Psychiatrist Dr Tony Mastroianni: why we need to stop treating mental illness solely with medication

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Alright, we're on it. I wonder what you mean when you
use the word I use the word Idi,taking a break.
We have an aversion to ourselvesand to what's happening inside

(00:21):
us, inside of us. I've been very interested in
this problem for a long, long time.
Something settles. Welcome back to another episode.
Today we are talking to a psychiatrist and even hearing
that word when I was in my darkest hour would have

(00:44):
triggered me beyond belief. And now I'm sitting on couches
getting the chance to interview people like today's incredible
guest doctor Tony Mastriani, a registered medical practitioner
and consultant psychiatrist. He holds a Bachelor of Medicine
and Bachelor of Surgery degree from Sydney University.
AKA he is very, very smart. He's a fellow and of the Royal

(01:10):
Australia and New Zealand College of Psychiatry and has
served as a consultant psychiatrist to the NSW Justice
Health Service for almost 20 years.
He is the founder of the focal length method, which is what we
get into detail about today, which is essentially how we look
at healing someones emotional distress or mental health

(01:32):
disorder, but through the lens of a much more integrated way
where we discuss everything fromgetting the blood results done
through to their social connectedness through to talk
therapy, attachment style, the whole works.
And I very rarely see a psychiatrist take this altitude

(01:53):
of of treatment. Usually it's come in, you get
your medication, you might do a bit of talk therapy at best, but
Tony has created this method or this model where you're looking
at the 360° human. I referred to it in our episode
as like the CEO of mental healthtreatment and what an incredible

(02:14):
North star to have for our society to look toward and and
see how do we make this the norm?
How do we borrow from his decades and decades of of wisdom
and being on the frontline, helping people with incredibly
complex mental illness and specialising in ADHD and and

(02:37):
schizophrenia. He he knows deep down that every
human has gold inside them, no matter how quote unquote sick
they are. And that's exactly where we
start this episode. And you'll see from the moment
we begin talking, just that belief system that it is his
privilege and honour to be able to bring out what is already

(03:00):
within, is such a refreshing mindset to hear from a medical
professional. We're going to unpack some
really amazing juicy topics, andboth of us try as much as
possible not to keep it too technical and to give you
constantly in this episode the So what, So that you, who might
not have a medical degree, can take this information and apply

(03:22):
it to your daily life. I can't wait for you guys to
listen to this. So without further ado,
introducing Doctor Tony, Doctor Tony, it's not often I get the
privilege of speaking to someonewho has the frontline experience

(03:45):
that you do. A lot of the exposure I get the
privilege of having directly is to people who struggle with
anxiety, depression, OCD, which are in and of themselves can be
incredibly debilitating experiences.
I think it's a true honour to also sit with people, whether

(04:06):
it's through them or more acute diagnosis like maybe
schizophrenia or bipolar 1 in very distressing circumstances,
sometimes even psychotic breaks.And I'm so excited and grateful
that we'll be able to touch on some topics that rarely I think

(04:27):
we go toward in this space. Like self help is usually the
way this is described and I never want to think of myself as
self help, Like I'm not here to just keep well people.
Well, I'm here to help sick people feel like they want to
live. And so I guess my first
question, which we start with all interviews with, is, what's

(04:50):
an opinion that you have or a belief that you have about
mental health that may be controversial but you still
wholeheartedly believe? I believe that mental health is
an integral is one part of a person because it's about their

(05:12):
spiritual health, their physicalhealth, their connectedness to
other people and energetically, practically the support that the
world can give them and that they can give to the world.
And obviously, mental health subjectively to the person is
really, really important becauseit gives them the clarity, can

(05:34):
help them develop a sense of purpose and a sense of well
being so that they can be the creator or the genius that they
actually were born to be. And that's ultimately what I've
always been about, is to actually find the real wonderful
person that's there and justice take away the bits that

(05:58):
hindering that. What an amazing approach.
I don't think a lot of doctors can say that.
I look at this model as integrated as you do like.
Even using the word spiritual asa psychiatrist delights me and
surprises me. Where do you think your approach
of being so rounded has come from?

(06:22):
Well, I think firstly from life experiences being taught to look
at the big picture of everything.
I've been very fortunate with people in my life that they were
there to explain very difficult concepts in a simplistic way and
using analogies. And I've been told by my

(06:44):
patients and everyone that knowsme that they call me the king of
analogies. All I can say is I'm I'm still
the Prince because the people before me and my family were the
kings. But they taught me and to see
the bigger picture and understand it in simple terms.
But that doesn't render it simple or simplistic and perhaps

(07:08):
if I can relate one story in my life.
And that was when I was a teenager and it was the first
time I'd gone to Europe and we visited the Vatican.
Was actually my first time in Italy, even though I'm Italian
background, and I was eavesdropping on a tour guide in
the Vatican that was explaining a statue of Michelangelo that

(07:31):
was called the Pieta, which is of Mary the Madonna holding
deceased Jesus. And she was saying that
allegedly Michelangelo was knownfor saying that when they asked
him how can you actually make such beautiful sculptures out of
a block of marble? Because that's all you've got to

(07:52):
work with. And his answer apparently was,
that's easy, he said. I can see the statue inside.
I just chip away at the bits that don't belong and as a 15
year old and me being open to those ideas, it just blew my
mind away. It was probably the main thing I
remember from that holiday and it's essentially how I

(08:14):
approached patients and how I approach life.
So you know, I'd like I can see the wonderful person that's
there. Yes.
I'm not in any which way diminishing the troubles that
they have and it's my role to help them achieve, to be the
beautiful person or sculpture inside.
What a beautiful analogy. No wonder you're the Prince that

(08:38):
is soon to be the king. I think that's a really healthy
therapeutic lens to take into treatment, which is my default
assumption and belief is that inthere is something gold we need
to take away the things that arehurting you versus the other way

(08:59):
around. You're sick.
We need to get you to fit into another box because this box is
full of shame and there's something wrong.
And I think even having that lens is going to play out in the
way you talk to people and connect with them.
And so I guess was it that 15 year old moment that inspired
you to want to pursue a life in the field of mental health or

(09:22):
was there something else? No, not at all.
I think that just blew my mind away as into how to
conceptualise people in life. No actually, again from personal
experiences, I originally was thinking in medicine.
I was going to be doing. Firstly I thought it was going
to be oncology treating cancer and then when I got to spend

(09:43):
time with kids I thought Oh no, I'd love to do paediatrics.
But then it just hurt too much seeing kids being sick.
And so I decided, no, I'm not going to do that.
And I guess the biggest pivotal moment in my medicine training
at university was the first weekI did my psychiatric rotation

(10:06):
and there was a psychiatrist whowas blind, and he was sitting
there in the chair and being a young student at, I think it was
about 21 at the time and impressionable, he could feel
what was going on in the patients.
He couldn't see them and yet even without words.

(10:26):
So he obviously could hear and speak, but even without words,
he energetically could feel where they're at.
And he was saying, you're feeling this.
What about tell me about this? And that blew my mind away.
Another pivotal moment. I said, I just want to know.
I just want to do what he does. I said if he can do that, that's
what I want to be able to do. So that's actually what's wrong.

(10:48):
Over to circuitry from that moment.
Single moment in Med school. That makes a lot of sense, tying
back to what we were talking about off air just before we
started. You know, I was talking, you
said you really value my lived experience and the way that it
can connect with people. And I said, well, you know, what
about your lived experience And and you said sometimes it's not

(11:12):
helpful and can actually interrupt the therapeutic
process. And you said something that
really struck A chord with me, which is that someone should be
able to feel that you understand, not just hear the
details of the story as to why you do.
And so I I want to click on thata bit more.
What does it feel like in therapy?

(11:34):
How does a patient know that youthat you as the treatment
professional get it? Well firstly it needs to feel
right to them. Now as human beings and you
don't need to be a therapist forthis.
We feel other peoples energy. I could be at the bus stop, you

(11:55):
could be at the bus stop and youcan feel that the person next to
you is not in a good space. You've never met them before,
You don't know the detail but you know they're not in a good
space because you can feel it. You can walk into another
environment and you can feel that people are really happy.
You don't know why necessarily, but you can feel it, and
especially in Western society, that's not being taken notice

(12:19):
of. It's all about what we can see
or hear and logically put our finger on, but certainly not
energetically what we're actually connecting to, when in
fact, on a subliminal level, that's what we're all connecting
to. Hmm.
And that's why people say, oh, Iget a gut feeling about this

(12:41):
person. And the gut feeling is they may
not know the detail, but their gut feeling needs to be listened
to because they're picking up something energetically.
So without having to give my personal details to a patient
because that actually interferes, that's me imposing
things, even if they're seeking it out.
It's been posing and and puttinginformation that doesn't belong

(13:05):
and is actually relevant to their journey, but energetically
I need to be able to feel where they're out if they're in pain,
if they're fearful, if they're bored, if they're tuning out of
dissociated, depersonalised in in the experience that we're
having relationally in, in the therapy.
And some part of you is constantly trying to see

(13:28):
something in them that you can build a thread toward, even if
you haven't had that experience directly.
Are you trying to relate to themon the level of I might not have
had depersonalization, for example, but I do understand
that the consequence of a bad experience causes anguish and
suffering, and I see your suffering in me.
And that and then that way we'reconnected.

(13:52):
You. The short answer is yes, But I
wouldn't be necessary talking like that.
I would just actually, I've beenfeeling in that moment that
they're disconnected, that they'll be personalised.
So I'll actually get them to feel what's underneath that.
And how do you get to so that? I'm taking now a layperson's hat

(14:14):
at some people might be listening to this being like
God. I would have no idea if the
person in front of me is feelinganxious or depersonalised.
How do we build that type of skill set so that we can start
to feel more with people? Basically, being able to tune
into yourself. The more grounded we are, and
mindful we are, we're actually tuning into ourselves.

(14:36):
And so therefore we can pick up what's happening in ourselves.
And if we come across someone else and all of a sudden what's
happening in us has changed, then if we're mindful of that
and calm, we can actually pick up.
Hang on, I'm feeling a bit disconnected here.
I'm actually feeling a little bit depersonalised.
Hmm. And you can actually feel that

(14:57):
that's where they're at now. At that moment, I may not know
unless I know the person's history and I will have to ask
them questions as to why and what's led to that.
Sure. But I could feel that they're
too personalising at this moment.
This brings me to a point that Italk about a lot in my real
conversations, workshops that I run with people that often the
biggest barrier to helping someone through emotional

(15:19):
distress isn't necessarily theirunwillingness to speak their
truth. It is actually us as a support
person getting in the way with our own stories and rejections
or to this point, not even having the awareness of tuning
in with your own body while they're talking about their
feelings. Why?

(15:40):
Because it's incredibly confronting and overwhelming to
feel with someone. And I always say one of the
biggest gifts you can do to helpother people is to go work on
yourself, whether that be through a mindfulness practise,
going to therapy, working on your trauma.
Because in that way, as we're inheriting or building someone
else's world, in our world, our dirty laundry doesn't get stuck

(16:05):
and we can spit back kind of a clean clothing or accurate
attunement that they're looking for.
How does that land with? You.
That's quite. I agree with everything you just
said is quite nicely said, actually, because in therapy
oftentimes I will get images of things that are in my life.

(16:26):
Hmm. And it's only because my emotion
that the person's been feeling actually has triggered that
memory and opened up that file inside me.
So I actually worked them backwards.
If all of a sudden my heads jumpto that thing will hang on.
Well, it actually acts as a reference for me to come back
to. This is what I'm feeling.

(16:48):
This is where this person's at. Because sometimes
subconsciously, not intentionally, but sometimes
also intentionally, people don'twant to address or don't want to
go where fully as pain. And that's a normal human thing.
None of us do. Yeah, absolutely.
Yeah. And I get that as as a fellow
human being, Yeah. We all do that in one way or

(17:09):
another. And therefore it's when they're
doing it subconsciously that it usually happens that I will get
triggered with thoughts and ideas that belong to my life,
because my brain is is connecting to those images and
those memories where that feeling state has been.
Takes a lot of consciousness, and the words escape me right

(17:34):
now. It takes a lot of something to
walk this line. And I think the line that we're
pulling on here is you want to be attuned with someone to the
extent that you can almost go into their inner world with them
in real time and hold it. But you don't want to be so
enmeshed in that feeling that you end up losing yourself

(17:55):
through your own stories and feelings, emotions, traumatic
history, which then attaches a story of how that person should
or shouldn't feel as a result ofthat.
So it's like, I'm a big believerthat life is about balance and
equilibrium. I subscribe to the Buddhist
philosophy and a very big way ofnondualism in the Middle Path.

(18:16):
How do we walk that line of I'm with you, I'm feeling with you,
but I'm not detached or disconnected.
I'm also not overly connected where I'm now completely
shifting the therapeutic processonto me.
Oh no I don't. I don't get involved when mesh
or try not to. Wouldn't imagine so people.

(18:38):
Get that? But I guess I'll go from my
experience in the extrapolate tothe to the person.
It's really when they're in one feeling state, it's actually
transient is actually allow themto sit with that feeling.
In fact, I use the term sitting with feelings we because they

(19:01):
may be extremely anxious and if they sit with their body, after
a few minutes it actually shiftsinto something else and then
into something else transient. So can you see what felt really,
really palpably anxiety provoking in their body at that
moment? Minutes later it shifts to
something else and when they realise hang on, the Doctor

(19:23):
didn't do anything. Similarly, the layperson hasn't
done anything, it's just allowing them to sit with it
rather than Stew on it. Because some people then get
stuck and ruminate in that spacewithout allowing themselves to
feel it. And then it shifts into, you
know, whether it's sadness underneath or ultimately, which

(19:44):
is the fuel for everything, a joy and love.
And when they realise that oh wow, I've just gone from being
very, very anxious down to yes, I actually felt sad or I felt
scared or some some other emotion.
It's almost like coming through the the atmosphere into the the
different layers of of of the Earth atmosphere.

(20:06):
And initially starts to get very, very hot as you're going
through and very uncomfortable. But then when you drop into
that, ultimately it is driven bythat joy and love.
They actually realise wow, actually you've just held my
hand without even realising thatyou've been holding their hand,
just allowing them to space to feel it.
On the climatized, I'm back in. Yeah, I want to chisel in here

(20:31):
because we've we've just kind ofstruck a little bit of gold dust
here in this rock that we're navigating around.
And I believe one of the best metaphors or analogies to good
support processes is basically the cleaner the mirror, the
better the experience. Because I think a good supporter

(20:55):
is, is just holding a really safe, non judgmental mirror back
to the person to be able to work, to build coherence around,
to build feeling around an experience that's seemingly
intolerable so that they can move through it and beyond it.
I often try. I I say the term, sit with

(21:17):
people in it and you know mine. Entire curriculum, real
conversations, is built on the science and art of understanding
that the greatest way to be helpful to someone pretty much
more than anything else is to connect with them.
Connecting by, defined as defined as the ability to
understand where someone is at. Because when people feel

(21:39):
understood, then the gateway, the plasticity, the willingness,
everything else opens to be ableto shift into something new.
However, it's really hard and maybe you can help me actually
describe what sitting in it or with it means in practise and

(22:00):
what's happening in the body. So I'll have first pass sitting
with an emotion. Say, for example, you're feeling
anxious means identifying OK, right now in my body, that's
being played out with accelerated heart rate.
I can feel like a fireball in mystomach, like trying to describe
it in your body. And then instead of running away

(22:22):
from it, it's the ability to actually just bring your
attention to it gently and allowit to exist.
And people might say, well, why would you want to maybe not
amplify but at least focus on something negative.
And what I believe is the greatest reason, even a
scientific reason, for what's sitting in it means, is your

(22:45):
nervous system is doing bicep curls every time you're feeling
an emotion without running away from it and therefore
essentially what you're doing. Kind of like desensitisation and
habituation, which essentially means I'm building my capacity
to feel bad and that capacity isalso making way for things to

(23:07):
feel good. What are your thoughts on the
sitting with it that I just described?
I I agree with what you just said entirely.
I just want to remind everyone and anyone that's listening that
that tension that we tune into is there all the time.

(23:32):
It's not that we've created it by tuning into it.
So it's like the radio, if there's talk back radio and I
don't really like to listen to it because this shock jock is
scaring people and spreading half truths.
I may not want to listen to it, but he's actually existing out
there. So just because I'm tuning into
it doesn't all of a sudden, oh, I've just created that.

(23:56):
So that tension, whether it's anxiety, fear, sadness, angst,
anger, disgust, all of those emotions neurologically, as
you've said, physiologically in our bodies, that's bubbling
away. And that then may manifest in
someone feeling overwhelmed or angry or going to their default

(24:18):
coping styles like overdoing things over compensating or
avoiding. So that's part of what I'm
saying in the in the focal length model in my approach to
psychiatry is and the holistic care of people is actually
making them realise what's actually happening in them and

(24:39):
integrating all aspects of the whole person and their lives to
be able to then not be afraid tosit with that emotion and see
how it morphs into another one and that one just disappears.
So the tension of the anxiety you were talking about just
morphs. It's just it just disappears
after you've sat with it for a bit, and then it may morph into

(25:01):
some other one. It may be feeling heaviness or
feeling powerless or feeling weak, and when you tune into
your body you actually feel it. That's where these words come
from. Doesn't matter what language,
what culture. It's not just poetic licence
that in English language we use the word heavy or broken hearted
or sickened. They're all physical terms

(25:23):
because that's where we feel emotion in in our body.
It's a neural expression. Is it too simple or reductive to
say that the inverse is true, IErunning away from, avoiding or
denying our emotions is the greatest way to get or keep us

(25:44):
sick? Oh, absolutely.
The body holds the score. And that's not something I've
invented. That's that's so, yeah, yes.
But in fact it's true people that suffer, you know, migraines
and tension and neck spasms and feeling heavy, you know that
that's where their bodies carrying that sense of burden on
that responsibility that they'reholding on physically into their

(26:07):
body or that they're having, youknow, gynaecological problems or
that they're having abdominal pains or that they're having
sexual issues or or any other manifestation is is a strong
believer that neuronal ally, that part is then susceptible.
That's how the body is expressing it.
And then once it expresses it one way, its pace, selective

(26:31):
attention to that, and thereforeonce it pays selective attention
to that part of the brain, it activates that network all the
time. So it becomes the to go to come
for an expression of that sort of distress.
What is your simplest definitionof resilience?

(26:55):
OK, the simplest definition of resilience, I'll just make it up
as I go along now, would be the ability to actually use the
inherent strength in every whichway.
Physically, emotionally, spiritually.
Sense of purpose, being able to draw on and knowing when and how

(27:20):
to draw on the supports around them.
Being able to modify the autopilot coping styles which
are usually maladaptive in most people or in everyone I should
say. And being able to recognise our
own maladaptive thinking styles and not to eradicate them, but
note them that they're there andthen move into another and move

(27:43):
into another sphere despite whatis happening in front of us.
So I for example user term emotional hygiene.
Yep, with my patients, which is really no different to physical
hygiene. So if it's a hot, humid day,
rainy day in the middle of summer, it it's not that my

(28:07):
body's animalistic or something with my body.
If I'm running around all day long, I will sweat.
I may have Bo. That's just a normal
progression. However, I can choose at that
moment. Do I just stay in that?
Is that how I want to be? Or do I choose to be different?

(28:28):
So I choose to be different, So therefore I will say, OK, I'll
preventatively what clothes I wear that day, will I shower,
will put deodorant, will I brushmy teeth, etc.
But even if with my best intention, that particular day
might be awful when it comes to humidity and sweat, etcetera,

(28:49):
that's not my doing. That's happened.
I need to accept that, but I still choose not to be in that
physical state. So I was there.
So I need to have another shower, I need to put a fresh
shirt on, I need to put extra underarm, deodorant, etc.
So similarly with emotional hygiene, our autopilot.
It's not that there's something inherently defective about us.

(29:14):
When life presents itself, as itdoes with challenges, which it
does to everybody, The emotionalautopilot is like the physical
autopilot is to become distressed.
It's to become maladaptive. It is to feel a lot of pain and
distress and perhaps even cause more distress to people around
us because of that distress. It's about learning how to

(29:38):
recognise that. And similarly to OK, I'm hot and
sweaty and and smelly, OK, that's not what I like to be.
I don't like that. Let let's come up with a
strategy to change that. Yeah.
So we've learned since we've been kids to do it physically,
but emotionally we're not taughtany of that.

(29:58):
In fact, many, on many occasions, the way we've been
taught actually exacerbates it because our parents and our own,
you know, whether it be teachersor people around us similarly,
are afflicted by the same thingswe are.
So it's about teaching one recognition, the patient to
recognise, OK, that's where I'm at, but I actually have a

(30:19):
choice. I can stay in there, I recognise
I am in that state so I'm not just pretending it's not there,
I recognise it, but I know for what it is and I've got a
strategy to move out of that. I think the keyword there that
you've picked up on very well isthe response.
You know a lot of resilience is in the response.

(30:40):
Building the ability to respond and then choosing the right type
of response to the inevitable shit that life is going to throw
us. Another hard question to put you
on the spot. No wrong answers, just super
curious what is not what is mental health to you?
Because I don't want a WHO definition, but a lot of people

(31:02):
don't really know when they've arrived.
You know, they're doing all thiswork and they're am I there?
What is even there look like so in therapy, I guess.
What's the simplest way of explaining what your goal is
when you're working with someone?
I'll answer that first with another question, which is not
necessary to you much, but for us to think about when are we

(31:27):
physically healthy. Right.
Is it? Is it when we look like someone
that in a GQ magazine or on a ona on a front page of sports
girl? Is that what is it?
Is, isn't it? We need to define that.
Well, the first thing that comesup for me when you ask that is,
is it just the absence of illness?

(31:48):
And I would say probably not, but it's the presence of
something, um, I'll tell you what my definition of mental
health is. So it's the ability to respond
well to the inevitable challenges of life.
So I would call that my rebound rate.
So how effectively can I go fromnegative to neutral?
That's resilience. It's a whole bunch of other

(32:10):
stuff, nervous system, flexibility.
And then there's do I have the capacity to experience positive
emotions and have deep high quality relationships and the
function to be able to perform at work.
So that's three pillars of goingfrom neutral to positive.
And said another way, what I don't think mental health is, is

(32:33):
a perpetual state of happiness because the opposite of
depression is mania, which has been scientifically proven to be
sometimes just as dangerous. So the human body is not
designed to be up all the time. We are part of life, and part of
being mentally healthy is takingshit emotions, either responding
well to them or using them to cultivate more important

(32:54):
positive emotions. For example, love, love,
romantic love is tough. Sometimes you want to strangle
your partner, but it's worth it because it provides A deeper,
meaningful emotion where you integrate the negative purpose.
For example, man, making a purpose in the shit that I do.
Sometimes I'm just exhausted. I'm like, there's a million
easier ways for me to produce money and meet some joyous needs

(33:20):
from having nice food or going on holidays.
But I'm choosing this path and Ifeel more mentally healthy
because of it. So it can't just be the presence
of happiness. It has to be for me, the ability
to respond to the shit and then to be in pursuit of more
worthwhile positives like meaning, purpose, love and and
perhaps a moment of joy here andthere.

(33:40):
So just interested on your take on that.
I agree very well, said Mitch. With all of that, as far as
mental health, it's actually being content that you have
linked to actually what your purpose actually is.
Purpose is huge, hey. Absolutely, yeah.
And that you're thriving now, Thriving does not necessarily

(34:03):
mean, as you said, that I'm always happy.
Yes. It it means that I'm if I'm
feeling sad, that I can feel that sadness feel how it can
feel weak only because of the mental constructs of the
physical sensations we're feeling.
But I can then drop into the love that's fuelling that

(34:27):
sadness and that actually drivesme then to to thrive.
And it's when we're not mindful and connected like that that
someone is suffering from mentalill health.
So it's similar to physical health.
It's not that a person who's physically healthy doesn't get
aches and pains if he's done toomuch work out at the gym or

(34:50):
doesn't feel sick, if he's had acertain food but he's still
physically healthy or she's still physically healthy.
But then they can bounce back and they know how to bring
themselves back, Yes. So they've got their physical
awareness. And similarly with emotional
Wellness, it's the same thing. Because emotions are feeling.

(35:10):
I mean their feelings, yes. But that's no different to if
I'm sitting too long on a chair,the back of my legs might get a
bit sore or a bit. There's too much pressure there.
I don't have a disease, but it'san uncomfortable feeling.
If I've had too many baked beans, I may have, you know,
abdominal distention and feel, you know, get some cramps.

(35:31):
I don't have a disease. And similarly with mental
health. And I think the words that that
people have been using over time, we're using words that are
normal human emotions, albeit painful ones and painful states
to be in to equate to disease. So the the favourite one, mind

(35:53):
that I like to always give example, is the word depression.
Really that's the equivalent of saying sore tummy, right?
It's it's a normal human emotion.
Sure you feel depressed and to feel sad.
Hmm. But imagine if we use the word
sore tummy to mean anything fromtoo many baked beans to Crohn's
disease or stomach cancer, and we just use the same word, sore

(36:16):
tummy. Well, in fact, that's what's
happening. You know we've we've gone from
calling serious what used to be called melancholia where the
whole body it's it's an energy shutdown of the body.
Depressed mood is only one symptom of that.
It's it's the whole body shuts down.
People can't move. They have no energy not because

(36:37):
they can't be bothered. It's they actually don't have
any energy. They actually can't think their
processing is actually slowed down.
And yes, one of the symptoms is depressed and black moved.
Hmm. And we've gone from that's
equivalent of stomach cancer andthen we've got all the way
across to someone who's demoralised because they didn't

(36:58):
get what they'd hoped for. They put meaning onto that loss,
which makes it even more painful, mind you, a meaning
which is always false. Yes, something because of this
scheme and they their belief systems about.
Them. So I need this to feel like I'm
good enough, and it's that that attribution that's causing the
pain. It's not the actual loss itself.

(37:20):
Absolutely. So I didn't get into the
basketball team like I wanted. I didn't get into the firsts.
I had given it a value that because of my own inherent
belief systems, if it was mine, that I am incapable and I'm not
worthy. So I have placed value that if I

(37:40):
get into the basketball first team, I have value.
So obviously when I don't get in, it's not just I can have a
wonderful time in the seconds and really shine there and
really enjoy basketball, which is what I really love to do.
It's no see that proves that I don't have capacity.
I'm worthless. That's the pain.

(38:02):
I'm a failure. That's my pain, that I'm
creating the pain. It's not actually that I didn't
get into the first. So I'm creating that distressed
and I will be demoralised. I will feel in pain and the pain
feels real and one needs to validate that because the person
is actually feeling in pain. But if you start stepping back a

(38:24):
bit and making them realise thatit's their belief systems,
they're coping strategies, it that's actually causing their
pain and then it lifts. So were they in a depressed
state? Yes.
Do they actually have depressionthat needs a tablet or that
needs something, you know, quickfix, which is where our society
goes. Not at all, in fact, by

(38:46):
sometimes by actually going for the quick fix.
Oh yes, you're depressed. You need a tablet.
Actually reinforces that value. I'm broken.
Hmm. There's I'm defective or
something wrong with me? This is going to be a big one.
Nature versus nurture. There's two parts to this.
Part One, do you think every, let's say, negative emotional

(39:08):
experience from I'm not OK all the way through to mental
illness and I'm in the full spectrum from a little bit
depressed all the way through topsychosis?
Do you think everything is always a combination of nature
and nurture, the chemistry and environment?
Or do you think sometimes it's all the all one or?

(39:29):
All. It's always both.
Always more, Yeah. OK, say more about that and
more. Well, that's essentially why I
come up with the focal length model.
Yeah, I can't wait to dive into that.
Because it's it's always more now.
The reason I use even the term focal length is an analogy to

(39:54):
photography, yes? So if I'm looking or if we're
looking at a picture. The subject matter will depend
on what focal length I'm lookingat.
So at the moment, for our viewers, I'm I'm looking, if I
took a picture of where I'm sitting at the moment with with
Mitch, if I took one focal length, I'll see a fit looking

(40:16):
young man. If that's where my focal length
is, then Mitch, you're the subject of this photograph.
If, however, I change the focal length and it's actually about
the coffee table in front of you, then really it's about the
coffee table and you just happento be a subject that enhances.

(40:36):
So this is someone's coffee table, the subject is actually
the coffee table. And what's on the coffee table.
If I extend it even further back, it's actually, it might be
about the bookcase or it might be a bit back that the beautiful
pop plant that's behind you. So really that's the focus.
So this is someone's bookcase, and there's someone might be the

(40:57):
person that's also in the picture, but the bookcase is
where the focal length is. Now.
As people, it's quite normal, either because of our own
understanding of ourselves, understanding of the world, our
training, our own personal biases, our avoidances.
We will, all of us, focused on one or two aspects of a picture.

(41:22):
So when when a person presents in pain, they will present with
the focal length that that they are particularly hooked into at
the moment and looking at and focused on.
And that's a very valid 1, right?
And can you see if they went to a therapist?
Who? Because of their own bias or

(41:45):
because of their own training, says Oh yes, but I can see
another focal length in your picture now.
At that moment, it's going to bequite jarring and invalidating
for the person, the patient who presents, because so that
person's not listening to me. Yes.

(42:05):
If you speak to the to the the so called therapist or
counsellor, whoever it might be,they may say, oh, the patient
isn't ready right, they're not in the right space there.
Whatever term they want to use, um, it's because they're they're
looking at different focal lengths.

(42:27):
So for them, for one party this is what's important and this is
the main subject and it is real.And for the other one, it's it's
not that. And and so I guess from my own
psychiatric training when I was doing psychiatry and in the sub
specialty of ADHD in adults, which I've been spending 25

(42:49):
years treating and lecturing about and trying to educate
fellow psychiatrists who have ignored it for many years.
I would here in my training, very clever professors saying,
Oh no, no, there's no such thingas ADHD.

(43:09):
Look at this person's attachment.
They're clearly traumatised. This presentation that they
they're scattered and they can'tconcentrate and they hyperactive
and impulsive is because of their trauma.
And I could see that, Oh yeah, that makes sense.
And and then, but then I'd say here someone else who was
equally intelligent and studied and well thought out saying, no,

(43:33):
they actually have these cognitive problems.
And even when they're not in a heightened state, they actually
have these cognitive problems. They're structurally cognitively
limited in these processing or in these working memory of
these, these angles of cognition.
Well, that makes sense too. And then here's someone else

(43:54):
saying, Oh no, it's all in the gut.
It's because that that's where our mind comes from.
You know, that that's really where where you know the the
body, all our emotional reactions and all our chemistry
and thinking is all because of the gut.
And they would give very good explanations how the gut is
involved and all that makes sense too.
And I thought, well, hang on, how can everyone, all of these

(44:16):
experts and lived experience by people, including myself as a
human being, have so many different opinions?
And I think, hang on, we are we just looking are we 360° looking
at the same thing from differentangles and actually seeing
different aspects. So asides use the idea of focal

(44:40):
length. Do think, hang on, if you just
have a system where you stop at different focal lengths when you
look at a picture to make sure firstly that you're getting as
much of a picture as possible, that secondly you go to areas
that may not be your area of strength and our tendency is to

(45:04):
avoid them. Our own blind spots, so to
speak, and keep us constantly vigilant that we're never
someone presents with an issue such as ODOC.
I can't start things. I procrastinate, or I'm a
hoarder or I'm this or that thatyou can actually sift through

(45:27):
each focal length to think. Hang on, how much of each focal
length is actually operating at the moment?
Which ones are relevant? And these are the ones that we
need to work on, not just for meas a therapist to work on high
and money to actually make the person understand.
So that empowers them, because that's my approach.

(45:48):
This is not about just the therapist having this system.
My aim is to actually make people understand these, so that
empowers them, yes. So when they go to a particular
person, their GP, their General practitioner for example, and
the general practitioners, are we going to run these blood

(46:08):
tests? It's not like, oh she or he's
not hearing me. It's I get it.
They have to look at the physical domain because there
could be all these other physical.
Things. That's one of the focal lengths,
so that's OK. But then I also am empowered to
say that's fine, Doc, but what about these other bits?

(46:28):
I'm still in pain. I think those other things need
looking at too. So what I'm hearing is your
approach. Doctor Tony's approach to
treatment is held under the container of what's called this
focal length model. And that is essentially the
belief that there are multiple dimensions or ways in which we

(46:53):
could be looking at a problem and we need to meet people where
they are at the different focal lengths.
And based on your description, there are certain domains that
at each focal length just beforewe get into the domains.
Maybe to help people understand this even more, how would you
characterise like this focal length model and its core tenets

(47:16):
and beliefs? And why is that different to the
traditional therapy model or practise for treatment?
Firstly, I'd like to say I'm notinventing the wheel.
All I'm doing through this focallength method is actually having
a system to look at all the spokes and don't forget any of.
Them. So the spokes are existing, yes.

(47:38):
You're just putting it in a framework that is maybe a bit
more actionable. Absolutely, yeah, and
understandable. So we're rendering are very
complex presentation and optionsand and and different facets for
this person to get them to be the optimum they can be as a
person and rather than getting overwhelmed by that which is the

(48:01):
normal thing to do it's a systematised way of doing
things. It it's really no different to
anything else like building a house you need to have a system
ties with you you know. I mean you need to have a
surveyor coming and survey the land 1st and then you need to
have an architect and then you have to do the building
construction. Now if I'm an interior designer

(48:21):
and that's my bent and I'm involved in this, can you see
I'm just going to be constantly worrying about how it's gonna
look and what colours are gonna happen, are going to happen.
And yet the builder is trying tosay, listen, we haven't even
started the foundations. We don't even know we're.
Putting up the list yet? Do you know what I mean?
So, but it's not to say that that's not a valid part of the

(48:46):
building process because absolutely we need to.
That's what the house is for. It's to create an ambiance.
So that designer and the colour absolutely is critical.
That would be one of the focal lengths.
But can you see there's a systemthat's put in?
Place so traditional therapy mainly focus on one focal length
and ignores a whole bunch of others that might be playing out

(49:06):
at the same time. Yes, in theory they say they
don't. The term holistic care I haven't
invented. Yes.
Alright, it it is something thateveryone aspires to and everyone
understands. In practise though, it's not

(49:28):
about the whole person in. In theory it might be even in
the assessments. It may be if you've got someone
who's really assessing the person as a whole person, but in
practise that tends not to happen because of our own
biases, both from the person whopresents.
They have their own biases and resistances, but also from the

(49:52):
inherent biases that a therapisthas.
And so having said that, it's incumbent on having some sort of
system to break that down and then integrate it.
So again, another analogy is a bit like a sound engineer at a

(50:14):
concert. You need to have an ultimate
vision. What are we aiming for?
Well, we want optimal sound for this stadium, for this band.
Now can you see if I had different frequencies?
I don't just pump up the base all the time.
That's going to distort the sound.
I'm not going to just do the treble, you know, like an old

(50:35):
fashioned transistor radio. No, I have got multiple channels
and I need to tweak based on what's in front of me now.
So if you're for this particularsong where this band member is
singing as opposed to the other band member, I will need to re
tweak certain frequencies to getmy vision which is optimal

(50:58):
sound. So if this particular song has
got more bass or more some otherinstrument, I need to tweak it
so it's not just about the vocals, or I need to still hear
the vocals. So I'm constantly adapting, yes,
each frequency in front of Maine.
And that's what I'm saying aboutthe focal lengths.

(51:19):
I visualise them almost like a. Sound.
A sound board. So therefore, how much at this
presentation is this? Now?
Do I need to tweak anything there?
Yes or no? I go through it as a medical
doctor, one of the physical for example, and I go through all of
them saying which ones are relevant at this moment.
Yes, OK, I love this. Now the juicy part that I've

(51:43):
just been waiting all week to hear the little synopsis or
unpack of What are the levers onthe sound board?
What are their names? Obviously we'd have to come to a
lecture or seminar or workshop to fully learn about this in
detail, which, by the way, I whenever and wherever it is,

(52:03):
count me in. I'll pay whatever it takes, but
for what you're willing to sharelike on the pod, just to give
people a a general framework, can you kind of outline the name
and maybe a one sentence click on what these 10 pillars?
Are absolutely. And even though I accept what

(52:23):
you're saying about the word pillars, the reason I don't use
the word pillars is because if you had 10 pillars and one was
to fall off, the other nine willstill hold up and you don't know
which which pillar that falls off off.
The band you know that's not supporting at this moment, you
don't know a bit like Jenga, which one's actually going to

(52:46):
make the person crush. So that's why I don't use the
term pillar, even though I know what you're.
Saying yes, no, that's a great clarification.
And so that's why I prefer the sound analogy, because can you
see with the soundboard, if you're getting a couple of
frequencies wrong, this very, very good singer.
It's going to. Sound is going to sound off when
he's he or she's got an amazing voice.

(53:07):
You know what I mean? Yeah.
So it's the so-called 10 frequencies or focal lengths
because I need to focus on them.That's why I as a therapist like
use that term because it remindsme I need to focus on this.
Yeah, this is my. System.
So that's why this focal length I have to see the first one is

(53:28):
physical. So starting from basics like
sleep, hygiene, sleep plus exercise, the usual thing, but
also any physical ailment that may actually be that this
person. Yeah, sure.
So someone might come with depression for example.
And I had a person come in referred to me for ADHD and
depression and middle aged man and I went through the physical

(53:53):
first. Well, he was actually doing the
physical things as much as he could.
He was actually trying to sleep well, he's doing all those
things well. But when I actually went through
medically, actually discovered he actually a very low
testosterone. Being a.
And another. Changing that, you'll help him a
tonne, right? Absolutely.
I referred him to an endocrinologist and we fixed up

(54:13):
his testosterone and lo and behold, his energy, his
vitality, his cognitive issues that had been labelled as ADHD
and and perhaps and depression related by his GP because that's
what he presented with, you see.So he didn't say, oh, I've got
these other issues of testosterone.

(54:34):
He, he, the patient was presenting with his focal length
which is I can't focus. I can't remember things, I'm
distractible and I'm feeling really flat right.
And they, I think, and he had researched those and maybe did a
Google search and found out depression does that.
And if you've got concentration difficulties, the first thing

(54:54):
that pops up on Google is ADHD. So that's the focal length he
presented with. So that's what the GP just fed
back to me. That was one example where
physical, so physical is the first one.
The second one would be what I call the mental conditions,
which would be your schizophrenia, OCD, autism, any
label, anything. Perhaps in the DSM, ICD

(55:18):
classification, the actual conditions.
So many people, when they first hear of my model, they'll say,
oh, you know, are you throwing away diagnosis and going into
this other model? No, not at all.
In fact, if anything, I'm more rigorous about diagnosis.
It makes me more rigorous to seewhat's going on.
So that would be the second focal length.

(55:39):
To be very clear on what diagnosis is happening, the
third one is cognition. Cognition is very, very
important. And when I say cognition, it's
about one's actual ability. What is their concentration?
What is? How are they functioning with

(56:01):
working memory? What is their processing speed?
What's their social community ability to understand social
concepts? You know, spatial learning,
visual learning, work, visual memory or actual nuts and bolts
ability cognitively Because manypractitioners will say, Oh yes,

(56:23):
because of the second focal length of mental, the mental
condition say, oh, of course Mary can't concentrate.
She's got severe depression and so that becomes swept away.
Don't worry about cognition, so you don't really stop and think
well, firstly, this is a significant issue for her now,
but it's not about the here and now, only.

(56:45):
What about historically? What about even before that?
Because in all of these focal lengths, it's not just about the
person, it's also about the genetics.
They've got a story, not only their own story that they've
come up with, their narrative, that narrative comes from their
family's narrative. It also comes from their
physical genetics. So it may well be that this

(57:08):
genetically inherited difficultywith concentration and working
memory that this is genetically the mum had a dad had it, or
grandma had an Uncle Mary, UncleJohn had it.
So they were born with that manyyears before they got depressed.
So yes, now they're depression has made this worse, but as it
does so that would be the third one is cognition, the next one

(57:33):
would be what I call emotional. And I don't like the term
personality because sometimes itit's reductionistic and it
pigeonholes people and it actually doesn't really tell you
that much except a certain pattern which can vary from day
to day, mood to mood, week to week.

(57:54):
So what I call emotional would be their attachment style, their
temperament. Again, genetics, their life
experiences have led to those attachment styles.
Where are they in their emotional maturation, like the
Ericsson maturation scheme? Are they still at a teenage
emotional maturity level when they're 55?

(58:17):
You know, are they still at a haven't really completed all
those different things, different stages very well so
far in their lives where they don't feel heavy industry like
that's the stage of earlier childhood.
So you need to be aware of all of those things.
The next one is, they're all important, but the next one is

(58:39):
what I call schema, our belief systems.
So these belief systems for again going back to what of our
families, belief systems that already transmitted to us that
and we're carrying our own self beliefs.
So you know I'm not capable, I'mnot worthy, you know I'm not

(59:02):
important. All these self belief systems,
the cloud and our self perpetuating in our lives, the
cloud, everything we see, they distort everything we do and see
and perceive. Again, cultural a cultural
belief systems to be aware. How does that, how does that
affect this person? And it's not about me, just

(59:23):
seeing how it does. Yes, I'd like to understand
that, but it's about the person understanding.
Oh, I never realised that. So society or cultural ones also
their own sense of purpose. What is their belief about?
What do they actually even stop to think what their purpose is?
Or, like most people, we're justacting and reacting day by day.

(59:44):
Does purpose fall under belief systems?
That I, I, I I put it there because it's part of our
understanding. So I put our understanding of
ourselves. OK, Yep.
So that's why I put it there. But people can.
Put it wherever they want, as long as they don't forget it.
So this is just about a system of not forgetting and being

(01:00:06):
aware. Someone could very validly say
to me, Tony, perhaps that one should go in in the.
Morning. There's arguments for and
against all the check boards. Right?
You could. And I would say fine, I don't
mind, I don't mind. You could put it wherever you
like. Just so long as the outcome is
it's looked. At absolutely.
It's just to be aware and that the person understands it where
where they put it doesn't worry me.

(01:00:28):
So it's like if we were meeting with all the players involved in
building a house just because the surveyor is the first thing
that that has to it has to happen here.
It's not that they have to sit the first table on the first set
at the table. I don't care if you sitting at
the opposite end as long as we don't forget the surveyor.
You put them in order, So back to cognition, that's the other

(01:00:51):
one then the other one and self belief up to sorry schema which
is self beliefs now. The other one, which I find for
me really important because it helps me understand how many of
those others came to be, is trauma and trauma in every sense

(01:01:20):
of the word. So originally trauma was meant
to be what we used to call the big T traumas, you know, you
know, facing a war, seeing someone killed in front of you,
you yourself almost dying, obviously, you know, sexual
assault. So.
And they're very huge traumas and we call them the big tea
traumas. But if we don't even want to put

(01:01:46):
the term little T trauma, because that diminishes it.
But it's how do we get to those belief systems?
It's experiences, day-to-day experiences that we grew up
with. Some of them might have been
very big. Some of them might have been
smaller in the big scheme of things, but they still left a
mark. They changed how we thought our

(01:02:07):
narrative is about ourselves. Complex world?
Absolutely. And those traumatic events, the
reason I stop at that as a distinct domain to look at,
because that actually then givesme a way to help to change them.

(01:02:28):
Yep. And and be able to through
various treatments for those traumas to look at ah, this is
and make the person realise, oh,that's why I have this, these
beliefs and these ideas, that's why I have these behaviours.
So trauma, which brings us then to the next focal length of
domain, which is our coping style.

(01:02:52):
So whether we avoid, whether we overcompensate is A to go to
that they've learned is to go towards drug, a drug or work or
gambling or sex or porn or computer games, any of those
things, even just constantly scrolling social media is a

(01:03:14):
coping style. We may view it as I'm
interested, but often it's not. So it's I'm bored, I'm
disengaged, I'm disconnected from thriving in my life and me
being present for my purpose today.
So therefore I'll spend 2 hours going scrolling through
Instagram or Facebook or lookingat YouTube.

(01:03:37):
So coping styles are really, really important because one so
that the person understands thatah, this is my coping style and
that might those coping styles might actually exacerbate the
original mental illness. So they may have, for example,
obsessive compulsive disorder, and they may have that, but

(01:04:01):
their coping style might be to overcompensate, to overcheck, to
overdo, to be perfectionist, to be perfectionistic and
everything they do. And that's part of their coping
style. So it's not necessarily that it
belongs only to the OCD and it doesn't mean they don't have
OCD, but people will say, Oh yes, that's just my OCD.

(01:04:23):
So in other words, I'm disempowered cause that's what
they hear. I'm broken.
I've got this disorder, and theymay have that legitimately, but
then that identifies them, that legitimises their schema, their
belief system, that I'm broken. Something's wrong with me.

(01:04:45):
So therefore that that will be may be reflected in there.
It will be reflected in their coping style.
So we can predict, we can actually say hang on, you know
this is happening to you. Just be aware of your tendency
to do this. And at that moment, as a
therapist, if I'm not aware of that whole soundboard, I may

(01:05:05):
just focus on the really depressed.
Are they suicidal and I do need to look at that?
Absolutely, But I may forget that.
Hang on, this guy spent five years trying to battle an
addiction and he's been so successful and he's been clean
for five years now. At this point, what's his coping

(01:05:29):
style? I I I need to be reminded
because at that moment I may, because of my own fears and my
own biases, focus just on the fact he's saying he's feeling
like self harming and I might help him through that but he's
still distressed and not realisethat.
Hang on, he's just relapsed 3 weeks later.

(01:05:50):
Realised he's relapsed on a drugor behaviour that he he spent
years trying to beat. Yeah, so.
Or that he isolates or whatever his coping staff would be.
Hmm. So then there be this coping
style. This one is of social.

(01:06:14):
Relationships. Absolutely, yeah.
Firstly, what are their social skills?
Because it's all very easy for us to say, yes, it's important,
but many people, for whatever reason, either they're cognizant
limitation or life experience limitations, don't have good
social skills. So it's all very well to say, oh
Johnny, you should get out there, make some friends and

(01:06:36):
join a group. Can you see?
Have to look at the other focal lengths they they're they're
self belief is I'm defective. I'm not you know no one wants me
I'm not worthy so that's alreadya block.
But cognitively if they don't understand social cues because
they may have autism it's overwhelming.

(01:06:57):
So we can tell them anything. They just feel more defeated.
So you need to look at what are they, what are they social
skills? But as you just said, what are
their social connections? What are their relationships?
Not just? Yes, I have two parents or I
have siblings. Yes, I have friends or even the
glib. I do go out, yes, but what are

(01:07:21):
the real connections? Are you just Are you
participating? Are you connected?
Or are you just attending these things?
Or are you just saying these things because it's too painful
and you want to avoid the topic Now?
Can you see, as a therapist, if I'm looking at the whole
soundboard, I'm looking at all the focal lengths here.

(01:07:42):
Hang on, that doesn't make that there's no way I can fill
energetically. This guy would not function well
socially. And and I can feel him avoiding
because I can feel it in myself.The resistance that's about, you
know, mirroring energies and tuning into yourself.
I would feel my own avoidance coming in.

(01:08:03):
I really do. I have to address this.
This is all too hard. And I could feel it in myself
and go, whoa, whoa, hang on, Whyam I feeling this?
Because I'm actually picking up that person's energy because
they're avoiding that area. But it's really, really
important in in the social sphere.
So that's another important thatconnectedness and that will

(01:08:26):
include now some people say it'sspiritual, whether the spiritual
belongs in there or it belongs in the belief system.
As I said, it doesn't worry me where it goes, but that's
really, really important. And they're connectedness to the
universe, not just people aroundthem in the sense of a social
sense, but where are they connected to life?

(01:08:47):
You know, whether they believe in a higher power or don't.
You know whether how they're connected to the universe,
what's their own connection to their own energy, what's their
higher purpose. So those things, that's critical
because unless you tap into that, that's the hub of of a
wheel. Ultimately, you know, if they
have that most people don't, youknow, saying Oh yes, I've been a

(01:09:10):
doctor for 20 years or I've beena nurse for for 50 years and
that person's done wonderful work.
Absolutely. What was their purpose?
They don't know because they mayrealise 30 years into working 80
hours a week. But what connections have I had
with my family and friends? Yes, I've helped patients, or

(01:09:32):
I've built wonderful houses, or I've done whatever I've done,
design wonderful clothes. And they have because they're
genius shines through. Despite their despite their self
limitations, their genius still shines through.
But have they thrived? No, So.

(01:09:52):
So that's social domain is really important.
The other one is actually the 9th one is functionality.
And what I mean by that is obviously for 25 years treating
some very severe mentally ill people in the forensic hospital
in Sydney. Is it people with very severe

(01:10:13):
mental illnesses? And it's not just a matter of
just the psychosis or they believe certain things that are
not reality based or they're having perceptions like
hallucinations. That's part of it.
But they're actually crippled intheir functioning.
They their brain is degenerating, so they actually

(01:10:35):
have cognitive problems, difficulties with with function.
They actually don't know how to plan a day or two, even tune
into the fact they need to shower, or that they
functionally know how to wash themselves, or functionally know
I need to go and do these thingswith the bank or Centrelink.

(01:10:57):
So you want it says. Where are they functioning like?
Do they have a driver's licence?You know, do they, are they
independent? What are they functioning like
in in other aspects of their lives at work?
For example what's they may be having a job but actually how
they're functioning in in that role because people say oh you

(01:11:19):
know yes I'm I work this job andtick the box the surface gets
all tick. Yes, $100,000 a year job.
They must be functioning really well and realise that this
person is really struggling at work and because of the other
domains it's really impacting ontheir work and their ability to

(01:11:41):
thrive and be the person they want to be.
And the last one is the actual social supports.
Where does it personally? What's your accommodation like?
Housing and lack of housing and and and insecurity of housing is
an enormous stress for anybody. You talked about being

(01:12:01):
comfortable in in this space that you're in here at the
moment, and it is. It's a wonderful space because
it gives you security, it gives you comfort, it gives you safety
and if someone doesn't have thataccommodation, what is their
accommodation? Where are they financially?
You know, you know, do have theygot the maximum benefits if if

(01:12:22):
they're on a pension, for example, do they have access to
all the rental assistance and other things, even if they have
a job? Where are they financially?
How They're managing their finances.
So what are their social supports?
Do they need national disabilityinsurance help to get them
access to certain things? We again talk about social

(01:12:45):
support. Now that could go into social,
but I like to see, OK, what are the support networks around
them? You know, are these people
accessible, these friends, Are they supportive or they're not
supportive or in fact, are they more toxic?
Do they actually make them feel even worse about themselves?

(01:13:06):
Other institutional things that need to be put in for support.
So, so the the 10 focal lengths and at any moment in time, and
I'll give you, I'd like to give you a story of a patient, um and
I have this patient's permission, although I'm not
going to say her name obviously to recount how this model would

(01:13:28):
work. And this is a patient who was
sent to me again for ADHD because that she had been to a
therapist for many, many, many years because of a very
significant trauma that happenedto her when she was a young
teenager. So she'd been having trauma
therapy and the the trauma therapist, very good trauma

(01:13:52):
therapist said, you know what, Iactually think that quite
separate to your trauma. I think you may have ADHD, so
it's not only when you're dissociating or do personalising
that you're having these cognitive issues.
So she came to me, and we actually again took the full

(01:14:15):
soundboard. The full focal lengths started
to focus on physically what's happening.
Well, we actually found out. When I started asking her
questions. It became apparent to her that,
Oh yes, she had hormonal issues related to her menstruation.
And so we, when we got that attended to though that was

(01:14:35):
already a huge boost to her whenshe went to the gynaecologist
and went to endocrinologist and actually found that she had
polycystic ovaries. Yep.
And they were significantly impacting on her physically.
So then I looked at, yes, the mental condition.
Yes, she had post traumatic stress disorder, definitely.

(01:14:57):
And she met a couple of the different criterias for
different diagnosis in there. OK, noted.
And then cognitively, yes, absolutely.
She had all of these cognitive issues that did fit into ADHD.

(01:15:17):
So then, by looking at the cognitive sphere became clear
that these cognitive issues werenot just related to trauma, they
had quite a different trajectory.
And genetically, we could bring it back to a whole line of
people that would have probably fit into that category and they

(01:15:38):
hadn't experienced her trauma, that she the type of trauma that
she, as far as we know and her cognitive issues predated that
trauma. But then we started looking at
her belief systems, and it was one of I'm powerless.

(01:15:58):
And OK, she's powerless. You know I'm not competent so
that without that defined I'm I'm, I'm powerless and I'm not
competent thought, OK, where didthis come from?
So then we looked at her attachment style, and it was
when an anxious attachment with people, and that was with her

(01:16:19):
parents, with her husband, with her own son, that that she had
emotionally, the attachment and belief system.
So we talked about the next one,which is schema.
Her belief systems included family belief systems.
She was comes from a family of Holocaust survivors.

(01:16:41):
So the inherent narrative of persecution, threat, fear, our
very existence that was in one that she had inherited that
belief system that was quite separate to her own sense of
incapacity. So then we looked at trauma.

(01:17:06):
And of course, I thought when I started to speak to her about
your negative experiences in life, Obviously her focal length
had been on the very big trauma that happened to her as a
teenager, but started going backa bit more in focus on her
experiences in life way before then.
And we actually found that her belief systems are narrative

(01:17:27):
about herself, came from experiences that happened at
3456 completely unrelated to that trauma that happened as
significant and as terrible as the trauma was.
So we actually did trauma therapy related to those
memories from the very formativeyears of her life.

(01:17:51):
Then when we looked at her, coping style was one of
avoidance. You know it was I don't have
competence in I'm. I'm powerless because of that
schema. Her coping style was to avoid.
Then we looked at socially whereshe was at, and again, because
of her attachment style, she would she didn't have that.

(01:18:14):
She had quite many acquaintancesbut she was always very anxious
in her attachment to these acquaintances.
So I wasn't going to all the details, but then we went to
looked at her, what she functioning like and she'd been
bullied at work. But because of her self schema

(01:18:35):
of I'm powerless, I'm incompetent, be concluded.
I'm trapped here at work. All these things that were
happening to her at work and shewas very miserable at work.
And then we looked at her support structures.
Well, her husband was trying to be a support structure in in his
own way, but we've actually got to look at what are your support

(01:19:00):
structures. So can you see, as we did all
that, it's like the soundboard. We tweaked every which one as
things were going on by addressing all of those areas.
In the end she ended up being because she had wonderful sense
of where you got her to be to realise her own sense of
purpose. She was incredibly empathic,
very bright woman, and she went on to become a counsellor, which

(01:19:25):
she was doing anyway. But she self-employed, running
her own business and thriving. Now this over several years.
And it's wonderful to see because it's like seeing the
sculpture. It's as soon as I saw, I think
watch this woman is is wonderfulenergy inside.
You can feel it, but it's being held back.

(01:19:46):
And yes, there are dirty bits ofthings all around that don't
belong, and we just need to clean them up and sweep them off
to reveal that the actual wonderful person that there was
inside. And so that's just an example,
yeah, of. How the model would apply and to
keep us honest on both sides because in explaining things to

(01:20:10):
her in that way, she would actually say, oh, I think this
we need to look at this. So I've actually been aware of
this that so it's not just aboutme secretly holding the cards.
This is my secret methodology. It's actually empowering the
person along the way. To understand where we're going,
thank you for that explanation and taking us through each of

(01:20:31):
the soundboard channels and for then bringing that home with an
example. It's so funny as you were
talking, I look at my career andwhat I'm doing in mental health
in three pillars. Connection or the power of
relationships. Real conversations is the main
technology I use to create change there resilience or what

(01:20:54):
I would call emotional fortitude.
How do you get sick people to become well or at least want to
survive? And then high performance, which
is how do you help people. 25 Connection is kind of where I'm
mostly focused and do a lot of my work in.
But I'm I've scaffolded a book that has taken me.

(01:21:16):
I'm writing one this year on Connection, Sorry.
This month I'm finishing it off and then I'm I've scaffolded my
next book on resilience and coping tools and getting people
better. And I've been taking notes on
that for literally two to three years.

(01:21:36):
And I currently just so that when it comes out, you don't
think Mitchell stolen my IP, have 10 pillars or.
But I much prefer your words in sound boards and they're they're
very similar. There are some slight
differences and I hope that as Iwrite that and as we grow our

(01:21:57):
relationship and friendship thatI can compare notes.
Because it's also very validating to hear that as such
an esteemed and established and credible and therapeutic
professional that you are. That you do agree that that you
can almost create this, like maybe not ingredient list, but
at least universe that you're like OK, if this is the headings

(01:22:21):
and there's puzzle pieces that sit under each one, regardless
of which one they sit under. If we tweak enough of these,
something good's going to happen.
And I wholeheartedly believe that before you got here and I
believe that even more, now thatyou get the right puzzle pieces
and you do the right work, good things will happen.

(01:22:41):
Now I guess my two follow up questions and I don't even know
how long we've been going, probably an hour and a half.
Yes. Yeah.
So we'll bring it home over the next 5 minutes.
But my 2 follow up questions that are hopefully simple, one
is when you're doing this map, this focal length model, and

(01:23:07):
you're almost doing an inventoryassessment, do you write them
out of 10 in each channel? And then when you sequence them,
do you go worse to best or how does that happen?
No, not at all. In the, in those, in each of
those frequent of those domains.I'm looking at strengths and

(01:23:28):
weaknesses. So it's not about putting a
value or a number, because I find that that that misses the
point because it doesn't actually make me see the bits
that I have to strengthen or help strengthen.
And it's not that I have to do it all because I don't pretend
to be that. Yeah.
But it's just to alert the patient.
Do you think? Sure.

(01:23:50):
Do you agree that this is an area that we need to strengthen?
Let's work together on how we can do that, but keeping in mind
you have all of these wonderful strengths.
Yeah, yeah, yeah. And.
In this domain, Yep. Because oftentimes in their mood
state at that moment, they may actually not even realise.
That 100%. So let's say you got the you've

(01:24:13):
got the physical and the social and the emotional, and you've
identified there's a bunch of strengths in there, but in these
three pillars there's something juicy, something crunchy.
I'd like to work. How do you know which one to
action first? It will depend on the one that's
probably holding them back. Yeah, the most.

(01:24:34):
Yeah. So you're going into time what
is presenting to be most disabling and will work from
there and into relief? Yes.
Yeah, yeah, that makes sense. And my.
And it's not necessary in one domain, because in addressing
that one thing, that one, whatever that thing is, could

(01:24:57):
actually need you to use 3 or 4 domains.
So you might be parallel parkinga few things.
At always. That's why I use the soundboard
analogy, right? Because you're constantly
monitoring that and doing the whole thing.
And I I don't want to oversimplify this again, but the

(01:25:17):
focal length model sounds almostlike A-frame of reference to
understand a problem and then identify a potential way forward
to healing that problem. But I'm assuming that when it

(01:25:40):
comes to then, OK, we've identified these are the
problems, these are the domains,the strengths, weaknesses, and
let's say we've identified 3 bigweaknesses that are ultra
debilitating. It could be a certain coping
tool, it could be a certain lackof relationship, and it could be
an attachment style. Then assume that the actual way
that you go and do the fixing ofthose things is using not then a

(01:26:06):
focal length treatment intervention for each pillar,
but you're going to pull in evidence based research for
whatever is the best tool to usein that pillar. 100%, yeah.
So you might use Doctor Dan Brown's Attachment Disturbances
in Adult psychology framework totreat that attachment issue, but
you've used focal length in order to know that the
attachment issue needs work in the first place.

(01:26:26):
Absolutely. OK, got it.
Absolutely. No.
Yeah. I don't pretend to be the genius
in all the things, in all the treatments, because they've been
very learned. People have and there's studying
and there will be. And so yes, and I'm, I'm not
going to teach grandma had to suck eggs.
It's basically just remember there's an egg there.
Yeah. How you have learnt to do it and

(01:26:47):
you know how to do it is fine aslong as you're aware that that's
there and keep that in mind constantly.
And you'll have preferred ways of treating different domains
like for example, there's multiple different ways in the
trauma domain to go about trading that it could be EMDR,
it could be re experiencing and reprocessing trauma, blah.

(01:27:08):
So based on your clinical experience, you're going to pull
OK in the trauma category. What I think works best is this
tool. I'm going to use this tool for
this patient. Is that right?
Absolutely. And for me to keep in mind that
that's limited that maybe my because of my experience, my
approach because of my experience in doing that, my

(01:27:29):
success. And I own bias in that because
it's self fulfilling bias. But being aware that if that's
not working and that domain needs to be strengthened that
I'm still monitoring and this whole soundboard so to speak to
think more hang on this is having limited effect.
Why? What is it in the other sound

(01:27:51):
boards that I'm missing that isn't this sticking if it's not?
Or is it perhaps that my particular approach is is
limited or not quite In Sync with where this person needs to
be, and then I can refer them onand there will be certainly
other things in that domain? The 10 domains of the focal

(01:28:13):
length model I don't have the expertise.
In yes. And you might outsource for that
or you might in source. I think we definitely need a
part too, because what I wanna do, now that we know the Mix
board, I'd love to geek out and go through each one and say
what's your preferred, what's your top two tools and why that
you use for each pillar. Because like again there could

(01:28:35):
be so many tools under each one.I'd love to know.
I have found that this form of attachment healing here and this
form of cognitive reprocessing and this one is is best like as
opposed to the trillion others. It'd be really interesting.
To hear I'm happy, I'm happy to do that, Mitch, with some

(01:28:55):
reluctance. Yeah, tell me.
And the reason is because, again, it's a biassed view and
it's only in my limited experience.
Oh, we would have painted as gospel.
No, no, absolutely, I get that. But can you see for someone
that's hearing it and I'd say, well, Tony Mastriani does this.
And yes, I have found that this A/B or CA way of doing these

(01:29:20):
things I found to be useful, butyou could get someone else
equally experience or more experience doing another 1D E or
F model that, depending on the situation, is actually far more
potent and more appropriate. Totally.
There's more than one evidence based tool that, and there's

(01:29:43):
also multiple evidence based tools that can work without them
being mutually exclusive and collectively.
Exhaustive. But I think in the doctor
community, maybe there's like almost a little bit of trauma
around. If you're claiming to be the
expert in something, you're justlike a sitting duck for someone
to come along and shoot you down.
That's definitely not the intention of this.
That was more just selfishly I love to hear what a the tool

(01:30:04):
because it's one thing to say problem, but then geeking out on
the tools and the pros and cons and not even saying like either
one works, just doing an analysis of these are some
things I've seen when I use thiswith this and this with this.
I think that would be interesting, but nonetheless
this has been incredibly captivating.
Because thank you. It's been great talking to you.

(01:30:24):
It literally back getting the message out there that it's at
awareness of integration of all of those domains all of those
focal lengths and the we need tohave the ultimate vision of what
we're doing. So you fixing the problem
terminology which everyone uses is not something I like.
To use no me either I was being shorthand.

(01:30:47):
No, no, no. You were.
But because I know what you're saying, but you still do all of
that. Absolutely.
Otherwise it wouldn't be here. Yeah, but it's really I need to
have a vision, and that is, thisperson needs to be, ultimately
their potential for what they were born to be.
Hmm. That's my vision.

(01:31:08):
Yep. So therefore it's not about the
problems as such. Yes.
It's not that I'm not aware of problems, but I'm not content
really. And it's not that I had to do
the whole journey either. But as long as I'm integral in
the in in being a catalyst for this, for the person that
presents to me to be able to getthem and give them an awareness

(01:31:31):
that they can reach that potential and where they were
born to be in their true purpose.
So yeah, so really. So if I guess if people want to
know more, they could go and focal length or com dot AU.
Plugfocallength.com dot. AU and and there will have
certain events we're actually doing starting in February and
March again next year to do events for both the general

(01:31:53):
public as well as professionals and educators.
We're actually focusing a bit more on educators next year.
So good. I think it's an incredibly, even
though this is fundamental by the way for medical
professionals I believe, becausewhat I've heard you basically
say is finally you're looking ata CEO for someone's mental

(01:32:13):
health. Like there's so many discrete
parts. There's like marketing here and
operations here and finance here, which is all these things
that's happening, which the GP at the moment is kind of set up
to try and run track across everything, but they're not
really, they're kind of like a shift supervisor.
And So what you're saying is there is potential for someone
to be this, well, technically speaking, the patience, the CEO

(01:32:37):
because they're entitled to their own domain.
But again, shorthand, your role is almost looking at the
altitude of all the business leaders and going, OK, why
aren't we profitable? Absolutely.
And I love that. Yes, and I want to educate every
person. 100%. That they realise, oh, this is
the model, this is how it works,this is how business of me runs.

(01:33:00):
And it's just like how you know,yes, people can go to business
and do a commerce degree, a professional would benefit from
looking at this model. But I think there are a lot of
people listening right now that entrepreneurs and mum and dad
shops that build those types of businesses.
I I can look after my own mentalhealth, even having this
viewpoint in this menu list, almost as a way of

(01:33:22):
conceptualising my healing to build emotional profitability in
my own life. And I don't know what your
future and vision is for this, but I really see like there's
some pretty simple workbooks andFlyers and and guided resources
that are already learning courses that people could do a
lot of their own work. With having having said that, we

(01:33:42):
actually have set up an online resource library which is split
up into the domains. Love it and with a lot of
resources, I think at the momentwe're probably, I think we're at
1500 links to free resources andit's going to grow.
It's just limited by time and resources.

(01:34:03):
So at the moment trying to do everything myself or with an
assistant is difficult, but actually we are looking into how
we can expand that. Alongside clinical practise as
well, I take my hat off to you for still having such energy and
motivation and not being trued up by the system and having the
boundaries to make it this far in the marathon and still want

(01:34:27):
to do more like that's his enormously commendable thing.
Well, I can tell you, like any other person my autopilot would
be to fall into. I don't have that.
Yes, and it's actually part of your own mental health.
And what I'm espousing is to actually look at my own and say,
hang on, I have to tune into my own purpose and my own energy of

(01:34:48):
why I was born to be otherwise. Without that, what am I doing?
So really, it's not just pointing the finger at everyone
else. It's something.
It's a journey all of us have to.
Make and I think you have so many.
You have so much good stuff. Say, it's almost a shame if you
aren't consolidating your legacyinto a framework that other

(01:35:11):
people can borrow. And so I'm so glad that you have
taken the effort so that we can all learn and grow from the work
that you've done that you continue to do.
So, thank you so much for comingon.
I encourage everyone to jump on and check out the focal length
method, and hopefully I'll be able to convince you in for a

(01:35:33):
Part 2 of this someday soon, Tony.
OK. Thank you.
And thank you very much for the opportunity because I really,
really appreciate it and I really want to wish you well for
everything you're doing because it's a wonderful, wonderful
movement and an awareness that you you're doing another one.
Thank you for that. Thanks, Mitch.
Take care. Cheers.
Motions have. Natural tendency to dissipate

(01:35:55):
unless they get reinforced. And so if there's more thoughts,
more stories, more intentions come along.
So the act of how am I leaving it alone is an act of not act.
Adding more stories, adding fuelto it.
So it might not go away in 2 minutes, but it begins to relax,
it dissipate. And so, rather than being the
person who has to fix it, would become the person who makes

(01:36:16):
space for the heart, the mind torelax and settle away itself.

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