Data Science, Personal Connection, and the Future of Therapy

Richard Zwicky: Hi everyone, it's Richard Zwicky with The show that again. Hi The shows now I've flustered myself. Hi everyone. It's Richard Zwicky with My thy. The show where we know there's no one path to healthy so we explore them all. If you haven't subscribed yet, please do on Apple Podcast, Spotify, or your favorite podcast listening tool. Today, we're joined by Naveen Calfan, a licensed marriage therapist and family therapist with experience across hospitals outpatient clinics, addiction centers, and digital mental health platforms who also is currently working at Headspace. Welcome aboard the show, Naveen.

Naveen Kassamali: Thank you.

Richard Zwicky: So, one of the things I want to address today is truly a fundamental question, which is many people spend years in therapy wondering whether they're actually getting better. Why is progress in mental health so difficult to measure compared to physical health? You break your leg you set your leg, you're fixed. It's not the same. Why are we not measuring progress to help people understand how they're getting better or what they need to do differently?

Naveen Kassamali: So sometimes with therapy it's really hard to measure progress like medicine because we use a lot of self-reporting tools like PHQ and JAD and those tools measure how you feel in the moment and you could be having a really good day and your scores are going to be really high but that doesn't mean that anything has really shifted in your life. And another reason is therapy is usually what 45 to 50 minutes a weekly if you decide to do so. You have to be doing a lot of things outside of therapy to notice a shift internally.

Richard Zwicky: You do because it doesn't just happen in isolation in that one hour session. You see it in the rest of the day. And that also goes fundamentally to one of the aspects which we need to spend delve more time into which is if mental health treatment were invented today using the data science we have access to would it look anything like the system we currently have or would we approach the whole situation differently from birth?

Naveen Kassamali: It seems like in our society currently, everything is about data. And if we had started it now and if it was all about data, I don't know how successful therapy would be because it's not really about for example if we look at positive psychology and see okay I'm going to do these things to make myself happier. So it's gratitude journal this. You can do those things but that doesn't necessarily make you happier. I mean Those tools are part of it, but a huge thing that shifts how you feel is your internal conversation that you're having with yourself daily. And that really can't be tracked unless you're tracking it yourself. It can't be tracked by data really unless I mean there could be things like biometric data where you're wearing something or constantly answering a questionnaire but I don't know how much people would be willing to do that. A lot of knowing that you're getting better is through yourself. When I started meditating years ago, I didn't notice a difference till a few months later when I was like, " I'm not thinking the same way that I used to or I'm noticing this thought." But how that only I was able to see and maybe a therapist would be able to see because they would see how you're behaving differently or acting differently or talking to yourself differently.

Richard Zwicky: That's very true. And in most areas of life, we operate to the truism you can't manage what you don't measure. And we can track our sleep, our heart rate, our steps, our productivity, any number of things. But when it comes to mental health, progress is still often managed by how do you feel this week? How do you feel today? How can mental health keep up with the changing dynamics of the modern world operating with such limited data and the stress on the therapists because you can't get to everybody

00:05:00

Naveen Kassamali: I guess one of the things that have shifted a lot is short-term therapy. Whereas maybe before back in the day, it was more like long-term. So now you come for a specific issue maybe like 10 sessions and then you work on that issue through measured data measure tools that will lead to the data and then you exit and I do think that could be really helpful but I don't know if that's always the case because a lot of clients want to stay on. There's always stuff happening in your life that you want to maybe process or talk about or understand. Mhm.

Richard Zwicky: There's also the sad data point which is 50% of adults don't have a close friend to talk to. They need someone to be able to speak with to get feedback And sometimes, it's to hear your own voice saying your thoughts out loud helps you come to terms with things. Which also goes into the question of most progress is measured through self-reporting questionnaires, which is imprecise. That incomplete picture of healing that you're talking about where people stay on beyond what they necessarily need to resolve but they always have new things. How can we look at the emotional fluctuations that will arise to help people understand as a baseline they are improving as opposed to they're caught in a cycle. Right?

Naveen Kassamali: How they're responding to it. So we had sort of talked about how people move through cycles and they revisit patterns throughout their lives but they revisit those patterns with increased awareness which the data can't capture but you see how you respond to it. So for example, somebody who came in to therapy to process their sexual trauma, had the difficult time, felt that they were able to manage their life, moved on. Now years later, they come back to therapy because they have a child. But are they going to respond the same way as they did the first time? No. Because now they have tools. Now they have the awareness of what's happening and they don't have to feel like they're going to crumble. And that's the win that you receive from therapy or gain. Mhm.

Richard Zwicky: Healing is rarely linear, right? Life is longitudinal and we talk about longitudinal studies. But we also talk about relapses and a relapse some people look at as being a failing. The reality is we take two steps forward one step back. How do your models that you work with recognize the cyclical or developmental nature of that progress?

Naveen Kassamali: That's a conversation you're having with yourself a story you're telling yourself that, I'm just back to where I am. So that is what a therapist is there for is to help you notice where you have improved and changed or you participate in a different pattern without even knowing and then seeing how you can even get better at recognizing it before it even happens. Mean when people go to AA right even though they're starting over if they've had a relapse no there's no conversation about you're back to what you were and why is that because if that's the conversation why would anyone move forward Yes.

Richard Zwicky: And relapse isn't a failure. It's an adjustment in your path. Going to that and goes into also measuring and helping people show they are making progress despite those setbacks. Exactly.

Naveen Kassamali: So if you're going to say in the data I relapsed." And the data shows " they've not improve." that's not okay cuz that's not true.

Richard Zwicky: When you're looking apart from tools like transcription tools which help when you're doing virtual meetings helping you keep track of what's been said rather than note takingaking which allows you be more present full mind on some level. What other tools have entered into your toolbox in the last few years that have really changed how you're able to help patients?

00:10:00

Naveen Kassamali: The biggest thing has been the research the research that's out there and how you can easily get access to it. I've been really interested in gut brain and how people use hypnotherapy which I had no idea that was even a thing and I was a kind of take the training on it and realize that really helps with cuz it's all connected it's all connected your nervous system is a lot of times causing gut issues without even understanding that it's not something that can be fixed with medicine, which is why people are now, and this is all new. And I wouldn't have even been aware of it if it was 10 years ago.

Richard Zwicky: And I mean the data also shows when you don't have a well- balanced biome in your gut, it throws off your mental health as a result of long COVID, I lost the ability to extract tryptophan from my food. Without that, I don't make seroton my body can't make serotonin or melatonin, which means I have a hard time staying awake and focused or sleeping properly during memories. I have to take The supplements corrects the problem. But that single amino acid sets my whole system off and creates horrific issues. That gut biome to mental health connection that you were talking about has to be explored more deeply. In fact, we've got a professor from Stanford, Todd Coleman, coming on the show in the next few weeks about that. But understanding all those data points, what would you like to see brought in as measurements so that you are able to better understand and guide the patient? Because what you're talking about isn't just dealing with their mental health condition in isolation. It's actually helping them understand all the other things they can be doing in their day-to-day life, their diet, their exercise, and so on. And being able to show them data why it's interconnected and working for them.

Naveen Kassamali: I do think that would be actually very beneficial if they came in with the full picture. Which is why I think I used to work in hospitals and the team working in a team setting was really nice because you could see what kind of information the client gave to the doctor or what kind of information to the nutritionist because it's all different and we only see the part of the patient that they're showing us. So, it's really nice when you get to see the full picture of who they are and if we can get that information how long are they sleeping? What are they eating? How much are they exercising? Who are their friends? Who do they return to when they need somebody? And then maybe even showing those little shifts normally I would isolate, but today I went and did this. And sometimes, patients come and they will tell you that they did that but not all the time because sometimes there's so much to talk about that those things kind of like go through the site, right?

Richard Zwicky: They do and all of those things do combine and it must be more diffic it's more difficult to deal with that in a remote nature where you're not seeing the patient as opposed to in person. Do you find how people approach challenges and why they're coming to virtual sessions is different from when they come to in person and how they approach the issues.

Naveen Kassamali: I don't necessarily what I do think has shifted is people are more open to virtual therapy because it's more convenient for them and it's easy for me to get in touch with someone if they've overslept or forgot about The thing that I think has and also what I do think has helped is the barrier of having to actually step into an office has shifted whereas it's much easier to be on a virtual platform. You can find time in your house and you're more comfortable rather than being uncomfortable in a new place where maybe the therapist has even more power. I mean, not like no one's thinking of it consciously, but it's more just like,

00:15:00

Richard Zwicky: The therapist create the environment as opposed to you being in your environment,

Naveen Kassamali: I'm Yes, exactly. But I think the stuff that people are coming for are probably similar.

Richard Zwicky: Which is interesting because the growth in demand has surged so much in the last seven years. And

Naveen Kassamali: I think because of co Mhm.

Richard Zwicky: Awareness, And co forced us to spend time with ourselves and reflect on what's working, what's not or seeing behaviors we otherwise have been able to ignore because we weren't locked in with ourselves and people in the same way as before. That goes also to body awareness and nervous system regulation. Why are these difficult but essential to measure?

Naveen Kassamali: Because it's all connected, If you don't feel safe in your body, the idea of sematic therapy is if you don't feel safe in your body, you're not going to be able to change anything in your life. So, for example, this happens often where people are like, " I really want to start going to the gym. I'm going to go daily." And then they have this huge momentum, but then something always happens and it falls off. And the idea of sematic therapy is because your body doesn't feel safe to move to this new level of who you want to be. And how do you do that is through nervous system regulation. And learning those tools can help you be the person that you want to be.

Richard Zwicky: They can. Now shifting a little bit with regards to that is of course AI and digital mental health tools are advancing quickly and changing the landscape for when patients come to see you what they've also already investigated and what they think they're dealing with versus what they could be dealing with or sometimes they've been forced to confront things they weren't ready to. What excites you most about the potential of these tools? And later we'll go into what happens if you go down the wrong path. Right?

Naveen Kassamali: What excites me is that if you're coming into therapy with more awareness and even just the desire to be more aware, therapy is going to be exponentially more beneficial to you. Sometimes when people come in and there's not an idea of what you want to do, where you want to head, of course you can explore, but that's when things start to feel like am I just venting because there's no direction that we're going in. So that is really exciting to be able to come in with this specific thing I think I really struggle with this. And the other part of it is if you need a specific tool in the moment, I think an AI tool can really help with that, which is like you can look up, hey, can you give me a tool to manage this and then therapy could just be focused more on insight building and figuring out if things have improved and the connection that a therapist has with their client because that is the number one indicator of success anyway. Mhm.

Richard Zwicky: It is but as you know on this show we also had a couple of guests on who have spoken about how the brain hasn't evolved at the same rate as our innovations are moving faster than our minds and faster than clinical understanding of what the impact is. And when people turn to, and I'm a big proponent of AI, as know, I built a predictive analytics platform, which uses AI to process the data, but it's around helping people get that awareness so that be more effective with therapist. But people who turn to chat GPT or claude or any of the other AI tools, the challenge is those tools don't have guardrails. They don't know, they're not defined to understand who you are. Where therapist immediately starts learning about you from a mental health perspective. A chat GPT is used to dealing maybe building a profile of you based on your workplace or other things which can lead you down the wrong path. What do you as a therapist do and need to do to help guide patients around proper use of AI to support the work you're doing and they're doing, right?

Naveen Kassamali: Hatch or any AI tool cannot be used as a replacement because they're going to tell you what you want to hear. They're not going to be able to connect with you, which is what you need. That's the point of therapy is how can you be vulner how do you teach to be vulnerable? How do you teach someone to express emotions? How do you teach someone to hold boundaries? How do you teach someone like therapy is basically a training tool for you to take out into your real world?

00:20:00

Naveen Kassamali: And an AI tool cannot teach you how to live because it's never lived. So it can be used in conjunction with you but it definitely cannot be a replacement because what you mentioned before about how someone doesn't have a close relationship to talk to. That's what therapy is like teaching you how to be close to somebody.

Richard Zwicky: I think the data is 50% of it adults don't have a close friend whom they can turn to talk about private and things which is incredibly sad.

Naveen Kassamali: It's incredibly sad and it's going to make you more lonely if you're using an AI tool.

Richard Zwicky: It's only going to enhance your isolation because it's going to give you a false sense of where you're sharing and it's not going to connect to the real world.

Naveen Kassamali: It's easy. But that's the point of therapy isn't easy. Wounds and

Richard Zwicky: I mean, therapy is hard work. Therapy is about confronting really severe wounds. That have hurt you and continue to hurt you and pain. Yeah.

Naveen Kassamali: Fears. Yes.

Richard Zwicky: And pain and fears are things we are taught biologically to avoid, And then overcoming that is what separates a therapist from a computer A computer doesn't have any concept with regards to that. It can help you frame reflection, but it can't help you understand what it actually means.

Naveen Kassamali: And it can't help you. For example, if there's something that you are feeling shame about, it can't give you the empathy that you need for you to be able to

Richard Zwicky: It doesn't have empathy,

Naveen Kassamali: Then Yeah.

Richard Zwicky: So looking ahead over the next decade or so how could data and insights from data not just data it's easy to collect data but insights from data are what matter how could that fundamentally change and what insights you would like to see that would fundamentally change mental health treatment

Naveen Kassamali: I think that what could help is being able to understand a person the full person through the data that they provide or the information that they provide which would be easier to get through these tools rather than asking. And then also another thing that could be really helpful is the research that is going on that maybe is harder for me any therapist to get in touch or to be able to receive if it was an easier way to receive that or even see this specific thing really works with people who are struggling with OCD are like this thing really works. And then having that be accessible so that you set up your practice to be able to help that way.

Richard Zwicky: The insights can help guide you and the patient to a quicker resolution by helping guide what's the right path for this combination of things because the ACE study which the studying to adverse childhood experiences is 10 questions and you add and gender, age, ethnicity, and orientation. At 14, we can combine that 265 million different ways for one individual. That's a puzzle that you as a therapist are going to take months to figure out. Any guidance you have helps speed the speed the process. That's transformative. And I look at the data insights that can be gained as being allowing you to spend more time with the patients who need more assistance. Because those who can self-help have the tools and

00:25:00

Richard Zwicky: The guidance from the therapist to get going and don't need as much intervention. When you see that dynamic changing, what excites you about it?

Naveen Kassamali: I guess the thing that makes me excited is I feel like therapists will become more specialized in specific areas and

Richard Zwicky: And they will.

Naveen Kassamali: It's exciting because those areas probably excite the therapist anyway and it will bring more passion into their

Richard Zwicky: And I think it fundamentally under underscores point you made earlier which is healing isn't just about better treatments. It's about helping people find better ways of understanding themselves and learning forward. Naveen people who want to learn more about you, the work you do, how to reach you, how can they go about that?

Naveen Kassamali: I have a website. It's called groundingtree.com.

Richard Zwicky: The grounding tree. Great.

Naveen Kassamali: And you could go on my website. I have a psychology today profile and I see clients on Headspace, Headway, and other platforms as well. So, okay.

Richard Zwicky: Wonderful. Thanks for joining us today on High on Healthy. Me,

Naveen Kassamali: Thank you so much. I really appreciate the conversation.

Richard Zwicky: And thanks to everybody for listening. I'm Richard Zwicky with High on Healthy and we'll be back again with you soon.