# Dr. Doug Behan discusses What Works in Therapy. **Channel:** TherapyShow **Source:** https://www.youtube.com/watch?v=LV0cqtI-TkQ **Transcript page:** https://www.withtranscript.ai/video/LV0cqtI-TkQ ## Chapters - 0:02 — Introduction, Licensing and Continuing Education - 10:37 — Barriers, Theory and Common Factors - 19:27 — Assessment, Treatment Process and Goals - 26:26 — Repair, Stigma, Future and Closing ## Transcript **[0:02] Speaker A:** Hello, I'm Dr. Bridget Nash and I'd like to welcome you to the Therapy Show, a podcast series that seeks to demystify mental health treatment. Today I'm honored to welcome Dr. Doug Behan, who is here to discuss the common factors that make psychotherapy successful. Dr. Behan is the Director of Continuing Education and an assistant professor of Professional practice at Rutgers School of social work. Dr. Bean has been at Rutgers School of social work since 2007, where he enjoys leading the nation's large university based continuing education program for social workers and teaching clinical courses to MSW students. Dr. Behan has over 30 years of experience in a variety of social work settings. **[0:44] Speaker A:** He has worked extensively in the mental health field as a clinician, supervisor and administrator. In his career, he has enjoyed developing many programs, including the school's continuing education program, professional conferences and certificate programs, and international training programs in China and India. Dr. Bean has a deep connection to Rutgers, where he's earned his undergraduate, master's and doctoral degrees. Dr. Bean, welcome to the therapy show. **[1:15] Speaker B:** Thanks, Dr. Nash. Thanks for inviting me. I'm really glad to be here. **[1:18] Speaker A:** Can you start by telling us a little bit about your personal background and professional development that led you to research the common factors that make psychotherapy effective? **[1:27] Speaker B:** Sure. I'm a licensed clinical social worker and I've been a clinical social worker for over 30 years. **[1:33] Speaker B:** I got into the field as a therapist. Basically I was doing family therapy, group therapy, individual therapy in mental health centers, and that was how I started my career. And I evolved. I started to do supervision. I eventually became a director of an outpatient psychological services program at a hospital. **[1:50] Speaker B:** And then I went into working in a physical rehab hospital where I was coordinator of mental health services there. So I did lots and lots of therapy for years and supervised clinicians. And then in 2007, I came to Rutgers where I was doing some more training, eventually became the director of the continuing education program, which is really the largest training program for social workers in the United States. **[2:12] Speaker A:** Before we begin, can you talk about the difference between a licensed social worker and a licensed clinical social worker? **[2:18] Speaker B:** Well, when a social worker graduates from a master's program, before they can actually practice, they need to become licensed. **[2:26] Speaker B:** And in New Jersey, the first license that they can get is called a licensed social worker. And they have to take an exam, they have to have a master's degree in hand, and if they pass the exam, then they can actually practice social work, but they can't do therapy. Yet. The thinking there is that in order to do therapy, you really need to have more experience under supervision before you're able to do that. So social workers need to practice basically for two full years under the supervision of a licensed clinical social worker, and then take another exam, state administered exam, that allows them to get that clinical license, which then allows them to be in private practice or to do psychotherapy with clients in a less supervised way. **[3:07] Speaker B:** So there's really two tiers. Now, some people don't necessarily need to become a clinical social worker if they're going to work in policy or in government or in areas where they're not doing straight clinical work. A licensed social worker is a perfectly acceptable license for social worker. It just doesn't allow them to do the clinical portion, which is a subset of what social workers do. **[3:25] Speaker A:** Don't social workers do a large portion of therapy? **[3:27] Speaker B:** Yeah, they do, actually. I mean, they are the largest mental health provider by far, out of all the professions, Way more than counselors or psychologists. There's a lot of social workers out there, and sometimes it's misunderstood what social workers do. They do a lot of different things. They work in child protective services, they work in adoption, they work in hospitals, they work in medical settings, but they also do psychotherapy and they work in clinical programs, working with people with eating disorders, working with older adults in aging programs. **[3:56] Speaker B:** So the way social workers practice is really vast. But one of the ways that they practice is to do psychotherapy. When you look for a psychotherapist, you're going to see a lot of social workers out there with various licenses, depending on the state that they're in, but they're all out there as bona fide psychotherapists. **[4:12] Speaker A:** How would you briefly explain what continuing education is to a non professional? **[4:17] Speaker B:** Continuing education is really an important part of being a professional. **[4:20] Speaker B:** You'll see this with most professions. When a person is practicing, they need to maintain their edge and their knowledge. It doesn't matter if a person's a lawyer, an architect, a nurse, a social worker, a dentist, by part of their having a license. The license usually requires them to continue to get training every year throughout their career. And the reason for that is that it would be kind of dangerous if somebody relied only on the training that they got while they were in university and then tried to practice a full career without really updating their skills. **[4:55] Speaker B:** Most people probably would still update their skills, but the license is really a safeguard towards that. It's kind of interesting because most people don't really realize the purpose of a license. A license is something that the state issues to allow a person to do that type of work, whether it's, you know, social work or dentistry or medicine. The state says, you have to show us that you have done the right amount of education and you have the right amount of supervision to practice that type of work in our state. And when a person does achieve that, then the state says, all right, here's your license, go out and practice. **[5:29] Speaker B:** Now if that person does something that's inappropriate or problematic, the state can also take away that license and protect consumers by saying, this person's no longer allowed to practice. Now, part of a license also to protect the consumers is to maintain a license, you have to do a certain amount of continuing education hours every license period. And for social workers, it varies from state to state. In the state where I'm from, in New Jersey, it's 30 hours every two years for a licensed social worker and 40 hours every two years for licensed clinical social workers. So that's a lot of hours. So people really need to spend time away from their jobs learning. That's a really good thing for the consumer. You know, it helps professionals stay sharp, helps them learn new things, helps them learn new developments, what the research is saying. So it really gets them back in the classroom, reengaged and learning, so then they can bring that back to their work with their clients and really do an effective job. **[6:23] Speaker A:** Many clinicians participate in institute training programs as well as continuing education. **[6:28] Speaker A:** What is the difference between the two and why are they both important? **[6:32] Speaker B:** Most continuing education for professionals is basically a day or half a day long. So they take time away from their normal practice, they'll go take a course and they'll learn, and then they'll go back to their normal job the next day. That's effective in terms of it works with their job. They can get away for a day. **[6:51] Speaker B:** The expense is not extraordinate. So they can get out and then get back to work. An institute level program is something that is much more intensive. And that's the kind of thing where a person, often early in their career, they're looking to add a real specialty beyond what they got in their graduate program. And as a consumer, that's something to look for. **[7:10] Speaker B:** When you're interviewing for a therapist or a social worker, you might want to ask, have you had any institute level training? What kinds of things have you done since school? And if they have shown the desire and the energy and the effort to go and get higher level certifications, that's a good indicator that this person works hard, is serious about being a lifelong learner, they probably will have A good skill set that will translate into their work with you. So the institute level training isn't required. And you can have really amazing social workers and therapists who don't have that. But it's a sign that they've put in the extra effort to build their skill set in a more detailed way. **[7:46] Speaker A:** Does Rutgers Continuing Education offer institute training? **[7:50] Speaker B:** We do. We have certificate programs in various topics in child and adolescent mental health and gerontology and adoption, trauma and crisis response. We also have a certificate program in a form of family therapy called Bowenian Family Therapy. So we do offer those, although the bulk of what we do are single day workshops or two day workshops, because that's really the most popular to do an institute level training. It's expensive and it requires a lot of time out of the office. And that's not always so easily done once a person becomes a busy professional. Most of what we do are single day trainings, which are certainly wonderful. We make sure that they're engaging and informative so people get a good experience when they're there. But we actually do offer both levels. Yes. **[8:30] Speaker A:** What do you think is the biggest barrier to continuing education that clinicians face? **[8:35] Speaker B:** Part of it is just time away from work and people develop caseloads. Agencies are usually really busy and when somebody's out, it makes it harder to get the work done and take care of the people you're taking care of. So every day away from the office is hard. So I think it's just time away from the office. It's hard for people to get that. Back when I first started in my career, agencies also invested more in training. They gave people more time out of the office that was paid often. Now for a clinician to do that, they have to use a vacation day or find a day where their agencies close, like a weekend to do the training. So that also adds an extra barrier. When you're getting a paid day to go take your training, it's a little bit easier. So I think that's one way that organizations you really can help their staff by giving them paid days. **[9:17] Speaker B:** But that's becoming less common, unfortunately. So that's definitely a clear barrier. And also cost. Social workers in general don't have the highest salaries, so taking money to pay for a day of training is expensive and again, often not necessarily reimbursed by their employer. Sometimes it is, but often it's not. So cost is an issue. And the more cynical answer to your question is not everybody is a motivated learner. Some people get very complacent with their education and they aren't learning new things. And as a consumer, that would concern me. I want to go see a social worker who is having a vibrant career and learning and engaging with new knowledge all the time. And that's something I'd want to ask them about and see what their answer is. Because if it's kind of a lazy answer, like, oh, you know, I go once in a while or I read a book here or there, and you're not getting a sense that they're intellectually alive, you might be getting some really old knowledge or old training, and that's not necessarily ideal. **[10:11] Speaker A:** That's a good point, because one of the things I found through my podcast is that we have so many excellent therapies now that really are effective. **[10:19] Speaker B:** There are dozens, even hundreds of different types of therapy. People spend their career developing theories, doing research, honing these different approaches, and they become quite intricate and have been proven effective in many cases by lots of research. **[10:37] Speaker A:** So how can we remove these barriers for social workers and other clinicians? **[10:41] Speaker B:** Well, I think it comes down to leadership and money. Agencies really do well, and it's something I really believe in investing in, training their staff and making that a commitment. Because when staff feel energized and learning new things, they usually do better work. You have better morale, you have better productivity, better client satisfaction. This little kind of pennywise pound foolish to say we can't afford to train our staff. You know, we just need to keep them working and working and working, and they have to figure that out on their own. That sets up a kind of a bad culture where people really aren't intellectually engaged and alive. They start to burn out more. So the training is something that an organization really should be investing in. The higher level is, you know, having parity in how mental health is funded, but still not really getting the same kind of funding and attention that medical illnesses get. **[11:29] Speaker B:** You know, insurance tends to be less accessible and less robust than medical illness treatment. So I think the more there is money for training and for getting social workers and other mental health professionals educated, the more that benefits the consumer. **[11:45] Speaker A:** I was also thinking perhaps policy wise, we can do something in the tax code or making it tax deductible for employers. **[11:53] Speaker B:** Absolutely. I think that's something that, again, sort of a commitment as a society. And there's been a long history of looking at mental illnesses, not necessarily the same as a physical illness. The funding hasn't been equal. And I think if we start to look at how tough life is, how complicated life is, how Hard life is all the trials and traumas that can come across a person's life. We really need to look at that as something that needs really robust attention and funding. The more we invest in that, the happier and healthier people are, the more stable families are, the better occupational productivity is. I mean, really the trickle down effect of supporting mental health is really strong. There's a lot of research on that. So I think as a culture we need to invest more. Now there's been progress in that in mental health and insurance and parity, but still we're not there yet as a culture. **[12:41] Speaker A:** There's much talk in the field about evidence based, evidence informed and research based therapy. Can you talk a bit about the importance of clinicians using theory to inform their practice? **[12:52] Speaker B:** Yeah, I can. I mean, I think clinicians should be using research and theory to drive what they do. That's been really supported by lots of research. When there is a clear map of how to understand what the client is going through, what to do about it, how to get the client engaged in that, then the outcomes are stronger. I think everybody has a smattering of theory and understanding of research supported treatments, but they're not necessarily always following them. So again, as a consumer, that's the kind of thing you're going to want to ask before you sign up with a therapist, is you want to ask, so what's your approach and how does that inform you and how current are you with new information about that? You want to get a sense that the person is really actively learning and excited about their approach. On the flip side, you know, and I've seen way, way too much of this in my career. **[13:42] Speaker B:** Lots of people who are really pretty good, smart, talented therapists, but they're kind of lazy, right? They do this therapy that is not driven by theory. It's more they're shooting from the hip, they're kind of making it up as they go along. I call it, how's it go in therapy. People come into their office and they say, so, how was your week? And they just kind of give them some ideas or suggestions or advice, but there's no real plan, there's no real map, there's no real overlay for making sense of what that client's bringing in that's based on research and theory to take it somewhere effective and improved. **[14:18] Speaker B:** That kind of lazy, relaxed approach to therapy is something that really is something to be careful about. I hear people talk about being in therapy and they say, oh, it never worked, it didn't work. And I'll Say, well, tell me what it was like. What happened? Well, you know, I really liked the therapist. She was wonderful, or he was wonderful. And we talked a lot, but I don't know, it just never seemed to really go anywhere. Never really seemed to do anything. We just kind of just talked about various things that happened that week. But I never got the sense that there was much of a direction. **[14:47] Speaker B:** That's a sign that the person's not really using theory, not using research to drive their practice. They're just kind of winging it. And sometimes that helps people. But often, if there's a complex situation or problems are involved, you need some structure around what's happening in that therapy room for it to be effective. And that's something that every good therapist should be doing. **[15:06] Speaker A:** And you also need the human factor as well. And as you know from your work with common factors theory and psychotherapy, can you explain what these common factors are and their significance in providing competent practice? **[15:18] Speaker B:** This is an area that I've spent a lot of time researching and writing about and reading about. It's called common factors. And the reason for that is that the various approaches that are used to treat people, and there's, you know, people have heard things like cbt, which is cognitive behavioral therapy or behavioral therapy, or psychodynamic therapy or humanistic therapy. There's a lot of general approaches to how to treat people. Over the years, there's been lots of research to say, well, which one is the most effective, which one works the best? And CBT has the most research saying that it's effective. But when they do what's called a meta analytic study, where they put a whole bunch of studies into one statistical analysis, what they find is that all these models are basically about the same level of effectiveness, which is kind of a strange, surprising outcome. **[16:07] Speaker B:** Like you would think after all the years of refinement and research and practice, that one would have emerged as the winner. **[16:13] Speaker B:** And these approaches tend to be similar. The question becomes, why is that? That doesn't make a lot of sense. There's been a lot of research over the last 30 years or so saying it's really not what's unique about all these approaches. It's about what they all have in common. **[16:28] Speaker B:** So what are those factors, those common factors in between the theories that they're all doing, that really help people get better? Because psychotherapy works, it's been shown to be a very effective modality for all kinds of human suffering. But the factors that make it work are these common factors. Now, one of the common Factors we just talked about a couple minutes ago is having a theory. Now, it doesn't necessarily matter what the theory is, but there's got to be some kind of map that the client and the therapist agree upon that says, this is what the problem is, this is what we're going to do about it, and this is where we're going to get to. **[17:03] Speaker B:** So there's this common map that they're both following that provides structure and something to do in the therapy. The weird answer, though, is that it doesn't necessarily always matter what that map is. It's got to be a map that matches the client's preferences more than anything else. Other common factors include things like the therapeutic relationship, which is really the king of all the factors. It's how well the client and the therapist are connected. **[17:29] Speaker B:** Clients should be feeling things like empathy, understanding, warmth, like the therapist is glad to see them, that there's a sense of relationship that develops. And if that doesn't happen in a therapy relationship, then if it's not strong and connected, it's probably not going to work. It doesn't matter how expert, how many degrees or institute training set a person has, if they're not connecting with a client, it's probably not going to be good therapy. Really, the relationship is king. That's been a very robust finding in multiple. Multiple studies over years and years and years. That's the kind of thing, as a consumer, what you're looking for is you really want to feel like, I can talk with this person. This person gets me. I get them. The interesting fact there is that the best therapists are people who connect with all kinds of people. **[18:16] Speaker B:** Not people just like them. Not people who are similar, but people from a broad range of race, class, age, gender, sexual orientation. They can relate to most people pretty darn well. But the other side of that is that not every therapist is going to connect with every client. It just can't happen. **[18:32] Speaker B:** People are too complex. We each have our own cultural and idiosyncratic history. We can't connect with every client, and that's really okay. And a good therapist will know, I'm not clicking with this client. I got to refer them to somebody else. **[18:45] Speaker B:** Now, the real sad thing that happens sometimes is a person often doesn't enter therapy very easily. So they'll go see a therapist and the click doesn't happen. And they think, I can't do therapy or therapy doesn't work. Therapy's not for me. And really the answer is no. Probably you just didn't click with that One therapist, because not every two human beings are going to hit it off and you probably need to try one or two more even before you find that person. Where you're like, I can really talk to this person. This person gets me, I get them. Now we can get down to work and make things better. And unfortunately, that's not always easy to do the first time you meet somebody. But that therapeutic relationship is really king. And that's really the main common factor I would want to people to look for is that good connection with the therapist. **[19:27] Speaker B:** And then what's called the therapeutic alliance. You connect and you form a bond and then you have this common understanding of what the problem is and where you're going. That's the alliance part, includes the therapeutic approach. **[19:39] Speaker B:** If there's an alliance, we feel connected and we understand what we're going to do about it and where we're heading. When that's been shown to be existing in therapy relationships, it's usually a pretty good therapy. Usually people improve and look back on the treatment and they say, yeah, that was good, that was worth it. **[19:56] Speaker A:** I think the more confident the therapist is in their skills, I think that the more relaxed they can be in the room, wouldn't you think? **[20:03] Speaker B:** I do. That's something I talk to students about because often when they're starting to learn, they're pretty nervous and they feel kind of like an imposter. And I'll say, clients, they want to see you feeling comfortable in your role. I wouldn't want to lay in a dentist chair and have a dentist work on my teeth if they didn't seem like they knew what they were doing and feel competent, incapable. If they look iffy, I'm going to climb out of that chair. There's a lot of other dentists out there. I'm not going to necessarily let somebody who's unsure of themselves. So when the therapist feels capable, competent, self assured, respectful and engaging towards the client, clients think, all right, I'm in good hands here, this person can help me. That's a huge part of forming that alliance. So, yeah, the confidence and a sense of competence by the therapist really go a long way. **[20:45] Speaker B:** It's really important. **[20:47] Speaker A:** Can you explain what the assessment, diagnosis and treatment process should look like from the client's perspective? **[20:53] Speaker B:** So, and this is another thing I teach students all the time, therapy should not feel like you are being evaluated in a laboratory. Again, good relationships start with conversation, with eye contact. If you have a therapist who's filling out forms or very stiff or very formal and you're not feeling comfortable there. That's not really a good assessment. A good assessment is conversational. Now, there might be some forms at some point, like, I need to ask you a few things, like give me your age and your Social Security number and all that stuff. But it should be embedded in a more relational kind of start. A good therapy has that connection as the primary goal. If you make your goal getting a lot of data right up front, that's a big disconnect. And people experience that. Now in healthcare, it used to be you would go in and talk to a doctor. **[21:38] Speaker B:** Now you talk to a doctor who's looking at a screen and typing, and it's not building great rapport. They're getting lots of data, but you're not getting a sense of, does this doctor understand me as a human being? So I think the assessment needs to be engaging and it needs to be collaborative. **[21:52] Speaker B:** One of the things the research shows is that therapy is much better when it's not a passive client and a therapist telling them what to do and telling them everything that's wrong. It needs to be a collaborative effort because the client is the expert on themselves and their history and what they think and feel. And the therapist is there to try to make some sense of it and walk along with them for a journey, for a part of their life. But they're not necessarily ever going to be an expert on that client. The client's going to understand much better. So it's got to be very much a collaborative approach, and there needs to be some empathy. And honestly, therapy should be relatively brief. I mean, most people don't want to be in lifelong therapy or in therapy for years. And some people want that, and that's awesome. **[22:32] Speaker B:** But most people want to feel better as quickly as possible and get back on with their life. And I think therapists need to understand that because people are going to drop out after the research shows, you know, anywhere from three to 10 sessions, they're going to stop anyway. So we should be thinking about, let's maximize and move things along as quickly as possible and renegotiate if we get to the goals, whether we should continue or stop. The treatment process should be fairly connected, empathetic, clear goals, clear objectives to meet those goals, and a clear time frame. If a therapist is doing that, clients usually are going to do well and really have a good experience and then come back to them as much as they need to, off and on throughout their life course. **[23:11] Speaker A:** And shouldn't therapists talk about goals and objectives? **[23:14] Speaker A:** First of all, tell us what they Are and shouldn't that language be right at the top of the assessment process? **[23:19] Speaker B:** Absolutely, Dr. Nash, you're right. **[23:20] Speaker A:** Give us an example. **[23:22] Speaker B:** Like I said earlier, the bad side of that is when a client doesn't really know what's going to be done any one week. The therapist is just doing that. How's it going that week? Therapy. When there's goals and objectives, there's going to be some sense of continuity. Like, so we talked last week about you were going to not apologize when you speak up in a meeting at work. You were worried that you were apologizing too much. **[23:45] Speaker B:** And we talked about some confidence building cognitions that you could run through your mind before you go into that meeting. So you could feel sturdier and stronger and then speak your mind and not apologize. How did it go? Did you have any opportunities this week giving the person some tools and some ideas? You're tracking their progress during the week. **[24:03] Speaker B:** You're troubleshooting if it went well or not. And that becomes something that is towards the goal of more self confidence. Maybe that's the goal. So you're tracking that, you're checking in on that self confidence goal. There could be a million different goals between any client and therapist, but it has to be something that they both agree upon and negotiate and keep revisiting on a regular basis. **[24:22] Speaker B:** And the other side of that is that when there are goals, it helps the client stay accountable because they know, look, I gotta work on this assertiveness stuff because I know she's going to ask me about it next week and I got to try to use these tools. And it keeps them busy and working outside the therapy session, which again, promotes good, positive change. **[24:40] Speaker A:** It also keeps the therapist accountable as well. **[24:43] Speaker B:** Yes, they should be accountable. Right? You're getting paid, you're taking somebody's precious life and trying to help them. You should be accountable towards the goals as well. Absolutely. And I think one of the things that the research shows is that the best therapists create an environment with a client where they are open to hearing feedback about how they're doing. How am I doing here? **[25:03] Speaker B:** Is there anything that I'm doing that's not working or anything I'm doing that's annoying you or anything I'm doing that you don't feel is helpful. And most clients, when they hear somebody say that will be polite. They will be, oh, no, everything's fine, you know, it's okay. And because that's what you do in real life, you don't necessarily say something that could hurt somebody's feelings. But what the therapist should be doing is giving a sense of, yes, I do want to hear this. I do want to know how I'm doing. And if I do something that upsets you or doesn't feel like it's working, please tell me, because that's getting in the way of our work. And I need to know that I'm okay to hear that. And when a client really understands that, then they can get over things that become impediments. If they don't establish that kind of rapport where the client can speak their mind and course correct with the therapist, then what happens is it becomes this unspoken hidden barrier, and then eventually clients drop out. **[25:54] Speaker B:** You know what? She just annoyed me too much. She kept asking about my mother. I didn't want to talk about my mother, but she asked about my mother every week. So I decided I'm not going back. **[26:02] Speaker B:** And that's unfortunate because maybe that could have been a very effective therapy. And if the therapist was soliciting like, how am I doing? And the client was able to say, you know, you're asking a lot about my mom. I'm not ready to do that yet. Too much, then they could of course correct it, but otherwise it winds up being a treatment failure. And often the therapist scratches her head and they're like, I don't know why they dropped out. They have no clue. And that's unfortunate. **[26:23] Speaker A:** We call those the corrective emotional experiences. **[26:26] Speaker B:** Yes. And repairing ruptures in the therapeutic relationship. **[26:30] Speaker A:** Because that's oftentimes the first time the client can speak up. Maybe they couldn't speak up with their parents, or maybe they couldn't speak up in a relationship. And here they get that exercise of doing that with their therapist. It's very therapeutic and takes some work **[26:43] Speaker B:** to create that environment, to let a person know that you can do this differently in here. You know, maybe you didn't have a good voice in your family. People didn't want to hear what you have to say or shot you down. But we're going to do it differently in here. I'm going to give you respect and I'm going to value your opinion, even if it's one that's a little provocative or one that's contrary to what I've been saying. **[27:02] Speaker B:** That's okay here. When clients really get a new experience of how they can relate to somebody, that's very, very important. Learning. **[27:09] Speaker A:** Can you talk about stigma and how it is a barrier to treatment? **[27:13] Speaker B:** Oh, wow. Yeah. That's a wonderful question. I think stigma about going into Therapy has been reduced somewhat. I mean, more people are comfortable saying, yeah, I'm in therapy, and I was talking to my therapist the other day. I think it's gotten better, but it's still an issue, right? A lot of people feel shame that they would need to go get some help with their life. And I always say to people, what's more complicated than your life? Human beings are really complex, and all the interactions and relationships and experiences that we have can be tough. Right? Life is hard, and nobody goes it alone. **[27:45] Speaker B:** And to be able to get help should be just a very natural instinct. It's kind of like saying, if you sprain your ankle and say, well, I should be able to walk on this ankle no matter what, I shouldn't need any help. Of course not. Your ankle sprained, go to the doctor, get a brace, get some medication, and then your ankle will heal and you'll walk well again. Well, when something happens in life, in a relationship with depression, anxiety, job issues, romantic relationships, friendships, all those things can have lots of problems. And to be able to go in and sit down with somebody and talk and figure it out who's there for you only, and able to listen to you, devote time to just listening to you without an agenda of their own, it's a pretty magical thing. And it can really put people back on course. **[28:28] Speaker B:** And I wish there was less stigma, but I think if more people think about it as just a very obvious thing, like get an ally on your team when you need it, and then when you're feeling better, you stop. And then if you need it again, you go back in. It's kind of like the family doctor, you know, you don't keep going for the rest of your life. Once you've had a cold, you go in, you get checked out, feel better, you stop. Therapy should be a companion throughout life as needed. And there's people who use it, and they'll tell you it's really changed their life. They are much more functional, happy people because they've been able to embrace therapy and not be scared away by the stigma of it. **[29:01] Speaker A:** Dr. Behan, what are you most excited about in mental health treatment today? **[29:05] Speaker B:** I think there's an emerging thing in the literature. There's more research being done on having therapists uniformly solicit feedback from their clients, either through a form or just conversation, deliberately asking them, how's this going? How are the goals for you? How am I doing? And that's not been something that's been taught. I never was taught to do that in a deliberate way. And unfortunately, when they ask therapists and research, how good are you? Where would you rank yourself? Would you put yourself in the top 25% or the bottom 25 or the middle? 86% of therapists put themselves in the top 25%. **[29:42] Speaker B:** So most people think they're doing a pretty great job. So I don't really need to check in with my clients because I know what I'm doing. I'm good at this. I've been doing this a long time. I got a lot of degrees. **[29:51] Speaker B:** They're also losing some patience because they're not asking those questions. So the idea of formally asking clients to assess that, and also the more you ask, the more they realize you really want to know. Like, you really do want to know what I think. All right, I'm going to tell you. And like I was saying earlier, that really makes therapy more effective when the client has an active voice. And I think that's an encouraging thing. I would like to see more of that. I would think that should be taught to people while they're in school, that seeking client feedback on a routine basis, either through a small checklist at the end of each session or a verbal check in, will reduce dropouts and improve the efficacy of their treatment. So I think that's something I'm really excited about that's emerging. **[30:33] Speaker A:** And if you had a magic wand and couldn't prove one thing about the mental health system, what would that be? **[30:38] Speaker B:** More access. It's really not a level playing field. I mean, people who have good insurance, people who have good incomes can go find a therapist and often who doesn't take insurance, and they can get good quality care. And somebody who doesn't have good insurance or doesn't have disposable income for therapy, they're not getting access to therapy. There's not a good, robust mental health system in our culture anymore. **[31:00] Speaker B:** There used to be much more big, large mental health centers with sliding scale fees with lots of therapists. And that's been really driven away. So getting access to be able to be in a room with a therapist should not be hard. It should not be something for the more privileged people in our culture. And that's really a crime. You know, we really should have much more open access to mental health care. That's where everybody wins. We have better productivity, we have less suicide, we have less broken relationships, we have less divorce. All of that happens with better mental health care. So it's an economic decision as well as it is a compassionate and emotional one. So that's what I would say if I had the magic wand, anybody would be able to get in to see a therapist pretty routinely, pretty easily, without cost being a barrier. **[31:42] Speaker A:** So how can my audience learn more about your work either online or in print? **[31:46] Speaker B:** I have a website. The website is for therapists, but I think consumers would really get a lot out of it. It would help you when you're shopping for a therapist, that's for sure. **[31:54] Speaker B:** It's called whatworksintherapy.com and on there is a website that digests the common factors and helps therapists see what things really should be part of their work if they're gonna do really good quality work. What does the research say really makes therapy effective? It's kind of designed for them to get that in a quick one stop shop. If you're a consumer, looking through that will give you some good ideas about what good therapy should look like. And if you're in therapy and you're not feeling like it's going well, it'll give you the right questions to ask your therapist or help you decide to move on. If you need to find somebody who you have a better rapport with, that's what I would say. What works in therapy.com Dr. Bean, on **[32:30] Speaker A:** behalf of myself, my listeners, and all of the people you have helped through your work, I want to thank you for your contributions to mental health treatment and for taking time out of your busy schedule to help me and my audience better understand the common factors that make psychotherapy effective. **[32:45] Speaker B:** Thank you. It's been a pleasure and I think your podcast is wonderful. I'm glad to be a part of it. Thanks again. **[32:51] Speaker A:** So be sure to check out my website, TherapyShow.com, which has many resources about mental health. There you will also find how to submit questions, stories or insights that you have about the mental health system, or suggestions about who else I can interview and how I can improve the show. I'd like to close by reminding our listeners to please subscribe, share and review this podcast so that you, someone you love, and people around the world can gain more benefit from therapy. **[33:17] Speaker A:** There's no need to suffer in silence. Get the help that you need to create the life that you want.