Final reminder for New York readers! This Thursday, May 28th, I’m hosting an event with Kenneth Cole and the Mental Health Coalition. This event is for us to gather and bond IRL! I’ll also be doing a short fireside chat with Dr. Naomi. I would love to see you there!  More details and sign up here

Last week, a user posted on Threads, “Why don’t influencers ever influence people to do good?”

Naturally, I had to chime in because something I think about a lot is, what does it mean when your actual impact can’t be measured by standard metrics like follower counts or post likes?

At the end of the day, brands want to make money, so they make judgment calls based on traditional metrics — how many followers someone has, how much engagement they get, how much product they can sell. But some of the most meaningful work people do online can’t always be quantified that way.

How do you measure the impact of making someone feel less alone? Advocating for inclusivity, social justice, or the environment? Helping someone believe in themselves again or find the courage to pivot to a new career?

Those things rarely go viral, but that doesn’t make them any less valuable.

I feel very grateful for the career I’ve had in fashion and the ways I still get to engage with this community. But at this time in my life, what means the most to me is the work I do here. The messages I receive from readers or people who follow me —telling me that I inspired them to try therapy or travel solo, or that they felt seen in something I wrote. I cherish all of those messages. Even if I don’t respond, I promise I read all of them! I keep doing this because of those messages, and because that is the impact I want to have in this lifetime.

Now, moving on to today’s guest, licensed clinical social worker Alyssa Mancao. We chat about the many different paths healing can take. We discuss the therapy modality with the best PR — CBT — alongside EMDR, and why the relationship you have with your therapist often matters more than the modality itself.

The conversation below has been edited and condensed. To hear the full conversation, listen to the podcast. 

Hi Alyssa, welcome to FWD JOY. How are you?

Alyssa Mancao: I'm good. Thank you for having me.

Of course. I reached out to Minaa, who's one of our mutual friends, to ask if she knew anyone who would want to talk with me about EMDR. Right away, she sent me your name. I was like, "Oh yeah, duh. I follow her already.” 

I'm so excited to get into all of your work. You're trained in CBT and EMDR, and you use a psychodynamic and relational lens. I want to get into what all those words mean because I think that for anyone approaching therapy and going through their therapeutic journey, you really just learn along the way what these things mean. But I think it's also hard to figure out exactly what's right for you.

Alyssa: And it's important because we do use these languages, and then when somebody's looking for a therapist, they want to know what does that mean? How does that apply to me?

Completely. So, before we go into the deeper psych work, tell me what you were like as a child. Describe eight-year-old Alyssa.

Alyssa: She was playful, fun. She's still friends with a lot of the friends that she had at that age, very close with her siblings, and just interested in life.

Tell me when an interest in psychology came into the picture?

Alyssa: The interest in psychology actually happened by accident. When I was in high school, I wanted to become a social worker. There was something about community activism that was really enticing for me. I got my sociology degree. You can't do much with a bachelor's in sociology. So I was like, what do I do next? I wanted to further the work in relation to activism. I was like, is there a degree in this? So I went, and I got a master's degree in social work, hoping that I could do more community organizing and planning and things like that. However, all of my internships were in clinical social work, which is therapy. And I really liked it, and I never left it.

So let's start off with CBT. Tell me about CBT because I feel like that is a widely recognized form of therapy for a lot of people. CBT has great PR, so everybody knows about it.

Alyssa: CBT really does have great PR. It's really easy to digest, too. A lot of times, when people are coming to therapy, they're looking for symptom relief, and CBT seems to offer that in the way that it's packaged. But really, what CBT stands for is cognitive behavior therapy. And when used with fidelity to the way it was designed, it's a very structured evidence-based approach to treatment that focuses on the connection between your thoughts, your feelings, and your behaviors. So it focuses on the way that we interpret situations and how that interpretation interferes or influences the way we feel and act, and therefore how we behave. So the goal is to work on the thinking aspect of things to reduce emotional distress.

Who would be the right candidate for CBT?

Alyssa: CBT has been very effective for people with both anxiety and depression because when a person has anxiety, one of the cognitive distortions that they tend to lean to often is catastrophizing. Worst case scenario, jumping to conclusions, depression, it's a lot of self-deprecation. So helping them learn and understand what type of distortions they're engaging in and teaching them actual, practical skills to challenge that thinking is really helpful. So CBT is very skills-based,

But there are also real limitations to it as well?

Alyssa: Correct. There are limitations to it. There was this quote that was going really viral on social media, it was like, you can't CBT your way out of systemic oppression. A lot of times, the depression and anxiety that people experience is incredibly real, and it was not meant to be CBT’d through.

I probably should have always been working with a therapist who was trauma-informed, but you only know what you know. Actually, my friend, who is a therapist, had once suggested, "Maybe you should look into a trauma-informed therapist." And I took it to my therapist at the time. He was basically like, "I don't think you really need it. " And I was like, "Okay, cool." I felt aligned with that because I also thought people have a lot of feelings about the word trauma and whether or not what they've experienced really fits under that term, because that term is so dramatic or feels very dramatic, right?

Alyssa: Feels very narrow.

Then, when I started working with a trauma-informed therapist, I was like, "Oh yeah, this actually really was right for me. " But it's not to say that the work  I did before wasn't effective. It still worked, and I've still learned so much. I like to switch therapists, on average, I've changed about every four years or so, because I think as I work with someone and I'm doing the work, and I'm someone who's very, very committed to doing the work. So I can recognize when I need something different, or I'm just not really getting to where I think I need to be.

I have really leveled up in my therapy journey, and that has led me to where I am right now, which is working with a trauma-informed IFS therapist who also knows astrology because I'm super into astrology. It's really nice to have someone who just speaks the language. I don't even incorporate it all that often into the session, but if I wanted to just be like, "I feel like this is coming from my Capricorn moon, my therapist knows exactly what I'm talking about. " And then she also does brain spotting. But EMDR is something I've heard so much about. I've had a lot of friends who have been doing it. So, I would love for you to talk more about it because I know my audience is also very curious about what exactly EMDR is.

Alyssa: Okay, EMDR stands for eye movement desensitization reprocessing, and it's a psychotherapy approach that helps people heal and process traumatic experiences. So the idea is that traumatic experiences are stored within our body, and oftentimes they can get suppressed. EMDR is based on the idea that these memories or even the physical sensations of the experiences get stuck. They become stuck in us in an unprocessed form. And because of that, we experience distress, we experience anxiety, we experience flashbacks, or negative beliefs, self-deprecating thoughts, even after the event has long passed. 

EMDR is not a talk therapy—it is a bottom-up approach. So it's working with the somatic experiences of the body, and then it uses your eye movements to go back and forth. Sometimes an EMDR therapist will use their fingers, an electrical light bar, or other times they have something you hold in your hands that buzzes in each hand, and you have your eyes closed. People also do EMDR virtually, where you're following something on your screen back and forth.

That's cool. I didn't know that was possible.

Alyssa: So the back-and-forth experiences with your eyes used in EMDR, that's known as bilateral stimulation. And EMDR has eight phases. One of those phases is identifying which traumatic experience you want to target, and you have options. You can target the very first thing that's ever happened to you that you remember that was painful, the very worst thing that has happened to you, or the most recent. So it's first, worst, and most recent. The way it's determined is which one is distressing you right now? Which one do you want to process right now that's causing you the most distress?

Is it possible for it to be too intense for people?

Alyssa: Yes. So I mentioned that EMDR has phases, one of those phases, in the beginning, you are working on helping the client develop something called the Safe Calm Place, which is a place that they can retreat to psychologically when they're feeling overwhelmed, when they're feeling distressed. It's a place they can go so their bodies can self-regulate. And then it's not like you're being thrown into this thing. Within each bilateral stimulation, there's a pause, and you talk to your therapist about what came up for you, what you notice.

Are you also familiar with brainspotting?

Alyssa: No, I'm not.

I feel like it's been touted as a lighter version of EMDR. So when I do it in session with my therapist, I do it self-guided, and sometimes she'll call it out. She’ll notice, oh, your eye is going to the right. So she's like, why don't you focus on that point? You basically meditate on an eye point that is apparently connected to where the memory is stored in your brain. I've had one or two pretty profound experiences with it. I wouldn't say things come up all the time, but one of the very first times I did it, I was hit with an intense vision of myself that felt deeply connected to one of my core wounds. But then you also have a place, you identify an eye spot that you can go to where you can connect to a feeling of safety or expansion. So they sound very similar, but I've never done EMDR—I always have this association that EMDR is quite intense and brainspotting is a lighter version.

Alyssa: EMDR light. So with EMDR, our eye movements are going back and forth because it's said that when we're able to move our eyes that way and that motion, the bilateral stimulation, we're mimicking what happens when we sleep. When we sleep, our eyes go back and forth. That's processing the day, and it's kind of storing things like long-term memory, short-term memory. So when we're going back and forth with our eyes or whatever other tool the therapist is using, it's helping to reprocess the traumatic event so that it can become unstuck in your brain.

I also sometimes listen to bilateral-stimulation music when I'm doing brainspotting. And my therapist is like, you can use it anytime. I went on a walk yesterday, and I just listened to my bilateral stimulation.

Alyssa: I've used it just like sitting on a plane, falling asleep.

I'm going to try that next time. In the therapy world, people can be a bit dogmatic about the modalities they practice, and this particular modality being the one that's going to help people.

Alyssa: There is no panacea because what this person has created might help a client that EMDR just didn't work for with me. There's no identical way to treat the millions of people.

I guess that's the thing that can be very tricky about it is that if you're going to therapy for the first time and you just want to work through whatever you've been dealing with, you don't really know what's right for you until you just dive in and start working on things with someone and then you figure out what the right fit is as you go along. Of course, hopefully the clinician you're working with can assess whether something is really right for you, but I think a lot of things are probably also just learned in practice.

Alyssa: And regardless of the treatment approach, it also depends on the diagnosis, but the research has shown that it is the relationship with the therapist over the modality. That's why when you're saying like, "Oh, with this person, they do astrology." That makes sense; it's a good fit for what you need now because there's also a good relationship there. The relationship that moves the treatment forward more than the modality that they're practicing. The modality helps. So if you're looking for a certain modality, prioritize the feelings towards that therapist and your relationship with them.

I've been very lucky. My last couple of therapists have been really fantastic, especially the one that I was working with before my current one.  I'm a real intellectualizer, and I love psychology, so I can therapize myself all day long. I think brainspotting is also really helpful in the same sense as EMDR because I don't have to talk as much. And that's actually a struggle for me because I love to talk.

So I'm trying to balance that right now in my sessions; sometimes I need to focus on brainspotting versus just recapping my last week. But I have also thought about whether EMDR could be right for me because I really struggle with emetophobia, the fear of throwing up. It's something that has dominated my life since I was a kid, and it's not something I've been able to work on in talk therapy. I don't talk about it very often with anyone because it's so uncomfortable for me. Or I need to get hypnotized.

Alyssa: Is that what you're working on right now in therapy?

Not entirely. I've struggled with anxiety, and so all of my issues are rooted in control and not wanting to feel out of control. I really struggled with a fear of flying for many years. I couldn't get on a plane. So for me, the fear of planes and my fear of throwing up feel kind of intertwined in a sense. I have been able to get over my fear of flying. I fly all the time now. I got over my fear of flying because of exposure therapy, of just doing it, and you can't do that with throwing up. I mean, I guess you could. I read a book called The Age of My Anxiety. It was written by Scott Stossel. I believe he used to be a writer at the Atlantic, and he also had emetophobia. I felt so seen by this book. So he tried to do an immersion therapy where he worked with a doctor who gave him medicine that's supposed to induce throwing up, but they gave him the wrong dosage, and he couldn't throw up. And so he was just dry heaving for a really long time, and it just sounded like an absolute nightmare. I'm like, I could never do that.

But yeah, I've addressed it a little bit just through focusing on what it feels like for my body to feel out of control.

Alyssa: EMDR can help with that, whether it's getting to the root of it or doing just the exposures around it. Every therapist is different, but one thing they could be exploring any memories or sensations associated with throwing up, just the root cause of it. If you can't get to the root cause of it, then it's just focusing on the fear around it and then just seeing what comes up, what is connected to this. See the throwing up as the tree stump. This is what we see. This is what’s bothering you, but then look at all these different roots that are connected to it. 

So when you're doing EMDR, you're just like, you're going down this root. You're clearing it up, going down this one. And that's what EMDR is doing.

Interesting. I actually just wrote for my newsletter about my very first panic attack, and it was brought on because when I was in middle school, a kid threw up on the school bus.

Alyssa: So, let's say you decide to do EMDR, you would focus on that memory and see what's connected to it.

That whole incident changed the trajectory of my life because I suddenly just became afraid of everything and things that I had never been afraid of. I couldn't get back on the school bus for years, couldn't perform because I was terrified that maybe I would get so nervous that I would get sick. So it's kind of been something I have had to organize my life around.

Alyssa: I have two questions. One, can you do roller coasters?

I used to be able to, and I can't anymore. I don't even know the last time I even went on a ride. Not since my anxiety started, for sure, but I used to love them.

Alyssa: Two, can you fly economy? I've treated plane anxiety, and typically, when somebody has severe flight anxiety, it helps if they can fly first class or business class. But then going back to the economy kind of reactivates the feeling.

So when the pandemic hit, I didn’t fly for about 20 months. So when my first work trip came up, I booked myself a business class ticket. In the news, there were so many headlines about people getting into fights on airplanes about wearing masks— and I was like, if I see that going on, I'm going to have a meltdown. I just really don't want to see that. And not to say that it can't happen in business class, but at least in business class, you're in your little pod, and you can kind of ignore what else is going on. So since 2021, I have almost exclusively flown business, at least for long-haul flights. Then, when I'm in Europe, yes, occasionally I will still fly economy because it’s just like a two-hour flight. 

And that is something I have designated in my life is a worthy expense because it makes me feel better. 

Alyssa: As you should.

How do you approach people who are kind of quick to dismiss that they don't need trauma therapy or that they don't have trauma? Because I think people will do a lot of like, "Oh, well, other people had it worse than me. "

Alyssa: You acknowledge that severity lies on a spectrum, but it doesn't mean that what happened to them wasn't traumatic for them. So even that sentence can be used to help highlight a high-level pattern. Do you have a pattern of dismissing yourself, your needs, or your experiences elsewhere? You zoom out because even just that sentence is very telling.

There's a saying, too: a person who drowns in six feet of water and a person who drowns in three feet of water, still drowning. You kind of just help them see that it's valid. What happened to you is valid.

Vienna Phaaron, who is also a guest on my podcast this month, wrote a book in 2023 called The Origins of You. She talks about five core wounds people can have, such as a safety wound or a priority wound. So I think that language is also really helpful for people because someone hears trauma, and they immediately think of abuse or rape. But I think that's also how I felt when I started thinking about whether trauma therapy was right for me. I was like, I don't have trauma, but I do. 

I've struggled with abandonment issues, and a lot of that is actually just generational. I'm first-generation, and there's a lot of history of abandonment in my family lineage. And so yeah, it's something that I have spent a lot of time unpacking, even though I haven't actually been abandoned in the traditional sense. I grew up with both of my parents. 

Alyssa: And it could get really confusing because we're trying to justify it. Why do I feel this way? Why do I feel this way when people have had it worse? I didn't go through anything. I had X, Y, and Z.  I think when people get stuck on the diagnosis, then it's just important to focus on the symptoms. What are you feeling? How is it impacting your life? How do you feel about yourself? And then let's go there because then we can really get caught up in the semantics.

Also, back to EMDR for a second. I once read that walking is a form of EMDR because you're scanning your surroundings, so that's why walking helps us process emotions, right?

Alyssa: Yes, and walking is good for all of us in general, but if we're using walking as an intentional form of processing our emotions, if we have the privilege, not all walks are the same. So a walk in a very intense, busy neighborhood with sirens might not feel the same as a walk in a quiet suburb or in the forest. So I just want people to keep that in mind when they're going for walks and like, "Oh, this was supposed to help me. " Think about where you're walking, what the environment is too. But yes, walking is supposed to help with reducing emotional distress.

Yeah, it has become a major tool for me in self-regulation. Anytime that I would feel this really overwhelming swell of emotions, it's like, okay, I've got to put my sneakers on and go outside. Sometimes I do it while I talk to myself and talk to my inner child. I feel like those two hand in hand truly rewired my brain.

Alyssa: It helps you slow down. It helps you stabilize.

What does the psychodynamic and relational lens mean?

Alyssa: Psychodynamic and relational lens refers to our earlier childhood experiences and helping clients understand how those experiences have an effect on the way they experience the world now. Oftentimes, people come into therapy with a presenting concern, and with that presenting concern, they just want to talk about the present moment and that. A solution-focused therapist might work on strategies and skills to target what you're experiencing now. A psychodynamic therapist might ask questions about earlier childhood experiences, your relationship with your friends, your self-esteem back then, your relationship with your parents, to help you understand any patterns in what you're experiencing, any patterns, and to also help you understand how and why you're experiencing things the way that you are. So it focuses on earlier attachment relationships. And when people think about attachment, it doesn't always have to be with your parents. It can be. But it's whoever your primary caregiver was too, siblings, babysitters, teachers. It takes into account pretty much all of your relationships. If you had a coach or especially if you had an aunt and uncle, what were those earlier relationships like? How did you experience them? What were your earliest memories of feeling alone? What were your earliest memories of feeling supported, and how are those experiences being brought up for you now?

How do you know when the EMDR is working for your client?

Alyssa: When you start EMDR, and you identify what the target memory is, you also ask, how distressing is this to you now as you experience it in this moment, from one to 10, 10 being the most distressing? And if they say 10, 20, and then at the end of each session, you can recap how distressing is it for you now? It might still be a 10. The next session you do it, so you're asking at each session, you're getting a marker of how distressing it is. So for me personally, I'm seeing progress when it's going from a 10 to a 9.7 and then eventually down to whatever number they've identified is tolerable for them, three. I've seen it go down to a zero, which is so incredible. And I've even seen that with some of my friends who have done it, where it just feels like one day they're suddenly like, "Yeah, I'm not as activated anymore, or I'm not as bothered by whatever the thing is.”

"I can think about this without my entire being shutting down. I can think about this without it affecting my whole day, without it affecting my ability to work. And more importantly, I can think about it. I'm not avoiding it anymore

Or without having this overwhelming reaction. The mind and the body are truly is just ... 

I love learning about this stuff, so I could listen to this all day because I just think it's so important for people to be able to move through the world with a little bit more ease if they can.

Alyssa: Everybody deserves ease.

What's something that you do just for yourself? What's bringing you joy?

Alyssa: Oh my gosh, great question. Actually have it in front of me. My inner child used to play the flute, and so now, as an adult, I'm taking flute lessons.

The Pain We Carry: Healing From Complex PTSD For People of Color by Natalie Guitierrez 

This book helps readers understand the impact of intergenerational trauma, cultural narratives, and inherited pain while offering language for experiences that may have previously felt difficult to name. I feel this book is especially meaningful for folks who are looking to understand their pain and feel empowered in their healing journey..

Break The Cycle by Dr. Mariel Buque 

BTC offers psychoeducation and practical tools around breaking intergenerational trauma patterns. Dr. Buque's work is accessible while still grounding readers in trauma-informed concepts.