Anchor & Sail Quarterly Musings

Anaheim, CA — The 40th Evolution of Psychotherapy Conference descended upon Anaheim this year like a gathering of therapeutic elders around a campfire, united in their conviction that (a) the world is ending, and (b) the DSM can go fuck itself. Okay, they didn't say it quite like that (except for Stephen Hayes), but the subtext was unmistakable. Here are my completely unsolicited impressions of my experience at this year's pilgrimage to Psychotherapy Mecca.

Evolution in the Rearview Mirror

Despite the moniker, the modal age of keynote speakers must have been in the 75-year-old range. Furthering this point, aging therapeutic giants, including Otto Kernberg, Donald Meichenbaum, and Helen LaKelly Hunt, all canceled their appearances at the last minute without explanation. Granted, we clinicians and academics attend such conferences in search of sage wisdom, but I couldn't help but notice the field's relative stagnation compared with the wildly shifting technology landscape swirling around us in the years since I last attended the Evo Conference in 2017.

Here's what struck me most: outside of sponsor booths and venture capital types circling like vultures, almost no one discussed AI's implications for mental health and psychotherapy. For a conference ostensibly about the evolution of our field, the silence was deafening.

Also, having to wear a BetterHelp lanyard for four days felt like being sponsored by the therapeutic equivalent of fast food, but I digress.

The Prevailing Mood: Apocalypse Now

If there were a drinking game for every speaker who alluded to civilization's imminent collapse, we'd all need detox by day two. Steven Hayes led the charge with existential gravitas, and others followed suit to varying degrees. Hayes's willingness to share his family's harrowing history cut through the doom-and-gloom with a genuine human connection, however. It was the kind of vulnerability that reminds you why we do this work in the first place.

The Great Diagnostic Manual Revolt

Across disciplines and theoretical orientations, one theme united the presenters with near-religious fervor: diagnostic categories are bullshit. From psychodynamic stalwarts to neuroscience enthusiasts, the message was clear—individual differences matter, and cookie-cutter treatment protocols are therapeutic malpractice by another name. Hayes' disdain for categorical diagnosis was unparalleled and, admittedly, movingly memorable.

Common Factors: The Therapy Illuminati's Secret Handshake

What emerged most powerfully was the convergence around common factors that actually predict outcomes: personality, temperament, and relationship. Whether you were listening to Nancy McWilliams (an absolute treasure of a human being) or Dan Siegel, the refrain was consistent. It didn't matter if you were wielding psychodynamic formulations or interpersonal neurobiology: relationship is the thing.

Speaker Snapshots

Nancy McWilliams: An incredible academic, author, speaker, and clinician. Worth the price of admission alone. See me fanboying with my signed copy of Psychoanalytic Supervision below:

Daniel Amen: Say what you will about brain SPECT imaging and his specious political ties, the man can work a room. Excellent public speaker, engaging, and knows his audience.

Jeffrey Zeig: Sweet soul. Terrible public speaker. The dichotomy was almost endearing.

Peter Levine: Watching Levine work with a police officer who'd lost his partner in a shooting was the kind of clinical moment that justifies the entire conference ticket price. The body doesn't lie, and Levine's ability to track and facilitate the officer's nervous system unwinding in real-time was both powerful and humbling.

Kay Redfield Jamison: I read An Unquiet Mind years ago and HAD to see her speak. Watching someone with her caliber of intellect discuss bipolar disorder, her own bipolar disorder, with such unflinching honesty and clinical precision was worth every minute. She embodies the integration of lived experience and scientific rigor in a way few can.

Harville Hendrix: Quirky as hell, but his relational insights cut deep. His wife, Helen, was notably absent, which added an odd undercurrent to his relationship-focused work. Still, the man understands how we wound each other and has spent a career figuring out how we might stop.

The Veteran's Perspective

Full disclosure: This was my second Evolution conference, the first being in 2017. Something felt different this time; less magical, perhaps. Whether that's because I've accumulated eight more years of clinical experience and the shine has worn off, or the roster was genuinely top-loaded with marquee names while the middle card underwhelmed, I can't say. Probably both.

I did, however, learn something new and personally shameful: There was an Evolution of Psychotherapy Conference in my hometown, and I missed it! In 1995. When I was 8.

The Verdict

For early career clinicians: Highly recommended. You'll leave with your theoretical allegiances shaken, your relationship to diagnosis complicated, and a healthy dose of existential dread tempered by renewed commitment to the work.

For seasoned practitioners: Your mileage may vary. The common factors message is important, but perhaps less revelatory after years in the field.

Overall rating: Solid conference. Valuable experience. Might attend again, but maybe without the BetterHelp lanyard.

The Evolution of Psychotherapy Conference continues to serve as the field's gathering place for big ideas and bigger personalities. Just don't expect anyone to solve the DSM problem or tell you how to feel about ChatGPT in the therapy room.