, and and I was very impressed. But I asked myself a question. I s I asked myself, are those pedals going up and down or are they going around? Because it looked like it looked like up and down, but it didn't make sense. From that age, I was always interested in how things work. And and that has has continued ever since. Um, and so um since early in my career, I guess one of the most formative experiences was working with uh early in my in my post-residency uh years, working with the woman who turned out to have uh dissociative identity disorder. And so she had dissociated parts and and a tremendous amount of huge trauma. And so as we worked on the trauma, one day she finally was able to tell me about the the first of a number of terrible things that happened to her, and and we extended the session. It was a couple of hours, uh, but at the end of that, we were both exhausted. But the horror she had about this trauma was gone. It was just, it was a dull ache, but nothing more than that, and that was permanent. And you know, I said, I said, my gosh, and um nobody taught about trauma in in my residency, so I went back and I read Freud and the early Freud, he had this concept of catharsis, and he said that making the unconscious conscious, which in those days meant helping people get past their dissociative memory barriers and re-re call things that had happened. And and he said, when you do that with feeling, then the trouble goes away and the symptoms disappear. And that was what I was found finding. But I also had a very strong hunch that it took something else, that there was something about the the presence of another person there. Now, Freud was a good Victorian scientist, and so he assumed that the therapist was an objective observer and didn't participate in what was going on. Um, but I thought otherwise. Um, and then um, as with many, many sufferers, many, many survivors of trauma, this this person had really, really chronic low self-esteem and some suicidal thoughts and things like that. And what I found was that resolving the low self-esteem was a whole different process, and it took much longer and was harder to do, actually, than the traumatic memories themselves. And so I said, wait a minute. That means that in psychotherapy, in this therapy anyway, there are more than one um um change process going on. And nobody told me that there were more than one change process. And so I said, Well, are there three? Are there more? Um, and I became very interested in how change actually happens. And um, so there's there's more to the story, but that really got me started, and that was in 19, probably about 1980. Um, so I've been at it for a long time. And um, you know, I have a have a private practice where I'm very happy to see whoever comes in the door, and that's given me a really broad view. If I was an academician, I would have had to specialize in something, but I haven't. And so so I have a pretty broad experience, and that's given me kind of a uh of an overview at the same time. So I'm always asking questions. I'm always wondering what exactly is going on here and how is this going to work and what should I do next? Uh so so that's a that that's the beginning of the story.

SPEAKER_00 8:06

Well, that's a wonderful beginning, isn't it? Um it's fascinating that um that drive the curiosity drive that uh we have as children. Yeah um to some of us, it it never departs from us, it's always remains in us, and we are constantly asking, what is this? How does it work? Where is it gonna go with with all that um operation? Um and and that really helps, but unfortunately some people get um astray from that drive, uh that path of asking questions. And I've seen it again and again. People that forgot to ask questions often get lost. And um it's it's a very interesting uh dynamic, which uh leads me to this um uh this understanding of cognition versus emotion. That um what do you think drives primarily? Is it uh the emotional drive that we have, or is it the structure of cognition that learning provides and that consciousness um controls in a way? Do we um are we product of the combination of the two? And is there proportion that we there's a formula that we can follow? Like how how much should we give way to our conscious understanding of the world, and how much should we rely on our emotional reactions to the world?

SPEAKER_01 9:57

Well, that's that's a great question, and and I think the place where I learned the most about it was also many years ago. Um, my career led me to um a role in in uh a program that provided addiction services. Um, by the way, I think you're in Katona, is that right?

SPEAKER_00 10:15

Yes.

SPEAKER_01 10:16

Okay, so I'm I'm about 10 miles away in White Plains.

SPEAKER_00 10:19

Yeah, well one of these days we should sit face to face instead of on the computer.

Two Minds At War In Addiction

SPEAKER_01 10:24

We we certainly should. So uh so somewhere um in probably the the the um uh 80s or 90s, um I I I got involved with working with with people with it with alcoholism primarily. And when when I was would be sitting with a person who was in early recovery, they had just come out of rehab, let's say, or they would had just recently become completely abstinent from drinking, and they were hell-bent to keep their abstinence, they really didn't want to lose it, did not want to relapse, and and so they were just determined to keep on with the sobriety that they had gained. And and as that was going on, I would sit and listen, and people would come and say, Well, maybe I'm not an alcoholic. And and or they'd have the idea of maybe I ought to go visit my old friend uh Joe, who was uh uh used to be a drinking buddy, but he respects my recovery, and and that'll be okay. And then then the person goes to visit with Joe, and and and uh Ralph comes along, and and Ralph doesn't respect anything, and he says, Let's have a drink, and and there it is. So what I realized was that there was another part, a non-conscious part of the mind, that had a really exquisite sense of what to say, what kinds of feelings to project into consciousness, what kind of impulses, like the person who would say, I was walking by a liquor store and my feet just turned right, and you know, my hand reached out to open the door. I don't, it just happened. Um, so I I became acutely aware that there were two parts of the mind that were not integrated, and that and that had had quite opposite ideas. And so the more I thought about it, the more I had studied it, I realized that the that what was going on, and there's a lot of research about threat processing in the mind, which goes on in the earlier subcortical um uh brain, the same brain that is very similar to those of your dog, um, and and operates in similar ways that are designed by evolution to for species survival. And so what happens is that part of the brain begins to think that drinking alcohol is good for the person. And so what I saw was how much power and subtlety it had in influencing the person to relapse when they did not want to. Um, and you know, that was already somewhat familiar to me from working with dissociative identity disorder, because I was used to sitting with, you know, two or two or more parts of the same person interacting all at the same time. Um, so so it wasn't so strange to me. And uh so so the way I understand it now is that that survival-oriented, non-conscious, nonverbal part of the mind that's operating on principles that have to do with survival more than anything else usually works in partnership with consciousness. But at certain circumstances, there's a disintegration, and that part of the mind now has a different agenda and a different plan, and and is working with a whole different idea. Um, and it's it's really quite amazing. Um, one of the things I've seen is that people who have a midlife crisis, um, not infrequently that midlife crisis comes because the inner mind has been has had a plan all along and is realizing that the time is getting short and that I'm gonna have to make my move pretty soon or I'm not gonna make it.

unknown 14:13

Right.

Survival Brain And Threat Signals

SPEAKER_01 14:13

And and so things like that, entirely outside of consciousness, um, really have important um influence on us. And I'd say that between the two, between conscious willpower and the non-conscious um motivation, that the non-conscious has the edge, it's it's it's somewhat more powerful when it when it really wants something different. Um and so I I frequently in my in my practice, you know, I work with people who have rationalizations that they talk themselves into maladaptive behavior patterns and and things like that. And um and that's a regular thing for me, so that my focus in working in psychotherapy is to help people change the the nodes of logic, the schemas deep down in their brain that determine these maladaptive patterns. So, how can we use consciousness to reach down into the non-conscious mind and deliver messages that are that are not familiar, that that can stir things up and bring about change? Uh so that's that's kind of been the the focus. But I think there's, you know, there was that book a few years ago um on uh thinking fast and thinking slow. Right. And and that's been put under question because it's really hard to tell which which you know there where the dividing line is between the two. Well, what I say is that normally those two don't really have much of a dividing line. They work together. But under circumstances where the inner survival-oriented mind has come up against a serious problem, then the solution becomes frozen in time. And the inner mind actually protects those solutions as if they were vital for survival. And so we get a lot of resistance that when we try to bring about change. And that's why, you know, self-help uh books don't really do very much good, and you really need some concerted effort and and somebody who knows what they're doing. I hope to help people change those really entrenched maladaptive patterns. Uh, so so that in a nutshell is is how I I see the disintegration of the mind when it's when it's really not that easy to to get things to to start working together. And um and that's why I think some of the you know maladaptive patterns and and and ideas and values and things like that, uh, that that usually come out of life and death experiences or things that are really close to that, um, that those become so entrenched and so and so difficult to let go.

SPEAKER_00 17:01

So this is very interesting, and I I I just want to further a little more that uh train of thought that you just developed now, uh, in terms of the the survival instinct, that it's often disconnected or disintegrated. I I I love that term disintegration. I I use uh integration, disintegration, and misintegration, which was introduced by Dr. Picoff. But but in this line of thinking, um when you um uh speaking of uh the disintegration between the the the conscious realization of what is valuable and yet the unconscious or non-conscious uh influence of what actually behavior manifests, um not as a result of uh what would be rational but what is conceived or uh experienced by the individual as being the survival um motivation to act in the way that they acted. So is it is it the case that it is the individual's understanding of what is survival required, or is it the objective uh formulation of what survival demands?

SPEAKER_01 18:25

Well, it's it certainly is is subjective, but but subjective in a complicated way. Um let me um I'll I'll I'll say a little more about this. This is really kind of interesting.

SPEAKER_02 18:35

Yeah.

Avoidance And The Inner Child

SPEAKER_01 18:35

Um, if you think about your dog and you get too close to the dog while he's eating out of his bowl, he's gonna growl. And and we say, oh, the the dog is is irritated or or he's a little bit on on edge about this. We assume that those are emotions, but we really don't know because we don't know what a dog is experiencing. But we have a very similar brain ourselves, which is still the main part of our of our brain that's that's tasked with survival. And and so um this what the dog's brain works pretty well because when it runs into, let's say, a life and death situation with a predator, with or with an en with a another dog, it has a very simple choice, flight, fight, or freeze. And so, and so that works really, really well. And what happens is the the way the brain works is there's an emotional signal, excuse me, there's an alarm signal once the brain has detected or predicted that there's a threat, then alarm signal goes out, and that alarm signal has an emotional content to it. It's it's a feeling. Um, and so I call it a proto-feeling because we can't really tell what exactly it's like, but there it is, and it does have an emotional uh content, and so that that proto-emotion tells the dog what to do, and in a feedback loop, the action that the dog takes or that the animal takes is designed not to get rid of the predator, but to get rid of the signal that's saying this is a bad situation, and so it's so the response is designed to calm down that alarm signal in the brain. Well, human beings ran into a whole different situation because our survival depends not so much on fighting off predators, it depends on social cohesion, on teaming up with other people and knowing who are your enemies and who are your friends and all of that stuff, which turns out to be much, much, much more complicated. And so it really sort of um I I I call this a design flaw of evolution, that the brain, that survival-oriented brain is not powerful enough to deal with the complexities of social life of humans. And so it often gets the wrong answer. Like, for example, let's say the most common phobia is is public speaking. And and let let's say you have a career where you need to give us give a talk for your colleagues, and and you're terrified to do that. Well, that's evolution saying you better not get up on a rock and proclaim something because you might be thrown out of the tribe and you're gonna die. Um, but in our society, it's it's a whole different thing. So that's a just a simple example. Um, so so what happens is the same shortcut gets used in our brain. This the alarm signal is used as a proxy for the danger. And so our brain wants to calm down that danger signal to quiet the emotion that's causing that's causing trouble. Well, we're but we're more clever than animals, and so we've figured out all kinds of ways to not have to feel uncomfortable feelings, and this all goes on on a non-conscious level, but it may also run in parallel consciously, because we certainly have conscious avoidance of uncomfortable feelings, but there's also even more important, a powerful non-conscious avoidance of uncomfortable feelings like fear or or fear of being alone and things like that. And and so so let's say for a simple example is somebody who's experienced physical trauma and and they're very afraid, but they're afraid what? Of what? Of remembering the trauma. So they they use you know drugs or something like that, so they won't have to remember the trauma. Does that make them any safer in the world? No, it makes them less safe. You know, so so we're dealing with this situation where under quite a number of different situations, um the mind um comes up with a different solution. One of the more common ones is that the inner Mind, the what this is the vocabulary I use with my with my patients, with my clients, that that the inner mind, when there's deprivation, let's say there's not enough support or love in a family to be able to grow the way I need to grow. And kids are very aware of what their needs are. So what do they do to solve that? Well, they're going to wait, they're going to put their growth on hold and wait until some nice person comes along who's finally going to give me the extravagant love that parents are supposed to give their kids. And so then along comes the therapist, and guess who is it? If the therapist becomes the person who's going to do that. And then we have a complicated sort of dance where the inner mind is influencing the person to try to, you know, to get something from the from the therapist that's going to say that this therapist is willing to do the work of helping me to grow up the way I need to. And as a therapist, there are some things I can do and some things I can't do. And so there's going to be a disappointment, and we have to work through that disappointment and ultimately to come to some realization. And you know, people's usual response when they realize that they do have an inner self that's operating independently of them and not always doing the things they want, they want to they want to kick that that kid out of the out of the house. You know, they they want to they want to punish that nasty little kid who's causing trouble. And I have to tell them, no, that doesn't work. That punishing children does never work, and it still doesn't work even when it's a child inside yourself. What does work is to is to understand and to empathize, but it also means sometimes taking your own little kid by the hand and saying, no, we're going to do it my way this time.

unknown 24:56

Right.

SPEAKER_01 24:57

So so that's a snippet of of some of the things that go on in my psychotherapy office.

Building A Shared Therapy Infrastructure

SPEAKER_00 25:05

I I I love that what um the the chain that we're building in this very short time of a conversation we're having is that what emerges out of this the value of connection, that connecting is the primary drive of our existence. Now, whether we're gonna connect with our mothers, with our spouses, with our children, with our co-workers, with our environment, with our ambitions. Whatever it is that we're gonna be connecting, whether it's gonna be alcohol or or tobacco, rock and roll, and sex or whatever it is, we're gonna connect with it because that's our drive. We need to connect, and that's how our nervous system is built. It's building connections. So we have to be mindful of what is it that we want to connect with, or who is it that we want to connect with. And it's very interesting the way you lay it out that you know you you may be aware of what you want to connect, but often you may not be aware of what you want to connect, and you just connect without being aware of it. And you certainly need psychotherapy um to achieve that explicit understanding of what is it that drives you, what is it that you want to connect with. And I guess uh I'm I'm not as familiar, unfortunately, with um uh the the great work that you have done. So I don't know it in detail, but for from what I know about you, it's commendable that you have focused your effort in connecting not only the individual in distress or in discomfort psychologically in a psychotherapy session, but you've you have understood the broader problem in psychology, that it's each one of us that has an idea of helping another, yes, we are helping to an extent uh with that other, but there are always gaps. There is no psychotherapy is perfect in its execution of providing that um you know um heaven that everybody is trying to connect with. Um so your effort is honorable, commendable, noble, and um I haven't read your book yet, but I'm looking forward to reading it. You you're writing about this, right? You want to bring those psychotherapists together. So the the question for me arises that what drives the effort of connection? Is it the clinical uh expertise that each uh psychotherapeutic school brings to the table, or is it a fundamental philosophical study of the mind and how men and women and children operate in in this world, in coexisting with each other, that drives the clarification as to what kind of integrative principle will uh will guide the unification of all these schools?

SPEAKER_01 28:29

Oh, good question. Boy, um I you know I I do think it's it's it's some of uh some of both. So all of those schools, you know, they each have their own theories because because nobody knew how the brain works uh or how the mind works. And I run into quite a bit of resistance. That's why I'm I'm talking mainly to young people who are more open-minded. Um many of the leaders in my field are have you know chosen their modality and and there's they're kind of stuck with that. Um but but each each of the existing therapies with its own own theories and everything, um uh has observed good things and come up with really, really good solutions. When you try to mush them together, they don't fit, and and so you get a mess. So what I've done is try to understand the infrastructure that lies underneath all of those all of those old theories. And I'm and I'm working on filling in an area that's pretty much um that's that's underrepresented in the existing uh theories of psychotherapy. So there's a lot of good stuff out there. And um and um, but the piece that I would add to that is I consider myself a student of inner minds and how they think, and that has a lot to do with children. Um, for example, um one one person I've I've worked with, the drive for that survival instinct for this person has been that her mother was psychotic, and but but she really, really wanted to be able to live the life, to have to grow up and and have the kind of career and life that that she her intelligence and her education um um told her she deserved. Now, right away I'm saying that's that's at least eight-year-old thinking. You know, that's that's not a four-year-old. That's that's a bigger kid. Whereas the one who's looking for the love that they didn't get, maybe that's a three or four-year-old. And so, so I'm always really interested in understanding. And lately, for example, one of the things that Freud pointed out, and he was a very, very clever guy, that the non-conscious mind does not have the concept of of absence, of zero. And and so when you tell somebody, you know, try to try to push those thoughts out of your mind. Don't have those thoughts. Those are those are wrong. That's not going to help you. You're asking the person to implement a knot, and they can't do that. So, what works much better is to say, let's think of a role model or an example, somebody who to you represents acting in the way that you'd like to adopt for yourself. That's much more powerful and and works much better. So, I think in answer to your question, I've learned a lot from various modalities of psychotherapy. Um, they all have something to offer. And at the same time, I think that that understanding this infrastructure is not that hard to teach as and and is really, really important in pointing us in the direction of understanding um the non-conscious part of the mind, the non-conscious survival-oriented uh part of the mind, and being able to work with that through some translation that goes on using words or experience or other things, non-verbal things like tone of voice and relationship and and so on, that that um reach down. Um, so so I I I learn from any any source I can.

Struggle Versus Suffering In Therapy

SPEAKER_00 32:20

Yes, indeed. Yeah. Um, yeah, yeah, I mean, to to that extent, um my orientation is more uh philosophical in the sense that I believe that because in in in the way I see it, we are driven by this desire to connect. We then therefore have to have a desire to see, which is interesting because desire to see is the etymological root of the term philosophy. I mean, we often translate it as a love of wisdom, but uh the breakdown is desire to see. And so if you don't have a desire to see, you're not gonna develop a love of wisdom, which is an inspirational phenomenon to the conscious realization of your interaction with the world or another that you see as a fulfilled character or better skill set or apprentice master. I mean, apprentice master relationship has been around for millennia. I don't know why we got rid of it, but we have to reintroduce it to society because it's crucial. If you if my father didn't give me what I required, my master will. Right? They will teach me how to pay attention to the thing that needs attention. They will teach me how to connect with my uh uh inner ability to develop a skill. Um and so it becomes um a trifactor. You uh connected with another that is with more experience than you have, more wisdom, more knowledge, and then through their knowledge and through your willingness to work uh under that uh platform, you develop a skill to work with the world, with an object from the world. And so you so it becomes a very healthy structure uh to work in. And so in that sense, uh I will be developing uh a non-conscious reservoir of experiences that are fully integrated in the world with another person as well if I am missing anything from my parents, which many of us unfortunately do. Uh, but the ones the one of us that uh the some of us that haven't had that um misfortune um can can see it right away in another that may have had that misfortune. And so that that different, and and then vice versa. The the people that have the misfortune see it in somebody else who has a tight connection with their parents and they're happy they've been happily raised. Uh so it it's interesting how much of that uh unspoken um apprehension that we've had uh had throughout our time comes out and and often comes out in a problematic way. It it creates a an issue for us. Um so um so so from that perspective, from that philosophical view of how integration uh finds a place in our daily life. Why is it important to integrate? Um I come up to the issue that why do we have this diversification of the process of integration? It should be much more um defined. It shouldn't be as broad.

SPEAKER_01 36:21

Um I I think it I think a lot of that um has to do with with motivation. You know, I mean some people have have I've I've heard some doubts about you know, I'm I try to simplify things. My my favorite motto is is making supposedly came from Einstein, make things as simple as possible, but not simpler. And and and you know, I'm happy to um to communicate with people who are are coaches or or or um represent other ways of of helping people. Um I have the privilege of working with people who come to me because they're really suffering. You know, people don't get psychotherapy just for fun. I can tell you that, and it's expensive anyway. Um they they they do it because there's a really powerful reason, and so I can use that motivation to then demonstrate and and pass on in uh what it is to connect, what it is to have a relationship. Um without that special drive, then it really depends more on, you know, how much does a person have the wisdom to realize what they don't know and um and to want to seek uh more knowledge. Um the I'm gonna can I can I show the cover of my book?

SPEAKER_00 37:39

Please do, yeah.

SPEAKER_01 37:39

Yeah. Okay. Um this is my new book that's that's this is the cover that's gonna come out. It's it's uh not uh, and it'll be available somewhere in the late fall or or I mean in the early fall or uh late summer. Um, and it's designed as a companion for therapists, but it's also meant for anybody who's interested in helping people change for the better. And it starts out with what are the attitudes of curiosity and how do you develop empathy? Um, how do you understand what's going on deep inside somebody? You know, there are people who've who've criticized that, that it's that it's making it too too simple and taking some of the of the mystery out of it. But I think the more people understand, the and and I've seen our culture come a long way in understanding things about human beings that um that used to be um quite mysterious. Um so so I think this is the kind of knowledge that um that uh that drives me and that helps me to connect. I think making that available to as many people as possible is a good thing. And and I laud what you're doing, you know, in in the same direction. Um and but you know, the hard part is is that unless people are suffering, then not everybody has that kind of curiosity and and desire to uh to deepen their their life. And so, you know, we have to do the best we can to uh to represent that and hope that people are drawn to it. Right.

SPEAKER_00 39:14

Um I mean, the way I see it, uh you don't have to let things go out of control so much that you have to suffer. I mean, struggling is fine, right? We all struggle. And I would rather go to a psychotherapist when I'm struggling, not when I'm at the position where I'm already suffering. And I think this is an important distinction to be understood that struggle is fine. I mean, we sweat, we there's a reason why we sweat, right? Struggle is good, sweating is good. There's always time to take a shower and sit down and relax. Um, but if you want to uh improve your struggles, then a psychotherapist is a good place to um uh uh visit to figure out how to get more effective if you haven't been able to figure out by yourself. Because when you're suffering, it's like you're already at the surgeon's table and it's very tricky. Uh it's very, very difficult. It's like uh almost impossible to recover. I mean it's improbable, but it it is possible. And and so the the interesting thing to me is that we have so much willpower that we don't have access to. And if we can open the road and open the horizon to that reservoir of power that we haven't dipped into, then um we become unstoppable. Then nothing will stop you. Right?

Resistance To Integration And Thought Leadership

SPEAKER_01 41:02

That's that's so true. You know, I I just want to say my my father was a philosophy professor at Stanford. And great. And so I decided somewhere in my freshman year in college, I I didn't want to be an academic. I wanted to to be part of the what in the 60s we called the real world. And and so that's why I went into medicine instead. But you know, I wind up thinking about about things in in much in ways that are similar to you. And and it's it's true. And one of the things that's um that's uh I do a lot of, and it's really important, and it's important for people no matter what, is to learn to listen to your own inside, to that motivation that's fundamental and deep and and and is not always aligned with what people are doing on the surface in their lives. And and so uh so I think connecting with one's one's you know um true values and true motivation is very helpful. And when the values, like like for that person who had low self-esteem, when the values are are not healthy ones as a result of trauma, for example, then changing those is not easy. It requires being very clear that you're carrying some values that aren't healthy and they need to be um reworked. Um so so that whole idea, that whole realm of listening to one's inside motivation is is really important. And that's where I think we by setting an example, you know, when whenever we're sitting with somebody and truly interested in them, we are setting an example and we're calling out those natural desires and needs um to to make connections, and and those are those are critical to uh healing and growth.

SPEAKER_00 42:49

Yeah, and you know, I'm I'm wondering if um if you think that you would ever succeed at your effort to um integrate psychotherapy, as a to to offer psychotherapy as an integrative, unified front.

SPEAKER_01 43:14

Well, that that's a good story. Um I started a blog in about 2010. Um and I and early on I wrote a post about um about attachment to your therapist, because somebody wrote me uh wrote me about that. And and so I talked about that being the inner mind seeking to get what it hadn't gotten when it when it was time. And that became pretty soon the the go-to place for people who had those feelings. And I kept hearing stories about somebody finally admitted to their therapist that they really felt a need for this person, and if you disappeared, I don't know what I'd do. And in five minutes, the security guard was there and marched them out of the clinic and said, never come back. Um, you know, terrible, terrible things were happening. And so around um around 2015 or so, um, I decided to change the direction of my writing and my and my work, and and that I would really make it my business to try to um to spread the word that we don't need to have all of these silos of psychotherapy that currently exist. Um it's been a tough go. Um I've had a lot of resistance, but I've managed to get um uh one important paper uh published in a in an academic journal. Um and and I'm beginning to be respected um as you know, I've had several leadership roles, and so I I'm I'm I'm having fun in my later career um seeing just how far I can go to spread the word that we don't have to be divided anymore. It's not necessary, and we can actually do a better job when we're not divided that way. So um, so that's what my book is about, and that's why you know I I'm here hoping to um uh to have more people um get interested in the fact that the science has advanced since uh 1890 and and that we now understand a lot of things that just were not clear back then.

SPEAKER_00 45:17

That's right. And I I really love this. I I love that you're uh attempting to do this. Um although uh that there is a tension between the approach to it, between my understanding and your understanding, but I really love the direction and I I really love the effort, and I'm you know, I'm I'm cheering you on, and I'm I'm a fan, and uh I I hope you succeed. Uh it's it it's a tremendous uh challenge. I'm not surprised that you have a lot of resistance. I'm actually um surprised that you have been able to get to the levels of execution that you achieved. And uh as you say it in my uh just uh mentioned it in passing, but I should let the people that don't know you, uh whoever is listening to my podcast that uh may not know you, uh, but you are the um past president of CEPI, Society for Um Uh Exploration of Psychotherapy Integration, and you are the um uh you are leader of the psychotherapy caucus of the uh American Psychiatric Uh Association. Correct, yes. So you you are not like just any psychotherapist or any psychiatrist, you are deeply involved in the mainstream organization of this field, and you're the one who says, guys, we gotta do something else.

Where To Follow Dr. Smith

SPEAKER_01 46:51

That's right. That's exactly right. And you know, I I took those leadership positions or I ran for them and and and got them on purpose because I it all started out with reading a book called Are You Ready to Be a Thought Leader? And and it had you know five steps, and and so I'm I'm I'm following that that book because it's not rocket science, it's just something that takes a lot of resilience and a lot of work and and just plugging away. So so thank you very much. I I'd really appreciate your your support. Um I would like to say, just so people are are aware, my my Substack is probably the main place where where people can can meet me and and my work, and that is at How Therapy Works, all one word, how therapyworks.substack.com. And um uh but but yes, I'm I'm plugging away and I seem to have a lot of energy to do that. And you know, I'm saying, you know, who who am I to do this? Um I I I don't know, I'm just you know, a well you're Jeffrey Smith.

SPEAKER_00 47:53

You you you're the man to do it.

SPEAKER_01 47:56

So so I'm gonna I'm gonna get as far as I can and and uh enjoy the process.

SPEAKER_00 48:02

Well, I love it. Thank you so much. And um I I'll be watching your uh progress uh closely. And um I know that you uh um uh pressed for time uh tonight, but I hope that uh we can revisit and discuss uh many other issues uh whenever you have the time to uh discuss those issues. Um but this this was really great pleasure, and thank you so much for coming on to the one in the many and sharing your um efforts and story. And um I'm looking forward to uh next one.

SPEAKER_01 48:42

That's that's great. Well, thank you so much for having me. You know, I think we it's really quite remarkable that we're both kind of focused on this issue of integration, but from from very different uh directions, and we and we kind of meet in the middle.

SPEAKER_00 48:55

Yeah, um I'm I'm looking forward to uh many more discussions and conversations and exploring the process of the integration from both uh psychotherapy and uh philosophy and how that process of integration can influence psychotherapy and ultimately help people understand the value of integration in their own lives so they can um get better, get more fulfilled.

SPEAKER_01 49:26

All right, well, thank you so much. I I really have a good had a good time.

SPEAKER_00 49:30

Thank you.