Psychiatry & Psychotherapy Podcast - Cohort Group Consultation and Reflective Function: Transforming Countertransference into Clinical Insight

Episode Date: May 22, 2026

In this episode, Dr. David Puder is joined by cohort leaders Dr. Allie Riege and Dr. Jeremiah Stokes to explore how reflective function transforms countertransference into deep clinical insight. Through their experience leading psychodynamic cohort consultation groups, they discuss the challenges therapists face with vulnerability, disavowed emotions, and the gap between theory and real-world application. The conversation dives into common therapist personality dynamics, enactments, boredom and irritability as valuable clinical data, and how group consultation helps clinicians develop greater self-awareness and empathy in their work. Drawing from Nancy McWilliams' Psychoanalytic Diagnosis and key concepts like concordant and complementary countertransference, this episode offers practical wisdom for mental health professionals seeking to improve their reflective functioning and psychodynamic case conceptualization. Link to blog Link to YouTube video

All right, welcome back. I am joined today with Dr. Ali Rega and Dr. Jeremiah Stokes. We are going to be talking today about the power of countertransference of understanding your own countertransference. We're going to be talking about a little bit about reflective function, how that relates. Dr. Ali Rega is a cohort leader, and so is Jeremiah. This is the second year. We've been doing cohorts with people that are listeners that join. And it's exciting to meet people that have been listening for a while or maybe pretty new to listening.

And we thought we'd come on and talk about the experience of that. And so, yeah, maybe I'll just have Ali start because Ali was once a cohort. Member now has for a year been leading your own cohort. And what has it been like for you? Okay. Well, let's see. Being a cohort member initially was, you know, something that I had been looking for for a while. I'm just wanting to dive deeper into psychodynamic case conceptualization and really like case consultation with others. you know, at that point we hadn't really articulated reflective functioning and like therapist reflective functioning as much, but then that sort of came to fruition during that time. That's my memory at least. And diving far more into like reflective responses and looking at how

early childhood dynamics and personality may be contributing to how we show up in therapy. Our preferences in therapy, our interventions, ways we may unconsciously collude with a patient, you know, ignore certain things, respond, value other things. And so that was that was something that I really dove much deeper into there. And then just sharing in this experience, hearing other people's cases, hearing their approaches and like people with such different personalities and training that really, yeah, just helped me think differently, more creatively. And then also, you know, attending to group process. I think that something that I really try to highlight now running a group is,

you know, this is sort of the opportune time, really a wonderful, you know, time to not only attend to the content, you know, of what we're learning because we are learning a lot. And for a lot of people coming into the group, you know, there's been no psychodynamic education. training. And so it's a lot of new material and it's very dense. And, you know, as you've talked about a lot on your podcast, you know, the huge gap between theory and application, I think, is where a lot of people feel stuck. Like, okay, I'm sort of starting to grasp what this means as far as personality and levels of functioning and transference and countertransference, but like, what now? So that's a piece of it. Like that's a huge piece of what we're doing is learning about that.

It's didactic that way, teaching it. But also really trying to support group members in attending to their countertransference, their interpersonal process, their emotional reactions, feelings they're having that are uncomfortable, whether it's, you know, some sort of like disgust, shame, shame, embarrassment, envy, not wanting to come to group, wanting to speak up and not saying something, feeling inadequate, all of these things that are constantly there, right, under the surface.

And so having that be a real focus of the group as well. Yeah, really good. Yeah, and Jeremiah, any thoughts? As you kind of listen to this. Yeah, no, I think that's a great overview. I think running this consultation group, it's evident that people are hungry. They're hungry for more depth. They're hungry for more understanding, understanding the nuance,

understanding the complexity that is our patients. And so I think there's been, I really noticed this drive for more depth with regards to case form. I think the other part of this that has been fascinating to observe is the growth that I have seen in cohort members as it relates to their own personal experiences. And Ali referenced, you know, what some of those things could look like, whether it's through countertransference or, you know, really engaging in a group, in a really meaningful, connective way. I've seen professionals grow tremendously in terms of acquiring more knowledge of themselves and how that shows up in the work that they do with patients. And so I think what we've been able to facilitate in this group is not only expansiveness as it relates to understanding cases and psychodynamic theory and depth, but also just really helping people understand themselves in a personal context and how they show up with their patients.

Yeah, it's been a lot of fun. I used to lead groups for residents. I know both of you have led other groups as well in the past, but I think there's something nice about there's no grade. This is not like a gatekeeping exercise. So much of residency is like you feel like you have to show up in a certain way just to get through. So maybe you hold back a little bit. There's a degree of vulnerability that isn't there.

You know what I'm talking about, Allie? Yeah, it's been, it's certainly, we've had many discussions with how challenging this has been. And I know, you know, most group members, most cohort members have spoken to that, have said, like, you know, this has been maybe the hardest part of this whole group is, you know, allowing myself to be vulnerable. opening up a little bit more. You know, I think that many, many people that come have been in their own personal therapy before. And so there's, there is experience with that, but this starts to elicit all types of emotions that I think make many a bit uncomfortable and, you know, unsure of what and how to share,

particularly in the role that we're in because so often wearing this hat or, you know, the role of therapist or, you know, psychiatrist and P, like, you're not sharing or you're told not to. And that's something that we certainly work on through learning how to use countertransference, which is I know something that we'll talk about in a little while and why. it's so important to do some of this self-reflective depth work in this process is, you know, in effort to be able to use the countertransference and transference in our work. But I would say, I don't know what you guys think, but I would say that that's certainly been an area where most members have felt surprised a little reticent to engage at times.

oftentimes there's a trickle down a fact of one or two people being willing to sort of jump in, dive in, and then others might open up more. But yeah, it's been that's definitely an area that I think

surprises people. Yeah, and I think that like we're enculturated, at least in medicine, to really have a very strong social veneer. But if all you do is ever talk from the

place of a social veneer, right? It's actually low reflective function. If you're not able to say what you actually feel or what you actually like have maybe some embarrassment about saying, you can't really get in touch with your countertransference at all, right? Like, so I think this is this is the case for group members when they're like, gosh, I'm having this stuff come up for me. and it feels like if I share it, it's going to be too much. But I really care about every single member that I've ever worked with, you know,

like I think the best for them. They may fear that I'm critical of them. I'm really not. I really want them to thrive in their work and life. And I realize that we're all in process. And there are some things that we're going to have lower reflective function for and some things we're going to have higher reflective function for. But the things that we already have high reflective function regarding, then we may not

need to discuss those things at all. They're not distressing to us in the same way as the things, the memories, the events with patients that maybe don't come out as smooth. Maybe there's a bit of like difficulty even saying it out loud, right? That's like, that's usually where the good stuff is and where growth can happen. And I was thinking about the place of disavile. emotion. Maybe we should talk a little bit about that, like how the group really will feel whatever is disavowed. And this is something that it's like, it always surprises me, right? When someone, maybe they have a lot of disavowed anger, someone in the group is going to feel that anger. Do you know what I mean? Yeah. Yeah, it comes up all the time. Someone's

sharing a case. I love going around and just hearing like one. or two words of what's coming up for everyone in the group emotionally, right? There's this, and I'm guilty of it too, like there's this desire to like leap in and sort of intellectualize and what might be going on here, but really making a point to say what emotion of being elicited for everyone right now. And oftentimes there, I mean, most of the time, there's, there's meaningful data. And it might be about, it might be about the patient that we're talking about, but oftentimes it's about, it's about who's, you know, presenting and what might be there for them that

is, you know, disavowed. And I think when there is something that's disavowed emotionally, it's almost felt tangibly by the group. And what I found, though, is that oftentimes it takes processing with the group for each group member to sort of assess and evaluate, what am I feeling? And so I found that let's say there's a member who has disavowed anger. It may not be indicated from another group member immediately. It may take 30 minutes of group discussion and processing for us to sort of arrive collectively.

It's like, oh, so that's shame or that's anger that you're feeling. And so I think when the group picked up on that which is disavowed, there's an additional step in group processing where we all work together to sort of discern. what are we actually feeling in the room? And I think that's really important when we're thinking about countertransference with our patients, because I think oftentimes we're picking up on obviously things that are disavowed, but we may not know exactly what it is. And so we need time to process that.

We may need consultation. These are the cases that we bring to consultation. And so I think that's the magic of the group is when the collective sort of works together and explores, it can really help reveal these unconscious processes. I think in a way that you don't get an individual consultation. Right. And the finding of the disavowed is an increase in the reflective process, right? Like if there is disavowed emotion, and if you just jump to intellectualization,

you're staying at like a level four or a level three RF, right? And so intellectualization is disconnected. It's theory, basically. you're trying, it's distancing from the emotion. And this actually happens a lot in like different therapy communities. It's like someone to share something and it's like, well, this reminds me of the self-object

transference and blah, blah, blah. It's like, well, that would be okay if it was connected with the emotion, but if it's just like, and then everyone's like, well, I have no clue what this person said, but, you know, sounds like really intelligent and like, and so I think we can do a disservice to people who are training because

then they're like not able to like we should be able to talk in a way that everyone understands and I've always thought about this for my podcast it's like every podcast episode everything I say should be understandable ideally I mean something's harder harder to understand than others but my hope would be I wouldn't overly complicate the language for the sake of sounding intelligent right because that's a defense that's a defense right and that's the beauty of the group is is that if someone is in fact intellectualizing you know you have the group there to kind of stop and go, wait, what is this really about? What are you feeling underneath that?

Yep. Yeah. Something else that's coming to me, too, that's somewhat related is, so giving voice to, you know, these qualities that are pretty, that are common to people in our profession. And normalizing those, but also talking about, you know, in, in, in, in, in, talking about the strength and the qualities, but the vulnerabilities, you know, in terms of how that might impact the relationship, the ability to look at what might be meaningful data and the countertransference, slipping into like a particular role, responsiveness or

enactment without really understanding what is being pulled for. So like, you know, spending a nice amount of time on like common factors of therapists and obviously it doesn't relate to everybody, but at least a few do to all. And I know Nancy McWilliams talks about sort of the depressive personality style. And so, you know, commonly a disavowed emotion that might be shared by the therapist, clinician, and patient is just about anger, an inherent sense of guilt

that is unconscious. And so it's not coming into the space. What's needing to be talked about and are brought into the open is ignored and unwittingly. And other common factors

like this desire to nurture, a need to nurture. feeling responsible for the patient's well-being, feelings, this pressure to do and act. And I think that's why Nancy McWilliams text initially for so many people in the cohort groups, they feel so connected and seen by this idea of not needing to do, not having to do, needing to act, but needing to focus a little bit more on the emotional space, attainment. Yeah, I find that so many of the cohort members come in and just feel a little at sea with this idea of like, I need to be doing something all the time.

I have to make it better, a desire to be liked, a desire to fix. and that isn't really achievable, as I'm attainable, or you're going to end up, you know, going in circles with many, with many patients without this greater awareness of what might I be reacting to and responding to that is both inherent in like my own personality and drives and wishes, but also what they're, what they're, you know, sort of pulling for in me. And so that's been a major shift, I think, in cohort development and in sort of what they're attending to. And I'll be honest, like sometimes I will find myself in my own head thinking, I need to bring this cohort value. I need to say things that are going to help them, equip them, like, am I doing enough, right?

And then the problem with those types of internal thoughts is it takes me away from what someone is saying. in the cohort. And so I almost like have to forget and have no, it's like I've prepared, you know, I've read the chapter article, whatever we did before coming in, but then I also have to kind of just see what people bring in and kind of forget my, um, my need to sort of teach, be a podcaster, kind of, you know, put stuff out there that's valuable. Yeah, or have the answers, right? Like, That's what it's like I'm speaking of, you know, as like a therapist, you know, I feel I'll fall into that feeling like, oh gosh, you know, they're looking. I need to have the answer. And, you know, I'm almost better in my role as therapist, you know, being much more comfortable in the not knowing. And then in the cohort group really having to remind myself like, this is this is the same thing. Sure, I have, I have. I have training and I'm prepared and what we're going to be talking about and some experience, but maybe I can bring to group, but that there's also, you know, there needs to be space for

my own not knowing, right? And like bringing that to group and making space for that. And there's a lot of collective, there's a lot of collective wisdom in the group members. Yeah. Oh, yeah. Yeah. Yeah, and I mean, I think that as the group facilitators, that's our way of practicing vulnerability. Right. So being present, understanding the fact that we don't know everything, our own shortcomings. I think that requires us to be vulnerable. And so I think in a way we're sort of modeling that.

I think there's a lot of power, for example, in saying, I don't know, you know? Like there's times where I'm asked a question in group or when I was teaching classes and I don't necessarily know the answer to that. And I think there's something that can be modeled through that level of vulnerability. And so I think as group facilitators, we're essentially doing the same thing. Absolutely. So, okay, getting back to countertransference a little bit, I guess we're still talking about countertransference. But we're talking about group, maybe group level countertransference. What emotion is disavowed?

What emotions are felt? Why do we feel the way we do? Right. That's the reflective function question. So if all you do is you feel anger and you have no clue why you feel anger. And if the, you know, if you were in like the adult attachment interview and they were like, well, why do you feel anger? It's like, well, I don't know.

You tell me, you're the expert. It's actually a negative one, right? And so on the score from negative one to nine, so the question is like, well, how do you, how do you get in touch with the why that you're responding to this client, right? and I think that it's like the why can lead to increased empathy okay so the journey through the why the journey through increasing reflectiveness leads to increased empathy so what do you guys think about that idea how does it how does it lead through to increased empathy do you see that Well, I think when we're questioned about the why, it forces us to try to have a deeper understanding emotionally of what's underneath all of that, right?

Whereas if we, for example, if we intellectualize a response or if we have purely an intellectual analysis of what's going on with our patients, I think we lack the depth and truly understanding their experience. And so I think by doing a search, and I think this can happen with the group when the groups, sort of shepherds us into doing an internal search, we're able to sort of, through the emotional process, we're able to discern what exactly that's all about and the true meaning underneath that. Yeah, it allows different information, right, to empathize with, right? Like, you might be experiencing the emotion that the patient is feeling, right? And so like you're really attuning to that level of pain or fear or shame and you're feeling that deeply. And so that allows for, you know, hopefully for them to feel seen in that way.

But there's another level of empathy that can come from countertransference information and our reactions. and that, you know, is sometimes what, you know, it's what they're eliciting in us that might be a reaction, whether it's projective identification or like a role responsiveness. And that what are they trying to communicate to me right now that they don't know, that they can't articulate that's outside of their conscious awareness? and it might be rage or a desire to flee. Like, leave, I can't wait until this is over. Or a desire to just fix everything, you know, frustration of like, this problem is clear. Let's solve it. So, but containing that.

And here's where you get to more of the empathy of like, okay, on the one hand, this might be what many other people in this person's life is feeling. And so they're moving through the world in conflict of, say, like, desperately wanting closeness, but this is what they're eliciting in people. You know, they're not knowing fully how to get those needs met in a way that they would want to. And at least for me, that that does create, you know, a significant degree of empathy. Now, you know, what next, right? How to use that depends on the patient's level of functioning, their attachment injuries.

Like, you know, can they tolerate some sort of, I don't know, cognitive distance? here? Can they can, you know, what's the ego strength like or do the, or is this somebody who really just needs containment right now for me to contain what's happening and provide some stability and, um, not react in a way that I'm being pulled to react. And, and so, and, and, and I think the patient communicates what those needs are. Yeah. So there's, there's these various ways, many ways that the countertransference can show up, whether it's, you know, attuning directly to what they're feeling and being able to connect with them there versus like, wow, you know, interpersonally what the frustration or suffering might be for that patient, as well

as the people in their lives and what and what they're reacting to. I think on a simple level, being able to just ask as the therapist, what am I feeling? You know, what is, what's in the room right now? What, what is being invoked within me? And I think oftentimes clinicians, they, they lack that first step. And I think that's the gateway to empathy, right? Is being up not necessarily what is the patient feeling, although that's needed as well, obviously, but what am I feeling in response to what's just been disclosed? You know, is this, is this more of my stuff? Is this perhaps how other people in their lives experience them? Is it a combination. And then I think that can really inform the next intervention. You know, there's

ways to do that. Like, I'm feeling a lot of anger in the room right now. And I'm wondering, is this, you know, are you angry? Does this story, I'm wondering if this story is sort of eliciting a sense of anger within me. I'd like to process that with you. And so I think a simple identification of the emotional experience that is being invoked and then verbalized, I think, is a really simple intervention that can go a long way. Maybe I can give an example. I'll read a little passage here from Nancy talking about countertransference, specifically a narcissistic personality disorder. And so I'll show this for those of those of you that are on YouTube. So related to these phenomena are countertransference

that include boredom, irritability, sleepiness, and a vague sense that nothing is happening in the treatment. A typical comment about a narcissism. narcissistic client from a therapist in supervision. She comes in every week, gives me the news of the week in review, critiques my clothing, dismisses all my interventions, and leaves. Why does she keep coming back? What is she getting out of this? A strange sense that one does not quite exist in the room is common.

Extreme drowsiness is perhaps the most unpleasant of the countertransference reactions to narcissistic patients. Every time I experience this, I find myself generating biological explanations. I didn't get enough sleep last night. I ate too big of a lunch. I must be coming down with the cold. And then once the patient is out the door

and another one is inside, I'm wide awake and interested. Occasionally, once countertransference to an idealizing person, is a sense of grandiose expansion, of joining the patient in a mutual admiration society. but unless the therapist is also characterologically narcissistic, such reactions are both unconvincing and short-lived. So what I was thinking about with this one specifically is like boredom,

like it's hard to say as a therapist that a patient bored you. It's like it feels very like risky to even tell yourself that that's the case, right? And so she's saying to herself, what she inevitably tries to do is say, oh, you were just tired or you're, you know, had a big lunch, right? She's trying to find any reason to explain it. But there's something about when you're listening to someone and they're talking from a grandiose facade

and you're not really meeting the real person in the room, you're not reading the real emotions, the deeper emotions like the shame and the vulnerability that, you know, inevitably could be there, you might become a little bit tired and fatigued, right? So if you're my patient listening, of this and you remember me yawning during a session, I may have just been sleep deprived. I mean, really, that could be, that could be the case for me. So don't like, be yourself up.

But what I'm saying is that with the same person over and over again, if you find this reaction, it's like, oh, is this because we're not really talking about what's really vulnerable, right? Or that, you know, I'm not really here. I'm not really in the room to this person. They're talking at you, not with you. But I think, you know, it's a good point, right? Like, is this something that I feel somewhat frequently? You know, it's familiar to me versus is this something that's noticeably outside the norm? Like, I remember one really jarring instance of, like, my patient at the time was violent,

was really quiet, was pretty withdrawn. But I felt like outside the window I could see the tree outside, and it suddenly felt like it was not really there, was I really here, and this sense of like my insides, like maybe I was going to like, I don't know how to put words to it, combust, cease to exist, right? With real annihilation anxiety, which later I could put words too.

And understanding that that was, you know, the patient needing to withdraw right there was so necessary for safety and kind of grounding himself, but also there's that, you know, empathy of like that tremendous amount of fear and confusion in the moment, which, again, like, you know, that was something that happened frequently. then, you know, I might think about what else might be going on for him, but certainly in that situation, that was a very, he was communicating something to me that he couldn't put into words. And I wonder in that case example from McWilliams, it's almost like this feeling as the therapist of dissociation. You know, you're dissociating, right? And so it's almost like you're probably

encapsulating how other human beings feel in this patient's life. Because if this patient is constantly self-idealizing. We know with idealization, there's automatically going to be devaluation interpersonally. And so it's like, does the therapist feel so small that they simply have to dissociate and disconnect from that experience? And that may feel like what it means to be that patient's kid or that patient's spouse. And so I think, you know, I think it is really important to look at all of the details, the, you know, the character structure. And yeah, what does it mean to be in relationship with you because we are in relationship with our patients. And so how do I as a representative of your world, what am I embodying as I work with you? Because chances are other people

are feeling something similar. And I think it's our job, there as professionals to really draw the insights to help produce that data for the patient. And David, you brought up a good point that I don't want to, like I want to give a little bit more attention to is like, you know, feeling bored are these reactions that, you know, maybe a really seasoned, um, psychodynamically trained therapist is, is more open to. Um, but, but for so many, like, feeling like dreading a patient coming or feeling judgmental of them or disgusted is something that most people, most feel like I shouldn't be feeling this way. There's something, you know, this, you know, I should have this like unconditional positive regard.

I feel like that's like what every basic level training is like, this is what, you know, you need to, how you need to see people, treat people. And so it's dismissed right away. And I think that the cohort space really digs in for that. Like, it tries to pull that out and normalize it, not have shame around it. I know I certainly try and make a point to talk about my own reactions frequently just to sort of, I don't know, make it okay. Because, yeah, they are frequent reaction.

Yeah, we can have strong thoughts, strong feelings. Of course we do. Because patients come in with strong feelings and complex childhoods. You know, sometimes, you know, we talked about with countertransference with yeomenes this concordant versus complimentary countertransference, concordant that the therapist is feeling what the patient is feeling, complimentary, that the therapist is feeling

what the patient's early object felt like. So it could be like they're picking up, they're feeling what the father felt like to the patient. The father felt maybe sadistic and angry and violent, and all of a sudden you could have some desires to raise your voice at the patient. Now, if you had that and you weren't thinking psychodynamically,

you would have a lot of shame about feeling that way and you might push that into your unconscious. If you're curious about it, maybe it can give you some information on how to have empathy for what that was like, for that kid growing up in that family where the father was sadistic and yelling at him and how awful that must have been.

And like suffocating maybe even like panic oriented. And so I think like it can give us clues on how to have deeper empathy, maybe empathy where the empathy gaps even are. Or help or help them own that, own that emotion themselves. Like maybe it wasn't a parent that was feeling that way, but the patient themselves and they just have not felt it was not safe and it still doesn't feel safe to feel any of those things. And so, you know, is what I'm feeling right now really a projection,

not, you know, not necessarily, you know, a relational pattern that's being elicited. Right. And we don't know. We're speculating. Yeah. And that's to bring to the face. Like, you know, patient of mine has like, I'm just, I can tell you're angry with me. Like you're, you know, you're angry with me and I feel, genuinely feel no anger and just floating the idea that they might be angry or, you know, that's too strong a word, like a little bit annoyed, a little bit frustrated.

That can be terrifying, but such a vital part of the work that we're doing together. And without that curiosity, without doing a deeper dive with what we're experiencing, we write it off. I think oftentimes clinicians will just say, well, I'm just bored. They're just a boring patient. And we know that, no, there's a lot of data there. It means a lot more than they're just boring. They may also happen to be boring. But why are you embodying that experience?

And I think it does, one of you mentioned curiosity. I think it's so important for us as clinicians to make. maintain a almost like a childlike curiosity throughout our entire careers, especially as it relates to countertransference. I think coming back to like how reflective function can be, can actually help us make sense of countertransference. It's because part of what's higher reflective function is allowing yourself to see something translucently, not clearly. And so we could, to have an open-mindedness and speculation around what these things might mean, actually is a higher reflective function stance.

And also to tie in to developmental ties to ourselves. Like, what is it about our own childhood that led us to feel the way that we felt with that particular patient? You know, I was practicing this with myself, with one patient recently, and I was going through, like, okay, what are all the things that have led me to have this huge reaction to this person?

And one of them was, the death of my grandfather. He died, he was mugged outside his office. And I myself, as I was sort of contemplating, free associating, and my countertransference for this one patient,

who I thought was going to be dangerous towards me, remembered that my grandfather was mugged and eventually died by it. He inhaled the old fire extinguisher things and got fibrosis in his lungs. It took a while. But it's like initially when I had a very strong reaction to this patient and my sense of safety, I even found myself like as I was exiting my building, you know, looking for this guy.

That was a lower, that was almost like I was embodying the level of paranoia, right, of this persona. Only later did I have that free association with Jeremiah. We're on a walk. I'm talking about it. shared it with him. And it was like deepening to have a deeper reflectiveness on like what was going on, right? It lessened the intensity of the countertransference, right?

So some things from our developmental past pull us in very powerful ways. And if they remain outside of our awareness, we're in a more reactive position where we, this is how enactments happen in therapy. An enactment is you start behaving in a different way towards this client because of this strong countertransference reaction. So anytime you find yourself behaving in a different way

that you normally wouldn't behave, be curious about it. There was an analyst who once said that I don't remember who was, but he said like, it's not that you will be able to achieve some countertransference nirvana and get to a person. point where you will never enter into an enactment. You will always enter into enactments. You just have to be curious about why they're there and start to deconstruct that with supervision and, you know, with cohorts like this. And hopefully the enactments don't get to a place of you doing something that would be unethical. Yeah, and that's, you know, I think that's such a

meaningful part of the cohort group is the curiosity of all members asking these different questions. but and looking at like what role might they be responding to. And at times it can feel very healing, right? Like, okay, this is my job, my aligns with my value system. And then you miss out on important information of what the patient's communicating to you about what their needs are. and it's really your own needs being met. Not that they both can't be simultaneously. I think oftentimes both things are happening,

and that's inevitable. And there's nothing wrong with that. But I think group members can offer these different perspectives or curiosities as to these reactions. and I mean, how many times have I been, like, totally blind to my own experience and situations and see it clearly in someone else. And then someone else brings it to my attention. And you feel kind of like, oh, like, how did I not?

But it's just, I think it's the way that, you know, it's part of being human and having a necessary defensive process that we all have. And if you're a little bit depressively oriented and you have that kind of interjects of negativity, you could really beat yourself up over, you know, having this kind of countertransference type of enactment, right? Or if you're masochistic, you could beat yourself up and then feel like that's necessary. To have meaning and purpose. Yeah. Yeah.

The only way you know you're doing your job or something like that. I had a group member who said in group, you're trying, okay, we were talking about masochism. We were on a masochism chapter. She said, you're trying to buy love and the currency is suffering. You are prostituting yourself to buy love. And I was like, oh, that's so good. I got to write that down.

It's so deep, right? That's talking about, like, if you have a little bit more of a masochistic personality, you'll do anything to buy love, right? And suffering might be the currency to buy love. And if you are receiving a currency for love, that's inevitably a form of prostitution. So, really deep. Yeah, I think, too, like, you know, someone with more, like, you know, more dependency needs or,

you know, sort of an interpersonal style that way and, you know, the pull to like take charge, you know, and how that can feel like, oh, I've been struggling with this person. I don't, I haven't known what to do. There's all these symptoms. I feel like I'm putting out fires and here's, you know, here's a way for me to take charge. And by increasing your own reflective function, thinking about your early childhood roles and also, you know, your own personality dynamics, is that is that a vulnerability of your own, right? If it's like, you know, taking charge feels really good. You know, I don't like feeling sort of powerless. I feel like I'm failing this person and I, it's evidence I shouldn't be in this job. Whereas really, this is just a communication, you know,

from the patient of how they've been trying to get their needs met but often help rejecting right i don't actually want you to so you can tell me all the solves help me and nothing's really going to change um so not to have so much judgment of yourself but have much more awareness and how that can how that can really be um liberating yeah the dependency uh or someone with more dependent person could elicit a countertransference of wanting to help them, right? Wanting to save them. And one time a resident of mine entered into enactment like this where she was buying the patient or helping the patient buy plane tickets,

helping the patient like do things that was beyond the scope of what, you know, it was normal and, you know, good nature, not too harm, but at the same time, like, we, you know, let's be curious about that. Like, okay, what is it about this particular person where you feel they're powerless to do this themselves, right? That they need you to do it for them. What kind of, and if you're in private practice, another masochistic thing is sometimes, you know,

undercharging or never charging certain people or seeing certain people that may be abusing you in some way, right? And sometimes in group these things come out. It's kind of like it kind of allows the group member to grow a little bit. You know, like how many hours of charting is too much per night? Probably somewhere above 20 minutes is too much, right? Or you get some group members that come out and they confess, I chart for three to four hours every night.

and it's maybe a more obsessive need. Maybe it's a need to feel in control. When they feel out of control, it could be a lot of different things. It could be. But inevitably, the group can maybe come around them and help them through that. So, yeah, what, Jeremiah, what's coming to your mind right now

is we kind of, I imagine we're going to wrap this up eventually. Yeah, no, I mean, I think just, I think we're really speaking to the benefit of the group. You know, it's like as a clinician, I think through this process, you know, you're learning about your personality, character, style, you're learning about defensive processes that come up. Let's say, for example, there's an enactment that takes place with a patient, and maybe you don't even realize it's an enactment.

You share it with the group, and you have seven or eight people all have these insights that ask these questions, which then probe deeper self-reflection for the group member. And so it's like, I think the benefit of this group is to take these processes that, number one, unconscious to, which is normal. But number two, they're pretty complex and there's a lot of nuance. And so having the support and the guidance of the group can really help a person, I think, do a deep self-exploration that can really benefit the work that they do with their patients. Yeah, and not to mention, you know, experiencing what our patients are experiencing. Like really getting to, you know, viscerally feel what it's like to feel exposed, to really try and know parts of yourself that maybe you hadn't before that type of curiosity.

And, you know, even if there's a history of being in therapy, it's a different experience. And so I see that as so, it's such a significant, at least personally, it was such a, significantly positive part of being in group and challenging, which was such a good thing. Yeah, that's good. Okay, so we talked about some countertransference. We talked a little bit about how reflective function can potentially increase our countertransference responses. We talked about some of the things where group can really facilitate that increased reflectiveness and how understanding your own story can be part of increasing your understanding of countertransference and why it's necessary. Yeah, and I think this is a good discussion. We don't have to accomplish

everything here. I always want to accomplish everything. But yeah, any final thoughts? I think we'll need, I think we need another more time, not the same episode, to talk, you know, to dive into some of the other concepts that we really focus on, you know, levels, assessing levels of personality functioning and that working with people in that borderline range in particular and neurotic, you know, across the spectrum, but giving, you know, more time to that. But, yeah, it'd be great. Yeah. And I think in the, you know, the way that I like the cohorts being run is like half the time

we're talking about the material that we read, you know, a chapter. and half the time we're doing a reflective type of thing. And I think that that's really potent is to have people write out something before they come in, read each other's responses, comment on it. There will be some reflective function, where people are sharing with the group members, what they wrote, where there's like 50 comments

before the group has even come. Like people are reading and commenting on each other's, on each other's posts, which is, I think, it's really great. And then the, the processing of that deeper reflectiveness, you know, and slowing the process down, allowing for that sort of group thing to happen.

Some questions are like, describe your most difficult patient. Describe your Big Five. And, you know, we did the Big Five with every group so far, just to kind of understand ourselves more, understand each other, the Big Five personality type. You know, it could be just reflective,

on this chapter and what it stirs up for you personally, like on a personal level, you know, so getting away from just the pure, like, regurgitation of the information. So, great. Well, we will leave it there for today. Thank you so much for listening in. And if you're interested in becoming part of one of the cohorts, you could go to Psychiatrypodcast.com.

There's a tab on the top that says cohorts. If you get this and we've already filled, we're doing rolling admissions, We will definitely keep your name, and I will have Jonathan personally call you future years to invite you to the next year of the cohort. So plan on doing this for a while. Hopefully it'll grow, and we'll leave it there for today.