Depressive Personality Style with Jonathan Shedler

Dr. David Puder and psychologist Dr. Jonathan Shedler explore depressive personality style—how it differs from clinical depression and why it often goes unrecognized. Through a detailed role play, they demonstrate how self-criticism, unconscious guilt, emotional deprivation, and suppressed anger emerge in therapy. They discuss: How depressive personalities form in childhood The role of introjection, self-blame, and gentle idealization Why therapists may miss key dynamics if therapy feels "too good" How to help patients access their real needs and frustrations This episode is ideal for clinicians and anyone interested in deep psychodynamic work. Shedler draws from the work of Nancy McWilliams and Otto Kernberg while offering his own insights on personality, countertransference, and therapeutic technique. Link to blog. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-241-depressive-personality-style-shedler Link to YouTube video. https://youtu.be/J2TiCHMsOls By listening to this episode, you can earn 2 Psychiatry CME Credits. https://www.psychiatrypodcast.com/cme-program

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:13David Puder?

  Okay, welcome back to the podcast. I am joined today with Dr. Jonathan Shedler to talk about depressive personality style. He has been on the podcast before talking about narcissism, obsessive compulsive personality, beginning treatment, psychodynamic psychotherapy. We have no conflicts of interest to report for this episode. We will be doing a lot of role play, trying to give a practical understanding of depressive personality dynamics, how it shows up in therapy, and how to start to help the person get in touch with their own needs, desires, and frustration. Individuals with depressive personality style are often

• 0:55David Puder?

  professionally and socially externally successful with a warm, engaging, empathic presence and invested in making other people's lives happy. Due to the adaptive childhood dynamics that they faced, how they adaptively responded to hardships, these people developed an accommodating nature and get stuck in relationships, even therapeutic ones, where their own needs, desires, and anger remain neglected, disavowed, and largely unconscious. Depressive personalities are distinct from clinical depression. Someone can have a depressive personality without

• 1:36David Puder?

  necessarily experiencing clinical depressive episodes. Paradoxically, individuals with a personality style often appear outwardly successful and high functioning despite inner feelings of inadequacy and chronic dissatisfaction. They typically struggle to experience genuine pleasure or joy. Within psychodynamic circles, the concept of depressive personality remains influential, especially the works of Nathan McWilliams, Ota Kernberg, and Jonathan Shedler. They emphasize underlying dynamics such as internalized self-criticism, unconscious guilt, and enduring interpersonal problems, which makes this meaningful to understand and address.

• 2:20David Puder?

  There are common patterns that show up in how they relate to others, including interjection, which means internalizing negative experiences and anger. There's a turning against the self, engaging in self-directed criticism and punishment. And there's a gentle idealization of others, coupled with, you know, when they do have frustration at others, they usually turn that on themselves and have this self-devaluation. So as they idealize the therapist, they may be covertly dissatisfied, but then turn that into self-blame and guilt. Counter-transference could include protective impulses, a feeling of desire to rescue.

• 3:03David Puder?

  There may be feelings that you pick up of their disavowed frustration, and you may feel the frustration that it's hard for them to feel. And there also may be feelings of helplessness that they feel and that therefore you also feel. And these things will be addressed in this role-play and in our discussion. And this concept has a rich historical lineage. Emile Kremelin first described depressive temperaments, highlighting the stable and chronic nature of this. People like Even Freud discussed in Mourning and Melancholia depressive dynamics. And depressive personality first appeared as a proposed diagnostic category in the DSM-3-R and DSM-IV in the appendix.

• 3:46David Puder?

  Depressive personality style was represented in DSM-5 as persistent depressive disorder and in ICD-11 as dysthymic disorder. But we are here to discuss this as a unique personality style. And so Jonathan Shedler, can you please talk to us about the historical context on how depressive personality disorder first came to be included in the DSM?

• 4:12Speaker 01

  Yeah, you know, actually, you brought up something that might be a useful little digression here about the impact of DSM on how we understand personality. You know, just to be clear, the concept of personality disorders actually didn't exist in the literature prior to DSM. The way that came about is that the framers of DSM III, you know, were published in 1980, were, you know, very determined to produce, you know, like a medical taxonomy of, you know, psychiatric, you know, psychiatric difficulties.

• 4:52Speaker 01

  So, you know, they made a decision upfront, everything was going to be a disorder, which plays out in, you know, funny ways. Like before DSM III, people were anxious, but the concept of generalized anxiety disorder didn't exist. Anxiety was a state, not, you know, not a disorder you had. So, I mean, it really changed the landscape of how we think about, you know, mental health difficulties. Personality in particular, they left it out entirely. It wasn't even on their radar screen, right? They had basically completed the entire, you know, development of DSM III without ever taking into account of personality. It was going to go to, you know, going to go to publication.

• 5:37Speaker 01

  And apparently, very late in the game, somebody said, well, what about personality? And it was added as an afterthought, literally an afterthought. That's why it was access two in DSM, you know, three through, through all the variants of DSM IV. And since it had to fit in a taxonomy of disorders, they took every, you know, they took the major personality styles that were, you know, familiar to psychoanalytic clinicians of the time, ratcheted them, ratcheted them up in severity, you know, sometimes to the point of cartoonish caricature, called them disorders. And all of a sudden, personality disorders became a thing on, on the map.

• 6:21Speaker 01

  So, a little, a little aside, but maybe relevant here.

• 6:25David Puder?

  Yeah, and I think it's so important in my mind to have empathy for clients, to understand our reaction of clients, countertransference, to deepen our reflectiveness into people's experience, to look at their individual personality styles. And I like how you parse that out and that everyone has a personality style.

• 6:50Speaker 01

  Of course, everybody has a personality. Every human being has a personality. Every human being has a personality style. And the, I guess, unintended consequence, I'm pretty sure I, by the way, I've got that story directly from Bob Spitzer himself. I mean, that, you know, how personality became access to came, comes right from the source.

• 7:12Speaker 01

  But the unintended consequence of that is now we have several generations of, you know, psychiatrists, psychologists, mental health professionals, who have no concept of, you know, personality, except if it's a disorder. So, you know, I do a lot of speaking and workshops and podcasts and, you know, and it happens all the time. I'll say something about somebody's personality dynamics or personality style. And the person on the other end will start talking about personality disorders as if that's what I said. And, you know, the way I look at it is there are certain kinds of patterns or constellations of personality that we see personality functioning, you know, that we see often enough

• 7:57Speaker 01

  that we can say this is a recognized personality, you know, style. And they all fall on a continuum of functioning from, from, from healthy, high functioning to, you know, really very seriously disturbed. And basically what DSM ended up doing was teaching generations of clinicians. If personality isn't at the extreme of disturbance, it doesn't count and we don't need to consider it. You know, we can talk about depression and isolation from, you know, the psychology of the person who has depression. And we can talk about anxiety in isolation from the psychology of the person who has anxiety.

• 8:39Speaker 01

  But that's not really a psychological understanding.

• 8:43David Puder?

  Right, we're, we're talking about today, someone who has defensive, psychological defenses that are in, inner experiences that lead to more of a chronic depression from adolescence that continues on until they get psychological work. Or how would you say it differently?

• 9:07Speaker 01

  Well, yes and no. So, so one thing that's important is, so just for the sake of listeners, you know, what is personality really? You know, it's, it's consistent patterns of, of functioning, right, that originate fairly early in life that consolidate, you know, by adolescence. And it subsumes, you know, patterns of how we relate to other people, relate to ourselves, how we cope with difficulties, our defensive processes, our organizing psychological themes, our motivation, basically everything that we talk about when we talk about somebody's psychological functioning, you know, is, is really in the domain of personality.

• 9:51Speaker 01

  So when we say depressive personality style, you know, it's pretty important to understand it's not the same as clinical depression. You, it often, it often leads to depressive episodes that you could diagnose as depression, but not necessarily. So you can have people with depressive personality styles who are not in fact suffering from clinical depression. In principle, you could see someone with a depressive style who's never had a clinical depressive episode. And, you know, and lots of people have, you know, chronic, consistent, you know, recurring depression who don't have depressive personality styles, right? They're somewhat different, they're different things.

• 10:35David Puder?

  Okay, so how would you define this?

• 10:37Speaker 01

  Depressive personality style.

• 10:38David Puder?

  Yeah.

• 10:40Speaker 01

  Yeah, so it's a pattern of functioning in the world and a way of experiencing self and others where the characteristic features are there are people who are very prone to negative affect, especially shame, guilt, feelings of failure and inadequacy. The most defining hallmark, I think, of depressive personality is if you were a psychologically sophisticated observer, like looking at this person from the outside, you might think this person is their own worst enemy.

• 11:21Speaker 01

  So they tend to be inhibited about seeking and experiencing pleasure, excitement, joy, satisfaction. It's as if there's something inside of them that's squelching their ability to allow themselves to enjoy that. And in some cases, they seem to, not consciously, not intentionally, of course, but it's almost as if they're seeking out experiences that are going to be, they're going to cause hardship or suffering or unhappiness.

• 12:01Speaker 01

  In that, in that respect, we can say they seem like their worst enemy. Interpersonally, people with this personality style actually tend to be pretty high functioning. It's generally not a disorder. If you think of a spectrum of levels of personality functioning from healthy through neurotic through borderline to psychotic, they tend to be in the healthy and the neurotic levels of functioning. Interpersonally, they often tend to be warm, engaging, empathic, pleasant to deal with. They tend to be people pleasers. And when they come into practice and into therapy, clinicians, and this is empirical,

• 12:44Speaker 01

  this isn't just my opinion, we have data showing this, clinicians tend to describe them as good patients. They feel really good about working with them. And the trap is...

• 13:00Speaker 01

  The fact that the clinician feels really good, they feel good because the patient is easy to deal with, they're accommodating, they're very appreciative of what the clinician offers. So the clinician tends to come out of the session feeling like there's a connection, feeling like they're being helpful to the person. And the danger is, the reason the clinician feels good is actually not a sign of progress, but rather a symptom. And the symptom is that they end up recreating the patient's relationship patterns in the therapy relationship. And the patient's relationship patterns are that they're very oriented toward other people's

• 13:45Speaker 01

  needs and feelings at the expense of their own. So they enter into a relationship, they tend in one way or another to devote themselves to making the other person feel good about their relationship, but often at their own expense. And so the other person's needs get met, but their own needs don't necessarily get met. They come in and they repeat this pattern with the therapist so that the therapist ends up feeling very good about the therapy. They both appreciate one another, but the patient doesn't change. That's the trap of treating depressive personality style.

• 14:22David Puder?

  It's like there can be some gentle idealization of the therapist. And if they have frustration towards the therapist, they usually turn that towards themselves.

• 14:32Speaker 01

  Yeah, they're not, right, the typical manifestation in therapy is they're not doing it right, they're not being a good enough patient, they're doing something wrong in therapy. So, and you know, you often see it in therapy in a very direct form, like the therapist makes a mistake, which is inevitable, we all make mistakes, you know, every day. There's no such thing as a therapy session without a mistake, I don't think. And typically, the patient either glosses over it, brushes past it, so that the therapist shouldn't feel bad about it, or the patient actively takes responsibility for it. Like, you know, it's not your mistake, I didn't explain it right, I gave you the wrong impression,

• 15:16Speaker 01

  I wasn't forthcoming enough, I didn't tell you all the information, it's on me, it's the patient, not on you. But they don't do it right because they're higher functioning, and the healthier the neurotic, you know, level of functioning. Right, it's not, it's not idealization in the sort of icky way that you would see in narcissistic or borderline functioning. Right, it's generally in a very engaging and appealing sort of way.

• 15:43David Puder?

  Yeah. So we have a role play. I have a character. I have a character. I've been working on this all week. Maybe I've been working on this for years. I don't know. But, um, okay. So, so I was thinking, maybe this is like, early on in the therapy. And, uh, and so we could just start it up. Okay.

• 16:08Speaker 01

  Okay.

• 16:10David Puder?

  I'm gonna try to get into person here. I like, I like how you said, you have to embody something that's real. When we were talking about this, because at first I was thinking about doing Abraham Lincoln and having Shutter do some, some therapy for Abraham Lincoln. Um, because I think he did have depressed, real depression episodes, but I think he had like a depressive personality. I really, I really think he did.

• 16:35Speaker 01

  I don't know.

• 16:36David Puder?

  I've been reading, reading some biography on him. Um, okay. But I will not be Abraham Lincoln. I will be.

• 16:44Speaker 01

  And the reason for this is that when we treat patients of our own, are we drawing, you know, our own immediate, personal experience? Right? If you have a patient in mind, we, we form identifications with the patient. We unconsciously identify with the patient. Right? In a way, even if, even if, even if the patient never says the specific words that come out in the role play, right? There's a way we can speak from within that person. And it's not, it's not, you know, it's not a conscious, planful process. We just, if we're, you know, if we're a dedicated therapist, you know, there's a way we just take in our patients, right? And try to understand

• 17:28Speaker 01

  them, or even understand, experience them from the inside out, rather than just as a observer from the outside, you know, outside looking in. Anyway.

• 17:37David Puder?

  Okay. So, here we go.

• 17:42David Puder?

  You know, Dr. Shedler, I wanted to reach out to you. But, you know, I know you were on vacation. I felt bad wanting to reach out to you, wanting to disturb your vacation, so I didn't. But I feel, you know, like I had this email, I started to write it. And, um, but I felt kind of guilty for, uh, you know, kind of interrupting. Well, I don't know if you were on vacation, if you were lecturing, but anyways, my, my father passed away this last week and it brought up a mixture of things for me.

• 18:27Speaker 01

  Well, I mean, I'm, I'm hearing two things. I'm tempted to ask you to tell me about what it brought up for you, but, you know, I'm also hearing this happened earlier while I was away. And it sounds like you were feeling bad about wanting to get in touch with me.

• 18:50David Puder?

  Yeah, and, um, you know, as a therapist myself, you know, when I'm, when I'm on vacation, it's like, I appreciate being on vacation. So I think I was just kind of leaning into that a little bit. And then, you know, I've had patients who reach out during vacation and, you know, sometimes you gotta, you gotta talk to them and stuff, but I know, I, I, I just, um, anyways, it's, it's heavy, uh, mostly for my father. It's weird. Everyone wants me to feel sadness. Everyone wants, it's like, oh, you must feel so sad, you know? We even had a funeral. It was, it was pretty short.

• 19:33David Puder?

  But more, you know, and I would like kind of, oh, yeah, yeah, I feel sad. And I would, I would kind of tell them that. And, but really what I felt was guilt that I didn't feel sad. And I felt more, um,

• 19:51David Puder?

  Like, I should feel sad, but I don't feel as sad.

• 19:56David Puder?

  Um, so.

• 19:59Speaker 01

  Um, just stepping out of the role play for a second. How long have we been in treatment? How well do, do I know this patient?

• 20:06David Puder?

  Um, let's say this is like third or fourth session.

• 20:10Speaker 01

  Oh, it's very early on.

• 20:12David Puder?

  Very early on.

• 20:13Speaker 01

  Oh, I don't know. I don't have a lot of history. We're really just.

• 20:15David Puder?

  So you can ask, you can ask the history.

• 20:17Speaker 01

  Okay.

• 20:18David Puder?

  Yeah.

• 20:19Speaker 01

  I, I, okay. So that's all I need to know. So let me jump back in. I gather you must have had a complicated relationship with your father.

• 20:31David Puder?

  Yeah. And I know, I know the first couple of sessions when we were meeting, it was mostly about patient issues. Um, and, uh,

• 20:41David Puder?

  and I, it's, it's kind of, um, you know, it's, it's like in my mind, I don't know why I go there, but I don't, I almost don't want to burden you with the story of my father.

• 20:54David Puder?

  Which I know you've consciously in my mind, I know you've been doing this a while.

• 21:00Speaker 01

  But something in you feels like it would be a burden to me to hear about it, to listen to you.

• 21:07David Puder?

  Yeah. Yeah. Um,

• 21:12David Puder?

  so, you know, my father,

• 21:16David Puder?

  uh, maybe I'll just start, you know, he left our family at around sixth grade.

• 21:22David Puder?

  He's kind of in and out of our life afterwards. He was, uh, he had probably true bipolar. You know, I didn't, I didn't know that back then, but I know that now.

• 21:35Speaker 01

  Undiagnosed bipolar then, I imagine?

• 21:38David Puder?

  You know, I think for the first. Decade of my life, he probably drank himself out of any mania. But then he developed chronic pancreatitis and he couldn't drink or he'd get acute pancreatitis, end up in the hospital. So inevitably, um, he became sober. And when he was sober, he was very miserable. And so

• 22:04Speaker 01

  Miserable, meaning how so?

• 22:10David Puder?

  Um, well, he, he was always, um, he was always angry, even when he was an alcoholic. But when he was sober, he was, he would kind of go between what I would consider like up, out, you know, having sexual flings, uh, men and women. He would, um, and then, then I would go to my grandma's house every, every other weekend and he would be there and he would just really stay in his, in his, um,

• 22:43Speaker 01

  When you say he was miserable and I'm understanding, I'm understanding that to mean he was miserable to you, miserable, maybe miserable to the whole family, but he was miserable to you. He treated you, I'm gathering, in ways that made you feel miserable.

• 23:05David Puder?

  Yeah, he, um, he would call me, he would call me his little bastard. Um, he met my mom during a fling. I don't think he really wanted me. Mom didn't abort me. He would remind me of that.

• 23:20Speaker 01

  You think he wished that, that she had aborted you?

• 23:24David Puder?

  I think he felt trapped and sometimes I feel, um, responsible for his unhappiness. I know as a therapist now, I know I probably shouldn't feel that way, but it feels really true. He blamed me for, for that.

• 23:44Speaker 01

  He blamed you for, he blamed you for his difficulties or his instability?

• 23:52David Puder?

  Well, his difficulty was this, um, you know, my mom, which I can get to later, but, uh, yeah. So, I mean, there were memories of like just him yelling.

• 24:06Speaker 01

  At you?

• 24:07David Puder?

  At me, spit flying, his face close to mine, you know.

• 24:14David Puder?

  Hard to predict.

• 24:16Speaker 01

  Was there physical abuse also?

• 24:18David Puder?

  Uh, yeah, yeah, there was, yeah. I mean, punishment, uh, just punishment that was random, it was chaotic, it was not, it was not like I did anything bad, I, per se, or maybe I did, but.

• 24:36Speaker 01

  Could you give me a, for instance, just whatever comes to mind just now?

• 24:44Speaker 01

  So like, just so I can get a better idea, when you say there was, there was punishment, so I can get an idea of, you know, what you're just, what you mean?

• 24:56David Puder?

  I, uh, he, he would come home, uh, had I been home for days, and he would be in a tirade, and he would, um, just nonstop be ranting about how unclean the house was. And it's not as if I didn't try to clean the house, you know, I think this was around when I was like nine?

• 25:22Speaker 01

  It was your responsibility when you were nine or 10 to clean the, clean the whole house?

• 25:28David Puder?

  Well, and, uh, you know, my mother was, um, at that point, so heavy that she couldn't get out of the couch very easily. And so she, um, and I hate even talking about it in that way, but the reality was she was pretty physically weak, I mean, compared to, so she couldn't, she couldn't really get up, and so.

• 25:53Speaker 01

  I'm assuming if she was too heavy or too weak to take care of, to take care of the household, assuming she wasn't really able to take very good care of you either.

• 26:06David Puder?

  Yeah, and this is, I mean, I hate to even get into this. But we would live in squalor. I mean, it was outright poverty. We'd move every month. I think when I just turned 40 and I just realized like I've lived in 39 houses. So I officially passed the number of houses that I've lived in.

• 26:34Speaker 01

  Sounds awful.

• 26:38David Puder?

  Yeah, and I think, you know, I worked since I was 12. So I would go to school, I'd work, do sports, go to work, come home at 11. Mom would talk to me from 11 to 1 a.m.

• 26:53Speaker 01

  Yeah, I'm sorry, go ahead.

• 26:55David Puder?

  About her issues, things that have come up in the day, you know.

• 27:00Speaker 01

  About her issues, you mean, her worries, her problems, what was, things that were bothering her?

• 27:06David Puder?

  Her anxieties, the weight that she carried.

• 27:11Speaker 01

  So, I mean, you're like nine or 10 years old. It sounds like, well, you're a therapist too. It sounds, I'm sure you know the concept. It sounds like you were, you know, became responsible for taking care of your mother, like you were her, like you were her parent rather than vice versa.

• 27:38David Puder?

  She had a lot of reasons. She had a lot of anxieties, you know, and I think she needed someone to talk to and so.

• 27:49Speaker 01

  So let me make an aside for the listeners, because, right, I haven't really done much by way of intervening yet. I'm still getting the lay of the land, the psychological lay of the land for you, for this patient. But I'm about to, this is going to be my first, you know, actual intervention. So I'm just sort of flagging this. I'm, you know, I'm about to do something that follows from an understanding of the personality dynamics that I see emerging. So jumping back in.

• 28:20Speaker 01

  You know, I can't help but notice I I commented about your experience, you know, the the burden of being in the role of having to take care of your mother. And your response was about your mother.

• 28:38David Puder?

  Yeah, and I think I think you got to understand like how hard it I mean, how the how difficult her life was, you know, and and she would tell me about how difficult it was. And she would tell me about it would be there would be men that would come and stay with us for a couple weeks at a time. And I would um, I would hear them, you know, at first, nice noises, giggling.

• 29:03Speaker 01

  You mean men that she was involved with?

• 29:06David Puder?

  Yeah, yeah.

• 29:07Speaker 01

  Mentally or sexually?

• 29:09David Puder?

  Oh, oh, you could hear you could hear it through the

• 29:12Speaker 01

  This was happening.

• 29:12David Puder?

  Walls in the walls. Yeah.

• 29:14Speaker 01

  This was happening right under your nose in your house.

• 29:18David Puder?

  Oh, yeah.

• 29:19Speaker 01

  Your father's out running around with other women, I guess, is how I understood what you said. Your mother's bringing other men into the home. And you know, there's something that doesn't quite add up for me, you know, she's overweight and, you know, too, too heavy or too depleted to take care of you. And yet it sounds like she has energy to bring in, you know, not just one man, you know, that she's right, but it's like a regular thing with different men.

• 29:52David Puder?

  Yeah, and um, she would, you know, she would meet these men online. They would travel sometimes from cities away, live for a couple of weeks. I mean, these were not like, these are not like my teachers, my coaches who I I looked up to. These were men that I hated or just disliked.

• 30:11Speaker 01

  So who who was taking care of you? It doesn't sound like your father was doing much of that. It doesn't sound like your mother was doing much of that. Was there somebody in your life who was there for you and there to take care of you?

• 30:30David Puder?

  Um, you know, I think, uh, I think I kind of figured it out. How to take care of things that, you know, I, I've, I felt a lot of responsibility.

• 30:43Speaker 01

  You mean, you had, you were the person taking care of you. And it sounds like, you know, in important ways, trying to take care of your mother and trying to take care of your father, too.

• 30:58David Puder?

  I mean, I think at around that time, like, oh, see, I'm, I feel like I'm like,

• 31:06David Puder?

  really giving you too much here.

• 31:09Speaker 01

  What do you mean, what do you mean giving me too much?

• 31:12David Puder?

  Well, I mean, I've, you know, I mean, it feels like, um,

• 31:17David Puder?

  I'm burdening you too much. I feel like this is going to be too heavy for you. Like, it's going to be like a lot that, um, like.

• 31:27Speaker 01

  I just can't, just as an aside, this is, you know, very fast. I mean, if this were real therapy, this would likely unfold over, you know, more sessions. But, but I want to be able to, you know, I want to be able to illustrate working with something here. So if this were in real life, this would be pretty abrupt. But, um, you know, I wonder if something is going on here between us that, that is similar or a continuation of, you know, what you're describing, growing up with your parents. Because, I mean,

• 32:07Speaker 01

  your mother was supposed to be taking care of you, you know, taking care of your,

• 32:15Speaker 01

  your needs physically, emotionally.

• 32:20Speaker 01

  She would burden you with her problems, her anxiety, she'd keep you up until 11.

• 32:26Speaker 01

  And I get the sense that it felt like your role was to

• 32:34Speaker 01

  not burden them, right? Not protect them from having to deal with your needs, your feelings.

• 32:44Speaker 01

  Your distress, little kid, having to fend for yourself. You were sort of protecting them from your needs. And I wonder if there's something like that that is continuing here with us when you say, you don't want to burden me, or it's too much for me.

• 33:06David Puder?

  Yeah, even, and I may have misspoke earlier. She would keep, she would, I would get home from work at 11. I mean, this was like in high school, junior high school, and then I would, I would be listening to 1am. I may have misspoke, so I apologize for that, but um.

• 33:24Speaker 01

  Well, there it is again, actually. You assume that you misspoke, rather than that I misheard or misunderstood.

• 33:30David Puder?

  Well, I think you're, if you think that you're like my parents at all, like, that's not the case. I mean, you, you remind me more of, I had a really good, I had a good basketball coach. I wasn't the best basketball player.

• 33:44Speaker 01

  Well, yeah. Well, I mean, the ways that I might be like or not like them. I mean, that's something else for us to talk about, but, but just at the moment. And what I was really getting at, it wasn't so much whether I'm, you know, like them in reality or not, but I was noticing, you know, your impulse to want to protect me, or your feeling that, you know, what you were telling me was, you know, too much, too much of a burden, you know, brings, brings me back to.

• 34:18Speaker 01

  Where we started, you know, which is your father just passed away. I mean, you must have

• 34:26Speaker 01

  very complicated feelings about it, to say the least. And, you know, you felt like reaching out to me was the same thing. You shouldn't burden me. I was, you know, I was off. Maybe I was on vacation. Maybe I was teaching, whatever. But, you know, you shouldn't, you shouldn't ask for that from me. And, right, and I I wonder if it's of a piece with, you know, you start to tell me about really how difficult things were for you growing up, how alone and uncared for you were. And, you know, your thoughts go to, it's too much for me.

• 35:11Speaker 01

  You shouldn't, you know, you shouldn't burden me with this.

• 35:17David Puder?

  Yeah. And, and like, I think-

• 35:20Speaker 01

  Like therapists only want, you know, like happy patients who are, you know, feeling good about things and don't have any, don't have any actual difficulties to bring into therapy.

• 35:35David Puder?

  Yeah, and I think,

• 35:38David Puder?

  I, I think that,

• 35:43David Puder?

  I guess I'm getting confused. I, it's like, I know logically, I should not feel like I'm burdening you.

• 35:57Speaker 01

  Well-

• 35:57David Puder?

  And somehow I,

• 36:00David Puder?

  and, um, yeah, I, I feel like almost critical of myself that I'm like, I feel almost critical of myself that I'm like feeling that way. But then I can also see how like deeply that resonates with so many things in my life, so.

• 36:19Speaker 01

  What? It brings up, I take it it's bringing up more for you?

• 36:26David Puder?

  Yeah.

• 36:30David Puder?

  Well, like, like I talked to you in the first couple of sessions, like it's, it's like, whenever my patients are doing well, I feel like they're, I, I, I don't feel much, I don't feel much gratitude, like, I feel like that's like, okay, that's expected, they're paying me, but when they don't do well, it's like, I really, really ruminate and.

• 36:55Speaker 01

  When it's, when they're doing well, it's, doesn't speak to your, to your credit, you know, it's hard for you to feel good about it, or feel like, you know, this is something that you helped to accomplish, but when they're not doing well, or when they're feeling bad, it's your fault.

• 37:15David Puder?

  Yeah, yeah. And so I've been, I've been thinking about that as kind of like a theme of our first couple of sessions. And I've been thinking about like, hmm, maybe there's some deeper reasons for that. So I'm like, with my dad's death, I feel like maybe this is a good time to look at those deeper things. And I think it's coming out. Yeah, I'm aware. Okay, so I may have some transference as well towards you. Now, I'm not like, as like, you know, articulate as you are about these kinds of things. So, but yeah, I can see it happening right now consciously, like in my mind, like, I'm like, oh, I'm like, feeling guilty about multiple things in life.

• 38:03Speaker 01

  You mean just here, just now between us? Or are you referring to other things also?

• 38:08David Puder?

  Yeah, I'm, I'm feeling like guilty in the here and now, like, just sharing this, which is kind of how I felt growing up as well, and how I feel with my patients. So there's like, I'm, I'm seeing that overlap.

• 38:27Speaker 01

  You were even feeling guilty about.

• 38:32Speaker 01

  About not about your reaction to hearing about your father's death. And like guilty that you weren't sad enough or weren't reacting the way you think you should have.

• 38:47David Puder?

  I think most of the people who are close to me don't really know much about my childhood. I've kind of kept that in a separate container.

• 38:59David Puder?

  Because, you know, things are so different now. I think most people, most of my friends, they came from good backgrounds. They wouldn't relate to the squalor, the decaying wood, the holes in the wall, the cockroaches on the ground, the,

• 39:19David Puder?

  you know, duct tape.

• 39:24David Puder?

  So I, so I think most of them expected me to feel sad when he passed. And so most of them would like sad for me. And I would, I think there was a part of you that kind of felt relieved.

• 39:37Speaker 01

  Yeah, I could imagine. I was, you, you got there first, but I was about to say, maybe you don't feel sad.

• 39:48David Puder?

  Yeah, he would, you know, he would come visit and he wouldn't really interact that much.

• 39:56David Puder?

  It was, it was kind of hard to have a conversation with him.

• 39:59Speaker 01

  And so, I mean, I imagine there's a lot of feelings in the mix. But you said there are complicated feelings, but among the mix of feelings, you know, I imagine there's a part of you that must be glad to be rid of him.

• 40:16Speaker 01

  Therefore, the relief.

• 40:18David Puder?

  Oof, I would feel,

• 40:22David Puder?

  glad to be rid of him.

• 40:26David Puder?

  I don't know if I'm there yet. I mean, I do feel some relief.

• 40:28Speaker 01

  Maybe I jumped the, the gun. Maybe tell me more about the feeling of relief. I mean, I jumped the gun and put words in your mouth that don't fit.

• 40:39David Puder?

  Yeah, well, thank you for.

• 40:43David Puder?

  Thank you for that, yeah, letting me have the space to kind of get in touch with what I feel. I, I think, I think it's like, um.

• 40:59David Puder?

  Okay, so I haven't told you this about him yet, but he would call me. And like, I would get these calls, he would be gone for weeks. I would get these calls from him, probably a payphone or. And then he would be telling me on the, the phone and, um, you know. Now it's kind of like, I think back, was he on drugs? Back then I didn't know, of course, you know, because I'm young.

• 41:22David Puder?

  And he would say things like, I'm gonna kill myself.

• 41:26David Puder?

  And he would keep me on the phone for, you know. And I wouldn't say things even back then, like I wouldn't say, oh, you're the best dad ever. But I would say, Dad, please don't kill yourself. Dad, please don't kill yourself.

• 41:43David Puder?

  And so, yeah, there's a weightiness, um.

• 41:49David Puder?

  With, with those memories.

• 41:53Speaker 01

  Well, what I'm hearing is how you ended up being the emotional caretaker for two parents.

• 42:04Speaker 01

  You know, like you were trying to be a little kid and trying to be a therapist to both of them at the same time.

• 42:16David Puder?

  Yeah, of course, you know, back then it's like.

• 42:21David Puder?

  You never have the right words to say to make them feel better. And so.

• 42:25Speaker 01

  It was your job to make them feel better.

• 42:30David Puder?

  Well, what I'm saying is like, as much as I tried, I don't feel like I ever really was able to do that, you know?

• 42:37Speaker 01

  Yeah, I guess I'm wanting to highlight something that I think was implicit in what you said. Right, you, you know, you tried and you never could succeed or never could succeed enough. But implicit in that was.

• 42:54Speaker 01

  It just seemed very natural and normal that it was your job to make them feel better. Right. And now you're going on, telling you why you failed at the job. You didn't, you know, you, you never could quite accomplish it or, you know, but I mean, it seems like in the background, it's like, like, like the default is, you know, of course it's your job to make them feel better.

• 43:25David Puder?

  Yeah. And, um, and now I, I do that for my, you know, my work. And, um,

• 43:40David Puder?

  yeah, I think the patients that I'm not good at doing it with gets to me, but.

• 43:48Speaker 01

  So when the patients don't get better, they're like, you know, your mother or your father or both, that you could just never do enough or could never succeed in making them feel better.

• 44:00David Puder?

  Yeah, I guess I'd never seen, uh, I guess I should, should have seen it like that, but I've never seen it like that. But that's, that's a, yeah, it's kind of like that.

• 44:13Speaker 01

  For purposes of the role play, suppose we skipped ahead about 10 sessions and, you know, your father's death is still in the air.

• 44:24David Puder?

  How do you, how do you feel it's going so well? Like, can I?

• 44:26Speaker 01

  I think you're doing an extraordinarily good job, maybe a little bit over the top in terms of the history, but an extraordinarily good job of, you know, of inhabiting a certain kind of depressive person, you know, and, and what I'm thinking, and I didn't say during the role play, but it's going on, let, let you and the listeners into what's going on in the back of my mind. Right. So here's a personality dominated by guilt, dominated by a sense that, that they're falling short or, you know, something about them is, is bad, you know, it isn't, isn't good enough.

• 45:02Speaker 01

  Somebody who had that kind of depriving childhood would feel, this is a combination of what we call anechoic and interd active depression, right? There's two different things going on. One is the absence, the loss of a real caretaker that every child needs, right? And that loss, that stays with us, right? This is, you know, it gives rise to an emptiness within, right? That's a hallmark of a particular kind of depressive personality, that, you know, you sort of feel depleted and empty and you try to fill that that hole by, you know, bringing other people

• 45:47Speaker 01

  into your life and you're by connecting with other people, except it doesn't quite fill it. And, and the connections are kind of a one way street, not because the other person is necessarily requiring that it's a one way street, but right? Because the patient is making it a one way street. It's about what can they do for the other person, right? Rather than what can they, what can they get taken that's meaningful to them? So that would be in a kind of anechoic, we call anechoic depressive style, where the person is very sensitive to loss and relational disruptions. But that's half of it. The other half that we didn't get to in this role play, which is why I was thinking of skipping

• 46:32Speaker 01

  ahead, you know, some sessions is

• 46:37Speaker 01

  somebody mistreated like that, somebody berated, yelled at, you know, your father, the way you were, you know, the way you were describing, I mean, it'd be less than fully human to not feel angry, resentful, deprived, you know, enraged about that, right? It's not just that you feel like, you know, the other person, not just the other person, you know, the people that you're supposed to rely on to take care of you, you know, it's not that they just, you know, didn't do right by you. And, and, you know, if you sound like you feel they didn't care for you well enough, they didn't care for you well enough in this particular, you know, this particular history that you're you're giving me, right?

• 47:20Speaker 01

  Of course, you know, of course, there'd be anger and resentment. And, you know, I think we just heard just a whisper of that when, you know, when your patient said, you know, well, I felt relief when he died, right? And, of course, behind that word, relief is a whole universe, right? If you're relieved from something, that means that there was something that you were experiencing as, you know, a burden or, you know, as burdensome or oppressive or distasteful or, you know, you're relieved from something bad that you don't want. Right? It just, it just hinted at that with the patient. And here's where you did such a good job of being this kind of patient. The patient's also very defended against their aggression.

• 48:03Speaker 01

  And this is the interjective version of depression. Right? They have a kind of impossible internal dilemma. And the dilemma is they are angry, but it's not okay to feel or express the anger. Right? So when in its extreme form, what this looks like in life is that the person ends up becoming a kind of a doormat in other relationships, not necessarily because they're surrounded by people who want to take advantage of them, but because they can't tap into, or it's a constructive aggression to, you know, assert, express their needs, their wants. And so they go without.

• 48:44David Puder?

  Yeah. And this is where like Kernberg's thought, which was so interesting, which I thought I would kind of pull in here, where he said, when I asked him, what was the main thing therapists need to learn?

• 48:57Speaker 01

  Yes.

• 48:57David Puder?

  And he said, is to get in touch with their own aggression.

• 48:59Speaker 01

  Yes.

• 49:00David Puder?

  And so, and I was thinking like, okay, so I was asking him about depression, personality, style, like, how does that show up? Is that the most common thing? He answers with that question, which is kind of the answer to this person. It's like, where's this person's aggression?

• 49:16Speaker 01

  Yeah. So that raises another issue. Let's definitely make sure we get to talk about this. So, I mean, people gravitate toward roles in life that, you know, that are consistent with their personality, organization, and their enduring psychological themes and conflicts and defenses. Anyway, that said. Depressive personality style is the most prevalent personality style among people in the mental health professions. And we'll talk about why. But let's stay with your patient for just a moment, then we can expand to how this plays out in the profession. So the person is in a really impossible dilemma, which is they are angry, but it's

• 50:00Speaker 01

  really not okay to feel it, let alone express it. And, you know, well, what becomes of it? Where does it go? Right? Because the one thing we understand psychologically is, you know, out of sight, out of mind, doesn't mean gone. It's still there. It's still having its impact. And you actually, you know, did a beautiful job illustrating it. If you're angry with someone, if you really don't like someone, and you're angry, and you want to punish them, you know, what do you do? You treat them really badly. You blame them, you scold them, you shame them for your failings, you find fault with them constantly, right? You're depriving, you don't, you don't want them to have a good time. You know, if, if

• 50:45Speaker 01

  something bad is happening, you want to rub it in, right? You mean, basically, you know, if you're really angry with someone and, and you act on it, what do we, you treat the person like shit, right? Hopefully, most of us have the capacity, at least professionally, to feel angry, to be aware of the internal experience and not have to act on it. But if you, if you were really angry at someone and acted on it, you would do that. And what, what we see in this, what's called infra subjective version of depression is the person is treating somebody, the, the, the person with depressive style is treating someone like shit, but it's themselves. And that's where you see the self criticism, the self

• 51:27Speaker 01

  deprivation, the self punitiveness, which is empirically the hallmark of this personality style, right? So it comes up immediately in our role play, but in a very small way. And it, you know, it's not, it's not present and palpable enough yet to, to work with in the session. So I let it go by. But you wanted to call me, you wanted to call me when you heard your father died. The reality is, for whatever reason, I wasn't there for you. Right? I took that period off. That wasn't your doing. No, I wasn't available to you. And, you know, I could easily imagine, it's not a capital offense. It's a small offense, a misdemeanor, maybe.

• 52:13Speaker 01

  But, you know, anyway, I could imagine why a patient in that position would feel you know, upset with me, you know, disappointed or irritated. Why, why am I not available? Right? And then your impulse is you wanted to reach out to me, you know, email me. Like, oh, no, you shouldn't do that. Right? So, so what happened immediately was the thought, you know, I wasn't doing right by you, transformed into, oh, you can't, you can't, you know, contact me. You wouldn't be doing right by me. Right? And that's a very, very small instance of,

• 52:55Speaker 01

  you know, that, that kind of, you know, criticism or punitiveness directed at the self. Right? So if we were put it, just sort of cast it in high relief. You know, I, I'm doing something not, you know, not that I'm a bad person, but I'm doing something bad to you by virtue of not being available. And in your mind, it turns into somehow you're doing something bad to me. And, and there's the reversal.

• 53:18David Puder?

  Yep.

• 53:19Speaker 01

  And it takes a lot of doing in therapy. I was thinking about this before the role play. It's very hard to illustrate because it doesn't happen in a, in a single, you know, compressed segment. But

• 53:30David Puder?

  I, I was thinking, man, we could, we could stretch this out for hours.

• 53:35Speaker 01

  Yeah, that's why, that's why I thought it might be good to jump forward some session. But the issue is, but the therapist is going to have all kinds of failings. Not necessarily intentionally perfectly reasonable things. Well, actually, I've had, I can think of a very specific patient. I've had interactions like this with patients. The most recent one being someone who was also a psychologist, a very good psychologist, by the way. And, you know, and

• 54:06Speaker 01

  I'm not there when she needs me, expects me. And, you know, she feels bad.

• 54:15David Puder?

  Yeah.

• 54:16Speaker 01

  About, you know, wanting something from me. And, and, you know, and we had this discussion. It was like, um, I got, you know, got something wrong. You know, I misunderstood something. And, you know, I fell short in some way. That was the reality was actually my failing. You know, a small one, you know, lowercase f. And, you know, she immediately took responsibility for it like you did in their own play. You know, oh, I didn't explain it right. I didn't, you know, say it right. And, um.

• 54:50David Puder?

  Yeah. And by the way, I did that on purpose because that's, I did that on purpose. So there's a lot of, there's, I've, I've been thinking about this case a lot. And a lot of it actually is very true. And it's not, it's not a patient. Um, it's not myself. But it's a very close, it's been a close person to me that I know their story very well. So I, I, I think what I'm talking about, and if you felt as a listener that I was embodying it accurately, it's because I really care about this person that went through this.

• 55:19Speaker 01

  And that's right. That's why it's so important that there's a person behind it.

• 55:24David Puder?

  Yeah.

• 55:24Speaker 01

  Um, you know, I realize I'm, I'm, uh, I'm thinking with my patient. I'm trying to also, you know, protect her.

• 55:34David Puder?

  Sure.

• 55:34Speaker 01

  Confidentiality.

• 55:35David Puder?

  Absolutely. Yeah.

• 55:36Speaker 01

  Uh, so let me, let me just make up a kind of an equivalent example.

• 55:41David Puder?

  And, and I'll, I'll say for the record, I got permission from my, my person.

• 55:47Speaker 01

  So let's say I missed a session or I was late for a session. Or actually I'll choose the example that you gave. I, I was, I was away. I had something else scheduled and I canceled the appointment in advance. I know, a good example. And I wasn't there for her when she wanted to reach out. And, um, you know, and she starts very much like you did, you know? Well, I really wanted to reach out to you, but you were away. I didn't, you know, I didn't want to bother you. And, um, you know, it must've felt.

• 56:21Speaker 01

  Felt pretty shitty that, you know, I wasn't there when you, you know, otherwise, you know, otherwise, you know, count on me to be there. Oh, well, I know you have your own life and, you know, you were doing some important thing and you were teaching and, you know, and I understand and, you know, of course you didn't, you know, of course you didn't do it deliberately to, you know, so that, um, you know, you didn't do it deliberately to, you know, not be there for me. Like, I understand and, you know, the same thing happened with me and my patients and, you know, everything you said, I said to her is, you know, everything you said is true.

• 57:01Speaker 01

  I did have a prior commitment. You know, I did let you know well in advance. Right? Right? It, I was, you know, just taking care of other business. It wasn't meant to harm you or to, all of that is true. Yes, I objectively had something else that I had to attend to.

• 57:21Speaker 01

  What does that have to do with how it might feel on your end when I wasn't there? Right? All of that is like, you know, your, your conscious, logical, rational mind telling me about external reality. You know, of course, there's very, very good rea-, you wouldn't just not show up for a session, you know, just for the hell of it or because you didn't feel like, I know you wouldn't do that. You had to have a good reason. Yes, I did. But who says your reactions to that, you know, like only what's logical and rational and reasonable? Maybe there's some other parts of you in the mix that, you know, is harder to hear

• 58:02Speaker 01

  from, harder for both of us to hear from. So, right, I didn't even bring up anger yet. I just, just, you know, you're giving me a very reality-based rational explanation for why, of course, it made sense that I would be away and she shouldn't have a reaction to that. But that doesn't subsume, right? The full range of our experience. We have lots of reactions that aren't so logical. And so what I'm doing is, in working with somebody like this, the aggression, anger and aggression is not going to come out naturally. Right? And we really have to very actively go out of our way to invite it in.

• 58:43David Puder?

  Yeah.

• 58:44Speaker 01

  For an example, I use in my chapter that, you know, I think you read was,

• 58:48Speaker 01

  the therapist is late. And the patient says, oh, you know, I understand. You know, you were running late. It happens, you know, no worries. Oh, I think it even came up in our last role play, the last time I was on your podcast.

• 59:02Speaker 01

  And, and, you know, nine out of 10 times, the therapist is like, you know, the patient's letting him off the hook and, you know, let's get on to the real work. That is the real work. The fact that the patient is so ready to let them off the hook and not bring in any other feelings, except, you know, their positive feelings. That's the action. That's where the work takes place.

• 59:20David Puder?

  Maybe let's, can we go back into the role play? And, and it could be a couple of sessions later. It could be the same session.

• 59:28David Puder?

  But maybe, yeah, I'd be curious to kind of play that out around the theme of the difficulty of reaching out. But I, yeah, let's go into another session and I'll bring up kind of another moment between us, like another, and we'll see how you deal with it. Okay, you ready?

• 59:45Speaker 01

  And just to make it crystal clear, this is the essence of depressive personality and the essence of the problem, the challenge that we're trying to address in therapy, that the person is not getting their needs met in life.

• 1:00:01Speaker 01

  But the person who's obstructing getting their needs met is, is themselves. Right? It's very, very difficult to get what you need, what you want.

• 1:00:14Speaker 01

  If, you know, you can't allow yourself to know it, to know what you want. Right? This is the essence of the problem. The patient in therapy isn't getting their needs met for, you know, good reasons or bad reasons, realistic reasons are anyway, whatever. We don't hear about their disappointment, their frustration, their resentment, their irritation. We don't hear about it. We like, we have to actively pursue that.

• 1:00:41David Puder?

  Yeah.

• 1:00:42Speaker 01

  Okay.

• 1:00:43David Puder?

  Yeah. Okay, here we go.

• 1:00:47David Puder?

  You know, I had a dream between sessions. Maybe I'll start out telling you that. Would that be okay? I don't remember a lot about it. But I was, I remember I was in this church. It was kind of, felt like it was almost falling apart, like an old church. Like it was kind of like a ruins of a church. And I go into a confessional and I start talking. And then I realized that you're on the other side.

• 1:01:23David Puder?

  And I feel like, you know, maybe watching some of your ex stuff, your posts kind of triggered that from the night before. I remember, I remember reading a couple of them about the frame, about the importance of keeping the frame. And I was like, so I, I went to bed and I had that dream.

• 1:01:52Speaker 01

  Could you connect the dots for me? What, what about my post about the therapy frame? Do you think, what about that? Do you think led to the dream?

• 1:02:03David Puder?

  You know, I, and I think in session, I've never felt like you've been critical of, of me. But I think there's something about when I read some of the posts, I feel a sense of like, oh gosh, like.

• 1:02:22Speaker 01

  Do you mean since you're a therapist too?

• 1:02:24David Puder?

  Since I'm a therapist.

• 1:02:25Speaker 01

  We're not doing it right.

• 1:02:27David Puder?

  Yeah.

• 1:02:28Speaker 01

  Like, like you hear my, you know, my posts about general, you know, general issues in psychology and therapy is a criticism.

• 1:02:42David Puder?

  Yeah, like I almost like need to go into a confessional and just kind of

• 1:02:48Speaker 01

  Confess.

• 1:02:49David Puder?

  Confess.

• 1:02:49Speaker 01

  Repent your sins.

• 1:02:50David Puder?

  Repent, repent my sins. Um, yeah. So, so, yeah, that's what I'm coming in with a little bit this week.

• 1:03:03David Puder?

  And then, um, I know we've been kind of talking about

• 1:03:10David Puder?

  getting in touch with my frustration, anger.

• 1:03:14David Puder?

  And, um, I had one memory that came back to me, which actually felt like a tinge of frustration.

• 1:03:25David Puder?

  I was, uh, I think I was about 14 or 15 and I was getting something from the back of the car, from my, my mom's car. And, um,

• 1:03:39David Puder?

  I got really close to stabbing myself with a needle. And I'm like, Mom, why is there a needle in the back of the car? And she said, oh, I needed the needle for, um, you know, something medical that she was going through.

• 1:03:55Speaker 01

  You mean like a Piper Durborough syringe?

• 1:03:57David Puder?

  It was a syringe, yeah.

• 1:03:58Speaker 01

  I was, I was picturing her selling needle for a moment.

• 1:04:00David Puder?

  Oh, so, yeah. No, she, you know, um, so she had, uh, picked up HIV at this point. And so when I, when I remembered this, I remembered, um, at the time,

• 1:04:17David Puder?

  I had felt immediately like awful that she had HIV and that she had, um, had to deal with that. But in the, when it came to me the other day, like I got tight in my, my chest and I was, cause I, um, I was hanging out with my, um, my niece, who's about that same age that I was. And I was like, I can't imagine

• 1:04:48David Puder?

  putting them in potential harms way to get HIV. And somehow that hit me for the first time.

• 1:04:57Speaker 01

  And that she was endangering you.

• 1:05:01David Puder?

  Yeah, yeah, I mean, I could have, I could have gotten, I could have poked myself. Like, I was so close to poking myself.

• 1:05:10David Puder?

  You know?

• 1:05:12Speaker 01

  You said at the time that you felt, when did you say that you, not now, looking back, but you said at the time you felt guilty or?

• 1:05:21David Puder?

  Oh, I, I just remember feeling at the time, like, I just was really upset that she had to have HIV in the first place.

• 1:05:34Speaker 01

  You were feeling bad for her.

• 1:05:36David Puder?

  Bad for her, yeah.

• 1:05:37Speaker 01

  That eclipsed, I guess, other feelings that were there, which was that she was putting you in harm's way.

• 1:05:45David Puder?

  Yeah, and somehow, like, it didn't really occur to me.

• 1:05:50Speaker 01

  You had.

• 1:05:51David Puder?

  I mean, I, I think it occurred to me, she's putting me at harm's way at the time, but it didn't occur to me until I had my niece, which was like my age at the time. I'm hanging out with her.

• 1:06:03Speaker 01

  You hadn't connected those dots until, until the.

• 1:06:06David Puder?

  The memory came back and I was like, oh, like, what? What was she, like, why? Why did she, like, why was she so careless about my life to not clean up after herself when she knew she had HIV?

• 1:06:22David Puder?

  And.

• 1:06:22Speaker 01

  She was putting your life in danger.

• 1:06:27David Puder?

  And like, as I say that right now, I feel like in some way I'm betraying her, which is a weird feeling, like, but I feel also

• 1:06:37David Puder?

  like she was kind of betraying me. I mean, it's like, I don't, like, and part of me is like, doesn't want to believe that she would be so careless, but then the other part is like, she was so careless.

• 1:06:51Speaker 01

  It gets a little confusing about who's betraying who.

• 1:06:56David Puder?

  Yeah.

• 1:06:58Speaker 01

  We aside for the audience here. So there's a kind of a clinical dilemma there, right? That I'm working through in my mind, which is it would be very, very easy to go into, go deeper into this experience about, you know, the, the syringe and the meanings and everything connected to that. Right. And it would likely be rich and, you know, constructive area to work. But the transference takes precedence. And this is on the heels of he had a dream that he, that he recognizes is about me. This is followed by this branch.

• 1:07:39David Puder?

  Okay. So, so, so I got, okay. So let's enter back in. Okay. Cause I got, I got something for this.

• 1:07:43Speaker 01

  So I'll take responsibility for that, right?

• 1:07:48Speaker 01

  Right. You're really, you're embodying the role. It's up to you to fix it. But actually, if I'm the therapist, we're doing this role play, it's up to me to fix it. Right. That, that we got away from the dream.

• 1:07:59David Puder?

  Well, okay. Yeah. And patients do that, right? So that's like, it could be, I could be.

• 1:08:04Speaker 01

  So there's my, and the, and the clinical dilemma is this is really filled with feeling. And there's two competing therapy principles here. And one of them is we really want to follow the affect and stay with what's emotionally meaningful, emotionally charged for the patient. But the other principle is we want to track the, the transference, especially the negative transference, and especially with somebody with a depressive personality style where it's so hard to see and so hard to, you know, get a hold of in the, in the treatment. So trying to, I'm trying to balance those two considerations. You could make an argument for going either way. But I think, you know, the transference is important. So let me, let me, we'll pick up the role play, but I'll jump in.

• 1:08:49Speaker 01

  You know, so we, we just left off with, you know, it's, it's kind of hard to track who's betraying who. It was like, you know, I, um.

• 1:09:02Speaker 01

  This, this experience around the syringe and HIV, I mean, it's really important. It's a big deal, a mother with HIV, especially because of her own recklessness, I guess. But, but I do want to come back to that, but it's on the heels of remembering this, this dream that had something to do with me, I mean, that feeling criticized by seeing one of my, my posts on social media. And I wonder if you could help me connect the dots. They, they must have something to do with each other.

• 1:09:45David Puder?

  You know, it's so, it's so interesting. I hadn't had this thought, you know, and you always say, just share whatever comes to your mind, like if it comes all of a sudden, right?

• 1:09:56Speaker 01

  Yeah.

• 1:09:57David Puder?

  And so I had this thought that I think connects the two. There's a, a verse in the, in the Bible. And it says, if you hate your brother, you commit murder. And I've always, it's, it's, it's always been like a part of my ethic to not hate anyone, you know? And so I think after I had that thought about my mother, that was, that was the same day that the dream came after. And I thought like, I'm going to tell you about this because I had some frustration

• 1:10:41David Puder?

  towards my mother, but then I think for some reason that, that sort of thought process comes through my mind, that it's something bad, you know, to have any anger or like hatred or, I'm not saying I hated her, of course, I'm just.

• 1:10:59David Puder?

  For some reason, that thought comes to my mind.

• 1:11:02Speaker 01

  It comes to mind in connection with me.

• 1:11:06David Puder?

  Yeah, because in the confessional, I would be confessing that I murdered my mother with my hatred.

• 1:11:14David Puder?

  That's the connection I'm drawing.

• 1:11:16Speaker 01

  Maybe I misunderstood. I thought the confessional was, your thoughts about the confessional is about, you heard my, my social media post is a scold. You're not doing it right. You're not maintaining the therapy for him properly. That, that was your sin. That was your, that was your original sin before.

• 1:11:33David Puder?

  That, that's what I thought. That's what I thought. But in session right now, and I hadn't planned this. I hadn't, I hadn't thought about the connection, but the connection is, is that like that niece incident, the, the memory, that was the day too. So I'm thinking that maybe the confessional, and I, I had thought at the time, I'm gonna, I'm gonna talk to Shudder about this, this incident, because the new memory with my mom and the HIV syringe, you know, and just thinking about being upset for my niece, like, oh, my gosh, like, how could anyone have harmed my niece? You know, like that.

• 1:12:09Speaker 01

  It's easier to be angry on your niece's behalf than on your own.

• 1:12:16David Puder?

  Yeah.

• 1:12:16Speaker 01

  But your niece wasn't the one being harmed and having, you know, and who could have jabbed herself with a, you know, HIV positive needle. It was you. It was easier to feel,

• 1:12:32Speaker 01

  it was easier to be upset on her behalf.

• 1:12:37Speaker 01

  And, and just so we don't lose this, because it, I feel like it keeps slipping away. And, and maybe we both have a role in, in it slipping away, that, you know, that the starting point from this was,

• 1:12:50Speaker 01

  was you feeling scolded by something I posted on social media, or, you know, or, you know, feeling you were being, you know, told you were bad. And it's in the context of, you know, actually,

• 1:13:08Speaker 01

  you know, you're the one who's been wronged, who feels wronged.

• 1:13:15Speaker 01

  You know, I, I think there may be more to this than, than meets the eye, that, you know, that social media post really didn't sit very well with you.

• 1:13:28David Puder?

  Yeah, and I think, um, well, and I, I feel bad even for snooping on social media in between sessions, you know, I feel like I'm complicating the work here. I feel like I should be.

• 1:13:41Speaker 01

  Another, another transgression on your part.

• 1:13:46David Puder?

  Oh, I know, I know, and I feel bad that like, I'm like, now I'm recognizing that I'm like, double transgressing myself with this.

• 1:13:54Speaker 01

  Um, no, I'm not saying that you, I'm not, I'm not saying it's a transgression. I'm saying that you're treating it, you're talking about it as if it's a transgression. Well, right, it's a transgression that my post didn't fit very well with you. It's a transgression that you were even looking at my social media.

• 1:14:16David Puder?

  Okay, okay. And I think there's part of me that sometimes, and I know I shouldn't feel this way, but sometimes I feel like I'm gonna tell you something and you're gonna get really angry at me. Like, really angry, like, I feel like it's like, it's coming.

• 1:14:37Speaker 01

  I guess we'll have to see.

• 1:14:39David Puder?

  Oh, see, there's like, part of me that thinks that that, huh, I don't know. I think it could be, like, there's, there's gotta be something that I could tell you that, or, I don't know, I just imagine, maybe I'm imagining incorrectly, but. Okay, I'm like, I'm, I'm sorry, I'm confused about.

• 1:15:02Speaker 01

  What happened just, what happened just here, right? Just at the moment when, you know, you said you feel like I could get angry or I could blow up at you at any moment, I haven't yet, but, you know, right, the next, I don't know, like, you know, the next one is gonna be the straw that breaks the camel's back. I'm gonna erupt at you. And I said, well, we'll have to see, something just happened. I'm not sure, I'm not sure what was, what was coming up in you at just that moment.

• 1:15:34David Puder?

  Uh, I feel like me sharing that would, would make you upset.

• 1:15:42David Puder?

  Like I'm blaming you for something that you haven't done.

• 1:15:45Speaker 01

  Sharing that you're worried that I would get angry, that I would derate you or explode at you.

• 1:15:53Speaker 01

  Sharing that is.

• 1:15:56David Puder?

  That feels dangerous to me.

• 1:15:58Speaker 01

  Is what?

• 1:15:59David Puder?

  That it feels, it feels, it feels dangerous.

• 1:16:03Speaker 01

  I, I wouldn't want to hear your thoughts and feelings about me.

• 1:16:11David Puder?

  Um, it feels, it feels like, um,

• 1:16:18David Puder?

  maybe I'm blaming you for accusing you of something or.

• 1:16:25Speaker 01

  Well, that's a possibility. It might be, you know, worried or expecting something that,

• 1:16:33Speaker 01

  you know, isn't really so much about me. It's also possible you're picking up on something about me. You know, something about me in the background that we haven't talked about explicitly. Maybe there is something you're picking up on.

• 1:16:49David Puder?

  Are, are you secretly angry at me between sessions?

• 1:16:54Speaker 01

  I'm leaving it open because we're really, we're talking about, we're talking about your experience of me. And, um, and, you know, you seem to have the idea that it, it wouldn't be all right with me to tell me about things I do or fail to do that disappoint you or upsetting or make you feel bad about yourself or make you feel like I'm like secretly angry and I could explode at any moment. But I think that, see, if, see, if I answered your question, I, I think, and you know, I, I think it kind of stares us into a, a dead end and, and that it, it forecloses

• 1:17:39Speaker 01

  the opportunity to find out more about what's going on in, in your mind and in your experience.

• 1:17:47David Puder?

  And I feel crazy even saying these things out loud because I know that you're professional and you're, you know, you're an expert. I'm sure you don't dislike your patients and I, I have no evidence to support that. And I, I also realize like, um, there's a.

• 1:18:09David Puder?

  Well, I may be laying this on too thick, you know, and I may be laying on too much of my, my own worries.

• 1:18:16Speaker 01

  I get you're working, I get the sense that you're working so very hard to be, you know, very reasonable and very fair and so.

• 1:18:29Speaker 01

  What if you weren't so reasonable and fair with me?

• 1:18:34David Puder?

  I, I think like if I wasn't reasonable and fair, I think you would, you know, find some other patient to fill my slot or something, you know?

• 1:18:47Speaker 01

  You think I'd want to be rid of you?

• 1:18:51David Puder?

  Yeah.

• 1:18:54Speaker 01

  What an awful feeling that, that would be to feel like, you know, the person, even the person that you come to for help doesn't want to deal with you.

• 1:19:09David Puder?

  I think it's just really weird to be in this role where like I'm the one talking, like I'm so like, and you know, all day long I listen to my patients.

• 1:19:19David Puder?

  I listen to my family.

• 1:19:21Speaker 01

  Well, I think that's a very comfortable, we, we both know, we've talked about this. It's a very comfortable and familiar role. You were training from it for you, for that role since early childhood. But what I'm starting to understand, you know, in a different way now is there's something about being here with me as a patient that's very fraught for you. That, um, you didn't say this in my words, not yours. So if I'm not getting it right, I hope you'll correct me. But that there's a, it seems to me like there's a way you're sort of walking on eggshells here that, that at any moment, you know, I might explode at you or, you know,

• 1:20:04Speaker 01

  punish you or, or throw you out of treatment entirely. And I know it not, hasn't been in the forefront of your mind. It's not like you're, you know, you know, editing and just censoring. Curating your thoughts is, you know, every moment to, you know, be careful not to, you know, not to offend me or not to say the wrong thing. But it seems like that's been with us in the background.

• 1:20:31David Puder?

  Yeah, and I think for most,

• 1:20:36David Puder?

  I think that that this is different because you know, I think with my like teachers, my coaches that I got good things from, of course, you know, I'd find that that thing that they're interested in, you know, and read a couple of books on it, becoming, you know, be able to dialogue on the thing that they're into.

• 1:20:59Speaker 01

  And I think the role is to be, you know, a very good student or athlete or, you know, and be very appreciative.

• 1:21:11David Puder?

  Yeah, and I don't want to come across as unappreciative.

• 1:21:16Speaker 01

  I wouldn't like, I wouldn't like an unappreciative patient.

• 1:21:21David Puder?

  See, I know you, I know there's a little tongue in cheek in there. Well, I, so yeah, I think it's, it's, it's like, I'm like, really trying to get into this role, but I'm also realizing how hard it is to get into the role.

• 1:21:36Speaker 01

  The role is one where you don't have to feel like you're walking on eggshells or taking care of me or protecting me from my feelings.

• 1:21:53David Puder?

  I think, I think there was something like very hyper vigilant about me when I was young to like be in that role with my dad, with my mom.

• 1:22:06Speaker 01

  Well, I mean, you know, the word is, I mean, it's technically the right word, of course, but I mean, there's something that's like pathologizing about, you know, your problem was you were hyper vigilant, you know, whereas in fact, you were, you were doing what you had to do to function and survive in that environment. It's not like you had a lot of choice, you know, right? It's not like as a, you know, small child, you could have, you know, just picked a different family, you know, or replaced your parents, right? You didn't have any choice. You had to function as best you could with the parents you had.

• 1:22:46David Puder?

  Yeah, it's so interesting how my language pointed at me at all times.

• 1:22:56Speaker 01

  Yeah, almost like it was, you know, your failing or your pathology that you had to be vigilant in the way you were, the ways that you were, you know, rather than you were growing up with two angry, volatile, neglecting parents, you know, who could explode, certainly your father, you know, at any moment, or just disappear and, you know, and leave you to fend for yourself for weeks on end, as they both did. And it's like there's, you know, there's sort of two parts of you here. I mean, there's the adult rational, mental health professional who thinks about things very rational and, you know, in careful and accurate way. But then in the

• 1:23:41Speaker 01

  background, it's like there's this part of you that's expecting the same treatment from me. And, you know, it feels like you have to be just as careful and just as cautious about, oh, you could say or do the wrong thing. And, you know, I wouldn't be here for you either. At best, I wouldn't be here for you either. I mean, at worst, I would actively attack you. Or I should say, I would actively attack you too.

• 1:24:15David Puder?

  Yeah, something about you commenting that I, hyper vigilant for me, it kind of puts it in my, like, something is bad with me. Whereas like, I was just trying, I was, I was responding the best I could in that environment. And that was, um, that was what was helpful at the time. And so I'm repeating that here.

• 1:24:39Speaker 01

  It was necessary to, I think that we're doing the best you could to survive that.

• 1:24:44David Puder?

  I guess, I guess the thing that I'm like, where I get confused is, um, it brought me a lot of good things to be very good at reading people, like my mentors. Um, like I had this really, some good English teachers and stuff where I was like, for me, kind of getting onto their page, you know, it gave me really good things to be able to read them and to be.

• 1:25:17Speaker 01

  Yeah, I think you're 100% right. I think there's no question about it, right? It's, it's kind of your superpower.

• 1:25:25Speaker 01

  But you know, like all superpowers, it also comes with a huge cost, which is when you're focused on what you think the other person needs and wants. And you know, and your needs and wants go in the back burner or don't get on any burner at all. Now, this was a place if we had started with the first session and we had kind of gone through the process of why is the patient here? What is the purpose of our therapy? What are we trying to accomplish here together? Right? We would have done all of this beforehand. This would be a place that I would refer back to that. And you know, that's why you're here in therapy. I'm just making it up because we didn't have that conversation.

• 1:26:07Speaker 01

  But you know, but you know, by objective, you know, external criteria, you're doing pretty well in your life. You know, good practice, successful in your career, you know, married, wife, family, right? But things feel empty and dark and sad and joyless on the inside. You know, that's why you're here. And I would, I mean, if that was the reason, there could be many, many reasons. If that was the reason, I'd want to make a very explicit link between what we're talking about now. This is sort of a little micro instance of, you know, this superpower, I'm very, very, very good at accurately reading and responding to other people. I don't want to take that away from them. Right? It's true.

• 1:26:52Speaker 01

  And I mean, that's why a lot of people with this personality style are drawn to the therapy professions, right? And right, they, they have a kind of hypertrophied capacity for empathy, which can serve them very well in, right, as a psychiatrist or as a therapist. But it can also come with a terrible price. So what I want to do at this point is link it specifically back and say, you know, here's your superpower. You're very, very good at reading and responding to what other people need, but it comes at this terrible cost that.

• 1:27:27Speaker 01

  We don't, when I say we, I mean, both of us, we don't always get to hear from what you need and what, right? What would make, what would make an interaction or make life, you know, feel satisfying, meaningful, you know, allow for pleasure and joy for you. So I'd link, right? Because they're flip sides of the same coin. There's the superpower and, you know, and

• 1:27:56Speaker 01

  a real, you know, liability, not a liability that affects other people so much, but that gets in the way of you being able to live a, you know, a life that you can enjoy.

• 1:28:14David Puder?

  Hmm.

• 1:28:16Speaker 01

  Whatever the, you know, whatever we agreed on is, you know, this is what we're trying to do in therapy, which would have to do with, you know, why you came in the first place. What was your, you know, if you came to therapy for

• 1:28:26David Puder?

  Right, right.

• 1:28:27Speaker 01

  I would take advantage of this opportunity to make the link, you know, this is why we're here.

• 1:28:31David Puder?

  Yeah.

• 1:28:35David Puder?

  Yeah. And I think, um, and I, I think when I hear, um,

• 1:28:43David Puder?

  I should, it's, it's interesting because I know that I need to get in touch with my own feelings and desires. And I think that was one of our initial goals that kind of we identified. And also kind of, you know, why am I extending myself too much at work, maybe?

• 1:29:00Speaker 01

  Yeah.

• 1:29:01David Puder?

  But I think part of the, the conflict is I've always had the, the philosophy of, um, serving others has intense value and, and, um,

• 1:29:15David Puder?

  and to kind of like put myself second or to diminish my own ego and the importance of it.

• 1:29:24Speaker 01

  You had the philosophy. You know, a lot of people find meaning, deep meaning, in living their lives and choosing to live their lives that way. I mean, that's an option. What I'm concerned about, I think what we're both concerned about for you is it's not clear as of now how much that's really a choice versus something that happens, you know, in an automatic obligatory way, you know? Like, for instance, you know, you saw a social media post of mine. You didn't like it.

• 1:30:08Speaker 01

  It felt critical. It makes you concerned about, you know, well, maybe you're not in the right hands after all. Maybe I could be.

• 1:30:16David Puder?

  Oh, no, no, that's not what I was thinking.

• 1:30:17Speaker 01

  Well, no, I'm saying it.

• 1:30:19David Puder?

  Okay, okay. But I like the post. It just was convicting that like I could, you know, I mean, I know, you know, I came in talking about how I overextend and maybe I need to.

• 1:30:33Speaker 01

  What I was getting at is I'm not sure if it were so that you were upset by the post or it made you worried about me. Right? I'm not sure it would have felt okay just to say so. In fact, I'm pretty sure it felt not okay to say so. And right to, you know, to respond to what you said about your philosophy of, you know, how to live your life. When I say, you know, it's a valid choice. But for you, just here and now, I'm not sure how much choice there's been. And I think that's why you came to therapy in the first place.

• 1:31:15Speaker 01

  Right? It's entirely different to say, you know, here's something I, you know, here's something I want for myself, here's something I desire. But, you know, there's other things that are more important to me that, you know, that preclude that. And, you know, and I'm going to make a choice. And I know this is something I want, but I'm going to choose something else that's more important to me. That's different than.

• 1:31:44Speaker 01

  Not being able to want it in the first place.

• 1:31:48David Puder?

  I, when, um, when I hear this, what I think about is, I think about a quote that I've memorized

• 1:31:57David Puder?

  from Dostoevsky.

• 1:32:00David Puder?

  "I'm not worthy of happiness. My life is a serious of errors, and perhaps this misery is what I must endure to atone for them."

• 1:32:11David Puder?

  I, I don't know why, but that resonated back in the day, like in college, and I memorized it.

• 1:32:19David Puder?

  It's, it's interesting because I feel like if I, like, did I reincarnate from like some awful person? To, to, to go through what, you know, some of the suffering I've gone through.

• 1:32:29Speaker 01

  It resonated because in a very important way, I think it speaks to the story of your life. This, this was the family you were born into. You know, your role was to suffer and bear the suffering for all of your parents' failings. And, you know,

• 1:32:51Speaker 01

  to feel like that was your lot, what you deserved.

• 1:32:56David Puder?

  Yeah.

• 1:32:58David Puder?

  Yeah. And so I think this is a, it's like something is shifting there. And maybe that's, oh, you know what, that's kind of come back to the dream. It feels like that, that kind of ruinous building that I was in. It feels like something is shifting, you know, like, like maybe,

• 1:33:19David Puder?

  maybe I can

• 1:33:22David Puder?

  kind of look at things a little bit differently, or maybe it's.

• 1:33:25Speaker 01

  That makes me think.

• 1:33:26David Puder?

  Go on.

• 1:33:28Speaker 01

  Oh, and they, when you said you, you, the ruinous building that you were in, in the dream. It seems like you just linked that, right, was right on the heels of my, you know, just saying directly, oh, how ruinous your childhood was. It sounds like you just connected those dots.

• 1:33:50Speaker 01

  That you were literally living in rooms in childhood, holes in the walls, cockroaches and hypodermic syringes and car seats.

• 1:34:04Speaker 01

  Your childhood and your family was the ruins.

• 1:34:09Speaker 01

  And in the dream, the dream depicts you as, oh, here you are enduring this and confessing your sins. Right?

• 1:34:21David Puder?

  Yeah, somehow it's, I still am blaming myself in the midst of that. Like, I'm like.

• 1:34:28Speaker 01

  Yeah.

• 1:34:30Speaker 01

  Stepping back.

• 1:34:30David Puder?

  Okay.

• 1:34:30Speaker 01

  So I'm being a bad therapist because I got kind of caught in the roles between talking to you and the readers and the role of being therapist. And if it were therapy, it really got a little too intellectualized and away from the immediate experience. So not a, not a very good model of doing therapy in this, you know, that, that last.

• 1:34:48David Puder?

  Which part, which part? I think you're being hard on yourself here.

• 1:34:51Speaker 01

  Part about.

• 1:34:51David Puder?

  I think it was really good.

• 1:34:53Speaker 01

  The part about the philosophy, right? Because it's really about, it got a little, I got a little.

• 1:35:00David Puder?

  Oh, really?

• 1:35:01Speaker 01

  And a little, I thought so, yeah.

• 1:35:03David Puder?

  Okay. Well, I, I think what I've realized is that as I reread this, you know, reread this stuff over and over again, I'm like, oh, people really adopt the philosophies based on their personality.

• 1:35:17Speaker 01

  People adopt a philosophy that solves.

• 1:35:20David Puder?

  That solves their personality.

• 1:35:21Speaker 01

  Psychological conflict.

• 1:35:23David Puder?

  Oh, yeah.

• 1:35:23Speaker 01

  Right? Your choice of career, your choice of partner, your choice of, you know, lifestyle is a compromise.

• 1:35:31David Puder?

  And that's not to negate if the philosophy being true or not true, because it still could be true.

• 1:35:38Speaker 01

  And it still could be a perfectly reasonable and valid and meaningful, you know, life choice. But we have to understand all life choices are over determined and reflect something of our own psychology.

• 1:35:50David Puder?

  But what I think I appreciate what you said there is like, okay. Even with this guy, he wouldn't want it to be unconscious. You would want him to have a choice if he's going to choose to be sacrificial, or if he's going to choose to maybe in touch with his aggression and have a boundary with his time.

• 1:36:10Speaker 01

  And this is ultimately the goal of psychodynamic or psychoanalytic therapy, and I would say of all good therapy that's aimed at self-understanding. The goal is to expand freedom and choice so that things that were previously automatic or experienced as obligatory, right, no choices, right, become a matter of choice. That's the goal of the work, to expand, you know, to expand freedom and life options. And the person might, well, you know, in any given circumstance, make the decision to do whatever they would have done before therapy. But now it's a decision.

• 1:36:55David Puder?

  Yeah.

• 1:36:55Speaker 01

  It's a decision made freely. And I'm a little mindful of the times I want to make sure we get this out, that we haven't named it explicitly, but you and I are describing and working on the role play. This is really the essence of this depressive personality style that we're speaking about, that typically, typically a child growing up is deprived or mistreated in some way,

• 1:37:30Speaker 01

  neglected, you know, in the most extreme case, you know, maybe actively abused. You know, more common cases, neglected. Even more common cases, like if you were looking from the outside in, like a social worker, you know, this parent's adequate. Maybe not neglected in any obvious, externally obvious way, but emotionally neglected.

• 1:37:51David Puder?

  Yep.

• 1:37:52Speaker 01

  But the child's experiences, they're not getting what they need, right? Because the parents aren't coming through, the parents are inadequate, meeting the child's needs. But it's an incredibly, incredibly dangerous thought for a small child. A small child simply cannot think this, pretty damn rare. Think, I have bad parents. My life, my well-being is in the hands of people I can't count on. Right? Like, you know, this is not a thought a three or a four-year-old could wrap their heads around. And you know, what the, the child's solution to this, you know, horrible, impossible dilemma is, well, I'm getting mistreated. It must be my fault. It must be because I'm bad.

• 1:38:37Speaker 01

  And the, the, right? So, right? So the child concludes that they're bad instead of the, the caretakers are bad in a very paradoxical way. There's something hopeful in that for the child. It, it allows the child to sustain hope because as long as the reason is because they're bad and it's their fault, then potentially it's under their control, right? They, they could become, you know, not bad. And then they'd have parents who love them and take care of them. Right? So in the child thinking, it's my fault. It's because I'm bad. At least there's a spark of hope that my parents could be good enough parents, you know, after all. If, if only it wasn't for me. Right?

• 1:39:17Speaker 01

  If a child thinks, you know, my well-being and my survival is in the hands of people I can't count on, right? That's just devastating. Right? So that's the essence of this personality style.

• 1:39:29David Puder?

  Yeah. Yeah.

• 1:39:31Speaker 01

  And then it comes out, you know, a light year later, you know, in therapy and, you know, the therapist had to miss a week and isn't available when your father died, for God's sakes. And your thought is, oh, I don't want to burden him. Right? We could draw a line from that childhood experience. I'm not getting what I need and it's because I'm bad. We can draw a line, right? I shouldn't call my therapist. That would be a burden.

• 1:39:56David Puder?

  Yeah. So it's like the, the, the anger is turned into guilt.

• 1:40:03David Puder?

  The the transference is set up so that there's a gentle idealizing and the anything bad from the therapist goes on to themself.

• 1:40:13Speaker 01

  The criticism of the other is turned into self criticism. So what starts out as this person, my therapist, isn't here for me when I need them, you know, turns into I'm too much, I'm asking too much, I'm too much of a burden, right? Something wrong with me.

• 1:40:30David Puder?

  Yep.

• 1:40:32David Puder?

  Yeah, no, I and I think it's like really helpful. I hope this episode is really helpful for for people who are listening. And I think it's been helpful for me to study it and really think through it. I think the questions they might still have is like the how, right? They always ask the how, like, OK. So they've been witnessing the how, the how to do it, right? How to help people who are like this? So any kind of

• 1:40:56Speaker 01

  Yeah.

• 1:40:56David Puder?

  Anything we haven't covered.

• 1:40:58Speaker 01

  We have to recognize the core enactment, which is that that there the patient is going to treat the therapist in a way that feels good to the therapist. And now it's easy to enter this, you know, I'm just making this up as I go, but this kind of like therapy pseudo paradise where we both feel so good about each other and we're so appreciative and the patient is so appreciative of us and we're happy for the patient because they work so hard in therapy and they pay their bills on time without fail and they come on time without fail and they're always appreciative of me. And and I feel so competent and so helpful, like such a good therapist when I'm with them.

• 1:41:38Speaker 01

  And what slips away unnoticed is the patient isn't actually changing in their life outside of therapy, right? That's the issue. And, you know, to get biblical about it, if we've created this sort of illusory paradise in therapy, you know, we need to invite the snake into the paradise, right? It's really not a paradise, it's an illusion of paradise. We need to get the patient's anger and aggression into the therapy.

• 1:42:13Speaker 01

  Because it's actually already there. It's just not there in a form that's being recognized and acknowledged. We need to make it possible. What do we have to do to make it increasingly possible for the person to bring in an increasingly larger range of their emotional experience, which of course has to include the whole spectrum of human emotions, right? Anger, resentment, rage, envy, punitiveness, vindictiveness. These are all human emotions. But the person with the depressive personality style doesn't experience it that way.

• 1:42:57Speaker 01

  Like, well, maybe they're human emotions for other people, not for me. I would never be that way. We want to make it possible for them to experience and integrate a fuller range of their emotional life.

• 1:43:11David Puder?

  Yeah, I think there's a, it's like, another way of saying this might be the most empathic thing to do would be to invite that other side. Because without empathy, it would be unempathic for you not to invite it.

• 1:43:31Speaker 01

  Exactly. And here's, this is the enactment and there's where, this is where exactly where therapists go, where therapy goes south in treating patients with depressive personality style. Because the therapists are very likely to have a depressive personality style. It's a perfect mesh. And you think about it, I mean, the therapy professions are like, like an invitation you can't refuse to somebody with this personality styles. What do you get, if you go into the mental health profession, what does it give you the opportunity to do? Well, you get to focus intensely on other people's needs, right?

• 1:44:13Speaker 01

  Not that that's bad in its own right, that's the job, but you get to focus intensely on other people's needs at the expense of your own. You get to constantly fault yourself, you know, however good you get at the work. No, perfection isn't attainable. Like I said earlier, you know, we're all making mistakes in every session all the time. You get to fault yourself perpetually for falling short of some, you know, unrealistic, unattainable, you know, internal standard, right?

• 1:44:40David Puder?

  A Jonathan Shutter superego.

• 1:44:42Speaker 01

  Right. You put, you put your own needs on the back burner. And here's where I see this just all, I'm so glad you brought this up because I see this all the time. The misuse of empathy as a defense for the therapist against the therapist's own aggression. Right? So what happens in therapy is that the therapist is very, very, very empathic to the patient's hurt feelings, broken feelings, you know, the sort of needy, childlike feelings needing to be taken care of. Empathy for that part of the patient, no empathy whatsoever for their envy, their anger,

• 1:45:24Speaker 01

  their aggression, their resentment, their vindictiveness, their competitiveness, their rivalry. All of those things are there. How do I know those things are there? Because they're human. Right? But the therapist has zero empathy for that. Right? So it's empathy, I would say pseudo empathy as a defense, both against the patient's aggression, and maybe more importantly, as a defense against the therapist's aggression.

• 1:45:51David Puder?

  Yep. Yeah. And as someone who's studied micro expression, you know, flat 10th of a second flashes of emotion on people's faces, every, every person has expressions of anger. Not everyone knows that they have the expressions of anger.

• 1:46:10Speaker 01

  And it makes a world of difference, right? Because that's information. It's information in the interaction, it's information in the countertransference. We don't want to shut down that counter, right? There's, there's three major channels of communication going on in therapy. I don't think he talked about this, but this really comes from Otto Kernberg's writings. Right? You know, one is the content of what the patient says. The other is the nonverbal things they express, you know, through facial expression, body language, tone of voice. That's the second channel. The third channel is the countertransference, what they evoke in us. We shut down that channel. We should shut down. You know, important information that otherwise should come through that channel.

• 1:46:53Speaker 01

  And we're really, really limiting our effectiveness as a therapist.

• 1:47:00David Puder?

  Yeah.

• 1:47:01Speaker 01

  We're having these reactions in therapy for a reason. It's information.

• 1:47:05David Puder?

  Can I, can I show you the micro expression just for those who are watching the video here? So this, I actually filmed a lot of people watching YouTube's and um, so this is what it looks like right here.

• 1:47:16Speaker 01

  Very serious looking person here.

• 1:47:18David Puder?

  But do you see the down and together of the eyebrows? Like, it's like one tenth of a second.

• 1:47:22Speaker 01

  Yes.

• 1:47:23David Puder?

  That's the micro expression of anger.

• 1:47:24Speaker 01

  Yeah.

• 1:47:26David Puder?

  So.

• 1:47:26Speaker 01

  That's a lovely example. And, and see a therapist who wasn't defended against that, you know, might register it, even if subliminally. Maybe they didn't get, you know, it was a, the movement of the eyebrow, they saw something.

• 1:47:40David Puder?

  They saw something, yeah.

• 1:47:41Speaker 01

  And that's a good place to say, you know, just, just, just to slow down there and say, you know, something just happened here.

• 1:47:47David Puder?

  Yes.

• 1:47:47Speaker 01

  So, you know, a reaction, you know, actually like, I don't know, we went, well, you know, well, your, your expression changed. I, I wonder if we could just slow down here and notice what might come up. So we, right, so we notice, we notice what it evokes in us and then we use that, right? That becomes, that becomes a signal to us to invite the patient to slow down and notice.

• 1:48:17David Puder?

  Yeah. And uh, I um, yeah, I could, I could get on to other tangents here, but I think we got to wrap it up. This was wonderful. I, I hope that people appreciate Jonathan Shedler and the, the expertise that you bring. Appreciate you coming back on and um, we will be posting this on X. We'll be posting it on YouTube. If you want to watch the video, I know a lot of people just watch the podcast, but if you want to watch the video, you could jump on there. And um, yeah, uh, any closing words?

• 1:48:55Speaker 01

  Yeah, just on a personal note, I have to say I was very aware coming on the show. The last two podcasts of yours that I watched were Otto Kernberg and Frank Yeovens. And boy, those are, you know, those are big shoes to follow.

• 1:49:11David Puder?

  Oh, they, well, I mean.

• 1:49:14Speaker 01

  Kernberg is a living legend, you know, for a reason. I mean, I could just, I almost did actually in real life. I was gonna say, sit at his feet and just listen to him and take it in.

• 1:49:27David Puder?

  Oh, yeah.

• 1:49:28Speaker 01

  And that actually happened, but I wasn't sitting at a dining table. But my experience was I could just sit here forever. And I mean, I think Frank Yeovens is one of the gifted master clinicians who, you know, who's publicly out there and teaching. And it just, I mean, every time I hear him, it's a pleasure and I learn something every time.

• 1:49:47David Puder?

  Yep.

• 1:49:48Speaker 01

  So I was very acutely aware, Frank, like, this is, these are the people I'm following on your podcast.

• 1:49:55David Puder?

  Oh, man. And I, I think I really appreciate you sent me a message like that was a historic interview. And I, I think if anyone hasn't watched Kernberg or Yeovens, both of them are amazing. Actually, when I was reading through the journal articles, looking at transference focused therapy, if you read the, the methods section for a lot of these studies, Yeovens is the supervising therapist on these studies. Like, he is the guy, right? And then, yeah, Kernberg is just masterclass. I mean, he is, and it's, it's like, I think you sent me in the message, like, I understand everything he was saying and I love it.

• 1:50:36Speaker 01

  Yeah, it was kind of scary.

• 1:50:38David Puder?

  Which, I'm like, you know, as I get deeper into this material, it's like, most of it's understandable and it makes so much sense. It makes so much sense.

• 1:50:46Speaker 01

  I'll just share with the audience what I wrote to you privately. So I remembered when I was, you know, 20 something year old grad student. Trying to read Kernberg's work, you know, his books, this rate, this goes back, books written in the late seventies, early eighties. And for anyone who's tried to read Kernberg's writings of that time in the original, it's a really, really, really hard to read, right? It is not an easy read. It's incredibly challenging and demanding. And I actually had the depressive thing. I was reading his book and I'm like, oh my God, I'm like, I'm really like, I'm stupid. I'm like, I'm not up to the work of this profession. Like, if this is what it is, like, you know, really inadequate. So, you know, fast forward a few decades, it's like, no, I'm pretty much tracking with everything. Yeah.

• 1:51:31David Puder?

  Yeah. Well, I, I was not expecting an interview. That's the wild part. I was like, expecting a phone call where like, we would talk about an interview and then I would spend like, a couple of months reading and rereading. And so like, I jump into this and it's like, okay, here we go.

• 1:51:53Speaker 01

  So I think you, I think that interview and the fact that, you know, you made it happen, whatever it took, it was like, I think it's, I think it's a historic event.

• 1:52:04David Puder?

  Oh, and I'll say, for those of you who have listened to it or listened to this, my new sort of approach to the write-ups is to do a really nice transcription, where then I put in footnotes and I put in the footnotes for the beginner. It's not for the expert, it's for the beginner. So if you are confused, if you want to go back, listen to this episode, you've listened to it, something was confusing, you want to go back, look at the transcript, eventually we'll have one up there with footnotes. Kernberg, we have one up there with footnotes on my website, psychiatrypodcast.com. It's free for anyone. All my stuff is free.

• 1:52:44Speaker 01

  Highly recommended for whoever's listening.

• 1:52:47David Puder?

  And so we, we will continue to produce good content. I think we're going to go through every personality style eventually. So, five years from now, we'll be done.

• 1:52:58Speaker 01

  David, thank you so much. It was a pleasure to be here.

• 1:53:01David Puder?

  All right, we'll leave it there for today.