Psychiatry & Psychotherapy Podcast - Understanding Mature Defense Mechanisms in Psychotherapy: Nancy McWilliams Framework with Clinical Examples from the Tuesday Cohort

Episode Date: May 11, 2026

In this episode, Dr. David Puder and the Tuesday 2025–2026 Psychotherapy Cohort explore mature and neurotic defense mechanisms through the lens of Nancy McWilliams' influential framework. Building upon the previous discussion on primitive defenses, they provide an in-depth look at how higher-level defenses such as regression, repression, compartmentalization, isolation of affect, intellectualization, rationalization, moralization, undoing, displacement, reaction formation, and sublimation operate in both everyday life and clinical practice. Filled with rich clinical examples drawn from outpatient psychiatry, emergency settings, trauma work, grief, OCD, and private practice, the cohort discusses the adaptive value as well as the potential costs of these defenses, offering practical insights for recognizing and working with them effectively in psychotherapy.   By listening to this episode, you can earn 2.0 Psychiatry CME Credits. Link to blog Link to YouTube video

Welcome back to the psychiatry and psychotherapy podcast. I'm your host, Dr. David Puter. Today I am thrilled to be joined by an outstanding cohort, my Tuesday cohort, the 2025 to 26 group of talented clinicians who spend a full year with me deepening their psychodynamic skills and reflective function. In our last episode, we explored primitive defenses. Today, we're moving into neurotic and mature defenses. Kicking us off is the compassionately discerning and quietly authoritative Dr. Jason Malo. He is an outpatient psychiatrist and director of an outpatient psychiatric clinic at Maine Health, Maine Medical Center in Portland. He is deeply passionate about psychotherapy and will be kicking us off talking about regression and then later

turning against the self. Next, we will have the nuanced integrator and psychologically astute Dr. Olga Kuznet Sova. She is a psychiatrist working in two academic hospitals in Boston, originally trained in internal medicine. And Russia, Olga now excels as an emergency and consultative liaisoned psychiatrist while also seeing patients for therapy and psychopharmacology. She's a dedicated CrossFit athlete, and we'll be covering compartmentalization and later repression.

Next up, we'll have the gracefully observant and finally attuned Dr. Jeanette Hotelling. She is a psychiatric mental health nurse practitioner in Montana, who lives right by Glacier National Park. After years of medical surgical RN work, she has had a powerful journey into mental health, an avid hiker, skier, backcountry adventure. She will be talking about isolation of affect.

Then we will have the genuinely, inquisitive and equanimous presence Jason Kent, a licensed professional counselor, who I would recommend in Charlottesville, Virginia. After 15 years of advertising for major brands, he transitioned into practicing psychotherapy and now worked extensively with addiction and failure to launch cases he will be presenting on intellectualization and displacement. Next, we'll have the subtly illuminating and warm Dr. Dina Golden, She is a nationally certified family and psychiatric mental health nurse practitioner and clinical professor at the Florida International University in Miami. She is the author of Fast Facts for Psychopharmacology for Nurse Practitioners, which I have a copy.

Dina will be covering rationalization. Then we will hear from the courageous and compassionately discerning Dr. Katia Reney. She's a psychiatrist with a deeply psychotherapy. based practice in Washington State. Katia grew up speaking three languages and has lived in multiple countries. She's an avid skier, hiker, swimmer, dancer. She will be discussing moralization. And in the second half, we have the sagacious and clinically luminous Dr. Natalie Dreyfus. She is a psychiatric nurse practitioner, founder of Doxide. psychiatry clinic in Seattle. She works with adolescents and adults and also does psychotherapy and has a

special interest in psychoancology. She brings a strong psychodynamic foundation along with somatic and holistic approaches. She will be presenting on undoing. Then we will have Chris Deidana, who is a heart centered and authentically attuned licensed mental health counselor working in Orlando, Florida. he is deeply passionate about real life transformations he witnesses every day in therapy. He will cover reaction formation. Then Dr. Amanda Sekhi Jima, the finely attuned and developmentally precipient child and adolescent psychiatry fellow at the University of Louisville, brings a rich background in movement, language, and cross-cultural experiences. She is presenting on identification and will close the episode.

with reversal. Finally, Dr. LaTal Melnick, a viscerally resonant and psychologically astute psychiatrist who works in an adolescent day treatment program in New York while maintaining a private practice and teaching fellows at Columbia will bring us a memorable Batman example when she presents sublimation. I hope you enjoy the episode. If you leave a comment on YouTube, I will be happy to share it with the people that are presenting today. And let's start the episode. Jason Molo, take us off with regression. Yeah, last night, I was watching this documentary,

and I just had to show this example because it really stood out to me. So it's a documentary on Mel Brooks. Okay. Yeah, he once played this love doctor on a dating show, and the interviewer asked him something, like, when can a heterosexual woman know when it's an appropriate time to get married? And his response was something like, oh, when their boyfriend puts down their rattle. Okay.

I don't know. That was fitting. But regression is, so it's a defense mechanism, where people seem to return to an earlier stage of development. It's definitely like a backtracking. to an earlier way of coping with stress. That can be psychological and or environmental. And, you know, our psychology does develop in stages. We've all heard of Freud's oral anal-phalic.

And for the parents out there, we definitely know kids don't progress in a straight line. There's an ebb and floated development, but there is a progression. And it typically with aging, this gets less dramatic. Yeah. Yeah. I've seen it with kids when they get sick.

They'll regress to earlier stages. You know, all of a sudden, the lose abilities that they had before. Yeah, so it's normal with kids to regress. Yeah, how do adults do that? How do adults regress sometimes? Yeah, it totally happens with kids. Like, you know, I know firsthand about like sleep regressions, But yeah, it happens with adults too, of course.

And it can be natural and adaptive for adults. It's not always, you know, pathological. And, you know, you can think of, like, romantic relationships where you'll hear, you know, partners talk with each other and, like, baby, like, voices. You know, like smoochi-wucci, cutie pie, that sort of stuff. Everyone else cringes, right? That's not a part of that regression. No, and yet, like, we do it as human beings. And, you're, like, capable, well-functioning adults.

I mean, you can all probably imagine someone going back to their home they grew up in, and then just, like, suddenly becoming, like, infantilized by a parent or, like, a little kid feeling, like, criticized, or getting into sibling rivalry, that sort of stuff. Mm-hmm. But then it can be maladaptive, too. I'm thinking of patients throwing full-blown tantrums in the office, stomping their feet, getting that fetal position on the floor. And, you know, Nancy McWilliams has pointed out that, like, somatization can be a form of regression.

And, you know, it reminds me of how Freud wrote about, like, the ego first being, like, a body ego. And so, like, the ultimate regression may be a somatic experience. in the body somewhere. Yeah, that's good. Or like a, like finally common pathway to dissociation, right? And just kind of, but in that, sometimes the regression, it feels like they're regressing to an earlier developmental time, right?

And that's, and so we may notice that as providers. We may be curious about it. What do you do? What do you tend to do, Jason? if someone regresses in your office? Well, you know, it can be, it can come in the form, too, of, like, you know, patients who have made strides with becoming more autonomous or just, like, having healthier behaviors at self-agency and yet, like, backsliding, right?

And then someone's, like, drinking again or getting into problematic relationships again. I think the good news is that with this defense mechanism, is that people typically don't lose what they've achieved. It's just at like where they're at right now, it's just overshadowing temporarily. And I think helping patients recognize that and become more cognizant of it can, and normalizing it too,

can help support them actually having some greater control over time. That's good. Yeah, it's like maybe their coping mechanism have gotten more advanced, but then in the regression, they go back to old habits. And so I love your positive view on that, that you have gained the ability to jump out of that faster maybe. Yeah, I like that. Yeah, and it might be just like you have to temporarily be somebody that kind of holds on to their

past successes until they can get to a point of recognizing it, but like you'll hold on to it for them and help them with like grounding and stuff like that to get out of it. That's good. Thank you. Jason. Let's talk about compartmentalization. Olga. Okay.

So I got confused, you know, about compartmentalization at first because there's one that is commonly known, right? And we use it sort of like in everyday live and it almost feels like it's a good thing to combat mentalize. And so it's just kind of like a definition as an act of mentally separating different parts of your life, thoughts or identities, so they don't conflict with each other.

So for example, and we all do it, like a doctor who focuses, or even a therapist, you know, who has some personal problems at home, but he can focus on sort of like problems of their patient, you know, and not be sort of like emotionally disturbed, you know, maybe during the session, right? Another example that I had is therapist who leaves work, stress at the office, and is fully present with family at home.

But we all kind of know that's not realistic. We all come home and kind of, you know, we feel like we need some time, you know, to ourselves. Right. So, yeah, it's sort of challenging. We can regress to earlier stages once we get home, right? Because it's a safe place. Yeah, and I think it's normal, right? Yeah. And so as a defense mechanism, it's more like the ability to keep conflicting beliefs, emotions, or behaviors separated so that they don't sort of like interact with each other. And a person is not sort of like feeling anxiety about it. And it's kind of similar to hypocrisy, which was new to me when I read, you know, in Nancy McQuilley.

about it. So, for example, person who cheats in business, right, but at the same time, you know, sees himself as a very moral and kind person, right? But at the same time, kind of like, do something, yeah, oh, bad. And or a person who acts lovingly towards family, but abuses others and thinks it's, it's okay, you know? So the other thing that I wanted to point out that it's similar to splitting two, right? And so there's this tension between, you know, those two sort of like different beliefs and it's not integrated. And I think in therapy, I don't know, I was thinking about how I would approach it. I'm sure it naturally came up during my therapy, maybe just kind of wonder, you know, gently why person sort of like acts a certain way.

I don't know, maybe somebody has other suggestions on how to manage this. kind of defense and therapy as well. I see it as largely adaptive, right? I mean, there was this guy who came on my podcast talking about ordinary men, and a lot of the times he was very cognitive. And Katte, I know this is one of your favorite books. Yes. And he was very cognitive and very emotionally distant.

And then there was this one part where he was talking about this early discovery. He was in Germany, and he found these files and he understood what he found. And he made this connection and he starts getting very emotional. And it's like he couldn't hold that compartmentalization anymore, right? Where it was probably very adaptive to be very intellectual and separate the emotionality when he was really trying to just find the facts

and the details would have this horrendous thing, right? So it would be totally overwhelming to fully grapple what that was like for the Jewish people to be murdered as they were by the German military officers. So, yeah, compartmentalization can be very adaptive. And so if it's happening, it's happening for good reason. I think about compartmentalization too. I like how you separated it with like this, the tool that we use. And I remember working as a nurse on the floor during conference. COVID. And, you know, walking into a patient's room who I distinctly remember, you know, this older

gentleman, and both were, there were two patients on my panel and both of them were COVID positive. One of them was not doing well, not all, tanking. And it was when visitors also couldn't be in the hospital. And so holding that space for this patient in the distress and then walking out of the room, kind of putting, gathering myself together. And then I go into the next room where this other patient is also COVID positive, not showing any symptoms, pretty happy, go lucky, he's able to talk to his family. And I think it was, when I was reading about this, I'm like, oh, okay, that makes a lot more sense to me in that I needed that tool to be able to do that work and like, be present.

Mm-hmm. Mm-hmm. Yeah, and I have talking about regression and kind of mixing these two together. I don't know if you all have ever had this experience where you feel sick, you know, maybe you have like a stuffy nose, a little virus, and you are, it's harder to compartmentalize, right? So I'm with a patient, and instead of normally I can compartmentalize, I can be fully present with that person. Now it's like other stuff from previous patients is leaking in, stuff from my home life is leaking in. You know, and it's like a little bit harder to control the affect that I made, the second arrow of critique towards those things creeping in, you know. Yeah. So. Yeah. I have that happened when I switch from one patient to the other. Sometimes it's really hard, you know, when there's something stressful.

Oh, yeah. It just happened. You know, you can't really get back to yourself and put it away right away. And so sometimes it takes time to kind of like, yeah, that's interesting. Yeah. I see that happen. Yeah. I was thinking about the idea of integration, like helping someone be able to handle integration more and more.

And specifically the example that came to mind was like helping someone who's an addict who is part of a spiritual community where they keep those two parts of their lives completely removed. but I've seen like real change happen when you're able to help that person get to the point where they can find a safe person to share this other part of their life. And when that integration happens, I think there's a strength that comes with that that starts to to heal some of like the maladaptive parts. Yeah. Reduces the shame, right, that person is holding too. if someone can hold that part of them. Yeah. Okay, let's go to turning against the self.

Turning against the self. Jason Malo, you're up again. Yeah, this one's me again. You've got me again. Yeah, turning against the self. So this one describes a unique kind of displacement where an individual becomes their own substitute target for negative emotions about another person.

And it's like what the ego does is it literally like reverses direction of things. It does a 180 of external, you know, blame to self-blame. And it can present itself in so many different ways. Self-criticism, self-harm, feelings of real like, real like shame, feeling fundamentally flawed. Knowing this, right, as a therapist, as a therapist, as, for you, Jason, as a psychiatrist, knowing this, has it helped you become conscious of it when you do it towards yourself? Like, have any of you caught yourself doing this now that you're conscious of it? Oh, yeah. Like, I, oh, yeah. I think so. You know, I, I think it's, it's, there's

some irony, and sometimes, you know, I'll catch it after the fact. It's, it's really nice when catch it when it's happening, but, you know, I'll find myself so, maybe, you know, I'll find myself so, maybe flustered or frustrated by a patient I'm working with. And, you know, for those of us and all of us who work with patients who have severe mental illness, it's inevitable. Like, we're going to have strong feelings about them. And so anyway, it's just ironic when that comes up and I'll find myself, like, going out of my way to, like, maybe help a patient or call them or spend extra time with them or

something like that. And it's like, wait, wait, what am I doing? And like, I was so frustrated and angry and where did that go? And what did I turn this into? And now I'm meeting with this patient three times this week. And but, but yeah, when you catch it, it's, it's super nice. And I think, I think being in a place where, like, we have good supervisors or maybe colleagues we can trust in or maybe, you know, David, David, we're part of a group supervision,

like your group supervisions where, where you can. can process some of that stuff, I think it helps you get ahead of it. Yeah. It's really, it's really painful, right? When you take that anger, maybe the injustice, and you point it at yourself, right? It's like, yeah, it could be very uncomfortable. Okay, what would we say to a patient who we see them, maybe take some anger and point it at themselves?

You know, I think one tactic here could be something like getting your patient to try to get their observing ego online and think about like somebody else in a similar scenario. Like think about a friend of yours or a family member of yours who they're in the same exact scenario that you're in. How might they respond to it? How do you feel about them? How, what, would you have compassion for them? Would you, would you critique them as harshly? You know, an example could be something like you've got this patient who, um, maybe, maybe they've got a boss who's, who's super critical of them.

But, but then they find themselves being really critical of themselves and feeling like, I need to work harder. Um, I'm like, I'm not doing enough. I got to step it up. and then they're offered maybe promotions or something, and they give credit to somebody else, and you're seeing this happening. I think you could ask them to reflect on imagining somebody

in the same scenario that's not them, and what would you advise them to do or imagine how you'd feel for them? Yeah, that's great. I love that. You know, I've also found that turning against the cell sometimes functions in trauma survivors who have experienced a great deal of powerlessness. And if they make it about them, it creates the illusion that if it's about them,

then there might be something they can do or something they can fix. And so it sort of attenuates that feeling of powerlessness. Which is tricky because if you're the provider and you try to take away this defense too quickly, it can make them feel powerless and dissociate even more. Right, right. Yeah. Like I'm the perpetrator. It could also be like anger, guilt towards themselves for putting themselves in this situation, not speaking up, not telling the person to stop more. It also could be like blaming themselves for future stuff. So like I've had patience to say like every time I masturbate, I am abusing myself. So there's,

they are continually turning against themselves with what would be like a normal thing. So you could be from the trauma. So it's a trauma-based perpetuation. So, okay. Shall we keep going? We're going to regression with Olga again. Wait, repression. Repression.

Yeah. Yeah. Yeah. So repression is unconscious. blocking of distressing thoughts, memories, impulses, so they don't enter consciousness. And unlike suppression, which is conscious, repression is automatic. Outside awareness happens kind of very quickly. And the other thing is that the person is not choosing to forget something again. It again happens automatically. And I want to talk about example, repressed anger toward a parent. And I see it all the time in

therapy, and I don't know if that's related to repression or maybe something else is involved here as well, I'm sure, but when a patient says that they have a perfect childhood and describe, like, parent as wonderful, you know, yet sort of like maybe you know a little bit of sort of like story to it, and then the patient has some symptoms, you know, could be some somatic symptoms, you know, headaches, or it could be some sort of like anxiety or debility with authority figures, right? So that anger could be repressed and it's really, you know, I guess frightening to the patient to imagine that, you know, their parent is not perfect, right? So maybe there's also some regression links here. So that kind of like interesting example. So but the emotion will still

leak out, right? Whatever is repressed, it's going to find it way out, but it's not going to be that sort of like obvious. Right. And I think that our job as therapists just try to link it, you know. Yeah. So repression in your example, the person is repressing any negative feelings towards their parent. They're unconsciously pushing them down. It happens automatically outside of awareness. As McWilliam notes, something must first register at some level before it is cosigned to unconsciousness.

Denial is the more primitive form. where memory or reality doesn't even come to the surface at all. Denial is more of a wholesale refusal to acknowledge something. Repression is different. Something may register briefly. A fleeting thought or feeling is distressing, but it gets automatically barred from consciousness. That is what gives repression its neurotic level quality.

It's more sophisticated than denial, but it keeps the material out of awareness, often leading to indirect leakage. In your example, it's great because the adolescent or the adult is having some passive, aggressive anger come out towards authority figures, maybe even towards you, Olga. I can see that sometimes as a compliment

because you are the safest person of the room, the one whom they can begin to allow the repressed material to surface in the transference. That's often where the real therapeutic work, begins. Yeah, and I think, you know, maybe part of why they are not comfortable expressing the anger towards parents because they're anticipating the parent is going to react a certain way, you know, that will be distressing to them. And I think your job as a therapist is to kind of, like, be neutral and contain the anger, right. Yeah, what about with grief? How can repression be a part

of grief. Yeah, that after losing a loved one, someone reports feeling completely fine. Everything is okay and shows no sadness. And months later, they developed depression or unexplained fatigue, for example. I just had a patient today, actually, in therapy that lost his best friend to cancer when he was eight. And when he got the news, his mom actually told him. It was his mom, you know, my patient, and his sister who barely knew

that person who passed. And so when she told him that she passed, you know, both mom and the sister, they burst out in tears. And he says, I really, I didn't cry. I couldn't express any kind of emotion. And there was,

I didn't expect. her to die so suddenly. Right. And so years later, what we've been working in therapy, he has trouble being there for someone who is grieving. You know, his girlfriend recently lost her cat, and she was, you know, had extreme sadness. She was crying. And he said, I was really uncomfortable sitting next to her, you know, while she was crying, and I wasn't sure what I could do.

And I really wanted her to stop. and not in a mean way or anything. I just didn't know what to do with it, you know. And we kind of like went back to that, you know, when he was aid, and I think he sort of like dissociate from that, you know, repress the grief and kind of like didn't learn how to maybe grieve in his own way. So we worked around that. I think it was interesting, you know, how he repressed it throughout his life

and it still kept coming out, you know, in a way of this weird feeling that he was experiencing. when somebody was grieving, you know. Yeah, yeah. Yeah, somebody else is grieving. I'm feeling anxious. I want to repress their emotions too. Yes. And you'll see parents who maybe don't have as much insight as your patient,

they'll say things like stop, stop crying, don't cry. You don't need to cry, you're done crying, you know, don't be angry. But if you're not crying, it's also strange, you know? So it has to be like a normal, you know what I mean? Like if the kid is not crying when it's supposed to cry, something sad happens. That also, you know, parents are worried. Yeah. There was a time when I was repressing some sadness and grief.

And luckily, I had a therapist who was really helpful, just giving me space, right? But there were also other relationships I was in where I felt like people wanted me to feel. And there was like a pressure in that. One of the things I feel helpful with working with repressed sadness, repressed grief is sometimes I'll just tell people, like, there is no pressure to cry here. You don't have to cry. I don't think any differently of you. I would just love for whatever comes up to let it come up. I found that to be really helpful in my own life, but also for clients to let them know, like, I'm not looking for a specific response.

Like repression makes sense in your story. So let's just let whatever comes up come up. And if it's tears, it's tears. If it's not, then fine. In our session today, actually tears come up, you know, and a couple of times he couldn't really speak, you know, because of, yeah. But I like your, you know, approach too. Yeah.

I think it's like whatever they're feeling shame for, if you can lessen a shame somehow. So it could be dissociation. I feel guilty that I feel so numb and I don't feel anything. It's like, I want to be with you in the numbness. It's okay to be where you're at. There's good reason for why you're feeling this. Let's be curious about it.

Let's try to understand it. Let's see if we could put more words to it, right? So let's see if anything, other thoughts on other images come up. But yeah, I think the key point is, like, people are feeling what they're feeling. They're having these defenses for various reasons, probably reasons that we don't fully understand. if we fully understood, maybe we would have more compassion, maybe they would have more compassion for themselves. Okay.

Let's go on to the next one. Isolation of Affect, Jeanette. Right. I actually think this is kind of a cool one. Isolation of affect is just what the word says. Basically, it isolates feeling from knowing. In other words, it operates by altering internal process. and associative function so that thoughts are accessible. You can see what's going on. You can reason it

through. You can make good decisions. You can still function. But the emotional significance of what's going on is actually blocked. And so you might observe someone that the content of their speech might be emotionally significant, but that isn't coming through. Like the emotion is absent or incongruent with what they're actually talking about. It's a super useful adaptive function for anybody that needs to be able to maintain competence in the face of really overwhelming situations that would otherwise be disabling. You know, medical professionals, I think we've probably all experienced that we needed to use this defense in order to stay competent and coherent with our patients without being overwhelmed by what we're actually seeing or

hearing or being involved in. First responders use it a lot. You know, combat military members definitely use that a lot in order to stay competent without being overwhelmed. And so it can be hugely adaptive and functional. But when it becomes maladaptive is when it becomes rigid or pervasive or chronic and you know you're out of the crisis and you can't shift out of that you can't start then feeling the emotional significance or you know processing that it can show up then in trauma contexts where you know emotional numbing is one of the main symptoms of PTSD and so isolation of affect can lead to that where people just can't feel what they feel or you know feel what it was like to experience it. At the most more extreme level, it can contribute to dissociation.

It's also in terms of personality style or personality disorder, it tends to show up with the obsessive personalities, you know, where they've done some studies that show there's that people with OCPD have an attenuated access to their emotional states and they might be able to reason about them, but they can't actually experience it. And so, you know, there's the benefit that people are protected from emotional flooding, but it can be at the cost of feeling alive and being able to actually participate and experience, you know, life and liveliness. As an example, I have this, I have a patient that I see on a weekly basis, 50-year-old guy who went through just really extreme domestic violence when he was a kid. And he watched his dad break his mom's arm. And he stepped

into the role of protector. And his mom would always side with his dad anyway. And just a lot of horrific stories like that. And as he talks about it, he can describe how terrible he feels, but he doesn't actually feel it. It's like it's very mechanical in how he talks about it, very wrote, somewhat pressured, but the affect there, being able to feel the grief, the fear, the loss, the betrayal, all of that, he can't access that. It's very hard for him even to, you know, to taste his food or see colors when he walks outside, you know, a sunset or a sunrise, to be able to just enjoy a sensory experience or an experience of relational pleasure. And so, So, yeah, it has come at a great cost to him.

Yeah, really, really articulate. Thank you. Thank you for sharing the story and the details on isolation of affect. Yeah, does it bring up any other thoughts for anyone else? I was going to ask you, so you're saying that this patient could not taste food, you know, enjoy sort of like an outside, you know, certain things. Is it because it kind of spread that isolation of affect, you know? Yeah, it seems like he's kind of globalized it.

Right. And I think it's, you know, it's contributed to some lexathymia for him. Also, it probably, probably, you know, connects with anadonia somewhere too. But, yeah, for him to experience feeling or, you know, of emotion or even sensory experiences, like, has become threatening to him. Yeah. And he's forgotten how to do it. He's more... That's something we work on, you know.

Yeah. It sounds like almost like a dissociation. I mean, it's a slight, it's dissociative to dissociate away from your emotions. It's also very adaptive. The member that came to me was when I went to Haiti as a medical student between my first and second year. There was, I followed an orthopedic surgeon. And within one week, we did like, 50 surgeries. And I remember just feeling very like robotic towards the end. I mean, no painkillers in

Haiti. You know, the wards are all open. So the beds are like two feet from each other. It's a very different experience than in the U.S. And I came back and I had video that I shot. I shot video the whole time. So I had like eight hours of video. And I spent a lot of time going through the video and I felt emotions in a way that I wasn't able to feel it then. And I think this is, like, that was therapy for me to go back to the video and edit, make a documentary or a little mini documentary. It really helped me kind of come to more of the emotional experience, try to evoke the emotions and other people watching the video.

Maybe that were hard for me to even feel. And, yeah, I think. that it can be very adaptive as a first responder, right, to be able to claim that. I saw this a lot in COVID, in like nurses that worked in COVID units. You know, it's like in health professionals. And there was a connectedness between first responders as well that I saw like because, you know, because of the harshness of the conditions at times and the, you know, there was a shortage because a lot of people were sick. And there was an unknown of how deadly it was

when it first came out, right? And a lot of fear. So, yeah, I think these are examples of, like, it could be very adaptive to isolate the affect. It's so interesting, too, David, that you, I mean, when you were saying that with your experience from being able to, I've never been able to conceptualize

until you were talking about it with kind of then feeling these emotions after watching, The experience that you had with the surgeries, when I was in working within like psychoancology, we worked with patients going through treatment like chemotherapy or transplant and things like that. And they were not able to verbalize what was happening. Or they could not even, you know, they wouldn't work with a psychologist on our staff because they were not in the mental space to be able to do that.

But we got a lot of referrals to our team after treatment was completed, when they have gone into remission or when they have completed their treatment courses or gone through transplant. Because then now they're able to really focus and now they're feeling all of these overwhelming emotions of grief and overwhelm and distress when they were so kind of hyper aroused in a state during their treatment. Yeah. Yeah. I was going to say that as a therapist, I think it's important to really pay attention with how contagious the isolation of affect can be because it's very easy to associate with people like this, right? They're so separated from their emotions and they might even talk about emotions, but

in a really flat way that feels, as a therapist, it feels really very boring. deadening. And so it can be a challenge to just stay awake and alive and to really actually encourage your feelings and not just sort of this distance talking about what happened. Yeah. Right. Without actually feeling. Yes. Katia, I was just, you were just reminding me of clinically how this can come up where we're working with relationships or couples. And this feeds into a gender stereotype. But like where one of the partners could be more of a fixer or doer

and the other one more emotional and really trying to give some education or encourage each of the people in the relationship to see the other person's point of view. You know, I think it comes up in relationships where one could be holding not being more of the, I'm going to stuff these emotions and the other being, I'm going to take action here.

Right. The pursuer, withdrawer, dyad, you know, like the pursuer is putting their emotions right out. The withdrawer says, if I share these emotions that I'm having, it may be dangerous to the relationship, I'm going to hold these in.

And the pursuer hears that as like, they're lonely, they feel disconnected, They don't know where their partner's at. And the partner gets the message of doing it wrong. And then they get in this dance. And the dance becomes the attachment, dysphoria, the attachment. So, okay, let's keep moving so we can get through half of this. Intellectualization, Jason.

All right. So intellectualization involves retreating into abstract thinking, analysis, theorizing to avoid the experience of the emotional weight of a situation. So the person thinks about feelings rather than feeling them. Think of that as like a left brain fortress against emotional right brain experiences. Nancy states that intellectualization is like a higher order version of what we just talked about. So the intellectuals, the isolation of affect.

So the difference being person using isolation of affect typically report, like kind of just reports no feelings while the intellectualizer talks about feelings in a way that it kind of strikes us as emotionless, like kind of like reading a weather report. Yeah, or they could just move into the theory of emotion, right? Right, right. Let me tell you about the micro expression that I just might have flashed on my face. I'm an example of trying to engage in an emotional experience of someone with grief, You know, and they were like, well, I know there's five stages, and I think I make sense that I'd be in the depression stage right now, you know, sort of just like in this detached way.

Or there's five stages of grief according to the first theory, but I actually prefer the new theory where there's actually seven stages. And let me tell you why I think that's actually more advanced. Yeah, that's good. Sometimes, for me, at least, I get kind of allured to like, I get, kind of alert to like, I get, I can. get like drawn into their you know intellectualization sometimes and you know you want to like banter with them but uh you okay so yeah it could be a distraction right right a distract it's a wonderful way of avoidance for the anxiety of feeling right yeah um probably kind of common with um just a compulsive or high functioning depressive personalities you know it's like a really

good allows, you know, it's like a CEO, right? It allows goal progress in the face of sort of emotional weight or like public opinion, like a lawyer. It's adaptive as long as the feelings postponed, not eliminated. Obviously, it's maladaptive and it like, you know, you feel like a, you feel like a lack of connection with these people, with these people. People that go on dates with someone that's a heavy intellectualizer may say, like, he was very smart. He's very articulate, but I didn't feel a connection. I didn't, I don't even know a sense of who this person is, really. Let's all, what do you think? I was thinking that's a really nice example of actually a defense, right? This guy is so smart, but he's defended and it's protecting

himself, but it's actually totally a barrier. So I love your example in that way. It is a defense. You're trying to protect yourself from an experience and what you're actually feeling, but in you're protecting, you're hurting yourself. Yeah. Would this be considered intellectualization? So I had a therapy patient that was stage four cancer, so we talked a lot about death, dying. And he was talking about who he wanted to make decisions for him in the end. And he ranked family members like, okay, well, I will say my song first because he's in the army and he's seen a lot of things, like he's seen combat. And so he knows death. And then number two, you know, my wife because she knows me well. Number three, my daughter, because she's a social worker,

so she knows these sorts of things and, you know, gave a weatherman report analysis on family. It does sound like intellectualization, yeah. It sounds like, and not all intellectualization is bad. I mean, he may be making a good decision based on that. It's like sometimes you have to have that intellectual process and then like, well, what is your, like, say, right? What do your emotions say? So it's like a mixture of the mind, right, cognitive process and the emotional mind, wise mind. Yeah. It feels really close to that isolation of affect, really similar. Yeah, it does, doesn't it? Is that interesting? Is it a matter of degree that

makes the difference? This is where I think the affect is missing in the isolation. of affect. In the intellectualization, it's more of what they're doing. They're developing theories and ideas around the emotions or to even take themselves further from the emotions. So in one of our groups, LaTal was giving examples of emotions in like game theory and stuff like that. And I was thinking about it afterwards and I was like, well, this is not intellectualization because it's a way of trying to communicate her emotional experience, right? So I feel like intellectualization actually moves people further

from understanding your experience of emotions because it's so heavily intellectualized. You know, a lot of philosophy that's like very dry or it's very like, it's like people who have, it's like if they have strong erotic drives, the intellectualization of eroticism might not be anything erotic. You know, it could take them further away,

where a sublimation would take them into maybe dancing or doing something, you know, that resembles erotic. But the intellectualization, I feel like, can get someone further distant. So that's the way I understand it. That protects you from your feelings. I think even reading, you know, deep psychodynamic text, right? psychoanalytic literature, you might be thinking about really interesting and intellectual, even

philosophical ideas that are actually quite far removed from the emotions. Yeah, absolutely. Especially if the people are talking about like, oh yeah, this is the Etyple triad. It has nothing to do with the Etyple triad. It has nothing to do with like, but it's sometimes the big words almost distract, right? Or it's like the reaction formation and the egosentonic feelings of this person. And when I listen to all of those words compiled together,

I don't even, it's like, I don't even understand. And I've like read a lot of this stuff. So it's like, do they understand? You know? And if they don't understand, then is it like, is it a way of detaching from the distress? Maybe they understand, but they don't feel it. maybe yeah there you go that's that's the whole defense right yeah yeah thinking equals safety you know

i'm thinking about those patients who come in and use um medical jargon or the dsm lingo and you know someone was in my office the other day like telling me all about like i was manic and all i i i kept on coming back to this like just take me through more details here where were you like i just need more context here. And I worry, like, yeah, jargon can be, or diagnostic jargon can be picked up and used this way, like, intellectually.

Yeah, and I could intellectualize using the very words that we're talking about today to disconnect from the emotional experience, you know? Like, if I was just, oh, what you're doing right here, Jason, is you're intellectualizing? And that's really what's going on. is that a regressive voice david this is my regression

into nerddom when i was when i was not an athlete and i avoided p.e right those nerds are coming back when they're when they're lawyers you got me the tall you got me blushing here

oh my gosh i'm like oh i feel like what that felt like fifth and sixth grade you know awkwardness. Okay. Dina, let's talk about rationalization. Okay, so rationalization is essentially a cognitive distortion where someone would reframe their actions or thoughts to protect themselves from painful realities or unconscious conflict. So the motive of feeling is unconscious, but the person creates a conscious, socially acceptable, logical explanation to make themselves feel better or to protect themselves.

And it's used for protection from an unacceptable, maybe impulse or cognitive dissonance, internal conflict, to deflect responsibility for actions or outcomes and also for someone experiencing anxiety or shame. So there's a few different ways that rationalization works. So for the one of them is it's known as sour grapes, right? So that's when a person devalues what they can't have or can't achieve. So they'll say something like, I didn't want that promotion anyway. Or if they wanted, let's just say a house that they didn't get. They would say, or they couldn't afford. They would say, well, that house is too big for us anyway. And the sour grapes comes from Aesop's Fable, Aesop's Fable, that where the Fox was like

reaching for the grapes and wasn't able to get the sweet grapes. So the Fox just says, like, I don't want them anyway, right? So that's just an example of one way of using rationalization. Another is known as sweet lemons. And this is where it's a kind of self-deception where a person, like, to obtain comfort and accept reality, they use a more optimistic approach, right? So they'll, that's when something bad happens and then they'll, something bad will happen and then they'll make it okay. So for example, something bad happens and they'll respond like, well, that was a learning, you know, that was a learning experience or if they break up in a room have a breakup in a romantic relationship they'll say that that breakup was great i didn't really like that person very much anyway or we were very different

something like that rationalization also can be used to justify a behavior um or to put meaning to a behavior. So it can be good or bad. So oftentimes someone won't be able to maybe justify doing something good, right, for themselves or unless they give themselves good reason to do it. Or they can do something not good. Like for example, someone that, a parent that hits a child and has a lot of aggression and says, well, it's good for the, it's good for the child, what I'm or let me think what else. They can eat junk food, for example, and say, oh, life is short. I deserve to enjoy what I'm eating.

So they'll justify what they're doing. As far as a defense, you know, it's considered more mature because although it's unconscious, it does involve some contact with reality and logic and reasoning and also to understand like what's socially acceptable. They have to have some insight to do that. As far as clinically, it can be a way of not, you know, can be used to not take responsibility. Let's just say a client that misses appointments or is resistant during sessions, sometimes defensiveness, so that they don't ever have to really explore the core issue.

it can impact, you know, trust. And then also it's very important as the clinician to not start to believe, like, if you start to, like, use the rationalization, it can also not help the patient because it's like they're not going to get to where they need to go and what they're trying to, the internal, the internal. root issue. So it's important as the clinician to maybe notice patterns and bring that up or to, you know, explore the underlying conflict or something like that, if that should happen. So the defense can operate benignly when it allows someone to make the best of a difficult situation, but the drawback is that it's a defense strategy that virtually anything can can be and has been rationalized. So it's good and bad. Like the sweet and the sour. So that's too much and too little. You know? The soup is the soup is too hot or too cold. Right.

Yeah. Yeah. And I great job by the way. Great job going through that. Really like how you separated that with Asap's Fables and stuff. That's good. And you could see how someone would be pulled into this, you could see how, like, we all are. We all rationalize. I was even thinking, you know, with the breakup thing of like, oh, you know, it was a learning experience. It's like, yeah, I mean, maybe it was. And maybe that's worth emphasizing thinking about what are the things that have been learned from it. Or after like a kid's sporting thing, after one of my kids sporting thing, it's like, they lost and they're disappointed. It's like, they're disappointed. It's like, well, okay, here's the things that went well, and here's, like, you know, takes time to get

better. And so we're going to work on this, we're going to work on this. And, you know, like, I don't know, is that a rationalization? Maybe that's not quite a rationalization. Or maybe if the rationalization would be lessening the blow of the loss, you know, instead of like sitting in my kid's disappointment, it would be like, no, this was great. You learned so much. Yeah, that would be rational. Yeah. It's. It was a learning experience. Like you can, even though you feel bad, you lost, it was a learning experience. I've heard sometimes someone will say to someone after a really bad breakup, like, well, dude, you dodged a bullet, you know, count yourself lucky.

Seems like a little bit of the sour grapes. But maybe they did dodge a bullet. Right. Maybe they did. Maybe they did. It might be true. Yeah. Well, I think the point is to not have it repress the feelings, right?

So it isn't that it's a problem to have to use one's intellect, right? To make sense of it or to make the best of a bad situation. But the problem is if you're trying to fast forward the feeling, right? The disappointment, the pain, the hurt, the tears, all of that, and then jump straight to, oh, don't worry about it. You know, you dodge a bullet, right? That's great. I was rationalizing the rationalizing and Katya just cut it to the core of like... I cut you that.

Good job, Katia. She went straight into the higher reflective function position of like, no, you got to like sit with the grief. You got to sit with the emotion. I thought Nancy Nick McWilliams, she gave a really good example in her book where a therapist is insensitive and raises a patient's fee and then rationalized. the greed by deciding that by paying more, it'll benefit the patient's self-esteem. Yeah. The patient will feel better about themselves. What?

Oh, the patient will feel better. Good, Katia. Well, Dina, I was also thinking about how I'm going to be talking about moralization, and it's a really specific kind of rationalization you touched on some of the issues where it could be a sort of a moral issue, like, oh, well, actually, this is going to be good for the patient, right? When actually, you know, you just want to raise your fee. Right. Or like if you're morally corrupt, you then would rationalize. Why don't, because there's so similar, Katsya, why don't you go through moralization now?

Sure. I'd be happy to. It's, yeah, we've warmed up. And it really is a very specific type of rationalization. So there's quite a lot of overlap. It really, the point of it, well, like a lot of unconscious processes are to protect from painful feelings like shame of behaving in a way that's hurtful or selfish. And to maintain a narrative that one is not a villain. So a benign example would be similar to what Dina was saying, you know, like I steal my roommates left over birthday cake. like, oh, it's for his own good. He's on a diet. He didn't really want to eat it. It's for his own good. So, you know, this sort of relieves a little mild guilt. It justifies a little misconduct, but it's all fine. But then there's really much more traumatizing ways of using this

moralization defense. And so jumping straight from the benign a little funny is, you know, it's a really typical example of justifying sexual assault. And so from a person, perpetrators' perspective, you know, the unconscious moralization would be, this would be the stance. It would be something like saying, well, this is socially acceptable. So, for instance, a man feels entitled to claim that a behavior, a sexual assault is normal or ordinary or understandable because, for example, you know, I paid for a date, we went out for dinner, of course, I'm entitled to have sex. Or, you know, the shifting blame to the victim, that's another type of way of, say, of moralizing one's behavior and saying, well, she clearly invited

it, she participated. She actually wanted it. It's almost like it's for her own good. I mean, she was wearing, you know, provocative clothes. I just did what she wanted to. Almost, almost like justifying to himself, and I'm using himself, but because that's usually what happens, justifying that it's almost, almost a favor. Or another type of moralization is to say, well, is to not have a malignant intent. And so saying, well, things got carried away, but I didn't mean to hurt her. I thought she was into it. The other really big one is a moralization by saying, well, everybody does it, right?

A group think type of mentality. And so for a pedophile to say, well, it's normal for grown men to like younger women or even underage girls. And so to justify that or horribly in wartime sexual assault, it's, you know, that type of behavior is so pervasive that it can be explained in the way. So the treatment for that type of moralization behavior, whether it's more benign, you can kind of let it go and have a laugh. But if it's more severe, you have to really try to get to the shame and to address some of these ways of splitting off, well, a lot of emotion, but also the splitting of good

and bad, which is a part of moralization, and to really shine a light on this shame. And then, ideally, to understand and accept it so that amends can be made, some type of amend. Yeah. I was thinking about the pedophilia one. We did an episode on this with Cummings a while back, another episode with some forensic guys. Some of the beliefs that they have is like, you know, the kids enjoy sex, kids are sexual creatures. It's a form, you know, kids wanna connect through sex. And it's like these cognitive lies, these moralization lies allow them to maybe exculpate

their own guilt, right? And so it's like, no, that is not reality. Like that is a lie and you, guilt is actually teaching you something, right, about your values and that you don't really value doing that. And so the guilt is underneath. The guilt is sometimes hidden. And sometimes they, you know, people turn to alcohol or drugs or heavy benzodia use or heavy, uh, sleeping medications to deal with the guilt, so they can cope with the guilt. And it doesn't really quite ever leave them. So they have to numb it somehow. So,

something I've been thinking about. You know, it's quite possible that, yeah, anyways, I could go on. So moralization. Any of you guys, anyone else have any thoughts? Come through your mind as Katia wonderfully goes through moralization. I don't think this really adds to the discussion much, but I just think of the moral, with physically abusing kids, one thing I've come across,

heard of is people defending it by saying like, oh, I'm teaching this kid how to fight for themselves and to be stronger. It's just building their strength. Yeah, there's no data to support that unfortunately, you know. So, unfortunately for that, for that person that's lying to themselves with that moralization. Or they'll use like some spiritual verses to support their, you know, actions or whatnot, but they're cherry-picking, you know, whatever spiritual discipline that they're going through. So, yeah, I've had debates with people who believe, like, it's, it's the best parenting method to spank your kids. And, you know, I've debated them and said, no, the data doesn't really show that. That's not, that's not actually, like, the best way of doing it, you know?

Like, corporal punishment doesn't really work. Or sometimes they'll use it to, they'll shame somebody, right? They'll shame someone and then let's just say what they're eating or something. Like, oh, I'm doing it because I'm helping them with eating healthy. You know, but if something comes out and it doesn't go well and they'll... Yeah, no, actually studies show if you shamed an alcoholic, they drink more alcohol. and they don't drink less alcohol, right? If you shame someone with, shame doesn't move people towards mental health.

No, but I'm saying the person that would do that, they can use moralization to justify, like, what they just did. Absolutely, yeah, I know, I'm agreeing with you. I'm agreeing with you. I know you're not validating that method. Yeah, no, no. When I was reading about motivational interviewing, I read that they did this study about like shame-based alcohol reduction.

It actually drove people to further drink, you know. Yeah. And, yeah, it doesn't work. It's like if you're depressed, I could shame you out of your depression. No, that's not going to work. That's actually going to push someone further into the depression, probably. Natalie Dreyfus, can you tell us about undoing? Yes.

So undoing is a defense mechanism where a person performs behaviors or mental acts to symbolically negate, reverse, or undo a previous thought, feeling, or action that led to some affect. Usually this is anxiety, guilt, or shame. Unddoing primarily affects observable behavior rather than internal perceptions, making it distinct from something like reaction formation, in that undoing is performing an external action after the fact to magically erase what happened, trying to cancel out this feeling, versus reaction formation, which attempts to transform feelings internally, trying to mask the feeling. So I like this example, because it just really simply put this, when we think about undoing,

it can be thinking about trying to unsend a text message, except the person believes that if they perform the right ritual, they can take back not just the message, but the thought or feeling behind it. Undoing exists on a spectrum. So it is a normal human experience, but it can be problematic when it becomes rigid, time-consuming, or causes distress. And we see it, and it's most clinically relevant

in things like obsessive-compulsive disorder and borderline personality disorder. Treatment like psychotherapy can help develop more flexible, adaptive ways of managing anxiety, and the goal in treatment isn't to eliminate the, defense. Because again, this is a normal human experience, but rather shift it towards more mature ones like suppression or humor. Great. So reverse, cancel out, neutralize a disturbing thought, impulse feeling or action that causes guilt, anxiety, or shame. Anyone have like an

example that comes to our mind of this in BPD? Or go ahead. Oh, sorry, I had an example. I said, I thought it was in Nancy McWillow's book or maybe somewhere else. The husband sort of cheating on his wife or flirting with someone coming home and kind of showering her with, you know, love and care and sort of like, yeah, is that that? Okay. Yeah. So maybe it could be a lot simpler. It could be like they have like some attraction to some other person, right, that feels overwhelming. and then they come home and to undo it,

to cancel it out, to reverse it, to neutralize it. They do this kind of behavior towards their wife, maybe bring her flowers. Right. Or some ritual. Yep, Olga, it was like this, they had the conflict the night before. And then the spouse was coming back

and giving the wife flowers, trying to undo this conflict or feeling guilty. for having this big altercation. So, okay, like, how about an OCD? So OCD is, and doing is the actual compulsion. So it's that compulsion of ritualistic behavior that temporary relieves obsessional anxiety. And so thinking about OCD, there can be like a 45-year-old accountant who has fear of contamination. It's a common one. But after touching a doorknob, the patient washes his hands in

specific sequence. So he will apply soap three times, water temperatures adjusted to lukewarm, he rubs his hands together for 30 seconds, and then dries his hands with exactly four paper towels. Now, if any of these steps feel wrong, the entire sequence must be repeated. And the lashing ritual, so it's unrelated to the actual hygiene of washing his hands. It's the washing ritual is undoing the fear of contamination and that anxiety around contamination. So someone with like a pure O, like a pure OCD, primarily obsessional, they feel they need to mentally behaviorally reset their day after they've had some sort of bad thought that's contaminated it. So they may do this by repeating prayers, mentally erasing the thought. starting routines from the beginning to achieve a clean state.

So that's another example. And that would be also considered undoing, right? Because it's not, just because it's not externally. Right, yeah. A behavior. Okay. I think so. Okay.

Jason Kent. Let's talk about displacement. Right. So displacements, the defense in which a feeling of impulse drive or behavior is redirected from its original target to a safer or less threatening substitute. So it's kind of an unconsciously saying, I can't direct this feeling here, so I'm going to direct it there.

And why do we do that? It's sort of directing the motion towards the original target would produce anxiety or fear, potentially of retaliation or abandonment. Maybe like a, you might have anger towards a parent, but it might not feel safe or guilt, guilt for being angry at someone you love or perhaps some helplessness so a classic example which nancy puts in there too is the individual has a bad day at work it's yelled at by his boss

goes home and yells at his spouse who turns in turn scolds the kids who kick the dog and the dog takes it out in a toy just constant displacement down the line but maybe more appropriate example for therapy, you know, maybe someone's processing or experiencing a great deal of grief, but they've targeted the hospital or the doctor or the health care system. Nancy points out to the maybe when there's been an infidelity in a relationship, the betrayed partner will direct the anger at the other person instead of the unfaithful partner. I've seen that, yeah. Yeah.

And then the family, she mentions the, but when family systems, the idea of the triangulation, so maybe the tension between parents gets just shifted to the, to a third of the child, which of course happens quite a bit. And then there's the sexual displacement or like this, sometimes the fetish of a fixation on feet is a redirected erotic interest from the genitals that might have a, invoked anxiety from historical fears of castration or, you know, maybe a parent, like, made that part of their body fearful.

Interesting. Does, is scapegoating apply here? I could see how it would. The way, you know, you're describing it, Jason, that, like, you know, when people are unhappy with whatever life circumstances, pick out the faulty party and blame that. I could think on an individual level or even like societal. Like, oh yeah, like things are really bad. If we just took care of this group of people,

like everything would be better. Right, right. Like a very safe target, right? It's not, you don't have to, no consequences there. I think that would fit because you're, displacing a feeling impulse drive or behavior from the original target to a safer or less threatening substitute, right? So the scape goat is the goat.

The goat takes the blame rather than the person for their wrongdoing, right? So, yeah, I think that would work. It can show up too, like just in a session where maybe someone's, maybe a client's actually kind of angry with you, but they're not sharing that. They're pointing out their anger at like all these other people. Or they could be displacing their angry from other people onto you as well.

Right, right. Probably more common. Yeah. So maybe like, maybe you deserved 3% of the anger of their, but you got 100% directed at you. Good opportunity for noticing the transfer. France. Yeah. Yeah, I've seen it from like the boss example. Like guy gets, you know, gets beat up by his boss, comes home and just tears into his wife. It's just really, really nasty displacement, just awful. So obviously very maladaptive in that text and in that sense. Okay, what about reaction formation? Chris, talk to us about reaction formation. Yeah. Well, reaction formation is when someone is dealing with an emotion unconsciously that might feel threatening to their self-image or to an important relationship and they turn it into the opposite feeling. Right. So probably like a classic example would be someone harboring a lot of anger and resentment towards a coworker. Right. It's kind of.

of undelt with disavowed underneath the surface, but on the surface, it looks extremely kind, like overly accommodating, right? So almost to the point where it feels fake. I was even thinking about, you know, a recent client that I had and just the, that when they first came in, they were describing their marriage, right? And it almost seemed too good to be true, right? It's like everything they said about their spouse was everything was perfect right and so it put me in a weird position where I'm thinking like this doesn't seem

something doesn't feel right here right so this is like the classic alarm that reaction formation is present when things just feel too good to be true sure enough after about a month or two this person starts to uncover

some deep resentment and anger and rage they had towards their spouse and so much so that they felt like they wanted a divorce, right? So three months difference started with this person's perfect, right? They could do no wrong. Three months later, it's like, I want to divorce this person, right? Because for the first time, they're uncovering all of this anger that had been sitting under the surface. Right.

So the reaction formation was from idealization, right? They were hiding the anger with idealization. Yeah. And when it comes out, it can come out very, it can swing the other direction sometimes, right, where it can go from 100% love to 100% hate. Yes. Yeah.

And the way, thinking about the way to actually work with someone who is displaying reaction formation, is to just give them space, right? So I didn't really have to do much with that client. It was just giving them the space to really open up and figure out what might be underneath the idealization, right? I didn't tell them, right? You have the defensive reaction formation. I noticed it, but kind of let them wrestle with it a bit and kind of guided the sessions to the point where it became clear.

They didn't feel like they could hold. this, these good feelings they had towards their spouse with the angry feelings they had towards their spouse. So they had to just hang out in the idealization area. I think also it could be like

a momentary thing. So maybe a more normal, neurotic-oriented person would have like some anger towards their spouse and instead of being angry, they would go kind of clean the dishes, right? It would go clean.

It's a loving thing to do potentially, and they're doing in the midst of anger, which is kind of counterintuitive. But that's a reaction formation as well. Yeah, any of those simple ones that you guys think of when do you think of reaction formation? I always think of like the little kid who's super jealous of their sibling and really wants to shove them, but instead goes to hug them, right? Because it's like unacceptable to shove your little brother or sister. but sometimes it's not the nicest hug either or sometimes it's like too much hug you know it's like the hug that never ends uh ogah what was your thought someone who's attracted to this you know same sex sort of like you know it's like this classic

example and then kind of like repressing you know their own um sexuality basically and so that in a way that they oppose it you know and sort of like maybe joins some kind of like anti-homosexual movement or stuff like that, you know, and kind of like very vocal about, you know, not supporting it, but kind of like deep down they're actually attracted, you know, to, you know, same sex. So I was thinking that that was reaction formation too, like in a very extreme form, I guess. Oh, I think about like the, I mean, there's been some public cases of pastors who like are, who yell vehemently against, you know, homosexuality.

And then it's like that is the reaction formation against the desire, right? That is, you know, and the further unconscious these things are, the more dangerous they are, right? So if someone is very unconscious of it, then, and they're acting out it with very low insight, that's when they can then impulsively go the other direction in a way that could blow up their life rather than it just be like holding a fantasy and then holding the fantasy of both sides because that person is

is acting upon in a way that's very destructive sometimes if that makes sense yeah instead of just allowing a feeling to be present it's like you you can't handle that right so you have to keep it out of your awareness and allow the opposite to take precedent like you're saying it's like homophobia versus saying i have an attraction to the same sex it's like you can't admit that so it turns into homophobic tendencies it's like you're undoing it in a way you know so like yeah like extreme you know way of undoing it maybe the undoing would be going on X and posting a mean hateful tweet, you know, to show how much you don't align with

this issue. It was interesting because when I was looking at like undoing and then reaction formation and the distinctions between them, I was reading up on, and I forget where I thought, but there was a school thought of like some individuals or some providers think that reaction formation is the first hoping mechanism or second or first defense and then when that fails undoing can become the one that they rely on. And I think we're going to just be distinct that this is like unconscious, right? Because if you know that you're putting something out there that is harmful to a person or a group

of people, then you know it. And it's no longer this defense, right? once it's a conscious action. You can't just be like, oh, I'm self-aiding or I'm just about this part of myself because now you're conscious, so you don't get to fall back on kind of like defenses, your reasoning.

Once you know it, you know it. Yeah, reaction formation is unconscious. So, yeah, I don't know. What do you guys think? Would it make sense then? Like, if you know you have attraction to the same sex, Could that be?

No, because once you know, and you're doing, if you're conscious, and I don't think it counts, you just, you can be a self-hating gay. Well, maybe you don't hate that part of yourself. Right. But if you're now just like kind of bullying other people or punishing other people for how you feel about yourself and you know this? Then that is, then that is, acting upon with a hateful, hatefulness, yeah, I agree.

Yep. Okay, let's keep going. Identification, Amanda. Yeah, I was actually going to, one of my examples for identification, I was going to tack on to Chris's reaction formation, because Stockholm syndrome, and I'll get more into the identification with the aggressor, but I was thinking, is that a form of reaction formation? Stockholm Syndrome's complex.

I mean, I imagine there's a lot of defenses at play. There's denial, right? True. It is kind of a more psychotically oriented reaction formation. Like, there's a lot going on there, right? It's a complex behavior. So Stockholm syndrome is like if someone was like abused and then goes back to the abuser. Right.

And so sometimes I've heard this happen and then the person feels a lot of guilt. Well, why did I do that? I don't understand why I did that. So they're unconsciously driven sometimes back to the abuser. And so it's like, well, why were they driven back to the abuser? And in that way, it's like maybe the hatred towards the abuser turns into love. Right? That would be the reaction formation.

but I think that there's a lot of other primitive things there too dissociation they could dissociate the bad out the bad memories out they could deny the bad memories they could remember only the positive if there was positive uh there could be a uh so there could be like an idealization you know like an abusive sadistic person demands a level of idealization or the person is very much abused and so There could be like a forced, kind of like a programmed idealization of the abuser. There could also be fear of death,

fear of like something bad is going to happen. If I don't, right? So there could be like a, sometimes abusive people, in a way, program people to believe that bad things will happen if they ever say anything or if they ever leave the person or, you know, like, so there's also like going to the most, feared object the most feared object is the object to be worshipped in some people's psychology so if they feel that the abuser is the most powerful person in the

world type of like belief it's a belief right it becomes a belief out of the trauma then they could want to join the abuser until until like they wake up to that not being not being reality not being the case not not not being helped you know it's so toxic for them that they are psychologically falling apart I'm thinking of that case what was like I'm having a brain fart right now the case years ago with the young girl that was kidnapped by the two it was like a couple I can't I'm blanking on her name I don't know I even in the Epstein files I've I've heard of this happening in the Epstein files and so this is where it's really convoluted like is this person

someone who was abused or is this person who was helping Epstein now hurt other people? Are they helping Epstein abuse other people consciously? Or is it because they were

in kind of like a trauma-like state where they were fearing for their life? So this is that kind of like complexity. Jason, you were nodding your head. Well, I was wondering if you might be referring to I think it's smart

like yeah yeah yeah yeah yeah yeah and uh a documentary was released on one of it's streaming somewhere right now recently released and um I was fascinating about it is um the interview her a bunch and she's she's on she goes she's on the presenting circuit

but anyway uh I was I didn't get the impression that Stockholm syndrome actually applied to her but it was at risk of that happening and but it's almost like a compartmentalization sort of happened and this woman like survived disappearing for a couple of months with two abusers who took her from her home and she was found but um she her her identity didn't seem to be super rattled and my hunch is she got she got

a bunch of good psychotherapy what were her feelings towards her kidnappers i'm actually really curious. I'm going to look that up after this. Yeah, you're going to stream it. It's all on there. Okay. But it reminds me of turning against the self a little bit, too. Like, this is such a complex thing. I appreciate it.

Where, too, like, yeah, if you can't win, beat the aggressors, like, a possible outcome could be, like, you beat up on yourself instead and you just become defeated. Yeah, so many of the defenses are just so intertwined. it's so complex. But anyways, we kind of went deep into some of identification, but in the most simplest terms, identification is the ability to identify with another person or aspects, traits of another person. And like any other defense, it's an inherently neutral process, and it can have positive or negative effects depending on who is this, the object.

of identification. So I think like in mainstream language, you know, we say, I identify with this person that's a mentor that it's usually in a positive light. But psychoanalytically, we usually think of identification that's more motivated by the need to avoid anxiety, grief, shame, any of the painful affects in order to restore that sort of threatened sense of self. and promote self-cohesion and self-esteem. And in Nancy McLemam's book, she talks about how Freud, he was the first one that defined a non-defensive versus a defensive identification, so the positive and the negative. I'll go into the negative.

We kind of did a sneak peek with the Stockholm syndrome. But he basically said there's elements of both like a straightforward of, that taking in what is loved, like you identify with your parents, your primary attachment figures initially. And, you know, it's very simple. Like, I want to be like mom or dad. And you want to achieve closeness. And then a more defensive operationalization of that would be kind of what Dr.

Peter was saying. Like, I become the feared object. If I become them, their power will be inside me rather than outside me. So I possess that. So since I'm a child psychiatrist fellow, I'm always thinking developmentally. So I kind of think of identification. I'll explain it chronologically through the lifespan. So like I was saying, first identifications when you're a child.

with your primary attachment figures, and you kind of become like this hybrid person, kind of taking little bits of people that you, like mentors, throughout your life. And so it becomes kind of like a nuanced, mosaic person that you become is how I think about it. And it, positively, it's, if you think about it, it's the basis of empathy being able to identify with others. and Nancy McWilliams gives the excellent, the biggest example of therapy. So the propensity of the patient and to identify with the therapist is what is the magic secret sauce in therapy. And having that reparative relationship with the therapist. So those are the positive examples.

I'll go into the kind of Stockholm syndrome. talking about. So that is what Anna Freud first described as identification with the aggressor. And I never understood that term until this class. I'd heard it and then it finally stuck. So that's kind of the defensive identification where you identify with the bully, the aggressor. You consume them, you become them. You take it inside. You internalize that. That representation. presentation of them become them. And so, like, an example is, like, the child abuse, like, parent abuses kid, kid goes and bullies kids at school and then grows up and becomes, or and then abuses

their kids subsequently. So it's the mechanism of which, like, intergenerational abuse continues. which I'm actually doing an episode on like kids that were sexually abused and the rates of future sexual abuse. And it's actually, it's like it can be as low as like 3% in some studies. So this is, it could also be, abuse could also be stemming more from other personality pathology that's unrelated. Like sadism and psychopathy and, you know, stuff like that. They were talking about psychopathy, how I read somewhere where it's like a failure of identification or you don't identify with the values of society or something. And then that's kind of a trait of that psychotic personality.

Right. The people they maybe look up to are the least savory people. Yeah But identification with the aggressor I'm so glad that you figure that one out I know it was like Very very helpful Yeah

adopt and imitate internalize aspects of the aggressor internalize you know adopt parts of them like the the bad things that they're doing they see themselves it's either doing the bad things in fantasies of their mind

or in actual or like I am I am the abusive person. You know like you see it a lot in therapy with, you know, somebody who's maybe grown up in a very critical environment and the person goes and really internalize that aggression. And then what you see in practice is somebody who's always feeling guilty about anything and always kind of really hard on themselves, criticizing them. And, you know, I'm thinking a lot of times it's a real identification of the aggressor.

They've really sort of internalized that critical voice and they're constantly putting themselves down, making themselves sort of pay. Katia, amazing, yeah, very good. Yeah, because they, it was adaptive when they were younger, weren't necessary for them to survive, yeah. Totally adaptive. Yeah. And it's actually adaptive even as adults, right? Because people who are following the rules and doing everything right are generally widely beloved, right? But they suffer internally.

Good point. You'll see this sometimes, like, I've read some stories of true crime. Like, you'll get like someone who's doing a lot of criminal activity at a very young age, 17, 18, 19, and their dad was a con artist. You know, and so they were watching their dad do this, their whole childhood, right? They're sort of absorbing that. They identify with it. They go on in that criminal sort of behavior, criminal acts, right? You can see it in Colts.

I think Amanda, are you going to talk about that at all? Oh, yeah, Colts. So that's a big example that Nancy McWilliams adds. How others I kind of spoke about this defense is used to kind of build that self-cohesion, that ego identity. And so people that are more easily influenced by others. or have some, like, identity confusion are prone to, you know, joining cults. And, yeah, going back to kids, like, from an Ericksonian perspective, like, that time when their adolescence is when they're developing their identities and their ego identity.

And so, adolescents are really impressionable in that regard. Yeah, it's like people with the identity diffusion, they're like almost like stem cells for if they're put in a good environment, you know, they may adopt a lot of that good. If they're put in with like some very abusive person, they could become a counterpart of that abusiveness, you know? And so, yeah, it's really, you know, what makes me think of it in like, like, the stem so example like in pop culture you hear you hear like some very narcissistic grandiose personas

online and it'll be like oh yeah I like to date girls when they're like super young and blah blah right like and they'll they'll say so I can mold them how I want them to be and that like and they have a track record

of you know a wake of destruction behind them interpersonally right So it's like, it's cringe for me because I'm like, yeah, and then I'm going to be this therapist trying to put together, put these people back together, you know, or like training therapists that are putting these people back together. So, yeah, the identification is dangerous, right? When you're young, when you're impressionable.

And I think talking about it, putting it out there, developing a knowledge of it, it gives us power, right? Think twice. when we think about who we want to consume, who we want to kind of like allow into our brain waves, right? Yeah. One thing I wanted to ask everyone is the difference between interjection versus identification.

I couldn't, Nancy kind of mentions it in the book, but I can't figure out the nuance difference. I think she described interjection as like the precursor to identification. But it sounded similar to me, like, interjecting, like, taking internal representations of others when you're younger, kind of consuming that. So are they interchangeable?

So the way that I see it is that interjection is a much more primitive version in which you swallow whole all of the things of the other person, their ideas, attitudes, judgments, standards, values, all of them. You, you, you, you, you, you, you, you, you, you, you, you, you, you, you, you, you, you, you, you, uh, becoming like, like, uh, I have a lot of identification with Dr. Tar. I differed in some things, right? If I was maybe more primitively oriented, I would interject and I would almost sound like Dr. Tar in all of my answers. You know, instead I take in little pieces from different mentors throughout my life, right? I interject. Identification.

I have identification with various mentors. And that's a good thing. some mentors I know in person some I don't know in person that's a really good example of like what it looks like from a healthy perspective and from an unhealthy dysfunctional

perspective yeah it's like when people become almost the other person like you said like their tone of voice everything that's the defense also like I think interjection you end up with a lot of these

shoulds right and it's like a super ego structure. So for example, if you had a strong interjection of Jonathan Shedler, anytime you broke the frame, you would be crippled with guilt for days, right? Because you've gone against your favorite interjection guru. Whereas there's like, you know, the good side would be to adopt a lot of the good

and to appreciate the good from different people and different styles, right? So when I would watch video of residents, I never expected them to have the same verbiage, the same style as me. I wanted them to have empathy. I wanted them to have, you know, but for different people, that looks differently. For some reason, it came to my mind. I don't know if you know, Josh Shapiro, who is like governor of Pennsylvania, who sounds and acts just like Obama. Oh, clearly is the same, like, you know, phrases, just like.

Obama. You know, it's like, so definitely kind of interjecting a lot of Obama. And then

sometimes I think to myself, what's going on with America? And I pause like this every couple seconds.

You know, and if you do that, you know how to capture someone's attention. You string words together just the right way.

We're not blue states or red states. We're the United States. That's really good. That's good. I haven't practiced that, so I'll practice it. We can do a role play.

I'll be Obama. You be a therapist who's pretending to be. Yeah, okay. Yeah, it's like, it's hard to know, like, okay, does this guy just love Obama? And he's like, listen to Obama on repeat hundreds and hundreds of hours, right? So, sublimation. Letal. Okay.

I actually want to take a pause because we're doing mature defenses, and I want to recognize that these are, these drives, these negative self-states that we can see without any distortion. So we're working on them or trying to work through them, but we're doing it clearly. So different than some of the examples, we can be totally aware with. mature defenses and sublimation falls into that category. Consciousness. And so now I'm fully mature, I want to start with an illustration of a guy we all think of as really well put together. And I wanted to just start with Batman. For those of you who don't know who Batman is, he's a superhero without any superpowers living in the city of Gotham,

which is in comic bookland, and he has a really traumatic childhood where he witnessed his parents being murdered, right? And right there, we feel his helplessness, he feels helplessness, lack of control. As that develops, you can imagine rage-building with this guy. We can imagine, like, a desire for vengeance, totally brewing with that kind of loss.

in that kind of circumstance. And rather than identifying with the aggressor or totally falling apart with this loss, he's able to sublimate it, right? He's able to take it and focus it into something that is ultimately considered to be pro-social and that is taking out bad guys. So the lack of control,

he is so regimented about these workouts if you ever see a Batman movie this guy's working out no matter whose adaptation he is all about the science has to have the best tools and best weapons costumes whatever it is he wants to make sure he is not going to let this happen again

and that rage also comes at we see him throwing guys through brick walls we see him destroying lots of Gotham city. But the thing behind it is to try to make the city better and life safer for people. That is the sublimation aspect of it. And that really connects to what Freud saw about this defense, is that it can actually bring civilization forward,

not just the individual forward. So it's not unique to Batman to feel. rage to feel that the world around you needs to be put in order. And for you kind of credit, sublimation with a lot of government, with religion. Like, these are ways that people have taken these similar feelings and not just move themselves, so it moved everyone around them forward. And I kind of want to go back that, like, I picked Batman because we can see him in a black and white world. Like in his representation, none of these bad guys have their own trauma history. They are all just like bad guys.

Like no one had absent parents. No one's like hungry and doing crime for that reason. Like we can just see it as moving society forward. We don't have to see it complex. That was my example thinking. And so we are transforming like potentially very harmful, potentially very devastating drives into something that is progressive. of

yeah like dancing sexual tension right and the young person becomes dancing something like that right

I think like the classic examples are always like you have this desire to hurt and you become a surgeon or a dentist

like that's usually what you see in like the board review books we see that come up a lot right and that's

hmm it's kind of dark not everyone who wants to become a surgeon does that Not everyone, no, no, no. But I love your example of Bruce Wayne and Batman.

That's such a good example. It's such a good example of turning that anger into like, I'm going to make the world a better place. I'm going to fight for justice. Yeah, that's good. That's connected to because his parents, I didn't know that part, by the way, that died from the criminals, right? So he's kind of like trying to, yeah,

undo that a little bit. Yeah, there's some undoing in there. There's a ton of defenses and they go through. But I think of, I think of like some groups like there's a support group that, of mothers who have lost kids to overdose with drugs and then they unite to develop a support group for other parents who lose their kids. that feels like a really good example of sublimation too, of taking, you know, that grief and loss and anger

and then turning it into something that can help to breed, support and healing for other people. That's wonderful. Or like someone who's had a bad childhood and knows what it's like to suffer as a child, will go in and become a child psychiatrist to try to help other people or become a researcher to solve

you know, maybe their mother died of cancer, they'll become a researcher and spend their life trying to solve that specific type of cancer. These are, like, the world is a better place for this. And actually, sometimes with patients, I'll kind of try to encourage a good sublimation. Victor Frankel wouldn't see it fully as a defense. He would see it as actually like the path of meaning

and meaningfulness. It seems like it ties into reflective function, Like, why are we doing what we're doing? I think most, yeah, a lot of us told our stories of why we're doing what we're doing, and a lot of it had to do with, for good reason, right? A sublimation of sorts. If we're doing well, we can identify this in ourselves in some way. Yeah, absolutely.

And also humor, right? Tell us about humor. I'm so tempted to come on here with a Batman mask, but I just didn't answer. That's awesome. I would have been humorous. I could pull it off, you know? I've just got it into like, I just bought some Batman comic book. It was just like omnibuses.

I never knew like you could like go back and research different, like, decades. And then they like package them all together. It's like amazing. I think humor is more Spider-Man, though, and that's both in crime-fighting and talking to girls. If we remember Spider-Man, he's always like nervously telling a joke, and it's to lessen the tension. It's not to avoid it, but it is so he can move forward, right?

Going back to back superhero, but there's this movie called The Eventon, where he meets all the other superheroes. And he's like this high school kid, like, brand new to his powers. And he just doesn't have that, like, experience. And so they're all introducing themselves. And he said, oh, like, we're using our made-up names. Like, I'm Spider-Man, right? So he just tells a joke to lessen his nervousness and his anxiety.

But he can do it, right? He can still stand up with all these bigger guys and show up. So, yeah, humor lessens the feeling and allows us to move forward. I actually wanted to give a personal example as opposed to a patient example. I was recently at a memorial for a friend who passed, and it was just like, I couldn't even imagine, like, starting to speak. I was, like, frozen, just, like, overwhelmed the grief and sadness. And it was my turn. And I just like, I went to telling a humorous story, right?

Like, this was a very straight-laced dude. And I shared about a moment where we, like, jumped a fence in Costa Rica to, like, explore some river as a contrast to, like, his very Batman-regmented style. And, like, everyone laughed and, like, allowed me to have my walls come down and allowed me to actually face the stress and face the sadness. that I was feeling. And that was like me using humor. So good. And then like I heard this quote the other day and I wrote it down so I didn't get it wrong. Like I don't know if you guys have heard of Victor Burge.

He was like a composer. But his line is like laughter is the closest line between two people. And I think like that reflects like in that moment. Like that allowed me to transform the distance from anyone else. the room and it also is like a good line to myself like if i know i'm just like cracking a joke in the setting sometimes it is because of nervousness or sadness and allows me to come into it so laughter is like this great like step into like confronting or seeing other emotions and working through them and facing um and if you want the the border view example it's somebody uh

coming to their primary care doctor's office with like erectile dysfunction and like cracking a sex joke to to break the ice. So I'm giving you the textbook example as well. Well, they probably wouldn't be breaking much ice. Okay. I got you. Yeah. Yeah, I love the idea that the only one who could speak truth to a king is the, is the comic, right? So you have like this, the gesture is the only truth-teller of the king.

Everyone else is a sycophant. Everyone else is telling the king exactly what the king wants to know. And then the gesture comes up and says what everyone else is feeling or thinking. And then it's just like, it's funny so it works. He can get away with it, right? He can give away with saying things that no one else can say. It's like this truth-telling that can happen to humor that even brings down the other person's guard, right? not only is his guard down and everyone else in the room and the person hearing it. And do you think about how much humor is based on forbidden impulses, wishes, right? And it's kind of like that. Or even sarcasm.

Sarcasm can be like a sense of humor, but it can also carry a little bit of truth. I'm thinking about specific comedians, Littal. One, two people that keep coming to mind is Chris Farley. I don't know if you're familiar with. And I think about like the self-deprecating. I mean, he was hilarious. But you think about it from this point of view, it's like very maladaptive. But then I think about someone like Bill Burr.

Do you know who that is? And I don't know. He's more like, he's more in like higher RF. He's like in touch with his own humor and how he covers up things with his humor. And there's actually a different type of funny. I feel like that comes along with that where it's less maladaptive. I don't know. Do you guys, are you guys familiar with Bill Burr at all or comedians like him?

Yeah, he's kind of, yeah. Yeah, but he knows it. Yeah, yeah. Boston, he's got the Boston accent. I actually love him. I think he's great. Yeah. I was thinking of Conan O'Brien was on the podcast with Jason Bateman and, you know, his parents had died.

Both parents died, like, in the last year. And he just went and told this elaborate, funny joke about how, you know, Bateman had killed his parents and it was you can just see that was his way of dealing with the uncomfortableness of that story it was yeah i heard that one and yeah and all his friends went along with it because they knew that he was dealing with it in this way yeah that's good i also think humor can be really useful in really stressful situations like i have a number of combat veteran friends who talk about when they were under fire humor they were would crack jokes and that helped them diffuse the stress and just stay focused on what they needed to do.

Or when I used to work in ICU, sometimes situations would get really stressful or tense or sad or whatever. You know, a few jokes really help to kind of just lighten the mood so that you could carry on and do what you needed to do. Network with Spider-Man. Yes. Yeah, sometimes therapists can have some dark humor and uh i tend i you know i i try not to do any patient directed humor on this podcast or you know or in real life i don't think chris has heard me do too much patient directed humor just because like it's better just to get in touch with the real emotions underneath you know and process them but yeah so humor okay and we got we got one more reversal Amanda Okay. So reversal is, it's a really interesting one. So basically what happens is, you transfer form a passive position into an active position. So from switching passive to active victim to victimizer, you basically shift the power aspects of a transaction with.

another object that you're interacting with in order to deal with that sort of psychological threat in your situation. So the example, I'm always going to give the therapy example, since it's relevant for us as therapist, but Nancy McWilliams gave the example of how therapists are uncomfortable, not all therapists, but a lot of therapists are uncomfortable with their own dependency needs. and they actually yearn to be cared for, and they vicariously are cared for through the care that they provide to their patients. And so they unconsciously identify with that person's gratification. So that's the more adaptive version.

You know, altruism is a good simple example. The more maladaptive examples is like fraternity hazing or like any hazing, abusive rights of passage, like where you are switching from that passive position, getting hazed. And then when you're the upperclassman being in the active transformation, but with that own or with that sole transformation, the affect around it changes. see her more. It's a more positive thing. And I was actually thinking about that example. I was like, oh, yeah, I remember getting hazed in sports when I was younger. And it was the worst thing when you're going through it. But then the next year, you're like, oh, yeah, this is so awesome. And I'm like, whoa, okay, I haven't even thought about that until I had to do reversal for the podcast. But, yeah, Yeah, repressed memory unlocked, and so I understand reversal.

What other, anyone else have any other examples that come to their mind of reversal? It could also be positive, like you're being taught and then you become the teacher, right? I think you see it sometimes in sports where someone's extremely nervous, but they don't seem that way. They push through, they become overly confident. and sometimes I think it actually might be better in that fearful state. Or kind of going back to the tall sublimation, doing that positive switch, you know, from a more like helpless position, a powerless position to a more,

in using that pain to go to a more powerful position, like how you were giving the example, Dr. Peter, where people go into medicine, because of that reason and what experience in their younger. Yeah, so maybe when they were a child,

they were abused, they felt powerless. Now they're having a reversal where they are powerfully helping someone overcome it. So they're in a position of power in the therapy office, helping someone through

the trauma that they themselves got through. This is a really wonderful wonderful ripple effect of positivity, right? It's like we need more of that. So yeah, that's where I kind of get into, this is no longer almost, it's not a defense mechanism.

It's not like there's something underneath it that's better, right? It is the good. Now, if they maybe were working 100 hours a week and couldn't stop and like, you know, crossing boundaries with patients, like maybe that would be a place of like, necessary supervision or some direction outside of that

where they can live life and not feel in a compulsory position to always help, right? I don't know if this is another example of reversal, but I think of people who have survived food insecurity or in eating disorder who grow up to become a chef or a dietitian. And there's a therapist component, but there's also even the dependency for food that, of course, you have,

and to reverse that hunger into literally feeding somebody else. Yeah. Or you'll see, like, someone who's very high in disgust, high in order, go into infectious disease, and they're fighting off the discusing. disgust and the, you know, the putridness of bacteria and viruses. You know, infectious disease doctors always have the longest, most detailed notes, right? Which is part of orderliness.

Yeah, that's a good example, Katia. I wonder if this might apply. It might be a stretch, but I saw someone present recently who was a fabulous speaker in front of others. and they spoke about their nervousness and anxiety with public speaking. And I'm thinking of performers who can experience, I imagine a number, maybe not everybody, but a number have a lot of anxiety and just psychological tension, and then you head out onto the stage. And it's like an escape maybe.

Maybe there's some euphoria that comes with it. but I wonder, like, is there where that could apply here? Yeah, I think they're mastering that fear, right? And they're switching from a place of weakness or fear into strength and, like, success. And I think that can feel very gratifying. All right, guys, I think that is where we will end. Maybe before we end, does anyone have any last thoughts on what this was like? Any thoughts on what it was like to present?

What defenses were coming up for you in the midst of it? I really liked it, and it inspired me. I want to give lectures to my residents, you know, over defenses, and they seem to be very excited about it and want that. So we're definitely going to go over all the defenses. You know, we don't have to all. but at least, you know, maybe in an hour. So they're like, yeah.

So thank you. Yeah, I think it can be very helpful. Great. And, you know, if you're listening to this, if your biggest takeaway is just to, when a patient starts having a defense, just to blur it out, that's a defense of blah, blah, blah, you know. Go back and listen to it again.

Listen to some other episodes as well. That's a really nice identification there. So, yeah. Intellectualization. Yes. That would be a, that would be a very nice intellectualization. Yeah, I second what Jason was saying, I'm seeing the defenses all over the place.

I was like, well, I must have been missing all of these. Like, I knew all the board examples that LaTal was giving, like, as a med student. But, I mean, I've had such a deeper nuanced understanding. just going through this with you all. So things like clicked, like finally. And I can make deeper formulations, like everything. So I appreciate you all. And I second that as well.

I feel that just in my, I have like a self-note section when I'm charting or when I'm talking with a client. And I think I've been able to just pick up on some of these things. And I've noted it down in my self-notes of, okay, like let's come back to this. and being able to walk through this and, you know, teach it to go through. It just helps to solidify the understanding.

So this has been a great experience. I'm enjoying using it even in day-to-day reading the news and just kind of reflecting on what might be going on. And, of course, we can never really know because, first of all, it's unconscious. And a lot of times you don't really know these actors because they're not in therapy. but I do find that interesting helps to reflect on things on a deeper level. Okay, we'll bring it to a close here. Thank you, guys.