Psychiatry & Psychotherapy Podcast - Using Microexpressions in Psychotherapy

Episode Date: May 24, 2018

In the third and final installment on microexpressions, Ariana Cunningham and Dr. David Puder talk about how learning microexpressions can help you build empathy and connect with other people. As Paul Eckman demonstrated in his research, they can be potent glimpses into someone's emotional experience. In this episode we talk about: How emotions come into play in our dreams and other unconscious ways. How to use what we learn from them carefully and with curiosity, rather than with a know-it-all attitude. How we create psychological defense to cope with reality How we might experience problematic relationship patterns through a theory called object relations. How our emotions happen out of our awareness. Preventing emotional overload and empathic exhaustion. Emotional transference and how to stop it. By listening to this episode, you can earn 0.75 Psychiatry CME Credits. Link to blog. Link to YouTube video. Join Ariana on Instagram: @joyspotting Join David on Instagram: dr.davidpuder Twitter: @DavidPuder Facebook: DrDavidPuder

Welcome to the Psychiatry and Psychotherapy Podcast, the podcast to help you in your journey towards becoming a wise, empathic, genuine, and connected mental health professional. I'm your host, Dr. David Puter, a psychiatrist who splits his time practicing psychopharmacology, individual and group psychotherapy, medical director of a day treatment program, medical education research, and teaching, residents, and medical students. All right, so welcome back, and we are going to get into the different aspects of empathy today. And some of the use of microexpression in terms of understanding the unconscious and dream analysis and psychological defenses and ways to use it to improve therapeutic alliance, ways to understand it in terms of object relations theory, counter transference, and warnings about using it. And so this is the third part of the using microexpressions to create micro connections.

And I'm here with soon to be Dr. Arianna Cunningham. Third time's the charm, right? Yeah. So, which might be the best part. So, Ariana, tell me what are the three different types of empathy? Yeah. So basically the three elements are the cognitive, effective, and compassionate with this associated concept that I guess kind of maybe isn't necessarily part of empathy, but is necessary to maintain it, which is self-other distinction. So those three parts with this associated concept.

Okay. And so tell me what cognitive empathy? is? Yeah. So when we say cognitive, I mean, just the word itself is more of like a mental, mentalizing conception here. It's someone's understanding of the other person's experience. And what I really liked is that that can be subdivided into intuitive cognitive empathy and pursued cognitive empathy. Intuitive is, I guess, more of like mimicry or resonance, whereas pursued is what we think of when we are intentionally trying to get better understanding of someone's, which is like information gathering and then us, I guess sort of like constructing a model of

understanding how the other person is feeling or what led to that feeling. Okay, so that seems like really theoretical. Yeah. So maybe let's, let's ground that into like, so give me an example of cognitive empathy. Yeah. So when we say cognitive empathy, it is saying like, hey, I am seeing from these more, I guess you would say like observable tasks versus just gut feelings. Like I am observing your facial expressions, your body language.

Some of that is just responding within myself. But I'm like observing and pursuing details to better understand what led you to feel what you're feeling now. And all the details that I can pull like what your face is doing, what your body is doing and what your words are saying about how you're feeling right now. It's kind of like when we think of like professional empathy. or even just a friend who's really invested in you, that you might be getting a lot of cognitive empathy from these people. And when we talk about microexpression training, to my understanding, this is the best place that we can understand it fitting in really well.

Yeah, so I think like if, like let's say someone says, you know, I'm feeling sad, maybe you don't feel the sadness, but maybe you observe the slump of their posture, you know, their eyebrows going up and together, the pouting of their lips and you're saying, you know, like, oh, you know, as you say that, I hear and see that, you know, this has been a really sad time or sad moment or this is distressing for you or something like that. So maybe you don't feel it in the same way as affective empathy. So tell me about the self-other distinction in this.

So this is, I think, really crucial for especially professionals who are attempting to, I guess, be better at giving empathy is that we need to maintain this understanding, awareness, conscientiousness of what feelings are sourced from myself versus from the patient. So this self-other distinction is delineating, it's where the emotion lies that we're talking about or that we're empathizing with. Yeah, I think that's really, really important. And I think young kids, they think that everyone's having their experience. Yeah.

And as we get older, we learn that, you know, other people have different experience. and knowing what's yours and what's other people's is like really important. I think especially for the more empathic, for highly empathic people, they can have a harder time knowing what's their desire versus other people's desires. And we use, there's some cool words that we use like emotional contagion, vicarious burnout. So tell me what emotional contagion means. That is kind of what you were saying is that if I'm sitting in the presence of someone who is experiencing an emotion to a high degree, let's say, let's say sorrow for this instance,

because I think that's when we can easily understand that I myself will start to feel what the other person is feeling. And when we say like vicarious burnout or vicarious trauma, that if you're experiencing these emotions as a patient and I'm your provider or your care provider, that I'm going to start to like experience all those motions and go through the same degree of, man, just exhaustion that you are. Yeah. And so usually when I, am kind of walking to greet someone or when I'm, you know, the moments before I check in with myself, what am I feeling? How am I feeling grounded? Am I feeling, you know, lightheaded, disconnected? How am I feeling? Am I feeling sad or happy? And then after a couple, you know,

maybe even 10 or 20 seconds, how does my affect change while I'm in the midst of someone? Yeah. And I think it's a cool concept because it allows you to express empathy without being so fully immersed in the other person's experience that you are no longer able to communicate in a way that's helpful. Like you're unable to give them any neutrality or any insider overview because you're like fully swept along the experience with them. Yeah. Yeah.

Yeah. It's the old joke of, you know, what does a, what does a policeman do when they see someone drowning in a pool? Jump in. They jump in and rescue them, right? Or maybe stick out a pole to grab, to have them grab on. Yeah. What does a doctor do when they see someone drowning in the pool?

Yeah, I was like, swim out or get out of the pool. They may direct someone else to jump in the pool to rescue them. And what does a therapist do to someone who's, you know, drowning in a pool? Would they like yell encouraging things? I'm not sure. They jump in and drown also. Oh, no. Yeah, so that would be jumping in and drowning all.

also would be what we're saying, like, that emotional contagion. That would be, yeah, that would not be what we want to do, but that's a joke. To clarify, that's not our end goal. Emotional contagion. Kind of just like, and another word is empathic distress. So when you feel someone's sadness so much, it can be overwhelming. Yeah. And sort of this like unguarded nature, this habitual openness can leave you really vulnerable to that.

And as much as I think feeling deeply what other people feel can be such a tool, I think there needs to be some safe boundaries that you put up for yourself if this is your job, if it's something you're doing multiple times a day, you know, just so that you can be sustainable in that effort. Absolutely. And so I think the cognitive empathy and recognizing what the other person is experiencing, does two ways of combating that. One, it helps your affective empathy know what's,

what's yours and what's theirs. Which makes you more accurate, for sure. Yeah, and it makes your affective empathy more accurate over time. The other thing it does is when someone feels connected and heard and understood, they often will move out of their distressful state. And so the more you could accurately give them empathy and the more connected someone is to you, the more you're going to leave an interaction where they feel different.

And you feel some of the positive emotion and the gratitude. or the connection, then you feel those positive things. And that's very life-giving. So I think it's cool to kind of like cement in that once again, like maintaining this distinction helps both the patient and yourself long-term. Yeah. Okay, so let's move on to the use of micro-expression to understand the unconscious. Enter, stage right, mirror-neuron system.

Okay, so tell me what you mean by that. So mirror-neuron system. I think we talked about in a previous section, but it's just this concept that there are parts of our brain that internalize how others feel, even like some of the actions that you do if I witness them, that you in a sense will also experience some components of that action or that feeling kind of automatically. Yeah. And so tell me how that has to do with the unconscious. Yeah. So I think you brought out a really good patient example of how you can actually internalize. like if I think in this case it was a patient who had like a physical deformity of some kind

and began to internalize other people's reactions of let's say disgust or fear even into their own identity of how they viewed themselves. So how we are viewed in the reactions that other people give when they see us, we can sort of absorb and take into our own view of ourselves a little bit. Yeah. So this, you know, it's truly unfortunate. but some people will react to you either positively or negatively throughout your life. And if this one patient in particular had a deformity, so people would feel a very, they would flash

micro-expressions of disgust towards this person. And this person would internalize it, so they thought that they were disgusting. And it was kind of imprinted on a deeper level that they had to work through. and the sort of the meanings that they attributed to themselves were through these people who, you know, who did this. And it was unfortunate. And over time, she was able to kind of create, like, what are my values?

What, who am I as a human being? What do I, what do I bring more than just, you know, this issue that I had as a child? And it was very powerful when she was able to recreate sort of a narrative on how she sees herself and it be more accurate to all the giftings and the personhood that she has. So that's one kind of way of the unconscious sort of leakage into our own experience. The opposite spectrum may be someone who struggles with like anorexia, but has very sort of a positive reaction towards people being thin and being or, you know,

kind of like internalizing that the attraction that she feels from people. And that kind of drives on their sort of self-destructive behavior. A little bit of a positive feedback cycle. It's kind of a positive feedback, yeah. It's actually really interesting. I mean, it's something I think in like popular culture we take in that like the narratives others speak into our lives we absorb. But this kind of gives some grounding as to how that happens.

Right. Or the statement that you become like the, like the, like the, the closest five people in your life, you become to some degree. And I think it's true. Like, I have people that when I'm around, all of a sudden, I'm thinking about money. I'm thinking about how to make money. There's another guy. You get that with me? No, not at all. There's another person that I get this feeling of just extreme competitiveness. And it's, it took me a while into my adult life to realize that I'm just picking up other people's experience and just their unconscious stories and narratives.

And so if I am then able to identify that, then I can not necessarily go along with that narrative and fight against it a little bit when I'm with them. Bring some intentionality, some awareness into what you've, I guess, like, just been reacting to for a long time. Some, I can put it to words rather than it just being an unconscious thing. Yeah. So I'm thinking of how do we use the micro expression, though, to understand the unconscious.

And I think that I really haven't unpacked it yet. So let me try to do that. So what we've been talking about is someone's unconscious speaking to our unconscious. Yes. And then us creating narratives that go through that and like through mimicry. It feels very matrixy when we talk about unconscious responding to unconscious. But yeah, and we're just bringing that into conscious reality. We pay attention to the micro-expressions.

I hope that people are still with us. But the way that I use micro-expression to read someone's unconscious is largely when I'm treating patients with bodily pain. And emotional pain that has been stored in the body in different ways. And these people will be telling a story and they'll flash an emotion. and the emotion is not yet conscious. And if I were to say, you know, while you're telling me that story, it seems like you feel anger,

they would actually get angry at me because that feeling of anger is totally unconscious. It's totally put into, out of their conscious awareness and even psychologically defended against. Let's talk about dream analysis and the effect of therapy. Man, so I mean, I don't have any, let's say, like, practical experience in this like you do, but I did some, like, really interesting lit reviews. Tell me what you dug into.

Yeah, so there's been, I mean, just historically speaking, there's been a lot of different ideas that we as a culture have had on what dreams are. Are they random or do they have a sense of purpose and meaning? Is there a functionality in the time period that we dream? It's been really cool. I mean, I guess all to say that the conclusion, over the time in history and in the notes, there's a more full outlay of all those contributors in this process. But like, Mishkin and Appenzeller, like 1987, kind of came to this point to say,

and they had some support for it, Dreams, Link, Affects, and Memory Processing. And then Riser went on to create this kind of model of understanding that memory is organized around nodal points of intense emotion that expand into networks. Like, I think something that we learned in medical schools that like negative emotions have a stronger stimulus for creating memory than do positive ones. That it's like intense emotional experiences that form these kind of points of organization for memory. And they found using some PET scan studies, collecting data on the dreaming brain that these limbic and paralytic areas that are involved in linking affective memory are also activated during REM sleep. Super cool stuff. To distill it down,

to one sentence, the thought right now is that dreams are not random. But there's a, there's a component that links memories and emotions during that time period. And this is kind of an organizational schema that's happening. Yeah, I, um, super cool. I'm a big fan of using dreams, especially in patients who don't have access to what's congruent or what it makes the most, um, and by congruent, I mean, like, what is the most, um, um, um, and by congruent, I mean, like, what is the most most emotionally relevant to work on in psychotherapy. So some of my patients through dreams will go right there. And it's like as they're telling me, their stories,

they will flash a micro expression in their telling me of the story. And even that part of the dream may be still unconsciously. They're not consciously aware of the emotion that they had with that, but then they may be able to have that emotion. And often it's like they have very strong emotions and troubling thoughts, but they cannot consciously register them. So they have to create them in their dreams in such a way that would allow them to actually represent them and try to work through them, which is why people dream.

So for example, patients will have strong, maybe positive or negative emotion towards you. and you may be represented by someone completely different in the dream, but there may be some attributes of you that are similar to the person that they're describing. And the emotions towards you, whether either positive or very negative, are things that they can never express to you in person, like either sexual desires or desires to kill you. Like they're not going to come out right and tell you this, especially early on, but they may have those strong emotions towards you for various reasons, usually linked to early developmental relationships that they've had. So then it can be really powerful to kind of unpack those things or to lessen the tension

around them and then to interpret them. And sometimes it takes like a whole, like an hour to even unpack one single series of dreams and the associations that come with it. So the use of the micro expression for me really comes into. to play of like, okay, as they're telling me the story, I'm remembering the story, the narrative of the story, but also I'm now getting access to some of the emotions in the midst of the story that maybe I wouldn't have otherwise. You know, and there's some cool, there's some really cool, I guess, supporting studies, like a

fisherman one that was done in 2016. They did this big functional MRI scan study with dream words extracted during dream analysis interviews and they looked at this group of patients over the course of one year and kind of what you were saying is that through some therapeutic interventions and dream analysis involved, they were able to see a decrease in the activity of a certain portion of the brain associated with decreased experiences of distressing nightmares, basically secondary to the psychotherapy they were receiving. Yeah. And, you know, I mean, I see this all the time. It's like the dreams fundamentally change as the psychotherapy progresses.

Yeah. So at first they may, they may have the distressing dream of the event, but then as time goes on, maybe the event is still happening, but maybe they're a little bit distant from it. Or maybe you are now in the dream protecting them, or some other male or some other woman is there protecting them,

or like a friend, or maybe like a loved one is there in the midst of it. Or maybe the thing is happening and then it's stopped, you know? And so, like, yeah, there's this amazing, progression and dreams, especially when they relate to trauma, I think, where as the trauma's worked through, the dreams fundamentally shift. And there's like a pattern. And there's some really cool studies that have read on that as well. Yeah. I'd love to hear it like someone who maybe has

a lot of experience working with patients who are experiencing PTSD or things like that, like how much they find this to be useful or relevant in their practice. The use, the specifically being able to read their micro expressions while they're listening to the dreams. Or any secondary benefit in like sleep patterns with decreased distressing dreams as they work through things. Oh, yeah, I know that sleep will improve as people work through it. So the next topic is using microexpression to understand psychological defenses. Yeah. This one, this is a really interesting concept.

And I think this is like where microexpression detection comes in is very, very important because it's more about seeing emotion. patterns as far as like what happens first and what happens second can be real cues in for you. Yeah, so maybe I'll just kind of define psychological defense. Oh, good idea. So traditionally there was thought to be some signal anxiety, which leads to a psychological defense. So for whatever reason, let's say you have some taboo thought and your brain will not consciously allow you to register that thought.

Because it's so distressing. Because it's distressing. So then it causes this thing. called signal anxiety, which is signaling the brain to defend against it. And then the defenses come, right? So a defense may be denying that you had the thought or like a hypomanic defense of like overly doing positive like, oh, I'm not feeling bad. I am amazing, you know? Yeah. I'm not having negative feelings towards this person. I love them so much. Yeah. And that while they do that, they have an expression of anger on their face.

And then, you know, other things like reaction formations. So it's like I'm upset at my, you know, someone and so I go clean my house or, you know, sublimation. So I'm having sexual desires and so I go dance instead. So it's like you're finding in that sort of pattern something that's socially acceptable to sort of bring out this drive that you're defending against. And so this is largely an unconscious process. It's not like they're deciding. People aren't deciding to do this. And people do it all the time.

It's like a survival mechanism. It's an adaptive function of the brain, right? Smart people have intellectualization all the time. So they pontificate and rationalize and intellectualize. And I hope that we're not teaching people to do that just even better. Yeah. And then, you know, smart people also have rationalization, intellectualization. and denial of affect, so they kind of deny that the emotion was there.

Okay, so that all being said, how do micro-expressions inform this? Yeah, like in your practice, you might see someone flash a certain micro-expression and then immediately followed that up with like a different one or some of their... Do you see this yet in other people? I've seen it. I think when I shadow you, that's when I'm able to more so have it pointed out. In day-to-day living, I feel like I'm maybe sometimes a little bit too involved in it to have good insight. That's probably good.

No, I definitely turn this off when I'm at home or with friends. Yeah. And sometimes some things may leak through. So, yeah, so you see the signal anxiety is sometimes really just the emotion, is what I've realized. So people have the emotion that's associated with the foreign or taboo thing. And maybe like we've talked about certain upbringings where let's say anger is considered like not something you're supposed to experience ever. So then there's that secondary. Yeah. Or maybe you have discussed towards someone you love and you have really conflicted feelings with that and tension about that. And so you automatically want to suppress it. So anyway, so I see these people. So a couple years ago when I started really paying attention and really being able to pick this up very fast after I built the app actually. Because I think when I built the app, I spent so much. many hours like looking at people's expressions and really trying to fight like which one's which

and going back to the books and really studying it. And through that process, all of a sudden I just started seeing this. And I started seeing people's facial expressions and then I would see the defense come right afterwards. And what I realized I could do was I could empathize with the emotion and they wouldn't even know that they had the emotion, but I could still empathize with it, and the same effect of calming down their system would happen, or I could empathize with the distress of them not wanting to look at the emotion, and then they would be able to eventually come around to being able to tolerate the affect.

Yeah, because if their body and their mind are avoiding these initial emotions or reactions, then it's understandable that it would be pretty abrupt for us to point out, like you're disgusted with your spouse or, you know, something like that would be maybe too much. It would be aggressive. Yeah. It would be aggressive and they would get angry at you and they would probably leave and you'd probably... Yeah. You'd really send them back a few steps instead of forward in that point.

Right. Right. But I think where it's helpful though is like, let's say you're talking to someone about this, then they do this and this is what's emotionally relevant. Yeah. This is the emotion, the tension that's there. And often it's mixed feelings. Like, so they'll both feel anger towards their parents but love towards their parents. Yeah. like holding those two things in in their brain at the same time causes this sort of cognitive dissonance and energy that needs to be released that leads to some sort of neurotic behavior

almost so it's like sometimes it's it's having people like people to unpack the varying different emotions and have them be entitled have them allow them to feel entitled and like they're able to experience the emotions in their body and in a way that's palpable and giving them empathy for that and and and and you understanding why they're having it and where how it's adaptive yeah and the meanings that might be attributed to it i think that's where the therapy really comes alive yeah oh man that's just such a cool concept too because it's yeah it's something that this person may be experiencing conflict over and about for such a long period of time without any respite because they aren't consciously aware that that's the thing causing this tension so to help

bring that into awareness or sympathizing with that. It could be so. It's powerful. Yeah. Okay, so let's get on to. Therapeutic alliance. Therapeutic alliance. And yeah, so we talked about how microexpression training can increase empathy.

Yeah. So there's some cool studies that support that connection, like the Hojat and the Reese. And as we sort of talked about the three types of empathy beforehand, micro expressions can help you understand the patient's experience, that cognitive empathy. By paying attention to those micro expressions, you can maximize your mirror neuron inner mimicry, the effective empathy. And as far as your response, by gauging those real-time feedbacks, you can improve your therapeutic dialogue just by seeing how your words are being received or kind of what emotional

experience they're having in and of the moment, not just in remembering the past event that you're talking about. Right. And that's important because empathy leads, small moments of empathy lead to an increased therapeutic alliance. And we know therapeutic alliance is one of the things in psychotherapy that we know is the strongest. When we put CBT versus, you know, other types of therapies and we look at meta-analysis,

often the difference is very minimal. but the therapeutic alliance difference between treatment providers and clients and the effectiveness of the therapy means a lot. And so therapeutic alliance is like one of those things that's like, okay, what increases therapeutic alliance? Let's focus on that. How do we train the next generation of therapists and psychiatrists to have a higher amounts of therapeutic alliance or physicians? and one of the ways in which I use microexpression is the empathy to increase therapeutic lines. And I think the other way is to actually be able to notice when patients are upset at me. And it's sometimes hard to come to terms with.

Right. And I think it's something that like once you, once your ego can tolerate it and embrace it almost, that that's going to happen, that that's a part of human interaction. Like in every human interaction at some point, someone is going to. be upset at you for not understanding them. Yeah. And then when you, if you can recognize it and the earlier you can recognize it, the earlier you can mend it and the earlier you can mend it, the stronger connection you'll have

with the person. And my theory, and I think this is true from what I've seen so far in my life, is that if you can mend those moments, you can have a stronger alliance than you did before because they'll feel safe disagreeing with you or they'll feel safe. being unhappy with you and knowing that the relationship will go on, the connection will go on. That that isn't going to be something that causes you, the provider or the other person, the relationship to leave, to bail. Yeah.

That's usually, that's like kind of the safety net of family, but it's hard to find in good friends and then even more so I'm sure in provider situations where there's maybe a little bit of hierarchy or, yeah. It's hard to find, period. I mean, a lot of people don't have good connections with their family. And a lot of it has to come down with communication and how closely the other family members understand them or listen to them. Yeah. And so on and so forth.

Okay. Really briefly, let's get into object relations. This one I think is definitely more your field. I've got like a theoretical understanding of it. But as far as the practical application, that's a bit harder for me. So basically, object relations theory in a nutshell, is that we internalize primary caregivers, very important. relationships into our sense of self. And these are like defined as like objects.

So the people inside of us are like are represented and that's the that representation is called an object. So object relations is that we are in relationship with these objects even if the person is no longer in our life. So the conflicts, the emotions, the desires, the wishes for, all of those things are still there and still connected to that object, that person, that primary caregiver. that thwarted relationship, that the unresolved conflicts, all of that is still there. And so the micro expressions, I think, just like any other emotion, emotion will take you to

what those core conflicts are. And so as a person describes those primary caregivers, they'll often flash the emotions that I think are attached to the object. And it's using your ability to read someone else's. expressions as they talk about the person that may lead you to what are the most emotionally relevant and conflicting feelings that they have towards someone or towards themselves in the midst of it. So for example, I had a patient with lots of bodily pain who had lots of anger towards her father, but then she also had anger and guilt towards herself. And I think the anger towards

herself was the anger towards her father that she couldn't express towards her father. And the guilt was kind of like how she put words to it, or the guilt was towards the anger that she was suppressing. So whenever she would- You have to have a little bit of a sleuthwork attitude as you're like sifting through dialogue and micro-expressions that you know to relation to different relationships or topics. You can't assume things. You have to kind of, you kind of have to, as you slowly empathize with the distress of different emotions, you'll get further into what might be going on. But it might not be completely self-evident right away. Yeah. So that's why I think like diagnosis is so limited to some degree because like we make a diagnosis right away, but then

three, four weeks later, we may figure out, oh, this is what's really going on. You know, three, four weeks have seen them every day. Yeah. Okay. So, um, so that's object relations. And, um, we'll have some more examples of that on the website. Yeah. In the outline. for sure. So what about the use of micro-expressions to decrease counter-transference? Yeah, so I think as we kind of talked about the concept of

us feeling our patient's emotions via that mirror neuron system, the automatic mimicry, kind of our affective empathy, that dynamic of it, that as a professional, our goal is to feel the other person's emotion to the point that we can empathize

cognitively and effectively without becoming emotionally flooded. we talked about that emotional contagion, empathic, was it empathic? Intathic distress. Empathic distress, yeah, or vicarious burnout. So we don't want to become so emotionally fallouted that we fall into enactment as that will impair our ability to actually reflect, offer insight or therapeutically influence through our own mirror-neuron response.

So we want to, I guess, use those microexpressions to help with the self-other distinction to make sure that we aren't being swept away, but we were able to positively influence or therapeutically influence might be a better way to praise it. And another kind of bringing back to the object relations, often when people have strong countertransference or strong transference to you, meaning that they're throwing on new emotions from their past,

it has to do with figures from their childhood. So maybe you felt very positively towards someone and now you feel very positively towards this new sort of authority figure in your life. When I walk into a patient's room and like, you look just like my granddaughter. And that could be a good thing or a bad thing. Yeah, yeah. With that tone of voice is probably a good thing. Yeah.

But then there's your reaction to anything about the patient, which is what I would call countertransference. So it's not just a reaction towards their transference, but anything about them. And, you know, sometimes we feel really warm and fuzzy and we want to be friends with patients and we feel attracted to them. And, you know, they're just, it's just like, wow, I really like this person. And other times we feel revulsion or anger or upsetness. And so I think to some degree, being able to understand better the patient and their emotional reality and where they're coming from and why they've come from the way they've come from, it can help us maybe have some more compassion towards them.

Yeah. And compassion towards ourself or how we may be reacting towards someone that, if they remind us, of someone from our past as well. Yeah. And I think like the practical application is a little bit like when you're first learning to drive and they said every, was it, 10 seconds, check your rearview mirror, check your side mirrors, like just see the environment around you as you're driving down the road as a beginner. Now we do it reflexively, but maybe as a beginner trying to implement these skills,

every few seconds, every few minutes, just take stock of your own emotions, your experience towards the patient and what you're seeing on the patient's face. Yeah, maybe every few minutes. Every few minutes. Every few seconds would be exhausting. Every few seconds would be like, you're thinking about yourself too much. Yeah. Yeah, and putting towards what those things are and why you might be feeling them.

Okay, so finally, warnings about using microexpression of therapy. Ooh, beware. So I think we've given a couple warnings throughout this thing. Yeah. But it's always good to just reiterate, I think, something you've told us and that you model pretty well is like, don't outright be like, that was anger. That was sadness. First of all, you don't really know why someone's really. feeling or flashes the emotion.

And or the first mistake would be to miscategorize someone's emotion and then to believe your categorization above the person. And this is where like, you know, I tell people play the app until you're hitting 90% over and over and over again. Yeah. Because then you'll have some ability. Like some basis of some basis. Yeah.

Accurate reading. But the, so that would be the first thing is make sure you are actually accurately reading someone. Yeah. And then two would be to not, to not sort of jump to conclusions of why they're feeling that emotion, because they could be feeling it for a whole number of reasons. Yeah.

But so to be maybe curious. And then three would be to not put words to it too quickly, but allow the person to put words to it. And start off using the words that they offer. And use the words that they offer. Knowing that if they didn't use the word that you saw, Like let's say they didn't use anger, but you saw anger, but they used frustration, that's fine. But if they use sadness or something like that, then it's like, okay, maybe that anger is really

going to be important for them to express down the road, but they haven't accessed it yet consciously. And maybe they're stuck in that. And that's what might be going on. And that might be the bigger sort of conflict, you know? So what is, like let's say they have a hard time experiencing anger and towards authority figures. Like, could they potentially learn to experience anger towards you first? And that may be the first place they can safely experience it. And then once they can safely experience it. If you like encourage and applaud and make that a safe environment in which they can't express it. Yeah. And then once

they can safely experience it towards you, maybe they can start to unpack it towards people in their past. So, oh, yeah, give people the freedom to correct you. Yeah. They're the expert of their own internal experience. Figure out and really be comfortable with like how it's adaptive and emphasize that because I really think it's the truth. So we want to emphasize how having these different emotions are adaptive in the adaptive role. And that every emotion they're experiencing is valid. Valid and has an adaptive capacity even though it's, even if it's maladaptive at this point because it's causing them to be stuck. But at some point it was adaptive. Yeah. In the psychological defenses at some point were adaptive.

And they're entitled to their sort of experience of those emotions. Yeah. I think that's a pretty radical shift of like mindset to take, just to kind of remind yourself of those things before you enter into an encounter. Yeah. So in the conclusion, you know, I think the micro-expressions are unique stepping stone into the realm of empathic understanding. Oh, yeah.

And I think that creating these small moments of micro-connections will lead to, you know, better connections with people. And I think connections in the end are pleasurable and gratifying. In and of themselves, they're in-of-themself. In-and-of-themself, that is how therapy works in my mind. Yeah, any other conclusions you've drawn from this? Welcome to The Matrix. I feel like once you kind of get into this state of mind of looking for micro expressions,

it can really offer not even just on a provider scale, but even on an interpersonal like you with your friends and family, just some without being aggressive in pointing it out, but just for yourself, it makes you a much better listener and an observer and kind of like partner in their experience that they're feeling. Yeah. Yeah, I've wondered, do you think you've improved in that way? I think so. I think I'm a much better, I do prefer FaceTime now.

I realize that I think it Yeah I think it has made me Much better listener because I am more engaged As opposed to in my head being like What do I need to do afterwards? Okay What's the list of da-da-da-da? I think that task as it becomes a little more

Yeah, as it becomes a little more reflexive It keeps you more engaged in the moment I think it's like you can be grounded in an observation Yeah and another person's experience, which I think is really powerful. And sometimes, like, I think people with social anxiety are often thinking about what people are thinking about them. And this takes you out of this self mode and into more of the, like, curiosity about the other.

Yeah, what is the other person experiencing? How are they experiencing me? Well, Ariana, thank you. And if you have any questions, please, please shoot me an email or, throw it up on to one of my social media threads for these topics. And, you know, I appreciate good reviews. I'll throw it out there again. Gratitude is always something that's contagious.

Yeah, gratitude is a way to form another micro-connection. Yeah, yeah, absolutely. And if this was helpful, you know, I like to hear it. I really do because if it can make, you know, if I can make the difference in one person's life, that's enough. You know, and so hopefully if you, learn this stuff and if you apply it and if it's helpful I would love I would love to hear it and it would be very encouraging me all right we'll leave it there awesome