How Do You Heal From Borderline Personality Disorder BPD? Imi Lo and Jon Frederickson

So, if we do talk about the causes, what I mean at the center of something like personality disorder or borderline personality disorder, it's a difficulty in, well, relationships, but also emotional regulation. That's right. And both anecdotally, experientially, and statistically, we know that there is a link between childhood complex trauma or neglect with this type of distress.

Why do you think that is? Why would someone being abused or neglected cause problems in emotional regulation? Well, the, you know, one way we could look at it is that every child has emotions that come up. And, uh, you know, if whether it's a distress because a diaper needs to be, uh, needs to be changed, the baby is hungry, um, it fell over and hurt itself, whatever, and and the mother or father come, they pick up the baby, they soothe the baby, and the baby has the experience over time that when it has an emotion, it can count on the other person to regulate that emotion, to calm the baby, to be a source of calm, and that there's a dyadic regulation that together, work done by Stern, right, together we, we can regulate feelings and anxiety. Right now, of course, what we know happens in trauma is that an apparent, through some kind of abuse, triggers massive feelings in the baby or in the child, but the child has a problem because the source of the, the person who's supposed to be the source of safety is actually the source of danger, and the child knows, "I, right now you hurt me, so I, I love you and I feel tremendous anger at you for hurting me. Yes, I have these mixed emotions. How do I deal with the fact I love you and I'm feeling angry and you are causing danger?" So, so the child learns, the child learns, "I actually can't rely, I can't depend on a parent for affect regulation, so I have to rely on defenses for affect association."

Yes, and what the, the this, what the, the theorist Harry Stack Sullivan said, the child is actually going to use defenses to regulate the parent. Yeah, right. Oh, my feelings will be too much for the parent, so how much of me do you need me to hide so you will calm down? Absolutely. So we forget that actually the child uses defenses not only to deal with its own feelings, the child initially uses defenses to regulate, to, to protect the parent from feelings that would dysregulate the parent. Yes. And so in that sense, like every defense is actually the child's active love, uh, "how much of my feelings do I need to hide so he could love me?" If I turn my anger on myself, can you love me now? If I send the feelings out of myself and I empty myself, can you accept the absence that's left? It's terribly sad, but very moving when you put it like that, and you're right, that's a beginning of the development of what the W, what's wiot called, false self. You know, that's right. It's like you can't deal with who I am, so how much of me do you need me to remove so you could deal with the false self that's left? Yes. And then, of course, the child, of course, is, is simply, these defenses are just a way of adapting, right? And the earlier these traumas happen, right, uh, the more severe these defenses have to be, the more severe the trauma or prolonged, the more severe these defenses have to be, the more entrenched, yeah, the codend, they're always going to be entrenched because they're unconscious, but the earlier they are, the more likely they're going to have splitting. The earlier the trauma, the more likely we're going to have splitting, projection. If trauma happens like after about eight years old, the child is going to have a very different set of defenses, which might be what, um, anything in isolation of affect where they can just intellectualize, change topics, be vague, or rationalize. So actually, from our clients' or patients' presentation, we can speculate when the trauma happened, isn't it? Yes. And, and, and also to get a sense, you might have a patient where both parents were quite disturbed, so the patient is probably going to have a lot of split projection. She might have had one parent who is disturbed and another person who was less disturbed, so you might see different kinds of defense systems in at different times. Yeah. And the other thing to keep in mind is that you see the earlier trauma happens and the less affect regulation there is by the parent, then the child's anxiety never gets regulated, and when anxiety doesn't get regulated, the body doesn't return to homeostasis; it remains in a permanently elevated level of anxiety that we call allostasis.

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Hello everyone, welcome to Exell Transformations, a podcast for intense people. My name is Emy, and I'm here with you on the journey.

Hi there. Well, you know, I really enjoy doing this podcast for the selfish reason that I get to speak to people who have inspired me, influenced me, and even changed me. Now, now whenever I read a book that blows me away, my immediate thought is to speak to the author. They don't always respond, but whenever they do, we always have such good conversations that whatever I learn from them stays with me for a long time. Today we have Dr. John Frederickson. He is a therapist with over 25 years of experience, especially specializing in working with people with personality disorders. John is also the founder of Intensive Short-Term Dynamic Psychotherapy. It is based on psychoanalytic ideas such as transference and defense mechanisms, but is renewed into a much more active and pragmatic format than traditional psychoanalysis. In this conversation, we dive deep, deeper than ever, into topics such as borderline personality disorder, complex trauma, defense mechanisms such as splitting and projection, and how relational therapy works to heal your childhood. Honestly, it was like I was receiving the most insightful supervision from a wise sage. There were also moments in the conversation where I felt quite vulnerable as I shared my frustrations as a therapist. You will basically hear two therapists having a frank and in-depth dialogue about the following questions: Why your therapist's blank screen approach does not work; what happens if you do not know what to talk about in therapy; should you or your therapist be in the driver's seat; why a diagnosis of borderline personality disorder may not be what you think; do most therapists underestimate how much anxiety you have; what is projection and what is splitting; how personality differences with your parents can hurt you; why some of us are afraid of dependency, including dependency on our therapist. I could talk to John about these complex, dynamic topics forever. I think I may have to invite him back for a second round, but for now, I hope you enjoy this deep dive and learn something from it. Now to John.

Hi John, good evening.

Hi, welcome, and thank you for coming on to the podcast.

Well, thank you for inviting me. So before we dive in, would you mind—I know your background, and I've, I was familiar with your work from many years ago, um, and I've read your book throughout the years, um, it feels pretty surreal to, guess, you on and to speak to you directly, but for my listeners who don't know you very well, would you mind telling, um, them who you are and the kind of work that you do?

Sure. Well, my name, of course, is John Frederickson, and I'm a psychotherapist in Washington, D.C., and, uh, I got my degree about 40 years ago, and during that time I worked in a clinic and then later, um, have been a teacher at the Washington School of Psychiatry, and I've written, uh, uh, I think it's four books now on psychotherapy and about 70 articles. And these days I spend most of my time actually teaching and supervising therapists, and I have students around the world and training groups around the world. So some, before Covid, I used to travel quite a bit, but now I do all my teaching here, uh, via the Internet, and spend most of my time actually just teaching and supervising psychotherapists, um, using videotape of their work, so we really have an empirical basis to really look at their work and how to help them be more effective.

And you seem to develop, uh, you have developed, and you, I guess you supervise a particular approach.

Yeah, the approach that I teach is known as Intensive Short-Term Dynamic Psychotherapy. So it's, it's a dynamic psychotherapy; it's not always so short-term, obviously. The more severe the troubles a person has, the longer the therapy has to be, um, so for some people only a few sessions is all that's necessary, but other people will have to see for several years. So I prefer to think of it as just more time-efficient, where the therapist takes really an active approach rather than a passive approach, and where the patient and therapists can have a conscious agreement what they're going to work on and where the patient really understands what we're doing and why we're doing it in this session.

Yes, and that active approach plus the medium-to-short term is really historical, not done in dynamic or old-school stereotypical analytic therapy.

Well, it depends, you know, actually Freud was quite active, uh, which is very interesting, and actually two of the members of his early circle, uh, came up with an active form of brief therapy, Otto Rank and Sándor Ferenczi. But over time, people adopted a very passive approach. Yes, uh, and, uh, and they actually misunderstood some of Freud's ideas. You know, Freud said, you know, the patient just had to say what comes to mind, but in 1923 he said, you know, that actually doesn't work; people actually, you know, people can't keep talking about something that's troubling; if something's troubling they're going to shift to some other topic.

Absolutely. So we actually have to help them with the defenses that keep him from speaking freely, but people didn't really quite understand Freud, so they thought, well, if we just sit back and let people talk, the magic will happen. But as many of your listeners know, just talking while a therapist listens passively doesn't always lead to magic.

No, actually it can create a lot of anxiety and distress and dropout, as you would know.

Absolutely. Yeah, I mean, I've always loved that dynamic way of thinking, but then that's blank screen approach and the authoritarian stance was what I've always had issues with. So I once had a really strict analytic supervisor, and we really didn't see eye to eye. I, I in the end had to do my own thing and develop my own way, but I still absolutely think of things in a relational, dynamic way. So I'm glad to have, you know, this newer way of looking at psychodynamic therapy and of doing things that makes me feel less, um, alienated in my own way.

Absolutely. And, and like it, it, you know, we really have no right to ask people to do anything they don't want to do. We have no right to ask them to look at feelings they don't want to look at. We have no right to take a role of authority of therapist knows best. We always need to find out what the patient wants to work on, what is their will, uh, because the therapy really has to be driven by the patient's will. And, and oftentimes the issue of the patient's will really gets ignored, I think a lot in therapy, and that's where a lot of difficulties, uh, end up coming up in therapy—the therapist trying to go one way, but the patient doesn't really see why they should go that way or they don't want to go that way, and then there's the kind of conflict that's actually unnecessary.

Yes, that idea of will is something you talk about a lot. I don't know if people would misunderstand what you meant. Do you mind expanding a bit more of what you meant by will?

Sure. You know, like, uh, we'll start and find out what the problem is the patient would like some help with, and then I might just check in and, and, "Is this the problem you want to look at for your benefit?" It's just to find out, is it their will to look at this problem for their benefit? They might say, well, I don't know, what do you think I should work on? Right? Say, well, you know, since these aren't my problems, it really can't be my therapy, so this can't really be driven by what my will. So we have to find out what you think would be in your best interests here for us to work on. So really making sure that the patient is in the driver's seat.

What if they say, "I don't know"?

Then that's wonderful, right? As a therapist, we know, wow, if a person doesn't know what they want in therapy, they probably don't know what they want in a lot of situations. And if a person is, uh, doesn't know what they want, maybe they grew up in a household where they weren't supposed to say what they want, maybe they go along with the desires of others, maybe that's what happens in their relationships, in which case, for the therapist, the fact they don't know is really important information.

Exactly. Yeah, so you might just say, well, I appreciate you being so honest, yeah, because if you don't know if this is a thing you want, want to look at, um, we really have no right to explore it. So that lets the patient know, oh, I'm not going to push you to look at anything, even if you're uncertain.

Yeah, I often have people who want me to be in the driver's seat, and, you know, they come to a session and say, okay, so what are we going to talk about today, Amy?

Exactly. And, and, and now I'll just respond, that's a really good question you're asking yourself. Yeah, what is it you would like to work on? But then I also understand it's that they, they are confronted with a lot of inner confusion, emptiness. It's not that they have just given up; it's just they literally don't know. They don't know. And also, insofar as, say, "What should I work on?" when they invite you to be in the driver's seat, that might be a pattern in their life. Maybe they learned, "I should always let my father be in the driver's seat. I should always let my mother be in the driver's seat. I should always let my boyfriend or husband be in the driver's seat." Right? So in that way, we're learning, oh, this might be a problem in your relationships, and you're just showing me unconsciously a relational problem that, that I need to help you with.

That's a really good point. And also, that's really very much how I would like to work, which is relationally—the things that are showing up in the session actually probably reflects a lot of what's happening in people's lives. Yeah, you could even just say, um, yeah, but if I'm in the driver's seat, you would just get better at being a passenger in life, and then you wouldn't be the driver of your life, and that may be a familiar place to be, but ultimately not what they want to do; that's why they're here. And then we just, I wonder if something feels risky about saying what you want for yourself in a relationship. And then say, "I think it does feel risky," and then we're on our way. So in that way, even a problem like answer like, "I don't know," isn't, isn't really a problem; it's an opening. Oh, this is where you need help.

That's wonderful. Thank you. Well, I feel like I was getting, I'm getting a bit of supervision here.

Well, also, and also for your listeners who are patients, it can be helpful for them to realize that as a patient, you, you, you can't do therapy wrong, because any answer you say, even if it's a defense or no matter what it is, your response, like even "I don't know," is actually unconsciously telling the therapists where you need help. That's, I always say to patients, you are always doing therapy perfectly; I have to figure out why your response is perfectly showing me where you need help. Yeah. So in that sense, yeah, it's not to worry; it's like when we get something like that, how could this be the perfect expression of where this person needs some help right now?

Gosh, this direct, this, this conversation is going in such a rich direction already. Now, I know you have a lot of experience, as I do too, working with complex trauma and what we diagnostically called personality disorders or people who are on the, I know they're trying to make it a spectrum thing, and so to loosen the definition, but let's call it personality disorder spectrum or people who are diagnosed, especially with something like borderline personality disorder, um, how do you conceptualize this diagnosis? Why do people who get BPD, essentially?

Well, you're going to hear kind of a radical point of view on this, so, so let me just offer a couple of thoughts that might be a bit of a surprise for you and, and certainly for some of your listeners. First of all, what everyone, listeners should know is that we have these diagnoses, right, from the Diagnostic and Statistical Manual of the American Psychiatric Association or the ICDM, which is the manual used in Europe. Now, what most people don't know outside the field is that these diagnoses are neither statistically reliable nor valid. In other words, if five therapists evaluated the same patient on the same day, the patient wouldn't get the same diagnosis. And if you, if you diagnosed a patient six times over the course of a year, the diagnosis would be different.

Yeah. So then, so, and, and all the psychotherapy researchers will tell you this; it's this is a really big problem. These diagnoses are not statistically reliable or valid. Now, here's the radical point: What we call diagnosis is actually not a diagnosis. When we, when we give someone a diagnosis, it's, for instance, if borderline personality disorder, it just means a patient has five out of eight traits. Exactly. So what does that mean? It's a description. For example, um, if, if you had a terribly high temperature that wasn't coming down, you'd go to the doctor. Now, if the doctor said, well, Emy, your diagnosis is fever, he said, "Doctor, I know I have a fever; that's my symptom, but what's causing my symptom?" He'd say, "Oh, you want me to diagnose the cause," and then he'd be checking, is it Covid, is it a cold, is it the flu, is it, you know, could be many different things, and then he would diagnose the cause of the symptom. In psychotherapy, in psychiatry, psychology, most therapists never diagnose the cause; they see a symptom picture; it doesn't tell you what's causing the symptom picture. So what we call diagnosis is actually not diagnosing the cause; that's why telling someone they have a diagnosis actually doesn't do any good, just like it could do no good for a doctor to say to you, "You have a fever," because you, yes, diagnose what's causing that symptom picture so he could treat the cause. So the interesting thing is, in, in this field of psychotherapy, although we use the term diagnosis to refer to these descriptions, um, we actually don't diagnose the cause. And a really good way to put it is that a description is not an explanation, and that's why when someone says, "Oh, you have this description," you say, "So what?" Because since it doesn't explain what is causing your difficulties, you can't have any realistic way of figuring out, okay, how is therapy going to help me? And in fact, if your therapist can't figure out what is causing your symptom picture, your therapist can't have any kind of reasonable treatment strategy.

You think, well, some people think the cause doesn't matter; we just treat the behavior.

Yes, that's not how I work either, but I know some people do.

Right, right, right. Well, and that's, and that's a very, that's a very important part of the mosaic, but when we look at a mosaic, we understand that there are many pieces to the mosaic. And what happens in the psychotherapy field sometimes, someone will take one piece out of the mosaic and say, "This is my form of therapy," like I only pay attention to thoughts, or I only pay attention to behaviors, or the body or the mind.

Yeah, exactly, rather than realize these are all very important parts of the mosaic, but we would never equate any chip with the whole picture of a mosaic.

Yeah. So if we do talk about the causes, what I mean at the center of something like personality, personality disorder or borderline personality disorder, it's a difficulty in, well, relationships, but also emotional regulation. That's right. And both anecdotally, experientially, and statistically, we know that there is a link between childhood complex trauma or neglect with this type of distress. What do you think that is? Why would someone being abused or neglected cause problems in emotional regulation? Well, the, you know, one way we could look at it is that every child has emotions that come up. And, uh, you know, if whether it's a distress because a diaper needs to be, uh, needs to be changed, the baby is hungry, um, it fell over and hurt itself, whatever, and and the mother or father come, they pick up the baby, they soothe the baby, and the

Baby has the experience over time that when it has an emotion, it can count on the other person to regulate that emotion, to calm the baby, to be a source of calm, and that there's a dietic regulation that together, right together, we can regulate feelings and anxiety. Right now, of course, what we know happens in trauma is that a parent, through some kind of abuse, triggers massive feelings in the baby or in the child. But the child has a problem because the source of, the person who's supposed to be the source of safety, is actually the source of danger. And the child knows: I right now you hurt me, so I love you and I feel tremendous anger at you for hurting me. Yes, I have these mixed emotions. How do I deal with the fact I love you and I feel feeling angry, and you are causing danger? So the child learns, the child learns: I actually can't rely, I can't depend on a parent for affect regulation, so I have to rely on defenses for affect association. And what uh the the this what the theorist Harry Stack Sullivan said, the child is actually going to use defense to regulate the parent.

Yeah, right. Oh, my feelings will be too much from a parent, so how much of me do you need me to hide so you will calm down? Absolutely. So we forget that actually the child uses defenses not only to deal with its own feelings; the child initially uses defenses to regulate, to protect the parent from feelings that would disregulate the parent. Yes, and sense like every defense is actually the child's act of love. Uh, how much of my feelings do I need to hide so you could love me? If I turn my anger on myself, can you love me now? If I send the feelings out of myself and I empty myself, can you accept the absence that's left? It's terribly sad, but very moving when you put it like that, and you're right, that's a beginning of the development of what the w what's when called false self. You know that's right. It's like you can't deal with who I am, so how much of me do you need me to remove so you could deal with the false self that's left? Yes, and then of course the child, of course, is, is simply these defenses are just a way of adapting, right? And the earlier these traumas happen, right, the more severe these defenses have to be. The more severe the trauma, or prolonged, the more severe these defenses have to be, the more entrenched. Yeah, the codependence, they're always going to be entrenched because they're unconscious, but the earlier they are, the more likely you're going to have splitting. The earlier the trauma, the more likely we're going to have splitting and projection. If trauma happens like after about eight years old, the child is going to have a very different set of defenses, which be what um anything, an isolation of affect where they can just intellectualize, change toic, be vague, rationalize. So actually, from our clients' patients' presentation, we can speculate when the trauma happened, isn't it? Yes, and and and also to get a sense, you might have a patient where both parents were quite disturbed, so the patient is probably going to have a lot of splitting projection. She might have had one parent who is disturbed and another person who was less disturbed, so you might see different kinds of defense systems at different times. Yeah, and the other thing to keep in mind is that you see the earlier trauma happens and the less affect regulation there is by the parent, then the child's anxiety never gets regulated. And when anxiety doesn't get regulated, the body doesn't return to homeostasis; it remains in a permanently elevated level of anxiety that we call allostasis.

So very oftentimes, if if anyone has been diagnosed with borderline personality disorder, the various personality disorders, very oftentimes in the very first session I'll just mention, are you aware of feeling anxious sometimes? The patient won't be aware of feeling anxious, but I'll ask, um, are you aware of feeling tense? They may not feel tense, but I'll ask, do you have a sick stomach? Oh yes, I get sick to my stomach a lot. Do you suddenly have to go to the bathroom a lot? Oh yes, and was diagnosed with irritable bowel syndrome, or I have Crohn's disease, or I get migraines. Those are all signs of anxiety in the parasympathetic nervous system; those are very common signs of allostasis in personality disorder. Another group is where anxiety goes into the parasympathetic nervous system even more severely, and these are patients where they get dizzy, they get faint, they have blurry vision, they get ringing in the ears, they have trouble, they start to have trouble thinking; um, they'll suddenly go very limp, and and and so we in this model of therapy I do, we would call that cognitive perceptual disruption, but these are very severe forms of anxiety, and a lot of patients don't realize when they're having these symptoms that they're actually experiencing severe anxiety because people tend to think of anxiety as just like tension, um, which is true if anxiety goes into the somatic nervous system; that's actually the healthiest form of anxiety. So if someone constantly gets tensed up and they sigh or they cleanse their hands, that's a sign their anxiety is well regulated. But you know, most people in in uh who have personality disorders have anxiety that's chronically elevated, and no one has ever uh identified it or regulated it. So these are people that go through life uh really tremendously anxious, and they're not necessarily aware of it. So one of the first things a good therapist would do would be to identify where their anxiety's discharged and help them regulate it. That you remember that from uh my book, *Co-creating Change*, where I had a huge chapter on anxiety identification regulations, just absolutely essential.

Do you think most therapists neglect or underestimate the role of anxiety? Yes, absolutely, because I really only see it in this in this diagnostic manner that you, from anxiety, but actually it's present, it's very present. A lot of uh a lot of therapists have grave misunderstandings of anxiety; they'll think that like someone says uh I I worry a lot, well that that would be a thought, right? So they think of anxiety as purely a thought, right, that someone worries a lot or I'm anxious; they'll hear the thought, but they actually, but anxiety is actually a biological discharge pattern in the body. Yeah, and it's caused by the central nervous system. So if if therapists don't know how to look at the body and pay attention to symptoms, they actually won't be able to assess anxiety adequately. Yeah, I in what um in my line of work, the the defenses that I see the most often would be splitting, projection. I don't know if you consider dissociation a form of uh defense, but these are the three that I see the most, which we will definitely go into.

Absolutely. Well, and here's a way to think about it: when when the baby is is struggling with a parent, right, and it's being abused, right, it's feeling anger, but it's feeling anger toward a parent it loves; it's struggling with mixed feelings, and those mixed feelings are triggering tremendous anxiety. So later in any relationship, right, just think even if a a dog was abused, um, if we went to a dog pound and we walked near a dog that was abused, it's going to start to, it's going to to start to bark, it's going to start to urinate; it might even defecate, right? Yeah, this anxiety will go into the smooth muscles, right? It those are the anxiety, same anxiety symptoms, and that dog will have sort of a dog transference to us; it's afraid that on a bodily unconscious level, anyone approaching me is going to hurt me. You know, patients who have been abused, they know in their head I'm coming to see you, right? But when they come in, their body has the same reaction a dog would have. Yeah, and so we have to remember, yes, with their head, with a higher mind, the patient knows it's you, but the lower mind has another reaction. Yes, and that reaction, it takes takes us for anxiety. Now what happens is when they're meeting us, they're they want a new experience; they already have positive feelings; that's why they called you; they have positive feelings, but the memories of the past are negative feelings. So when they meet us, they're having positive and negative feelings that trigger anxiety. But what happens, their anxiety goes high so fast, and it'll cause stomach problems, it'll cause dizziness, it'll cause blurry vision, ringing in the ears, confusion. What happens is that when the anxiety gets too high, the mind splits to two feelings apart to stop the anxiety. Yeah, and then because then once it's then you know like someone could just feel pure rage toward you as an all bad person; at that moment they're not anxious. So what happens when we when we when our anxiety gets too high due to these mixed feelings, the mind has to split the feelings apart, and then when split them apart, then whatever feeling they can't tolerate inside they'll project outside. So often, so oftentimes the patient can't tolerate their anger inside; they'll be afraid that someone outside them is angry with them, like me, or if they, yeah, right, or if they can't tolerate that they that it's their desire uh to to you know, like it's there, just you know, every patient comes to you because they have questions, you know, basically why am I why am I struggling? Why do I have trouble at work? Why do I have trouble with mood swings? Um, why do I have trouble in relationships? Patients always come with a question, but when they want to depend on you and and find out answers to questions, that wish to depend makes them so anxious, they may project; they'll forget I have questions, and they'll say so I I just feel like you're you're wanting me and ask answer questions; I I don't want to talk about; they're actually projecting their own wish yeah to get to know themselves. So we might just say, well, I have no right to ask any questions that you don't want to look at; that's only you find out from you what questions would you like answers to, so that the therapy would give you the information you're looking for.

Well, these are some really great examples of splitting and projection. If we rewind a little bit, bit and explain to our listeners what these mechanisms are in more simplistic terms, you know, what's projection, what's the difference between projection and projective identification? Quite a bit of, well, let's just take it actually in sequence, because first we split feelings apart, right? So um a person might come into my office and sit down and say, I'm anxious, I don't want to be here. Now what he what he's forgotten is that he wanted to come here because he's in my office; the only thing he's aware of is I don't want to be here. So I actually have to remind him that actually he came, uh-huh, coming uh uh not wanting to be here and coming here, not wanting to be here and coming here, and what's it like to notice this complexity inside you right now? And I guess that's what we always struggle to hold these opposites, the love and the hate. Or a person comes to you and says, you don't care about me, and so on and so forth, and I know it's because this and this, and then you might say, well, really, that must be very puzzling, because remember last time you were talking about how you felt I really understood you and that I understood what was going on with your mom, and then now now there's this other thought that that that I don't that that I don't understand you. What's that like to notice how there's these two different perceptions that can happen in the same mind? What's it like for us to notice that together? So in a way, when the patient has trouble tolerating mixed experience, they'll split them apart, and has to help them bear the complexity, view and the complexity of feelings. Now when they split a feeling off, they might project it. So, for example, I let's suppose that I'm your patient, and I I could say, no, I I didn't want to talk to you tonight, Emy; you made me you made me talk to you tonight because I got that email and I just knew that if I didn't do it that you would really be angry with me, right? So in this point, I have forgotten that actually I made the choice to be in contact with you; I made the choice to email you back; I made the choice to click on your Zoom link, and I made the choice to converse. But in the heat of the splitting and projection, I project onto you that you wanted me to talk to you, and I've forgotten that actually I wanted to talk to you as well. So in projection, when I have an urge in myself that I can't tolerate myself, I'll I'll attribute it to someone else. So I might say, oh no, I'm not angry with my boyfriend; I'm afraid he's angry with me. Um, it's it's not that um it it's not that uh it's not that I uh uh it's not that I want to talk about my problems; I can just see you, my therapist, are wanting me to talk about stuff I'm I'm not comfortable talking about. So when there's an urge inside that I can't tolerate inside, I'll project it outside. So I might project that you're angry, right? Or a psychotic person will project that they think the government is angry with them, right? And this is what you meant, put outside, yeah, the how that's how what you meant by people are interacting with a projection rather than the real person.

That's right. And see, projective identification is different. I I could project and think that you're angry with me; in projective identification, I'll act with you in such a way that you actually start to feel angry with me. So I'll actually get you to feel something that's congruent with this projection. Human relationships so messy. Exactly. And then and then when you talked about dissociation, yes, dissociation is a kind of of splitting; it's a way of saying something of my experience doesn't belong to me. So it's like a person can feel I'm not here, and they can feel like they're back against the wall. What we call secondary dissociation or tertiary dissociation is where I think, oh, I don't have this feeling, but I have this personality, Mary, and oh, Mary is really angry. Yeah, and sometimes I don't know how to bring the person back because they have left the room, I mean not literally, but yeah, yeah, yeah. And and and I think oftentimes uh oftentimes what we need to be thinking about is what was happening the previous five minutes because anxiety has risen in some way and I didn't catch it, and at a certain point when anxiety rises the patient starts to have this cognitive perceptual disruption where they get a little dizzy and they have trouble hearing, trouble seeing; they have these anxiety problems, then they then they start to split, and then they start to dissociate. So the thing is, if you can assess their anxiety a little earlier, you can keep working with them before um they dissociate. Yeah, um or if it's secondary dissociated, like they're back against the wall, you know. Yeah, why is relational regulation powerful? That's a really good question. What do you think? My thought was the trauma itself happened in a relationship, so it gets healed in the most powerful way in a relational experience, although that's also the hardest, right? But what was harmed in a relationship must be healed in a relationship, and this and it must be healed in this this relationship. Yeah, and not just once, but again and again, with again and again, and that's it's an emotional healing; it's not like head to head; it's heart to to heart, body to body; it's you know, it's not like oh, if you just get the right answer that you're reading a book, like everything changes inside; there has to be because in a way the patient, if you think about it, the patient is regulating you the way she had to regulate her parents. So when you ask about feelings and you work in the relationship, you're implicitly restructuring her attachment strategy, and it has to be done relationally because in a way, by your regulating anxiety, by your inviting feelings toward you, you're conting the patient know you don't have to protect me from your emotions; you don't have to protect me from your thoughts. So the patient actually has to experience that they can share forbidden thoughts and feelings with you, and you will stay stay regulated and you won't ask them to put some thought or feeling away to regulate you. So much is happening in the relational process. My frustration is sometimes clients don't see that, and they really crave a kind of explicit structure or really obvious quick signs of improvement, what which I can fully understand, but it's also sometimes quite difficult to communicate these subtle but powerful changes. What's what's an example you're thinking of?

Um, I'm thinking of people who come in and ask for a lot of structure and signs of progress and um um marker of when the process will be completed. So let's think about that: there they they're they're uh they come in uh and they're they're want they're wanting markers of progress and they're wanting advice, want to be told what to do. What do you what do you notice feeling when uh when you're sort of uh hearing this, that want markers of progress and they're feeling that you're not quite up to, pressured um a bit of frustration, sometimes irritation. Exactly. So what kind of relationship is this is the patient setting up with you? That's right. It's almost like inviting me to be critical and stoppy, well, actually, there being a critical parent placing all kinds of demands on you and that you could be dumped at any point unless you meet these demands. Oh, absolutely. I do feel under, and you feel kind of irritated at these demands and pressures. Absolutely. Absolutely. Now, so when they do that, what does that tell you about what does that tell you about their family background? That's probably what they received or their lives, and and it's probably a way they treat themselves. Yeah, yeah, yeah, right, that they're probably excessively demanding, that they're feeling like always should be meeting some expectations, and they feel like they're they're never quite good enough. It's a really good point, and I would flip from feeling sometimes eager to please, like, oh, I better come up with some markers and explanations so that this person wouldn't leave me and stay in the work. Yeah, and that must be how they relate. Exactly. So sounds like you're having some reactions here um when when you're feeling like somehow the therapy isn't as helpful as you would like. Well, yes, because I think uh so I wonder what feelings are coming up toward me. They may not be brave enough to to say that, but it's nonetheless a very useful question. They they won't be brave enough, but the defenses they've used to protect their parents from criticism will come up, and perhaps they'll even go to self-attack to protect you from this criticism. Yeah, and then you can help them with that, which is what they have done all their lives with their parents. It's my fault; it's me; it's not you. Well, but so could this be a critical thought, and could that critical thought be making you depressed? Could that critical thought be unfair to you? So I wonder could we look underneath those critical thoughts and see what feelings are are coming up here toward me, because my concern is that when you go to these critical thoughts, it's the way you're hurting yourself in our relationship, and naturally I'm concerned about anything you would do here that would hurt yourself in our relationship. So could we see what feelings are coming up here with me that would make you hurt yourself this way in our relationship, John? This is really good; you are really good. See, and then and and of course you're making indirectly a comment about how they learn to hurt themselves in order to maintain a relationship with a parent and protected a parent from from anger by going to self-blame. Wow, but that gives you a lot. Now you're saying, oh, it's not just a a defense, but oh, it's a way they are protecting me. Yeah, yeah, and when you turn the anger on yourself, could this be a way that you're protecting me from these critical thoughts? Yeah, and then when you protect me this way, could that be hurting you? So could we see what feelings are coming up here toward me? There's one more defense that I'm dying to talk about, which is what I excellent, yeah, but before that I also have more questions about, okay, um, you know, very earlier on like 20 minutes ago you were explaining why people get traumatized with complex trauma or or the lack of nurturance from their parents, and you said all children have feelings. Do you think some people

Some are born more intense and sensitive than others. And would the temperamental differences with their family be more, you know, there are many cases where siblings with the same parental treatment turn out very different. What do you think?

Absolutely, absolutely. Because, well, you've got there's a lot of research to support the existence of temperament. Obviously, you have children that are very shy, children that are very impulsive, children are very outgoing, right? There's there's definitely uh differences in temperament, and almost any set of parents that's had a number of kids can point to differences in temperament that were visible in the very earliest days. Yeah, and and as long as we're looking at genetic factors like temperament, you also have factors like neurocognitive deficits, right? If someone has a sensory integration difficulty, like they can't tolerate the feel of certain clothing or tags on clothing, right? There children, certain children that cannot integrate sensory experience from skin that some they have trouble tolerating being touched or they have to be touched in a certain way. These kinds of neurocognitive deficits have a very big impact on how they internalize relationships, right? You're right that a mother hugging at one child at works and for another one it's just squirming, wants to get out of her arms, you know, and you know the poor kid, it's just it's not his fault; he's got this this wiring problem. And of course, some mother could take personally, like he doesn't like me, not realizing, oh, he's got he's got a lot of skin sensitivity; we have to find another way to make contact. So I think I think the role of neurocog deficits is is very important to keep in mind.

I had a patient one time, for example, where um she she'd had a number of therapies, nothing had really helped. And when I was working with her, I noticed there were all these emotional breakthroughs that were happening, and I thought, well, Frederickson, you're good, but you're not that good; what's what's going on here? But then I noticed the pattern that if I said two sentences, she almost always would break into tears. And I began to realize this woman had an auditory processing problem; she actually couldn't keep up with conversation with friends if they spoke rapidly or two people spoke at the same time. Her her brain simply couldn't process auditory information, so she had a really hard time maintaining friendships; she couldn't have friends in a group; she could only have friends individually and only if they talk kind of slowly. And and I began to see too that her processing speed was reflected in kind of a slow speech manner. So I learned to speak as slowly as she did, so she could process what I spoke. But that finding, that realization of her unique wiring and what needs to happen, it must be so powerful.

Totally, totally transformed her understanding of of her childhood, right? Not many, not all of us are wired in a way that is within the norm; we just have these quirks that require, like I'm the kind of person who have the tag problems, um this kind of sensitivity and that kind of sensitivity. And actually, as a grownup, it's more important to own it and then find a way, find the place in the world where people celebrates you.

That's right. And I think a lot of times therapists are taught about the role of temperament, the role of neurocognitive deficits. Here's another kind of important fact: within people have a borderline personal disorder, a a significant percentage have had brain injury, all right? And brain injury will affect um you know all kinds of brain function uh but when you think about it that when you've got trauma, a lot of kids are you know they're their heads, they're going to have head hits or or you got car accidents, you know, but there's different, you know, this is something most people don't talk about, and the the role of head injury, you know, so you have so when we talk about borderline, of course, I think about it from a psychological point of view, but I'm also thinking about temperament and and like we talked about in our e, it's not just the temperament of the child, you know. If you have a parent who understands the temperament of the child, it's not a problem, but if you have a parent who really hates a particular temperament, yeah, it's going to be a mess. So like if you have a child that's very shy and parents are giving the shy child a hard time, the shy child is going to really suffer rather than just, no, she's shy; she'll she'll always be shy, but she'll be able to have a very rich internal life, so on and so forth. Or you might have a very uh inquisitive, asked a lot of questions, very active child with very introverted, quiet parents. I have very close friends; they had a they had a son; he was just so he was just incredibly defiant and oppositional as a little boy, just but his mother was so fantastic and dealing with him; she really was able to give him a lot more freedom; there were always limits, but she could always figure out what the maximum amount of freedom to allow him so that he didn't have to butt heads so much.

That's wonderful. He's doing fabulously well now as an adult. It can be done, parents; it can be done. Really hard, but but it's really hard, and parents oftentimes don't get the advice that they need with.

Yeah. All right, thank you all. I know your time is valuable, but I really want to talk about counter dependency. What is it? You used this really wonderful phrase, fantasy of omnipotence, which to many of my listeners may not sound explicit uh immediately obvious what it means, but I kind of look at it, I may be wrong because I used to work counter dependency a lot in my work, in some articles that I've written, is that the same thing where people kind of avoidance of dependency, afraid of being dependent on anyone or even anything, um they kind of like to I'm pulling together a whole lot of traits, and a person with counter dependency may not take all the boxes, but maybe they hold a lot of resources; they make sure that they're knowledgeable; they make sure that they can survive in an apocalyptic situation; they may isolate themselves; they may work on overdrive; they may have very little or to no relationship, or they maybe even deny that they need relationship; they're just afraid of being dependent, including on a therapist or coach.

Oh yeah, is that related to what you call fantasy of omnipotence, or are they different?

Well, it it can be, you know, I mean, this is really such a universal conflict, isn't it? There's a wish to depend on someone, the anxiety of depending, and then the defense of avoiding depending on someone, and and and there's a whole spectrum of that, right? You can have something as the husband who's just afraid to to share some some upset that happened at work with his wife, right? It could be just a small anxiety about dependency, a little minimal defense or whatever, um and then you have people where it's they um they claim they don't want to depend on anyone, right? And that they want to be able to do it all, and there yes, then we start to see omnipotence, right? We live in a in a world of interdependence, right? Uh we're we we we rely, you know, I rely on my wife, rely on friends, and the most rely on the farmer to to farm so I can have farm our foodish fish our fish, the yes farmer to bring apples, right? So we live in a web of inter interdependency; there's no way to avoid that. But when people have had an experience of depending where was dependency led to pain, then often times some people will choose the solution, well, I just won't depend on anything on anyone. And so then in a sense, they they're afraid of a f future apocalypse, so they try to store up all this food. What they fail to realize is that the trauma they fear in the future already happened in the past. People who are preparing for a future trauma are displacing into the future the trauma they already had; they're trying to prepare for trauma, but it's too late; the trauma actually already happened. And so often times with patients, we have to help them see where the real trauma was so we can help them deal with that so that the rest of their life doesn't have to be based on this displacement of trauma throughout life. And and of course, if we can't tolerate depending on another, then there's the wish that we could just depend on ourselves and no one else, which means that I would be omnipotent. The the British psychoanalyst uh um Melanie Klein had a funny way to put it; she says every child suckles on a breast that you got that person who thinks he actually is the breast so he can suckle on himself, right? And so so the the greater the uh anxiety about depending, then the more extreme these forms will be where people claim not to depend on anyone or where they they uh people claim or claim that they know everything, you know, like in this Covid period, we've had some people who read everything thinking if that if I just know enough, I won't catch Covid, right? Well, if you know enough, you'll you'll know enough uh but knowledge doesn't necessarily mean lead to omnipotence. And and no matter how much you've read, you know, wouldn't no matter how smart you or I may be, no matter how much we read, we're not going to be an epidemiologist or we're not a specialist; we can't possibly know as much as they know, so we don't even get omniscience uh about that area.

What kind of events or situation would break a person's fantasy of omnipotence? Set like a midlife crisis where suddenly their defense is no longer work or relationship problems, maybe?

Yeah, there has to be there has to be there has to be some impact where reality bumps against their fantasy, right? If someone actually gets sick from Covid, yes, they may realize, oh my God, Covid is not a hoax, although we've had a few cases here in the United States where someone was dying of Covid and they said, no, this can't be because Covid is a hoax. It's like denial can be breely powerful, yeah, but if someone but but the only way someone can get get loosened up from denial is it to be reminded of reality that conflicts um with their denial.

I hear that there are a lot in the conversation we just had; a lot I feel like intellectually stimulated, and personally, I don't know, I'm getting a lot from this. If someone is listening to that and they're getting lots of insights, but they maybe they're not working with someone, is there something a person can do themselves without a therapist if they struggle with say emotional regulation? Is there anything they can do themselves for emotional regulation?

I uh I think that uh one of the best things you could possibly do would be to you know pay attention to to what you feel in your body and just sit still for a while and pay attention to symptoms in your body. Uh sometimes of biofeedback can be extremely useful, so I always for people who have problems with anxiety, if you don't have access to a therapist, biofeedback can be an extremely good way to regulate your anxiety, um and there's there's different kinds of biofeedback devices that are out there that are really good way to regulate your anxiety uh just just on your own. Because we talk about emotional regulation, but actually um emotions don't need to be regulated; we talk about emotions being unregulated because an emotion occurs with anxiety, and the anxiety is unregulated. If you can regulate the anxiety, the emotion is what it is.

Yeah, I like that. Yeah, but it's it's that there's a combination of anger plus way too much anxiety, so if we can regulate the anxiety, yes, someone can be doing a lot better, but they can actually with a wider scope of emotions rather than trying to make them smaller. Yeah, and if you know my my first book uh well not my first book, but the a couple of books ago um co-creating change has a big section on an anxiety and and it's written so anyone even if you're not a you could you could understand that chapter and uh and if and for people who are working with personality disorders or whatever, my most recent book, co-creating safety, really talks a lot about how to work with fragile people, how to regulate anxiety because in a way for the fragile patient they have to feel safe in the body, right? As a first step, you know, therapy can't be safe if the patient doesn't feel safe in the body, and you have to regulate anxiety, and then you have to deactivate any misperceptions of the therapist so that the patient can feel safe with you. So you actually have to regulate anxiety so the patient feels safe in the body, and you have to deactivate projections so the patient can feel safe with you, and then from that safety then you can go ahead and and do the work of therapy.

I hope listening to this point, people who struggle tremendously would feel some sense of hope that absolutely change can happen.

Absolutely. And I think for for those of you not therapists uh there's a book I wrote for the general public called The Lies We Tell Ourselves, which is a really nice introduction to different kinds of defenses we all use, and and it's full of all kinds of examples that that a lot of lay people have found very helpful.

That's the one I haven't got; I'm going to buy it.

Oh oh oh, well, we'll have to get together again after you bought that.

I I hope you I would love to I would love to talk to you.

Yeah yeah yeah, it's because that's really designed for the general public.

Yeah, The Lies We Tell Ourselves. This is recorded, John. I will get you back.

Well, I'll look forward to it.

Oh wonderful. Okay, well, I know your time is valuable; I have a few more questions.

Sure.

What is your definition of resilience?

Resilience, you know, there was an interesting statement by um child psychoanalyst many years ago, E. James Anthony, because he uh he had studied you know just you know thousands of children in his career, and he had this kind of funny thing he said, you know, there's glass children that when they when they're dropped, they shatter, they break, and then and then you have steel children that when you drop them, nothing happens; they're just like tough. And then he said you have rubber children that when when you drop them that they absorb some of it, but they bounce back. And I think we can we can all see that. I think that but the resilience we get it is due to the resilience of of of the parents we had. And so often times if if we we didn't get that kind of resilience uh from them, we're going to have to get it from a therapist. We'll have some inborn genetic uh resilience, which is what I think he talked about; there are there are children that just through genetics yeah can just seem to be unphased. Some are like rubber, and some shatter. But for those of you who you bounce and you absorbed quite a bit, you don't feel you quite bounce back, then a lot of that resilience you're going to gain from therapy in large part through learning about anxiety, identifying it, regulating it so that once you're is regulated, you're going to be in a resilient physical state and a psychological state more of the time. And then therapists can help you deal with the feelings that other people couldn't help you with. And as you build a certain kind of affect tolerance and ability to tolerate these mixed feelings that had to be split apart in trauma, as you gain the ability to tolerate these mixed feelings that increasing intensities um yes, therapy will build your resilience.

Thank you. That's good. Thank you. Um can you share with us a book that has changed your life?

Book that's changed my life? Gosh, they're so I've read so many books, thousands; I you know, right now I don't work out of my office, so it's a very expensive library right now, you know, thousands of books. What's what's the book that's changed me the most? I I just I really don't I really don't know off the top of my head.

That's okay. That's okay. Yeah, I mean, it's just there's so uh so so many books.

Yeah. I just would you recommend one book to our listener off the top? It doesn't have to be the book, just anyone, maybe your own.

Well, I think for the general listener out there, I would definitely recommend um this book, The Lies We Tell Ourselves. Yeah, and for for anyone out there who's working with fragile patients, my most recent book [Music] um yeah, because it's unlike a lot of uh therapy books because it'll tell you about theory, but it has lots of examples of patient vignettes, so you really get clear examples of how to intervene, how to understand responses, so it's very very helpful when you're wondering what to do or how to understand the situation. That's really useful.

All right, final question; I'm going to challenge you a little bit. If you were to sum up your work or your position in one to three messages or just a few lines, what would you say?

Um, that psychotherapy is an exercise in faith that will become well by becoming reunited with the truth, and that that we learned to hide certain truths about ourselves to keep a relationship, and that we basically have to accept inside what others asked us to put outside, and that the more we can accept of our inner life inside without placing in in outside, the more we can accept ourselves inside, the more we'll be integrated; that that that's really the path of health.

That's wonderful. That's wonder whatever you were taught to reject in yourself, you must learn to accept yourself, and that can happen within a therapy relationship that accepts everything uh in you.

Thank you. You're very welcome. Thank you for inviting me. I have learned so much.

Thank you so much. I can't wait to get this out.

Oh good. Personally, I've really learned a lot; I felt like I was getting good supervision, and there were points, especially when you said the thing about how the thing you dread the most has already happened. I personally struggle with quite a lot of anxiety, fantasy like happen that might happen, and that really gives me a good perspective on, hang on, actually, you know, that may relate to something I've already experienced.

Exactly. It's so easy for us to misuse our powers of imagination for the purpose of self-torture; it's so easy to do. You are a wonderful force in the field; please never stop doing what you do.

And yeah, it's such an honor to speak to you.

Well, thank you so much; it's been a pleasure. Take care. Bye bye. Bye bye.

Hey, thank you so much for tuning in. For more, please head to xshell thy.com. There you will find more stories, articles, and resources for people just like me and you. Bye now. Now keep putting one foot in front of the other, moving forwards, never looking back, just one more foot front of all those countless others, and we're there. Imagine that.