Psychiatry & Psychotherapy Podcast - Disavowed Anger and Positive Emotions with Paul Wachtel
Episode Date: January 5, 2026In this episode, renowned psychologist Paul Wachtel, PhD, returns to explore disavowed anger and disavowed positive emotions in psychotherapy. Discover how anger differs from simple repression, its ro...ots in childhood and preverbal experiences, its positive functions (like self-protection, boundaries, and drive), and the vicious cycles of over-niceness that can lead to frustration, psychosomatic symptoms, or explosive outbursts. Dr. Wachtel also contrasts collaborative, integrative approaches with more adversarial models, emphasizing how therapists can help patients reclaim disallowed emotions for a fuller, healthier sense of self. By listening to this episode, you can earn 1.75 Psychiatry CME Credits. Link to blog Link to YouTube video
Transcript
Discussion (0)
All right, welcome back. I am joined with Paul Wachtell. He is a return guest. He has written a book on
therapeutic communication and the disavowed emotions. And today I thought I would ask you more about
disavowed anger. And we'd kind of go from there into other aspects of the disavowed. Maybe we'll get
to disavowed disgust. We'll talk about maybe how to talk to patients in such a way that the disavowed
becomes avowed.
Yeah, and I think, you know, as we're talking even,
this actually hadn't occurred to me,
though it's a kind of rhyming or clang association of sorts.
The disavowed is also the disallowed.
It's the things that the feelings and perceptions and desires
that in the course of growing up we learned were not permissible
even if they were organically part of us.
And so we needed to push them away.
And they don't completely disappear.
That's why I kind of like the idea of thinking of them as disavowed rather than simply repressed.
You know, we're not able to completely make them either disappear or even be invisible to us.
but we can push them aside to such a degree
that we really lose touch
with some of our own most vital experiences,
desires, emotions,
both positive and negative.
And, you know, Kernberg was on my podcast a couple months ago,
and he said that the thing that therapists
most need to understand is their own anger.
So I think there's some,
something about therapists in particular, myself maybe included, where disavowed anger is a normal
part of our development. And yes, I think this would be a good conversation today. So tell me more
about disavowed anger. How has it been disavowed? What are some examples that come to your head?
Well, I'd like to first, since you mentioned that comment by Kermberg, I think I would not completely
go along with what he's saying.
I do think that
because
we try to be
in a facilitating
relationship with the
person, we're
often not comfortable
when we have more negative
feelings, so I would agree with him
in that respect.
But I think that some of
the
what
many therapists experience
has disavowed anger,
is actually an artifact.
And it's an artifact of not really sufficiently thinking in terms of disavowed emotions.
And let me, that's kind of cryptic, so let me try to spell out what I mean by that.
Part of what made me increasingly interested in this concept of the disavowed is that,
is that I was thinking about the way
psychoanalytic formulations in particular,
but we'll probably get to talk later
about how other points of view in our field
have also adopted this,
kind of began with the idea
that we deceive ourselves,
that we fool ourselves,
that we create a pretty story
about what we're really like,
but deep down
the picture
is really kind of
uglier in a way.
And I think that was a core
kind of implicit
assumption and that
the therapist's role
is to kind of
rip away the illusions
and force the person to come
to grips with the reality.
And
I don't approach therapy
from that vantage point.
Even though
I am looking at very much
the same phenomena. I approach it from the vantage point that in the course of growing up,
you know, because we are so dependent on our attachment figures, every nuance of how they
see us or don't see us, love us or don't love us, respond to us or don't respond to us,
we are especially sensitive to early in life,
and we kind of build a kind of picture of ourselves
and of who we are and who we're allowed to be
that is almost inevitably restricting.
And I'll probably come back to that later.
But in one way or another, almost all of us,
some part of us, some important parts of us,
get pushed away. Don't get fully acknowledged, fully elaborated, and yet they don't disappear because they are
important. And so I see our job as therapists to help the person recover those feelings,
reintegrate them into a fuller sense of who we are. And I think when you have that perspective,
that you're not ripping away illusions, you're not trying to, you know, get through a facade of a false self or a false presentation, but instead are trying to help the person expand their sense of who they are.
You're much less likely to be in an adversarial relationship with the person.
so that, for example, when I think of Kermberg's approach, or the general approach of
transference-focused psychotherapy, which there's a lot in it that I value, there's a lot in
it that I think is really important, but there is a way in which it tends to retain that
kind of adversarial stance that is embodied in the very term,
resistance, you know, the idea that the patient and the therapist are almost in a kind of battle
over who's going to define what's real. And I don't encounter that much, quote, resistance,
though I think I see the phenomena that they get called resistance. What I encounter is anxiety,
this comfort, a kind of difficult.
in the person feeling able to accept one aspect or another of their experience so that it feels to me
like I get into less adversarial ways of interacting and so have less not totally none,
but less need to disavow anger because I'm more on the patient's side, I think.
I think that when you're thinking of the disavowed rather than the repressed, so to speak,
of the disavowed and the disallowed rather than the hidden and secret,
you are more able to be on the patient's side, and it becomes less adversarial in that sense.
I can resonate with this idea that there are parts of us that we were not allowed to be.
There are other parts of us that we were allowed to have.
And so you're trying to, rather than deconstruct the whole sense of personhood,
it's like you're trying to pull in aspects that were disallowed or disavowed.
Yeah, I think in my conversations with yeomen and Kernberg,
I don't necessarily, I mean, I think I thought it would be more caustic or more adversarial.
I don't know if I experienced that from yeomen's when I talk to him one-on-one about supervision.
It's like he'll see the interpersonal exchange and he'll focus in on like a small moment of emotion that's there.
that's between the client and him.
But I think that I could see how, I don't know,
I think Kernberg definitely has a lot of energy.
That's a nice word, a nice way to put it.
And I don't want to be in a position,
because I'm not, of just disavowing, as it were,
in a different sense of the term,
everything in their approach,
because I think there's a lot that's enormously valuable.
But when you say that Kermberg says,
you know, the central struggle for the therapist
is dealing with their disavowed anger,
I think that's somewhat of an artifact
of the kind of relationship that gets set up.
And my guess is that, you know,
if you compare, say, Kermberg and Yeomens,
I could easily imagine that
humans has less
trouble with struggling with that.
You know, we each have our
points of vulnerability.
Certainly I must have
my own, and I put it as
must have rather than have,
because the very nature of those
vulnerabilities is we
kind of, you know, sweep them
away from our
line of vision, so
we're less in touch with them.
But I'm not presenting myself
as I'm without them by
any means.
Is anger in a way linked to drive and movement forward?
And, you know, could you see it as like, you said, like, it's not that it doesn't
take place, but maybe there isn't the words around it, right?
And I see this in my early life, like I was an athlete.
I think in my conscious interactions with people, I don't know if I felt anger a lot.
But I felt anger and sport, right?
And that's a place where I was allowed to feel it.
Yeah, and anger, I want to be very clear.
I'm not trying to sort of whitewash anger, you know, from the human repertoire.
Anger is both often valuable in various situations where if we're not angry,
we're likely to be taken advantage of.
And anger is one of the central kind of experiences
that people are conflicted about.
And indeed, much of many of the cases
that I've described, you know,
in the course of, you know,
illustrating my ideas over, you know,
various books and articles and so on,
are people who struggle with anger.
So I'm by no means saying
disavowed anger is not of great importance, it is. And we may very well be spending a lot of time
in today's discussion talking about this about anger. That's not something I disavow, so to speak.
But I was responding just to your initial comment that Kermberg had framed it as if that's
sort of the core struggle of the psychotherapist. And I don't find that to be necessary.
thoroughly accurate.
I think that
the most amiable way
of describing what he was talking about
was that if you were naturally very empathic
and you can feel other people's emotions
quite a bit and you are
in a place because of that
that you like to peace keep
and you like people to be happy,
sometimes your own anger may get in the way of that.
And so to have a voice
to be able to keep a frame,
be able to have boundaries.
All of this may be things you have to learn in adulthood
if you have disavowed anger in your childhood.
Not that we can't learn those things,
but I think we may need to get away from his statement of it
and just get into what it means for you.
But any thoughts on those things that I put forth?
Well, my association to a number of the things
we were just talking about, and maybe this is a usefully clarifying thing as well,
is that people who have disavowed anger, who disavow their anger,
are not necessarily people who aren't angry a lot,
in the sense that part of the irony,
One of the other important framing ideas that for me goes with understanding disavowed emotions and perceptions and motivations and so forth is that we get caught in vicious circles in our lives.
This is what I call the cyclical psychodynamic point of view, where the nature of what our internal states are, the wishes, conscious and unconscious, the anxieties, the conflicts, lead us to act in the world in certain ways.
and then other people respond to the way we act in the world,
and that feeds back to either maintain or change our internal state.
And one of the things that often happens when people don't make room for their anger,
because we can't thrive in the world unless we're permitted to be anger.
You know, just like we can't thrive unless we're permitted to be loving, unless we're permitted to be dependent, unless we're permitted to be competent, you know, all the things people can struggle with.
Anger is important in that way.
And when we disavow anger and we have to always be the opposite, you know, the old-fashioned term, not old-fashioned, but long-standing.
term, reaction formation, you know, where the angrier you get, the nicer and sweeter and more
helpful and cooperative you are to push the anger down. When that happens, that sets things up
that we get taken advantage of in various ways. And the result is, it's likely then, ironically, to
stir still more anger, which we then have to, once again, disavow, push down, push away.
And sometimes the frustrations of those experiences can lead us to explode so that somebody who
has disavowed anger can also be problematically, explosively angry at times.
and then
humiliated, ashamed, guilty,
and rededicated to pushing that back away.
So it's not always so simple as it's either there or it's not.
It's that in a way,
the more comfortable you are with being angry
rather than being an angry person,
but having access to anger when it's more or less appropriate,
actually enables you also to be more effective when you express anger and more appropriate,
not being in a way excessively angry, but being effectively angry.
You know, when it's integrated.
Yeah, I think it's like what I'm hearing is that when you don't have conscious words for the anger,
it gets acted upon reaction formation,
so maybe someone goes and cleans the house
instead of being angry.
And then resents being stuck cleaning the house.
That's another important part of it.
You know what I mean?
Because then the anger gets refed
and then the house keeps getting very clean,
but the person inside is feeling more and more frustrated.
Right.
Yeah.
So that's an example.
other people, patients have had, you know, I ran a psychosomatic intensive outpatient program
for about 10 years. A lot of the patients had chronic or chronic psychosomatic issues from the anger.
Right.
I myself, when I suppressed anger in the past, could get migraines.
So there's like different things for different people that they, you know, they store it or they acted out.
They're not usually, when I think of disavowed anger, I don't think of someone yelling.
Are you in the same boat?
They're not like fighting or yelling.
That's not the type that we're talking about.
Generally, that's true.
I think the reason I was adding that example of sometimes there being outbursts is that I didn't want to sort of have a picture of it's all just buried.
You know, it's a continuously, it being any human experience, is continuously ongoing, evolving, interacting with how other people are responding to us.
And so there are, what I wanted to just highlight was that somebody where it would really be diagnostically
accurate to say that one of their central issues is that they are enormously uncomfortable with
being angry and keep trying to push it away, that somebody can have that struggle and yet every
once in a while be inappropriately angry, be, look very angry. They don't always have to be a kind
of milk-toast, quiet person, though often, I mean, that's sort of, that's sort of,
of the most common presentation, and even for the kind of person I was just describing,
they will often be overly nice and overly cooperative.
But then every once in a while, there's this explosion, I've been so nice to you.
I've done everything for you.
And they're reeling off the list of all the things they did kind of under internal duress
that maybe even the other person didn't ask for, but that they've,
were excessively providing, and then every once in a while they get really pissed off about
that, and that it's not inconsistent with disavowed anger for there also to be occasional,
you know, expressed anger, but what usually is the case is it's not effective expressed anger.
Yeah, I'm associating to this kind of thought that women tend to not like to date nice guys, right?
And what are we really saying, I think?
We're saying that women don't like to date guys who have disavowed anger issues who appear nice externally, right?
But maybe don't have that part of themselves integrated.
Any thoughts on that?
Well, I think being a man, I'm in the position most men are of not, I have to confess, not fully understanding how the world looks to women.
Obviously, I try to, and I think I'm as good at it as most men are, you know, the average man.
But I think there are mysteries, you know, we each have about each other.
And I think some piece of it probably is, you know, whether it's biological or whether it's just the way our society has structured things, there is certain kinds of strength and assertiveness have been associated with masculinity.
It's something that's in the process of being re-examined and changing.
And there are all sorts of, I certainly don't want to be stating those.
kinds of stereotypes is just the reality. But I think the perception when a woman, when I've
encountered women patients, for example, who are frustrated that they seem to always get involved
with the wrong kind of man, so to speak, who tends to be a tough guy who is attracting them
and they are not attracted to the nice guy and so on, that at least,
one piece of that is that the tough guy is a more of a seen as more of a protector, more of someone who will kind of create a safe, expansive environment. You know, there are all sorts of things that that complicate these things. But I certainly don't want to be put in the position of explaining, you know, why women are attracted to certain kind of men. I'll leave that to the women to, to,
to say.
I told stories that I think famously that every unhappy family is unhappy in their own unique way,
right?
Right.
And so I imagine there's a number of issues if a woman is attracted to dysfunctional men over and over again.
Yeah, I think it would be reductionistic to think that there's a singular thing.
I think my comment is just that I think that sometimes not having controversial
awareness of anger and the positive uses of anger. What would you say are some of the positive uses of
anger? Well, I think, I think, again, that we would be almost helpless without anger. You know,
that, and anger, for example, there have been a lot of studies from the vantage point of evolutionary
psychology and certain perspectives and social psychology that talk about ways in which being
angry when it works best doesn't actually have to need, have to violent acts or even aggressive
acts, you know, that when we, so much of what goes on between people, include,
signaling that neither party is fully even aware of, you know, that if somebody is doing something
that bothers me, and I begin to just sort of start to have reactions that are the precursors,
so to speak, of getting angry.
In good circumstances, the other person picks that up and retreats a little bit.
In other words, I think that probably 90% of the interactions that involve being angry,
the other person backing off when it's effective, occur without either party,
even noticing it, so to speak.
They're the sort of small,
mini-transactions.
So anger is not just
the big blow-up.
It's the subtle
signaling to ourselves
and to the other person.
When
more angry behavior
is necessary,
because the cues
haven't been picked up
or the other person doesn't want
to back off,
you know,
Again, anger is a part of the human repertoire, and we can't survive without it.
But it also is often a symptom, you know, and I think this is consistent with things you were
sort of implicitly pointing to a little while ago, it's also a symptom of frustration,
a symptom of not living well, not feeling good about where my mind.
life is, what's going on in my life, how I feel about myself. The better we feel about ourselves,
probably in most instances, the less angry we tend to be, but we can still encounter something
that appropriately looks anger. Right. So, okay, well, that last line, if we're not where we
want to be in life, then anger may be the energy to get there or to overcome the obstacle.
I see it as like we're headed towards a goal.
As long as we're headed towards the goal, we're not angry.
It's when there's an obstacle towards the goal that we get angry.
So just like an infant, you know, has a goal of getting fed.
When they're not fed, they can get angry.
They can reach out for mother.
If mother miss attunes and thinks, oh, they really want something else other than food,
will continue to be angry until they get the food, right?
And one of the, that's an interesting example.
And I think it sort of also points to further interesting ways that the disavowal of anger can develop.
Because if you, you know, babies are going to cry, you know, a lot and sometimes very vigorous.
and even whether that vigorous crying is seen as, seen by the parent, as anger, itself is a
somewhat of a perceptual phenomenon.
Is the child being vigorous and assertive or strong, or is the child being angry
and annoying. You know, the exact same behavior on the part of the infant who doesn't have that
many subtle variations in behavior, the parent's perception of it kind of begins to be fed back
both verbally and non-verbally and sort of shaping, you know, one parent sees a child screaming
and kind of embraces that and thinks of my kid is going to grow up to be a really strong person.
And another parent seeing the exact same behavior is this kid is really annoying and is going to put people off and he's got to tone it down.
And it's the same behavior.
but one kid learns that this part of me is valued and heard, and another learns this part of me
is something I need to get rid of if I'm going to make any connection with the people I need
to make connections with.
And this happens, I'm putting it in words, but it happens, you know, much earlier than words
and not in words.
And I think in some way, one of the things we get wrong as therapists is that, you know,
we try to put into words more than words can do, so to speak, in the sense that it is useful,
obviously, and it's our stock and trade as therapists, to articulate and put into words.
But we also, a lot of what we do occurs outside of the words, at the side of the words,
non-verbally, procedurally, implicitly.
And that makes sense because a lot of what we learn about
who we are and what is acceptable in us,
that learning begins long before we have words.
And I think the only error,
I think when psychoanalytic therapists
and other more developmentally oriented therapists
point to that, to those very early origins,
I think they're onto something really important.
I think where it can go wrong is in then thinking that
if I now tell you where it came from,
that will somehow change it.
And the only thing I think that really can contribute to changing it is more experiential,
which is equivalent to how it was learned in the first place.
Okay. Yeah, there's a couple things you picked up there. One was my labeling of the infant, wanting the milk as anger, could be in our culture seen with a moral attribution of negative, this is a negative word.
When I think of anger, I think of something very different. I don't think of it as positive or negative. Or you could say, oh, the parent is upset at the anger. And then subtly,
is then informing the child to maybe disavow that anger, right?
The micro-expression is more what I'm zooming in on
when I look at the infant.
So with my kids, you know,
I had already become an expert on reading micro-expression.
So when they had disgust, when they had anger,
you know, quick down and together their eyebrows.
Like I was reading that on their face.
So I wasn't necessarily putting a moral attribution on it
in my own experience of having kids.
But I can see why if a parent was doing that,
it would subtly inform the child in a nonverbal way
because the child doesn't have a verbal linguistic ability
to put words to these things yet, right?
Right.
And so I appreciate that sort of non-verbal, pre-verbal,
you know, neglect or trauma or stuff.
It's like, how do you get to that as a therapist?
And I agree with you that it's the experience
of the patient in the room
you that will be taken away, you know, do they feel held by your words, so to speak?
Do they feel like you've decreased their shame?
They've decreased their experience of what's going on is really rotten or bad and the labeling
of that as bad.
And I think another part of that is do they feel that what they are...
experiencing, whether they can put it into words or not, is engaged by the therapist.
In other words, I think that in a way, if the therapist isn't able to see if the patient
is angry, whether the patient acknowledges it or not, if the therapist kind of puts too positive
of a gloss on it, so to speak, and helps the patient, you know, sort of erase that part of
their experience altogether.
That limits the therapy.
Sometimes what the patient may experience as most affirming is not even necessarily approving
of their anger, but if they're angry, but just seeing it, not pretending.
it isn't there because that kind of contributes to their, you know, having a part of themselves
become invisible and unintegratable.
You know, so we have to find a way to engage whatever the person is experiencing, you know,
and to do that through our own filters because, you know, we're not just seeing reality
raw and direct.
we're seeing it through our own needs as well.
Yeah, I like how you put that.
So it's like the therapist,
are they seeing the fullness of the person in front of them,
or are they restricting what they see
and glossing over what they see is like,
oh, this person's not capable of any negative emotion ever, right?
I almost remember, it makes me think of like
the AI, sick of family,
chat bots, right?
Right, right.
Where they repeat back to you,
only the positive about you, right?
And they're trained.
They're actually, you know, trained by humans,
and humans are like, oh, I like that response
better than the first response.
And the response they usually choose
is a little bit narcissistically inflating, you know.
It's like a little bit negating of the,
any negative aspects of the person.
So, yeah.
And what you're saying,
is interesting and it makes me think of ways in which the idea of the corrective emotional
experience, for example, is often misunderstood and constrained in exactly the way that you
were just pointing to, you know, and illuminating, that very often when people think of the corrective
emotional experience, you know, they are mainly thinking of the patient's parents were critical
and abusive and restrictive, and so the therapist will be kind and encouraging and open and so on.
And sometimes that is very helpful for people.
But if, for example, somebody grew up in a family where part of what went on is that the parents couldn't bear to even see their child as being angry at all.
And so just never related to that.
The therapist engaging the anger and not glossing over it and maybe even clashing a little bit.
can actually be a corrective emotional experience
because it sort of relates to more of the whole of the person
and that was what was missing in the course of their growing up.
I like it. Franz Alexander, corrective emotional experience.
He was a mentor of one of my mentors.
I see.
And my analytic therapist, therapist, he was the analyst of that person.
So there's some linkages to myself there as well.
I appreciate the idea of correct emotional experience.
I think also it links back to this sort of pre-verbal stuff that you're talking about
where it's like experientially something needs to take place,
which is another reason why AI therapy will never work.
If the therapist is too positive and is not seeing the fullness of the person
and that this person could have anger,
could have upsetness,
and that this is part of their experience,
they may be, in a way, having an enactment.
Right, exactly.
To what the parents were like.
The parents could not see that their child was ever angry,
or maybe could not tolerate their child's anger.
Right.
Right.
And neither of us are advocating therapists,
be angry in the room and nasty and so on,
but we are, I think, both saying a grounded response to as much of the reality of the other person in the room as we can,
and responding in our fullness to their fullness, even as we are also sort of stepping a little outside of it
and thinking about what is good for the patient in a way that we don't require them to think,
in terms of what's good for us.
So, again, if they're totally, you know,
if you have a patient who is constantly canceling sessions,
constantly, you know, doing all sort of,
you know, not paying their bills, whatever it is,
you know, then it's appropriate for us to think about,
they're not thinking enough about us, you know,
that we're not saints.
And if we were saintly, we would be ineffective.
You know, that's another part of that if the patient is acting in ways that really are hostile and inappropriate,
you know, just criticizing them is not going to be terribly helpful, but engaging it and countering it
and taking ourselves seriously enough that we often, that's a way that we can model a healthier way of dealing with.
displeasure with somebody else's behavior, you know, that if we always have to be just sort of
blandly warm and accepting no matter what's coming at us, that's a pretty poor lesson for the
patient, because that's not what we want for the patient. We want for the patient to be able to be
self-protective and considerate of other people,
not just one or the other.
Right, there's a bit of what Nancy McWilliams
has talked about, moral masochism,
where we can suffer and see the suffering
as endlessly helpful.
For example, if the patient was no-showing
and not paying for no-shows, something like that.
Yeah, so there are ways that the patient can act out
devaluation type of things towards us.
And I'm curious, like, what do you do?
How do you verbalize that to a patient?
Like, let's say I'm someone who is behind on paying you.
What would you say to, what would you say to me?
Well, I would first just point it out sort of factually,
you know, in the sense of, you know,
you, I sent you a bill last month and it had already a past due amount and it hasn't come yet.
And I would see what the patient says about that.
If that is sufficient, then it's sufficient, so to speak.
If it still continues, so you know, we've talked about this.
we've talked about this now a number of times and the payment hasn't come what what's going on you know
I would first still phrase it in you know relatively positive terms not abusive terms but kind of upping the ante a
little bit and then if it still doesn't happen then I think I'd say you know I don't know if we can
continue or you know are you say is this your way of saying
we need to stop because we can't just keep going this way.
And then I would be likely, and this has sometimes been helpful with a couple of patients,
to sort of step back for myself and think about how does this person interact with other people in the world?
And, you know, what have been the consequences for his life of treating other people this way?
you know, that, you know, I might say, you know, I'm beginning to have the feeling that you're treating me the way you were treating your wife when she left you.
Or that you're treating me the way you, in the kind of flippant way that you've interacted with your boss where your job has been in jeopardy.
There's something in the way you get into these patterns with people, and now it's happening right here with me, that not only gets the other person really annoyed, and I am feeling annoyed now, I have to acknowledge that, but ultimately makes your own life really difficult.
So let's take a look at, you know, if you're not paying me because there's something about what's going on between us that you're pissed off about, let's talk about that.
And let's see what, you know, what am I doing that you're pissed off about?
You know, obviously, exactly what I would say would depend on what was actually going on.
Shall we?
Because each person is different.
I feel like if we broke into a role play at this point, I think it might actually serve the audience well.
Uh-huh.
We can try that.
You know, I would, you know, we have to tip the audience off, so to speak, that not only they, but I am coming in in the middle of the movie.
So I don't know, you know, ordinarily, if this would have been going on, we would have had a history together, which would inform.
how I would respond, but let's try it and let's say, yeah.
And if you're one of the small percentage of my listeners who don't like roleplays,
I encourage you to voice your frustration towards me in the comment section.
No more roleplays.
And if you love the role plays, then you can voice yourself as well.
Okay.
Well, Paul, I will say,
that I don't think there's anything going on. You know, I'm just busy and I've forgotten to pay you
now for a month and a half. And I'm going to. And how much confidence do you actually have when you
say that? It says, take a second and look inside you and say, you know, is this just something
you're saying to get me off your back,
or does it feel truly grounded in you?
And take a second to look at it.
Well, there's a part of myself that thinks I could get busy again and could forget.
But I'm hearing from you today that this is very important that I may not be able to see you anymore if I don't pay you.
and
and so
I feel very confident
that I'll be able to pay you
well let's
let's just
think about
something that may be possible
because
you know
when I reached a point of
frustration
that was probably
greater than I intended
but it was
genuine and you saw it and you felt it and I talked about our possibly having to stop.
You looked almost like there was some part of you that felt some almost relief at that.
And I'm wondering, is there something that might otherwise, if we were really digging into
things, that might otherwise be coming up, that if, if you were really digging into things, that might otherwise be coming up,
that if we stopped won't come up.
Yeah, it's interesting.
You caught that I felt some relief.
I think there's a part of me
that doesn't think you would care if this ended.
That's a big thing.
That's a really big thing.
Yeah, I'm not sure what else is there.
Well, maybe
So I think
I think when I saw
that you were potentially going to end things,
it kind of showed me that,
yeah, maybe
you are okay if this ends.
So you were concerned maybe
I would feel some relief also if we stopped.
Yeah.
I think it's hard.
I think it's like
there's a part of me that says
this is not something you really want to do.
And, you know, as I'm thinking about that,
and I'm paying attention to my own experience
that I would actually feel very disappointed
if we had to stop,
I'm thinking that in some way
you have a sense that there are sides of you
like being the guy who's just not paying his bills,
that you want to know if I can accept that and relate to that.
And, you know, we have this kind of paradox here of sorts
where I've got to pay the rent.
So concretely, I do need to be paid.
But that doesn't mean that I can't bear being with the guy who's got a lot of feelings that maybe you think don't belong in some way, that there's, you know, stuff you're feeling and you're not sure I'm the guy who can bear what you're feeling.
I don't know if anyone
It's not like I'm sitting here
Paul
Thinking
Oh
I'm
There's another person out there
That could bear this better
Maybe no one can bear it
Yeah I think
You know
I think that sometimes is how it feels to you
No one can bear it
Yeah
I'm not sure
Yeah
It feels
It feels weighty
like coming telling you all the stuff I've told you
it feels like
well I almost feel bad that I haven't paid now
thinking about how it must feel to both receive it
and then not be paid would feel even worse
well I don't think either of us
have as our goal for you to feel bad
and I would like you to pay the bill
I don't have I'm not wanting you to feel
bad about not paying the bill.
I'm wanting you to, first of all, start paying it,
but secondly, and more important even in some way,
to get a sense of what was keeping you from doing it.
You know, I think in some way,
this moment, which we're still trying to figure out our way through right now,
this kind of hard moment between us,
that that's maybe what not paying the bill was trying to figure out,
that what's it going to be like?
You know, like I was pissed off at you.
That was real.
So what's it like to be with me when I'm a little pissed off at you
and I'm actually still here
and still talking to you.
Do I look, look at me right now.
Do I look like I'm withdrawing from you
or like I'm just letting you know what I'm feeling?
You're not withdrawing.
Yeah, you are letting me know what you're feeling.
And it makes sense.
And I honestly, like, I don't know if I was aware,
like I think I wasn't even thinking about not pain.
It was not something that I was going about my day thinking about.
But I think that the thing that comes to me is,
yeah, I think I don't want to be too weighty to anyone.
Yeah.
There's something about that.
Say more about that.
What would be too weighty?
Well, I guess I'm just confused on why that would keep me from paying the bill.
Well, let's not so much try to figure something out here as just let's try to make room for what you are having a hard time really believing I can stay engaged with.
I mean, I can tell you have stayed engaged, which is a little bit surprising.
But then something in my experience says that it's, that that may change or something that might,
I get the sense that that may change at some point.
Yeah.
All right.
That's really important.
And now we've got to do one more thing to see if we can feel together like we're not
bullshitting each other.
And that is not in your head, but from inside, what could make that change?
What could make me withdraw?
And don't think it, but feel it and half do it.
I mean, if I didn't pay, you would withdraw.
Like, that's the simple, that's the simple one, so to speak.
That's the simple one.
And we can both sort of attribute it to what our accountants are telling us, but that's not what's important right this moment.
You sensed that you had almost like dared to trust me a little bit, and that then made you think, I better not.
and you had some inkling of, okay, I'm with you so far,
but I sure wouldn't be if you took the next step.
Okay.
I see.
Yeah, I think that there's a thought if I continue eventually,
and you really see me, you will withdraw.
And it'll see.
What in particular?
I'm not even sure.
Parts of me that I hide from, maybe, parts that I don't even want to see,
parts that I know but don't want to say out loud.
See if you can say it out loud.
This is where I feel like we need to pause it.
Right, yeah, no, because after all, you're still David,
and I'm talking to the hypothetical patient,
and so you don't know him any better than I know him.
to speak.
I would be,
yeah.
Well, I think that there's,
I mean, first of all,
I used your first name
on purpose,
and I, you know,
like, I imagine that that was like
being a little bit too casual
of a, I don't know, patients usually
probably call you Dr. Rock,
Tau, you're right?
No, actually, most of my patients do call me,
Paul. Okay. And in fact, I'm
often,
when a patient doesn't.
They kind of, and they do it even without my telling them to.
Huh.
They sort of pick it up somehow in my style.
Yeah, so they're almost all of them do.
Okay.
I think that the, you know,
a lot of what we talk about before this roleplay is kind of theoretical,
but I really do enjoy this mock roleplay.
is it kind of like it feels to me like I can understand how you do therapy, you know?
And I think you're modeling that you can't have emotion, right?
And that that then may allow the patient to feel like they can have their experience.
Yeah, no, I think you're right.
And I think that's important that I don't, it's not often in my practice.
that I say to a patient, I'm pissed off with you.
I mean, that's certainly not what I teach my students as the first, you know,
here's how you do therapy.
You tell the patient you're pissed off at them.
That's unusual.
And I think I was doing it in a way to model a certain kind of getting real with each other
because I think the way I had constructed this scenario, you know, again, without really knowing the patient,
was that the not paying was a way of avoiding something else.
It was a way of expressing something certainly, but it was also a way of avoiding something.
thing, especially because he was describing why he didn't, I just get distracted, I'm busy, etc.
You know, he wasn't, he wasn't owning it as anything intentional.
And so I was sort of role-playing it as somebody who is struggling with feelings that,
could be intense and generally unacceptable, so to speak,
that would just be sort of written off blandly,
as I just was busy.
I didn't get around to it.
And so I was trying to make sure I was engaged with the person
and trying to create a kind of a little bit of a hot house at that moment where he felt both hold upon to come out with a little bit more,
but also to notice if I was engaged or withdrawing from him.
you know um
you know
in a
you know in a
you know in a quote real
case so to speak
the specific might be different
I mean at this point I was
you know we were both
creating a fictional character so to speak
so we don't know for sure
what was relevant but what I think
maybe a different way of putting it is that
uh and and
it
came up at one point when you, as the patient were saying something like, well, maybe I just
don't accept me or something like that, which is a kind of an abstraction. It's kind of a terminology
that we kind of learn verbally. And that what I was trying to do was to get him to come out
with it, by which I didn't, I wasn't thinking out with it in terms of let's reveal the secret,
but out with it in the sense of let's experientially interact with whatever it is he was avoiding.
So I was, in that sense, I was trying to invite him out into the.
the interaction more.
And so I'm curious how it felt
experientially at the other end.
I think experientially,
I think this,
it's interesting with you in particular,
with these role plays,
I find myself being able to act very poorly.
And instead,
I pull from like my own experiences more,
which I think,
and I think you start picking up on
little threads of my own experience.
I think last time it was,
we were talking about chess
and the disavowal of aggression
that the father may have had
by flipping the board
and allowing the kid to not lose, right?
Mm-hmm.
Which I had never thought about before,
but that's possible, right?
So I think the trouble with continuing to go
It's like, it's like, you know, it gets into like, it's, it gets like uncomfortable in the way that it would be comfortable one-on-one with you.
I think it's uncomfortable doing it in front of 20,000 or 50,000 people.
Yeah.
And especially where on top of all that, there's this ambiguity of what's you and what's this hypothetical made-up patient.
Yeah, yeah, yeah. And there's a mixture sometimes, right? And that's that that makes it even more real. I did a very long roleplay with Shedler and it was it was like a roleplay of one of my best friends and all of the stories I've heard from him. But I, you know, mixed in some of my own experiential aspects, you know, as probably all actors do. But yeah, it's it's fun, but it's also like,
it's getting a little bit too hot for me.
Yeah.
And it's,
you know,
it's interesting because I,
right at this moment,
I,
I feel in my body a certain,
like,
exhaustion,
like I've,
you know,
like,
because I was into,
I was in a sense,
almost,
it's,
it's odd because I was being myself,
but I was also role-playing myself.
Right.
And, you know,
it wasn't necessarily,
what would actually have happened in my office,
because it obviously would depend on exactly who the person was
and what our history was and so on.
But I was getting into, I guess, a certain, you know,
an interactive role that was also designed to illustrate something.
And I think what I was trying to illustrate is the difference between
kind of asking a question trying to get an answer versus trying to promote an experience,
you know, so that I was not trying to get the patient to reflect so much and be able to
verbalize, though it's at other points that might have been also something that would be trying to do,
but trying to create circumstances where he could come out a little,
bit of wherever he had retreated to, you know, because it's, people can be very forthcoming as a way
of retreating also, you know, that what was the part of him that he sensed just maybe even just
peripherally he was keeping under wraps? And it was, the aim is not so much for him to know what it
was, obviously that's also a value, but to experience actually feeling it, expressing it
in relation to another person. And then I was also, at that moment, calling his attention
to watch me and see whether I'm withdrawing or whether I'm still engaged because he was
feeling, you know, if he was really himself, I would
disengage. So I hear that it was, there was something about it that was
exhausting for you, you said? Or, yeah, fatiguing? Yeah, I mean,
not in a, it's, like in a countertransferential way, like, in a countertransferential
way, like, in a countertransfercial way, but also in a way that it's like, you know,
there's a, a kind of, a countertransferential way, like, you know, there's a, a,
of exhaustion, let's say, after an athletic event.
And it's a positive exhaustion.
Okay.
You know what I mean?
There's another kind of exhaustion where when you can't reach, what I find is
when I can't reach the patient, when there's a kind of blandness and the person is two or
three steps behind who they are, I can get exhausted.
I can get tired because it's sort of like nothing is coming.
There's a dissociation away from all of their experience.
Yeah.
A lot of their experience, so you feel, yeah, I feel that too sometimes.
Yeah.
And that exhaustion, that's a negative exhaustion.
This was a kind of positive exhaustion.
It was like, you know, the exhaustion after an athletic event.
You know?
No, I appreciate that.
And I think good therapy is, it's, um,
doing good therapy is
it is exhausting
in a unique way
and I appreciate the differential there
and it can be in a good way
you know
like I can feel very
exhausted by the Friday night
it's funny
I play a lot of chess nowadays
my son is really into chess
so I've gotten back into it
and I play in the morning
and I'll have these winning streaks
of like five games in a row
on chess.com
and I have a certain score
so they're putting me against, like, people of my score.
And then I play at night, and I'll lose, like, five games in a row.
These are short games.
And, you know, the work that we do is exhausting, right?
In its own way, it can be good at the same time.
Yeah, like you would feel good at the end of a sports match.
Yeah, so I like how you put that.
Yeah, and I think,
one of the things that both came up in the role play and that we're talking about as well and reflecting on the role play
is that engagement is a very central part of what we try to do and that that itself creates these complexities and paradoxes
where there are certain patients where I have to learn in a way to be less engaged,
you know, that I have to learn that I have to be more subtle in my engagement,
that too much engagement can feel threatening.
Like I can think of a patient, for example, who every once in a while,
when we were talking about something relatively important, he would turn away. He would turn to the side like this. And I was very aware that, you know, some therapists, some schools of therapy would interpret that, would point that out because it was, you know, a defensive effort.
And I instead made a very definite decision that I would not comment on it.
I eventually did much later in the work when it felt like he was ready.
But it felt like to comment on it would be like I was being the smart-ass therapist
who was showing what I had noticed.
And that would have been counter therapeutic.
He needed those breaks.
he needed not quite as much engagement.
You know, it was a different kind of engagement
because I was attuned to him enough
to not comment on it,
but I had to let him sort of take his breaks, so to speak,
and then he could get back into it.
And I think if I had commented on it,
it would have made him retreat
and it would have been less,
productive. So engagement is a complicated thing also because sometimes we engage best by not being
so manifestly engaged. Yeah, I think what you're what you're noticing is there's a intuition
that develops on the on what you should comment or not comment on. Some things that you
comment on may be shame inducing and him pull him, him,
needing that space from looking at you right in the eyes,
I think gave you that sort of signal that maybe he,
if I comment on it, it will heighten his experience of shame
that he might already be having.
Right, exactly.
Which might cause him to disavow more, right?
Because I think there's an assumption that we should reduce shame
to allow for the disavowed or the disallowed to come forth
Yeah, and shame and also even
also potentially intrusion
you know that if
sometimes I think a patient can feel
almost too well understood
and we sort of if even if we are understanding it
we have to kind of keep it
you know
unstated so much because
in a way, shame would have been part of it, especially if I called attention to it because
it's behavior that's nominally avoidant, et cetera, but that what he was also, I think,
experiencing and why he needed to turn away was he was feeling, and he actually, I remember
in least one occasion, I remember him talking about feeling really understood by me.
And as he was talking about that, that was one of the times he turned away.
And so in a certain sense, you know, another one of these paradoxes is I was now understanding even his need to turn away.
But if I had expressed that, that would have been felt like still more of an intrusion.
Yeah.
Yeah.
Yeah.
I'm thinking about this,
you know, I have a perceptive son,
and he, when playing him chest the other day,
he beat me.
How old is he?
He's nine.
It's pretty good.
He's getting good,
and he's got a brain for this, you know?
And he could tell that I was upset.
You know?
And he pointed that out.
And there was part of me that was like, yeah, he's seeing this accurately, but there's
another part of me that's like, I don't want to be upset.
You know, like, I want to be purely happy for him, which I am like actually in, we got
him a chess coach.
And the thing that I put in the intro thing as the goal is for him to beat me.
Like, what is Luke?
What is my son's goal to beat?
dad, you know. So I don't, I, I think I said something to him like, well, I think there's a
mixture of things going on in me. I'm both very proud of you for beating me, and I also don't like
losing. But that doesn't mean I'm going to stop playing you. One of the other nice things
about that is that then he knew, you know, in contrast to the, the, the, the, the,
father and son that we had talked about the last time that you were bringing up just before about
knocking over the chessboard, he knew that he had beaten you when you were really trying to win,
you know, which makes the victory even sweeter, so to speak.
Yeah.
I think it's like this thing of, you know, I've thought about this with this chess coach.
Like, what would it feel like for the chess coach to lose, you know?
like it would be very like difficult yeah but at the same time like isn't that the goal of the coach
to see their students surpass them and so yeah i don't know how this i think it relates to our
idea of disavowed anger with this kind of like allowing you know our own kids to have a place
of positive aggression put you know like yeah it's okay to want to beat someone and that's good
and that's a part of life, right?
It's to compete and to do your best.
And when he lost the other day at a tournament,
I said to him something like,
well, I'm in it for the process.
We're learning from our mistakes
and we're trying to grow and, you know,
it's a process, right?
And so I think inevitably it's like,
okay, how do we help our patience in that process as well
not be overcome by their defeats
to a place that they stopped trying,
but also not being afraid of, you know, being in the arena.
Yeah.
You know, what also occurs to me
because you were coming back again to the disavowed anger,
and it made me think about something
that I hadn't fully thought about until this conversation,
which is that when I think about,
as I first began developing the point of view that informs my work, you know, looking back, you know, many, many years now,
I think the examples that I mostly would offer in workshops or in things I wrote were some version of,
of, I didn't call it then disavowed, that was, I didn't use that terminology until relatively
recently, but some, but basically some version of disavowed anger, that that was what I,
mostly was initially focusing on, not, obviously not exclusively, but a lot.
And I don't know how much that had to do with issues I was struggling with.
or how much it was that that's a bad feeling.
You know, it's one of these, you know,
affects or motives that are generally not so socially encouraged.
And what I'm aware of is that in recent years,
more of my illustrations of disavowed feelings or motives
or experiences,
have been disavowed positive feelings.
People who have trouble in wanting to be admired
or wanting to be loved or wanting to be helped
or even wanting to be understood in some ways,
that those are actually often more subtle forms of disavowal.
Like I'm thinking of, I've had a,
I've been particularly interested in recent years and then sort of can think of a number of people where this was the case, where they kind of learned early that wanting too much love or contact or understanding or affection, that that was what was most dangerous.
And so they learned to be more or less self-sufficient, you know, very independent people, go-getters, and so on.
But the need and the wish that we all have also for love and even protection and help and support and all of those things, those never go away.
They can be disavowed, but they never go away.
And that what often happens in those instances is that the person starts to express it,
you know, again, because it doesn't just disappear.
So the person thinks they are asking for affection, for, you know, let me know how you feel.
I feel very warmly toward you, whatever it might be.
They think they're expressing it,
but because it's been such a source of discomfort and anxiety,
they express it in a kind of hesitant way
that the other person misses.
So an example that I was just writing about,
the other day, and I still haven't got the passage completely worked out, but was describing
an interaction with a patient or telling me about his interactions with his girlfriend.
And there was something that he was, he was both wanting more contact from her, more sense
of feeling her caring about him.
and also was worried about something in particular and wanted to run it by her and have her help him with it.
And he said to her, and she, you know, like the hypothetical patient we role played who was very busy, you know, she was busy.
And in fact, part of what his early growing up was like is his parents had been very busy.
They were nice people, but they weren't really that connected with him.
They were always just busy with things.
That's part of how he early learned to be self-sufficient.
So he said to her something like, boy, it's really beautiful out today.
I think I'm going to go for a walk.
I know you're busy, but if you want to come with me, you know, it's nice out.
and he thought he was basically his experience as we explored it was he was emotionally he thought
I was he was saying to her I really want you to come with me I really need you to come with me
she was hearing I know you're busy but if you feel like it you can come with me so she
said no picking up on the you know the that side of his message
he then later felt crushed that she had rejected him.
And then in these vicious circles that happened with people, having been crushed that way,
he would be more likely the next time again to express it in a very hedged, hesitant,
you know, I know you're busy kind of way, that would make it likely he would need.
with the same response.
So that for him,
the wish for
connection,
understanding,
help, affection,
that was the disavowed feeling,
even though those are,
quote,
socially acceptable feelings,
for him and his,
you know,
life experience,
those were the feelings
that were dangerous ones.
And I've been aware
that in,
in recent years, maybe because I had given so many examples in earlier in my writing about
disavowed anger, I've been more thinking about and writing about these kinds of disavowals
in recent years.
I really like that.
I really like that.
I think that the wanting connectedness, but not knowing how to express it in a way to get it,
and then it kind of gets reinforced.
Yeah.
By the way he asks it in a kind of hedged, non-assertive way.
Yeah, that's really good.
I think more of the dismissing attachment style personas have a lot of this.
They're dismissing of the need for attachment superficially a lot of the times,
but it's very important for them.
and they may not even be able to verbalize how important it is for them.
Right, right.
I think putting it in those attachment terms is very apt.
I think you're absolutely right.
And then I think what I would add to the way attachment is often discussed
is that the dismissing attachment style or any,
especially insecure attachment style
is not only an internal working model,
but it's a working model
that leads to behavior in the world
that has consequences
that then feed back again
to very often contain that model.
There's kind of a,
oh, it's almost like a trope at this point.
There's a bunch of funny videos
of this trope
that, you know,
the male partner should never express
any vulnerability to the female partner.
And there's these kind of comedic sketches
where the female partner
is getting opened up to the first time
and is then thinking inside of their head
like really negative things,
like, oh, I'm going to bring this out
when I break up with this guy.
And the comment section, though,
is like, absolutely never express yourself,
you know, never say anything vulnerable to your partner
and like just like hundreds of these comments, you know?
So this, there is a real belief that what you're talking about
is like a conscious belief of wanting too much affection,
expressing it, this kind of thing.
It's not only believed, but it's been reinforced
to the point that people are seeing this as kind of like,
trope.
Yeah, yeah.
And I think as is also implicit in what you were saying,
and it went back to something we talked about a little bit earlier as well,
that these things then become part,
they become crystallized in the culture,
and then that becomes a sort of another independent source of pressures.
You know, we have cultural images of what men and women are like,
and so forth, that kind of become themselves self-fulfilling prophecies.
Yeah, I think that when I brought this up with Sue Johnson on an earlier podcast episode before
she passed, sadly, she was like, naughty, naughty. That is a naughty belief.
and I could see through EFT and through this kind of like, you know, putting to deeper words and vulnerable
situations, it often starts with frustration from one of the, usually the pursuer partner.
And then underneath that is deeper emotions of fear and sadness.
But sometimes you don't get to that deeper fear and sadness without first,
experiencing consciously the anger and expressing the frustration.
Yeah, and there are, I think, very few instances where it really is like just one emotion,
you know, like there's this single latent content to the dream that idea.
Right, yeah.
And, you know, I think dreams almost never have a single latent content.
latent content. That was Freud's
artistry and storytelling. But
dreams are a whole entangled
set of all of the threads
in our thinking and our emotions that
sort of are loosened up when we're asleep. But it's not
really like you get to the singular
motivation. And you're, you're, you're,
we're sort of highlighting that's true when we're awake too.
Here's coming full circle to what you're talking about.
Earlier in your career, you talked about disavowed anger,
and then you found underneath it, or maybe deeper,
once you get through the disavowed anger,
there's disavowed yearning for attachment,
yearning for connection,
and I'm seeing that in patients as well,
and in couples in particular,
it's like they wouldn't have the anger
if this wasn't the most important person
in the world to them.
But in the midst of the anger,
they're usually not going to be able to hold that
at the same time as the anger, right?
Well, I think the way I would think about it
would be slightly different.
Just in, I mean, I basically am resonating
with what you're saying,
but I think rather than thinking of one
as beneath the other, I'm thinking of them all entangled with each other, so that the anger can
generate feelings of neediness, can impact the anger can be a defense against wanting affection,
and wanting affection can be a defense against anger.
You know, that all of the discomforts are like a kaleidoscope,
and they vary at different moments
so that the model of what,
certainly it is, I completely agree that at any given moment,
one feeling can be beneath another.
You know, one can be defending against another.
But at a different moment, it can be the actual reverse.
Yes.
What's the constant is, is our comfort or discomfort at any given moment with a particular feeling.
Yeah.
I resonate with that, and I would resonate also with the thought that one who did not love would not also have anger, right?
because it's like you have to protect that which you love.
And so there is this kind of like yin and yang mutuality,
idealization devaluation, this merging of these different aspects of oneself
and the cohesiveness that follows.
I think that's what you're talking about as like the goal of good psychotherapy
and the goal of us as therapists to bring forth in our clients
We have to embody that ourselves in our own journey.
And I would add in, I think that this all kind of like speaks to another thing I've been playing around with for a year or a couple years is reflective function.
And this idea that our ability to speak to the attachment and to speak to these attachment dynamics can increase with good therapy and can increase when we get in.
touch with the disavowed. Yeah. Yeah. I mean, that's, I think that's another good way of
describing the aim of what we're doing. And there are, there are, you know, I think you,
you referred a couple of times to tropes. And I think that's, that's, that's, that's a useful
way to refer to because we're, we're dealing with tropes. We're dealing with, we're dealing with
reality that is so multifaceted that we're mostly getting angles on what's happening.
We're not sort of, it's not like, you know, we dig deep down and we get the nugget out,
and this is what it really is.
It keeps changing, especially because not only do our feelings keep changing, but the circumstances
our feelings are creating keep changing.
and the people we interact with change, you know, so that with two different people, for example,
I, you know, with one person, I may have greater access to one feeling and much less to another,
and with another person that could be just the reverse.
You know, with one person I can be easily aggressive in a sense, but it's harder to be sort of sincere.
and soft. And with another person, it's very easy to be, you know, kind of the warm, good person,
but it's really hard to find how do we fit in the aggressive side of myself. And I think we all
have that experience that that the very, the very configuration of our personality is not a
constant. It's contextually related, which doesn't mean it doesn't
exist, it doesn't mean we're all just a product of the other. I think that's like been a
serious misunderstanding, sometimes offered of relational psychoanalysis as if, you know, because
it highlights a two-person point of view and that the experience in the room is co-constructed,
some people have read that as meaning the patient doesn't have an independent personality
that they had before they even walked into the room.
And that's clearly not what relational psychoanalysis means,
and that's not what I'm saying.
But this contextualization of it, I think, is really important.
Are there any personality types?
I think you talk about this a little bit
before this kind of idea that not all therapists
will treat the same personalities,
and there's some personalities they may not be a good fit.
Are there certain personality types for you that you have realized are not a good fit and you refer them elsewhere?
Well, it's interesting.
Here I am declaring to thousands of people who I don't work well with.
It'll help future referrals.
Right, right.
But I would say one thing that comes to mind,
most readily, is I'm not very good with addiction kinds of problems.
And, you know, addictions of all sorts, you know, not just, you know, somebody who's addicted
to heroin or whatever, that I tend not to be that addictive of personality.
I've got my other problems, but that one isn't one of them.
And I don't mean just substances.
I mean, like, for example, I'm aware that I can do better without my phone around than most people I know.
People talk about being addicted to their phones.
And I'm not, and again, I'm not presenting myself as a superior person.
I've got my own problems.
It's, you know, which of the things.
It's harder for me to empathize with a kind of an addictive dimension.
And I find even like my taste in movies, I love movies,
but when I read a review and it sort of is a movie about addiction in one sort or another,
I think it's probably, obviously there are exceptions,
but it's probably not one that we,
will be one that will really draw me in.
So if that's a prominent part of the presenting problem,
that would be an example of someone
where probably be much better for me to refer the person.
I also think, and this is much harder,
I think for our profession as a whole,
the in a way almost like the next great advance if we do make any
very advances is likely to lie in the realm of referral
you know that if the standard way of beginning a therapy relationship
started with you are seeing someone
just for two or three sessions, just for an evaluation,
not of your problems, but of who you might work best with.
And if we all became better at referring people,
rather than just taking people into our practices,
because I think, you know,
apropos what you were saying before about AI can't do the job, you know, that there's something in the chemistry between people.
We don't just have technical skills. That AI can sort of learn. But we're human beings with an emotional response to another person.
And just the way we can't, you know, successfully marry or have a love affair,
with just anybody, and we can't even really become a good friend, just anybody.
There are ways that pairing makes a difference.
I think we need to sort of learn more about that process, because I think that's probably
at the heart of when psychotherapy goes best is when the pair is right.
It probably doesn't matter that much what kind of therapy the person
practices as whether the pairing is right, as long as they're not practicing something rigidly,
you know?
Okay.
Yeah, I think that there's value there.
I think I've gotten better at after one session having a gut feeling if this is going to be a good
fit for me or not.
I think that will continue to improve hopefully.
But I think as well, as a psychiatrist, I don't always have to see someone for therapy.
they're often coming to me for medication.
Right.
And so I've had the joy of trying to think
who they would be a really good fit for.
And I kind of like, you know,
as I get to know, like a dozen therapists in the community,
you kind of have an idea,
oh, I think this person would be a really good fit.
And I get excited when I hear like six months later
from the therapist like, oh, great fit, great referral.
Yeah.
And some psychiatrists refer to me,
not because I'm going to be a great fit, but because they have no desire to treat this
president anymore.
Or they're, yeah.
So, I don't know.
I think good referrals are something we should talk about more and thinking about how to
maybe think through that.
That would be good.
Maybe future episode.
I think we should wrap this, wrap this up our time.
Is there anything else that's kind of like on your mind?
still that you wanted to get out before we kind of wrap it up?
I think we've sort of done a pretty nice job of going around the different dimensions,
and I think the role play was interesting as a kind of a core event in the middle of it
that probably gives further meaning to what we talked about both before and after it.
So I'm feeling relatively content that we did a nice job together.
Good, yeah.
I think hopefully people who are listening to this can get some more acceptance for their own disavowed emotions, experiences, both positive and negative.
I think that positive focus was great at the end.
I think that will resonate with a lot of people as well.
and yeah, if this was helpful, let me know,
and I'll be happy to pass on a word to Paul,
or you could reach out to Paul directly.
Go ahead. What did you want to say?
Yeah, no, I was just,
you actually touched on what I was going to say,
which is that I would be very interested.
You know, people who want to contact me directly, can,
but also I know, because you were referring to it earlier,
that you get lots of comments, you know, on these.
And if you get comments on,
our discussion, I would be very interested in, you know, just passing them along to me. I'd love to
see them. Likewise. Yeah. I know last time you said some colleagues who you didn't even know
were listening reached out to you and said they had heard you and previous students. That's fun.
Yeah. And so if you're one of those people, reach out, send Paul on an email. We don't like to
only get negative emails. We like positive emails as well. Right. Right. But if somebody's
got a complaint or a correction, let me put it more positively, a correction. I am interested in
hearing that too, because I could probably learn from it. Yeah. Okay. We'll leave it there for today.
Very good. Thank you, David.
