Show Notes for The Aspiring Psychologist Podcast Episode 134: What is indirect self-harm?

Thank you for listening to the Aspiring Psychologist Podcast.

Dr. Marianne Trent discusses the concept of indirect self-harm with guest expert Eva Perry. Indirect self-harm refers to behaviours that may cause unintended harm to oneself, such as social isolation or sleep deprivation. These behaviours are not deliberate or highly visible like direct self-harm, but they can still have negative effects on physical and mental well-being. The importance of awareness and support networks in recognising and preventing indirect self-harm is emphasised. The episode also touches on the relationship between trauma and indirect self-harm, as well as the need for mindfulness and alternative coping strategies.

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The Highlights:

• 00:00 - Introduction
• 00:35 - Welcome to the Podcast
• 01:24 - Guest Greeting
• 02:11 - Introduction to Indirect Self-Harm
• 03:07 - Defining Indirect Self-Harm
• 04:37 - Examples of Indirect Self-Harm
• 05:40 - Social Isolation and Sleep Deprivation
• 07:09 - Self-Neglect and Motivation
• 08:42 - Culturally Accepted Behaviours
• 11:52 - Importance of Psychoeducation
• 15:23 - Common Indirect Self-Harming Behaviours
• 18:23 - Cultural Expectations
• 20:27 - Mindfulness and Alternative Strategies
• 22:27 - Screening for Indirect Self-Harm
• 35:39 - Closing Remarks

Links:

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Have you ever wondered in what subtle ways we might be harming our own physical or mental wellbeing? There's a concept called indirect self-harm, which doesn't get a lot of press, but I think it's time to turn that on its head. There are so many behaviours that can be classified as indirect, self-harm come along, tune in and see whether you might be able to improve your wellbeing or that of someone that you are working with too. Hope you find it so useful.

Welcome along to the Aspiring Psychologist Podcast. I am Dr. Marianne Trent, and I'm a qualified clinical psychologist. I am so delighted to be able to talk with you today with our guest expert for the day about a topic that you might not have considered before. I think it's especially relevant that we talk about indirect self-harm for aspiring psychologists as well who might be pushing themselves to the brink of exhaustion and applying all sorts of pressures to themselves too. I hope that you will find this episode to be a really thought provoking, inspiring, helpful. Listen, I'll look forward to catching up with you on the other side. Just want to welcome along our guest for today, Eva Perry. Hi.

Hi. Thanks for having me on.

Oh, well thank you so much for being so happy to talk to us. So it won't surprise anybody listening to this podcast that our paths crossed on LinkedIn, didn't they?

Yes. Yeah, I posted. I started making some information booklets and I think they've got some attention from the community, which is nice to see.

Yeah. So you are a psychology undergraduate and you are doing your psychology master's at the moment?

Yeah, so I'm a postgraduate in my master's course, so I've had my undergraduate degree in psychology and now I'm in my master's for clinical child psychology. So yeah, really enjoying it.

Hope that is going really well for you. And your undergraduate research project was on the concept of indirect self-harm. Is that right?

Yeah, that's right. It was a really new topic when I was looking through different ideas. The idea actually came to me. I had a placement year in my degree and I did a couple level two courses just alongside that, and one of them was in self-harm and suicide prevention, and they talked about indirect suicide, which led into indirect self-harm. And I thought it was so interesting. I've never heard of this kind of concept before, so it was a perfect opportunity to do some further research while I had the opportunity.

So suicide is when somebody has meant to hurt themselves but hasn't meant to end their own life. Is that right?

Potentially, yeah, there's loads of different ways it can happen. So whether it comes from medical neglect, for example, if someone has diabetes and they're neglecting their medication and then they end up passing away because of that or someone engaging in something really risky and they don't mean to end up dying from it, but they were aware of the risk or those sort of activities.

And in terms of death certificates, I'm thinking that's sometimes put down to death by misadventure as well. Yeah,

Exactly.

Yeah. Would that be indirect suicide? Would that be a cause of death that you are aware of, or would it always be sort of a medical cause of death that's used? So for example, if it's something to do with the brain or the head or the heart, what's your understanding of that?

Yeah, I'm not entirely well versed on how that would come up on a death certificate, but it would probably be put down as an accident of some kind. Yeah,

Yeah. Sorry to put you on the spot there, but way my brain works and it's like, oh, what would happen there? Okay. So tell us a little bit then about indirect. That's a really interesting area in itself, and so interesting that you did your research on it.

Yeah, yeah. So basically the concept of indirect self-harm is, there's several different definitions because it's such a new theory, but the main one I really liked was that it's an activity that might cause unintended harm. So it's not a deliberate seeking out harm. For example, when people self-harm, they might cut themselves. That's a very deliberate and highly visible form of hurting yourself, which those two aspects tend to be what many professionals say makes self-harm. Is it being highly visible and it being deliberate? So with indirect, it might be things like social isolation or sleep deprivation, just not looking after yourself. So it's not necessarily seeking out that harm intentionally, but it comes around as a secondary effect of what you're doing.

Yeah, really interesting. So actually a lot of the stuff that we might kind of see as self neglect, not eating, taking care of yourself, sometimes not even showering, I'm picking up your dirty socks off the floor, can potentially lead to sanitation, hygiene issues for yourself or issues of malnourishment that are often about motivation, about perhaps very low mood poor. I think sometimes there's factors involved with how many pressures you've got going on as well. So I'm thinking about, I'm a mother of two young children and in the times where they used to wake 37 times a night to wash your hair and have a shower and feel that there's any point in doing that because, so I think about that as being bone cold, tired, you just much left in the tank really. But also thinking about somebody who might have additional caring needs for their own partner or their children or a parent, for example. It's very easy to focus on meeting the needs of other people, but you might do that as a detriment to yourself. But actually it's a really interesting concept that technically that is in direct.

Yeah. Yeah, I mean there's a massive call for people to recognise that those sort of behaviours, usually they're talked about as almost a prerequisite to direct self-harm. So when it's applied in a clinical practise, you might look at indirect self-harm as a potential warning sign. So that theory can help preventing escalation of those behaviours. What you're talking about as well with this kind of socially accepted behaviours of indirect self-harm is the notion of culturally accepted self-harm acts, which is something that a brilliant researcher tur came up with, which I mean, it is what it says on the tin. So it is any behaviours that might be socially permissible. So obviously doing this research, I was a university student and in these environments there's so many of these behaviours come up, excessive alcohol consumption, experimenting with drugs and perfectionism. These sort of behaviours are very problematic and they definitely come under the indirect self-harm bracket, but they're so acceptable in university. That's just something that everyone does. It's almost like a rite of passage. So I think it's definitely as well very interesting looking at that from as I was living it, to be researching that. Yeah, it's interesting.

It really is interesting. And I'm married and I'm married to somebody who's currently, I think he's 48, winding him up about almost being 49, and one of his favourite food groups, which isn't even a food group, is sugar. He likes cakes, he likes sweets, he likes apple juice, he likes Pepsi, but he's in really good shape because actually over the last few years he's been kind of doing some strength training and kind of doing all that jazz. And it's always been, even since I met him, he's always been heavily into sugar, but he's been long and thin like a bean, and it's like, I don't really don't get how you're managing that. But actually it was interesting when he went to the dentist about seven or eight months ago, she was like, something is not right here. Your teeth essentially are not managing very well.

She said, are you sick a lot? And he was like, no. And he came home and told me, and I said, I think she's trying to ask gently whether you are making yourself sick because she's kind of concerned about the level of acid erosion on your teeth. And when he went back again the next week that he explored that with her and he said, I think it's maybe that I drink a lot of sugary drinks. Actually, all of the stuff I drink, so is tea, has tea with three sugars, and he'll murder me for talking so publicly about him. He's quite private, but sorry babe, but it's an interesting conversation. It was having an impact on his teeth. So we've now invested in a water pick flosser. He's now drinking more sugar-free squash, he's not drinking apple juice, he's swilling his mouth out after drinking Pepsi. So he's still not perfect, but I think he just hadn't quite realised that even that constitutes indirect.

Yeah, definitely. I mean, that's a brilliant example of it where it's not the direct intention to be hiring yourself in that way. These effects, they come up as an accumulation of behaviours or persistent behaviours. I do sympathise because I have a sweet tooth myself, but yeah, that's a really good example of it for sure.

I'll let him know that it was clinically relevant and approved favour. Okay, so yeah, this is a big topic and it's a really broad public health conversation, but is this that we need to be getting better at psychoeducation? How can we have a role for this? Many of the people listening to this will be working in mental health services, either as aspiring psychologists or maybe even qualified ones too. We've got some qualified listeners. How can we help to think about this with the people that we work with?

Yeah, I think it's really a matter of awareness. I mean, when I was researching this for my undergraduate there, I mean I could count how many papers were on indirect self-harm. On one hand it was really under-researched. And so I think having that awareness can be massively helpful. As I said earlier, can help with noticing early signs that may be leading to direct self-harming behaviours in clinical practise to notice those signs and kind of catch it before it escalates. And obviously the example with your partner, it's the concern that it might be an eating disorder. It's a bit contentious, but in indirect, I believe that eating disorders do come under that because it might not be the direct intention to be causing harm to your body. For example, with bulimia, you do get tooth erosion and those sort of effects. They're not doing that for that effect that they might be doing it because they have low self-esteem or they want to look a certain way. So I do think it's important to catch those behaviours before they might escalate into a full blown eating disorder, for example, or other negative behaviours. It's really important to have that awareness.

So I think often when I'm working with people with bulimia specifically, the tooth erosion takes a while generally, but the things with acid reflux and difficulty keeping food down even when you intend to, that happens a little quicker because of the way that the muscles and things work. So you can lead to lasting changes in your body because of bulimia is horrendous for people and it's a hugely distressing situation. So there's a variety of reasons why it crops up, and we know that it's a coping mechanism for a variety of challenging things, but these are not things that people do lightly, nor are they that easy to overcome, but there are consequences for your physical health, for your mental health. And yeah, I think indirect self-harm is such an interesting area.

Definitely. And on that point as well, one of the main things that differentiates it from direct self-harm is that with indirect self-harming behaviours, they usually lead on to other indirect self-harming behaviours. So for example, with eating disorders, you might then, if you're not eating, you might not be sleeping well, you might be neglecting a personal hygiene because of that. So you have this sort of knock on effect that you don't see necessarily with direct self-harm, usually there'll be one form of self-harm and then it doesn't impact so much developing another form of direct self-harm. With the research I did, we found that the average amount of indirect self-harming behaviours we saw was 10 to 12 in a month. So it's a very big variety that you get to see. Yeah.

What's your top 12? 12 might be too many to ask you to list off, but what are people most often reporting?

The top three were, I believe, yes, having self-defeating thoughts, comfort eating and declining to ask help when they were struggling emotionally or physically is the top

Three. Oh gosh, that number three is especially interesting for me and I think it very much weaves in with perfectionism and that desire, that belief that you can't ask for help or you shouldn't ask for help. And actually what I know now as a mother, my youngest is now very almost eight, he's eagerly planning his eighth birthday party and list. I wish that I'd taken the help that was offered for me, but I also wish I'd asked for more help when people came around to say, cuddle the baby. I wish I'd said, actually, can I have a nap? You take baby for a walk around the block in the push chair or in the sling, or actually when you are in the bathroom, would you mind just staying behind for five minutes and cleaning it for me? And there's not a single one of my friends that would've said no, they would've been happy to help, but I didn't know it was okay to ask for that help.

And I remember when I had my eldest who is approaching 11, he doesn't like me to say he is 10. I was in a different home to this one and he was asleep on my shoulder and I got so little sleep when they were asleep. I was very reluctant to put them down and my babies to wake up as soon as you put them down Anyway, and I was looking at the skirting board that was gradually getting more and more covered in dust and just thinking, I want that dusted and I'm not particularly house proud, but it got to the stage where it really needed doing probably three months ago, and I was like, I'm not going to get a chance to do that because when I have a spare moment, the last thing I'm going to want to do is to dust that skirting board.

But I wish I'd just said to somebody, I probably didn't even say to my husband, can you dust that skirting board? Because I felt that pressure to be the perfect housewife, the perfect mother to have a clean home. We had a brand new build property at that time as well, which probably didn't help because everything looked so shiny and white. And so then you notice those small changes. But yeah, it's really interesting to hear you say that that's the top three is not offering help that's offered to you or not asking to help. That definitely really resonates with me.

Yeah, I mean, thank you for sharing that. That's definitely an interesting story as well coming into that subject. So I think it comes back to what's culturally acceptable. So uni students, you are kind of expected to have those behaviours, and I'm not a mother myself, but my sister's a mother and seeing her experiences is you are kind of expected to have that difficult time. People always say, oh, terrible, tears watch out. And there's sort of that expectation that it's going to be horrible. So you might not feel perhaps that you should be asking for help. This is just how it's supposed to be. I think that definitely plays into a lot of the papers that we see,

And I think it's one of the beautiful things about this podcast and also lovely nourishing books is that it helps you think, oh, I didn't realise that. I've never thought about that, or actually I might use that or do that differently in future. So I wish that when I'd visited my friends with new babies that I'd said I bought my mini vac with me. I'm just going to is okay, I'm just going to whip it around for you because actually I think there's no shame in that, is it? We're not trying to shame people. We're trying to say, actually, when I come round, I really want to be as useful to you as I can, and actually if you don't need me to bring three brand new baby grows from next, can I bring you some home cooked meals that you put in the freezer that are going to really nourish you?

And actually when my friend was pregnant with her third child, she had her first baby, sadly her second was stillborn. She was really thinking about the birth of her third baby and rather than baby things, she said, could you cook me your favourites meals? Put them in some freezable containers. And then when I met up with her, I bought her a really lovely cool bag. I'd put some little kind of cold freeze things in there, and that's what she existed on when her baby was little. All of this made with love, really nutritious. She knows I like vegetables, so she knew that that would be food with love and to know that actually a time when you're going to be struggling, for example, I lost my dad and that was a really challenging time for probably the two years after that and when he was unwell, I wish I'd asked for more help and accepted more help at that time. But it's only really when we desham ourselves and when we go through adversity and then learn compassion that we know it's okay to ask for help. It doesn't say anything bad about you to do that.

Yeah, I 100% agree. It's so important to surround yourself with those positive people. I think a lot of times people you surround yourself with can facilitate those sort of behaviours. So as a uni student, if you're surrounding yourself with people who are experimenting a lot with drugs or promiscuity, alcoholism, those sort of behaviours, it's easy to get drawn into that. So it's so important to have that supportive network. It sounds like you are absolutely brilliant to your friend, definitely grateful to have you for that. It's a really important thing with indirect, so under-researched, not many interventions for it as such out there. So yeah, we've got to think about those sort of preventative protective factors in terms of reducing those behaviours. I think support networks is a massive one. Yeah,

Yeah, it is so new. Are there any outcome measures that yet screen for indirect?

Yeah, so there's one that I used for my undergraduate research, which is the direct and indirect self-harm inventory. And actually interestingly, the first self-harm measure that you're probably familiar with it, the self-harm inventory actually had quite a few indirect self-harming behaviours on it anyway, which I think is good. So for my undergraduate project, I merged those two together to get a list of indirect self-harming behaviours that people could rate, how often they engage in those. So it would be items like driving recklessly or exercising when you are injured or those sort of behaviours. It's very limited measures, but we do have a couple really good ones,

And that's another interesting one, isn't it? One of my besties has got into marathons and half marathons and all sorts of fitness in the last couple of years, and every time she runs, she runs for a distance, she ends up with a problem with her knee and I'm like, baby girl, I think your body is saying, I really want you to run. And she's like, no, it's telling me it wants me to run more. And I'm like, I'm not so about that my love. But it's really difficult when doing things we want to do. Our body doesn't necessarily like, and it's interesting to think about that as self-harm.

Yeah, 100%. It's being mindful of what your body's telling you. I think it's mindfulness with, I mean it's in most different therapies and counselling, and that's for a reason. It's so important to be in tune with the physical sensations and for example, certain indirect self-harm behaviours can be just picking your nails. My partner has this habit where he'll pick his cuticles and it looks so painful and it counts as indirect self. You are causing harm to yourself, but it's not the direct intention of it. And so those sort of behaviours, it's important to be mindful of when you're doing that and to kind of catch yourself from doing that to kind of stop those behaviours.

And that's interesting. I used to nibble skin down the sides of my fingers, but do you know what made me stop it was when I got an adult brace in 2008 I think it was, and I realised that I was pushing my front tooth, and so that's probably what had led to some movement in my teeth to begin with. So indirectly, my nibbling, my skin was also affecting my teeth, so there was two types of indirect, and I realised in the bar my fingers looked gross, so if I was going swimming or anything, my fingers looked gross and I was like, I don't want to do that anymore, so I'm going to put that down and make a conscious choice to not do that, to break that cycle. This is such a fascinating conversation, and as we talk, if people are watching on YouTube, they'll be able to see that I'm drinking a cup of tea, which isn't something I usually do, but we're talking in the afternoon and often I'll record podcasts in the morning, but I wanted to squeeze this one in because it had such an interesting topic that's relevant to the trauma stuff that I'm talking about at the moment, but also because it's just hugely interesting.

But I'm drinking a cup of green tea with lemon, and I have a cup of that every day at 1:30 PM I'm quite a creature of having, I tend to have lunch at the same time, and then as I'm preparing to come back online, it's about one o'clock, one 30, I'll have a cup of green tea with lemon, but that's the only caffeine I have all day and it's quite weak. But actually if I don't have that, my body is expecting it and feels a bit wobbly. And caffeine can be a really big deal, can't it? In terms of indirect.

Yeah, definitely. I mean any of those sort of addictions I suppose people have, so whether it's smoking, alcohol, caffeine, they can have a massive impact. And again, it's not the direct intention of it, although I would argue potentially the green tea sounds lovely, not a tea drink myself, but I've heard that it has quite a calming effects and it can be quite a positive.

Yeah, I don't think I'm a risk to myself or others with my one cup of very weak tea. It's got antioxidants and good stuff in it, so I think I'm doing all right, but I am concerned about caffeine and human brains, especially young brains. So my 10-year-old will often say, can I have coke at the pub if we're going out? And I'm like, no, Coke is not a treat. It's never a good thing. I know daddy drinks Pepsi, but it's not like a rite of passage. Caffeine is the largest unregulated drug in the world, and this is not necessarily something that I want my 10-year-old to have. And I had a conversation about this in my private psychologist group as a practitioner parent as well, to think about actually, how do we explore this safely? What I know is if we say no to kids, that they potentially go off and do it to excess anyway, and it's thinking about not making it a big deal, but not necessarily having it as a treat either. I don't want him to think that Coke is a treat. So as we record this, we went out for a meal yesterday to celebrate the end of his SATs, which is quite an important writer of passage for a 10-year-old. Definitely, yeah. And he said, can I have a Coke? And I was like, no, not today baby. Because I will sometimes say yes, but I didn't want him to think that the way we celebrate is with the buzz that comes from caffeine. Does that make sense?

Absolutely. Yeah. Those associations are so important and recognising those behaviours and reducing them, what you mentioned earlier as well about the trauma aspect of it. I mean, we see in so many cases with trauma rates of eating disorders and direct cell harm as well, and alcoholism, all of these risky behaviours. I mean it doubles with when you add trauma to it and adverse childhood experiences. So it's really important that childhood, the effects it can have on whether you develop these behaviours. It is such an important time of someone's life and whether they'll go on to develop those for sure.

And I think I'm just trying to be generally more mindful about everything. So I went away in April this year to go and see, take that with my friends, not necessarily because take that we're playing, but because we were looking at getting together that weekend and we're like, what should we do? Oh, take that playing, let's do that. But I decided actually I'm not going to drink this weekend because I really want to value the time with my friends, but also because I'm driving home for two hours the next day, I just don't want to ruin my night's sleep and then ruin the way that I feel the next day, or I'm not a great drinker anyway, so I'll sometimes feel quite sick and two drinks is about as much as I can handle, but I was like, what would happen if I freed myself up to not drink at all?

So I didn't and one of my friends didn't either. And that weekend has been so restorative for me. I still think of it really fondly the whole week afterwards. I just felt incredible to have had that time with my friends, the joyful experiences we had together that were take that related or non take that related, and it just had such a lasting impact that's just warmed my cockles in a way that I know it wouldn't have done had I drunk because my body and mind would've needed to recover from that energy. And I think that is the gift that I've given future me to not have to do that. And it's actually, I've avoided indirect self-harm there.

Brilliant. Yeah, I mean that's a brilliant example. It sounds like it was a great experience. It is definitely having that introspective awareness. I think psychology professionals, they tend to have that awareness anyway just from the learning about it. And so having that awareness, and again, it comes back to who you surround yourself with. So your friend, she sounds really supportive, didn't drink either, but obviously in some groups, especially I think in male friend groups, there can be that sort of stigma around those sort of behaviours where they'll say, you and I are fun, or they'll make fun of you, and then you might feel pressured to, oh, okay, then I'll have a drink. So I think, yeah, it is so important who you surround yourself with and

I absolutely, and when we got together and to have lunch, two of my friends had a glass of champagne and I considered it for a moment and I just thought, you know what? I know I will feel a bit, we headed and likely want a nap if I have it, and actually that's not what I'm choosing for myself this afternoon. So throwing no shade on them, but they had one glass of champagne and that's how that went down for them and they had a great time as well. But yeah, I think when we were in the arena, I also don't want to spend nine pounds on a pint of something that I don't really like anyway. It just wasn't right for that occasion, but I'm not saying I won't ever drink again. I don't know. I likely will, but I'm just doing it more mindfully, I guess. I don't want this episode to come across really preachy. That's not at all what we're saying, but we are just having a curious conversation really about some of these things that we might never have considered or that we don't routinely discuss with our clients.

No, definitely. Yeah, I don't want it to come across like that or it's mainly just kind of spreading the awareness to perhaps be more mindful of those behaviours and the effects that they can have. Obviously a drink every now and again, it's probably not going to be particularly harmful. It's a bit of fun. It's when it accumulates and it starts causing those negative effects. I think that that's when you perhaps need to check what it's doing for you and if you do need to alter those mindsets. But yeah, generally it's just about starting that awareness of I think.

Yeah, and I think often it can be really useful to take it back to the window of tolerance and to look at how we regulate ourselves when we are hyper and how we regulate ourselves when we are kind of a bit freeze or flop, bit hypo aroused, and actually I often find that can be a really helpful conversation with clients to think about what strategies they use to either bump themselves up or to kind of bring themselves down, and many of those will be in direct self-harm, but what we try to role model is actually soothing within breathing is a really great alternative to that or a bit of mindfulness or maybe going for a walk. I find going for a run really, really helpful because my knees don't seem to mind it's short runs. They either manage really, really helpful for keeping me well, but also shifting my mindset in a way that probably is going to be better for me than a Mars bar or better for me than a glass of wine and have a more lasting impact for me.

Definitely. Yeah, and it comes down to, I can't remember the specific term. I think it's risk reduction, but it's when your client is perhaps self-harming and you encourage 'em to adopt other strategies that might still be harmful in a way. For example, using an elastic band against your wrist instead of cutting yourself, I can't remember the specific term for that now, but

Is a stepping back so that you're getting the similar sensation but in a way that actually isn't going to risk. So if someone's liking the elastic band, they're getting that sensation on their wrist without cutting their wrist, that can open them up to blood infections and blood loss as well, and pain and yeah, I can't remember the term either, but I think it's something we'll often see. So you know what I'm talking about. Yeah, I do something we'll often see in dialectical behavioural therapy as well, that kind of thing. Thank you so much for your time. If people want to come and have a look at your research more fully, is LinkedIn the best place for them to do that, Eva?

Yes. LinkedIn. I'm Eva Perry on LinkedIn. I'm happy to, if you want to send me a message, I'd be happy to talk to anyone to discuss further. It's an interesting subject and I'd really like to share what I found and spread that awareness for the community start a discussion. Yeah,

It really is. I think it's going to be a case of watch out world for when you go on to do whatever kind of professional qualification that you do, but yeah, thank you for having this conversation with our audience and for demonstrating that actually really brilliant stuff goes on, even at earlier stages of people's psychology career.

Brilliant. Yeah, thank you for having me on. It's been really nice to discuss with another professional. Yeah, thank you.

You're so welcome. Take care of yourself and be kind to yourself and always ask someone to Hoover your house should you want them to.

Brilliant. Will do. Thank

You. What an absolute pleasure to speak with Eva. Please do go and follow her over on LinkedIn, and I would love to know your thoughts about this episode. Do come and let me know what you think on my social media, Dr. Marianne Trent, I am that everywhere. But also come into the group, the free Facebook group, the Aspiring Psychologist community with Dr. Marianne Trent, and let me know what you think to it there. Perhaps it might be useful one to share with your service if you think that they might find that beneficial. The Aspiring Psychologist community is also the home of Marianne's motivation and mindset videos, so that's the only place you can watch 'em. So come and join and come and join in. If you enjoy the podcast, please do rate it. Please do review it. Please do subscribe, follow the show as it helps us to reach a wider audience, and it's the kindest thing you can do for absolutely free if you love these kinds of growth conversations that really help you stretch and grow and think about important issues in psychology.

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