Psychiatry & Psychotherapy Podcast - Depressive Personality Style with Jonathan Shedler

Episode Date: May 23, 2025

Dr. David Puder and psychologist Dr. Jonathan Shedler explore depressive personality style—how it differs from clinical depression and why it often goes unrecognized. Through a detailed role play, they demonstrate how self-criticism, unconscious guilt, emotional deprivation, and suppressed anger emerge in therapy. They discuss: How depressive personalities form in childhood The role of introjection, self-blame, and gentle idealization Why therapists may miss key dynamics if therapy feels "too good" How to help patients access their real needs and frustrations This episode is ideal for clinicians and anyone interested in deep psychodynamic work. Shedler draws from the work of Nancy McWilliams and Otto Kernberg while offering his own insights on personality, countertransference, and therapeutic technique.   Link to blog. Link to YouTube video. By listening to this episode, you can earn 2 Psychiatry CME Credits.

Okay, welcome back to the podcast. I am joined today with Dr. Jonathan Shedler to talk about depressive personality style. He has been on the podcast before talking about narcissism, obsessive-compulsive personality, beginning treatment, psychodynamic psychotherapy. We have no conflicts of interest to report for this episode. We will be doing a lot of roleplay, trying to give a practical understanding of depressive personality dynamics, how it shows up in therapy and how to start to help the person get in touch with their own needs, desires, and frustration. Individuals with depressive personality style are often professionally and socially externally successful with a warm, engaging, empathic presence, and invested

in making other people's lives happy. Due to the adaptive childhood dynamics that they faced, how they adaptively responded to hardships, these people developed an accommodating nature and get stuck in relationships, even therapeutic ones, where their own needs, desires, and anger remain neglected, disavowed, and largely unconscious. Depressive personalities are distinct from clinical depression. Someone can have a depressive personality without necessarily experiencing clinical depressive episodes. Paradoxically, individual, with a personality style often appear outwardly successful and high functioning despite inner feelings of inadequacy and chronic dissatisfaction. They typically struggle to experience genuine

pleasure or joy. Within psychodynamic circles, the concept of depressive personality remains influential, especially the works of Nancy McWilliams, Ode Kurnberg, and Jonathan Shedler. They emphasize underlying dynamics such as internalized self-criticism, unconscious guilt, and enduring interpersonal problems, which makes this meaningful to understand and address. There are common patterns that show up and how they relate to others, including interjection, which means internalizing negative experiences and anger. There's a turning against the self, engaging in self-directed criticism and punishment, and there's a gentle idealization of, of others, coupled with, you know, when they do have frustration at others, they usually turn that on themselves and have this self-devaluation. So as they idealize the therapist, they may be covertly dissatisfied, but then turn that into self-blame and guilt. Countertransference could include

protective impulses, a feeling of a desire to rescue. There may be feelings that you pick up of their disavowed frustration, and you may feel the frustration that it's hard for them to feel, and there also may be feelings of helplessness that they feel, and that therefore you also feel. And these things will be addressed in this roleplay and in our discussion. And this concept has a rich historical lineage. Emelon Kremlin first described depressive temperaments, highlighting the stable and chronic nature of this. People like even Freud discussed in mourning and melancholia,

depressive dynamics, and depressive personality first appeared as a proposed diagnostic category in the DSM-3R and DSM-4 in the appendix. Depressive personality style was represented in DSM-5 as persistent depressive disorder and in ICD-11 as dysthymic disorder, but we are here to discuss this as a unique personality style. And so Jonathan Shedler, can you please talk to us about the historical context on how depressive personality disorder first came to be included in the DSM. Yeah, you know, actually you brought up something that might be a useful little digression here about the impact of DSM on how we understand personality. You know, just to be clear, the concept of personality disorders actually didn't exist in the literature prior to DSM.

The way that came about is that the first. framers of DSM-3, were published in 1980, were very determined to produce, you know, like a medical taxonomy of, you know, psychiatric difficulties. So, you know, they made a decision up front. Everything was going to be a disorder, which plays out in, you know, funny ways. Like before DSM-3, people were anxious, but the concept of generalized anxiety disorder didn't exist. Anxiety was a state, not a disorder you had. So, I mean, it really changed the landscape of how we think about, you know,

mental health difficulties. Personality in particular, they left it out entirely. It wasn't even on their radar screen, right? They had basically completed the entire, you know, development of DSM-3 without ever taking into account of personality. it was going to go to publication. And apparently very late in the game, somebody said, well, what about personality?

And it was added as an afterthought, literally an afterthought. That's why it was Axis 2 in DSM 3 through all the variants of DSM 4. And since it had to fit in a taxonomy of disorders, they took every, you know, they took the major personality styles that were, you know, familiar to psychoanalytic clinicians at the time, ratcheted them up in severity, sometimes to the point of cartoonish caricature, called them disorders,

and all of a sudden personality disorders became a thing on the map. So a little aside, but maybe relevant here. Yeah, and I think it's so important in my mind to have empathy for clients, to understand our reaction of clients, countertransference, to deepen our reflectiveness

into people's experience, to look at their individual personality styles. And I like how you parse that out and that everyone has a personality style. Of course. Everybody has a personality. Every human being has a personality. Every human being has a personality style.

And the, I guess, unintended consequence, I'm pretty sure. By the way, got that story directly from Bob Spitzer himself. I mean, how personality became access to comes right from the source. But the unintended consequence of that is now we have several generations of, you know, psychiatrists, psychologists, mental health professionals who have no concept of, you know, personality except if it's a disorder.

So, you know, I do a lot of speaking in workshops and podcasts and, you know, and it happens all the time. I'll say something about somebody's personality dynamics or personality style, and the person on the other end will start talking about personality disorders as if that's what I said. And, you know, the way I look at it is there are certain kinds of patterns or constellations of personality that we see personality functioning, you know, that we see often enough that we can say this is a recognized person. personality style. And they all fall on a continuum of functioning from healthy, high functioning, to really very seriously disturbed. And basically what the SM ended up doing was teaching generations of clinicians, if personality isn't at the extreme of disturbance, it doesn't count, and we don't need to consider it. So we can talk about depression in isolation. from the psychology of the person who has depression.

We can talk about anxiety in isolation from the psychology of the person who has anxiety, but that's not really a psychological understanding. Right. We're talking about today someone who has psychological defenses that are in inner experiences that lead to more of a chronic depression. from adolescence that continues on

until they get psychological work? Or how would you say it differently? Well, yes and no. So one thing that's important is, so just for the sake of listeners, what is personality really? You know, it's consistent patterns of functioning that originate fairly early in life

that consolidate, by adolescence, and it subsumes, you know, patterns of how we relate to other people, relate to ourselves, how we cope with difficulties, our defensive processes, our organizing psychological themes, our motivation, basically everything that we talk about when we talk about somebody's psychological functioning, you know, is really in the domain of personality. So when we say a depressive personality style, you know, it's pretty important to understand, it's not the same as clinical depression. It often leads to depressive episodes that you could diagnose as depression, but not necessarily. So you can have people with depressive

personality styles who are not, in fact, suffering from clinical depression. In principle, you could see someone with a depressive style who's never had a clinical depressive episode. And lots of people have, you know, chronic, consistent, you know, recurring depression who don't have depressive personality style, right? They're somewhat different, they're different things. Okay, so how would you define this? Depressive personality style. Yeah. Yeah. So it's a pattern of, you know, of functioning in the world and a way of experiencing self and others where, you know, the characteristic features are there are people who are very prone

to negative affect especially shame, guilt, feelings of failure and inadequacy. The most defining the hallmark, I think of depressive personality,

if you were a psychologically sophisticated observer, looking at this person from the outside, you might think this person is their own first enemy. So they tend to be inhibited about seeking and experiencing pleasure, excitement, joy, satisfaction. It's as if there's something inside of them that's squelching their ability to allow themselves to enjoy that. And in some cases, they seem to, you know, not consciously, not intentionally, of course, but it's almost as if they're

if they're seeking out experiences that are going to be, they're going to cause hardship or suffering or unhappiness. In that respect, we can say they seem like their worst enemy. Interpersonally, people with this personality style actually tend to be pretty high functioning. It's generally not a disorder. If you think of a spectrum of levels of personality, functioning from healthy through neurotic, through borderline to the psychotic, you know, they tend to be in the healthy and the neurotic levels of functioning. Interpersonally, they often tend to be

warm, engaging, empathic, pleasant to deal with. They tend to be people-pleasers. And when they come into practice and into therapy, clinicians, and this is empirical, this isn't just my opinion. We have data showing this. Clinicians tend to describe them as good patients. They feel really good about working with them. And the trap is the fact that the clinician feels really good. They feel good because the patient is easy to deal with. They're accommodating.

They're very appreciative of what the clinician offers. So the clinician tends to come out of the session. feeling like there's a connection, feeling like they're being helpful to the person. And the danger is the reason the clinician feels good is actually not a sign of progress, but rather a symptom. And the symptom is that they end up recreating the patient's relationship patterns in the therapy relationship, and the patient's relationship patterns are that they're very oriented toward other people's needs and feelings at the expense of their own.

So they enter into a relationship. They tend in one way or another to devote themselves to making the other person feel good about their relationship, but often at their own expense. And so the other person's needs get met, but their own needs don't necessarily get met. They come in and they repeat this pattern with the therapist so that the therapist ends up feeling very good about therapy. right, every they both appreciate one another, but the patient doesn't change.

That's the trap of treating depressive personality style. It's like there can be some gentle idealization of the therapist, and if they have frustration towards a therapist, they usually turn that towards themselves. Yeah, they're not, right, the typical manifestation in therapy is they're not doing it right, they're not being a good enough patient, they're doing something wrong in therapy.

And you often see it in therapy in a very direct form. The therapist makes a mistake, which is inevitable. We all make mistakes every day. There's not such thing as a therapy session without a mistake, I don't think. And typically the patient either glosses over it, rushes past it so that the therapist shouldn't feel bad about it. Or the patient actively takes responsibility for it. It's not your mistake. I didn't explain it, right.

I gave you the wrong impression. I wasn't forthcoming enough. I didn't tell you all the information. It's on me as a patient, not on you. But they don't do it, right, because they're higher functioning and the healthier, the neurotic level of functioning. It's not idealization in the sort of icky way that you would see in narcissistic or borderline functioning.

right? It's generally in a very engaging and appealing sort of way. Yeah. So we have a role play. I love it. I have a character. I've been working on this all week. Maybe I've been working on this for years. I don't know. But okay. So I was thinking maybe this is like early on in the therapy. and so we could just start it up, okay? Okay. I'm going to try to get into person here. I like how you said you have to embody something that's real

when we were talking about this, because at first I was thinking about doing Abraham Lincoln and having Shedler do some therapy for Abraham Lincoln. Because I think he did have real depression episodes, but I think he had like a depressive personality. I really think you did. No, no. I've been reading some biography on him.

Okay, but I will not be Abraham Lincoln. I will be... And the reason for this is that when we treat patients of our own, or we draw on our own immediate personal experience, if you have a patient in mind, we form identifications with the patient. We unconsciously identify with the patient. In a way, even if...

even if the patient never says the specific words that come out in the role play, there's a way we can speak from within that person. And it's not, it's not a conscious, planful process. We just, if we're, you know, if we're a dedicated therapist, there's a way we just take in our patients and try to understand the works, not even understand, experience them from the inside out, rather than just as an observer from the outside, outside looking in. Anyway.

Okay. So, here we go. You know, Dr. Shedler, I wanted to reach out to you, but, you know, I know you were on vacation. I felt bad wanting to reach out to you, wanting to disturb your vacation, so I didn't. But I feel, you know, like I had this email. I started to write it.

and um but i felt kind of um guilty for uh you know kind of interrupting well i don't know if you were on vacation if you were lecturing but anyways my my father passed away this last week and um it brought up a mixture of things for me

well i mean i'm hearing two things I'm tempted to ask you to tell me about what it brought up for you. But, you know, I'm also hearing this happen earlier while I was away. And it sounds like you were feeling bad about wanting to get in touch with me. Yeah. And, you know, as a therapist myself, you know, when I'm on vacation,

it's like I appreciate being on vacation. So I think I was just kind of leaning into that a little bit. And then, you know, I've had patients who reach out during vacation. And, you know, sometimes you got to talk to them and stuff. But I know, I just, anyways, it's heavy. Mostly for my father, it's weird. Everyone wants me to feel sadness. Everyone wants, it's like, oh, you must feel so sad.

You know, we've even had a funeral. It's pretty short. but more, you know, and I would like kind of, oh, yeah, yeah, I feel sad, and I would kind of tell them that. But really what I felt was guilt that I didn't feel sad. And I felt more like I should feel sad, but I don't feel as sad. So. Just stepping out of the role play for a second. How long have we been in treatment?

How well do I know this patient? Let's say this is like third or fourth session. Oh, it's very early on. Very early on. Oh, I don't know. I don't have a lot of history. So you can ask the history. Okay.

Yeah. Okay, so that's all I needed to know. So when we jump back in, I gather you must have had a complicated relationship with your father. Yeah, and I know the first couple sessions when we were meeting, it was mostly about patient issues. And it's kind of, you know, it's like in my mind, I don't know why I go there, but I almost don't want to burden you with a story of my father, which I know you've consciously in my mind. I know you've been doing this a while. But something in you feels like it would be a burden to me to hear about it, to listen to you.

Yeah. Yeah. So, you know, my father, maybe I'll just start. You know, he left our family at around sixth grade. He's kind of in and out of our life afterwards. he was he had probably true bipolar you know i didn't i didn't know that back then but i know that now undiagnosed bipolar then i imagine you know i think for the first decade of my life he probably drank himself out of any mania um but then he developed chronic pancreatitis and he couldn't drink

or he'd get acute of pancreatitis end up in the hospital so So inevitably, he became sober, and when he was sober, he was very miserable. And so he... Miserable meaning how so? Well, he was always angry, even when he was an alcoholic. But when he was sober, he would kind of go between what I would consider like. up, out, you know, having sexual flings, men and women. He would, and then I would go to my grandma's house every other weekend and he would be there.

And he would just really stay in his room. When you say he was miserable, I'm understanding that to mean he was miserable to me. he was miserable to you. Maybe miserable to the whole family, but he was miserable to you. He treated you. I'm gathering in ways that made you feel miserable. Yeah.

He would call me, he would call me his little bastard. He met my mom during a fling. I don't think he really wanted me. Mom didn't abort me. He would remind you. me of that. You think he wished that she had aborted you? I think he felt trapped and sometimes I feel

responsible for his unhappiness. I know as a therapist now, I know I probably shouldn't feel that way, but it feels really true. He blamed me for that. He blamed you for... He blamed you for his difficulties or his instability. Well, his difficulty was this, you know, my mom, which I can get to later, but yeah, so, I mean, there were memories of, like, just him yelling

at you, at me, spit-flying, his face close to mine, you know, hard to predict. Was there physical abuse also? Uh, yeah, yeah, there was, yeah. I mean, punishment, uh, just punishment that was random. It was chaotic. It was not, it was not like I did anything bad, I, per se, um, or maybe I did, but. Could you give me a, for instance, just whatever comes to mind just now? Um, so I can get a better idea when you say there was punishment. So I didn't get an idea of what you're just, what you mean. I, he would come home, had I had been home for days, and he would be in a tirade, and he would just nonstop be ranting about how unclean the house was.

And it's not as if I didn't try to clean the house, you know? I think this was around when I was like, Nine? There's your responsibility when you were nine or ten to clean the whole house? Well, and I'll, you know, my mother was at that point so heavy that she couldn't get out of the couch very easily. And so she, and I hate even talking about it in that way, but the reality was she was pretty physically weak. I mean, compared to, so she couldn't, she couldn't really get up. And so.

I'm assuming if she was too heavy or too weak to take care of, to take care of the household, assuming she wasn't really able to take very good care of you either. Yeah, and this is, I mean, I hate to even get into this. But we would live in squalor. I mean, it was, it was outright poverty. We'd move every month. I think when I just turned 40, and I just realized, like, I've lived in 39 houses, so I officially passed the number of houses that I've lived in.

It sounds awful. Yeah, and I think, you know, I worked since I was 12, so I would go to school, I'd work. do sports, go to work, come home at 11. Mom would talk to me from 11 to 1 a.m. Yeah, I'm sorry, go ahead. About her issues, things that have come up in the day, you know. About her issues, her worries, her problems, what was things that were bothering her?

Her anxieties, the weight that she carried. So, I mean, you're like nine or ten years old. It sounds like, well, you're a therapist too. It sounds, I'm sure you know the concept. It sounds like you were, you know, became responsible for taking care of your mother like you were her, like you were her parent rather than vice versa. She had a lot of reasons. She had a lot of anxieties, you know, and I think it, it, it, she needed someone to talk to.

And so, um, so let me make an aside for the listeners because, right, I haven't really done much by way of intervening yet. I'm still getting the lay of the land, the psychological lay of the land for, for you,

for this patient, but I'm about to, this is going to be my first, you know, actual intervention. Um, so I'm just, I'm just sort of flagging this.

I'm, you know, I'm about to do something that follows from an understanding of the personality dynamics that I see. emerging. So jumping back in, you know, I can't help but notice. I commented about your experience, you know, the burden of being in the role of having to take care of your mother. And your response was about your mother. Yeah. And I think, I think you got to understand, like, how hard it, I mean, how difficult her life was, you know, and, um,

and she would tell me about how difficult it was. And she would tell me about it would be men that would come and stay with us for a couple weeks at a time. And I would hear them, you know, at first, nice noises, giggling sometimes. You mean men that she was involved with? Yeah. Yeah. Lamentically or sexually. Oh, you could hear it.

You could hear it through the holes in the walls. Yeah. So this was happening right under your nose, in your house. Oh, yeah. Your father's out running around with other women, I guess, is how I understood what you said. Your mother's bringing other men into the home. And, you know, there's something that doesn't quite head up for me.

You know, she's overweight and, you know, too heavy or too depleted to take care of you. And yet it sounds like she has energy to bring in, you know, not just one man, you know, that she's right, but it's like a regular thing with different men. Yeah, and she would, you know, she would meet these men online. They would travel sometimes from cities away, live for a couple weeks. I mean, these were not like, these are not like my teachers, my coaches who I looked up to. These were men that I hate it or just disliked. So who was taking care of you?

It doesn't sound like your father was doing much of that. It doesn't sound like your mother was doing much of that. Was there somebody in your life who was there for you and there to take care of you? You know, I think I kind of figured it out how to take care of things. I felt a lot of responsibility. You mean, you mean, you have. had you with a person taking care of you. And it sounds like, you know, in important ways,

trying to take care of your mother and trying to take care of your father, too. I mean, I think at around that time, like, oh, see, I feel like I'm, like, really giving you too much here. What do you mean? What do you mean giving me too much? Well, I mean, I've, you know, I mean, it feels like, I'm burdening you too much. I feel like this is going to be too heavy for you.

It's going to be like a lot. I just can't, just as an aside, this is very fast. I mean, if this were real therapy, this would likely unfold over, you know,

more sessions. But I want to be able to, you know, I want to be able to illustrate working with something here. So, if this were, real life, this would be pretty abrupt.

But, you know, I wonder if something is going on here between us that is similar, or a continuation of what you're describing growing up with your parents. Because, I mean, your mother was supposed to be taking care of you, you know, taking care of your... your needs physically, emotionally. She would burden you with her problems, her anxiety, she'd keep you up until 11. And I get the sense that it felt like your role was to not burden them,

right, not protect them from having to deal with your needs, your feelings. your distress, little kid, having to fend for yourself. You were sort of protecting them from your needs. And I wonder if there's something like that that is continuing here with us when you say, you don't want to burden me or it's too much for me. Yeah, and I may have misspoke to earlier. She would keep, I would get home from work at 11.

I mean, this was like in high school, junior high high school, and then I would be listening to 1 a.m. I may have misspoke, so I apologize for that. Well, there it is again, actually. You assume that you misspoke rather than that I misheard or misunderstood. Well, I think you're, if you think that you're like my parents at all, like, that's not the case. I mean, you remind me more of I had a really good basketball coach.

the best basketball player. Well, yeah. I mean, the ways that I might be like or not like them, I mean, that's something else for us to talk about. But just at the moment, I mean, what I was really getting at, it wasn't so much whether I'm, you know, like them in reality or not. But I was noticing, you know, your impulse to want to protect me

or your feeling that, you know, what you were telling me, it was too much, too much of a burden. It brings me back to where we started, which is your father just passed away. I mean, you must have very complicated feelings about it, to say the least. And, you know, you felt like reaching out to me was the same thing you shouldn't burden me.

I was off. Maybe I was on vacation. Maybe I was teaching, whatever. but you know, you shouldn't ask for that from me. And I wonder if it's of a peace with you, you start to tell me about how difficult things were for you growing up, how alone and uncared for you were. And, you know, your thoughts go to, it's too much for me.

you shouldn't burden me with this. Yeah. Like therapist only want, you know, like happy patients who are, you know, feeling good about things and don't have any actual difficulties to bring into therapy. Yeah, and I think that, I think that, I guess I'm getting confused.

It's like I know logically, I should not feel like I'm burdening you. Well, you know. And yeah, I feel like almost critical of myself that I'm like, I feel almost critical of myself that I'm like feeling that way. But then I can also see how like deeply that. resonates with so many things in my life. So it brings up, I take it, it's bringing up more for you. Yeah.

Well, like I talked to in the first couple sessions, like it's like whenever my patients are doing well, I feel like they're, I don't feel much. I don't feel much. I feel like that's like, okay, that's expected. they're paying me, but when they don't do well, it's like I really, really ruminate. When they're doing well, it doesn't speak to your credit. It's hard for you to feel good about it or feel like, you know, this is something that you

help to accomplish, but when they're not doing well or when they're feeling bad, it's your fault. Yeah, yeah. And so I've been thinking about that as kind of like a theme of our first. couple sessions and I've been thinking about like, hmm, maybe there's some deeper reasons for that. So I'm like, with my dad's death, I feel like maybe this is a good time to look at those deeper things and I think it's coming out. Yeah, I'm aware. Okay, so I may have some transference as well towards you. Now, I'm not like, as like, you know, articulate as you are about these kind of thing.

But yeah, I can see it happening right now consciously, like in my mind. Like I'm like, oh, I'm like feeling guilty about multiple things in life. You mean just here, just now between us? Are you referring to other things also? Yeah, I'm feeling like guilty and here and now, like, and just sharing this, which is, kind of how I felt growing up as well and how I feel with my patience. So there's like, I'm seeing that overlap.

You were even feeling guilty about not your reaction to sharing about your father's death. Like guilty that you weren't sad enough or weren't reacting the way you think you should have. I think most of the people who are close to me don't really know much about my childhood. I've kind of kept that in a separate container

because, you know, things are so different now. I think most people, most of my friends, they came from good backgrounds. They wouldn't relate to the squalor, the decan wood, the holes in the wall, the cockroaches on the ground, the, you know, duct tape. So I think most of them expected me to feel sad when he passed.

And so most of them would, like, get sad for me. And I would, I think there was a part of you that kind of felt relieved. Yeah. I could imagine. I was, you got there first, but I was about to say, maybe you don't feel sad. Yeah. He would come visit and he wouldn't really interact that much.

It was kind of hard to have a conversation with him. So, I imagine there's a lot of feelings in the mix. You said there are complicated feelings, but among the mix of feelings, I imagine there's a part of you that must be glad to be rid of him. Therefore, the relief. I would feel glad to be rid of him. I don't know if I'm there yet.

I mean, I do feel some relief. Maybe I jumped the gun. Tell me more about the feeling of relief. I jumped the gun and put words in your mouth that don't fit. Yeah, well, thank you for, thank you for that, yeah, letting me have the space to kind of get in touch with what I feel um i i think i think it's like um okay so i haven't told you this about him yet but he would call me and like i would get these calls he would be gone for weeks i would get these calls from

him he probably a pay phone or and then he would be telling me on the the phone and um you know now it's kind of like i think back was he on drugs back then i didn't know of course you know because I'm young. And he would say things like, I'm going to kill myself. And he would keep me on the phone for, you know, and I wouldn't say things even back then. Like I wouldn't say, oh, you're the best dad ever. But I would say, dad, please don't kill yourself. Dad, please don't kill yourself. And so, yeah, there's a weightiness with those memories. What I'm hearing. What I'm hearing. is how you ended up being the emotional caretaker for two parents. You know, like you were trying to be a little kid and trying to be a therapist to both of them

at the same time. Yeah, of course, you know, back then it's like you never have the right words to say to make them feel better. And so... It was your job to make them feel better. Well, what I'm saying is, like, as much as I tried, I don't feel like I ever really was able to do that, you know? Yeah, I guess I'm wanting to highlight something that I think was implicit in what you said, right? You, you know, you tried, and you never could succeed or never could succeed enough, but implicit in that was, it just seemed very natural.

and normal that, you know, it was your job to make them feel better, right? And now you're going on telling you while you failed at the job, you didn't, you know, you never could quite accomplish it or, you know, but, I mean, it seems like in the background, it's like the default is, you know, of course it's your job to make them feel better. Yeah, and, um, and now I do that for my, my, you know, my work. And yeah, I think the patience that I'm not good at doing it with

gets to me. But so when the patients don't get better, they're like, you know, your mother or your father or both that you could just never do enough for. You could never succeed and make them feel better. Yeah. I guess I never seen, I guess I should, should have seen it like that, but I've never seen it like that. But that's a, yeah, it's kind of like that. For purposes of the role play, suppose we skipped ahead about 10 sessions and your father's death is still in the air.

How do you feel it's going so well? I think you're doing an extraordinarily good job, maybe a little bit over the top in terms of the history, but an extraordinarily good job of inhabiting a certain kind of depressive person. And what I'm thinking, and I didn't say during the role play, but it's going on, let you and the listeners into what's going on in the back of my mind. So here's a personality dominated by guilt,

dominated by a sense that they're falling short, or something about them is bad. It isn't good enough. Somebody who had that kind of depriving childhood would feel, This is a combination of what we call anaclytic and interjective depression. There's two different things going on. One is the absence, the loss of a real caretaker that every child needs. And that loss, that stays with us, right?

This is a, you know, it gives rise to an emptiness within. That's a hallmark of a particular kind of depressive personality. You feel depleted and empty, and you try to fill that hole by bringing other people into your life and by connecting with other people, except it doesn't quite fill it. And the connections are kind of a one-way street, not because the other person is necessarily requiring that it's a one-way street. Because the patient is making it a one-way street. It's about what can they do for the other person, right, rather than what can they get taken that's meaningful to them? So that would be kind of an anachlytic, what we call anaclytic depressive style, where the person is very sensitive to loss and relational disruptions. But that's half of it.

The other half that we didn't get to in this role play, which is why I was thinking of skipping ahead some sessions. is somebody mistreated like that. Somebody berated, yelled at your father, the way you were describing. I mean, it'd be less than fully human to not feel angry, resentful, deprived, you know, enraged about that. It's not just that you feel like, you know,

the other person, not just the other person, you know, the people that you're supposed to relate, lie on to take care of you. It's not that they just didn't do right by you, and it's not that you feel they didn't care for you well enough. They didn't care for you well enough in this particular,

this particular history that you're giving me. Of course, of course there'd be anger and resentment. I think we just heard just a whisper of that when your patient said, well, I felt relief when he died. And, of course, behind that word, the relief is a whole universe, right? If you're relieved from something, that means that there was something that you were experiencing as, you know, a burden or, you know, as burdensome or oppressive or distasteful or, you know, ear-relieved from something bad that you don't want.

It just, it just hinted at that. With the patient, and here's where you did such a good job of being this kind of patient, right, the patient's also very defended against their aggression. And this is the interjective version of depression. They have a kind of an impossible internal dilemma, and the dilemma is they are angry, but it's not okay to feel or express the anger. So when in its extreme form what this looks like in life is that the person ends up becoming a kind of a dormant in other relationships,

not necessarily because they're surrounded by people who want to take advantage of them, but because they can't tap into, it's a constructive aggression to, you know, assert, express their needs, their wants. And so they go without. Yeah. And this is where, like, Kernberg's thought,

which was so interesting, which I thought I would kind of pull in here, where he said, when asked him, what was the main thing therapists need to learn? Yes. And he said, is to get in touch with their own aggression. Yes. And so, and I was thinking, like,

Okay, so I was asking him about depression, personality style. Like, how does that show up? Is that the most common thing? He answers with that question, which is kind of the answer to this person. It's like, where is this person's aggression? Yeah, so that raises another issue. Let's definitely make sure we get to talk about this. I mean, people gravitate toward roles in life that, you know,

that are consistent with their personality organization and there are enduring psychological themes and conflicts and defenses. Anyway, that said, depressive personality style is the most prevalent personality style among people in the mental health professions. And we'll talk about why. Let's stay with your patient for just a moment, and then we can expand to how this plays out in the profession. So the person is in a really impossible dilemma, which is they are angry, but it's really

not okay to feel it, let alone express it. And, you know, well, what becomes of it? Where does it go? Right? Because the one thing we understand psychologically is, you know, out of sight, out of mind doesn't mean gone. It's still there. It's still having its impact. And you actually, you know, did a beautiful job illustrating it. If you're angry with someone, if you really don't like someone and you're angry and you want to punish them, you know, what do you do? You do? do. You treat them really badly. You blame them. You scold them. You shame them for your failings. You find fault with them constantly. You're depriving. You don't want them to have a good time. If something bad is happening, you want to rub it in, right? Basically, you know, if you're really angry with someone and

you act on it, you treat the person like shit, right? Hopefully most of us have the capacity, at least professionally, to feel angry, to be aware of the internal experience and not have to act on it. If you were really angry at someone and acted on it, it would do that. What we see in this, what's called, infrajective version of depression

is the person is treating somebody, the person with depressive style is treating someone like shit, but it's themselves. And that's where you see the self-criticism, the self-deprivation, the self-punitiveness, which is empirically the hallmark of this personality style.

So it comes up immediately in our roleplay in a very small way. It's not present impalpable enough yet to work with in the session, so I let it go by. But you wanted to call me when you heard your father died. The reality is, for whatever reason, I wasn't there for you. I took that period off. That wasn't your doing. I wasn't available to you.

And, you know, I could easily imagine, it's not a capital offense. It's a small offense, a misdemeanor maybe. But, you know, anyway, I could imagine why a patient in that position would feel, you know, upset with me, you know, disappointed or irritated. Why am I not available?

Right? And then your impulses you wanted to reach out to me, email me, like, oh, no, you shouldn't do that. Right. So what happened immediately was the thought, you know, I wasn't doing right by you, transformed into, oh, you can't, you can't, you know, contact me. You wouldn't be doing right by me.

And that's a very, very small instance of, you know, that kind of criticism or punitiveness directed at the self, right? So if we put it, just sort of cast it in high relief, you know, I'm doing something, not that I'm a bad person, but I'm doing something bad to you by virtue of not being available. And in your mind, it turns into somehow you're doing something bad to me. And there's the reversal. Yeah. And it takes a lot of doing in therapy. I was thinking about this before the role plays. It's very hard to illustrate because it doesn't happen in a single, you know, compressed segment.

But I was thinking, man, we could, we could stretch this out for hours, right? Yeah, that's why I thought it might be good to jump forward to some session. Yeah. But the issue is that the therapist is going to have all kinds of failings, not necessarily intentionally, perfectly reasonable things. Actually, I've had interact and think of a very specific patient. I've had interactions like this with patients, the most recent one being someone who's also a psychologist,

a very good psychologist, by the way. And I'm not there when she needs me, expects me. And she feels bad about wanting something from me. And we had this discussion that was like, I got something wrong. I misunderstood something. And I fell short in some way. That was the reality.

It was actually my failing. A small one, lowercase F. And she immediately took responsibility for it, like you did in their own play. I didn't explain it right. I didn't say it right. Yeah. And by the way, I did that.

purpose because that's I did that on purpose so there's a lot of there's I've been thinking about this case a lot and a lot of it actually is very true and it's not it's not a patient um it's not myself but it's a very close it's been a close person to me that I know their story very well so I think what I'm talking about it and if you felt as a listener that I was embodying it accurately it's because I really care about this person that went through this and that's right that's why so important that there's a person behind it. You know, I realize I'm thinking with my patient, I'm trying to also protect her confidentiality.

Absolutely, yeah. So let me just make up a kind of an equivalent example. And I'll say for the record, I got permission from my person. So let's say I missed a session or I was late for a session. Or actually, I'll choose the example that you gave. I was away. I had something else scheduled, and I canceled the appointment in advance. A good example.

And I wasn't there for her when she wanted to reach out. And when she starts very much like you did, well, I really wanted to reach out to you, but you were away. I didn't want to bother you. And I said, you know, it must have felt. It felt pretty shitty, but, you know, I wasn't there when you, you know, otherwise, you know, otherwise, you know, count on me to be there. Oh, well, I know you have your own life and, you know, you were doing some important thing

and you were teaching and, you know, and I understand. And, you know, of course you didn't, you know, of course you didn't do it deliberately, you know, so that, you know, you didn't do it deliberately to, you know, not be there for me. Like, I understand. and, you know, the same thing happened with me and my patience. And, you know, everything you said, I said to her, you know, everything you said is true. I did have a prior commitment. You know, I did let you know well in advance, right?

Right. I was, you know, just taking care of other business, right? It wasn't meant to harm you or to. All of that is true. Yes, I objectively had something else that I had to attend to. what does that have to do with how it might feel on your end when I wasn't there? All of that is like your conscious, logical, rational mind telling me about external reality. Of course, there's very, very good reason.

You wouldn't just not show up for a session, you know, just for the hell of it or because you didn't feel like I know you wouldn't do that. You had to have a good reason. Yes, I did. But who says your reactions to that? you know, or like only what's logical and rational and reasonable, maybe there's some other parts of you in the mix that, you know, it's harder to hear from, harder for both of us to hear from.

So, I didn't even bring up anger yet. Ray, just, you know, you're giving me a very reality-based, rational explanation for why, of course, it made sense that I would be away, and she shouldn't have a reaction to that. but that doesn't subsume, right, the full range of our experience. We have lots of reactions that are so logical. And so what I'm doing is, in working with somebody like this, the aggression, anger and aggression is not going to come out naturally, right?

And we really have to very actively go out of our way to invite it in. Yeah. For an example I use in my chapter that, you know, I think you read was the third. is late. And the patient says, oh, you know, I understand, you know, if you were running late, it happens, you know, no worries. Oh, I think it even came up in our last roleplay that one last time I was on your podcast. And, you know, nine out of ten times as a therapist is like, you know, the patient's letting them off the hook and, you know, let's get on to the real work. That is the real work. The fact that the patient is so ready to let them off the hook and not bring in any

other feelings, except, you know, their positive feelings. That's the, you know, the action. That's where the work takes place. Maybe let's, can we go back into the role play and, and it could be a couple sessions later. It could be the same session. But maybe, yeah, I'd be curious to kind of play that out around the theme of the difficulty of reaching out. But yeah, let's go into another session and I'll bring up kind of another moment between us, like another, and we'll see how you deal with it. Okay. You ready? And just to make it crystal clear, This is the essence of depressive personality and the essence of the problem, the challenge that we're trying to address in therapy, that the person is not getting their needs met in life. But the person who's obstructing getting their needs met is themselves.

It's very, very difficult to get what you need, what you want. if you know, you can't allow yourself to know it, to know what you want, right? This is the essence of the problem. The patient in therapy isn't getting their needs met for, you know, good reasons or bad reasons, realistic reasons are anyway, whatever. We don't hear about their disappointment, their frustration, their resentment, their irritation. We don't hear about it. We, like, we have to actively pursue that.

Yeah. Okay. Yeah. Okay, here we go. You know, I had a dream between sessions. Maybe I'll start out telling you that, would that be okay? I don't remember a lot about it. But I was, I remember I was in this church. It was kind of, I felt like it was almost falling apart, like an old church. Like it was kind of like a ruins of a church. And I go into a confessional. I start talking and then I realize that you're on the other side. And I feel like, you know, maybe watching some of your X stuff, your posts kind of triggered that from the night before. I remember reading a couple of them about the frame, about the importance of keeping the frame. And I was like, so I went to bed.

bed and I had that dream. Could you connect the dots for me? What about my post about the therapy frame? Do you think what about that, do you think, led to the dream?

You know, I, and I think in session, I've never felt like you've been critical of me. But I think there's something about, when I read some of the posts, I feel a sense of like, gosh, like, you mean, since you're a therapist, too, since I'm a therapist.

You're not doing it, right? Yeah. Like, you hear my, you know, my posts about general, you know, general issues in psychology and therapy is just a criticism. Yeah, like, I almost like need to go into a confessional and just kind of. Confess, repent your sins. repent my sins yeah

so so yeah that's what I'm coming in with a little bit this week and then I know we've been kind of talking about getting in touch with my frustration, anger and I had one memory that came back to me

which actually felt like a tinge of frustration I was, I think it was about 14 or 15, and I was getting something from the back of the car, from my mom's car. And I got really close to stabbing myself with a needle. And I'm like, Mom, why is there a needle in the back of the car? And she said, oh, I needed the needle for, um, you know, something medical that she was going through. I mean like a pipe a derby, a syringe? It was a syringe, yeah.

I was picturing her selling needle for a moment. Oh, it was a sewing needle, yeah. No, you know, so she had picked up HIV at this point. And so when I remembered this, I remembered at the time, I had felt immediately like awful that she had HIV, and that she had had to deal with that. But in the, when it came to me the other day, like I got tight in my chest

and I was, because I was hanging out with my niece who's about that same age that I was. And I was like, I can't imagine putting them in potential harm's way to get HIV. and somehow that hit me for the first time. And that she was in dangering you. Yeah, yeah. I mean, I could have gotten, I could have poked myself.

Like, I was so close to poking myself, you know. You said at the time that you felt, when did you say that you, not now looking back, but you said at the time you felt guilty or? Oh, I just remember feeling at the time. Like, I just was really upset that she had to have HIV in the first place. You were feeling bad for her. Bad for her, yeah. That eclipsed, I guess, other feelings that were there,

which was that she was putting you in harm's way. Yeah, and somehow, like, it didn't really occur to me. I mean, I think it occurred to me. She's putting me at harm's way at the time, But it didn't occur to me until I had my niece, which was like my age at the time, hanging out with her. You had connected those dots until the memory came back and I was like, oh, like what? What was she, like, why?

Why did she like, why was she so careless about my life to not clean up after herself when she knew she had HIV? She was putting your life in danger. And like, as I say that right now, I feel like in some way I'm betraying her, which is a weird feeling. But I feel also like she was kind of betraying me. I mean, it's like I don't, like, part of me is like doesn't want to believe that she would be so careless. But then the other part is like she was so careless. It gets a little confusing about who is betraying whom.

Yeah. We, aside for the audience here, so there's a kind of a clinical dilemma there, right, that I'm working through in my mind, which is it would be very easy to go into, go deeper into this experience about, you know, the syringe and the meanings and everything connected to that, right? And it would likely be rich and, you know, constructive area to work. but the transference takes precedence. This is on the heels of he had a dream that he recognizes is about me. This is followed by this branch. So I got, okay, so let's enter back in, okay, because I got something for this.

So I'll take responsibility for that, right? You're embodying the role. It's up to you to fix it, but actually if I'm a therapist and we're doing this roleplay, it's up to me to fix it. that we got away from the dream. Well, okay.

Yeah, and patients do that, right? So that's like, it could be, I could be. So there's my, and the clinical dilemma is this is really filled with feeling. And there's two competing therapy principles here. And one of them is we really want to follow the affect and stay with what's emotionally meaningful, emotionally charged for the patient. But the other principle is we want to track the transference. especially the negative transference,

and especially with somebody with a depressive personality style, where it's so hard to see and so hard to get a hold of in the treatment. So I'm doing to balance those two considerations. You could make an argument for going either way, but I think the transference is important. So let me, we'll pick up the role, but I'll jump in. Yeah. You know, so we just left off with, you know,

it's kind of hard to track, Who's betraying who? You know, this experience around the syringe and HIV, it's really important. It's a big deal, a mother with HIV, especially because of her own recklessness, I guess. But I do want to come back to that, but it's on the heels of remembering

this dream that had something to do with me. Feeling criticized by seeing one of my posts on social media. I wonder if you could help me connect the dots. They must have something to do with each other. You know, it's so interesting. I hadn't had this thought, you know, and you always say, just share whatever comes to your mind, like if it comes all of a sudden, right?

Yeah. And so I had this thought that I think connects the two. There's a verse in the Bible. And it says, if you hate your brother, you commit murder. And I've always, it's always been like a part of my ethic to not hate anyone, you know. And so I think after I had that thought about my mother, that was the same day that the dream came after. And I thought, like, I'm going to tell you about this

because I had some frustration towards my mother, but then I think for some reason that sort of thought process comes through my mind, that it's something bad, you know, to have any anger or like hatred or. I'm not saying I hated her, of course, I'm just, for some reason, that thought comes to my mind. Or it comes to mind in connection with me. Yeah, because in the confessional, I would be confessing that I murdered my mother with my hatred.

That's the connection I'm drawing. Maybe I misunderstood. I thought the confessional was, your thoughts about the confessional was about, you heard my social media post as a skull. You're not doing it right. you're not maintaining the therapy properly. That was your sin. That was your original sin before.

That's what I thought. That's what I thought. But in session right now, and I hadn't planned this, I hadn't thought about the connection, but the connection was, it's like that niece incident, the memory that was the day too.

So I'm thinking that maybe the confessional, and I had thought at the time, I'm going to talk to Shethler about this incident because the new memory with my mom, mom and the HIV syringe, you know, and just thinking about being upset for my niece. Like, oh, my gosh, like, how could anyone have harmed my niece? You know, like, that... It's easier to be angry on your niece's behalf than on your own.

Yeah. But your niece wasn't the one being harmed and having, you know, who could have jabbed herself with a, you know, HIV positive needle. It was you. It was easier to feel, it was easier to be upset on her behalf. And just so we don't lose this, because I feel like it keeps slipping away,

and maybe we both have a role in it slipping away, that the starting point from this was you feeling scolded by something I posted on social media, or, you know, feeling you were being told you were bad. And it's in the context of, you know, actually, you know, you're the one who's been wronged, who feels wronged. You know, I think there may be more to this than meets the eye that, you know, that social media post really didn't sit very well with you. Yeah, and I think, well, and I feel bad even for snooping on social media. in between sessions, you know, I feel like I'm complicating the work here.

I feel like I should be... I'm sorry, I'm like... Another transgression on your part. Oh, I know, I know, and I feel bad that, like, I'm like... Now I'm recognizing that I'm like double transgressing myself with this. No, I'm not saying that you... I'm not saying it's a transgression. I'm saying that you're treating it.

You're talking about it as if it's a transgression. Well, it's a transgression that my post didn't sit very well with you. It's a transgression that you were even looking at my social media. And I think there's part of me that sometimes, and I know I shouldn't feel this way, but sometimes I feel like I'm going to tell you something and you're going to get really angry at me. Like really angry. Like I feel like it's like it's coming. I guess we'll have to see.

Oh, see, there's like part of me that thinks that that, I don't know, I think it could be, like there's got to be something that I could tell you that, or I don't know, just imagine. Maybe I'm imagining incorrectly, but. Okay, I'm like, I'm sorry I'm confused about. What happened just here, right? Just at the moment when, you know, you said you feel like I could get angry, I could blow up, you at any moment. I haven't yet, but, you know, right? The next, I don't know what, like, you know, the next one is going to be the straw that breaks the camel's back and then erupt at you.

And I said, well, we'll have to see. Something just happened. I'm not sure. I'm not sure what was coming up in you at just that moment. I feel like me sharing that would make you upset. Like, I'm blaming you. you for something that you haven't done. I'm accusing you. You're worried that I would get angry, that I would derate you or explode at you. Sharing that is...

That feels dangerous to me. Is what? It feels dangerous. I wouldn't want to hear your thoughts and feelings about me. Um... Hmm. It feels like maybe I'm blaming you for accusing you of something. Well, that's a possibility.

It might be worried or expecting something that isn't really so much about me. It's also possible you're picking up on something about me. something about me in the background that we haven't talked about explicitly. Maybe there is something you're picking up on. Are you secretively angry at me between sessions? I'm leaving it open because we're talking about your experience of me. And you seem to have the idea that it wouldn't be all right.

with me to tell me about things I do or fail to do that disappoint you or upsetting or make you feel bad about yourself or make you feel like I'm like secretly angry and I could explode at any moment. I think that, see if I answered your question, I think, and you know, I think it kind of steers us into a dead end and that it forecloses the opportunity to find out more about what's going on in your mind and in your experience. And I feel crazy even saying these things out loud because I know that you're professional and you're, you know, you're an expert. I'm sure you don't dislike your patience and I have no evidence to support that. And I also realize, like, Like, there's a, well, I may be laying this on too thick, you know,

and I may be laying on too much of my own worries. I get the sense that you're working so very hard to be, you know, very reasonable and very fair. And what if you weren't so reasonable and fair with me? I think like if I wasn't reasonable and fair I think you would find some other patient to fill my slot or something you know you think I'd want to be rid of you

yeah what an awful feeling that would be to feel like you know the person even the person that you come to for help doesn't want to deal with you. I think it's just really weird to be in this role where I'm the one talking. Like I'm so, like, all day long,

I listen to my patients, listen to my family. Well, I think that's a very comfortable, we both know. We've talked about this. It's a very comfortable and familiar role. You were training from it for that role since early childhood.

What I'm starting to understand, you know, in a different way, now is there's something about being here with me as a patient that's very fraught for you. That you didn't say this in my words, not yours, so if I'm not getting it right, I hope you'll correct me, but that there's a, it seems to me like there's a way you're sort of walking on eggshells here, that at any moment, you know, I might explode at you or punish you or or throw you out of treatment entirely. And I know it's not, hasn't been in the forefront of your mind.

It's not like you're, you know, editing and censoring, you know, curating your thoughts as, you know, every moment to, you know, be careful not to, you know, not to offend me or not to say the wrong thing. But it seems like that's been with us in the background. Yeah, and I think for most, I think that that this is different. Because, you know, I think with my, like, teachers, my coaches, that I got good things from. Of course,

I'd find that thing that they're interested in, you know, and read a couple books on it, become an, you know, be able to dialogue on the thing that they're into. And I think that- Your role is to be, you know, a very good student or athlete or, you know,

and be very appreciative. Yeah, and I don't want to come across, as unappreciative. I wouldn't like an unappreciative patient. See? I know there's a little tongue and cheek in there. Well, so, yeah, I think it's like I'm like really trying to get into this role, but I'm also realizing how hard it is to get into the role.

The role is one where you don't have to feel. like you're walking on eggshells or taking care of me or protecting me from my feelings? I think there is something like very hypervigilant about me when I was young to like be in that role with my dad, with my mom. Well, I mean, you know, the word is, I mean, it's technically the right word, of course, but I mean, there's something that's like pathologizing about, you know, your problem was you were hypervigilant, whereas in fact you were, you were doing what you had to do

to function and survive in that environment. It's not like you had a lot of choice. It's not like as a small child, you could have just picked a different family or replaced your parents. You didn't have any choice. You had to function as best you could with the parents you had.

Yeah, it's so interesting how my language pointed at me at all times. Yeah, almost like it was, you know, your failing or your pathology that you had to be vigilant in the way you were, the ways that you were, you know, rather than you were growing up with two angry, volatile, neglecting parents, you know, who could explode, certainly, or father, you know, at any moment, or just disappear and, you know, and leave you to fend for yourself for weeks on end, as they both did. And, right, and it's like there's, you know, the sort of two parts of you here, right? I mean, there's the adult, rational, mental health professional who thinks about things are very, you know, rational and, you know, and careful and accurate way.

But then in the background, it's like there's as part of you that's expecting the same treatment for me. And, you know, it feels like you have to be just as careful and just as cautious about, oh, you could say or do the wrong thing. And, you know, I wouldn't be here for you either. At best, I wouldn't be here for you either. At worst, I would actively attack you. I should say I would actively attack you too. Yeah, something about you commenting that, hypervigilant for me, it kind of puts it in my,

like something is bad with me, whereas like I was just trying, I was responding the best I could in that environment. And that was what was helpful at the time. And so I'm repeating that here. It was necessary to, I think they were doing the best you could to survive that. I guess the thing that I'm like, where I get confused is it brought me a lot of good things to be very good at reading people. Like my mentors, like I had this really, some good English teachers and stuff where I was like, for me, kind of getting onto their page, you know, it gave me really good things to be. able to read them and to be...

Yeah, I think you're 100% right, right? There's no question about it, right? It's kind of your superpower. But like all superpowers, it also comes with a huge cost, which is we're focused on what you think the other person needs and wants. And your needs and wants go in the back barrier. or don't get on any burner at all. Now, this was a place if we had started with the first session

and we had kind of been through the process of, why is the patient here, what is the purpose of our therapy, what are we trying to accomplish here together? We would have done all of this beforehand. This would be a place that I would refer back to that. You know, that's why you're here in therapy. I'm just making it out because we didn't have that conversation.

But, you know, by objective, you know, external criteria, you're doing pretty well in your life. You know, good practice. successful in your career, you know, married, wife, family, but things feel empty and, dark and sad and joyless on the inside, you know, that's why you're here. And I would, I mean, if that was the reason, there could be many, many reasons, if that was the reason, right, I'd want to make a very explicit link between what we're talking about now. This is the sort of a little micro-instance of, you know, this superpower.

I'm very, very good at accurately weeding and responding to other people. I don't want to take that away from him. Right. It's true. I mean, that's why a lot of people with this personality style are drawn into the therapy professions, right?

And, right, they have a kind of hypertrophied capacity for empathy, which can serve them very well, as a psychiatrist or as a therapist. But it can also come with that. a terrible price. So what I want to do at this point is link it specifically back and say, you know, here's your superpower. You're very, very good at

reading and responding to what other people need. But it comes at this terrible cost, right? That we don't, when I say we, I mean, both of us, we don't always get to hear from what you need

and want, right? What would make, what would make an interaction or life? you know, feel satisfying, meaningful, allow for pleasure and joy for you. So I'd link right now because they're flip sides to the same coin. There's the superpower

and, you know, and a real, you know, liability, not a liability that affects other people so much, but that gets in the way of you being able to live a, you know, a life that, you can enjoy. Whatever the, you know, whatever we agreed on is, you know,

this is what we're trying to do in therapy, which would have to do with, you know, why you came in the first place. What was your, you know, if you came therapy for, I would take advantage of this opportunity to make the link. You know, this is why we're here. Yeah. Yeah.

And I think, and I, I think when I hear, I should, it's interesting because I know that, I need to get in touch with my own feelings and desires. And I think that was one of our initial goals that kind of we identified. And also kind of, you know, why am I extending myself too much at work maybe? Yeah. But I think part of the conflict is I've always had the philosophy of serving others has intense value.

And to kind of like put. myself second or to diminish my own ego and the importance of it. You had the philosophy. You know, a lot of people find meaning, deep meaning in living their lives, in choosing to live their lives that way. That's an option. What I'm concerned about, I think what we're both concerned about, for you is it's not clear as of now how much that's really a choice versus something that happens

in an automatic obligatory way. Like for instance, you know, you saw a social media post of mine. You didn't like it. It felt critical. It makes you concerned about, you know, well, maybe you're not in the right hands after all. Maybe I could be... Oh, no, no, no, that's not what I was thinking. Well, no, I'm saying it. Okay, okay. But I like the post. It just was convicting that, like, I could... You know, I mean, I know, I came in talking about how I over-extend, and maybe I need to touch...

What I was getting at is, I'm not sure if it were so, that you were upset by the post, or it made you worried about me, right? I'm not sure it would have felt okay just to say so. In fact, I'm pretty sure if you felt not okay to say so. And right to respond to what you said about, your philosophy of how to live your life, when I say, you know, it's a valid choice. But for you, just hearing now,

I'm not sure how much choice there's been. And I think that's why you came to therapy in the first place. It's entirely different to say, you know, here's something I, you know, first thing I want for myself or something I desire. But, you know, there's other things that are more important to me that, you know, that preclude that. And I'm going to make a choice. And I know this is something I want, but I'm going to choose something else that's more important to me. That's different than not being able to want it in the first place.

When I hear this, what I think about is I think about a quote that I've memorized from Dostoevsky, I'm not worthy of happiness. My life is a serious of errors, and perhaps this misery is what I must endure to atone for them. I don't know why, but that resonated back in the day, like in college, and I memorized it. It's interesting because I feel like if I, like, did I reincarnate from like some awful person to go through what, you know, some of the suffering I've gone through. It resonated because in a very important way, I think it speaks to the story of your life. this was the family you were born into

your role was to suffer and bear the suffering for all of your parents' failings and, you know, to feel like that was your lot of what you deserved. Yeah, yeah, and so I think this is, it's like something is shifting there, and maybe that's, oh, you know what, that's kind of come back to the dream.

it feels like that that kind of ruinous building that I was in it feels like something is shifting. You know, like maybe maybe I can kind of look at things a little bit differently.

That makes me. Go ahead. Oh, and then when you said you, the ruinous building that you were in the dream, it seems like you just linked that, I was right on the hills of my, you know, just saying directly how ruinous your childhood was.

It sounds like you just connected those dots, that you were literally living in ruins and childhood, with holes in the walls, cockroaches, and hypodermic syringes and car seats, right? your childhood and your family was the ruins and in the dream the dream depicts you as oh here you are enduring this and but confessing your sense right oh yeah somehow it's i still am blaming myself in the midst of that like i'm like I'm like stepping back so I'm being a bad therapist

because I got kind of caught in the roles between talking to you and the readers and the role of being therapist and if it were therapy it really got a little too intellectualized and away from the immediate experience so not a very good model of doing therapy in this

that last which part which part I think you're being hard on yourself here part about I think it's really good the part of the philosophy right because it's really about, it got a little,

I got a little, explain. And a little, I thought so, yeah. Okay. Well, I think what I've realized is that as I reread this, you know, reread this stuff over and over again, I'm like, oh, people really adopt the philosophies based on their personality. People adopt a philosophy that solves their personality.

It solves their personality. Psychological conflict. Oh, yeah. Right? Your choice of career. your choice of partner, your choice of lifestyle is a compromise. And that's not to negate if the philosophy being true or not true, because it still could be true.

And it still could be a perfectly reasonable and valid and meaningful life choice. But we have to understand all life choices are overdetermined and reflect something of our own psychology. But what I think I appreciate what you said there is like, okay, even with this guy, he wouldn't want it to be unconscious. You would want him to have a choice if he's going to choose

to be sacrificial or if he's going to choose to maybe in touch with his aggression and have a boundary with his time. And this is ultimately the goal of psycho-dynamic or psychoanalytic therapy, and I would say of all good therapy that's aimed at self-understanding.

the goal is to expand freedom and choice so that things that were previously automatic or experienced as obligatory, no choices, become a matter of choice. That's the goal of the work to expand, you know, to expand freedom and life options. And the person might well, you know, in any given circumstance, make the decision to do whatever they would have done before. therapy, but now it's a decision. It's a decision made freely. And if I'm a little mindful of the times, I want to make sure we get this out, we haven't named it explicitly, but you and I are describing and working on the roleplay. This is really the essence of this depressive personality style that we're speaking about,

that typically, typically, a child growing up is deprived or mistreated in some way, neglected, in the most extreme case, maybe actively abused, more common cases, neglected, even more common cases, like if you were looking from the outside in, like a social worker, you know, this parents adequate, But maybe not neglected in any obvious, externally obvious way, but emotionally neglected. Yep. But the child's experiences, they're not getting what they need, right? Because the parents aren't coming through.

The parents are inadequate meeting the child's needs. But it's an incredibly, incredibly dangerous thought for a small child. A small child simply cannot think this, pretty damn rare. think, I have bad parents. My life and my well-being is in the hands of people I can't count on. Like, you know, this is not a thought, a three or a four-year-old to wrap their heads around. And, you know, the child's solution to this, you know, horrible, impossible dilemma is,

well, I'm getting mistreated. It must be my fault. It must be because I'm bad. And the parent, right, so, right, so the child concludes that they're bad instead of that the caretakers are bad, in a very paradoxical way. There's something hopeful in that for the child. It allows the child to sustain hope. As long as the reason is because they're bad and it's their fault,

then potentially it's under their control. They could become not bad, and then they'd have parents who love them and take care of them. So in the child thinking, it's my fault, it's because I'm bad. At least there's a spark of hope that, you know, my parents could be good enough parents, you know, after all, if only it wasn't for me, right? If the child thinks, you know, my well-big,

my survival is in the hands of people I can't count on, that's just devastating, right? So that's the essence of this personality style. Yeah. Yeah. And then it comes out, you know, a light year later, you know, in therapy and, you know, the therapist had to miss a week and isn't available when you're,

your father died for God's sakes, right? And your thought is, oh, I don't want to burden him. We could draw a line from that childhood experience. I'm not getting what I need, and it's because I am bad. We can draw a line, right? I shouldn't call my therapist. That would be a burden. Yeah.

So it's like the anger is turned into guilt. The transference is set up so that there's a gentle idealizing and anything bad from the therapist goes on to themselves? The criticism of the other is turned into self-criticism. So what starts out as this person, my therapist, isn't here for me when I need them, turns into, I'm too much, I'm asking too much, I'm too much of a burden, right?

Something wrong with me. Yep. Yeah, no, and I think it's like really helpful, I hope this episode is really helpful for people who are listening. needed. I think it's been helpful for me to study it and really think through it. I think the questions they might still have is like the how, right? They always ask the how, like, okay, so they've been witnessing the how, how to do it, right, how to help people who are like this. So any kind of anything we haven't covered. We have to recognize the core enactment, which is that

the patient is going to treat the therapist in a way that feels good to the therapist. And it's easy to enter this, you know, I'm just making this upside-go, but this kind of like therapy pseudo-paradice where we both feel so good about each other and we're so appreciative and the patient is so appreciative of us and we're happy for the patient because they work so hard in therapy and they pay their bills on time without fail and they come on time without fail and they're always appreciative of me and I feel so competent and so helpful like such a good therapist when I'm with them. And what slips away unnoticed is the patient isn't actually changing in their life outside of therapy. That's the issue. And to get biblical about it, if we've created

this sort of illusory paradise in therapy, we need to invite the snake into the paradise. It's really not a paradise, it's an illusion of paradise. We need to get the patient's anger and aggression into the therapy because it's actually already there. It's just not there in a form that's

being recognized and acknowledged. We need to make it possible. What do we have to do to make it increasingly possible for the person to bring in an increasingly larger range of their emotional experience, which of course has to include the whole spectrum of human emotions, anger, resentment, rage, envy, punitiveness, vindictiveness, these are all human emotions.

But the person with a depressive personality style doesn't experience it that way, right? Just like, well, maybe there are human emotions for other people, not for not for, not for me, I would never be that way. We want to make it possible for them to experience and integrate a fuller, you know, fuller range of their emotional life. Yeah, I think there's a, it's like another way of saying this might be the most empathic thing to do would be to invite that other side, because without empathy, it would be unempathic for you not to. Yes. Yes. invite it. Exactly. And here's, this is, this is the enactment and this is where, this is where exactly where therapists, you know, where therapy goes south in treating patients with

depressive personality style, right? Because the therapists are very likely to have a depressive personality style, right? It's a perfect mesh. And you think about it, I mean, the therapy professions are like, like an invitation you can't refuse to somebody with this personality styles. What do you get, if you go into the mental health profession, what does it give you the opportunity to do? Well, you get to focus, you know, intensely on other people's needs, right? Not that that's bad in its own right, that's the job, but you get to focus intensely on other people's needs at the expense of your own. You get to constantly fault yourself, you know, however good you get at the work. Perfection isn't attainable. Like I said earlier, you know, we're

We're all making mistakes in every session all the time. You get to fault yourself perpetually for falling short of some unrealistic, unattainable, internal standard. A Jonathan Shedler's super ego. Right. You put your own needs on the back burner. And here's where I see this just all that. I'm so glad you brought this up because I see this all the time.

The misuse of empathy as a defense. for the therapist against the therapist's own aggression. So what happens in therapy is the therapist is very, very, very empathic to the patient's hurt feelings, broken feelings, you know, the sort of needy childlike feelings, meaning to be taken care of, empathy for that part of the patient, no empathy whatsoever for their envy, their anger, their aggression, their resentment, their vindictiveness, their competitiveness, their rivalry, things are there. How do I know those things are there? Because they're human, right? But the therapist has zero empathy for that, right? So it's empathy, I would say pseudo-empathy, as a defense,

both against the patient's aggression, and maybe more importantly, as a defense against the therapist's aggression. Yep. Yeah. And as someone who studied micro-expression, you know, a tenth of a second, flashes of emotion on people's faces. Every person has expressions of anger. Not everyone knows that they have the expressions of anger. And it makes a world of difference, right?

Because that's information. It's information in the interaction, it's information in the countertransference. We don't want to shut down that countered, right? There's three major channels of communication going on in therapy. I don't think he talked about this, but this really comes from Otto Kernberg's writings.

One is the content of what the patient says. The other is the non-verbal things they express, through facial expression, body language, tone of voice. That's the second channel. The third channel is the countertransference, what they evoke in us. We shut down that channel. We shut down important information

that otherwise should come through that channel. And we're really, really limiting our effectiveness as a therapist. We're having these reactions in therapy for a reason. It's information. Can I show you the micro-expression just for those who are watching the video here? So I actually filmed a lot of people watching YouTube's, and so this is what it looks like right here.

A very serious-looking person here. But do you see the down-and-together of the eyebrows? It's like one-tenth of a second? Yes. That's the micro-expression of anger. Yeah. That's a lovely example. And see, a therapist who wasn't defended against that, you know, might register it.

Even if subliminally, maybe they didn't get, you know, it was the movement of the eyebrow. They saw something. They saw something, yeah. And that's a good place to say, you know, just to slow down there and say, you know, something just happened here. I saw, you know, a reaction. You know, and so like, well, you know, well, your expression changed. I wonder if we could just slow down here and notice what might come up. So we notice, we notice what it evokes in us, and then we use that, right?

That becomes a signal to us to invite the patient to slow down and notice. Yeah. And I could get on to other tangelo. engines here, but I think we got to wrap it up. This was wonderful. I hope that people appreciate Jonathan Shedler and the expertise that you bring. Appreciate you coming back on. And we will be posting this on X. We'll be posting it on YouTube. If you want to watch the video, I know a lot of people just watch the podcast, but if you want to watch the video, you can jump on there. And yeah, Any closing words?

Yeah, just on a personal note, I have to say, I was very aware of coming on the show. The last two podcast of yours that I watched were Otto Kernberg and Frank Yovins. And boy, those are big shoes to follow. Oh, big? Well, I mean. Kernberg is a living legend, you know, for a reason. And I mean, I could just, I almost did actually in real life. I sit at his feet and just listen to him and take it in.

Oh, yeah. And that actually happened, but I wasn't sitting at a dining table. But my experience was I could just sit here forever. And, I mean, I think Frank Hulman is one of the gifted master clinicians, who's publicly out there in teaching. And it just, I mean, every time I hear him, it's a pleasure, and I learn something every time. So I was very cutely aware.

Like, these are the people I'm following on your podcast. Oh, man. And I think I really appreciate you. You sent me a message like that was a historic interview. And I think if anyone hasn't watched Kernberg or Yomens, both of them are amazing. Actually, when I was reading through the journal articles looking at Transfers Focus Therapy, if you read the method section for a lot of these studies, Yeoman's is the supervising therapist on these studies.

Like, he is the guy, right? And then, yeah, Kernberg is just masterclass. I mean, he is, and it's like, I think you sent me in the message, like, I understand everything he was saying, and I love it. Yeah, it was kind of scary. Which I'm like, you know, as I get deeper into this material, it's like most of it's understandable. And it makes so much sense.

It makes so much sense. Well, I'll just share with the audience what I wrote to privately. So I remembered when I was a 20-something-year-old grad student trying to read Kernberg's work. It was books this goes back, books written in the late 70s or early 80s. And for anyone who tried to read Kernberg's writings with that time in the original, it's really, really, really hard to read. It is not an easy read. It's incredibly challenging and demanding.

And I actually had the depressive thing. I was reading his book and were like, oh, my God. I'm like, I'm stupid. I'm like, I'm not up to the work of this profession. Like, if this is what it is, like, you know, really inadequate. So, you know, fast forward a few decades. It's like, no, man, pretty much tracking with everything. Yeah, yeah.

Yeah. Well, I was not expecting an interview. That's the wild part. I was like expecting a phone call where, like, we would talk about an interview. and then I would spend like a couple months reading and re-reading. And so like I jump into this and it's like, okay, here we go. I think you, I think that interview and the fact that, you know, you made it happen, whatever it took. It was like, I think it's a historic event.

Oh, and I'll say for those of you who have listened to it or listened to this, my new sort of approach to the write-ups is to do a really nice, transcription where then I put in footnotes and I put in the footnotes for the beginner. It's not for the expert. It's for the beginner. So if you are confused, if you want to go back, listen to this episode, you've listened to it, something was confusing. You want to go back.

Look at the transcript. Eventually, we'll have one up there with footnotes. Kernberg, we have one up there with footnotes on my website, Psychiatrybodcast.com. It's free for anyone. All my stuff is free. highly recommended for whoever's listening. And so we will continue to produce good content. I think we're going to go through every personality style eventually.

So five years from now, we'll be done. David, thank you so much. It was a pleasure to be here. All right. We'll leave it there for today.