Radically Genuine Podcast with Dr. Roger McFillin

Sean (00:01.278)
Welcome to the radically genuine podcast. I'm Dr. Roger McFillin. Prior to and during the pandemic, as the world's mental health plummeted, the volume of mental health content on social media surged. Today, the hashtag mental health boasts over 70 billion views. Adding to this, TikTok's popularity has more than doubled since COVID struck. And now TikTok therapists are broadcasting advice to their followers.

in large numbers. As more and more therapists have begun posting advice online, especially on TikTok, professional bodies have been struggling to keep up. In the United States, the American Psychological Association recently published its first set of social media guidelines for psychologists in October, 2021, but these guidelines fail to effectively address the issue.

The truth is that American culture is undergoing a radical transformation, driven in part, if not entirely, by technological advances and the rapid dissemination of information. The world is shrinking and the concept of mental health has become nebulous and lacks consensus as it has been commodified and packaged for consumption.

Some of the social media content produced by therapists and psychiatrists borders on the absurd, overgeneralizing complex concepts and producing intellectually vapid ideas that reflect an obscene toxic positivity, pop culture understanding of health in combination with some skewed version of identity politics. Some therapists are purposely building a brand and clearly love the attention and potential for side income. Some are...

clearly political activists disguised as mental health clinicians. On the other hand, as our collective mental health deteriorates and scientific and medical misinformation is disseminated to serve various industries, psychologists and researchers like myself are confronted with a dilemma. We must decide whether to speak out against the harms and attempts to promote meaningful change that are aligned with our ethical obligations or maintain relative anonymity.

Sean (02:19.438)
to adhere to the traditional persona of what a therapist should be. Regardless of the choice made, consequences await. To discuss this issue and more, I came across an interesting debate posted on social media between our guest today, Sarah London, and therapist Sarah Winn, who is the host of the podcast, "'You Must Be Some Kind of Therapist.'" She's also an associate producer of "'No Way Back' The Reality of Gender Affirming Care."

Stephanie has over 30,000 Twitter followers. The debate arose after Sarah, our guest today, became critical of Stephanie's online presence and the implications of her content. Sarah has been critical of therapists, use of social media, and the dangers of therapist influencers. Fireworks ensued and they decided to debate the topic live. I found it actually very refreshing, given the current social media culture, as well as...

generating important questions that are rarely asked. Found our guest to be fascinating and interesting as I started to explore more of her work. Sarah London is an author and freelancer. She has a master's degree. She writes in psychology, mindfulness, modern therapy, culture, and work-life balance content for a global client base. Her first book, which I just finished reading this morning, which is based on her intensive graduate research program and psychoanalysis is

called The Performance Therapist, an authentic therapeutic identity, which was released earlier this year. She's also a former Psychology Today blogger, current Substack columnist, and she creates think pieces, interviews clinicians about various topics in mental health. Sarah, welcome to the Radically Genuine Podcast.

Sara London (04:11.001)
Thank you for having me. I hope you liked my book. Good.

Sean (04:13.99)
I did. I mean, I got tons of questions, of course, as I always do. And I think it offers us an opportunity to have some nuanced discussion and certainly on the role of the therapist and where therapy in the way that we define it is. Changing as American culture changes, but one of the things I wanted to ask you is you seemed very surprised when I chose to follow you on Twitter and invite you on the show. Why were you so surprised?

Sara London (04:42.536)
I'm so used to the very divisive culture of Twitter that when I see someone who I consider a big name, to me you're a big name because I see you everywhere. When I see someone like you follow me, I'm like, oh man, what is this about? Like immediately my radar goes up and I'm a little bit mistrustful, which again, reflective of online culture, definitely would not have happened if you came up to me at a conference or something. But that was just my first inclination was like, oh God.

Oh no. Which I know now is not. And actually, you know, it's funny, I learned something from it is that you really shouldn't, you know, look before you leap when it comes to that stuff. You really never know who will start following you and be interested in you even if you think like, oh, this person might more so be affiliated with a different side or, you know, stuff like that. Because I know you did have Stephanie on the podcast before. So

Sean (05:33.038)
Actually, I was on her podcast. I haven't had Stephanie on my podcast yet. Yeah. Yeah, so I wanted to ask you, so what that says to me is that you had a certain idea of me or there is a persona that I was presenting online that you believed would somehow maybe conflict with some of the things that you're writing about or posting about. And I think that's a great way to open up the discussion is what did you assume was my persona or my personality or who I am by way stop?

Sara London (05:35.784)
Ow, whoops.

Sean (06:02.626)
by what I do post on Twitter.

Sara London (06:05.948)
Definitely your Twitter persona I find to be a lot more, I guess I would use the word incendiary because it's a character limit of course included with all this stuff and you wanna get engagement and there's like a lot of other factors when it comes to this which I do kind of reference in my book of like, it's really hard to just do one thing, be an authentic therapist anywhere because like there's so many other variables out there that will influence you in one way or another. And so I guess when I saw your online content and I saw

this very kind of like strong opinionated force, mostly about meds and stuff, which I do definitely agree with you on some of that stuff. But still that very, I guess, kind of forceful image was one that I had to contend with. And I thought, oh, so this person is gonna be just as, I guess, opinionated about something that I have to say as they are about their own, you know, things that they talk about usually. And again, that's very different from.

the person that I know you to be now listening to your podcast, which I find kind of fascinating that that's like this very, uh, like what social media does to a person, what it does to their image, what it does to their ability to relate to others.

Sean (07:16.278)
Yeah, that's where I thought your points were really valid when you were having that debate with Stephanie. And if we could stay away from kind of extreme ends of an argument and, you know, kind of walk a middle path together today where we can accept multiple truths to occur, then let's start with what I believe your arguments were extremely valid, was that we do have a responsibility as...

mental health clinicians and me as a psychologist, I do believe I have a responsibility in how I present information to the general public and how I disseminate that information. And that could negatively influence somebody in the way that they're interpreting it or reading it. And it's also balanced with, I think, other aspects that are related to the ethics of our field.

So if you probably are learning more about my background right now is how much research I have done and how much work I do with people who have really suffered from psychiatric diagnoses and the psychiatric treatments which are pharmaceutical based and how many people are harmed and trying to advocate for a harmed population and try to disseminate information to the greater public in order to at least provide informed consent and prevent other people from going down that road. Where.

where now I understand more after reading your book about what actually performance art actually is, is that I had to create content in a way to bring attention to the issue. If I just did what I was always doing, then no one was going to get this information. And I...

believed I had information from my understanding of the scientific literature and my experience in working with patients over a couple decades, that was necessary for me to report to the general public. And so just typical being an academic in some way leads you to only have academics are the ones who are kind of following you. And I was angry. A lot of this is genuine.

Sean (09:28.674)
The language I'm using is kind of the way I would talk about this day to day. And I just decided that I'm just going to type my thoughts out, you know, how I'm thinking about something, I'm going to write it out. And then that is eventually what led to attention to the issue and increasing. Uh, the follower count that put us in a position to have more nuanced discussions on the subject and others on the radically genuine podcast. So my question for you is.

like given that context, would you question, you know, the ethics and the value of doing something like that, like the choices that I personally have made?

Sara London (10:08.524)
Um, my answer would be that it all for me boils down to intent. And you could also say this about performance art too. It's like when someone like does something stupid, like they spray paint like a penis on a wall or something and they're like, it was performance art. And then you're like, no, you just did that because you're an idiot. The reason that someone would go online and say what they have to say, say their piece with their credentials, if they're doing it for a purpose, for a higher purpose, for the benefit of mankind.

Sean (10:22.85)
Thanks for watching!

the

Sara London (10:37.916)
get across a political motive or to try to sway people one way or another or to get money or to get followers. You have to weigh intent. And of course, I talk about this a little bit in my book, I tie together in my head intent and authenticity because authenticity is not black or white and it's non-static. So you can have the intent of something and also do things that might be slightly against the natural intent of what you would want.

your message to be to get across the message, if that makes any sense. So like going online and you're like, oh wow, I'm really angry. I'm going to post something that reflects my anger. Like you also have to remember at the same time, like Twitter is a culture of anger. So you're this feeling is a genuine feeling. This feeling is a genuine emotion. It also exists in the confines of this space in which anger is a very prevalent emotion for many people. And those two things exist simultaneously, you know, holding two ideas in your head at once.

The answer to that would be, I would judge anybody's intent before I judged their, you know, what they actually said and did, because this world is way too complicated to have any kind of black or white thinking.

Sean (11:46.474)
Yeah. I got a question. Is it possible for a professional to 100% be authentic through social media? It's almost like, Roger, what percent of your persona do you believe is authentically you? I think that gets into the deeper question of trying to define authenticity. So, you know, I was trying to think through some of the some of Sarah's

chapters around like the definition of authenticity. And so I want to bring it, you know, to her first about like, let's try to identify what that actually means. And then we can talk about like who I am, like who I am to you Sean as my brother is different than, you know, the clients who I, I presented myself to the clients yesterday and maybe who I am on a, on a podcast or who I am with a friend. And in my opinion, all of those are aspects of me.

amongst different contexts. So like, I want to get Sarah's kind of thoughts on authenticity. And then we can move on from there.

Sara London (12:53.232)
So first off, I want to say I was so excited for this question because I cannot wait to tell you how much I dislike this question. I'm so excited to talk about it. You did it. You did your job. Because I love talking about this issue. I love talking about when people ask me like, okay, you wrote a book on authenticity. What's authenticity? My answer, the answer that I'm pulled to say, is I don't like to tell people what authenticity is.

Sean (13:01.986)
Glad I could help. I'm going to step aside a little bit.

Sara London (13:20.572)
because I think that the more you try to tell someone, the less authentic it becomes. You really have to know what's authentic. I think, let me like, sorry, pull something up back here. I am a mess without the written word. In my book, I put that authenticity is like its connection and communication and sensitivity and curiosity and empathy and all these other things, which to a therapist would be kind of intuitive authenticity. But in reality, authenticity in the way I would define it, which again,

everyone would have a different definition because it is like the core of what it is to be a person. It's the urges and desires and the feelings that you have at your base sense of who you are as a person. So it's not a choice, authenticity is not a choice, something that you're pulled to. It also can be, again, like really convoluted because sometimes you're pulled to stuff that you feel like may be authentic, but really that's just a displacement or a projection or other things. So again, like

I think it's more helpful to talk about what authenticity looks like than what it is per se. So I think I mentioned this before, is that authenticity is, you know, it's not black and white. It's not something that you can just say, I am authentic or I am not authentic. It exists kind of in this unconscious state where you have multiple potentially conflictual thoughts going on at the same time about any given experience. So with.

DW when it cuts hate in the counter-transference. Without love, there is no hate. Without fear, there is no pride. It's all these things that contrast all at one time. You have all these feelings. It's also not just an abstraction. It's not just like I am authentic in a vacuum with myself when I'm home alone, because sometimes that might not be the case. You have to weigh your internal processes with also what's going on in your external environment. So you're not always authentic. You're always...

not authentic, it's whatever it is in the different context of your life that you're in. And the other one I thought is that authenticity is not a linear journey. So it's not like one day you're born and you're this tabula rasa and you're an infant and you're as authentic as can be and all you want to do is you know use your diaper and eat and cry and be held. And that's your authentic self. Authenticity is not you start out in one way and you end in another. You are sometimes authentic, sometimes not.

Sara London (15:38.032)
in different stages of your life, in different places. I don't think necessarily that someone who is 70 years old is more authentic than someone who's 40 years old or someone who's 20 years old, because again, different stuff happens at different times. Which is, I know this is totally a non-answer to a question, but I hope that helped a little bit.

Sean (15:56.938)
Yeah, I think we have to tie it down to some specifics, right? Would you agree that authenticity is an important presence for a therapist to be effective?

Sara London (16:08.841)
It is paramount. Without authenticity, there is no therapy.

Sean (16:12.414)
Yeah, I would agree. My challenge in my history with receiving some psychoanalytic dynamic training, although I'm a board certified in behavioral and cognitive psychology and I do dialectical behavior therapy, I did receive some training in psycho dynamic and analytic therapy. And I had a hard time with the stance of a therapist from that perspective, because I didn't see it as being authentic.

I thought it was extremely limiting in your role is almost like a blank slate in some ways and like, putting any aspect of the self to the side and therapeutic neutrality and things of that nature, when I believe there is a power and a relationship and an energy in that and collective humanity in a connected kind of experience where there's an openness and a genuineness is extremely valuable.

But your background, your training, your academic world seems to be around psychoanalytic understandings and philosophies. I think I even read that your fiance maybe is a psychoanalyst, is that true? So how do you see the role of the therapist as a psychoanalytic or psychodynamic therapist?

Sara London (17:26.108)
That is true.

Sara London (17:35.668)
So I think that there's sometimes this misunderstanding about how neutral and abstinent a therapist needs to be. I think like back in the day, it was, you know, guy with glasses sits there and it says absolutely nothing for 20 years and you just talk about all your neuroses and then you're never cured and nothing ever happens. And that's like what people usually think of when they think about analysis. But it's so much more than that. I think the literature has really evolved, especially in like terms of relational psychoanalysis, which kind of.

puts the clinician more at center space in the therapy. But I also think like, you kind of bring up something important, which is I think that in order to be a therapist, there is a balance between authenticity and performance, which I say in my book. So the performance kind of realm of it is that oftentimes you're taught to do things that would not normally be intuitive for you as a person, different for everybody. So like the structural performance is what I call it. It's kind of the bare bones of your practice, the house from which you

build your theories, your training, your schooling, your supervisors, your all that stuff, just the actual academic portion of it. And so I think a lot of people are trained, especially in the psychoanalytic field, to do these things that they wouldn't do when they're out with a friend. When you're out with a friend, you would not be neutral and abstinent. You would be like, oh my god, girl, I can't believe he did that. So like at the same time, in other modes of therapy, I think that can also be applicable. So

really not super familiar with DBT, roughly familiar with DBT, but I'm sure in your training, it kind of taught you things to say, things to do, that maybe did not align with what your intuitive impulse was. And I'd be curious to hear if you have any examples of that. That'd be really cool.

Sean (19:15.454)
Yeah, no, actually want to share the opposite with you is what attracted to me to DBT was that the training isn't in that perspective of training me to say or do things that are opposite to what my you know, impulse ours. So I don't know if you understand the background of radically genuine

Sara London (19:34.236)
I'd love to hear it.

Sean (19:35.434)
Okay, so radically genuine is considered a high level of validation. So there are six, there are six different stages of validation, ways that you can validate from lower level to higher level. Radically genuine is actually a concept of treating the individual as an equal. That, you know, it's eliminating all therapy speak.

that is it's truly trying to interact with that person as a human being on their level, in some ways trying to even eliminate the hierarchy, understanding that one that does exist, but trying to even move past some of the traditional rules that have been developed and therapy in itself is in its infancy stages still. But a lot of the theorists that you were referring to in your book, I mean, we're talking 80 years ago or even more, right? So it's like,

It's a different culture, it's a different time, and it's of limited understanding. So there are a lot of limitations and boundaries of what the therapist or who they should be. When dialectical behavior therapy was a treatment that was developed for people who were really experiencing their emotions quite intensely and have a history of invalidation, and that invalidation from the environment has generally led to difficulties in regulating really intense emotions.

So just the therapist being kind of non-responsive or non-reactive or acting in therapy speak or under certain rules in which they should behave is extremely difficult for that type of client to tolerate. And so it's really important that you change your persona. I mean, actually not change your persona. Don't provide that therapist persona, right?

where you're there, you're kind of analyzing and you are making interpretations on behavior and just exploring openly. It's being real, actually just being real. And that's considered the highest level of validation when you can truly be that to an individual. Now that's extremely hard to achieve because there are so many variables that are affecting the therapist, mostly fear and mostly previous training and ideas. And so one of the...

Sean (21:45.57)
things that I was probably concerned about in your viewpoint from some of the therapist's content online was that in some ways it seems to limit the therapist into a restricted role. And they're not allowed to then enter into various public spheres and have opinions and be a separate person. Because that somehow could

damage the therapeutic relationship of their current clients or impact their profession in some way. Now I could be off on that, but that was one of my concerns.

Sara London (22:23.208)
I think that, you know, in a perfect world to some psychoanalytic thinkers, we would all be, or not we, royal we, editorial we, would be, you know, these neutral analysts who never went on the internet, never even had a social media account, never did any of that stuff. But we don't live in this, you know, utopia in which therapists are all blank screens because they're also people.

especially we live in the world of social media, of Psychology Today profiles, of podcasts, of interviews. We have therapists who are using their platform to be public facing. And I think that while it takes a certain level of responsibility, it shouldn't be completely discounted that this is something that therapists can do to help spread a...

a better message about things that are going on, which actually interestingly feeds into what I was going to say about the DBT stuff, which is I can totally understand how modern therapists would be pulled to DBT to cut through the bullshit. Because when I was listening to Radically Genuine this week, something that really struck me was this frustration, mounting frustration with the way that things are in the therapy world now. Everything from the way that medicine is prescribed to people to the way that we use therapy speak to group think to all this stuff. And I can totally understand.

I also roll my eyes to the extreme at the therapy jargon that we throw around and think that it means something when ultimately it's just a bunch of empty phrases. The same time, I think I would say that really...

I have trouble conceptualizing a real relationship that doesn't exist between a therapist and a patient without some sort of known exchange, without some sort of, I guess, I would say the word power dynamic, which I don't know if that's a great term to use, but it's the one that I have available, so I'm just gonna use it, which is that one person in the relationship has a degree, they have training, they have the ability to create a holding environment for this other person.

Sara London (24:27.42)
and the other person is there to receive help. And that inherent structure, I think, creates a certain relationship that is unlike any other, that really, I think, boils down to something a little more than just like, I'm being real and you're being real and we're both real with each other, because you can absolutely be authentic with another person without feeling like you're constrained by the what seem like very rigid psychoanalytic values that are put onto therapists when they choose to enter into that training. But at the same time, I think that there are things

that are a little bit more, it's a little more structured and I think that structure helps. I think that structure provides something for the patient and of course for the therapist too. I mean, what would a therapist do if they went in and they really didn't know what they were doing? They had no training, they had no letters after their name. They would just be a friend. They would feel helpless to be able to contain this other person's emotions.

Sean (25:23.722)
Yeah, I guess if we identified the dialectical extremes on one end, it would be without any boundaries or without any clear, you know, professional purpose, and it's just developing a relationship. And the other end would be around some, I think, very restricted and professionalized role as a detached human over there that is, you know, unable to connect with you in an emotional way.

I think when we talk about what radically genuine does mean, we're still clear about the professional boundaries. And there is a contract that's developed upfront between a client and a therapist or a psychologist. And that's where you are talking ahead of time before you do therapy. You are choosing to enter into a certain agreement. This is what I do. This is who I am. This is how I help. This is the manner in which I do it. Here are the limitations.

Here are your alternatives. And that's actually a legal and ethical imperative. It's called informed consent. And it's also like probably important that if you as a therapist do other things and psychologists may be different like that. I don't identify as a therapist. I was trained as a psychologist. Psychologists have multiple roles. Some are researchers, certainly provide therapy. I also do various psychological interventions.

I do research myself, I do consulting, I do what's called coaching in both the role as a therapist and outside of other areas, which is taking my expertise and giving people information that they can use to help solve problems that may exist. So there's just this diverse role for a psychologist. I just feel like mental health treatment is certainly going to be moving in that direction.

away from these singular aspects of medication and therapy that have been part of the past that really don't have great outcomes, unfortunately. And then what describes, what defines therapy can differ so greatly. I probably would be considered the anti-psychoanalysis analyst by everything that I believe in. In fact, I have traditionally seen psychoanalysis as almost like a luxury of

Sean (27:47.614)
in a way that doesn't have a lot of value for assisting the overwhelming amount of people who are suffering and the people I see on a day-to-day basis. It's kind of really only practiced in some of the major cities with practitioners with cost ranging from $250 per session to $750 or even more per session.

Sean (28:12.09)
some of the some of the cases that I'm working with people with very severe eating disorders, suicidal, self-injurious, been victims of some of the most horrible abuse and neglect and the only way they're able to afford any help is the use of insurance. Rarely are you going to find psycho and psychoanalysts or psychodynamic therapists able to know how to effectively

help those people, especially in early stages, when they're so dysregulated and they're entering in substance abuse or other problematic behaviors. And we have some good scientific evidence to support that, that doesn't diminish its value and that it has value for maybe a certain group of people under certain contexts or certain times. But there's so many of these.

Sean (29:04.318)
I want to sometimes call them gurus in psychoanalysis, Jonathan Shedler being one of them, that kind of he posts information without a lot of substance to it. So you know, it's always this great personal growth and what is real therapy, it's very romanticized and he can't really provide much detail on how maybe someone who is in really these extreme

states of distress and chronic mental and physical health problems are able to really improve. And then you look into his background, and he's kind of venturing back and forth from Aspen to San Francisco, you know, seeing clients who can pay $500 per hour, like who's he seeing, right? And what, what is his experience? Come to my center and sit with the people that I'm working with and tell me how you apply what you know.

to help that person, I guarantee you, they will drop out really, really quickly. Or you're just not going to make enough progress to help someone who's in life-threatening situations. Let's say you.

Sara London (30:13.248)
I love the Shed, so I can't hate on him too much. I really, some of his work that I read in grad school, it was just incredible. Shed their 2010 Denver University study is just like this insane, amazing, like groundbreaking work on empirically evidence psychoanalysis, which is very fun. At the same time, I completely agree with you. I love psychoanalysis as a way for me to look at the world as a philosophy.

as a way that I can understand the world around me as a way to analyze things that don't make sense. I think that when you're looking at populations who have not that much money, not that much time, I think I certainly made this argument in a paper or two in grad school that what happens when someone is working for 55 hours a week at three different jobs, 60 hours a week, and they can't afford the time to much less make their kids dinner.

if you want to get psychotherapy, that's even more insane. You need things that are very practical and things that can help someone on a day-to-day basis get out of this kind of hole that they're in. And I think DBT and CBT, of course, can be very useful for this because it's like very actionable items, stuff you can really do. Then you have the luxury of being able to be curious at a different time. That being said, I think that we shouldn't kind of say that the tenets of psychoanalysis are only for a more...

distinguished class who can afford it. I think that anybody can take things from psychoanalysis, stuff like really being curious about who you are and the environment that you're in, why you think the way you think, what you do the way that you do. And I think that all of that is just so important for being a person who is engaged in the world around them. I think it shouldn't be just something that people can afford who can get it.

I think that these things are things that people can think about whether they are in psychoanalytic therapy or not in psychoanalytic therapy. I think that there's a place anywhere for curiosity.

Sean (32:15.862)
Yeah, totally agree. And I think there's a time and place for that type of work. And my problem with the general psychoanalytic academic like Jonathan Shedler is he's not going to acknowledge certain things. So you have a client who steps into an evaluation with you and they're binging and purging three times a day. They can't keep food down, maybe a few times a week, or they've been in hospitals before that hasn't worked.

And the attempt to do psychodynamic or analytic therapy with that type of client who's in what could be a potentially life-threatening situation requires you to utilize other interventions, behavioral-based interventions, pull from the medical literature, motivational literature to actively work with somebody in a skill-based way. You know, one of, there's a randomized trial that occurred.

that was published in the American Journal of Psychiatry in 2014. And this was done by psychoanalytic clinicians in Europe. So it was a center for psychoanalysis where they were trying to prove that they could have lasting effect with like a clinical presentation like an eating disorder, severe as an eating disorder. And what they did is they created a randomized controlled trial where

One group got only 15 sessions of a treatment called CBTE, it's an enhanced form of cognitive behavioral therapy for the treatment of an eating disorder, versus two years of psychoanalytic therapy.

How did those balloons just jump in the back of my? You hit something on your keyboard. We don't have balloons back here, but I hit something on my keyboard. But to get back to my point, so two years of psychatlantic therapy versus, I'm sorry, it was 20 sessions of CBT over five months. And about 60% of the clients in the CBT session over the course of, in a two-year follow-up overcame their bulimic episodes.

Sara London (34:00.335)
We're having a little party.

Sean (34:23.114)
44% were better in just 20 sessions. And do you know how many, the percentage of people who were in the psychoanalytic psychotherapy actually stopped binge eating and purging? Only 15%. They were in therapy for two years and 85% of their clients were just as sick as they were when they started.

Sara London (34:48.24)
In psychoanalysis, two years is like the warm up. Two years is like, we're getting ready to do therapy.

Sean (34:51.371)
Yeah.

And so my problem with the model is that they don't recognize that. And someone like myself might work in 20 sessions with somebody and get them to stop binge eating and purging, but behind all that might've been a history of sexual abuse behind all that might be, is generally real, legitimate pain. And now we can start having a reasonable conversation about psychoanalytic

interventions and that process of recovery and growth and so forth. So we shouldn't be talking about therapies in terms of schools. We're way beyond that. These therapy schools, these treatment packages, we should be talking about what works for whom and why. And that doesn't happen in the psychoanalytic world. It almost feels cult-like to me.

Sara London (35:50.084)
I agree with you. I have my own issues with psychoanalysis, having studied it for such a long time, having lived in the psychoanalytic world. I've been in analysis for six years, like therapy for the first four and then analysis for the last couple. And I totally get that it sometimes can seem kind of cult-like. I have no idea the literature on psychoanalysis for acute conditions, but also like the other thing that I think is really constrictive is like,

the system that we're living in is just not realistic. When you get someone who comes into an emergency room and says, I feel like killing myself, that if they don't have insurance, like that hospital bill is gonna be insane, they're not gonna wanna pay for more therapy. If they do have insurance, their insurance company is gonna say, okay, here's 15 sessions to not kill yourself, you're gonna be fine after that, right? You're totally good. So like you can't do psychoanalysis in 15 sessions, you have to work with what you have, which I totally agree that like, I really in terms of like, people who practice psychoanalytically in New York, I can't.

think of a single one who practices only psychoanalysis. Everybody's interdisciplinary. So I think that unless you like go to Nipsey, the New York Psychoanalytic Institute and like see 400 year old people there who still are practicing like Freud did, which like that is definitely a dying breed. I think people are recognizing the realities of the world and kind of having to acclimate to those. But I do see there are issues in psychoanalysis. It is very...

it can be very exclusive. And I think they're trying to not have that, maybe be a little more inclusive, but there are definitely some issues. I mean, with any academic field, there are issues. With any therapy field, there are issues. I mean, do not even get me started on the cult of AEDP. I mean, that stuff is over the line for me and I'm sure there are a lot more like it. So yeah, I think it's definitely not a problem that's exclusive to psychoanalysis, for sure.

Sean (37:41.502)
I'm interested, maybe going back to the social media component in terms of, I mean, you guys went deep in the weeds on, on two different approaches to therapy, which was interesting. But when it comes to, you know, engaging in social media, do you believe there is a role for mental health professionals and therapists to engage in that space?

Sara London (38:05.22)
of us. Oh yeah, absolutely. Oh yeah, for sure. And I think actually, funny enough, I have looked at your substack, Roger, and I like some of the stuff you have to say. I really like the thing that was like five things to help your children understand mental health. I can't remember the name of the article, but it was like stuff like teaching them resilience, teaching them frustration tolerance. Like I think that in terms of therapists participating in the world around them.

Sean (38:06.038)
Sarah, sorry. Okay.

Sara London (38:34.1)
there's absolutely a place for psychoeducation. Because I think that the world right now, with the psychotic age of the internet and everything everything's going through, we need someone to come in and tell us, hey, everybody, just relax. This is what being a human is. We need to almost relearn some of these very basic tenants of being a person. And so I think that is definitely the place for mental health professionals to say, we are in a mental health crisis, we're here to help. And also, like, this is,

maybe a little bit of a hot take, but I don't think that if a mental health professional sees something that is not necessarily a strictly political thing, but something that aligns with identity politics issues, yet they see it as a mental health crisis or something that could turn into a mental health crisis, I do appreciate when I see someone speak up in a way that is respectful, that's dignified, that's well-educated, someone who writes papers about things that they see. I think that is...

something I really like. I like to see people engaging in what's going on now because otherwise we really don't have a voice for how crazy the world is. I mean, my whole thing is everybody has mental health, so everyone thinks that they're a mental health expert, but that's just not true. There are mental health experts out there.

Sean (39:49.942)
Yeah, I guess that's where I'm struggling is, you know, now that Roger's been engaged in that social media space for the last two years, I've seen labels of extremist viewpoints. And I'm always curious, like at what, what's considered an extremist viewpoint and to whom, because depending on where you are, and your awareness of certain things, it may feel extreme to you. So I'm curious.

What are your thoughts on that in terms of somebody who works in the field, becoming aware of certain topics that might be a little more controversial, trying to bring attention to those things and doing so in a way, because you use the word incendiary, uh, to, to kind of describe Roger at first. And, um, and, and maybe some of the content does come across that way, but the way that he's engaging in that space, is it being done in a way that is professional?

Um, to educate or is it being done in a way that's trying to elicit a response?

Sara London (40:52.948)
That's a fascinating question. I love that question. I think for me, the definition of extremism is something that is said diametrically, something that's said without the possibility of engaging in another side, that you just have one view of the world and that is the only view of the world and any other views of the world are not, they just don't exist. They're...

you know, seen as psychotic, you know, you need to do like reality testing on someone because they think that genders exist. It's like, ah, that's a little bit of an extremist view. But I would say that only someone who is posting their own content can look at their own content and determine whether or not they are open to the possibility of engaging with someone. I think oftentimes...

if you are open to the possibility of engaging with someone from a different sphere than you are, yet you say things that are on the surface seem to shut down the conversation, I think that that's something worth looking at, which I know sometimes I've seen, Roger, on your social media, it's these very kind of like intense statements. And I know talking to you right now that we have views that we disagree on and it's totally civil.

you're a smart, well-educated guy, and this is a lovely conversation. So it's so, I think, interesting how, and I think that this is really something that social media is doing, something social media is bringing out of us, is that it takes us and it turns us into people who feel like we need to have extremist views in order to get attention. And I don't think that's a thing. I don't think we need it. I think that the more we open ourselves up to having

reasonable dialogue the more we can make social media a better place.

Sean (42:50.67)
Yeah, I have a great example of that. So I think a lot of people would take this one statement that I've thrown out there and I've done podcasts on it where I say there's no such thing as ADHD and that gets everybody riled up until they understand what I actually mean by that because I talk about it with the nuance it deserves. What I say is that attention deficit hyperactivity disorder is a social construction.

It's not an identifiable medical illness. It's like nothing you can go into the doctor and test for. You cannot observe it. It is a label put onto a behavior or an action. So even the idea of focus or attention is very difficult to measure and it could be influenced by many factors. So if Sarah falls down the stairs and bumps her head and she thinks she's all right,

and then has some memory problems or some focus problems, difficult for her to read in the same way that she did previously. And she's just not herself. Without context, someone could label that as ADHD. She's having difficulty focusing. But the real problem was that she has a traumatic brain injury. Same thing if somebody, you know, is a victim of, you know, childhood abuse and neglect or someone's a worrier and highly anxious.

their symptoms of attention and hyperactivity are related to other reasons, other causes, same thing with nutrient deficiencies or other medical conditions. So the label of ADHD is widely applied without understanding its causes, which limits our ability to help somebody. And actually, in fact, it stops investigation. But what it does is it sells stimulants. So we have a manufacturing issue with

Adderall right now so many people are trying to get Adderall because it's a performance enhancing drug at least in the short term we have this rising number of people who I'd self identify as ADHD but so many of them legitimately have phone addiction and Aren't active enough or maybe obese or maybe depressed so legitimate reasons why they're not focusing But they take on an identity of ADHD

Sean (45:08.082)
ADHD was just created for the general public in 1980, you know, didn't exist before then. And it's also a label that is placed on people who are just on the spectrum of diversity. Now you put someone in the classroom, for example, and they're not meant to be there. And they want they meant to be active, they can't sit still for long periods of time, they want to be connected to nature, work with their hands, they're creative, whatever that may be. And now they're attaching to this label of ADHD.

So on the surface, when I say there's no such thing as ADHD, it sounds extreme because of what they know. They're limited in what is sold to them in the way it's been packaged. But when they have the conversation, if they look at the science or so forth, they get a better understanding of what I mean. Almost everyone who comes into this center at this point says they have ADHD. So it's just like, it just becomes extremely frustrating and we have to, I feel like I do have a role as a psychologist to be able to have

those greater discussions. So, and that's as a, as a marketer, um, I, I look at just social media as like one channel to communicate a message. So for Roger, maybe it's communicating the, uh, an idea through Twitter and doing it in the form of 140 characters or whatever, but the idea is like, you want to have your message coming out through multiple channels, let it be the podcast, let it be, uh, you know, YouTube as your media vehicle and there's TV print rate, whatever.

But we're limited, you know, as a small scale, uh, we'll call ourselves like a media channel at this point to communicate an idea. So the idea of social media and just using like Twitter as the example, because of the limitation within there, people know the space to be negative. So whatever comes through that might have an opposing viewpoint, the tone that people read those messages automatically comes from a negative perspective.

If they can read the same message, but adjust the tone in a more conversational way, then I think people won't get as angry to a viewpoint that often goes against there. So there needs to be the platform needs to evolve in a way where it is this open, you know, town hall to have these conversations and these dialogues. And I think that's why it's important that everybody's viewpoint is in there. And there's no algorithm, just kind of limiting what you're being exposed to. What are your thoughts on that, Sarah?

Sara London (47:27.02)
For sure, I totally agree. And I can absolutely relate to this kind of stuff. I mean, knowing SEO, search engine optimization, and all this other stuff that I need to know as a freelancer. I am very schooled in the world of clickbait. I wrote clickbait, getting started as a writer, got paid for articles like, you know, the top seven proteins you need to have right now and stuff like that. And it's kind of how I made my bones.

And I recognize that in some ways, it's extraordinarily problematic, but it's also in some ways kind of needed because otherwise you really can't get engagement. But I think fundamentally, I mean, of course it's a world we live in, so we kind of have to like do with it what we can, but I just think it really sucks. I just really wish that we could do things in a different way. And I think like, I would love to brainstorm.

at some point with some people about like, what do we do? How do we change this stuff? Because even though I'm certainly on my sub stack guilty of posting titles that I think will get some sort of, I changed the title of my book for the sake of SEO, my editor and I talked about it. I mean, it's just stuff you need to do in order to get yourself out there as a entrepreneur, as someone who has something to say. You have to speak the language of the people that you're speaking to. But I guess my problem is necessarily like, in some ways it's like,

are we handling? Maybe we should be handling it better. But in other ways, it's like the whole concept of this thing we feel like we need to do is just a big bummer, to me at least.

Sean (48:57.634)
No, I agree. And I want to go back to the original question for you, Roger, about persona and authenticity. Do you feel like your online persona through Twitter has evolved because of the way that social media rewards certain tones or messages, although your intent is still there, is it your message that's been adjusted based off of what gets traction? I don't necessarily construct my messages in order to get more

views. I think the ones that tend to get the most traction are the ones that really were authentic and emotional in the moment. So it has become a bit of an outlet for me. So you just get done with an evaluation of somebody who was hospitalized, they come out there on six psychiatric drugs, and they're, you know, they're sleeping 12 hours a day, and they had to

withdraw from school and then you learn more about their background and you understand that they are you know, just suffering from post-traumatic stress and they just really need help but they've been assigned five separate psychiatric diagnoses and they're pretty much sedated into a Lesser version of themselves and you're heartbroken and you feel helpless because there's nothing more than you can do but to help that one person, but you know, this is happening exponentially out there and so

using that as a way of just kind of communicate what I'm seeing. And then people responding and retweeting it, it's another way to disseminate information. And I think the radically genuine nature of that I think people connect with because it's different than the typical therapist or

Sean (50:51.178)
It's allowed me to go on other podcasts and different shows and be able to communicate this message, which I think is starting to gain traction. You know, I hate the word anti-psychiatry as you know, but there is a movement that's developed and psychiatrists are now a part of it too, that we're just moving out of this era of DSM diagnosis and pharmaceutical control and the distrust of the medical authority.

Certainly post COVID has allowed for a global awakening. And it's only going to, I've said this before, it has to come out of a place of love and compassion. If it's a place of trying to draw attention, I don't want that type of attention. I don't even like it. It was never a 47 years old. I didn't start doing this stuff till I was 45. That's not who I am. And I hate getting attention drawn to myself, but at the same time, I wanna be able to sleep at night and I wanna be able to have my life have some form of value and purpose. And so,

When I became more authentic to that side of me is when I started to feel better about what I was doing professionally. And yes, it does ruffle the feathers of some people. It's uncomfortable for others. For people who don't know what I know, it can come across in a certain way. But it has driven attention to a message. And we've sat on this podcast where we've had to talk to, you know, parents who've lost their child for suicide when they weren't suicidal prior to going on the drugs. And we're in.

There's no doubt the statistics are overwhelming. You know, when you see more and more people going on the drugs, you know, it, you understand that we're not doing enough. And so to me, it's, it's as authentic, as genuine as I can, as I can be while also maintaining a balance of professionalism and compassion. And hopefully that there's legitimacy to what I'm, what I'm doing. Cause I do balance with a lot of science and I try to bring on as many experts as I can, and I'm so open to the alternative.

perspective, you know, want to have those conversations. It's just really hard for people to be willing to jump in them.

Sean (52:52.974)
So Sarah, I'd like to go back to you in terms of this persona, authentic, authenticity, online image. You know, Roger's been at this for two years now. We've had the podcast for two years, and we've put out some content on YouTube. Everybody go and follow us on YouTube, please. A lot of work goes into that. But if you were to be critical of the work that we're putting in terms of your position about the role of a therapist in online space, what would that criticism be?

Sara London (53:26.085)
As in...

Sean (53:29.072)
in terms of like maybe our intent.

Sara London (53:37.7)
I don't know. I have to think about it. I haven't thought about it that much. What I was going to thinking about though, is I think there's this kind of like elephant in the room when I talked to therapists about this, especially therapists who are online and trying to get a message across, which is you're saying I have a persona or go, I'm not authentic. And I think that in some ways that is a grave misunderstanding. Cause I think that it performance and authenticity go hand in hand. You really cannot have one without the other.

Sean (53:41.1)
Okay.

Sara London (54:07.292)
And I think that the more that we acknowledge that there is a way to cater what your message is, how you say it, say it in the exact right way. I mean, it's, you know, I have certainly been accused of not being polished. I am not polished. I am just a person who probably needs to get a little more polished because I certainly say things that ruffle some feathers at some points, but the whole idea of becoming polished, to have your message come across in a certain way, the way that you want to relay it, I think that in that,

is a sort of performance. Doesn't mean you're not authentic. I mean, you can certainly have authentic feelings, drives, emotions behind that performance. But the way that you express it to the public, I think, is thought out. Anybody, not just you guys who are running an empire here, but anyone who aspires to get a message out there and change the world, even if you don't want, you know.

the world's eyes on you and you're like, oh man, this criticism is like not great. I'm really not into this. I'm not into the hatred online. I'm not into like the criticism I get, but I really want to get this message across. I think that the way to get the message across is by catering it to a population, as anybody would know. It doesn't mean you're not authentic. It means that you're trying to take on this persona of someone who knows about XYZ or someone who has a message to send about XYZ, even if you feel like I'm not really...

you know, this is not really my scene, it's not really what I want to be, I really want to be doing other stuff. You're like, okay, I need to understand what it is to be this person that projects this image out there, and then you can go forth and do it.

Sean (55:42.882)
I almost feel like part of this is like a pendulum swinging back. Because we've been exposed to kind of this political correctness in a lot of ways. And then you see that people are fearful of offending others because of what's been presented to us, like words are violence. And if you have an opposing viewpoint, it's like traumatic and, you know, college campuses have like safe spaces and trigger warnings. And it's led us to...

I think the unintended harmful consequence of this is we treat people as extremely fragile, which means you have to overthink everything, which loses, in my opinion, authenticity. In your book, and here's a quote, there's a couple quotes that I liked. First one was, performance art was made in opposition to rules. And so I'll let you just kind of...

comment on that and I'll tell you what it meant to me.

Sara London (56:43.344)
I love it, I love it, I love performance art. Really, I think the whole backstory of it is, I think it was Hugo Ball who said that, your language does not suffice for us paraphrasing here. So it's like the preconceived forms of art that you had, the painting, the drawing, the writing, all that stuff really doesn't capture what we feel like we have to say. We need a different language, we need noise poetry, we need me to get up on stage and a...

costume made of feathers and stand there awkwardly until everybody leaves the room. Like that's the kind of art that we need. And that's what that means to me, I think, is that there's this kind of like, we need to shock ourselves out of this tradition that we thought that we had. And I'm fascinated to hear what you think about it too.

Sean (57:28.886)
Wait, even Yoko Ono?

Sara London (57:31.688)
Yoko Ono's noise poetry, you see that? At the MoMA, she got it there, ay, ay. Love her, love that.

Sean (57:35.578)
Yes, yes I have. All right, this is where we're gonna disagree.

Sara London (57:43.088)
No, it's not for everybody, for sure, not for everybody.

Sean (57:47.722)
Yeah, so I mean the way that I kind of view that is very similar. So these rules are being set and developed about, you know, how we should behave and how we should interact in our society, as well as who a therapist should be or what is mental health. And so some of the performance art of radically genuineness in opposition to those rules, right? So say what's on our mind, what we believe. I mean, I'm interested in knowing about people who are thriving in life, right?

people who are just doing really, really great. They have good relationships, they're solid people. You can count on them. They have purpose, they create. I love just talking to interesting people. All right, how do you approach life? How do you approach life when you're thriving? Well, it's fucking in opposition to the rules that are being taught to us in school and these media messages that are being sent to us. Now, I'm not going to worry about every identity marker of another individual and then have to promote.

promote myself in a way that is absolutely inauthentic because I'm so scared of how you might judge me or think about me in all these words. I mean, like, you know, one of the things I certainly agree with you is like how you have like therapists, they're putting on their pronouns and they're, you know, there's this social justice orientation and they're just trying so hard to almost meet this woke ideology as if that is some form of like healing.

The only way someone could ever feel safe with you is if you are just like them. You look like them, you have the same identity markers, and you agree with everything they agree with. And that is crap. In fact, like some of the greatest values that we have is like differences. How boring would the world be if we were all the same? It's diversity that makes it so worth living and interesting. You just learn from people who are different than you. You know, as a white male treating a...

you know, like a 19 year old who was like sexually assaulted. That relationship is valued and like working with someone who's African American who's so much different than me and us like really caring about each other through that opportunity to have those discussions. Like that's what makes my job incredible. I don't have to post my pronouns online in order to like promote that I care about all people regardless of like your sexual orientation or your identity.

Sean (01:00:08.502)
Like I don't have to prove anything. You know, that kind of idea just really, really bothers me.

Sara London (01:00:15.828)
I feel like as someone who's been canceled online four times, I really can't say much about kowtowing to public opinion because I unfortunately am incapable of doing that for some reason. I just say whatever, even if it gets me in trouble. I think at the same time I really like the whole idea of, you were talking about the social justice therapist, I think to kind of like scale back and extrapolate. I mean...

You can look at the psychoanalysis stuff in the book, but I think I say like, insert your modality here. Really, I'm just talking about any certain modality of therapy. You have a structural performance, you have an emotional performance, here's how you act. And I think at the baseline, any therapist of any modality, any denomination of the church of therapy they pray to needs to look at who they are as a therapist.

and who they see as the ideal therapist and why they're trying to live up to an ideal. I recently had someone who was doing a class on imposter syndrome and he cited this chapter in my book. I was very happy about that. But it was all about like, you're essentially as a therapist always trying to live up to something that you think is the ideal therapist. The ideal.

a social justice therapist, the ideal EMDR practitioner, always in your head, whether it's a picture of your favorite professor, a picture of a supervisor, a picture of someone who you follow online, you have this idea in your head of what you aspire to be. And I think that one of the most important things about doing this profession in particular is looking at why you feel like you need to live up to this unattainable, a Horknian idealized image of what you see.

because only when you figure out why you want to live up to this image that may or may not correspond with who you actually are, what you actually believe in, then you can start doing the real work. Then you can start doing real intimate therapy with people once you know this about yourself.

Sean (01:02:05.582)
Another quote, performance becomes a way to relate to the world rather than a way to hide yourself from it. And, you know, one of the things is we, I guess, we're always presenting ourselves to the world in some way. So how you dress, your style, what your office looks like, where your office is, how you present yourself through your bio, you know, you're already given out tons of information about who you are.

Sara London (01:02:11.121)
Yuh!

Sean (01:02:33.802)
you are presenting in identity. It says a lot about you and the words you choose and the manner in which you dress and all that's already available and your clients have already made assumptions based on all of that, right? Similar like you had an assumption about me just through tweets, which are limited characters, right? So you get an idea and you create an idea in your mind about who I am, that affects how you feel, it affects how you relate.

and interact, we all do this. Like we create our own realities. We are living there. And in some ways to be able to really function well in this world, we have to have the ability to observe that internal reality that was created and test it out. You know, and be able to ground ourselves in the present moment in order to move beyond those preconceived notions and just to engage with people.

and develop relationships. But that is all performance art. It's always there. You're presenting yourself in a way that you've chosen and that you believe presents you yourself in a manner in which you want to set a certain impression. The world is a stage.

Sara London (01:03:47.804)
and yeah, it is, absolutely. And I think also we've been talking a lot about social media in particular, but like the way that a therapist presents themselves is with anything, like you just said, the way that you dress, the way you have your office, what kind of camera you use to like FaceTime with someone or something, and teletherapy, like any of these teeny tiny little things. I think like one of my favorite papers ever is Paul Meehls, Why I Don't Attend Case Conferences. It's...

So fucking funny, it's so good. And it's so indicative of some of the ways in which people kind of perform as who they see themselves as a therapist in a professional setting that's not necessarily in with a patient. So like you think, okay, I'm a therapist, I sit down with a patient.

in that space I'm a therapist, I get up and go, I'm a regular person again. It's not that simple. You can still be a therapist when you're in a case conference, when you're talking to colleagues, you hold yourself in a certain way, you wanna make them think that you are a great, professional, wonderful therapist, and so you say things maybe that wouldn't be like totally copacetic with who you are when you're just chatting with your friends. Like all of these things feed into what you could call the therapeutic performance, being the performance therapist. And I think that it's best to, the more you know,

the more you're able to act like yourself as a therapist instead of just acting like a therapist, capital A, capital T therapist.

Sean (01:05:09.482)
I think that exists in every profession. I mean, it happens in the world of advertising. Think about police officers. I mean, a cop acts like a cop. I'm gonna need you to step out of your vehicle. Would you do that for me right now? Okay, right now? Come on. Can you give me your license plate? Okay, right now?

Sara London (01:05:12.916)
Oh yeah.

Sara London (01:05:19.324)
I have a friend.

Sara London (01:05:27.232)
I had a friend who works in finance and she read my book and she was like, can't wait to implement this at the office. I feel like I act like a different person when I'm at the office. I act like a business professional person instead of acting like myself. Can't wait to think more about that. Awesome.

Sean (01:05:43.378)
Yeah, I want to transition this one final topic. I know we've taken a lot of your time, but it's around self disclosure, you've, you know, have aspects of that within your in your book, and the role of self disclosure and authenticity and therapeutic value. You know, I want to get you know, your ideas of that as a scholar, but also a client yourself, like, you know, what do you view to be appropriate self disclosure that is helpful? And where is that boundary?

Sara London (01:06:12.528)
Ooh, I wrote this down. Oh, cause I knew it was coming. I knew it was coming, I wrote it down. Um, I feel like, to me, a self-disclosure is anything. Self-disclosure is like just a fact that you tell a patient about yourself and it carries all this weight. What is a good self-disclosure? What's a bad self-disclosure? And I think the best self-disclosures, i.e. the ones that are actually good for the patient, are

Sean (01:06:17.183)
Hahaha

Sara London (01:06:39.516)
well-boundaried self-disclosures, patient-centric self-disclosures. So well-boundaried self-disclosure is one that still maintains you as a therapist and doesn't sink into you as a friend or you as a mentor or you as anything else. I think it depends, like if you're coaching, then it's you as a coach. If you're doing psychoanalytic therapy, it's you as a psychoanalytic therapist. It really depends on the context of what you're doing, but it has to maintain your stance in the relationship or else the dyad just like...

sinks. The holding environment's gone and all of a sudden the patient sees you as someone who you're not in that moment and essentially your cred goes missing. Then to have a patient-centric self-disclosure, which is the one that I kind of go a little more into, is like you can't just say something out of the blue that's like not relevant to the patient. So I think the most classic example that I see all the time is white therapists sitting in their office and a black patient comes in and the white therapist first thought is, oh no we need to talk about the race in the room.

Like, this person's black and I'm white. That's crazy, oh my God. They're gonna freak out about this. So first thing they say is like, so, how do you feel about the racial dynamic in the room? And the person comes in and they're like, I kinda just wanted to talk about something else. Like, what's on my mind? Like, you brought this thing into the room that was not necessarily about what I wanted to talk about.

So I think keeping it patient-centric is so important. The person comes in, they guide the therapy. They're there for their reasons. They're not there for your reasons. If you feel motivated to say something, maybe that's coming from inside you. Some sense of guilt, some sense of shame. You need to like kind of be clear about that.

Sean (01:08:04.364)
Yeah.

Sean (01:08:11.726)
But yeah, Sarah, that's such a good point. And unfortunately, that's how therapists are trained in this current culture. That comes from academia. It's pushed down their throats that people are race, or they're race, it's their identity markers. When in actual reality, it is part of a greater puzzle of who the human being is, and your curiosity and interest in who they are as a human is enough.

If the client itself has concerns about their race and the differences in race, well, then yeah, there's the opportunity. But they're not taught that. They're taught that it is the highest value and it is the most important thing that defines them and therefore they are scared. Therapists are scared not to bring it up because they assume that's what everyone must think and it's not the truth. And that's why, you know, academics.

have way too much importance. Like most of these academics who are even training people to do therapy don't even do therapy themselves. You know, it's completely, it's so unfortunate. But I wanna piggyback off those comments of self-disclosures. I think dialectical behavior therapy and cognitive behavioral therapist are trained a little bit differently because they're viewing things from a perspective that clients do have skill deficits through exposure, through learning, through environment.

So it's really important for self-disclosure to be used at the appropriate time for the client's benefit and for them to learn something from it. So sometimes it is about normalizing things that are normal. So I said earlier that we all kind of create our own realities. So a client might be thinking that, you know, they are so much different than everyone else that they're broken and no one has to go through what they're, you know, what they have gone through. And

appropriate self-disclosure might be saying, I remember a time, you know, not, I was not too much younger than you at the time that I experienced something very similar. And this is how I pulled myself out of it. That kind of self-disclosure is valuable because it allows the client to see you one as a genuine person who experiences what they do. And to understand that it could be a path of overcoming that which can provide some hope. The other thing about what is now natural,

Sean (01:10:31.994)
is that clients want to know more about you up front. Therapy, which was something that was kind of reserved for the elitist class at different points in American history, is now widely accessible. And so people often come shopping for the right fit or therapist. And so that initial conversation that you have with someone and it's around informed consent and you're talking about therapy, they wanna know who you are.

They want to know why you do what you do. They want to know what you're doing, what informs it, how are you going to be different than the next person? It is not that out of the ordinary for someone to say to me, are you married? Do you have children? And that's on my finger. So I mean, yes, and yes, and I'll say my children's ages. Any other questions about that? What does that mean to you? Does that make you more comfortable? You know, those...

It opens up for dialogue, but to think that that's somehow pathological or strange or worth a lot of analysis just doesn't fit. It's just, I think, typical, normal, and expected when you're going to meet a stranger.

Sara London (01:11:46.224)
It's absolutely different strokes for different folks. I mean, you can't diametrically say that any level of self-disclosure about anything, you have to look at the context, what the patient wants, what the patient needs. I think from a psychoanalytic point of view, definitely people have trouble with some of the more basic like tenants of self-disclosure. You know, if someone asks, are you married? It's more like, what would it mean to you if I was married? Like that would be the stock answer. And for some people that...

Sean (01:12:12.962)
That's therapy speak.

Sara London (01:12:14.48)
Well, for some people, I think that would drive them away. For other people, it would be like, oh, I never really thought about that before. You really have to think person to person. You have to get to know the person in front of you to figure out what would be the best intervention, as they say, in order to be able to help them.

Sean (01:12:28.874)
Yeah, and back to what we were saying before that, you know, people do come into that initial session and they have a story about you in their mind. And it's really important for them to be able to talk about the story. Sometimes I don't hear the story until weeks or months down the line, where they say, you know, I had this idea of who you are by the base of like how you look and, you know, your persona on your

your bio and you're standing in the community or what's like, they have an idea of you and they'll say things like you're nothing like I thought you would be. You know, very similar Sarah to what you said when we opened it up. And I think that's just natural and normal is that people just develop an idea of who someone may be in order to be prepared to self-protect and so forth and to make decisions. I think it's our job to help people observe the stories their minds create and to understand how that impacts them.

Sara London (01:13:24.084)
I think that's actually kind of a fascinating point, something that someone who is a public-facing therapist does not have to, has to deal with, that someone who is not a public-facing therapist does not have to deal with, which is what story have you made up in your mind about me, judging on what you saw online about me before you came in this room? How can we work with it? What are we gonna do with it? And I think that that's a very important question that therapists have to ask themselves if they have a public-facing presentation is.

what is this person bringing in that they wouldn't be bringing in if I was just a, you know, regular psych today person with like one bio and that's that on that. Um, which I think is so fascinating. It's such an interesting like wrench thrown in the, you know, whole idea of modern therapy is like what happens when your therapist is, you know, out there.

Sean (01:14:12.03)
Yeah. There was a interesting article that was written about that. I think you posted it on your Twitter. That's how I got a hold of it that just said, wait, my therapist is an influencer or something like that. That was like, that was the title. Yeah. So, um, I mean, that's speaking to a different level. I mean, I guess there, there are people out there that are, have huge, huge followings, like even a million followers. There's a, there's a psychologist. But that may be a reality for you one day. I doubt it.

Sara London (01:14:22.588)
Oh my god, he does.

Sean (01:14:41.435)
I wouldn't rule it out. All it takes is like one video to get shared by the right person and things can go viral and all of a sudden you have a lot more followers than you ever believed was going to be possible. Yeah, but

Sara London (01:14:51.276)
Or someone writes a medium article about how you're a horrible racist and you should be canceled. That also can happen. Not at all speaking from experience. Yeah. There is a... Oh God. Oh no. I'm gonna reopen this can of worms. I'm gonna get in trouble all over again. Oh God. It's a very long story, but the long and short of it is that, um... Oh God. Oh no. It was a whole thing with Psych Today.

Sean (01:14:58.786)
Did that, did that happen to you?

Well, tell that tell the story.

Sean (01:15:09.27)
Maybe.

Sean (01:15:19.166)
Yeah, you said you were what is with your balloons? You're getting texts. That's what it is. It's connected to your phone or something. Um, but something's going on with Roger. He keeps getting balloons. Anyway.

Sara London (01:15:30.1)
We're having a great time. We got the balloons. We got the tiny hand on my finger. We are just having a ball.

Sean (01:15:34.998)
But Sarah, you said you were canceled four times and we glossed over it. I was like, wait a minute. What? But maybe you can list them out. Don't go into all of them, but list them out.

Sara London (01:15:37.244)
Ehehehe Kaka

Sara London (01:15:41.428)
I don't want to be known as a canceled girl. Okay, first one I was canceled for being a racist. Second one I was also canceled for being a racist. Same person, few months later. Think maybe she just didn't really have a lot to do that weekend and just kind of popped up in the algorithm. Oh yeah, I remember Sarah London, she was horrible. And then I think the third and fourth ones were trans. I know the third one was the trans stuff that I believe that trans people exist or that I believe that

children should have trans drugs or god I don't know. So that was the latter two. It's really only been the trans stuff and the racial stuff. I haven't yet got canceled for homophobia but I'm working on it.

Sean (01:16:23.406)
You want to do that right now? We could really use more followers. I'm thinking this might help our brand. No, I'm kidding. I'm joking. Horrible joke. Yeah. I mean, that's the risk that you take when you put yourself out there. Well, because when you have so much content out there, it's very easy to pull pieces and put together something that portrays you in a certain way. Yeah. And

Sara London (01:16:25.3)
HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA

Sara London (01:16:30.946)
Oh man.

Sara London (01:16:34.724)
No, it was actually really funny.

Sara London (01:16:52.127)
Oh, no, go ahead.

Sean (01:16:54.006)
Yeah, my point was going to be if there's, you know, for me, it's always about the, you know, when I'm talking so much about the drugs, right? And the pharmaceutical industry is just such a powerful entity in American culture. And they have so much power over the major medical organization. So, you know, I'm often going against physicians globally. And, you know, the more that follower count begins to increase, then the more you're a threat to

you know, some of what some of the product that they're trying to push. And so then, you know, we already deal with the ad hominid hominin attacks and, and so forth. But it's just a matter of time before something kind of gets pushed in a way that is either fake or misrepresents an idea. And you just have to accept that. And you have to have somewhat of a thick skin to be able to continue to put yourself out there because there's a lot of nasty

mean people out there who want to use social media to, X in particular, to, you know, just denounce your character.

Sara London (01:18:03.672)
My favorite thing about getting canceled is the fact that I can turn my phone off and then turn it over and then I'm not canceled anymore because it doesn't exist outside the Internet. The first time it ever happened. And there's all this stuff with psychology today, which I'm sure one day I'll talk about at the moment. I still need to gather my thoughts about it. But my fiance was like, Oh, my God, are you OK? Like you were canceled. This is crazy. I'm like, yeah, when I put the phone down, it doesn't exist anymore. So.

Sean (01:18:10.308)
That's right

Sara London (01:18:31.58)
It's so, I think people are so scared of saying something that will get them in the wrong hands and ruin their reputation online. And we forget this very transitory nature of the internet. I mean, anyone remember Kony 2012? Harambe? Anybody? Okay, we do remember. All right. But like there's this stuff that just happens like so many years ago. It's like things move so fast now that even if you are canceled, I mean, you're just

Sean (01:18:46.506)
I remember.

Sean (01:18:51.092)
Yeah.

Sara London (01:18:56.52)
back up on the horse doing something the next time. It's just one person who has an axe to grind or a few thousand people who have axes to grind and they need something to do and you are that activity for the week and then they move on to something else. And it's this really kind of like desperate, oh no, my career is ruined and I'm just getting started. I mean, for me especially, I'm very early in my career, just published my first book, I'm only 29 years old, plenty of time left, but at the same time.

You can think like, oh no, it's all over for me. And why would you ever do that when you know that these things, nothing is, nothing is back to this authenticity thing. Nothing is static. Nothing is black and white. There's always something else in life. You can move on to the next thing.

Sean (01:19:41.45)
Yeah, that's why I love the mindset that, you know, you're only canceled if you allow yourself to be canceled. It's an idea that you'd have to create about it. Life is an adventure, you know, let it unfold and no matter what you're learning, even through the hard and challenging and difficult times, it's an opportunity to express and to learn. And I think perspective is everything in how we approach life. We're all going to end up in the same place. The body is going to just be into the earth or ashes to dust.

Sara London (01:19:46.044)
Yeah.

Sean (01:20:11.21)
We all end up in the same place. Stop it.

Sara London (01:20:16.232)
to tell my grandchildren, your granny one day, there's this website, first it was called Twitter and then this South African guy bought it and it was called X and they'll say grandma it's time for your tapioca pudding in your nap.

Sean (01:20:32.4)
Well, Sarah, we really enjoyed this conversation. You know, I know you're early in career, but I think you have really fascinating and interesting perspectives that are of value and we do appreciate you coming on. Where can people find you?

Sara London (01:20:46.956)
Oh, everywhere. I'm on Twitter. It's where I get canceled. Come cancel me on Twitter. No, don't do that. It's S. Jessie London at S. Jessie London on Twitter. I think my Instagram is sarah.jesse.london. Most preferably come to my Substack, sarahlondon.substack.com. Multiple times a week I will say things that are on my mind written in a tongue and cheek satirical tone for your enjoyment and convenience.

Yeah, I think that's it. Oh, buy my book. Buy my book. It's on Amazon. It's on the Rutledge website. It's great. It's fun. Email me. Maybe I'll email you a chapter or two if you're interested. You want to test it out. Yeah. Thank you so much. This has been so much fun. It's been such a wonderful opportunity and I really, really appreciate you giving me the platform to be able to say my piece. I think I have something to say and it's really, really cool when someone else does too. So I thank you so much.

Sean (01:21:40.51)
Yeah, you got to give her a follow folks on X. She's very witty, very funny. And she's a beautiful, beautiful writer. And, you know, and you'll enjoy you'll enjoy the even if you're not a therapist, but just the psychoanalytic thinking. If you're in any way a thinker or a philosopher, and you like just to, to read good writers, go to her sub stack and certainly buy her book.

Sara London (01:21:48.516)
Oh you! Thank you!

Sean (01:22:08.214)
Sarah London, we want to thank you for a radically genuine conversation.

Sara London (01:22:14.056)
Thank you! Yay!