Tauranga Psychologist | Therapy, Coaching & Burnout Support – Inked Psycho

[00:00] People that were labeled a psychopath were seen as untreatable. Some research that was done, apparently, efforts to treat psychopaths not only didn't work, it made them worse, which is everyone's worst nightmare. When you visit them in their homes and they're busy telling you, oh, I don't drink anymore, but you had to abseil over the empty bottles at the back door. They're denying they're still up for crime, but there's all these brand new stereos still in the box and the framed Luger on the wall and all those sorts of things. Did you do training with the FBI in Texas? didn't do training with them, but I had the opportunity to spend a bit of time with some of the FBI from Quantico where they do the profiling at a conference in Texas in 2015. I was a keynote speaker at a conference in Austin. And it was a very interesting conference. was law enforcement and psychology. So the audience was made up of some very interesting characters from the alphabets, the FBI, the NSA, CIA and FBI, as well as Texas Rangers, they're in their white hats and boots with everybody was virtually armed. Even some of the psychologists, which I was a bit shocked by and talking to them over coffee, et cetera. There was a degree of embarrassment, but they were also quite excited by their gun collections, including one of them who had an electric Gatling gun.

[02:19] And the only really rationale was, oh, it's just part of our culture. But they were aware that there was a mismatch between their training and the work they did in this enduring interest in guns. But there were some excellent presenters and the interface between psychology and the law is only grown over the years. When I first trained, there was no need for us to learn about the law, but it was pretty clear even in my first year when I was called upon to give evidence in an immigration tribunal deportation hearing. And the fact that I was called to be a witness had to go all the way up. to our then general manager because it was unheard of that we put our feet into a judicial setting. the growth over the years in terms of psychologists giving evidence both in the criminal area but also employment, civil area, it's just grown hugely and The number of laws that specifically mention medical practitioner evidence as being important to decide elements of a decision is really growing. But in keeping with the question about the FBI, besides traumatising us all with pictures of crime scenes, particularly when they were talking about psychopaths and the fact that the FBI work off a behavioral footprint of the crime scene when they're trying to decide on who had carried out the crime.

[04:37] And part of that is you make some inferences from some of the actions that have happened. And so, they were showing how the posing of the victim's body was deliberate and related to the actual person's desire to either shock the first responders or indeed to continue the humiliation and harm of the victims after death. So we got to see a lot of photographs that I'll never be able to unsee. But besides that, like I said, I got to spend time with some quite famous FBI profilers and learn about their work, some of which was similar to what you see on the movies, where they get to go and actually come up with profiles and actually find the people responsible for some of these terrible serial murders. murders but also every year they have to go around all of these high profile serial murderers and interview them and that's because it's a known artifact of serial murderers that they never give up all their victims. There's always victims that we are implicated with but the bodies are never found. Sometimes this is just because they want to avoid the death penalty or they have some hope of being released. But also probably more importantly, they have trophy victims and these are victims that they have a particular emotional connection to or attraction to. And so they hold on to them because you know, they gain a lot of ego reinforcement from that.

[06:47] But the FBI shared that it's a, it is quite difficult because it's almost a very practiced intervention because they're going to see them. But also with some of these men, they're up against the impact of time, both in terms of just the natural fallibility of memory. but also Alzheimer's because some of these men are getting quite old, they're never been released. And they told me one of them was a truck driver. I know it's very stereotypical, the interstate truck driver, there's truth to these stereotypes. And for this man in particular, when they arrested him, they found he kept a log book. mainly around his trucking movements, but it had a code in it and they've never been able to decipher the code and they believe it shows where some of the bodies are buried, but they're up against the fact that this man's now becoming quite demented. How did you become a keynote speaker in the United States? Well, You know, this is because I developed some expertise and knowledge in the area of psychopathy, which dates back to probably as early as 1995, when I did my master's thesis on children with psychopathic tendencies. And then later, got the opportunity around 1999 to do my PhD on the area of criminal psychopathy. And in those days, there wasn't as much research as there is now. And I was able to, through my research, connect with some of the major figures around the world.

[08:59] And also, to become quite good friends with Dr Robert Hare, who is seen as the person in the modern day who's created the framework to look at criminal psychopathy and has worked in this area since the 1970s. you know, he was… I believe responsible for getting me the chance to go to this conference, mainly because of the work I'd done on looking at the treatment of psychopaths. That was an area that not many people had looked at, mainly because with the rollout of the psychopathy checklist and its use to decide on sentencing and parole, It was seen solely in terms of its inability to assess risk. And in assessing the risk, people that were labeled with the label of psychopath were seen as untreatable, both because of the perhaps stereotypes associated with being psychopathic as somebody that's relentless, never going to change. But secondly, some research that was done and published in 1992, where apparently efforts to treat psychopaths not only didn't work, it made them worse, which is everyone's worst nightmare. So that research, published in 92, was responsible for many jurisdictions when they didn't identify someone as psychopathic. denying them the chance for treatment. But I was fortunate in New Zealand that there was more of an enlightened view.

[11:09] We recognise that we can't keep the people we've labelled as psychopaths in our prisons. Most of are on determinant sentences, they're going to get out. So what can we do? to reduce their risk. both from my original PhD research where I followed up a group of psychopaths who had been out for between five to 10 years and hadn't come back to prison. That was always actually the original reason I wanted to do the research. I wasn't that interested in just validating the measure or albeit that's important, I was always fascinated by people that had all these risk factors that beat the odds and didn't come back. They couldn't all have gone to Australia. So some of them must have remained in New Zealand. So I was lucky to be able to tag that on to the study and follow them up and interview probably about 75 % of that, what we call a false positive group, they didn't do what we predicted. And at the time I thought, hasn't having other people done this sort of research, but the reality was they hadn't.

[12:42] It was difficult. The people you're wanting to interview don't like us very much. So, and of course in other jurisdictions like the US or even Australia with the state system, it's hard to track them down. So they're all over the place. So we had some advantages in New Zealand. We have one justice system, one computer system to rule them all. And so we're able to track them down in our island nation. So. Like I said, it's still the biggest study of its type where there's been an interview and that was 30 years ago almost. So it was a privilege because I was relatively new to being a psychologist, but it was a hot house experience in terms of learning. I got to meet people that had been involved in crime for many years. they were pretty disclosing to me of their lives. I met them mainly in their own homes, which is quite interesting because when you just see people in your office, it's very sanitized. They're on their best behavior. Hopefully we're on our best behavior, but it's not necessarily reflective of their lives. And so when you visit them in their homes and they're busy telling you one thing, oh, I don't drink anymore, but you had to abseil over the empty bottles at the back door, you can draw your own conclusions. They're denying they're still up for crime, but there's all these brand new stereos still in the box.

[14:44] Just even the ability to, while perhaps filling out some questionnaires, to wander over and look at the books in their bookcase and the framed Luger on the wall and all those sorts of things. So besides spending several hours, sometimes up to three or four hours with them, as soon as I got back to my car, I had a dictaphone and I would just debrief myself into it because there was so much information from the environment and interaction that wasn't captured by the tools that I was using. What's the bullet point summary from your thesis? that those that are high on psychopathy are at higher risk of returning to prison for violent crime. but while they have a higher odds of returning, not all do. It also taught me that we can have a label which is very, homogeneous that sort of implies that there's one type of psychopath. And as soon as you start to interact with them, you realize that while there's these commonalities around dysfunctional ego, narcissism, as well as insensitivity to the impact on others, there's also lots of differences. So you do the concept of disservice if you don't look at them beyond the label. Because that's where often an ability to know their true risk as well as their true ability to change comes from is that comprehensive approach. know, psychologists and The general public are both very much in love with the media stereotypes and so a lot of the work is moving beyond those and seeing them for the whole person. I seem to remember from one of your trainings that Some of those you interviewed had managed to stay away from violent crime through staying away from people or aging out or… Yeah, that was one of the insights was the high use of avoidance. Now, I always say to people, avoidance is one of our most natural behaviors. animal trainers when they're trying to train an animal to do a trick. They'll always look for the behavior they do in the wild that they can build on. So I do wonder, know, as psychologists, we need to always keep in mind that people are predisposed to avoid when we're actually looking at both their issues, but also how to change their behavior. So yes, avoidance, but I was surprised by how effective it had been. I'd always seen avoidance as a short-term strategy. You we always lecture our clients, oh no, you're gonna have to one day face up to this. But these people have been avoiding family risk situations for five to 10 years. And it's actually more impressive than that because a few years after my PhD study, I got invited to a conference in Bergen in Norway to talk about treatment. And besides being excited by the trip because they were paying all the costs, the Norwegians have lots of money. strongest currency in Europe, think, all that North Sea oil. The thing was I then had to think of what I was going to talk about.

[19:28] So I thought about the people that I'd originally followed up in way back in 2000, 2001. And I thought, what are they doing? So I went back and looked at them again. And they've now been out for 16 to 26 years. Now, when I say to people, Well, I followed up a group of high-risk offenders putting aside the label. And after five to 10 years, they hadn't come back to prison. People tend to still say at that time period, oh, they're just getting away with it. You haven't detected it. But when you say 16 to 26 years, there is a distinct silence. It has a gravitas. You know, they're realizing that maybe they've made some real changes. yeah, so that's what I found. They were continuing to make those changes. So as a psychologist, it made me realize that maybe avoidance can be a longer strategy than we realize in terms of effectiveness, especially if the person is aware of that if they stop avoiding, that the risk might be as fresh and tasty as the day it was put in the fridge, and that they need to maintain the avoidance. The hope is that over time and through this avoidance, they create a life worth living that maintains the avoidance in a positive sense rather than a loss of reward. Can you expand that a little more? Well I think what can undo avoidance is why. The longer you avoid something that you might have enjoyed, the more you become sabotaged by the vacuum that it may lead in your life. So, you know, when you're looking at people changing, there's a series of questions that you want to have answered, you know, can they answer? What is it like if I change? Can I change? What will I have to give up if I change? Can I trust this therapist to take me through the process? Well, often they don't have an answer for what do I have to give up to change? And if you don't understand that, it'll come and sabotage the change process. And you know, the true, The is, no matter what change people want to make, they have to sacrifice something. And so that's a conversation you have to have early on before change occurs, because if they can't do the cost plus analysis or can't replace the behaviour they have to give up, then they're not going to succeed in the change they want. it's always, that's one of the things I drop in the first session.

[23:24] I talk about change involves sacrifice. So that I'm already planting the seed that it's not going to be as simple or seamless as they may have thought. so That first session you have with someone is really important for setting the scene, both in terms of the work they have to do, the work you're going to do, the length of treatment, because you should be already selling them when treatment's going to end. That can be confronting for many, but it also can lead to some good conversations about Their role versus your role. They are the driver of change. And they're going to drive change at the end of treatment and on their pathway of change. They can't rely on you being there. So it helps to set up that at the start. And also, like I say, I talk about how change occurs, what those questions are, get them thinking about it. all within the first session. So, you know, if you don't, and you'll often see that first session with some of the mahi, some of the work they're going to have to do, you'll talk about that, you'll get them to be working on homework that they'll need to undertake monitoring of behaviour. All like I say, It's really interesting to me that if you wait even until the third session, they often don't take it well. It's almost like they've got used to the fact that they're not going to have to do all these things and they feel a bit ripped off. Well, why didn't he tell me this to begin with? You tricked me. You tricked me. You've taken $500 off me without doing anything. Yeah, you've got to be upfront. if at that time they're not ready to change, it's actually probably a good thing they walk away rather than feel a failure by going three or four sessions in before they pull the pin. The average number of sessions that people attend therapy for is one. because that accounts for number of no shows. So many years ago, I went to a presentation on brief intervention therapy, which was really useful for me and started me thinking about that therapy will be spread across someone's life, maybe brief at points, lengthier at other points. but it's a cumulative. And so you can be the poor sod that starts it off, who only really raises some of the issues, raises some of the challenges for the client, gets little feedback or credit, or you can be the lucky one 10, 20 years later that has the client come in and basically just seek endorsement. for all of the good work they've done, who gets all the credit. But what it brought home to me is you've got to treat each session as if it could be the last, that you need to leave the client. If they do stop, you leave them with the understanding of the work they've done so that they They don't see it as a waste, even if it's just growing insight.

[27:32] And then secondly, you leave them ready for the next opportunity. So you do no harm. You don't want to put them off seeking help in the future. Is that across all client types, including psychopaths? So the reason I ask is that we started talking about psychopathy and then you talked about change and treatment change. And then you talked about sacrifice. And when I think of psychopathy or when we think about the media version of psychopathy on movies, TV, you wouldn't think that change is possible, nor that psychopaths might be interested in sacrifice. Good insight, Matt. They are highly reward dominant. So they're driven by rewards and they are very poor at recognising the punishment that that pursuit of a reward will bring. So if you know they're reward dominant, part of the sacrifice might be that they sacrifice short-term rewards to gain longer-term ones, or they sacrifice anti-social rewards if they engage pro-social rewards. Because they will cut their nose off to spite their face. They'll go on about Oh, I got 20,000 for that armed robbery. And you point out the five years in prison and they would have got more on the dole. But over time, you find that they become aware of their inability to hold on to rewards. Because, you know, they have a why as much as the general public. And their why is to be seen as successful, be able to pursue hedonistic rewards. So the key is showing them a way they can do that without impinging on people's liberty or pursuit of crime. So I was treating a young man in South Auckland many years ago. high on psychopathy, had committed several rapes and was now released into the South Auckland community and wanted to get on with his life. He had a girlfriend who was now pregnant. He had some family support, but he was, he wanted to be able to find a job that would fit. with his desire to be seen as successful and would fit with his skills. And after we put him off taking a job going door to door selling home alarms because of the obvious risks at this post, we found a job, or he actually found a job, we encouraged him. He got a job as a car salesman in South Auckland. He was great at the front of house stuff. He was a very charming young man and good looking and he could engage people that were tire kicking on the front yard. And so it was a job that was pro-social, that met his needs both in terms of interpersonal success.

[31:39] but also monetary gain. So it was a win. variant. How does a bouncer from Timaru end up presenting around the world as a psychologist? Well, we're some total of everything we've done. I don't think we can tie it to my work as a bouncer. I think we can take it back as far as becoming a policeman at 19. because I was always drawn to one, wanting to help people. Hence why I wanted to be a policeman, because it seemed to be a role where you could get immediate reinforcement that made a difference. The job also meant that I got to interact with a wide range of people with a range of issues. And I'm not just talking about my fellow policeman here. I'm talking about the general public. And so I got to see people often with severe issues and I still recall having to babysit a gentleman who was subject to being placed under a compulsory treatment order and they were waiting for a second doctor to sign off on him. So I spent a total of about three hours with this man who was very elevated in terms of paranoia. And after three hours in the room with him, I was quite paranoid. I was convinced there was cameras everywhere. And I'd have to emphasize this is the days before cameras, but I was looking up in the corners. I found that, course, that as I've discovered now that the paranoid are very virtuous and compelling in trying to convert the rest of the world to their view. while they're a bit crestfallen at their inability, it is a lifelong strategy for them if only other people can see that they are right. So yeah, it can be very, like I said, virtuous, but also… strident in their views. And was that one incident amongst many that led you to think about the human mind or how did that turn into psychology? Well…

[34:49] It was an experience of that range of people and sometimes an understanding that people didn't operate on the same contingencies as me. So I would not do things because they were painful or shameful, but I was clearly around people that were not inhabited by those. I got the first hand, things only later I understood. But I always wondered about such as learned helplessness. I can still remember, you know, domestic violence incident where the woman had been seriously harmed by a partner. He had broken her arm, broken her face in terms of her cheekbones and nose. We arrested him. and she went off in the ambulance and we get a phone call from the hospital saying don't press charges, I don't want to press charges and in those days we were reluctant to continue without the victim pressing charges. Of course that changed, rightly, later years. But it wasn't in those days something that we would do without the victim. It got so frustrating that at one stage we used to get them to sign a little statement in our notebook saying they wouldn't withdraw charges because we got so sick of taking them down the station and then having to kick them out because the charges were waived. Now I later on ran across that woman. probably 10 years later. She recognized me. I didn't recognize her. I'm terrible sometimes at that. But she said, I could see how frustrated you were, but you just didn't realize it was scarier life without him than life with him.

[37:07] I knew he would be nice to me afterwards. But he paid all the bills. He'd totally taken control of her life. So experiences like that helped me to become more and more interested. But I don't know if it's a story I should tell. don't know. I had a girlfriend when I was a nightclub bouncer who was a police woman. And… She was doing study through, I think, Massey at the time in sociology and psychology. And I used to help her with the homework because you do that sort of thing, doing great share yourself. And she used to say, oh my God, you do this so easily. it's all these little seeds that get planted. And I was at a point in my life where I wasn't really going anywhere. I knew I didn't want to be a nightclub bouncer for the rest of my life. I knew I had perhaps more potential than that. so, and there was that sort of midlife crisis, 28, 29, and then I decided to want to do something different.

[38:33] But I realized… Um, that while I could get another job to get a job I really wanted to do, I'd have to go to university and I decided, uh, obviously quite late in life that, excuse me. that I'd go to university and I'd become a clinical psychologist. I knew very little about what that meant. I'd never spoken to a psychologist. I'd only going off what, of course, I'd seen in the media. And I even misspelled psychologists in my application, which Canterbury University took great delight to point out. But off I went to Canterbury University and I just loved it. I loved the intellectual challenge that it brought that I hadn't had since I'd left school. And I believe I brought, because of my years of work, a good work ethic and I had success. and it just, you the marks started to just keep going up and yeah, so I just, I really enjoyed my time at university and applied for a number of clinical programs, got into more than one, but chose to go to Waikato because it had, at that time, the only cross-cultural pathway. So when I started at Waikato, we had sessions with Pākehā Treaty Action Group.

[40:31] We very much worked on understanding our own cultural bias. And so I'd always thought that I'd want to work in corrections. So I knew I was going to be working with lots of Māori and I wanted to be effective. And so that's why I went to Waikato. It was also because they had just appointed Professor Ian Evans, who I'd looked up and found he was one of the top 50 psychologists in the world and that they were very lucky to have had him. And so, yeah, I mean, it worked out really well because I became his research assistant. He supervised my masters and my PhD, became a huge mentor for me. And just last week, he sent me notification that he'd quoted some research that we'd done in his latest book, which he had written in 82. And so, you know, he's also mentoring me that there is no retirement. Yeah. So that was the 90s. What psychological theories were in vogue at that time? Well, at Waikato, and it was mainly behavioural and even radical behavioural intervention. Other universities were more cognitive, so more CBT. No one was psychodynamic. Did that hold me back? No.

[42:21] I believe that that behavioral with CBT overlay has seen me in good stead. I have a good model that I can fit other things around. I always say that the model you learn becomes your Rosetta Stone, which is that famous tablet in the British Museum that has the same phrase in ancient Hebrew, I think ancient Egyptian written language, but also hieroglyphics. And it was the ability to then translate hieroglyphics, which had been lost over the mists of time. So without that one thing to interpret all. So I always say for any someone starting out as a psychologist, don't get too absorbed about knowing all the models. If you know one model well, you can pick elements of other approaches, pull them into your work, understand them well. I think that psychologists that leap from faddish intervention to intervention without having a grounding, they're confused and the clients are confused. But if you've got that good grounding, can always provide an explanation that has some depth. So I use psychodynamic, I use a range of approaches. So quite eclectic in that regard, but I'm always bring it back to a behavioral understanding. Even personality and psychopathy. I can talk her to a behavioural understanding.

[44:21] And in fact, you know, when you're talking about a behavioral understanding, you're talking about function. And that to me is always the thing that you can sell to a client. They understand, I do this because I get this out of it. And so it's always a good place to start. are similarities in that. Sorry, there are similarities between function. ABA and psychodynamic though, There is. The underlying reason for your behavior. you're trying to tell us a story about why it happens. I never had a great love affair with psychodynamics when I started, increasingly in understanding concepts like transference, counter-transference, grief, yeah, there's some real benefits from the psychodynamic approach. And many of the big theorists that I follow, Erik Erikson and others, of course, are psychodynamic. So I still use the psychosocial stages of development.

[45:52] think they're very useful. In some ways, you've got to understand that After psychodynamic took the world by storm, there was a backlash, particularly in terms of its apparent ability to show change. so that's when there was the backlash was driven by behaviouralism because behaviouralism was very clear. can measure things, we can show change. And then the third wave, was the CBT wave because again, behaviouralism had its limitations. But it's good to actually look at the history of psychology to realise why perhaps psychodynamic got a bad name, but also how the field's continuing to develop and realise there is no one single approach. But in saying that, I'm more and more aware of common elements. And I think that's the future. I worry about the artificial separation of different modalities. Just like I worry about the psychology field being split up into multiple scopes of practice. When every scope has the commonality of assessment formulation and treatment. Whether you are working in HR or you're working in school, you know, there is those elements, but there's an artificiality to the scopes because they're always focusing on the difference rather than the similarities. I'd rather that we all psychologists had a single scope and then we had endorsements of practice based on some expertise. We're a long, narrow country. We've only got about three and a half thousand registered psychologists, not all of whom are working full time. And many of them are really old like me. So how long we're going to go with three and a half thousand is moot. I think we've, you look at the age distribution, we're heading towards a cliff. Now, while there's all these initiatives, psychology assistants and others that's, know, fiddling while Rome burns because there'll be no one to supervise them. There'll be, know, so I think that if we, we'd be rather off recognizing the The skills of psychologists are not just in one area. You might be the only psychologist in a town. You might need to treat everything that comes before you.

[48:58] How do you allow them to have safe practice? Well, that's where encouraging them to learn things outside of their scope, to seek specialist supervision, rather than getting them to avoid work. because they can't work in a particular area because of a prescriptive scope. But yeah, I don't know where I'd probably lost my place in terms of the questioning, but I had to talk about that issue of if there are common principles, there should be common skills for psychologists to apply those. So there's common principles in terms of understanding behaviour and there are common principles of change. That's not to say there isn't another layer of expertise you can bring to it, but first of all understand those common principles. And so I do find in training that sometimes in endeavouring to train people in all these multiple different approaches. There's a loss of understanding of common principles. That's just my view. And then if you look at the research in terms of what clients say is important about a therapist or a psychologist and… what actually works over time. What does that say about modality frameworks? It's always a bit sobering, realizing how little the clients retain. However, it's also sobering to know that they often retain what they need to know. And so, and What I've found is that the things they retain are often the very basic things. I don't know why it is, but we sort of, we doubt our expertise, so we have to show off to the clients. And I think often we think we have to add more than the common elements to be worth our wage, without realising that in fact those common elements are common to us, but may be new to the client. that what we assume is common knowledge is not true in terms of common. Or if it is known, the person is unable to apply it to themselves. you know, besides cookery books and gardening books, self-help books are the next biggest bargain bin at the Lions book sale. Why do so many people buy them and then discard them? It's because they're written for the group. And when the individual's trying to apply that knowledge, they go, yeah, I can see it makes sense.

[52:23] but I can't see how I apply it for me or I tried and this worked but this didn't work. And so our ability to know what is vital for the change process versus a nice to have and how to perhaps change an element but keep faith with the intent. That's where therapy will have a life beyond AI or bibliotherapy. So common elements between frameworks, psychological theories. Yes. Are essentially new frameworks or theories are repackaging. Repackaging, coming from a different, all roads lead to Rome, know. So, but there may be common elements in terms of. the client will need to have a good view of where they want to get. So the goal, but how you get to the goal might differ depending on the cognitive ability of the client, their perhaps existing efficacy in other areas that you can pull in, their environment, their setting. Often when you're working with someone in a prison setting, radical acceptance becomes very attractive because there are so many things they cannot change, but which are all consuming. And so sometimes to get them to move, they have to practice radical acceptance. You would have seen lots of different theories come and go. Are there any that you've picked up in your kitty and then dropped? Or are there any that you've refused to pick up? slightly controversial.

[54:32] I've been a bit resistant for EMDR, but I recognise its value for certain conditions under certain settings. some of the reluctance has come about because of the mixed nature of the research. I make no excuse for being evidence driven. And so I have looked at the research and I had a client recently where I considered whether I could apply a CBT approach for PTSD or I needed something else. But I that in selecting a CBT approach it was because this particular client was not suffering from vivid dreams or vivid recollections. I felt that I was able to do this without, but I'm not averse to looking more into EMDR. But I'm just, like I said, I need to perhaps better understand some of its use. But also when it's misused and it's like everything, when a new treatment rolls out, it starts to be applied to its area of development, but then you get creep. so suddenly it's being used for everything. And you saw this one.

[56:19] Prozac first came out, it was just being used for depression. Oh, but let's try it for this, let's try it for that. And so it started to move beyond its remit, beyond its evidence base. And that's the worry I have with some of the new approaches. Approaches that have really resonated with me that I use a lot is ACT. ACT has been around for a long time and is built off behavioural principles developed in the 60s. It's a repackaging. so again, I think the future is probably packaging rather than there is a single thing that's the way, the truth and the light. I'm always really Not apprehensive, I'm suspicious, about when you're dealing with complexity. I there's a famous saying by Mencken that goes, for every complex problem, there's a simple solution that will not work. Because it makes no logical sense that for a complex problem, there'll be a single solution, a simple solution that's easy to implement. So I'm guided by that because the other thing people forget about is that…

[57:58] We can make people better. we can have no impact, but we can make people worse. And yet very few people talk about the fact that we can create for our clients a worse situation than when they came to see us. When I mentioned this, where I work, it's like I've vomited it in church. How can… therapy not make people better or at the very least do no harm. And yet, when we look at the research, perhaps the unpublished research, we find lots of examples where intervention has increased distress or left people in a worse state. And increasingly I see this where I'm working where the argument is, oh, let's just give them any treatment. Any treatment is better than no treatment. And I think that's an incredibly dangerous assumption to make. We know that when people drop out of treatment, violence treatment, anger treatment, their risk of re-offending goes up. Doesn't go down, doesn't stay the same. There's something about the process of failure that increases their risk. So you've got to be very careful about putting people into treatment where they will fail or… just as importantly putting them into treatment and allowing those around the person, including the client, to think, no, that's dealt with all your issues. You are fixed. You are safe. And that's very dangerous.

[1:00:02] Just recently we've seen the Backbone report come out from the government on domestic violence, clearly showing that for all the millions that have gone into domestic violence treatment, The stakeholders of most importance, the victims, are seeing no change. And the treatment programs aren't tapping into that. So they're just thinking, job done. Does that approach, and when I say, sorry, let me rephrase the question. That idea of being careful entering into treatment, does that apply for non-mandated clients? I think it does. think, um… Once you engage in treatment, other… change mechanisms may be ignored. So. You may rely less on your friend group. You may neglect other wellness or resilience things that you may do because you're thinking, I'm gonna fix it in therapy. And a lot of the change mechanism may be from your engagement with those things that are under your control and will endure outside of therapy.

[1:01:47] You may also find in therapy that your expectations are not met. And so you may go into therapy thinking it's going to solve all your issues and then feel a sense of disappointment. I've seen a lot of people go away on weekends away where they're encouraged to be emotionally free and, you know, to… This is the safe place to disclose. And they often come back and they tell me they felt really good. But then that feeling of elation and freedom disappeared because the intervention gave an experience, but not change. And we saw that with a lot of the work that was done on adventure therapy with youth. who had been offenders. Oh, let's just engage them in canoeing and tramping and all the rest of it. So they were given an experience, and there was a belief the experience would automatically lead to change. But in the end, it was just a positive experience.

[1:03:13] Yeah, and. no opportunity to take those learnings and apply them to their everyday normal life. Well, that's the hard work and that's where the client has to accept that. Because some of those things that we're talking about is basically a belief that change occurs through osmosis, like dipping that chalk into the ink that it's going to… But we know that there's a lot of effort needed by clients as well as an environment that will support that change. And if that's not present, you may be setting them up for failure. And in the mandated area, like I say, sometimes when we treat someone, we then believe there's less need for external management. when in fact there might be just as great a need or more. And so sometimes if someone can't be effectively treated, it might be better off to externally manage them. Because that's more reliable than relying on very short contact or inappropriate treatment, like the wrong goals.

[1:04:39] targeting the behavior and changing it can be effectively done by external management as well as internal change processes. Somebody, basically when you're externally managing something, you are getting someone to, as I do, so shall I think. Instead of reliant on someone's insight, whether they want to or not, they are changing their behaviour. The hope is that they therefore are gaining from the insight of others. Modelling. Yeah. Modelling or psychodynamic would say that the external environment is becoming external ego. So it's providing controls over impulses. So it's another way of looking at it. So when I'm dealing with someone that's quite resistant of change, paranoid, I'll often get people around them to take on the role of being the external ego. So their interaction with the client might be for other tasks. It might be exercise related or art or something else that the client enjoys. And during those interactions, they might disclose their internal world, thinking. And the person that plays the external ego can proffer their understanding.

[1:06:41] that the client's wrong or this is the truth. It's just very much, you have to train them to do this so they don't buy into the distortions of the client. You've got to just get them to just say, perhaps extra information that the client hasn't thought about, but in a way which is non-confrontational, non-challenging. Because, know, obviously the paranoid, the worst nightmare is that people are trying to control them, control their thoughts. But if you do it the right way and you just proffer it like a gift, leave it on the table for the client to pick up if they want to, that can often lead to modifications of their adaptive schema. You're not going to change their view the world's a dangerous place. But you might change their interpretation of today being dangerous or the setting being dangerous. And that can be really important in at least not making them worse. And hopefully maybe over time, them starting to trust that others might have something of value to say. What we're dealing with when you're dealing with someone with personality disorder is they, particularly at the far end, it's dimensional, so we're talking people with this being prominent. There's a loss or a severe impairment in the self-reflective loop, which is that little voice we have in our heads when we do something that debriefs us and goes, mm. Maybe you could have dealt with that differently.

[1:08:35] Maybe you could have said it in a different way. And so we do that and, or do I need to find out more information? So it's a reflective loop. Whereas those with a disorder, they have a ruminative loop where they just double down. They're not seeking new information. They're not. doubting their efficacy, they just think I did the right thing. And so you get confirmation rather than the need to change. Now we try and change that for clients, but some clients find that almost impossible. So hence why we're giving them the benefit of an intact self-reflective loop. In some therapy, we do that where the client will just give it a go because they trust that we might know what we think. And our hope is that when they try something and they have success. then it becomes something they'll continue to do. What popped to my mind as you were explaining that was schema therapy. Different ways of teaching about reflective loops and the ability to externally model things for a client with a longer term hope of having them internalize those processes. Yes, that's the key thing is. is them internalizing it.

[1:10:14] That can be difficult. So what do we do? Well, this is we go back to behavioral things. And, you know, when I started out, I'd often make little cue cards for people, laminate them. They can carry it in their wallet, you know. And now we've got the benefit of phones and other things. I think, you know, part of that modeling can be Especially when we're modeling behavior that is difficult to internalize. We want to make the environment prosthetic. We want to make the environment work for them. It's like dealing with someone that's alzheimer. You put on the drawer a picture of a sock. That's the sock drawer. You make the environment work for them. And when you say hello to them, you say, hi, Mr. Wilson. It's Thursday and it's 10 o'clock and you've got this happening tonight, you're providing information. So make the environment provide information. Interesting. I want to change text a little bit. I'm aware that you're interested in the work of Viktor Frankl and I respect you so much that after I heard that you were interested in that, it kind of gave me permission to look further into, because I'd always heard about his work, but thought, ah, it's from the 50s, 60s. Surely it's a bit old school. 40s? And so as I've been learning more about logotherapy and what he has to say, what struck me through reading you know, his books and some of his articles and watching on YouTube, is it feels like a very philosophical approach to life. And that somehow feels different than my training. And like he's talking a lot about existential.

[1:12:22] Well, he was a colleague of Anna Freud. Erik Erikson was a student of Anna Freud. So yeah, they're very psychodynamic at one level. I mean, Viktor Frankl had started to develop his beliefs around logotherapy before the Second World War. He was already working as a psychiatrist. But it became sharply evident to him and his experience across those four camps, Dachau and Auschwitz, of when he was wondering why he survived, his family died and so many other people around him died. Why did I live? Maybe we wouldn't have given his views as much weight. But I don't think you can divorce the man from his experiences. And, you know, it's incredibly confronting when you're saying, you know, he's eating a piece of bread in front of other men that are starving, you know, and just savouring the piece of bread. know, and he dictated that this famous book, you know, Man's Search for Meaning, I think it was a period of nine days or something. He just dictated the entire book. He'd basically written it in his head while he was in the camps and not long after, think it was 46 or 47, he dictated it. But the other thing I was always impressed by him, and this is perhaps philosophical, is he didn't lose his sense of humour. He could continue to find things funny. his logotherapy, therapy of meaning, is I think very philosophical. But if you look at Like I said, the contemporary Erik Erikson, it's all about finding meaning in life. If you don't find meaning in life, you get to that last psychosocial stage, ego integrity versus despair, because your life has had no meaning and there's no time left to change it. In fact, Erik Erikson lived so long, he lived into his 90s. that he thought there should have been a ninth stage because he said you had ego integrity at 65, but at 80 or 90, you start to lose it. Because now so divorced from your generativity in terms of value.

[1:15:22] What popped up? So it just means you got to keep working. Never retire. What popped into my head as you explained some of that was something you said right at the start around your thesis and looking at those diagnosed as psychopaths and them needing to find meaning, taking things out, but needing to replace. what you've taken out with something meaningful. in my mind is like… question around humans seem, regardless of what you're diagnosed with or not, humans need meaning. not less, I think more so. think, you know, people's ability to find meaning has got less. I think that's because… they don't trust. what's around them is having value. If we look at the impact of social media. You're always having your own value diminished by the achievements of others. So it's not just finding meaning, but being satisfied with that meaning.

[1:17:07] So, and maybe even similar to the Gottman's looking glass self, we want to see that the things we regard as having meaning are reflected in our society. And that society values them? Well, society models that these things are valued, but where are our… models of society that both that things have value and that value is enduring. because of the rapid change. It's almost like Alvin Toffler's Future Shock, which is a very famous book in the 70s, 80s. After the Second World War, which had led to such a leap in technological advancement and changes in the whole world, changes in society, there was a whole group that just couldn't keep up with the pace, yearn for the good old days. were suffering a lot. And what were they suffering? They were suffering a loss of their ability to find value and stable value. And maybe we're about to go through another period where the rapid changes are causing us to doubt things we previously thought had value. Think about work. Think about other things that we've been told have value, like being able to have a family, to be able to have a house, to be able to afford things that you regard as valuable, like good food or things like that. This is all under huge stress, but I really think the employment thing's gonna be big. I look at some young people now and even the people now at school, they may never have a job. That's huge for me because I was brought up at a time where unemployment was virtually non-existent. There used to be a joke that the then Prime Minister in the 60s, Holyoake, that there was only 760 unemployed people in New Zealand and he knew the name and address of everyone. I walked out of school and there was like, job here, job here. There was no problem. It's a very different world than having an expectation that my life will have value because I'll be able to get a job and then all these other things will fall out of that. So when we talk about search for meaning, I think that the search is getting harder or we're going to have to change what we model to people gives them meaning. gives them generativity. Because mean, Erik Erikson's model was based around, particularly for men, being able to gain achievement, employment, but also to have a family. But there's now whole sections of the population that will not have a family and may not get a job. So where do they draw meaning from?

[1:20:49] My mind instantly goes to concepts like economic systems, politics, and where does psychology fit into this? Where's the value of psychology? How can we contribute or not? I have always had the belief that we come into our own when complexity is on the table. Because we're trained to deal with complexity. We're trained to try and produce a gestalt, to bring a whole, to bring things together into a formulation, particularly when there is complexity. That's what we do. to make sense of all of this, to be able to decide which is the keystone issue, to know about the links between things, to be able to understand the etiology in terms of distal and proximal antecedents, to be able to understand that behaviour change might lead to both immediate and long-term consequences, to have that old picture. That's what we do. So I don't think we're going to get out of business.

[1:22:17] What I've found is that I went through a period where I was almost, not ashamed, but I was reluctant to talk about complexity because it scared people, it scared policymakers. They just wanted the simple one-pager. They wanted the simple solution. They weren't interested in the unintended consequences of what they were doing. And I brought into that because I wanted to not be the naysayer. I didn't want to be the skeleton in the closet. But what I've changed is that I believe we have to actually talk about complexity and how to embrace the complexity, not to be scared by it. But complexity brings opportunity. If there's only one solution to an issue and it doesn't work, you're lost. But if you can see that a behavior has multiple functions, multiple determinants, that means there's opportunities. We can't do anything about that, but we can do something about this. And so I think as psychologists, don't be afraid of the complexity and perhaps telling people what they don't want to hear, but actually we need to sell the complexity as an opportunity, as well as a reality.

[1:23:55] Yeah, and life certainly is becoming more complex for me. I'm not sure if that's because I'm aging and more aware or if life is… Like is that a subjective thing or is it objectively becoming more complex as the world goes further on? Well goes back to that whole issue that I think it is more complex and people feel it's becoming more complex and fast pace and that's overwhelming and so you know maybe time for us to look back at some of that work that Alvin Toffler did and about how we need to understand the psychological processes happening for our society where there's no certainties. You know, the world can change rapidly. The first time I thought about the world changing rapidly was I went to Europe in 1989. Went to Germany. could only go to West Germany because it was separated by the wall. In fact, I briefly got detained by the East German border guards because we didn't have a piece of paper for the car. So it was all very fraught. And then I come back and within two months of coming back, the wall came down. And suddenly there was major political things. But I think since then we've had a number of weberites, the more recent one with COVID, just things of just people just go, wow. And they even talk now, oh, that was before COVID or after COVID, recognizing, you know, just like they used to talk, oh, that was before the war or after the war. And people are using this to try and put markers down to try and make sense of the change.

[1:26:05] Are there similarities? and how as a general society people coped with change when the Berlin Wall came down in 89 versus COVID that you see. I think COVID, because it was worldwide, was probably closer to the Second World War, where it affected every part of the globe. Whereas the wall coming down was mainly a European issue, although it did affect America because of its investment in European peace. But for something to have such a global impact, probably you'd have to go back to the Second World War. to find something of similar global significance. But, you know, and it happened and it happened fast. You know, we can all remember March. Suddenly the whole world changed. You know, I was due to fly to Australia on the 20th of March and we thought we were still flying, wife and I, visit a family until I think about eight days before that has closed the border. Bang. And yeah, and very shortly thereafter, we were in lockdown for the first time. And then it dragged on, just like most crises do.

[1:27:47] If it abated immediately, but it went on long enough to have some enduring impacts. And I mean, we're still seeing the impacts now in terms of the change. and our political environment, the rise of conspiracies, et cetera, et But I think it comes back to the coping, how people are coping with that. It's not just coping with COVID and the changes that brought us, we're coping with AI, we're coping with huge instability around the world at the moment with the war in the Ukraine, the war in the Middle East. So I think people are… They're not thinking much beyond the week. And that has its own issues when you have such a short frame of reference for predictability, then you start to suffer if other things happen to you. It's easy to fall into hopelessness and helplessness because you're only living perhaps day to day or week to week because you can't plan beyond that. Interesting. As soon as you said suffer, my mind just went back to logotherapy, which is meaning and suffering part of it. Well, that's right. you know, there's a famous case that Viktor talks about seeing a man who had been in an accident. and his wife are involved in an accident. His wife unfortunately died and he just couldn't get over the grief. He was, his life had no meaning and his suffering was intensified by this.

[1:29:54] And Viktor asked him in therapy at one stage. So we'll call him Nick. So Nick, you've really suffered from this. What would it have been like if your wife had survived and you had died? And the man went. Oh, she would have been destroyed by this. I'm sort of barely coping, but she would never have coped. And so that one insight that while he didn't want his wife to die, was better that if one of them was gonna die, that it was her because she would not have been able to cope going forward. So. That's where you can draw value out of suffering. But ultimately it's about finding the value. it has to be a value that resonates with you. So obviously for that man, you know, he was taking one for his loved wife and that was going to be an enduring value for him. It wasn't going to be fleeting. So you got to find things that you can draw upon that have reliable value. And I think that's the challenge, finding reliable value in a fast paced changing world with unpredictability. I think people will pull back, maybe it's Maslovian, which is again philosophy, that you pull back to the things that are most important in terms of value.

[1:31:42] Yeah, interesting. That example made me reflect on helping a client perspective take or change perspective, kind of cognitive reframing the narrative that we tell ourselves about stories. Hmm, sorry, I got we kind of got quite philosophical. Well, let's be honest. My psychology department, I co-housed with philosophy because of the overlap. Just like a lot of psychopaths are fascinated by certain philosophers, mainly Nietzsche. You'll often find books on Nietzsche on the bookshelf of a psychopath. The futility of life, there is no God, that sort of thing? Well, the nihilism, but also the right to, if you're a superman, to write to predate on others. the whole thing that, you know, what doesn't kill you makes you stronger. So, which is a great narcissistic sort of thing, you know, I survived, you know, and you didn't. Because, you know, the subtext of, you know, what doesn't kill you makes you stronger is you have to survive. There's no learning if you don't survive, if you're just broken.

[1:33:23] So sometimes there's like a degree of narcissism and being able to take joy from the fact that you're a survivor. But others haven't. Something special about you. The psychopath doesn't experience survivor guilt. They, um. The most primitive form of empathy is personal distress. You see this in really young children where a child will start crying and other children will cry around them even though they don't know what that very primitive empathy is. But it disappears over time because we replace it with more cognitive elements where we can suspend empathy or pick it up or… pump it up if we want to. But that primitive empathy disappears because it actually becomes dysfunctional after a while. I wouldn't be able to be a dentist if I couldn't inflict pain or sometimes, you you have to let your children fail, you know, all those sorts of things. So, you know, that personal distress declines. But with the psychopath, they've never had it. Certainly the primary psychopath. They're often quite puzzled by it, by even the thing that they would feel distress. Well, we're on that note. I'm going to ask you question from the Mount Maunganui College Psychology students. And it's along the lines of, we know that environmental factors and biological factors have an interaction for the psychopath. In your mind, if you had to choose one, which one is weighted heavier?

[1:35:30] I would say for the primary psychopath it's the genetic component. But 30 years of studying this area, I recognise that there's a whole group of people that become psychopathic because of life experiences, particularly under the age of 12. Take the earlier, the worse their prognosis. we used to call them sociopaths or secondary psychopaths. they can be just as dangerous, but they seem to have with the right intervention a greater ability to change. So, but if we're looking at the more primary psychopath, the one that has that total loss of empathy, coldness that's genetic and doesn't seem to be modifiable. There was a study by Lynam where they looked at a group of individuals that were assessed as psychopathic at age 13 and then later on I think at age 25 or 26. So they were assessed at these two time periods. And besides being assessed for psychopathy, they assessed a whole lot of other environmental or social events that were happening. And they found that those that were low on psychopathy, who had the adverse events happen, became high later on as young adults. But those that were high on psychopathy at 13, no matter what happened in the meantime, they stayed high. at 25.

[1:37:36] this is where there's a, and I mean, Terrie Moffitt's work in the Dunedin Longitudinal Study found that she could identify three, those people that had many of the psychopathic traits who then entered into being life course persistent adolescent, sorry, life course persistent. anti-social individuals versus those that came into it because of life events, divorce, doing badly at school, that came into it 12 or 13, got up to just as much delinquency but didn't truck on. There was a temporary basis to it. They could be pulled back into prosociality even without intervention in their late 20s. But the other group the 5 to 7 % of the delinquent sample kept on trucking. And at three years of age, you could pick up that slightly lower verbal IQ. And they had the presence of, often given multiple diagnoses, ADHD, conduct disorder, et cetera.

[1:38:55] Nick, I'm going to ask you some quickfire questions. Your answers can be longer. What's one insight that you wish you could go back and tell your younger psychologist self? to have realistic expectations of the amount of change clients can make. not to feel disappointed when they don't meet your expectations, but they may be meeting the client's expectations. That was, because there was always this, maybe it was my own Pollyanna nature and my desire to see more growth, but just realizing that clients change as much as clients can change. And that's fine. What case or experience marked a genuine turning point in how you practiced as a psychologist? when I was quite junior. had the experience in my internship year of working with someone for an entire year, which was quite unusual. Usually you were lucky to get six to 12 sessions treating someone, but they wanted to give me a mix. And because I had a full year internship with Corrections, they said, right, besides you picking up this workload of a number of clients on shorter sentences. We've got this guy stuck in high security on a long sentence and we want you to work with him for the entire year. So I got to work with him for something like 26, 28 sessions. And that was golden because I got to see what you're able to do once you established a very strong relationship. But I was also able to see change in him. because I had contacted him over such a long period. When I first saw him, he was in high security.

[1:41:24] By the time we ended, he was in low security. It was also, he'd committed a very serious crime involving the attempted murder of a child. He had been given all sorts of diagnoses at the time, including being accused of being a psychopath by a psychiatrist that saw him for 15 minutes. […] So my client had committed a very serious crime at the age of 18. He was on a long sentence and he was, like I said, stuck in high security, constantly in fights with other men. in the exercise yard. And initially, he would often come, only want to come and see me because he could look out the window. Because in his cell, he could only see a wall. So he looked out his cell window, there was just another wall, concrete cinder block wall. And he was very visual, very artistic young man. In fact, one of the things he drew was a picture of what he could see outside his wall versus what he could see outside the psychologist's window. So when he first would come into session, he'd often go and just stand by the window because he could see trees and hills and greenery. But we worked closely together and I was very proud of being able to get him out of high security, get him into minimum security. But it was like the gift that kept giving for me in terms of my growth because he was later released.

[1:43:49] He went and did other treatment and I had contact with him while he was doing that other treatment. I also picked him up in the community for some post treatment work and I was lucky enough to be able to even visit him with his family. I, yeah, so you don't often get those opportunities. It's like the full court press. got to do everything, work with his family, work with him on multiple occasions. And, you know, he was also a lesson for me that I had high hopes, as you should do. He got out. He stayed out. Even though that psychiatrist I mentioned said he would immediately re-offend, kill someone and should never be released, well, this man stayed out. Life wasn't totally smooth for him. He had an addiction, problems with alcohol that undermined his change. His father died, which was a major role model for him. But he got married, his child. There was some stability there, but the key thing is he stayed out of prison, even though life hasn't been perfect for him. But it was a great learning for me at an early stage in my career. What do you think the pros and cons are of a clinical diagnosis?

[1:45:32] I think the pros are it enables you to access research that's been formed around understanding and intervening with that. it's a shortcut to be able to get the right information for your client. The downside is the person's more than their diagnosis. And for some… people, that seems to be the end of interventionists to gain a diagnosis. And I'm seeing it amongst many people now where they just, come seeking a diagnosis and I always go, why? What difference will the diagnosis make? What difference will this label make? And they're a bit stunned. There's almost this belief that the diagnosis in of itself will solve their problems. And everyone wants one. There's no appetite for eccentricity now. No, there's got to be a disorder. Used to be when I was growing up, normal was a big house. Now we're down to a couple of rooms. Because if you leave normal, you've got to have a label. amongst some of my daughter's friends, they've all self-diagnosed. And so when someone comes to see me now, one of the questions I ask in that first session is, what do you think's wrong with you? Because they've all gone to Dr. Google, they all believe. And not only are they seeking a diagnosis, they're seeking one diagnosis. And there's a concept in psychology called diagnostic overshadowing.

[1:47:24] Sounds really fancy, but what it just means is the error in expecting one diagnosis to explain all behavior. So I first came across it when I was working at Tokanui Mental Hospital before it closed. I was working with the intellectually disabled. And I was working with a man who had been in that hospital since he was eight. and he was probably in his early 40s. And while there's no denying that this man had a mild, relatively mild intellectual disability, he had an IQ of about 65. It's pretty functional. However, it was only in the last year that he was diagnosed with bipolar disorder. Prior to that, he was seen as just regularly naughty. And that regimen of Largactil, which would suppress his behavior. And then he'd be quiet for a while before he cycled back into a manic phase again and was like said this repeated. Once he was diagnosed, you could clearly see from his file this regular cycle. sad thing is that even though he had this mild intellectual disability, he was quite functional. He was never released up until we found what the problem was because his problem was seen as more complex.

[1:48:55] But all that naughty behaviour was just seen as an expression of his intellectual disability. And so it was a real eye-opener to me about being careful about a single diagnosis. So most people I meet want a diagnosis, but they only want one. So they're not prepared to entertain that there could be other issues for them. Does that answer your question? What's the most popular diagnosis being sought at the moment? ADHD followed by ASD. No one wants the other ones. No one wants to be GAD, general anxiety disorder. No one wants to be depressed. They just want those ones. Even though of course depression and anxiety are often associated with both of those. No one wants a personality disorder. I haven't had anyone come to me and say, I think I'm histrionic or I think I'm narcissistic. So they're always seeking certain types of diagnosis, either because that's fed to them or they, yeah, I mean, yeah, I don't know about your experiences, Matt, but that's my experience that they don't want complex diagnosis. And they're also often, like I said, a bit confused about what they want from it.

[1:50:27] And even, I was reading recently about the impact for many women who have dealt with ADHD in terms of coping with it, but it becomes something they can't cope with when they go through perimenopause. And so they've now got the presence of two things. They've got the… increase the symptoms associated with ADHD, but they're also dealing with perimenopause, which isn't going to disappear if you put them on Ritalin. Yeah. Or Concerta. So it's complexity, which goes back to what I was talking about, to embrace complexity and not allow perhaps our clients to try and overly simplify things. While not scaring the horses, we don't want to make it seem that you can't do anything about it. That's what I mean by embrace the complexity, show there are things we can do. So for that person that's suffering from the combination of perimenopause and ADHD, who had previously coped, maybe the intervention is dealing with the perimenopause, not necessarily ADHD.

[1:51:49] What's something that a client has said to you that has genuinely stayed with you? Well, you can learn a lot from clients. I was busy doing lifestyle balance with a client. And at one stage I said to him, we were talking about the need to have not just work and obligations, but to have other things on the other side. I said to the client, although I say, I said to him, sometimes work can be pleasurable when he says, Nick, Works always work. It stuck with me. Works, always works. And this is the same client that later told me that, who was in a maximum security, says, in here, he says, Nick, a glass of water looks like an oasis. Quite profound. What are some psychological interventions or frameworks that you have applied to your own life or that of your family's? probably behavioural approaches with my children when they were younger in terms of stimulus control, crying. You know, I can still remember having to convince my wife to stay sitting on the sofa when one of the children would cry when there were babies and wait for a certain period of time. And she'd be like, the starter gun's gone off and she'd be already into, I've got to go in and I go, no, we have to wait for another minute. But it worked. You know, we learnt how to manage those contingencies. The child became familiar with their bedroom and their environment, were able to self-soothe, which is really important. So that was one thing I did apply that worked really well. Albeit there was a fraught situation while we were, oh no, this is the second time we have to wait long. More recently, my children are now adults. I've used my understanding of psychosocial stages and their needs to understand their desire for some degree of autonomy and identity and therefore that my role has to therefore develop one where we need to have contact as a more of friendship. You know, I found with my son that I was falling into nagging him a lot about his room, which is still untidy.

[1:54:46] But also other things that are happening in his life. And I thought, this is not what a friend would do. I'm still staying in parent mode. So I found something that we could do together. weren't dad and son. We were two guys doing something together. And so that has worked really well. and establishing a better relationship. So things like that. So yeah, I use psychology a lot. The worst thing though is you can't tell them you're doing that. Puppet master. possibly at one level. And look, let's be honest, as psychologists we know. how to pull the rabbit out of the hat, but also what's happening. We know what's behind the scenes, but it still works. And so that's the power of psychology. Even when you know the mechanisms, if it still has an impact, that's very powerful. It doesn't rely on a subterfuge. Nick, throughout your career, you've been in a variety of situations that would have been very emotionally taxing, I'm sure. How do you manage the emotional weight?

[1:56:18] I'm no different from anyone else in that isolation increases the emotional experience. So being part of a team, having colleagues around that understand what I'm going through, understand the practice, my family, supervision. Supervision is is so key to what we do. sometimes I've had to compartmentalize, but I know I have to deal with it. So one of the tricks that I do is when I'm working with a client and something they do or say has a particular emotional resonance with me, I'll write a note and I'll put a little box around it. because that's my way of acknowledging it, putting a box round to manage it in the moment, but I'll know I'll have to go back and deal with it in supervision. And if it keeps coming up, I'll sometimes, it now gets little guard towers and barbed wire around it. And that's really telling me I need to get onto that, can't wait for the next supervision. So there are tricks you can do to manage that immediate emotion, but… I recognise that if something, particularly if I'm ruminating on something, I take it home, this is the pathway of PTSD. So that's telling me I need to take it to supervision and not wait necessarily for the next session. The longer you allow something to remain in your conscious, the more likely it is to generalise and become hard to extinguish.

[1:58:08] So I recognise that. But yeah, I'm often a bit amazed. 30 years I'm still doing it and it's quite often emotionally taxing work. That shows that it's not necessarily the stress that nails you, it's the inability to manage the stress. I think the other thing that can sometimes lead to unmanaged stress is if you lose the value, if you lose sight of why I'm doing what I'm doing. So you can carry a high level of stress if you are quite motivated by the value and direction towards that value, goals towards that value. But I think if you lose that leadership, it self or other leadership, towards goals towards the value, then you can be overwhelmed by the stress that you've previously been managing. But it can be, you know, and I've come close to tears on occasions, you know, and that is sometimes I'm a bit surprised by it because you get to a stage where think, oh, but when something happens like that, you got to think, wow, is this aberrant? Is this because of a particular emotional stressor or is this because I'm now carrying a lot of stress in this? small innocuous event has put me over the top. And so, yeah, I was giving evidence in a coroner's court a wee while ago and it was a very fraught situation involving a man that had killed several people, but also a family member had committed suicide. So this is all public. So it's not confidential as such because I was on the media every day. But all the family members were present in court for the two victims of the murders, as well as the family of one of the family members that committed suicide. And there's even down to some of the family, a box with the ashes of the last victim in front of them on the table. And so this is an incredibly fraught situation and quite rightly the family were elevated at the start of this hearing because they want answers and they want accountability. And so, you know, was a tough situation, tough audience, if you want to put it like that. But over the course of that hearing, Even though I didn't realize the impact, all the family members made an op- made a um, when they had the opportunity took advantage of that to thank me for my evidence. Even though I didn't think I was offering much, they just wanted to understand why did it happen? They knew they couldn't bring their loved one back. but that waited off in decades or certainly long periods of time to just know why, why did this man do this to their loved ones? And so I can still remember on the fourth day of evidence and eventually I was being excused from further evidence so I could head to the airport and get on a plane and come home. One of the… The mother of the last victim asked the judge if there could be a recess and she took that opportunity to come and give me a hug and to thank me. So yeah, it was a few tears from me.

[2:02:24] Yeah, it was very special but also, yeah, but so that was a particularly stressful event. Another event that more recent, not too far along, I was reading the pathologist report on the lady that had been murdered in Christchurch. And I was just overwhelmed with anger and I just, and so I immediately took that supervision. And I think it was a combination of the harrowing account of this brave young woman, but also cumulative in terms of there being too many of such incidents. So that told me that I was carrying too much. Have there been any client demographics or client types that you've refused to work with or that you no longer wish to work with?

[2:03:46] Oh really? I've worked four times and yeah. I didn't enjoy doing couples therapy. That was pretty demanding. But I wouldn't refuse to do it. But I'd lay the rules down very carefully on how we were going to work. Just because the devotees, when you're working with both, are being pulled into one side or the other. I don't do couples. But I've also seen it work really well. yeah, so it's valuable work. yeah. A very specialist area. I think so. Yes, and… Yeah, it's just very difficult because you're working with often different contingencies. You're trying to keep them together and then you find out one party's just waiting it out before they can leave with the new partner or you realise very soon it's about safe disengagement rather than engagement and that can be difficult.

[2:05:17] I've had some questions come in for you. As you think about your career as a psychologist, what makes you proud? What makes me proud? Well, I said at the beginning, I'm in the business to make a difference that drove me as a policeman and drove me as a psychologist. And I've been lucky enough to be involved in the creation of, because you can make a difference with one client or if you go in group work, a group. But if you get the opportunity to do research that affects the practice of many people. It's an amazing experience. And so I've been lucky enough to both be responsible for, like I said, the development and the maintenance of many psychometrics, what I'm quite proud of, but also the development of tools that have then shaped practice and probation and case management. So I'm really proud of that. I'm proud of my efforts to bring about a belief in the treatment of criminal psychopaths that didn't used to exist. There's now, we've got runs on the board. We're able to point to research showing that we can make difference in them.

[2:06:48] I'm really proud of bringing in suicide assessment using a validated tool across all of. corrections and probation. I'm proud of being able to then use some of that success to influence people overseas and other jurisdictions. So some of my measures have used overseas. So that's really cool. But I suppose if I was to pick one thing I'm personally most proud of is I've had an enduring ability to put my hand up for things. and to make and have success in them. Sometimes it's taken a degree of bravery, perhaps delusion, but that's where those opportunities have come from of that in both combination of an inquiring mind as well as a degree of self-belief. That's what I'm quite proud of maintaining. I've had setbacks, but I've not allowed them to take away from the enduring pathway. How has your worldview changed since being a police officer?

[2:08:24] I think. As a policeman, you are very goal-focused on, in this case, apprehending and taking someone through the system. But you don't have any enduring contact with them, both victims and the offenders. And so that's the big difference for me is… having more of that long view. You know. It's, yeah, I suppose that would be it. It's a small country. I'm sure, Matt, you often see clients out and about. so it's, yeah, it's just not being able to, I think when you're a policeman, to cope, you deal in compartmentalization. But as a psychologist, you can't be effective. if you can pack me the lies. Does understanding how biased human cognition is make you more distrustful of people's judgements, including your own? Or does it lead somewhere less cynical? And if so, how?

[2:10:11] I think right back when I did my PhD, my mentor, Ian Evans said, you need to talk about who you are when you start your thesis because the reader needs to know the person that's gathered this information. And so it was a good eye opener to me that you can't, if you're looking at something, you can't divorce it from the person. and the filters and the biases that they have. Just like you should never meet your heroes. I've fortunately had situations where some of my heroes haven't quite matched perhaps the impression I had of them from their work. So I think it's good to have an awareness of that bias, but it hasn't led to me to be cynical. everyone's got filters, everyone's got biases. The big thing is being aware of them and part of that awareness is why I'm a big believer in use of measures and other things to address that bias, why I use supervision to address bias. It will never eliminate it but it makes it transparent and therefore you can then engage in reasonable efforts to manage it. And I think that's the key thing is reasonable efforts. Part of reasonable efforts is talking to others and saying what, especially others who are psychologists to see how they manage it and then judging your efforts against that. I mean, reasonable efforts is something that should guide all psychologists. It used to be part of civil law, but it's increasingly come into other areas. And I use it all the time. Have I made reasonable efforts? Is it less than reasonable? Have I made too much effort? Where's that sweet spot? So I always have that as my mantra.

[2:12:24] So you're aware of biases, you take information given to you with a grain of salt? Healthy skepticism, you know, I don't. Some people get upset with the clients for lying to them or not, you know, a mission of information. I put myself in the shoes and go, oh, probably be lying too. I'd feel a bit shameful about this. First of all, I expect people not to tell me everything. I do reasonable efforts to try and pull that out, to triangulate information. So self-report is always treated with skepticism. I always look for other sources. That doesn't mean I don't give weight to self-report. I'm just not reliant on it. But like I said, it's reasonable efforts to deal with self-report. And I quite like the term healthy skepticism because it is healthy to be skeptical. It doesn't mean you're being cynical. You're just actually bringing some degree of rigor, recognizing that people struggle to be both objective and truthful, just like we do. Is part of that buffer, is part of that buffer between cynicism and healthy skepticism empathy? Realistic empathy.

[2:14:10] Empathy doesn't mean you get pulled into a subjective alliance. empathy doesn't lead you to necessarily to advocacy. Empathy, perhaps realistic empathy, or I think the term used is accurate empathy, is where you… have an understanding of the person. yeah, so just came to me, I want to keep talking about realistic empathy, but the term, if you want to look it up as accurate empathy. Where do you think the future of psychology is heading or is needing to head? Well, as I alluded to earlier, to more of a cohesive whole, more integrated, less split and more grounded in common principles while open to innovation outside of those through new approaches. I think we're going to have to head towards more acceptance of the principle of least intervention because we're not going to have the time, the clients aren't going to have the capacity for lengthy intervention. But that doesn't mean that change doesn't occur or keep occurring outside of intervention. And that could be where things like AI and other things can be really useful. Um I think we are under a lot of struggle because of the numbers to accept people as psychologists who may not have gone the path that you have. So whether that's psychology assistants or people from overseas that haven't had the same training or length of training, there's quite a challenge at the moment for psychology to move to acceptance of qualifications that are taught masters or basically qualifications without research. There used to be a core facet of the Boulder model, the scientist practitioner, that you had to have some understanding of science. so that you were able to understand research and apply it with the person that you were seeing. So I have a feeling that that should continue, but I don't think it will.

[2:17:16] So the challenge is going to be how we equip those that don't have the research experience with the critical thinking needed to understand and apply the research. I hadn't thought of that. That actually blows my mind a little that we wouldn't be thinking about the scientist practitioner model. mean, the scientist practitioner just means that you're operating not just in your therapy, you're operating not just on your own experience, but you're able to pull in the science behind it. need to have done a master's or a PhD to do that. But it's not just having a master's or PhD, but a qualification where thesis was a major component. But increasingly, one, the universities are struggling to supervise all of those students. And two, a lot of the students don't want to do research. Really? Which could also be an issue where people are resistant to doing something where there may not be a defined outcome or right answer.

[2:18:59] Which doesn't speak well for critical thinking because critical thinking you already know there's more than one right answer and that you could be wrong. Yeah. And that's research tells you. Null hypothesis. But people want to know I can start this qualification on date X and finish on date Y. As you'll know from your own experience, when you're having to do research, certainly trying to gather data, it just means there's no certainty to how you're doing. And it also is costly. So I think there's lots of headwinds that mean that we may have to consider a different model. But for those that, you know, don't have the benefit, if we see it as a benefit of such research, how can we make sure that it doesn't impact on their practice? because that's not safe for clients. Well, it may not be safe and it may not be as efficacious because I'm a lifelong learner and you know Matt, because I bombard you with articles and bits and pieces that I haven't stopped. You know, I talked about my mentor has just published a new book. Why I immediately put an order in for it, you know. But I'll be honest if I talked to a lot of psychologists now that reading little or they're reading or they're listening to podcasts like this or You know what? mean there It is harder for people to to continue to learn So maybe we have to make it easier I Don't know sometimes I'm asked to train on something just because I'm the only person that read the book.

[2:21:12] But certainly my career has been, think, partly the success has come from that lifelong learning, but also learning upon learning. So I worry that people will asymptote out and therein lies perhaps a psychologist that will be limited, but I would put money on the fact that psychologists that will burn out. I'll lose the value. meaning that got them into the profession? Yeah, and the sense that they know what to do. They'll lose that. They might have it when they first come out of training. Oh, yes, I know what I'm doing. But over time, that'll degrade if they don't keep filling the bucket up. Continued professional development. Yeah. And just that enduring curiosity. Well, Dr. Nick. Have you watched much of The Simpsons? Yes. I love cartoons. Hi everybody! Hi Dr Nick! It's Nick Riviera, isn't it? The dodgy plastic surgeon from Mexico. Every time I write to you, I always say Dr Nick and every time I do it fills me with joy because I remember that character. And that's what I love about Viktor Frankl's work is embracing of humor. Even the whole paradoxical intent is a use of humor. I thought that's, just recently there's an article came out on the use of humor in therapy and it extensively quotes Viktor Frankl's work. But just it's an area that we don't get a lot of training on, but it is very powerful. Yeah, it's powerful for the clients, powerful for us. Dr. Nick, thank you so much for your time today, but thank you for your generosity throughout your career to many, many people you've influenced. I I worked in corrections for 10 years. You were one of the most influential people there for me. You can't get trainings, whatever. And so if it's true for me, it will be true for many people. So thank you so much for your generosity and sharing your knowledge, your passion for psychology and the clients that we work with. Thank you, Matt.