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Matthew McKay, Ph.D. - Guest
Dr. Matthew McKay is a clinical psychologist, professor at the Wright Institute, founder of New Harbinger Publications, and author of research and over 40 books on CBT, ACT, trauma, and emotional healing, including Mind and Emotions, The Relaxation and Stress Reduction Workbook, and Emotion Efficacy Therapy. He cofounded the Haight Ashbury Psychological Services agency in 1979 and served as its Clinical Director for 25 years and is currently the co-director of the Bay Area Trauma Recovery Clinical Services (BATRCS). Matt's interests extend to writing poetry, fiction, and music, and he has a published novel and two books of poetry. |
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W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Keith Sutton, Psy.D. (00:24):
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including family systems, cognitive behavioral therapy, emotionally focused couples therapy, eye movement desensitization reprocessing, motivational interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using emotionally focused couples therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and oppositional and Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:32):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, Psy.D. (02:19):
Today I'll be speaking with Matthew McKay, who is a clinical psychologist, professor at the Wright Institute, founder of New Harbinger Publications, and author of research and over 40 books on Cognitive Behavioral Therapy, Acceptance Commitment Therapy, trauma, and emotional healing, including the books Mind and Emotions, The Relaxation and Stress Reduction Workbook and Emotional Efficiency Therapy. He co-founded the Haight Ashbury Psychological Services Agency in 1979 and served as its clinical director for 25 years, and is currently the co-director of the Bay Area Trauma Recovery Clinical Services. Matt's interests extend to writing poetry, fiction and music, and he has published a novel and two books of poetry. Let's listen to the interview.
Keith Sutton, Psy.D. (03:05):
Hi, Matt. Thanks for joining me.
Matthew McKay, Ph.D. (03:07):
Glad to be here.
Keith Sutton, Psy.D. (03:08):
Yeah, thanks so much. So, Matt, I've known about your work for many years now. You've written so many books in the areas of Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Acceptance Commitment Therapy. You're very involved with the CBT network in the Bay Area, done some talks at the clinic that you had started, the Haight Ashbury Clinic in San Francisco, and I know you're also involved with the Wright Institute's Clinic. I've had actually some folks in my practice that went through that program. I know you've got your wonderful book, The Mind and Emotions where you're using a transdiagnostic approach, kind of integrating the different, you know, CBT and Third Wave CBTS. So yeah, you've done so much and I'm so excited to hear about kind of what you've been doing lately. But first, I always like to find out about, you know, how did you get doing what you're doing, you know, kind of what was your evolution of your thinking? How did you get to the work you're doing?
Matthew McKay, Ph.D. (04:09):
Well, let's see, it goes back a long, a long way. I mean, you know, my original training was in Gestalt therapy, and I was really struck with how-- it's a fun therapy. It's fun for therapists. It's a really intense experience for clients. But I noticed that people weren't changing a whole lot, and Gestalt didn't have really an agenda for changing other than being in the present moment and embracing experience as it evolves. And, you know, then I got interested in, got trained in CBT. Partly because of my own experience, because I had had an anxiety disorder, and I found that CBT worked a lot better than anything else. And really, and so it made me interested in using cognitive behavioral therapy approaches to treating particularly panic disorder and some generalized anxiety disorder and so forth.
Matthew McKay, Ph.D. (05:19):
So, and I really, you know, I saw it made a big difference in my life, and it made a difference in the lives of my clients. So that sort of launched me in the, in the CBT direction. But it also became apparent to me that CBT didn't have the answers for all of the problems that I was encountering with clients and, in particular emotion dysregulation. And I then got very interested in DBT because it had a whole skillset that supported emotion regulation for clients who were not just anxious or not just depressed, not just perhaps angry or ashamed, but every emotion was elevated. And so I became interested in a therapy that had something to offer them. And then, shortly after that I was also becoming aware that there are certain clients who live with unavoidable pain.
Matthew McKay, Ph.D. (06:40):
It could be physical pain, it could be certain kinds of loss, grief, you know, pain that came from certain kinds of unavoidable failures in their lives. And CBT didn't have much to offer them either because, frankly, those painful experiences didn't go away. And so I got very interested in ACT because ACT offers another route to-- instead of getting rid of the pain, primary pain, it's about really helping people face and accept pain and develop a new relationship to pain. So I guess the long answer to your question is that I kept being driven to new kinds of therapies and evolving therapies because I had clients who were not really being helped by the skillset I had at the time. I kept looking for something else.
Keith Sutton, Psy.D. (07:52):
So you kind of were-- when you had the clients, it was kind of like client-directed when the clients were not able to, you know, use those to address the issues, then kind of looking for something else and kind of bringing another tool into your toolbox.
Matthew McKay, Ph.D. (08:09):
Exactly. And, and it's happening still, you know, I mean, I see limitations in terms of ACT, you know, the Six Practices Processes in the Hexaflex. There are a lot more ways of helping people than those six processes. And so, the other thing is that it's a sort of a one size fits all therapy. I'm sure ACT people wouldn't be happy to hear me say that, but it is, like, you know-- we basically do the same thing with everybody. And I think now we're moving in the direction of what we sometimes now call Precision Therapy, which is therapy that is focused on the individual characteristics of each client, each human and is not, you know, protocol based and one size fits all, but in fact identifies what's unique about this person and tailors the treatment to their unique characteristics, problems, symptoms, what have you, mechanisms.
Keith Sutton, Psy.D. (09:24):
Is that what led to your transdiagnostic approach with the mind and emotion where you're kind of, you know, having the-- evaluating the client and seeing what areas they need help with, and then kind of applying the different techniques from the ACT DBT or CBT?
Matthew McKay, Ph.D. (09:39):
Well, one of the things that, you know, going back to 2007, we started developing a measure called The Comprehensive Coping Inventory, and it's really basically looking at transdiagnostic mechanisms. And it went through a number of evolutions: the CCI-55 now identifies or measures 11 transdiagnostic mechanisms that I think are responsible for most emotional disorders. And so, rather than targeting the symptom set or the diagnosis, I think it makes more sense to target those individual mechanisms. And each client has their own profile in terms of which mechanisms they use -- those maladaptive coping mechanisms -- which ones they use most frequently and are most influential in terms of their symptoms set. So, you know, we've moved in the direction of, "Okay, let's, let's look at the individual characteristics of this client in terms of their unique endorsement of use of these mechanisms. And, and now we'll tailor our treatment to this client and this client's elevated and most used mechanisms."
Keith Sutton, Psy.D. (11:12):
Oh, great. Can you give me an example of one of those 11 and how that kind of connects to the interventions?
Matthew McKay, Ph.D. (11:20):
Well, emotion avoidance is a mechanism that's used by lots of clients, and emotion avoidance has to be targeted with things like emotion exposure, mindfulness of the emotion of, you know, observing the emotion, you know, noticing the four parts of the emotion, the thoughts, the feelings, the sensations, the action, or being able to watch and observe the emotion without acting on it. So, you know, we attempt to treat emotion avoidance by, you know, turning toward the emotion and observing it and and exposing to it. I mean, those are just some of the...
Keith Sutton, Psy.D. (12:05):
Sure, sure.
Matthew McKay, Ph.D. (12:06):
...tools we use, but that's an example of a mechanism. And then it has to line up with specific, you know, targeted treatments. I mean, cognitive avoidance is another mechanism where you don't want to have certain thoughts, and you try to keep pushing them away. And also, we see that a lot in trauma -- the individual is wanting to avoid the memories and the images and the thoughts associated with the trauma -- and, you know, and so we have a whole set of treatment processes for that, including prolonged exposure. And there are all kinds of processes that a lot was used -- something called the white room meditation, where you keep observing your thoughts one after another or labeling them. And so there's a whole set of treatment processes for each one of these mechanisms.
Matthew McKay, Ph.D. (13:05):
And those are just a couple of examples of things that, you know, we use. But, the point is to not treat things that it aren't problematic for this individual client. And protocols do that -- protocols just line up step-by-step what we're going to do for this category of, or this diagnostic label. And some of those things are unnecessary. And also, then the protocol misses some things that are necessary for this individual. And so that's what we're trying to do. We're trying to tailor treatments to fit the unique needs of each client who shows up.
Keith Sutton, Psy.D. (13:44):
Well, and as you were kind of mentioning emotional avoidance, I know that was something significant in my training. I did some ACT training with Robyn Walser some years ago. And, you know, sometimes as therapists are trying to help clients with say anxiety or their distress, that sometimes they might be given coping skills, like breathing skills or relaxation or so on. But if emotional avoidance is really a core piece, then sometimes that can actually unknowingly reinforce avoidance of the idea that, "I must get rid of this feeling and must, you know, have a different feeling," rather than being able to sit with and, you know, kind of, be mindful or be with, and kind of ride the wave of emotional experience.
Matthew McKay, Ph.D. (14:29):
Right. And we now know there's a lot of data -- and ACT has provided a lot of it -- that the more we suppress emotions, the more we get stuck at the top of the wave, the more the emotion becomes chronic as opposed to episodic and wave-like. So, you know, that's right. And now we realize that, you know, it's totally understandable that the clients don't want to feel painful emotions, but that effort to suppress them is actually responsible in many cases for getting stuck with the emotion and making it chronic.
Keith Sutton, Psy.D. (15:02):
Yeah. Prolonging it, prolonging, definitely. And so, that's great. And tell me a little bit about New Harbinger because I know that you've been a prolific writer. I don't know, how many books have you written?
Matthew McKay, Ph.D. (15:18):
Well, it makes me look kind of crazy, but, I mean, upwards of 40.
Keith Sutton, Psy.D. (15:23):
Upwards of 40.
Matthew McKay, Ph.D. (15:24):
How does he keep doing that? What's wrong? What's wrong with this guy that he keeps writing books? But yes, I've written a fair number.
Keith Sutton, Psy.D. (15:32):
Yeah. No, it's great. I mean, you've got many wonderful books. And they're also very useful and very, you know, kind of, a lot of workbooks and exercises and so on, and really practical for clients and therapists to use. And you started a publishing company to be able to support other therapists, you know, writing books and publishing for clients. Is that right?
Matthew McKay, Ph.D. (15:56):
Yeah well, it was 52 years ago we started New Harbinger, Pat Fanning and I, and our agenda was to publish books that would impact human suffering, you know, that would offer tools to reduce the amount of pain that people live in. And then we sort of invented the workbook format, which, you know, was always-- the focus was always on evidence-based therapy. We were not interested in publishing, frankly, psychodynamics, psychoanalytic, other kinds of theory-based treatments. But we wanted to focus on what the evidence and the research supported that, you know, actually did help people. And the workbook was, you know, something where, you know, the client would actually do fill-ins and engage in active treatment processes, guided by the book. And so we wanted to, you know, we wanted to focus on what would help, what was evidence-based and what people could learn to do themselves to give them tools to change their lives.
Matthew McKay, Ph.D. (17:14):
And yeah, so it was a mission. And for many years I was the publisher and stepped down three or four-- three and a half years ago, I think. But I'm still there and developing new products. We just developed something called Therapy Assist, which is a homework product for therapists at-- you know, we took a lot of our content and coded it and turned it into a searchable library that the therapist can go and identify what they want the client to use during the week. And so it augments the therapy process with evidence based process, worksheets and...
Keith Sutton, Psy.D. (18:06):
Sure.
Matthew McKay, Ph.D. (18:07):
...education, and so forth.
Keith Sutton, Psy.D. (18:08):
Oh, that's great. And so it's like a library of different things, and then you can download it and send it to the client, or is it like a system that the client like signs into or gets emails or something?
Matthew McKay, Ph.D. (18:20):
It's a huge library, thousands of pieces of content, which are all organized and easily searchable either by, you know, either by diagnostic categories or by mechanisms. It also has a whole set of assessments that the therapists can use and track the client's improvement with. So, yeah, it is something that's been kind of a project that I really wanted to do for quite a while. Finally, we got to launch it a couple of months ago, so that's-- and so, yeah, so I'm pretty involved still in New Harbinger and developing new products. So I just don't-- I'm too old to actually run company, the leadership, anyway.
Keith Sutton, Psy.D. (19:09):
You get to do the fun, creative kind of pieces of it, rather than necessarily having to do the daily nuts and bolts. Well and it sounds like I'm hearing that like, you know, that there's both making all these resources accessible to clients through workbooks and so on, clients that maybe can't afford therapy, or are trying to do self-help work, or also kind of the accessibility for the therapists to augment their work, and having, you know, worksheets and so on, which is such a great thing because, you know, sometimes it is harder for clients to find the time, have the money, and so on, to go through the processes. So kind of empowering them to have resources that they can use themselves and, you know, take this science and this research and evidence-based work, and then actually, you know, use it themselves and apply it in their own lives is great. And you've been doing some research also, is that right, with the Wright Institute? Or I don't know if that's still happening, or if that was happening before in that kind of transdiagnostic approach, or maybe I'm misinformed.
Matthew McKay, Ph.D. (20:16):
I mean, I am co-director of the Bay Area Trauma Recovery Clinic and we do a lot of research there. I just actually did a very interesting piece of research that is going to be presented at CBS in July. And we found-- what we did was we compared ACT alone for -- this is for PTSD -- ACT alone, versus ACT plus EMDR, versus ACT plus WET (Written Exposure Therapy) and we found that actually if you add either EMDR or written exposure therapy, it greatly improves ACT in terms of outcomes with trauma, outcomes with thought suppression, and anxiety. And so, you know, because there's been a lot of sort of controversy-- is ACT sufficient to adequately treat PTSD.
Matthew McKay, Ph.D. (21:29):
And there's been some interesting research that kind of looks at both sides of that. But what we found was that: no, you really need to add something that helps process the trauma -- either EMDR or WET -- in order to get maximum outcomes. So that's an example of some of the research we've been doing. But we're also, we're just-- we have a new bit of research where we're taking a look at Polyvagal Theory and, you know, because we see that a lot of our clients, our trauma clients, do have a component of the trauma where it's reflected in their physical well-being and we don't really have a good method for targeting that right now. And ACT by itself doesn't seem to target you know, physiological processes very much.
Matthew McKay, Ph.D. (22:31):
And so now we've put together, you know, a module, mostly aimed at the vagus nerve. And now we're going to see, you know, does that improve our outcomes with clients whose trauma is manifested physically.
Keith Sutton, Psy.D. (22:52):
Oh, that's great.
Matthew McKay, Ph.D. (22:53):
Well, I mean, it's lots of fun. There's lots of good research and of course we continue to use our comprehensive coping inventory with the 11 mechanisms. And we're also, you know, trying to see how we can improve outcomes with some of these key mechanisms, like rumination, for example, which we see a major factor for trauma survival. And, you know, is what we're doing sufficient for rumination, and do we need to add other treatment components as well? I mean, is for example, is diffusion enough for rumination, or do we need to add attention training, and then other kinds of interventions that help clients learn how to direct their attention? So anyway, it is all fun. It's great opportunities to learn and also maybe to improve our treatments.
Keith Sutton, Psy.D. (23:49):
Sure. Well, that's great. And it sounds like-- you were mentioning about adding in EMDR or the written exposure, the WET approach with ACT, and I know in my own experience of learning ACT, after kind of beginning to really understand it, I kind of was thinking like, "Oh, this is almost like motivational interviewing for like, then exposure that you're, you know, being able to accept the emotions, be able to sit with, go in the directions of one's value, being open to the full range of the human experience. And then it's kind of a primer for them being willing to actually feel the discomfort or do whatever the exposure is." And I know, I think there's been some combinations of the ACT and ERP exposure with response prevention for OCD that's really great that you're doing ACT and then kind of adding in these different treatments for trauma and kind of seeing how they complement each other.
Matthew McKay, Ph.D. (24:49):
Yeah. And it just goes back to what I was saying a little while ago, is that instead of doing one size fits all, it's, "Let's make sure that we understand: what are the unique characteristics of this particular client? How does their problem manifest? How do they cope with it in ways that don't work? And so forth." And once we kind of have a profile of those unique characteristics, then we can shape a treatment plan, rather than just do it with, you know, the typical, you know, step-by-step approach.
Keith Sutton, Psy.D. (25:25):
Sure. Sure. And I would love to get your thoughts on, you know, something that I've always kind of, you know, grappled with is that: on the one hand, in exposure with response prevention or, you know, in ACT sitting with, and not emotionally-- not avoiding, we're kind of helping clients to lean in, sit with the discomfort, kind of ride the wave, not kind of distract themselves or so on. But then on the other hand, in DBT, there's so many skills to be able to bring in distraction, bring in coping skills to decrease the distress. Polyvagal has a number of, you know, approaches that-- or techniques to kind of help with the dysregulation of the nervous system. And I'm always curious as how people think about how those kind of reconcile -- not avoiding emotions, but then at the same time using these different techniques to manage or shift attention or, you know, breathing techniques, or so on.
Matthew McKay, Ph.D. (26:32):
That, you know, you've just targeted or underscored this major controversy really, in the ACT community. I mean, can you use coping skills and strategies? Is coping avoidance, or is it something that augments emotion regulation skills and acceptance? Does it promote acceptance? Because, you can actually, you can stand the pain, you have techniques for really enduring and getting through the pain. And, you know, it's been kind of a big deal. And so, I did some research on a treatment that we called EET Emotion Efficacy Therapy. And we, you know-- it involved emotion exposure to the painful affect and learning to hold the emotion. But it also involved six of the coping skills that are mostly borrowed from DBT and melding them together in the service of being able to act on value.
Matthew McKay, Ph.D. (27:45):
So, it was inserting coping into the ACT model. And we did a lot of research and it's really effective, and we use it-- our clinic and other clinics are using it. But the ACT community was very ambivalent about it because again, it involved coping and there was a lot of controversy, like whether this was consistent with ACT and finally, Steve Hayes declared that it was ACT and the controversy sort of went away, but the problem or the issue lingers, you know. And this is, you know, truthfully, I mean, I love ACT, I practice ACT with great, you know, commitment. But, but there are some limitations. And one of the limitations is, "Oh, we don't do that, and we don't do that, and this doesn't fit our model."
Matthew McKay, Ph.D. (28:43):
And, you know, coping doesn't fit our model because it's avoidance and-- but we know that coping works. It's, you know, so we're going to just throw out, you know, something that actually works and gives people a greater level of distress tolerance. Because, I mean, distress tolerance is like, you know, it's two things: is one, it's the belief that I can stand the pain. But the second thing is, I have the skills, or I have the resources to stand this pain. And the coping skills are part of knowing that you have the resources to stand and endure certain kinds of emotional pain. So, it's been a bit of a struggle to get ACT to include some of these other-- another thing that we got into trouble with was, bringing schemas into ACT.
Matthew McKay, Ph.D. (29:36):
And we developed, we did some research on ACT for interpersonal problems. And identifying the 10 key schemas that are most often involved in interpersonal, chronic interpersonal problems, and the schema coping behaviors, the avoidance behaviors that actually then cause most of the damage in relationships, and then using them in ACT model to try to build acceptance for the schema pain and then values-based responses when the schemas get activated to protect the relationship. Well, that ran into a lot of concern in the ACT community, because now what are schemas doing in ACT, you know. And what, we don't deal with schemas and trying to change schemas or trying to change thoughts or something like that? And of course, that's not what we were advocating, we were advocating you accept the thoughts, the schema pain. But, nonetheless, it's, you know, it's this resistance to adding anything to the six processes that are the Hexaflexes. It's like, "Oh, no, this is sufficient. This is good enough." And so we keep trying to add something and augment, what is it? Beautiful therapy. But, but there are other treatments that could make it even better and could be included. And so anyway, this is, you can tell that this has been kind of an issue for me because I have been in trouble with the ACT community.
Keith Sutton, Psy.D. (31:06):
Yeah. Yeah. Well, and it-- and I know that you integrate, right? Because there's all these different pieces and the schema and is that kind of schemas, like Jeffrey Young schema therapy schemas? Or is that...
Matthew McKay, Ph.D. (31:18):
Yeah, but from an ACT point of view, you don't try to change the schema. You change your behavior in response to the schema, from schema coping behavior to values-based behavior. So, yeah. So I mean, we use ten of Jeffrey Young's schemas, the ten that all relate to interpersonal.
Keith Sutton, Psy.D. (31:44):
And so it's kind of understanding your schema, knowing that schema gets triggered and leads to an impulse to react or cope in a certain way, but instead going in the direction of your values, rather than that kind of more automatic kind of, reactive coping.
Matthew McKay, Ph.D. (32:04):
Or, yeah. Instead of the avoidance behavior of, "I'm going to try to get rid of this pain." I mean, you know, at a typical example, let's say you have a defectiveness schema and you come home and your partner says something kind of critical about, you know, your behavior, and the defectiveness is schema gets activated and you feel a lot of shame and, "I'm bad," kinds of emotions. And so, typically schema coping behavior is, you know, false in one of three modes. It's either kind of aggressive, or it's kind of giving up surrendering, or it's withdrawing. Those are the three main modes. So, you know, you do one of your schema coping or avoidance behaviors, you get mad and pick a fight, or you just shut down and withdraw, or you just give up and disconnect.
Matthew McKay, Ph.D. (33:02):
And so, but the problem is the scheme of coping behaviors all damage the relationship, and ultimately, the relationship becomes less and less viable. And so, rather than change the schema, which is the Jeffrey Young approach, how about changing our behavior in response? Let's do something other than those schema coping behaviors, that damage relationship. Let's use values and figure out, "Well, what is my value in this moment?" You know, "How do I want to be and show up even though I'm in pain, even though I feel all this shame and this impulse to get mad or withdraw? How could I bring my value into this moment in time?" And preparing for that and helping clients rehearse and-- we use a lot of cognitive rehearsal where we visualize the event that triggered the schema, and then try to hold the emotion for a while, and then visualize actually acting on values instead of acting on the schema avoidance. So, yeah. It's cool stuff to, yeah, to bring schemas in and, and really look at how they're influencing relationships and use ACT as a way of responding and coping differently.
Keith Sutton, Psy.D. (34:18):
Definitely. Well, it sounds like, you know, because I guess the one way I think about it is, you know, in cognitive behavioral therapy, it was like: you're trying to refute or, you know, kind of get rid of these negative thoughts or so on in ACT you're acknowledging, allowing those thoughts to be there, not necessarily getting into this battle, just allowing, you know, the positive, the negative, and so on. And it sounds like the schemes are almost like just a way of having a label for identifying some of those thoughts that-- to be diffused. And also, at the same time then, you know, kind of making a choice on how you want to respond, rather than react, to those particular instances. And that's why I think too, with cognitive distortions, with schemas, it oftentimes helps to externalize and simplify almost even what is getting triggered so the person can sometimes diffuse even quicker. And then, you know, kind of not react and again, be able to kind of respond into the situation.
Matthew McKay, Ph.D. (35:25):
Exactly. To be able to label.
Keith Sutton, Psy.D. (35:27):
Exactly
Matthew McKay, Ph.D. (35:27):
What kind of thought is this. And we know in Buddhist practice that labeling thoughts is actually, it helps distance from them. And they begin to lose their sense of truth. And the label simply puts them in the category like, "Oh, there's another one of my, 'I'm bad' thoughts." Or a defective schema, "Well, okay, yeah. And I've got a label for it. But I'm also now moving it at some distance from me, so that I am-- and also I'm not viewing it as the absolute truth, but as just a thought, that kind of thought again." So, yeah, I think schemas really are a helpful way of labeling certain categories of thoughts that are characteristic and are happening over and over again.
Keith Sutton, Psy.D. (36:20):
Yeah, definitely. And back with the kind of coping and the avoidance, the way I've thought about it too is that, you know, sometimes we might use these coping skills to be able to do some of the healthy kind of compartmentalization. We might need to, you know, having an emotional reaction, but we have to go back to work, or we have to do something, but then we can go back to it, sit with it, and be with that discomfort. Or sometimes, like the breathing techniques, just of helping you be grounded not to get rid of the anxiety, but to allow you to actually be with the discomfort and kind of sit with and ride that wave, rather than, again, kind of that more reactive, you know, aspect.
Matthew McKay, Ph.D. (37:01):
That's so right. I mean, and you know, we see this with anger all the time. It's like, "Okay, so let me pause for a minute and let me take a couple of breaths, which is a coping response, to reduce the arousal level that's part of my anger experience. And then while I am coping down my arousal, I'm also planning a values-based response instead of my angry, attacking response." So, yeah, coping can be a vital part of helping the client, any of us, move toward values-based behavior as opposed to automatic, reactive kinds of behavior.
Keith Sutton, Psy.D. (37:49):
Sure. Definitely. Yeah, and learning to kind of build that muscle to sit with that discomfort, and kind of create that wedge between the reaction and the response. And I guess one of the other things that I oftentimes hear from folks in relationship to cognitive behavioral therapy and different-- is that the person can get to the place of, "Okay, I know that I'm not a bad person. Whatever I can understand and I agree with these kind of rational thoughts, although emotionally I'm still having that kind of reactivity." So the top down part is kind of there of the kind of frontal lobe, "Hey, I know I'm not a jerk or an idiot, or whatever, you know, take some deep breaths," but there's such significant dysregulation. And I integrate EMDR into my work and also some internal family systems kind of informed. And I kind of think about those approaches oftentimes are helpful with the bottom up as well as of course exposure. I was just wondering if you had any kind of thoughts on that, or if that's something you ever hear where people kind of saying that, "Yeah, the cognitive behavioral gets us, you know, ahead, but it doesn't quite kind of finish helping the person process," especially with trauma, for example.
Matthew McKay, Ph.D. (39:14):
I mean, I agree with you. I mean, I use EMDR a lot and we use it at our clinic a lot. And we use it to target, of course, the trauma memories, but we also use it to target the trauma-driven beliefs or schemas that accompany trauma. You know, one of the problems with treating trauma just with, you know, prolonged exposure or, what have you, is that you can reduce the person's-- the effect of the trauma memory. It no longer has the ability to intensely activate the person and create intense levels of pain, but it doesn't necessarily change the beliefs about self that the trauma created. So if I have a defectiveness belief or I have a responsibility belief, I'm responsible, this, "I'm bad, I made this bad thing happen," and those kinds of beliefs are not necessarily changed by some of our classic trauma treatments.
Matthew McKay, Ph.D. (40:26):
And EMDR, on the other hand, does target beliefs, and we can actually go right after those negative beliefs and we can actually, kind of almost miraculously, install alternative positive beliefs. And I see this happening over and over and over again. So yes, we can. And that's one of the advantages of EMDR. And also, you know, what you said is really true. The person actually knows that it's not true that they caused this pain, or they, you know, they're responsible, but they still feel that way. They still feel like, "I'm wrong, I'm bad. I did this." And no amount of cognitive restructuring really seems to be able to touch that. And we do need techniques that can change those cognitions on a deeper level. We also use a bilateral stimulation technique called ART: Accelerated Resolution Therapy. You use that? Yeah.
Keith Sutton, Psy.D. (41:29):
Well, I just actually interviewed Laney.
Matthew McKay, Ph.D. (41:32):
Yeah, it's really cool stuff. And, beautiful, beautiful therapy and it's also therapy that helps change the physical experience of trauma as well. And so, I mean, there are therapies that are now giving us more tools to impact these negative trauma driven beliefs. So I'm really grateful that this stuff is all emerging.
Keith Sutton, Psy.D. (42:04):
Definitely. Yeah. And I don't know if you've gotten into any of the internal family systems such, you know, I've thought about almost like, as my thinking's evolved with the CBT-- and I came to CBT, my minor in undergrad was in Eastern philosophy. So it really fit for me, you know, the CBT and the way that our perceptions color our experience. And I've thought about, you know, in CBT originally, you were trying to kind of get rid of those irrational thoughts or refute them, you know, ACT you're accepting and allowing all to be there. And IFS is almost like, you know, kind of looking at, understanding that those thoughts, that part of you, how they're trying to protect you, how they're trying to help you, what their function is. And you think some of those right brain exercises to get to know them and understand them, because sometimes, yeah, just the cognitive restructuring, you know, may not kind of shift it. And so there's another function that sometimes we're not as even aware of or the danger of giving up that protective part.
Matthew McKay, Ph.D. (43:08):
Yeah. And I sort of suspect -- I don't know what you think about this -- that IFS kind of has some of its roots in inner child work. And identifying that vulnerable part and figuring out what its needs are. And instead of trying to deny its reality and its feelings, it's like, "Well, let's make room for that part of me and also find a way to nourish it, protect it." So, yeah, I think there's a lot. It also goes back to something called Psychosynthesis. Assagioli, the Italian psychologist who, you know -- and so parts work actually has its roots in Psychosynthesis. It's very cool work. And Gestalt therapy used to-
Keith Sutton, Psy.D. (44:04):
Love that, I was going to say. Yeah.
Matthew McKay, Ph.D. (44:06):
And you know, being able to speak for the different parts and having have two-chair or three-chair or four-chair work where you have the different parts all able to convey some of their experience and their needs. Anyway, it's all fascinating and I think the internal family system is adding a lot to our repertoire of ways of responding to trauma, I think in particular.
Keith Sutton, Psy.D. (44:36):
Definitely. Yeah, and I would love to get your thoughts, since we're talking so much about trauma, and I know you came-- I had a dinner some years ago where I had a number of different folks that work with trauma -- yourself, some folks from ACT, folks from hypnosis, folks from AEDP -- and we were just kind of talking about, you know, trauma and working with trauma from these kind of different perspectives. And in the last ten years or so, I've been really digging into Complex PTSD and really kind of understanding that more -- really inspired by Pete Walker's book Complex PTSD: Surviving to Thriving -- and I was just kind of curious about your thoughts on Complex PTSD, because I think as you get more and more into trauma, right, that there's, you know, there's the single incident trauma, but there's also the more complex trauma where the person was -- and the way I kind of conceptualized it is -- when the person was growing up in prolonged periods of fight or flight as a child, either might be physical, sexual abuse, might be an alcoholic, you know, unpredictable parent, might be neglect, or so on -- basically not feeling safe and having to kind of take care of oneself. But this really kind of wires the nervous system and affects sense of self and, you know, part of the-- some of the structural dissociation models and such. And yeah, I'd love to hear any of your thoughts on complex PTSD.
Matthew McKay, Ph.D. (46:05):
Yeah. Well, at our clinic, I would say 70% of our clients have complex early childhood trauma -- physical or sexual abuse primarily and repeated. And you know, some of the things that make complex trauma more difficult to treat and really special, are that it's more likely in complex trauma to have these schemas because these are events that are repeated, they're happening early in life. And so it's during that period that schemas are most likely to form these negative schemas -- the, you know, the, "I'm bad," schema or the abandonment schema, or the distress schemas, and so forth -- that we see associated with trauma that also then have the effect of damaging relationships. And so complex trauma in my view is, you know, very challenging because those schemas end up functioning somewhat independently of the trauma memory and the trauma emotions, and having an ongoing effect on relationships, and on life, and they have to be treated. The other thing is, the complex trauma is more likely to affect the person on a physical level. And that's why, you know, polyvagal theory actually, I think, is more relevant to complex than simple trauma.
Keith Sutton, Psy.D. (47:56):
Yes.
Matthew McKay, Ph.D. (47:58):
So, yeah. You know, we're having cognitive effects in terms of schemas, we're having physiological effects in terms of dorsal vagal impact. And so, we have to have treatments that go beyond the standard, you know, prolonged exposure and what have you, because those things have to change, otherwise, a person isn't necessarily going to get a whole lot better. Just making sure that the memory is no longer disturbing isn't sufficient. And of course, the problem is that there are also a lot of memories.
Keith Sutton, Psy.D. (48:41):
Exactly. There's, there's a lot of different pieces.
Matthew McKay, Ph.D. (48:45):
And, by the way, when, in terms of dealing with, you know, multiple memories, I think ART -- Accelerated Resolution Therapy -- works better than traditional EMDR because you can weave together quite a few different experiences into a single scene, and simultaneously. Whereas with classic EMDR you've got a snapshot that's one moment in time, and you might get some halo effect from it, but it doesn't allow you to weave together multiple events into a single treatment experience. So, I think that, you know, complex trauma may be more easily treated with ART than classic EMDR. So it's just a thought here.
Keith Sutton, Psy.D. (49:30):
That's great. Well, that's great. And your experience that's been-- and something that's added and really kind of, you know, helped. Yeah. I'm just learning about ART and, you know, I've been hearing such wonderful things, and it sounds like a lot of people are finding it very effective in their work.
Matthew McKay, Ph.D. (49:48):
Really effective.
Keith Sutton, Psy.D. (49:49):
Yeah.
Matthew McKay, Ph.D. (49:50):
And effective for different reasons. One is just because, again, it does tend to focus on the physiological experience so that it keeps processing what's going on physically while you're processing the image in the memory. And so that's, I think, a really nice advantage. Second advantage is that you can process multiple related or thematically connected events at once. But, a third advantage is this whole thing about -- which you probably know now because you talked to her -- but, is with the so-called director's cut, where you can literally change the memory and when the memory is reconsolidated back into long-term storage, it actually goes back in a different form. And classic EMDR does that too. It tends to strip the memory of a lot of the emotions.
Matthew McKay, Ph.D. (50:48):
So when it's reconsolidated, a lot of the emotion is now disconnected, is gone. But with ART, you can literally change the memory itself. And it gets reconsolidated in a different form, particularly with resourcing. You can resources back to the moment of the trauma and change what happened in the imagery. And then, when that's reconsolidated, the memory now includes that resource, and all of what the resource did or said at the moment of trauma. So it's really got some wonderful advantages that I think-
Keith Sutton, Psy.D. (51:30):
That's great
Matthew McKay, Ph.D. (51:31):
--are worth learning.
Keith Sutton, Psy.D. (51:33):
Wonderful. Well, you know, we're nearing towards the end of our time, and I'd love to, you know, hear kind of what's next? What are you working on or what are you thinking about or what are you excited about recently?
Matthew McKay, Ph.D. (51:48):
Well, I have a textbook that's going to be coming out, I guess early next year. So, it's basically precision therapies, you know, it's precision-based cognitive therapies -- PBCT -- and it's using these 11 mechanisms and has a system for, you know, measuring them and then creating a unique treatment for each person depending on which of the mechanisms that they endorse and are elevated for them. And it starts with actually treating the stress that's maybe, you know, straining the whole system. But in any event, I'm really moving in that direction of precision therapy. And Steve Hayes has been doing that too. I mean, his work in process-based therapy, PBT, is basically precision therapy. It's saying, "Okay, we're going to see exactly what's wrong here, locate the problem, and we're going to -- and of course he uses network analysis to actually visit his assessment, which I think is too complicated -- but the point is that we're all moving in that direction. What exactly is the problem? And how can we line up and make our treatments uniquely focused on what this client is struggling with? And that-- I think we're all kind of moving in that direction and away from protocols, and that's kind of where I'm going.
Keith Sutton, Psy.D. (53:48):
So it's kind of, you know, being more precise, and, kind of, directing exactly what's happening for the client, and ultimately being more efficient, and really kind of addressing the client's issues.
Matthew McKay, Ph.D. (53:59):
And the key is, how do you measure what's going on for the client? Because that ultimately is the big question. How do we identify the things that we're going to target? You know, and we do it with, you know, our comprehensive coping inventory. Hayes does it with his network analysis, and other people are, you know, using other methods to do the assessment. But the point is that we have to have effective assessment systems in order to figure out, "What exactly are we targeting?" And so that's the challenge, I think, of precision-based cognitive therapy.
Keith Sutton, Psy.D. (54:37):
And how do people access your inventory?
Matthew McKay, Ph.D. (54:40):
It's at Harbinger. You can go to the New Harbinger website and it's free. And also there's a scoring system there. Go to the website and then just type in, you know, "comprehensive coping inventory" and you'll be taken to a place where you can take the test and also it gives you a score.
Keith Sutton, Psy.D. (55:05):
Okay. Great. Well, this has been wonderful talking to you today. And I just love the work that you're doing and just-- it sounds like you're always thinking and integrating and evolving in your work, and so I really appreciate you taking the time. I think this will be really helpful for folks to hear about.
Matthew McKay, Ph.D. (55:22):
Really enjoyed chatting with you, Keith.
Keith Sutton, Psy.D. (55:24):
Great. Thanks a lot. Take care. Bye-bye.
Keith Sutton, Psy.D. (55:27):
Thank you for joining us today. If you'd like to receive continuing education credits for the podcast you just listened to, please go to therapyonthecuttingedge.com and click on the link for CE. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, where we provide trainings for therapists in evidence-based models through live and online workshops, on-demand workshops, consultation groups, and online one-way mirror trainings. To learn more about our trainings and treatment for children, adolescents, families, couples, and individual adults, with our licensed experienced therapists in-person in the Bay Area, or throughout California online, and our employment opportunities, go to sfiap.com. To learn more about our associateships and psych assistantships and low fee treatment through our nonprofit Bay Area Community Counseling and Family Institute of Berkeley, go to sf-bacc.org and familyinstituteofberkeley.com. If you'd like to support therapy for those in financial need and training and evidence-based treatments, you can donate by going to BACC’s website at sfbacc.org. BACC is a 501(c)(3) nonprofit so all donations are tax deductible. Also, we really appreciate your feedback. If you have something you're interested in, something that's on the cutting edge of the field of psychotherapy, and you think therapists out there should know about it, send us an email. We're always looking for advancements in the field of psychotherapy to create lasting change for our clients.
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including family systems, cognitive behavioral therapy, emotionally focused couples therapy, eye movement desensitization reprocessing, motivational interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using emotionally focused couples therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and oppositional and Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:32):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, Psy.D. (02:19):
Today I'll be speaking with Matthew McKay, who is a clinical psychologist, professor at the Wright Institute, founder of New Harbinger Publications, and author of research and over 40 books on Cognitive Behavioral Therapy, Acceptance Commitment Therapy, trauma, and emotional healing, including the books Mind and Emotions, The Relaxation and Stress Reduction Workbook and Emotional Efficiency Therapy. He co-founded the Haight Ashbury Psychological Services Agency in 1979 and served as its clinical director for 25 years, and is currently the co-director of the Bay Area Trauma Recovery Clinical Services. Matt's interests extend to writing poetry, fiction and music, and he has published a novel and two books of poetry. Let's listen to the interview.
Keith Sutton, Psy.D. (03:05):
Hi, Matt. Thanks for joining me.
Matthew McKay, Ph.D. (03:07):
Glad to be here.
Keith Sutton, Psy.D. (03:08):
Yeah, thanks so much. So, Matt, I've known about your work for many years now. You've written so many books in the areas of Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Acceptance Commitment Therapy. You're very involved with the CBT network in the Bay Area, done some talks at the clinic that you had started, the Haight Ashbury Clinic in San Francisco, and I know you're also involved with the Wright Institute's Clinic. I've had actually some folks in my practice that went through that program. I know you've got your wonderful book, The Mind and Emotions where you're using a transdiagnostic approach, kind of integrating the different, you know, CBT and Third Wave CBTS. So yeah, you've done so much and I'm so excited to hear about kind of what you've been doing lately. But first, I always like to find out about, you know, how did you get doing what you're doing, you know, kind of what was your evolution of your thinking? How did you get to the work you're doing?
Matthew McKay, Ph.D. (04:09):
Well, let's see, it goes back a long, a long way. I mean, you know, my original training was in Gestalt therapy, and I was really struck with how-- it's a fun therapy. It's fun for therapists. It's a really intense experience for clients. But I noticed that people weren't changing a whole lot, and Gestalt didn't have really an agenda for changing other than being in the present moment and embracing experience as it evolves. And, you know, then I got interested in, got trained in CBT. Partly because of my own experience, because I had had an anxiety disorder, and I found that CBT worked a lot better than anything else. And really, and so it made me interested in using cognitive behavioral therapy approaches to treating particularly panic disorder and some generalized anxiety disorder and so forth.
Matthew McKay, Ph.D. (05:19):
So, and I really, you know, I saw it made a big difference in my life, and it made a difference in the lives of my clients. So that sort of launched me in the, in the CBT direction. But it also became apparent to me that CBT didn't have the answers for all of the problems that I was encountering with clients and, in particular emotion dysregulation. And I then got very interested in DBT because it had a whole skillset that supported emotion regulation for clients who were not just anxious or not just depressed, not just perhaps angry or ashamed, but every emotion was elevated. And so I became interested in a therapy that had something to offer them. And then, shortly after that I was also becoming aware that there are certain clients who live with unavoidable pain.
Matthew McKay, Ph.D. (06:40):
It could be physical pain, it could be certain kinds of loss, grief, you know, pain that came from certain kinds of unavoidable failures in their lives. And CBT didn't have much to offer them either because, frankly, those painful experiences didn't go away. And so I got very interested in ACT because ACT offers another route to-- instead of getting rid of the pain, primary pain, it's about really helping people face and accept pain and develop a new relationship to pain. So I guess the long answer to your question is that I kept being driven to new kinds of therapies and evolving therapies because I had clients who were not really being helped by the skillset I had at the time. I kept looking for something else.
Keith Sutton, Psy.D. (07:52):
So you kind of were-- when you had the clients, it was kind of like client-directed when the clients were not able to, you know, use those to address the issues, then kind of looking for something else and kind of bringing another tool into your toolbox.
Matthew McKay, Ph.D. (08:09):
Exactly. And, and it's happening still, you know, I mean, I see limitations in terms of ACT, you know, the Six Practices Processes in the Hexaflex. There are a lot more ways of helping people than those six processes. And so, the other thing is that it's a sort of a one size fits all therapy. I'm sure ACT people wouldn't be happy to hear me say that, but it is, like, you know-- we basically do the same thing with everybody. And I think now we're moving in the direction of what we sometimes now call Precision Therapy, which is therapy that is focused on the individual characteristics of each client, each human and is not, you know, protocol based and one size fits all, but in fact identifies what's unique about this person and tailors the treatment to their unique characteristics, problems, symptoms, what have you, mechanisms.
Keith Sutton, Psy.D. (09:24):
Is that what led to your transdiagnostic approach with the mind and emotion where you're kind of, you know, having the-- evaluating the client and seeing what areas they need help with, and then kind of applying the different techniques from the ACT DBT or CBT?
Matthew McKay, Ph.D. (09:39):
Well, one of the things that, you know, going back to 2007, we started developing a measure called The Comprehensive Coping Inventory, and it's really basically looking at transdiagnostic mechanisms. And it went through a number of evolutions: the CCI-55 now identifies or measures 11 transdiagnostic mechanisms that I think are responsible for most emotional disorders. And so, rather than targeting the symptom set or the diagnosis, I think it makes more sense to target those individual mechanisms. And each client has their own profile in terms of which mechanisms they use -- those maladaptive coping mechanisms -- which ones they use most frequently and are most influential in terms of their symptoms set. So, you know, we've moved in the direction of, "Okay, let's, let's look at the individual characteristics of this client in terms of their unique endorsement of use of these mechanisms. And, and now we'll tailor our treatment to this client and this client's elevated and most used mechanisms."
Keith Sutton, Psy.D. (11:12):
Oh, great. Can you give me an example of one of those 11 and how that kind of connects to the interventions?
Matthew McKay, Ph.D. (11:20):
Well, emotion avoidance is a mechanism that's used by lots of clients, and emotion avoidance has to be targeted with things like emotion exposure, mindfulness of the emotion of, you know, observing the emotion, you know, noticing the four parts of the emotion, the thoughts, the feelings, the sensations, the action, or being able to watch and observe the emotion without acting on it. So, you know, we attempt to treat emotion avoidance by, you know, turning toward the emotion and observing it and and exposing to it. I mean, those are just some of the...
Keith Sutton, Psy.D. (12:05):
Sure, sure.
Matthew McKay, Ph.D. (12:06):
...tools we use, but that's an example of a mechanism. And then it has to line up with specific, you know, targeted treatments. I mean, cognitive avoidance is another mechanism where you don't want to have certain thoughts, and you try to keep pushing them away. And also, we see that a lot in trauma -- the individual is wanting to avoid the memories and the images and the thoughts associated with the trauma -- and, you know, and so we have a whole set of treatment processes for that, including prolonged exposure. And there are all kinds of processes that a lot was used -- something called the white room meditation, where you keep observing your thoughts one after another or labeling them. And so there's a whole set of treatment processes for each one of these mechanisms.
Matthew McKay, Ph.D. (13:05):
And those are just a couple of examples of things that, you know, we use. But, the point is to not treat things that it aren't problematic for this individual client. And protocols do that -- protocols just line up step-by-step what we're going to do for this category of, or this diagnostic label. And some of those things are unnecessary. And also, then the protocol misses some things that are necessary for this individual. And so that's what we're trying to do. We're trying to tailor treatments to fit the unique needs of each client who shows up.
Keith Sutton, Psy.D. (13:44):
Well, and as you were kind of mentioning emotional avoidance, I know that was something significant in my training. I did some ACT training with Robyn Walser some years ago. And, you know, sometimes as therapists are trying to help clients with say anxiety or their distress, that sometimes they might be given coping skills, like breathing skills or relaxation or so on. But if emotional avoidance is really a core piece, then sometimes that can actually unknowingly reinforce avoidance of the idea that, "I must get rid of this feeling and must, you know, have a different feeling," rather than being able to sit with and, you know, kind of, be mindful or be with, and kind of ride the wave of emotional experience.
Matthew McKay, Ph.D. (14:29):
Right. And we now know there's a lot of data -- and ACT has provided a lot of it -- that the more we suppress emotions, the more we get stuck at the top of the wave, the more the emotion becomes chronic as opposed to episodic and wave-like. So, you know, that's right. And now we realize that, you know, it's totally understandable that the clients don't want to feel painful emotions, but that effort to suppress them is actually responsible in many cases for getting stuck with the emotion and making it chronic.
Keith Sutton, Psy.D. (15:02):
Yeah. Prolonging it, prolonging, definitely. And so, that's great. And tell me a little bit about New Harbinger because I know that you've been a prolific writer. I don't know, how many books have you written?
Matthew McKay, Ph.D. (15:18):
Well, it makes me look kind of crazy, but, I mean, upwards of 40.
Keith Sutton, Psy.D. (15:23):
Upwards of 40.
Matthew McKay, Ph.D. (15:24):
How does he keep doing that? What's wrong? What's wrong with this guy that he keeps writing books? But yes, I've written a fair number.
Keith Sutton, Psy.D. (15:32):
Yeah. No, it's great. I mean, you've got many wonderful books. And they're also very useful and very, you know, kind of, a lot of workbooks and exercises and so on, and really practical for clients and therapists to use. And you started a publishing company to be able to support other therapists, you know, writing books and publishing for clients. Is that right?
Matthew McKay, Ph.D. (15:56):
Yeah well, it was 52 years ago we started New Harbinger, Pat Fanning and I, and our agenda was to publish books that would impact human suffering, you know, that would offer tools to reduce the amount of pain that people live in. And then we sort of invented the workbook format, which, you know, was always-- the focus was always on evidence-based therapy. We were not interested in publishing, frankly, psychodynamics, psychoanalytic, other kinds of theory-based treatments. But we wanted to focus on what the evidence and the research supported that, you know, actually did help people. And the workbook was, you know, something where, you know, the client would actually do fill-ins and engage in active treatment processes, guided by the book. And so we wanted to, you know, we wanted to focus on what would help, what was evidence-based and what people could learn to do themselves to give them tools to change their lives.
Matthew McKay, Ph.D. (17:14):
And yeah, so it was a mission. And for many years I was the publisher and stepped down three or four-- three and a half years ago, I think. But I'm still there and developing new products. We just developed something called Therapy Assist, which is a homework product for therapists at-- you know, we took a lot of our content and coded it and turned it into a searchable library that the therapist can go and identify what they want the client to use during the week. And so it augments the therapy process with evidence based process, worksheets and...
Keith Sutton, Psy.D. (18:06):
Sure.
Matthew McKay, Ph.D. (18:07):
...education, and so forth.
Keith Sutton, Psy.D. (18:08):
Oh, that's great. And so it's like a library of different things, and then you can download it and send it to the client, or is it like a system that the client like signs into or gets emails or something?
Matthew McKay, Ph.D. (18:20):
It's a huge library, thousands of pieces of content, which are all organized and easily searchable either by, you know, either by diagnostic categories or by mechanisms. It also has a whole set of assessments that the therapists can use and track the client's improvement with. So, yeah, it is something that's been kind of a project that I really wanted to do for quite a while. Finally, we got to launch it a couple of months ago, so that's-- and so, yeah, so I'm pretty involved still in New Harbinger and developing new products. So I just don't-- I'm too old to actually run company, the leadership, anyway.
Keith Sutton, Psy.D. (19:09):
You get to do the fun, creative kind of pieces of it, rather than necessarily having to do the daily nuts and bolts. Well and it sounds like I'm hearing that like, you know, that there's both making all these resources accessible to clients through workbooks and so on, clients that maybe can't afford therapy, or are trying to do self-help work, or also kind of the accessibility for the therapists to augment their work, and having, you know, worksheets and so on, which is such a great thing because, you know, sometimes it is harder for clients to find the time, have the money, and so on, to go through the processes. So kind of empowering them to have resources that they can use themselves and, you know, take this science and this research and evidence-based work, and then actually, you know, use it themselves and apply it in their own lives is great. And you've been doing some research also, is that right, with the Wright Institute? Or I don't know if that's still happening, or if that was happening before in that kind of transdiagnostic approach, or maybe I'm misinformed.
Matthew McKay, Ph.D. (20:16):
I mean, I am co-director of the Bay Area Trauma Recovery Clinic and we do a lot of research there. I just actually did a very interesting piece of research that is going to be presented at CBS in July. And we found-- what we did was we compared ACT alone for -- this is for PTSD -- ACT alone, versus ACT plus EMDR, versus ACT plus WET (Written Exposure Therapy) and we found that actually if you add either EMDR or written exposure therapy, it greatly improves ACT in terms of outcomes with trauma, outcomes with thought suppression, and anxiety. And so, you know, because there's been a lot of sort of controversy-- is ACT sufficient to adequately treat PTSD.
Matthew McKay, Ph.D. (21:29):
And there's been some interesting research that kind of looks at both sides of that. But what we found was that: no, you really need to add something that helps process the trauma -- either EMDR or WET -- in order to get maximum outcomes. So that's an example of some of the research we've been doing. But we're also, we're just-- we have a new bit of research where we're taking a look at Polyvagal Theory and, you know, because we see that a lot of our clients, our trauma clients, do have a component of the trauma where it's reflected in their physical well-being and we don't really have a good method for targeting that right now. And ACT by itself doesn't seem to target you know, physiological processes very much.
Matthew McKay, Ph.D. (22:31):
And so now we've put together, you know, a module, mostly aimed at the vagus nerve. And now we're going to see, you know, does that improve our outcomes with clients whose trauma is manifested physically.
Keith Sutton, Psy.D. (22:52):
Oh, that's great.
Matthew McKay, Ph.D. (22:53):
Well, I mean, it's lots of fun. There's lots of good research and of course we continue to use our comprehensive coping inventory with the 11 mechanisms. And we're also, you know, trying to see how we can improve outcomes with some of these key mechanisms, like rumination, for example, which we see a major factor for trauma survival. And, you know, is what we're doing sufficient for rumination, and do we need to add other treatment components as well? I mean, is for example, is diffusion enough for rumination, or do we need to add attention training, and then other kinds of interventions that help clients learn how to direct their attention? So anyway, it is all fun. It's great opportunities to learn and also maybe to improve our treatments.
Keith Sutton, Psy.D. (23:49):
Sure. Well, that's great. And it sounds like-- you were mentioning about adding in EMDR or the written exposure, the WET approach with ACT, and I know in my own experience of learning ACT, after kind of beginning to really understand it, I kind of was thinking like, "Oh, this is almost like motivational interviewing for like, then exposure that you're, you know, being able to accept the emotions, be able to sit with, go in the directions of one's value, being open to the full range of the human experience. And then it's kind of a primer for them being willing to actually feel the discomfort or do whatever the exposure is." And I know, I think there's been some combinations of the ACT and ERP exposure with response prevention for OCD that's really great that you're doing ACT and then kind of adding in these different treatments for trauma and kind of seeing how they complement each other.
Matthew McKay, Ph.D. (24:49):
Yeah. And it just goes back to what I was saying a little while ago, is that instead of doing one size fits all, it's, "Let's make sure that we understand: what are the unique characteristics of this particular client? How does their problem manifest? How do they cope with it in ways that don't work? And so forth." And once we kind of have a profile of those unique characteristics, then we can shape a treatment plan, rather than just do it with, you know, the typical, you know, step-by-step approach.
Keith Sutton, Psy.D. (25:25):
Sure. Sure. And I would love to get your thoughts on, you know, something that I've always kind of, you know, grappled with is that: on the one hand, in exposure with response prevention or, you know, in ACT sitting with, and not emotionally-- not avoiding, we're kind of helping clients to lean in, sit with the discomfort, kind of ride the wave, not kind of distract themselves or so on. But then on the other hand, in DBT, there's so many skills to be able to bring in distraction, bring in coping skills to decrease the distress. Polyvagal has a number of, you know, approaches that-- or techniques to kind of help with the dysregulation of the nervous system. And I'm always curious as how people think about how those kind of reconcile -- not avoiding emotions, but then at the same time using these different techniques to manage or shift attention or, you know, breathing techniques, or so on.
Matthew McKay, Ph.D. (26:32):
That, you know, you've just targeted or underscored this major controversy really, in the ACT community. I mean, can you use coping skills and strategies? Is coping avoidance, or is it something that augments emotion regulation skills and acceptance? Does it promote acceptance? Because, you can actually, you can stand the pain, you have techniques for really enduring and getting through the pain. And, you know, it's been kind of a big deal. And so, I did some research on a treatment that we called EET Emotion Efficacy Therapy. And we, you know-- it involved emotion exposure to the painful affect and learning to hold the emotion. But it also involved six of the coping skills that are mostly borrowed from DBT and melding them together in the service of being able to act on value.
Matthew McKay, Ph.D. (27:45):
So, it was inserting coping into the ACT model. And we did a lot of research and it's really effective, and we use it-- our clinic and other clinics are using it. But the ACT community was very ambivalent about it because again, it involved coping and there was a lot of controversy, like whether this was consistent with ACT and finally, Steve Hayes declared that it was ACT and the controversy sort of went away, but the problem or the issue lingers, you know. And this is, you know, truthfully, I mean, I love ACT, I practice ACT with great, you know, commitment. But, but there are some limitations. And one of the limitations is, "Oh, we don't do that, and we don't do that, and this doesn't fit our model."
Matthew McKay, Ph.D. (28:43):
And, you know, coping doesn't fit our model because it's avoidance and-- but we know that coping works. It's, you know, so we're going to just throw out, you know, something that actually works and gives people a greater level of distress tolerance. Because, I mean, distress tolerance is like, you know, it's two things: is one, it's the belief that I can stand the pain. But the second thing is, I have the skills, or I have the resources to stand this pain. And the coping skills are part of knowing that you have the resources to stand and endure certain kinds of emotional pain. So, it's been a bit of a struggle to get ACT to include some of these other-- another thing that we got into trouble with was, bringing schemas into ACT.
Matthew McKay, Ph.D. (29:36):
And we developed, we did some research on ACT for interpersonal problems. And identifying the 10 key schemas that are most often involved in interpersonal, chronic interpersonal problems, and the schema coping behaviors, the avoidance behaviors that actually then cause most of the damage in relationships, and then using them in ACT model to try to build acceptance for the schema pain and then values-based responses when the schemas get activated to protect the relationship. Well, that ran into a lot of concern in the ACT community, because now what are schemas doing in ACT, you know. And what, we don't deal with schemas and trying to change schemas or trying to change thoughts or something like that? And of course, that's not what we were advocating, we were advocating you accept the thoughts, the schema pain. But, nonetheless, it's, you know, it's this resistance to adding anything to the six processes that are the Hexaflexes. It's like, "Oh, no, this is sufficient. This is good enough." And so we keep trying to add something and augment, what is it? Beautiful therapy. But, but there are other treatments that could make it even better and could be included. And so anyway, this is, you can tell that this has been kind of an issue for me because I have been in trouble with the ACT community.
Keith Sutton, Psy.D. (31:06):
Yeah. Yeah. Well, and it-- and I know that you integrate, right? Because there's all these different pieces and the schema and is that kind of schemas, like Jeffrey Young schema therapy schemas? Or is that...
Matthew McKay, Ph.D. (31:18):
Yeah, but from an ACT point of view, you don't try to change the schema. You change your behavior in response to the schema, from schema coping behavior to values-based behavior. So, yeah. So I mean, we use ten of Jeffrey Young's schemas, the ten that all relate to interpersonal.
Keith Sutton, Psy.D. (31:44):
And so it's kind of understanding your schema, knowing that schema gets triggered and leads to an impulse to react or cope in a certain way, but instead going in the direction of your values, rather than that kind of more automatic kind of, reactive coping.
Matthew McKay, Ph.D. (32:04):
Or, yeah. Instead of the avoidance behavior of, "I'm going to try to get rid of this pain." I mean, you know, at a typical example, let's say you have a defectiveness schema and you come home and your partner says something kind of critical about, you know, your behavior, and the defectiveness is schema gets activated and you feel a lot of shame and, "I'm bad," kinds of emotions. And so, typically schema coping behavior is, you know, false in one of three modes. It's either kind of aggressive, or it's kind of giving up surrendering, or it's withdrawing. Those are the three main modes. So, you know, you do one of your schema coping or avoidance behaviors, you get mad and pick a fight, or you just shut down and withdraw, or you just give up and disconnect.
Matthew McKay, Ph.D. (33:02):
And so, but the problem is the scheme of coping behaviors all damage the relationship, and ultimately, the relationship becomes less and less viable. And so, rather than change the schema, which is the Jeffrey Young approach, how about changing our behavior in response? Let's do something other than those schema coping behaviors, that damage relationship. Let's use values and figure out, "Well, what is my value in this moment?" You know, "How do I want to be and show up even though I'm in pain, even though I feel all this shame and this impulse to get mad or withdraw? How could I bring my value into this moment in time?" And preparing for that and helping clients rehearse and-- we use a lot of cognitive rehearsal where we visualize the event that triggered the schema, and then try to hold the emotion for a while, and then visualize actually acting on values instead of acting on the schema avoidance. So, yeah. It's cool stuff to, yeah, to bring schemas in and, and really look at how they're influencing relationships and use ACT as a way of responding and coping differently.
Keith Sutton, Psy.D. (34:18):
Definitely. Well, it sounds like, you know, because I guess the one way I think about it is, you know, in cognitive behavioral therapy, it was like: you're trying to refute or, you know, kind of get rid of these negative thoughts or so on in ACT you're acknowledging, allowing those thoughts to be there, not necessarily getting into this battle, just allowing, you know, the positive, the negative, and so on. And it sounds like the schemes are almost like just a way of having a label for identifying some of those thoughts that-- to be diffused. And also, at the same time then, you know, kind of making a choice on how you want to respond, rather than react, to those particular instances. And that's why I think too, with cognitive distortions, with schemas, it oftentimes helps to externalize and simplify almost even what is getting triggered so the person can sometimes diffuse even quicker. And then, you know, kind of not react and again, be able to kind of respond into the situation.
Matthew McKay, Ph.D. (35:25):
Exactly. To be able to label.
Keith Sutton, Psy.D. (35:27):
Exactly
Matthew McKay, Ph.D. (35:27):
What kind of thought is this. And we know in Buddhist practice that labeling thoughts is actually, it helps distance from them. And they begin to lose their sense of truth. And the label simply puts them in the category like, "Oh, there's another one of my, 'I'm bad' thoughts." Or a defective schema, "Well, okay, yeah. And I've got a label for it. But I'm also now moving it at some distance from me, so that I am-- and also I'm not viewing it as the absolute truth, but as just a thought, that kind of thought again." So, yeah, I think schemas really are a helpful way of labeling certain categories of thoughts that are characteristic and are happening over and over again.
Keith Sutton, Psy.D. (36:20):
Yeah, definitely. And back with the kind of coping and the avoidance, the way I've thought about it too is that, you know, sometimes we might use these coping skills to be able to do some of the healthy kind of compartmentalization. We might need to, you know, having an emotional reaction, but we have to go back to work, or we have to do something, but then we can go back to it, sit with it, and be with that discomfort. Or sometimes, like the breathing techniques, just of helping you be grounded not to get rid of the anxiety, but to allow you to actually be with the discomfort and kind of sit with and ride that wave, rather than, again, kind of that more reactive, you know, aspect.
Matthew McKay, Ph.D. (37:01):
That's so right. I mean, and you know, we see this with anger all the time. It's like, "Okay, so let me pause for a minute and let me take a couple of breaths, which is a coping response, to reduce the arousal level that's part of my anger experience. And then while I am coping down my arousal, I'm also planning a values-based response instead of my angry, attacking response." So, yeah, coping can be a vital part of helping the client, any of us, move toward values-based behavior as opposed to automatic, reactive kinds of behavior.
Keith Sutton, Psy.D. (37:49):
Sure. Definitely. Yeah, and learning to kind of build that muscle to sit with that discomfort, and kind of create that wedge between the reaction and the response. And I guess one of the other things that I oftentimes hear from folks in relationship to cognitive behavioral therapy and different-- is that the person can get to the place of, "Okay, I know that I'm not a bad person. Whatever I can understand and I agree with these kind of rational thoughts, although emotionally I'm still having that kind of reactivity." So the top down part is kind of there of the kind of frontal lobe, "Hey, I know I'm not a jerk or an idiot, or whatever, you know, take some deep breaths," but there's such significant dysregulation. And I integrate EMDR into my work and also some internal family systems kind of informed. And I kind of think about those approaches oftentimes are helpful with the bottom up as well as of course exposure. I was just wondering if you had any kind of thoughts on that, or if that's something you ever hear where people kind of saying that, "Yeah, the cognitive behavioral gets us, you know, ahead, but it doesn't quite kind of finish helping the person process," especially with trauma, for example.
Matthew McKay, Ph.D. (39:14):
I mean, I agree with you. I mean, I use EMDR a lot and we use it at our clinic a lot. And we use it to target, of course, the trauma memories, but we also use it to target the trauma-driven beliefs or schemas that accompany trauma. You know, one of the problems with treating trauma just with, you know, prolonged exposure or, what have you, is that you can reduce the person's-- the effect of the trauma memory. It no longer has the ability to intensely activate the person and create intense levels of pain, but it doesn't necessarily change the beliefs about self that the trauma created. So if I have a defectiveness belief or I have a responsibility belief, I'm responsible, this, "I'm bad, I made this bad thing happen," and those kinds of beliefs are not necessarily changed by some of our classic trauma treatments.
Matthew McKay, Ph.D. (40:26):
And EMDR, on the other hand, does target beliefs, and we can actually go right after those negative beliefs and we can actually, kind of almost miraculously, install alternative positive beliefs. And I see this happening over and over and over again. So yes, we can. And that's one of the advantages of EMDR. And also, you know, what you said is really true. The person actually knows that it's not true that they caused this pain, or they, you know, they're responsible, but they still feel that way. They still feel like, "I'm wrong, I'm bad. I did this." And no amount of cognitive restructuring really seems to be able to touch that. And we do need techniques that can change those cognitions on a deeper level. We also use a bilateral stimulation technique called ART: Accelerated Resolution Therapy. You use that? Yeah.
Keith Sutton, Psy.D. (41:29):
Well, I just actually interviewed Laney.
Matthew McKay, Ph.D. (41:32):
Yeah, it's really cool stuff. And, beautiful, beautiful therapy and it's also therapy that helps change the physical experience of trauma as well. And so, I mean, there are therapies that are now giving us more tools to impact these negative trauma driven beliefs. So I'm really grateful that this stuff is all emerging.
Keith Sutton, Psy.D. (42:04):
Definitely. Yeah. And I don't know if you've gotten into any of the internal family systems such, you know, I've thought about almost like, as my thinking's evolved with the CBT-- and I came to CBT, my minor in undergrad was in Eastern philosophy. So it really fit for me, you know, the CBT and the way that our perceptions color our experience. And I've thought about, you know, in CBT originally, you were trying to kind of get rid of those irrational thoughts or refute them, you know, ACT you're accepting and allowing all to be there. And IFS is almost like, you know, kind of looking at, understanding that those thoughts, that part of you, how they're trying to protect you, how they're trying to help you, what their function is. And you think some of those right brain exercises to get to know them and understand them, because sometimes, yeah, just the cognitive restructuring, you know, may not kind of shift it. And so there's another function that sometimes we're not as even aware of or the danger of giving up that protective part.
Matthew McKay, Ph.D. (43:08):
Yeah. And I sort of suspect -- I don't know what you think about this -- that IFS kind of has some of its roots in inner child work. And identifying that vulnerable part and figuring out what its needs are. And instead of trying to deny its reality and its feelings, it's like, "Well, let's make room for that part of me and also find a way to nourish it, protect it." So, yeah, I think there's a lot. It also goes back to something called Psychosynthesis. Assagioli, the Italian psychologist who, you know -- and so parts work actually has its roots in Psychosynthesis. It's very cool work. And Gestalt therapy used to-
Keith Sutton, Psy.D. (44:04):
Love that, I was going to say. Yeah.
Matthew McKay, Ph.D. (44:06):
And you know, being able to speak for the different parts and having have two-chair or three-chair or four-chair work where you have the different parts all able to convey some of their experience and their needs. Anyway, it's all fascinating and I think the internal family system is adding a lot to our repertoire of ways of responding to trauma, I think in particular.
Keith Sutton, Psy.D. (44:36):
Definitely. Yeah, and I would love to get your thoughts, since we're talking so much about trauma, and I know you came-- I had a dinner some years ago where I had a number of different folks that work with trauma -- yourself, some folks from ACT, folks from hypnosis, folks from AEDP -- and we were just kind of talking about, you know, trauma and working with trauma from these kind of different perspectives. And in the last ten years or so, I've been really digging into Complex PTSD and really kind of understanding that more -- really inspired by Pete Walker's book Complex PTSD: Surviving to Thriving -- and I was just kind of curious about your thoughts on Complex PTSD, because I think as you get more and more into trauma, right, that there's, you know, there's the single incident trauma, but there's also the more complex trauma where the person was -- and the way I kind of conceptualized it is -- when the person was growing up in prolonged periods of fight or flight as a child, either might be physical, sexual abuse, might be an alcoholic, you know, unpredictable parent, might be neglect, or so on -- basically not feeling safe and having to kind of take care of oneself. But this really kind of wires the nervous system and affects sense of self and, you know, part of the-- some of the structural dissociation models and such. And yeah, I'd love to hear any of your thoughts on complex PTSD.
Matthew McKay, Ph.D. (46:05):
Yeah. Well, at our clinic, I would say 70% of our clients have complex early childhood trauma -- physical or sexual abuse primarily and repeated. And you know, some of the things that make complex trauma more difficult to treat and really special, are that it's more likely in complex trauma to have these schemas because these are events that are repeated, they're happening early in life. And so it's during that period that schemas are most likely to form these negative schemas -- the, you know, the, "I'm bad," schema or the abandonment schema, or the distress schemas, and so forth -- that we see associated with trauma that also then have the effect of damaging relationships. And so complex trauma in my view is, you know, very challenging because those schemas end up functioning somewhat independently of the trauma memory and the trauma emotions, and having an ongoing effect on relationships, and on life, and they have to be treated. The other thing is, the complex trauma is more likely to affect the person on a physical level. And that's why, you know, polyvagal theory actually, I think, is more relevant to complex than simple trauma.
Keith Sutton, Psy.D. (47:56):
Yes.
Matthew McKay, Ph.D. (47:58):
So, yeah. You know, we're having cognitive effects in terms of schemas, we're having physiological effects in terms of dorsal vagal impact. And so, we have to have treatments that go beyond the standard, you know, prolonged exposure and what have you, because those things have to change, otherwise, a person isn't necessarily going to get a whole lot better. Just making sure that the memory is no longer disturbing isn't sufficient. And of course, the problem is that there are also a lot of memories.
Keith Sutton, Psy.D. (48:41):
Exactly. There's, there's a lot of different pieces.
Matthew McKay, Ph.D. (48:45):
And, by the way, when, in terms of dealing with, you know, multiple memories, I think ART -- Accelerated Resolution Therapy -- works better than traditional EMDR because you can weave together quite a few different experiences into a single scene, and simultaneously. Whereas with classic EMDR you've got a snapshot that's one moment in time, and you might get some halo effect from it, but it doesn't allow you to weave together multiple events into a single treatment experience. So, I think that, you know, complex trauma may be more easily treated with ART than classic EMDR. So it's just a thought here.
Keith Sutton, Psy.D. (49:30):
That's great. Well, that's great. And your experience that's been-- and something that's added and really kind of, you know, helped. Yeah. I'm just learning about ART and, you know, I've been hearing such wonderful things, and it sounds like a lot of people are finding it very effective in their work.
Matthew McKay, Ph.D. (49:48):
Really effective.
Keith Sutton, Psy.D. (49:49):
Yeah.
Matthew McKay, Ph.D. (49:50):
And effective for different reasons. One is just because, again, it does tend to focus on the physiological experience so that it keeps processing what's going on physically while you're processing the image in the memory. And so that's, I think, a really nice advantage. Second advantage is that you can process multiple related or thematically connected events at once. But, a third advantage is this whole thing about -- which you probably know now because you talked to her -- but, is with the so-called director's cut, where you can literally change the memory and when the memory is reconsolidated back into long-term storage, it actually goes back in a different form. And classic EMDR does that too. It tends to strip the memory of a lot of the emotions.
Matthew McKay, Ph.D. (50:48):
So when it's reconsolidated, a lot of the emotion is now disconnected, is gone. But with ART, you can literally change the memory itself. And it gets reconsolidated in a different form, particularly with resourcing. You can resources back to the moment of the trauma and change what happened in the imagery. And then, when that's reconsolidated, the memory now includes that resource, and all of what the resource did or said at the moment of trauma. So it's really got some wonderful advantages that I think-
Keith Sutton, Psy.D. (51:30):
That's great
Matthew McKay, Ph.D. (51:31):
--are worth learning.
Keith Sutton, Psy.D. (51:33):
Wonderful. Well, you know, we're nearing towards the end of our time, and I'd love to, you know, hear kind of what's next? What are you working on or what are you thinking about or what are you excited about recently?
Matthew McKay, Ph.D. (51:48):
Well, I have a textbook that's going to be coming out, I guess early next year. So, it's basically precision therapies, you know, it's precision-based cognitive therapies -- PBCT -- and it's using these 11 mechanisms and has a system for, you know, measuring them and then creating a unique treatment for each person depending on which of the mechanisms that they endorse and are elevated for them. And it starts with actually treating the stress that's maybe, you know, straining the whole system. But in any event, I'm really moving in that direction of precision therapy. And Steve Hayes has been doing that too. I mean, his work in process-based therapy, PBT, is basically precision therapy. It's saying, "Okay, we're going to see exactly what's wrong here, locate the problem, and we're going to -- and of course he uses network analysis to actually visit his assessment, which I think is too complicated -- but the point is that we're all moving in that direction. What exactly is the problem? And how can we line up and make our treatments uniquely focused on what this client is struggling with? And that-- I think we're all kind of moving in that direction and away from protocols, and that's kind of where I'm going.
Keith Sutton, Psy.D. (53:48):
So it's kind of, you know, being more precise, and, kind of, directing exactly what's happening for the client, and ultimately being more efficient, and really kind of addressing the client's issues.
Matthew McKay, Ph.D. (53:59):
And the key is, how do you measure what's going on for the client? Because that ultimately is the big question. How do we identify the things that we're going to target? You know, and we do it with, you know, our comprehensive coping inventory. Hayes does it with his network analysis, and other people are, you know, using other methods to do the assessment. But the point is that we have to have effective assessment systems in order to figure out, "What exactly are we targeting?" And so that's the challenge, I think, of precision-based cognitive therapy.
Keith Sutton, Psy.D. (54:37):
And how do people access your inventory?
Matthew McKay, Ph.D. (54:40):
It's at Harbinger. You can go to the New Harbinger website and it's free. And also there's a scoring system there. Go to the website and then just type in, you know, "comprehensive coping inventory" and you'll be taken to a place where you can take the test and also it gives you a score.
Keith Sutton, Psy.D. (55:05):
Okay. Great. Well, this has been wonderful talking to you today. And I just love the work that you're doing and just-- it sounds like you're always thinking and integrating and evolving in your work, and so I really appreciate you taking the time. I think this will be really helpful for folks to hear about.
Matthew McKay, Ph.D. (55:22):
Really enjoyed chatting with you, Keith.
Keith Sutton, Psy.D. (55:24):
Great. Thanks a lot. Take care. Bye-bye.
Keith Sutton, Psy.D. (55:27):
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