Transcription
I thought we would do a second debrief. The reason that we, you and I, talked about sort of re-upping this debrief is because it was a good opportunity to respond to some of the feedback and the comments that people are leaving on the channel.
So, one of the things that has come up is tolerating anger and actually the difference between anger and rage. So, can I, um, I wonder if it is okay if I reword the word "absolutely"? Because I think one of the things that, um, you and I had been talking about was, um, a repeated comment about the the recommendation to to sit with anger. And the first thing I would say about that is that having a goal of treatment is different than having a goal of the session. And the goal of that session, in my mind, wasn't to, in one statement or one session, somehow transform Charlotte's experience of intense anger and at times rage in a simple tolerated, but rather introduce the idea of not avoiding certain emotions, anger being one that has come up for her that she talked about the first time I met her and then again.
So, in her acknowledgment of having a range of emotions, which is, I think, a huge sign of progress, she also talked about how she was using certain strategies to sort of, what I might say, distress tolerance, emotion, intense emotions when they occur. And while that actually is not a bad strategy, what I hope to introduce was the idea that we have lots of emotions. Some we're more amenable to than others. Anger is one particular one that many people have a tough time with and was, I think, pervasive for Charlotte. I think an innovative idea is not to distress tolerance anger away, but rather to allow it to coexist with other emotions and not spend so much energy disconnecting or distancing oneself as though it's something to be feared. And when one fears something like anger, that's when I actually think it can build up to something like rage.
If I was in longer-term therapy with Charlotte, that would be a real point of therapy to actually invite some of these ranges of emotions in so they don't become so scary over time. If someone is willing to entertain the idea of inviting those emotions in and exploring how to begin to sit with them or tolerate them, like, why bother doing, like, why do it? Because we have a range of emotions. Some are, as I mentioned, some are more tolerable, more desired than others. It doesn't stop emotions that we don't appreciate from emerging and re-emerging and re-emerging over time. Being able to acknowledge anger or our own aggression is a challenge in and of itself, given that this is not something that's avoidable. It's a natural human emotion. We know it's going to come up again and again for all people, all humans. It behooves us to have some exposures to all of these emotions, anger being one of them, so they don't become these monsters that over time are deeply feared.
What's the prescription when you feel, when someone feels anger? I mean, I struggle, I forever struggle with this, you know, um, how do people make decisions about what to do with it? The thing is about something like anger, it's not like a choice. Do we want to experience it or not? It's going to happen. And the question is, are you sort of aware of when it's emerging, even at low levels? And when it does emerge, how do you, what is your relationship with your emotions? What is your relationship with anger? Charlotte mentioned that she goes from like zero to hulkish, is what she described. And the interesting thing, even in our session, which I didn't point out, but might have in longer-term treatment, is that even in our session, she was experiencing frustrations with me.
And I think another comment that you and I observed that kept on re-emerging was a comment I made about whether Charlotte was in fact cheated on, and the way I made that comment and why I made that comment, which I can speak to in a moment. But I think the benefit, sort of a silver lining of having made the comment in the way I did, was that her frustration was notable. And if this was longer-term treatment, I might have noted, "Hey, look at this. You feel like you go from zero to hulkish, and yet there's something going on here. What is that for you to be able to name these lower levels of anger that it didn't blow me up and it didn't blow her up?" And you would want her to note that because it was sort of an effective expression of it, regardless of interpretation. Absolutely didn't damage anything by her to express it. Whether, um, she and I might be aligned and seeing something the same way isn't necessarily for the purposes of this issue around anger. The point, the, the really important part of that interaction at the end of the day, this was not intended, was that she was frustrated. And to be able to be frustrated and actually state that frustration is really good news and should be acknowledged and highlighted.
There's a difference between a longer-term treatment and the interviews with Charlotte or the sessions with Charlotte. And, and it's coming to mind that that differential is actually quite important. When I met Charlotte a year and a half ago, it was really trying to understand her world through her eyes and get a sense of what she struggled with, what her hopes were, what her goals were, and what she thought she might want to work on. Seeing her a year and a half later was really an opportunity to say, like, how has it gone? What's, you know, changed, if anything? What did you take in from the session? And where do you want to go from here? It wasn't really an opportunity to start working on anger per se, but rather suggest that these are areas to work on for, for longer-term treatment. So what I might do in a session over a longer-term therapy is very different than what I might introduce or what I did introduce in those sessions with Charlotte.
I was going to ask, since you brought up that moment that a lot of people have thought about and said things about, which is this moment where, um, I'm not going to be exactly perfect in my quoting, but you said, "If you think that if that is what happened regarding everybody cheated on her, cheating on her." So, I, I had my thought about while I was watching it happen. I was like, "Oh, is Karen pointing out or investigating whether Charlotte's perception of the event is aligned with what, in fact, she is saying, or was there some misinterpretation of a behavior that led her to make this statement?" And, and the reason that was my read on your comment was like my sort of somewhat static knowledge at this point of like BPD and it being, I think, in certain ways, like a problem of interpretation and perception of interpersonal happenings that lead people to land in, [Music] firm decisions about a person or experience that may be off base, and then they behave in accordance with that perception, and it does a lot of bad. It blows up in their face because it is, in fact, kind of a misperception. So I thought you were headed in that direction, but it doesn't, I think when we talked about it, you suggested otherwise. So can you talk about what you did?
I think there was part of that re-buy going on, so I'm glad you mentioned it. Um, I believed Charlotte had that genuine perspective. I really believed she had that perspective, and I was challenging her on that perspective. Having some previous knowledge of Charlotte from my conversations with her, she comes to the world with a lens based in a long history of relationships that I think she really feels other people have failed her, not shown up in ways that where she's failed loved or cared for, parents, other relationships. And when we have these experiences, there's a way in which we continue to enter into relationships with a lens based on our experiences. So my pressing of the issue was really to sort of better understand what it was that she, how she was coming to that assessment.
There are lots of ways to ask, um, and there might be more sort of less valence ways of bringing up the same issue. I think that's a really good point. Um, but the point of saying something like that is really inquiring, what is she really taking in as evidence, as an understanding that's leading her to an interpretation, therefore responding to relationships in a very intense way with a lot of emotion? So no doubt that was her experience. But if this was a longer-term therapy, I would have explored that more. I would have been very curious. I sort of backed off a little. I could see she was frustrated. That wasn't the point to get her frustrated. I was actually happy to see that she could show frustration. Um, but to really understand what she was taking in as evidence to to assess the relationship in the way she did, because it can actually become a self-fulfilling prophecy.
So if I'm somebody who has feels like I can't trust people over time, I might be really skeptical of my partner. I may say and do things that indicate my suspicion or my skepticism that might generate an environment or contribute to an environment of mistrust where my partner then may be responding in kind. So it, in some ways, can become a self-fulfilling prophecy. And without one knowing that they may be contributing to this self-fulfilling prophecy, and I'm not saying that's what happened with Charlotte, but it can happen and often happens with folks who struggle with BPD where there are some cognitive distortions at times or paranoia to sort of challenge or explore, "What am I, what am I doing anything? Is there something that I'm doing that might actually be participating in this?" And the hardest thing is when people don't know where they don't see that aspect. It feels very out of control in some ways, almost like the world is doing something to them.
I mean, I'm like thinking, isn't that essentially transference? You're putting something out, unaware of what that thing is, that someone else is absorbing, feeling you're transferring something. When you reference transference-focused therapy as a potential modality for her to explore, let's say the person is not consciously aware that they're bringing this history of distrust into a current relationship, that the other person is then absorbing that attitude that they feel toward them. So, is the purpose of something like a transference-focused therapy to bring to the fore that kind of energy, attitude, perspective that you emit unaware in relationships, but you, the therapist, now is sort of the absorbing point or the the target for it?
Rebuy, it really is about a dynamic that emerges. So it is, it is, um, important to see patterns over time. So if you're somebody who says, like, "I don't understand what goes on in my relationships," it's actually quite painful. It's very painful. And yet, it's really painful to repeat these patterns without knowing what's going on. It's kind of like you're walking through the world with blinders on. And it can be really eye-opening to better understand how that dynamic emerges because if it continues to repeat, even with a therapist, and that is one of the focuses of TFP, transference-focused psychotherapy, to see these patterns when it's likely to emerge with a therapist and work on those patterns, is one reason why I felt for Charlotte, TFP could particularly be useful at this time in her life.
But the other thing about TFP and the other recommendation I made around why TFP might be useful for Charlotte at this time is it's also a therapy that really, really explores aggression and anger. It's, as a real centerpiece. And to notice, why is it, why do you think it's designed for that? You know, I, I don't want to, um, purport to be an expert on TFP. I certainly know TFP quite well and have been trained in it. Um, so I, I have this urge to say, I want to double-check this with Frank Yeomans. But what I would say about anger in particular, and so this is what, what made me think about this, is that TFP, to the best of my knowledge, was developed for BPD initially. I mean, it's really used for personality disorders, but one of the hallmark, um, challenges that somebody with borderline personality disorder experiences is a real difficulty with anger in particular, like disavowing anger, not wanting to see one's own aggression, you know, kind of splitting it off because it's too painful to see oneself in that way, right? And so, um, you know, to me, for Charlotte, both this issue of anger and her difficulty in her own relationship with anger, coupled with, you know, how she experiences relationships in the world, make TFP a, a good option for her. It doesn't mean it's the only option, but I think it's a good option for where she is right now in her own process.
In terms of like, you know, people splitting off their anger, is it just because people feel like they're not good people or something with anger? With why would you want to split off and not own your anger? What's, what's the big deal? Well, I'll use Charlotte's example. I think anger for her feels like she's a monster that she's going to destroy herself and everyone else around her if she gets angry. So it's a lot easier to split off and really try not to see it if it's that destructive to her and those around her, especially those that she loves. So she's going to try and contain it for totally understandable reasons. Except the problem is, we can't wish anger away. It's part of a human emotion that we all have. So it's bound to continue re-emerging and creating real challenges for her. Rather than sort of try and contain it, it's really about how I can have a relationship, allowing it to be more known, seeing when it comes up, and seeing that it's actually emerging even in small doses, even during my session with her. So again, I would have pointed some of those things out had this been a longer-term treatment.
Is it that people have such a hard time with anger just because everybody has different hard times with different emotions, um, or if that's a more commonly challenging emotion to figure out how to manage? Is it that way everywhere, or do you think there's, I mean, I'm asking you to become like a social scientist now for a second, but like, is that because, do you think that's, I mean, because we just don't have great examples of how to express anger? I mean, why, you know? You know, I, I have the urge to say anger is, um, one of those emotions that I think can be more challenging of emotions, much like shame can be really challenging for people. But when you're working with a particular cohort of people who have BPD, anger in particular is very difficult to experience, to express. It's scary. I think Charlotte described it beautifully. It feels like it's going to destroy them or somebody else. You know, one reason why people have reported to self-harm is because their anger is so extreme. I mean, certainly there are lots of reasons, but this is one. They'd rather take it out on themself than somebody else.
Yeah, that's interesting. I mean, shitty, but interesting. Um, and just one thing you just said back there, you said, you know, you were happy to see that she was frustrated. So I could hear, like, I can hear the audience without taking you to task for that a little bit, saying, "Yeah, and, um, let's just, let's just grab that up now. Um, why don't you say why you were happy?" Because I don't think you were egging her on to be frustrated. No, it's not about egging her on to be frustrated or celebrating somebody's distress. But when you're really in a therapy with somebody, it's making room for all emotions, particularly the ones that are really scary for somebody to experience. To, um, align with that fear is undermining somebody's process of healing, of recovery. So when I say I'm happy, it's not, I'm happy that I upset Charlotte. I'm happy that she actually has moments of lower levels of anger that she might not even be aware of, and that she tolerated without her knowledge. So it's actually a moment of success for her that I would have pointed out, highlighted. I would have been shining a massive light on that moment if this was a different circumstance.
People, you know, find Charlotte very appealing as a person, right? As do I. I care. I really love and like Charlotte. You know, I enjoy her. Um, it's hard not to like her. It's hard not to like, hard not, Charlotte, it's hard not to like you. Yeah, when you see this, if you see this, no, um, it's hard not to like Charlotte. And, um, and so I think we debriefed a little bit about sort of the people-pleasing aspect or, you know, working hard to be appealing. And that's clearly been effective and helpful to her in certain ways. I mean, better to be an appealing person than not. Absolutely. Where has that or where could that, if she isn't attentive to that instinct, put limits on her efforts to get better? This, this people's appealingness. The way I think about this actually is somewhat related to say, anger or keeping relationships where it feels like there's, um, minimal conflict, even with me. We started the session where the first thing she said, you know, is this apology for, um, how she, when she went back and re-interviewed this session herself, how she saw herself. And it was like trying to join on something with me and, um, relate. And that's actually a, a real asset in a lot of ways.
I would be curious whether that also functions to make it hard for people to confront her if there were problems, because she's so likable, because she's so appealing. What impact that has for other people on bringing up grievances, upsets? It would be understandable, especially given Charlotte's fear of conflict or anger. And if she really works to be related and appealing, it minimizes conflict and anger, at least active conflict and anger. It doesn't mean that people aren't frustrated or upset in relationships, but it may be hard to actually address those things directly, right? And it probably means for her as well, there are under, you know, I mean, none of us say everything we think or feel about a person because if we did, probably many of us would be very depleted with who's in our life. But, um, but it seems like she may also then not get out of relationships what she could because she's always working to relate and manage to avoid conflict. And so then parts of her that need to get expressed or seen to sort of stand up for some aspect of her authentic self get closed out. Yeah, I don't know. I'm guessing anyway.
There are all sorts of, um, outcomes related to this. Um, she might not be able to or feel comfortable sharing her frustrations until they become so big, right? Because conflict is so hard. So it's bidirectional. What she puts out there is part of who she is, but maybe not all of who she is. So it limits the sort of intimacy because if she's fearful that somebody really sees outside of her, especially if part of that is anger or aggression that she really doesn't want to see in herself, then there's part of her that's left unknown. And that's actually when people can feel really alone because there's a part of themselves that they fear to be seen. And it's again, these are very painful experiences for people. And you get to them slowly over time through therapy. When you have a lot of campaigns to conceal parts of yourself, there is a power in that because you know more than the other person. You hold something for ransom, in a way. And there's an aggression to that. I could just speak for myself when I, it was my power, you know, I mean, I wasn't very happy, so I don't know how great that power was.
Well, that's the trade-off, right? It's a trade-off. It's a, it's a, you have, you might have seemingly more control, but control over what? Control over being fully known? Where does that actually leave you if your hope is to develop an intimate relationship with somebody where you are known, right? So it's a real conflict. You.