Empathy in Therapy: Mastering Empathic Engagement with Dr. Douglas Flemons

In this episode, Dr. Puder engages in a profound conversation with Dr. Douglas Flemons, a seasoned marriage and family therapist and author of the newly released Empathic Engagement in Clinical Practice. Drawing from over 30 years of supervising family therapists, Dr. Flemons redefines empathy as an active, pursued skill rather than a passive feeling, distinguishing it sharply from sympathy. Explore common misconceptions, the pitfalls of sympathetic responses, debates on cognitive versus affective empathy, the role of microexpressions and universal affective states, and practical strategies for building genuine therapeutic connections without imposing interpretations or judgment. By listening to this episode, you can earn 1.25 Psychiatry CME Credits. https://www.psychiatrypodcast.com/cme-program Link to blog https://www.psychiatrypodcast.com/episode-258-empathy-in-therapy-mastering-empathic-engagement-with-dr-douglas-flemons Link to YouTube video https://youtu.be/JUFhxQK8Ed0

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

• 0:14David Puder?

  All right, welcome back to the podcast. I am joined today with Dr. Douglas Flemons. He is a marriage and family therapist, later got his PhD. He taught for 30 years, marriage and family therapy, family therapy. He has worked actively with topics like suicide. And today, we're going to be talking about a recent book he wrote, Empathic Engagement in Clinical Practice. So yeah, welcome to the podcast.

• 0:41Speaker 01

  Thanks for inviting me. Delighted to be here.

• 0:44David Puder?

  So I understand you're in North Carolina now?

• 0:47Speaker 01

  Yeah, at the moment, I'm in South Florida because it's very cold in North Carolina. But yes, I live in Nashville.

• 0:53David Puder?

  Okay, where in South Florida are you?

• 0:55Speaker 01

  In Fort Lauderdale.

• 0:56David Puder?

  Oh.

• 0:57Speaker 01

  When I was teaching at the university, we lived here. So we're just back visiting friends and getting work.

• 1:03David Puder?

  Wonderful. So tell me some misconceptions on what empathy is and how you define it. Maybe we could start there.

• 1:11Speaker 01

  A lot of people conflate empathy and sympathy. And that's not just run-of-the-mill laypeople, but researchers, theoreticians. They don't have any clear way of distinguishing between them. And so they use them interchangeably often. And that runs you into some trouble when it comes to trying to engage empathically with your clients. If you approach it from a sympathetic mindset, you can find yourself in a world of, I don't know, world of hurt, but a world of complication.

• 1:43David Puder?

  I feel sorry for people that find themselves in a world of complication.

• 1:48Speaker 01

  Right. Feeling sorry for is a sympathetic response. You feel bad, and you feel bad along with them. And then you then feel bad for the fact that they feel that way. So that lands you in the world of sympathy. And it's something that comes to us naturally as humans. We're wired in such a way that if you're demonstrating pain, and I'm close with you, or I care about you, or you're important to me, then my brain's going to fire in very similar ways to what's happening to you. And that's just automatic.

• 2:30Speaker 01

  That's sympathy, but that's not empathy. Empathy doesn't happen to you. Empathy is something you pursue.

• 2:36David Puder?

  Yeah, I think that often when people experience sympathy from others, you know, they're experiencing it from friends, it can feel almost weighty for me sometimes to have sympathy from friends. Because then I feel like, oh, I'm making them feel bad and sorry. And I'm feeling then bad for their experience of soriness.

• 3:02Speaker 01

  Yeah, so it can become sort of this ricochet effect. You feel bad, they feel bad for you. Now you feel bad, they feel bad. Now they feel bad that you feel bad about them feeling bad about you feeling bad. So that can get pretty twisted. But it's also, there's a quality, I don't know if this happens to you, but if somebody feels bad for me, it somehow diminishes me.

• 3:24Speaker 01

  Oh, you poor thing.

• 3:27David Puder?

  It puts me in the victim place, right? I'm a victim.

• 3:33Speaker 01

  And I think that happens kind of naturally because we have a sympathetic response for people who have had unfortunate experience. So if you're helpless or hapless, it's easier for the person to have sympathy for you than if they think that you're responsible for whatever negative experience you're having at the moment. So the feeling of sympathy automatically imbues the person with some quality of helplessness, haplessness.

• 4:06David Puder?

  Subtly?

• 4:08Speaker 01

  Subtly.

• 4:09David Puder?

  Yeah.

• 4:10Speaker 01

  And so that if you're the recipient of that, you mentioned the victim, victims have no agency. So if you're the subject or the receiving end of sympathy, there's a quality that your agency has been diminished or stolen from you in that quality of emotional connection.

• 4:31David Puder?

  Yeah, but what if the person's empathic experience of themself or the experience that they're having is one of a victim? And, you know, like, I feel like I am a victim. The world is all against me.

• 4:46Speaker 01

  So I can, I can have a sympathetic response. Oh, David, you poor thing for feeling like a victim. So that's certainly possible. But an empathic understanding of that doesn't have me feeling bad for you. It has me exploring the intricacies and the complexities of how it is that you're orienting to the world with that kind of belief system.

• 5:15David Puder?

  Do you think it's helpful to split empathy up into like cognitive empathy or affective empathy? I see these, these kind of differentiations in, in the research, compassion and empathy being the third one.

• 5:29Speaker 01

  Yeah. It's a very common division in research, cognitive and affective. I'm a big fan of Lisa Feldman Barrett's work on constructed theory of emotion. And she makes the point in a bunch of different writings that there's no such thing in the brain as an affectless cognition. You can't have pure rationality. In logic, it lives there. In philosophy, there's this idea of we're going to champion rationality over emotionality.

• 6:11Speaker 01

  But at the level of brain function, she says, you can't locate a thought that doesn't have an affective connection to it. And an emotion, she says, is a category of experience. So it's, it's feeling, it's affect, but there's a cognitive spin that is placed on that affect in order for it to be recognized and felt as an emotion. So that division between affect and cognitive empathy is a after effect, a downstream after effect of that kind of split.

• 6:56Speaker 01

  But if that, if the brain doesn't operate that way in the first place, then I think the division doesn't make as much sense. So I think of it as.

• 7:07Speaker 01

  Instead of affective empathy, our cognitive attenuated empathy. That is, there's not a hell of a lot of cognition going on, but it's not absent. And same thing, cognitive empathy being affective attenuated empathy. There's still an affective quality in it. So I don't find it an incredibly useful distinction.

• 7:35David Puder?

  Okay. So when you, when you kind of subscribe to her, her line of thinking, you know, do you, do you think that there are emotions as like universal experience across humans, animals, you know?

• 7:51Speaker 01

  Um, no. So universal affective states or universal ability to get ramped up and to have a positive or negative valence to that, that arousal, absolutely. But the, the defining of a, of an emotion is a social act. It's a psychological act. And you can have the same affective arousal with a different contextual orientation to it, and it shows up either as fear or as excitement.

• 8:32David Puder?

  Yeah, I, I think I differ from her. I think that micro expression is a real thing. I, I kind of think that especially with the congenitally blind studies where they look at congenitally blind individuals, you know, that are flashing very similar emotions to people that were born sighted. You know, I think there's a universal expression of emotion. Now, we may not be very accurate at reading the emotion and the person who has the flash of emotion may not be very accurate in describing their emotion. For example, people with psychosomatic illness or alexithymia.

• 9:09David Puder?

  But I kind of differ from her in that perspective. And I would look also to John Gottman's work where they looked at micro expression in newly married couples and then were able to predict months of separation later. They predict physical illness in the couples just by looking at micro expression and recording how much different couples flashed on their face. I don't know if you've seen that study. But I think that validates this idea that there is, there is universal expression of emotion. And I, I tend to differ from her in that perspective, but that we may be.

• 9:46Speaker 01

  Um, maybe, and I'm, I would be wading into an area that I don't have expertise because I'm benefiting from her research. I certainly didn't participate in, in creating it. But there is a point, maybe just make one point. The idea that, um, um, micro expression of an inner emotion. So you've got this, um, shows up on the face or in, in some kind of gesture of an emotion that's inside. So there's this coordinated communication between the two implies that the emotion is there and then it's expressed. But so much about human experience has this recursive fallback quality to it.

• 10:30Speaker 01

  So the identification of what it is that you're feeling contributes to the feeling itself. And I see this a lot, working with people with panic disorder. They start to feel, and they go, oh shit, I'm starting to panic, which is then contributes to a greater release of the hormones that they're recognizing in the first place that have them concerned. And so there's this spiraling that happens and a lot of it has to do with the way that they're making sense of their experience.

• 11:05Speaker 01

  Because of that fold back recursive quality to all experience, I think it's unhelpful to distinguish, to try to distinguish between here you have the pure, as you're talking about, here's the pure emotion and then here's the expression of it. There, everything is so intertwined, it becomes very difficult to talk about it and make any kind of coherent sense.

• 11:28David Puder?

  So the way that I understand, I don't know if you've heard of this idea of like the second arrow, whereas like the first arrow is like, you know, the person with panic has an initial like discomfort, maybe in their abdomen. The second arrow is the adding of meaning to that, right? Like, oh, I'm having this discomfort in my abdomen. I may, I may have a panic attack and then they start to get more. And then maybe they feel guilt, you know, that they're having this, this fear, you know? So then they have like, it's like the secondary type of things, right?

• 12:01Speaker 01

  Secondary tertiary, yep.

• 12:04David Puder?

  Which I think, I think that's like, that's not necessarily how I understand the usefulness of micro expression is, it's kind of a, that's like a separate category. If, if you're interested, and I know we're kind of having a back and forth discussion here, trying to learn how we, how we each think and where we're starting from. Here, I'll show you a video. So I videotaped people watching YouTube videos. And this guy is, is watching a YouTube video. And so this is the flash on his face. And this is the classic flash of like micro expression of anger, right? Now, if I was to pause him right here and to ask him what he was thinking or feeling,

• 12:44David Puder?

  he may not be able to tell me that he was feeling anger. He may say like, oh man, that's awful what I was seeing, right? And if I was thinking about being empathic towards him, I wouldn't say, well, you're feeling anger. Of course, right? But the anger is like a signal to me that something is there, an emotion, right? And so what I've seen since getting trained in micro expression, you'll see the flash and then they'll tell the story that, that proceeds. And some of that, some of the, the feeling in that story could be frustration. It could be anger. It's complex, right? Why are they feeling that? Why did they flash that? It could be a multiplicity of reasons. I may not have access to that, right?

• 13:28David Puder?

  I mean, you can't read into, they may be frustrated that I said something. They may be frustrated that. You know, their stomach is upset or they're hungry, you know. So I think that the flash of emotion, it is a universal, in my mind, expression of an emotion. What the meaning of that is very differently described in different cultures, by different people, with different levels of psychological awareness. People with alexithymia have a lower understanding. So this is my contention with her research.

• 14:04Speaker 01

  Well, I love how you said, I see something that shows up and I don't yet know what it means. But you're confident that it means anger. But as far as how that plays out in his experience and the story that's attached to it and so on, you hold back from presuming.

• 14:24David Puder?

  I would have a level of confidence like I would if someone said a word, that that word is trying to describe something internally inside of them. What it's describing or why it's describing that is a puzzle and I'd have to be curious about it, right? And this is where I think we might have some agreement in kind of like the, for you, empathy is an active imaginative relational process, right? And so I would never, if I said something and they're like, no, that's not what I'm feeling. I'd be like, okay, wow, thanks, help me, help me like understand what's going on.

• 15:05David Puder?

  So it's like, I'm not necessarily the authority on it, but it's helping me see a picture. It's part of the picture.

• 15:14Speaker 01

  We do meet there.

• 15:17Speaker 01

  For you not to impose your authority and to argue with them. No, no, no, I saw the microaggression on your face. You're definitely angry, you just haven't gotten in touch with it yet. For you to take that kind of position to try to help them get in touch with something that you're confident is there and they're not yet aware of would be an inter-actional probably disaster. They would then back away from you, be concerned about how pushy you were, et cetera, et cetera. For you to, to find it interesting, for you to hold it as a point of curiosity and perhaps to come back to it later, terrific. Including the possibility that

• 16:03Speaker 01

  you're seeing, whether with their words or what's showing up on their face, some quality of experience that they don't seem to be in touch with, and you don't get ahead of them, but over a period of time through conversation, they come to arrive at a recognition of, of some level of anger or something, that would be fine. So you get organized by what you're noticing, your expertise comes in being able to recognize patterns and so on, but you don't impose it. And I agree completely with that.

• 16:35David Puder?

  I, I think with my background, I, I worked 10 years, I ran this I O P partial program for people with psychosomatic illness. So a lot of these patients come in and they're medicalized, they're, you know, they don't have depression or anxiety, they, they experience all of their feeling in their body. And so the curiosity that I've always had is how do I get it out of their body and into emotional language? They have a lot of emotion when they talk about the frustration of the medical system because it hasn't helped them. And inevitably, they, they have a lot of disavowed emotion, disavowed experiences of emotion. They're not allowed to, maybe early on, they weren't allowed to experience anger, they weren't allowed to experience maybe even positive emotion.

• 17:20David Puder?

  So just to give you some context for why I'm interested in this.

• 17:24Speaker 01

  Yeah, I have expertise. So I would describe it a little bit differently.

• 17:32Speaker 01

  They have something going on with their body. They don't yet have a way of naming it. And the expression, the way it expresses with somatic issues, distresses them. And that if they can bring it into language, in conversation with you, it has a way of creating meaning that they didn't have access to at the beginning. And shifting the meaning is shifting the possibility of doing something different about it.

• 18:03David Puder?

  Yeah, yeah, I would agree with that. It's a fascinating, it's a fascinating field to think, to think through. Okay, so how did you get interested in empathy? Maybe let's, let's rewind here. Like, what was the impetus to, to think about this for as long as it took to write this out?

• 18:22Speaker 01

  Yeah, it took a long time. Well, I originally encountered it in my master's program. I was training counseling psychology and got the kind of typical entry into micro-processes that would add up to empathy, active listening and so on. But it really showed up in my supervising over 30 years as a family therapist. Family therapists don't generally talk about empathy at all. They talk about joining with clients, but very little thinking about, researching, theorizing about empathy. And so I was kind of an outlier, I guess, paying attention to it. And what I noticed is my, my students

• 19:06Speaker 01

  could have a very clear theoretical understanding of what it was that they were supposed to be doing with their clients. But if they couldn't figure out a way of connecting with them, then their theory was for naught. And so I ended up with this, and I did this live supervision. So I'm behind a one man mirror, six people on a team, six hours, and we see a bunch of clients and... Wonderful supervision process.

• 19:32David Puder?

  Wow, that's incredible.

• 19:33Speaker 01

  I started, yeah, I started focusing more on helping them have conversations with the clients where the clients weren't having to protect themselves from the therapist. Either taking issue with the way the question is being asked or being shut down or whatever. And so I ended up starting to talk a lot to my students about how to empathically connect and figure out, so how do you do that so it doesn't backfire in your attempts to do it?

• 20:06David Puder?

  Yeah, I had a similar, I had a similar experience with residents. So we watched video and I was one of the main educators at the university for a number of years with a mentor who's now passed, but he was, he was 90 years old at the time and very experienced. And we, so we'd watch videos of the residents interact with patients and it, it was like the micro moments of connection and empathy were probably the things we talked about the most.

• 20:32Speaker 01

  Wow, that's wonderful.

• 20:34David Puder?

  Yeah, like here, the patient says this and then what's the, what's the accurate, like empathic thing that you can say afterwards, you know?

• 20:43Speaker 01

  And in a medical setting, there's often an encouragement, at least, well, I don't know this directly, so you would be a better authority. But from what I've read, Jody Halpern, book on empathy, that the, the training of doctors is how do you make sure that you don't get too emotionally caught up with your clients? So you have a friendly bedside manner, but slightly removed. So looking at empathy as a goal is, from what I've read at least, rather unique in medical education.

• 21:20David Puder?

  Yeah, I think, I think, um, I think that it's incredibly valuable. And where I would be curious is like with Carl Rogers, like where do you align versus where do you part ways?

• 21:35Speaker 01

  Definitely align with a lot. He was so inspired to recognize the importance of, for example, letting go of judgment. And he didn't talk about it this way, but I think a lot about the boundary between therapists and clients. And judgment is one of those boundaries. So if you're my client, I hold you in judgment. I think what you're doing is wrong, for example. Then that judgment gets in the way of me being able to be curious about you. I already know something about you and I disagree with it, and so I'm, I'm, I'm back from you. So Carl Rogers is saying non-judgment is the way to go.

• 22:16Speaker 01

  Because when I'm not using that as a dividing technique, I can get inside of the logic of your world. And once I'm there, cool stuff happens. And if I can, if I can communicate my growing understanding of what it's like to be in your world, in your story of, of your life, you end up recognizing in me someone that, that gets you and you no longer feel alone. And so he had that statement, if you're understood, you don't, you're not alone. And that's such an incredibly important grounding for therapeutic change.

• 22:59Speaker 01

  He also looked at, okay, so how do you actually unfold this in, in conversation and recognizing empathy as something that you do, it's a skill that can be, can be developed. He regretted later having focused so much on the skills because then it became robotic in the way that people tried to train students in how to do it and people trying to do it in, in a, in a way that didn't feel human. But the commitment to learning the capacity to empathize, totally on board, a place that I disagree with him.

• 23:39Speaker 01

  And I think it comes out of his respect for clients is he saw a therapeutic encounter as being ideal if both the therapist and the client are open for change. And that the most meaningful therapeutic moments were places where he was vulnerable along with the client and he was, he was open to changing himself.

• 24:02David Puder?

  Hmm.

• 24:03Speaker 01

  And he, and he saw therapeutic changes, changing or altering personality, which I think is another thing that I won't go there. But anyway, this idea of mutual vulnerability, I disagree with completely.

• 24:18David Puder?

  What do you believe?

• 24:19Speaker 01

  That what our job is, is to be available to clients. And that there's a necessary asymmetry to that. It's not mutual. That if I think that my way to be able to help you embrace your vulnerability is for me to show you my vulnerability, that's the shape of a friendship. That's how you and I build confidence and trust in each other. You tell me something that happened to you that brought shame and I say, well, I can tell you something similar. Here's something that happened to me. We, as friends, terrific.

• 24:58Speaker 01

  But as therapists, if, if we try to use our own vulnerability as adjoining mechanism, it, it creates a style of relationship that puts our well-being at risk and puts the relationship at risk. Carl Rogers, for example, ended up at some point working with a schizophrenic patient for a couple of years, very intensely, and working empathically, felt like he was losing his mind. And he came very close to, he had to, to get out of Dodge because he was losing it.

• 25:39Speaker 01

  And I think that comes from him attempting and honoring the humanity and the, his commitment to equality meant for him that he was then in this position where he was at risk of himself having a, a loss of sanity in order to be able to connect with this person.

• 26:04David Puder?

  I've been very curious about that story. Yeah. She ended up, he was seeing her five times a week towards the end.

• 26:12Speaker 01

  Yes, yeah.

• 26:13David Puder?

  And he's said in autobiographies, I was gonna bring this up, actually. He said, he said things like, I got to the point where I could not separate myself from hers. I was on the edge of complete breakdown myself. I had to escape.

• 26:27Speaker 01

  Right. So, so if you think of empathy as the loss of the boundary between you and the other person, to my mind, that's the shape of sympathy. That's when you and I resonate with the same emotional valence. And we don't even really bother distinguishing whose emotion is it. And this is emotional contagion that shows up a lot in situations like suicidal clusters and so on. But, but that, that idea that in an effort to make the connection, we're erasing the differences between us becomes, I think, incredibly dangerous.

• 27:06Speaker 01

  The other version is, the one that I would offer instead is the more vulnerable you are, if you're my client, the more available I am. So I'm not meeting you with vulnerability. I'm meeting you with curiosity, with warmth, with exploration, with nonjudgmental acceptance.

• 27:28Speaker 01

  But I'm not positioning myself to demonstrate to you that I can be as vulnerable as you.

• 27:38David Puder?

  So, okay, so how does one keep a stance of empathic curiosity rather than presumption? And when do you, when do you notice maybe that it goes into more of that? It's going into kind of less curiosity?

• 27:56Speaker 01

  Well, so that's an added difficulty is to presume. That's you can have this complimentary positioning that I'm suggesting and still be presumptuous and still get yourself into a world of hurt by doing that. So I appreciate the question. You you hold back from presuming to know by embracing your ignorance. It's like what you said earlier. You can see something flashing on the person's face. You know that there's something going on and you don't yet know what it is. And the way that you're going to find out is not for you to confidently determine that

• 28:39Speaker 01

  you're going to go find out what you already know is there, but that you start a conversation and you start exploring. So if you continue to embrace the idea that you are not the expert of the other person, that they're the expert in your job, in order to to develop an empathic understanding is to get inside the way that they make sense of their world so that you can make sense of it from inside. You get there by continuing to check any kind of confidence that you have that you know. You can keep your confidence in your expertise, sure, but but not presuming that, okay, I'm already three steps ahead of you and I I know what's going on, even though you don't.

• 29:23Speaker 01

  You hold that presumptuous back.

• 29:27David Puder?

  Yeah, I tend to think it's almost like sometimes in insecurity, people hold to presumptions, right? It's like out of the insecurity, I think we get more rigid or we get more kind of caught up in our own experience. Think about like some of the hardest clients it might be to enter into, and you talk about in the in the book, suicide, specifically how you've noticed we can almost want to jump to a solution. We can want to jump to not be empathically like saying things to show people that we know how dire they feel internally. What would like, can you talk more about that? Can you put words to that, what you've seen? I know you've done some research on suicide as well, so I'd.

• 30:13Speaker 01

  So the broader point that you made, I absolutely agree with. Holding in, holding to uncertainty is very, very difficult for everybody, and therapists included. So when somebody's potentially suicidal and we're not sure, it creates, it's unnerving, creates anxiety. And, and there's this great desire to know, so that you then know, okay, so what's the next steps? What are we going to do to help protect the safety of this person if that's necessary? And so hanging out in uncertainty is incredibly uncomfortable.

• 30:54Speaker 01

  And being able to tolerate uncertainty for an extended period of time is a terrific skill to develop in order to be able to then not jump into the presumptuousness of preemptively deciding whether this person is or isn't suicidal. That requires you to be able to hold some sensibility of their desperation and their hopelessness and, and to just swim around in it with them and, and then offer questions with curiosity

• 31:36Speaker 01

  based on what you're coming to appreciate about their circumstances. But not to rush into an early decision. I mean, there's certainly sometimes it's a slam dunk. Somebody comes in and it's clear to them, it's clear to you that they have no intention to continue to live. So that's not what we're talking about. But the gray zone conversations, they have the idea that if they don't mention the word suicide, then you're not going to get the machinations of, of the state going. And, and so they just won't mention it, but it's implicit in everything that they're saying.

• 32:18Speaker 01

  Those gray zone conversations require us to be able to hold on to our distress and our uncertainty and just hang out with them.

• 32:30David Puder?

  I think it's very common as providers to feel fear in the midst of that, right? Like, what if this person does end their life? Like, so I think like, our own experience of fear can kind of come into making it harder to empathize. How do you deal with that?

• 32:52Speaker 01

  There's lots of things that can make it hard to empathize, and you're absolutely right, fear is one of them. The moment you're organized by your fear, and fear isn't a bad thing. If a person comes in and the hairs on the back of your neck are going up because of what they're saying, or what's showing up on their face, or whatever their indicators are, that fear can help organize the curiosity, so you should pay attention to it. One of the difficulties that my students would display is they would feel that fear and then think that that was unprofessional.

• 33:31Speaker 01

  Just like feeling moved by someone that's desperately sad and tears welling up in their eyes and feeling, I gotta stop that because that's unprofessional. So they're afraid for a client and they're trying to shut down the fear. Another conversation is with themselves. I gotta calm down, I gotta relax. If the conversation is with themselves, they're out of connection now, out of conversation with the person. So it requires being able to acknowledge that the fear is there, makes sense that it would be there, and have it not get in the way of a continued conversation and exploration.

• 34:14David Puder?

  Yeah, I think what you're describing is kind of like that, that the fear itself, if we can approach that with a lack of judgment towards ourself, right? Compared to then if we judge ourselves and then we're caught up in our own fear and judgment of ourself. And we're then more and more in our own experience, and it's harder and harder to empathize with the other person's experience.

• 34:37Speaker 01

  Judgment raises its head in both places. Both the other person is doing something that concerns us, that grosses us, grosses us out, that upsets us, that offends us. That kind of judgment gets in the way. But then if we're looking at our own reactions and judging those, that gets in the way and both block the empathic exploration of the person's experience.

• 35:08David Puder?

  Good. Well, okay, so I was thinking,

• 35:12David Puder?

  so I would be, do a role play with you. Okay. And so I'm going to be a clinician who has just met with a patient and it stirred up a lot for them. Okay. Because I think, you know, we have a lot of mental health professionals here. I imagine they feel some level of weightiness with some clients. So I was, I was thinking, well, let's, let me, let me create a scenario. Maybe that could resonate with some of them.

• 35:41Speaker 01

  Sure.

• 35:42David Puder?

  Okay.

• 35:44David Puder?

  Yeah, so you know, after, I left the session with this, this guy. And there was something about the session and, and this, this person that I was just like very, I felt, I felt I was like almost in danger.

• 36:01Speaker 01

  You felt something going on with him that worried you?

• 36:05David Puder?

  Yeah. Yeah, and I, I don't normally feel this way necessarily. And I don't know if it's like other things going on in my life right now. But I think the main thing was that I was just like, I, I don't know if like, like, I think this guy might want to hurt me almost, you know? And he didn't express anything directly towards that. But I felt that so profoundly.

• 36:27Speaker 01

  Then you started feeling like you weren't safe in the session.

• 36:31David Puder?

  Well, I didn't feel I was safe after the session.

• 36:34Speaker 01

  Ah. Ah, so that there some sense that he would have it in for you.

• 36:42David Puder?

  Yeah.

• 36:43Speaker 01

  On the way home or something.

• 36:45David Puder?

  Oh, I mean, I, um, I remember leaving my office and I usually leave one door, but I left the other door because I was thinking like, okay, if this guy's been following my patterns, maybe I'll throw the patterns off. But then I'm conscious of that awareness, but that's like a very unusual awareness for me.

• 37:06Speaker 01

  Uh, very unnerving. How, how early in the session, was this a first session?

• 37:12David Puder?

  Yeah, this was a first session.

• 37:15Speaker 01

  So how early in the session were you getting the sense of that, um, what he knew something about you or that he had a particular axe to grind with you? What, what was going on?

• 37:29David Puder?

  Uh, I think the way, uh, some of the, some of the content on how

• 37:37David Puder?

  just he was very angry, but also not very aware of the anger. Um, I very unhappy with, with a lot of things in his life. A lot of prior people in his life, very, very unhappy. But I've never, I, I, I left the session and I was just like, I guess I should probably leave the other door. Yeah.

• 38:07Speaker 01

  So his, you, you got the sense that he was relating to his world very much from this position of anger without really being able to recognize it in himself. So it makes sense that he was also relating to you in somehow in this angry mode. What were you picking up on that, that your spidey sense was picking up on the fact that he was angry at you?

• 38:36David Puder?

  There was some kind of challenging questions like, I don't know, I don't know if therapy works, I don't know if this is all bullshit, like, he kind of like, it's kind of like, he both wanted someone, but then also didn't want someone, if that makes sense.

• 38:54Speaker 01

  He was challenging you?

• 38:55David Puder?

  There was some challenging, yeah, there was a little bit of challenging, yeah.

• 38:58Speaker 01

  And then how did you respond?

• 39:03David Puder?

  I tried to come back to like, what were the, what were the goals that he was coming in for, and the things that he was hoping to accomplish that he had already stated, and how, like, I think a lot of those are helped in a relationship, and not just like some self-help book. But I think, yeah, it actually, you know, since this happened like a week ago, I've had like a nightmare of like, kind of like an intruder. And, and this is very, I mean, there, there is a little bit of background to this, you know, from my, from my story, which you might have remembered that my, my grandfather

• 39:47David Puder?

  died by being mugged outside his office. And so I wonder if that has anything to do with it, you know, like, if, how much is of it, how much is it my own stuff versus the patient's stuff? It's kind of confusing to me.

• 40:05Speaker 01

  Well, you're very aware that it's possible, in your effort to help people, to put yourself at risk, you've got your grandfather in mind.

• 40:17David Puder?

  Oh, there was also that therapist that was murdered in my city, actually, a couple weeks ago. And so that was, this, this has kind of been like in the news, and I've actually been doing some research on therapists and psychiatrists and social workers, mostly actually social workers, who have been murdered by former clients. And so I'm reading about this as well. So I don't, I don't know how much that has to do with it. So it's kind of, it's convoluted, like, am I, what is, is what I'm feeling, like, an accurate depiction of my, my danger with this person?

• 40:57Speaker 01

  Right, is it accurate and your sensitivity from what you've read in the news and your own family history, allowing you to be exquisitely sensitive to an accurate danger? And then to what degree is that sensitivity heightening your concern about danger beyond what it actually might be? And it's really hard to figure out, how do I tell the difference?

• 41:24David Puder?

  Yeah, it's really hard to figure out. It's really hard to figure out.

• 41:31Speaker 01

  When you were actually having the conversation with him, were these concerns on your mind at all? Were you aware of picking up on his angry countenance, his way of being?

• 41:47David Puder?

  There was a moment where I was actually, and I've never, you know, it's interesting because like we talk about counter transferance in our therapy sessions together. I've never had the thought before that this person might want to kill me. And I was actually worried, like, is this person, does this person have a gun on them? That actually occurred to me in my, in the session.

• 42:12Speaker 01

  Impossible, I would imagine, at that point for you to be able to continue the session in any kind of productive way. You're just concerned about your safety. If you don't feel safe, it's pretty much impossible then to undertake any kind of therapeutic conversation.

• 42:31David Puder?

  I think from our work, I try to get curious, like, huh, what is it about this guy that elicits this reaction? You know, like, what is it about, like, am I kind of picking up something that is kind of unsaid, a level of paranoia maybe, or some of the, some of this person's own internal world?

• 42:56David Puder?

  And so that's what I was thinking in session when that happened. I was like, huh, that this is very curious to me. But then it comes out in my dream a lot more impactful. It comes out a lot more scary in the dream that night where it's like, oh, there's a person at my door with a gun, you know?

• 43:15Speaker 01

  It sounds like, it sounds like when you're in the session, you were able to keep your professional identity informing your engagement. And then in your dream at night, it's more that role of trying to figure out him gets put to the side and it's just the raw fear of if he could pose a risk.

• 43:39David Puder?

  Yeah, the raw fear, right? Yeah. And it kind of jolted me awake too, with this like intensity. And this like, am I, am I safe? You know, like, like, yeah.

• 43:55Speaker 01

  What a fabulous question. And, and so you saw him a week ago? Did you schedule another session with him? What, what's the status of the appointment?

• 44:06David Puder?

  Hmm, yeah, scheduled another session.

• 44:09Speaker 01

  For when?

• 44:11David Puder?

  Uh, it was, it was, it was gonna be next week. Yeah.

• 44:15Speaker 01

  And you're wondering whether or not to cancel?

• 44:20David Puder?

  Um, I'm wondering whether or not this is, yeah, I'm kind of wanting to flush out like, is how much of this is just my circumstances in my life? Or is how much of this is a real paranoia that I should be concerned about this person?

• 44:36Speaker 01

  Well, you said that you had a unique reaction. So this hasn't happened to you before? You've seen lots of patients. So having this concern, is this, this is the first time you've gone out of separate entrance? It's the first time that you've had a nightmare?

• 44:50David Puder?

  I mean, I've had, I've had dreams and I've had some, some nightmares about patients, you know, but this, there's something about this that feels different, you know?

• 45:03Speaker 01

  So your your reaction can tell you a lot about what it must be like to be in his interpersonal network, what the people that he knows are living with.

• 45:14David Puder?

  Yeah.

• 45:15Speaker 01

  I really appreciate the danger that he seems to bring into his his relationships. But the real question is, can you help him when your life is potentially at risk?

• 45:29David Puder?

  Yeah, and it's like, I feel guilty that I even have these internal thoughts.

• 45:37Speaker 01

  Hmm. Hence, the questioning, am I only making this up because my grandfather was mugged outside of his office?

• 45:46David Puder?

  Yeah. Or the the recent death of the therapist in town, right?

• 45:51Speaker 01

  Yeah.

• 45:52David Puder?

  Which I I read the case on this therapist in town, and you know, this person had a prior history of violence, rape. This person was, you know, in jail for almost 20 years before released. So this was this was like a historically violent sexual offender. So that kind of helps me a little bit, you know, get my head around like, OK, like, this this client I saw didn't have a history of any of that, right? That he told me.

• 46:25Speaker 01

  That he told you. Yeah. And any you're the first practitioner in the practice to see him, so no one else has a has had an eye on him?

• 46:36David Puder?

  No, no, no one else had an eye on him.

• 46:41Speaker 01

  You you saw him, it sounds like if you're going out a separate entrance, you saw him at the end of the day. Were you the only person in the office?

• 46:50David Puder?

  Um, yeah, so I I think that the the fear that I have, I I don't know if like, this is going to be a good client for me, but I also have a lot of guilt about not seeing them. Like, I feel like I need to be able to help everyone.

• 47:09Speaker 01

  Yeah, it would be good for you to to let go of that idea. You're not going to be able to help everyone and you can't. You can't be helpful unless you feel safe. Physically safe, emotionally safe.

• 47:23David Puder?

  Wait, wait. So are we still in the role play? Is this what you would actually say to a provider in this case?

• 47:28Speaker 01

  Yes, absolutely.

• 47:29David Puder?

  Okay, so if you're a provider listening to this. And you're a female or male. And there's a client that you're seeing, right? And you don't feel safe. I my I would I would totally agree with you. Like, you don't need to see this person.

• 47:46Speaker 01

  I had a I had a student once. Who was seeing a client because he. I guess he thinks he was a diversion. Process he'd been. Caught masturbating in public and he was sent to therapy instead of jail. So she she's seeing him and she said. In the session. He was. Starting to. Indicate masturbation. And she was distinctly uncomfortable. And she she said, I didn't know what to do. I didn't want to be his mother and tell him to just stop it. I didn't want to just. Ignore it. I didn't know what to do and and I don't know how to.

• 48:31Speaker 01

  Help him, but I just don't feel comfortable.

• 48:33David Puder?

  Which which, by the way, I'm thinking about the audience of mental health professionals who are listening to this. This is a good. Thing to think about, how am I going to handle this type of situation? Because it could happen, right? You could have an autistic patient. You could have, I mean, different types of patients. At different levels of functioning, right? Could you could this could potentially come your way? So, okay, well, so what did what did you recommend?

• 48:59Speaker 01

  I said, it seems to me you have three ways to go. One is. You refer him elsewhere. Entirely legitimate. You can't help him unless it feels comfortable working with him. Second is you say. We're here to talk about masturbation, not to demonstrate it. And so if it goes from talking about. How that has impacted your life and how you want to change. Public masturbation into you demonstrating it, then we're going to stop the session. And I get to decide when it's gone into that realm, not you.

• 49:36Speaker 01

  And the third is you could you could utilize what's happening. And so when he goes and reaches for himself and you get curious about what is it that impelled you just now to reach for and start masturbating in front of me? Tell me what's going on for you right now. And you you could, in the moment, explore what was happening and make that perhaps therapeutically helpful, but that could only happen if you felt safe. And that, to my mind, would be best managed by somebody else being in the room with you.

• 50:16Speaker 01

  So three options, all all fine, but your confidence and comfort come first. And she said, I picked door number one.

• 50:26David Puder?

  Okay.

• 50:26Speaker 01

  So she made a referral, which I thought was entirely appropriate.

• 50:30David Puder?

  Yeah, I would be up probably to recommend door number one, unless they had, I don't know, like, what level of experience or comfort would be necessary to go through door number three, you know?

• 50:42Speaker 01

  I think profound experience, and it would be much easier if it wasn't a male-female kind of dynamic.

• 50:54David Puder?

  Yeah. I I think that for the for the sake of clarity with the podcast listeners, like, if it's a one-off countertransference of like, there's something about that that doesn't feel right, you got to listen to that, right? And the one of the supervisors I had recently said that they went immediately to Zoom-only sessions with this one person. And that was one step that she felt comfortable with, because then she wasn't in the same room.

• 51:28David Puder?

  But I get very, I get very sensitive to, to people, especially providers that feel a high degree of guilt that they need to see everybody. Whereas like, if you're, if you're feeling like this is, there's something really off, like maybe for good reason, you're feeling that.

• 51:49Speaker 01

  Yeah, in, in the role play that you were doing with me, the person nightmare, I, I was listening very closely to that because it's obviously something about what happened is, is spinning around and, and sort of pay attention to that and honor it. To, to honor any kind of emotional response, not necessarily be, be shut down by it. Like at the end of role play, your character was worried that perhaps the person was listening into our conversation.

• 52:33Speaker 01

  So, so that level of fear is then getting in the way of being able to, to, to think resourcefully about what steps do I need to take?

• 52:43David Puder?

  Right, right. And, and you know, there's a thin layer, layer between insight into psychotic thoughts, right? And actual psychotic thoughts versus like if this is actually the helpful, a helpful degree of paranoia, right?

• 52:58Speaker 01

  Absolutely.

• 52:59David Puder?

  And so I'm playing around with that. And I'm thinking also that the reason why I, I picked this specific story is that you had a story in your book that was very similar about a patient that elicited a lot of fear in you. Can you tell me about that story?

• 53:16Speaker 01

  This guy walks in to a clinic that I was.

• 53:21Speaker 01

  I was a graduate student at the time he walks in. We usually scheduled sessions, but I was around. Office manager said, can you see him? Yes, he walks in. He has mirrored sunglasses on, never takes the sunglasses off. And he says he's there because his wife left him and she set a precondition for me coming back as you getting therapy. So he says, I'm here to get therapy so that she'll come back. And however many sessions it takes, however often it takes, I just want her back. So we start to talk and he mentions along the way, when she does come back, I can't take it, her leaving me. This is not the first time she's left. I can't take it. It's not happening again.

• 54:02Speaker 01

  And he made it very clear that if she came back and tried to leave again, he was going to offer. And so I then got incredibly frightened that somehow my helping him was going to lead to her death. And I said that out loud. I said, I've got a problem. I welcome the fact that you've come for therapy and I look forward to being able to help you, but I recognize that if I help you enough so that she's willing to come back, it puts her life at risk and I'm not willing to do that. And he said, he leaned toward me conspiratorially and he said, hey, listen, don't worry, I

• 54:45Speaker 01

  won't tell anyone I was here, not even the cops.

• 54:50David Puder?

  I feel very safe knowing that. Knowing that bit of information makes me, oh, I feel very, I feel very reassured. There's almost like a projection that you are going to be just like him in that too? Like all people think like I do. All people think as Machiavellian, as psychopathically, sadistically as I do, right? And so you're just another guy that's thinking like I am. And you're like, uh, I don't know.

• 55:20Speaker 01

  My job is to be able to make sense of the fact that that's how he sees the world, but not for me to adopt the same principles. Yes. So I, I told him I couldn't continue to see him.

• 55:31David Puder?

  Yeah.

• 55:32Speaker 01

  And I, and I.

• 55:35Speaker 01

  It's a long time ago. I don't think that I did an adequate job of finding him an alternative. What I did do is call women in distress and let them know that if his wife was there, that she needed to take care.

• 55:49David Puder?

  Okay.

• 55:50Speaker 01

  But I could not be helpful because the stakes were too high for the possibility of this.

• 55:57David Puder?

  Yeah.

• 55:59Speaker 01

  Woman dying.

• 56:00David Puder?

  Yeah, I almost feel like that's it's reminiscent of the type of client that comes in and says, I really need Xanax because when I'm coming off of cocaine, it helps me relax. And I'm like, I can't be like complicit in you using a drug that could end your life. Right? So it's like, I can't be helpful in this, you know, like I can help you if you want to get off cocaine. But I'm not going to give you another controlled substance to ameliorate the suffering of coming off of an illicit substance.

• 56:34David Puder?

  On a ongoing basis.

• 56:35Speaker 01

  But the empathic way into that. I agree 100% with what you said. And if you present it that way, then you're just putting up a wall and saying, look, I'm not, I'm not going to be complicit in, in helping you in this way. To deliver the same message empathically would be, cocaine is providing excitement for you, or it's helping you cope in various ways. I want to hear all about that. And of course, it ramps you up in a way that then you feel so frazzled and you need something to be able to, to come down from it. And good on you, Xanax is one way to do that.

• 57:16Speaker 01

  If you were going to work with me, we would look at a way where you didn't need the Xanax and you didn't need the Xanax because you didn't need the cocaine. Would you be interested in exploring that?

• 57:26David Puder?

  It's reminiscent. I've been, I've been deep in the Epstein files and there's.

• 57:32David Puder?

  And because I'm a psychiatrist, I look up things like the different drugs and see if they appear in the Epstein files. There was a very lengthy description of the effects of GHB, which is the date rape drug, date rape drug, that a doctor was providing to Epstein. And there's some level of like, like, yeah, ick in that, right? There's like, no, that doesn't, that's not something. Yeah, anyways. It's kind of on this, this, this, uh, this association that you gave of this guy trying to control his, his, his girlfriend, right, to the point that she can't escape.

• 58:17David Puder?

  And I'm going to kill you, this homicidal level of, of power, right? If you do try to escape, like, I'm going to control you. And I think that was kind of that sadistic vibe I got in a lot of the Epstein files.

• 58:32Speaker 01

  Yeah. Yep.

• 58:36Speaker 01

  There are limits to what we as therapists can offer. If, if I had been able to provide an empathic response to this guy, if I could rewind and redo it, I would have said something to the effect of, your wife obviously means, means the world to you. And when she left you this last time, it turned your world upside down.

• 59:01Speaker 01

  If you agreed with that, I would proceed with, and so of course, you're desperately thinking, I've got to prevent her from ever doing this again. And, and the one way that you know is to do it through threat and through, through violence, prevent her from leaving. If you were to continue to come here,

• 59:22Speaker 01

  I would fully endorse the idea of your wife not having to leave again. However, what we would do is we'd explore a way for you to make it safe for her to stay, rather than for it to be unsafe for her to leave.

• 59:37David Puder?

  Yeah.

• 59:39David Puder?

  And I think that would be something that would get through maybe some of the like, you wouldn't, you wouldn't get an incredibly negative reaction from him because, you know, for the departure of like, no, I can't treat you.

• 59:54Speaker 01

  Yes. I was afraid to say, I can't treat you, that he would then, I was worried that he had a gun in the session and I was worried that if I said, I'm sorry, I can't see you, that he would then be violent to me.

• 1:00:08David Puder?

  Yeah.

• 1:00:09Speaker 01

  So being able to empathically connect with him so that it makes sense that I couldn't help him, so that he wouldn't then be in judgment against me, it was in part a way of, of keeping me safe enough to help him be safe, which would help his wife be safe.

• 1:00:29David Puder?

  Yeah. Yeah. I think the, the other option with a person like that is to refer them to a higher level of care. It'd be like, look, your level of care that you probably need at this point is, is more of like a partial level of care or an impatient even. If you want to really overcome things, that's what I would recommend. I don't, I don't think once a week is going to be

• 1:00:51Speaker 01

  Yes.

• 1:00:52David Puder?

  the level of care that is really going to help you accomplish your goals of developing a, a new psychological toolkit to deal with these huge emotions that you're dealing with.

• 1:01:04Speaker 01

  Yeah. And it comes back to what you said earlier, having the wherewithal and the ability to say, I can't, I can't help everyone. So I'm going to refer you to somebody that has expertise in an area that I don't.

• 1:01:19David Puder?

  What, moving more to like this idea of vicarious trauma, right? Empathically and being immersed in people's stories every day, day in and day out, and the vicarious trauma that we kind of absorb as mental health professionals. How, how does empathy help us? Or how, how do you supervise people in the midst of that?

• 1:01:41Speaker 01

  Yeah, great question. So facing vicarious trauma, it's very human to then just try to not feel as a way to cope. But that then leaves the practitioner numb and really not caring. And that creates burnout, so that doesn't really help. The alternative is to treat empathy, if you treat it as a skill for engagement, to then learn the skill of disengaging. So to begin a session and explore a way into the sense and sensibility

• 1:02:22Speaker 01

  of the person's experience requires you to have a felt sense of what's going on. It doesn't mean that you have to suffer in exactly the same way or to the same degree, but that you're allowing your body to register what's happening with them and for them and your response to them and all of that, so that you're emotionally available in the process. And then at the end, to come out of that session and to be able to release that connection, to disengage. And that can be done through mindfulness meditation techniques. It doesn't have to take a long time, but to have a

• 1:03:02Speaker 01

  or to have a kind of a ritual of entering into and entering out of, exiting from an empathic relationship and to do that between every client, every patient throughout the day and then at the end.

• 1:03:16David Puder?

  What's your practice? What do you do?

• 1:03:19Speaker 01

  At this point, it's now virtual. It's all virtual.

• 1:03:25Speaker 01

  Before, it was in person, but I do a lot of individuals, a lot of couples, some families.

• 1:03:30David Puder?

  Okay. What is your practice between patients? What do you do?

• 1:03:35Speaker 01

  I take, oh, I see what you're asking. I end the session and before I begin case notes, I turn toward my experience and I pay attention to what it is that I'm feeling, what I'm noting, what I'm remembering, and I'm releasing it. I'm on an exhale, I'm just letting go.

• 1:03:57David Puder?

  So you do some, you do some deep breathing?

• 1:04:01Speaker 01

  I actually don't do it with deep breathing, but I do pay attention to the, the release of carbon dioxide and I have an imagination exercise where I, I latch whatever it is that's going on physically for me to the carbon dioxide and gets released, binds to the carbon dioxide and gets released. So I do that in my imagination.

• 1:04:26David Puder?

  Okay.

• 1:04:28Speaker 01

  There's another practice that's related to the Tibetan Buddhist practice of tonglin, of being able to

• 1:04:37Speaker 01

  of taking what I'm feeling and then transforming it into relief. So just allowing the body to, instead of

• 1:04:48Speaker 01

  releasing what you're feeling to have it transform and then when it gets released, it's being released as, as a form of relief. It's another imagination kind of exercise.

• 1:05:01David Puder?

  I'm always interested in what people actually do to, and then what do you do on your time off to sort of decompress or, you know, what, what have you found most helpful in your, in your career?

• 1:05:12Speaker 01

  So the, the essence of, of meditation, to have a a focus, say on a breath focused meditation, and then recognizing that, that that focus gets lost, something intrudes, something interrupts. Recognizing what is interrupted, letting it go, coming back to the focus. And that's really the meditation practice is always coming back to some point of focus by letting go of or transforming some kind of interruption, something that's stolen away your attention into a distraction or a story or a memory or an anticipation or something. It's always just coming back to that. And so that is

• 1:05:57Speaker 01

  The same with empathy. After disengaging, anything that brings me back into thinking about a client. If it's useful, like I get inspired, oh, I didn't recognize something I didn't pick up at the time. Now something's occurred to me, I'll write it down so that I've got it when I go back. And then when I've got that, I then let it go. And if something's eating at me, I pay attention to is there something about this that I need to be paying attention to that wasn't picking up? And then once I've got that noted, then I let it go. So I'm not ignoring intrusions, but I'm I'm making use of them and then letting them go when I don't need them.

• 1:06:42Speaker 01

  Then I do just a bunch of stuff that has got nothing to do with seeing clients.

• 1:06:48David Puder?

  Yeah. Yeah, I think I think it's good to have like things that are completely, completely different.

• 1:06:58Speaker 01

  Can I ask what you do?

• 1:07:00David Puder?

  Um, well, life is full with kids right now. And so, you know, it's it's a good distraction from from work. When I'm, you know, go for walks with the kids, do play Minecraft together, stuff like that.

• 1:07:16Speaker 01

  Wonderful.

• 1:07:18David Puder?

  And I love good food. Sometimes, you know, like one of my just just having a break midday and go going to get some food, you know, there's something about that that's just nice to kind of turn it off. Sometimes to get angry at something else, you know, outside of like all the patient stuff, like the Epstein files, kind of it's a nice, nice distraction. And, yeah, I mean, I do a lot of the podcast stuff, so I feel like that takes a lot of the extra time. But I feel like I've gotten better at compartmentalizing that to not take over too much of my evenings.

• 1:07:55Speaker 01

  Wonderful. Yeah, that that's incredibly important is to protect your non-work time.

• 1:08:01David Puder?

  Yeah.

• 1:08:01Speaker 01

  Kids will be, kids are great for ensuring that that happens. Daddy, daddy.

• 1:08:06David Puder?

  Yep. Yeah. So this is wonderful. Anything, anything kind of like as we kind of wrap up our time, anything that's still lingering that you feel like is a big point that we didn't even really convey, but you want to make sure that you convey?

• 1:08:21Speaker 01

  Yeah, that the demonstration of empathy is different than the claiming of it. So a lot of people, practitioners, attempt to reassure their clients that they understand, oh, I get you. I understand. I've had something like similar that happened to me. So I understand what you're going through. And with all the cases that I've supervised, I've never seen that claim go well.

• 1:08:50David Puder?

  Yeah, yeah, yeah. Someone with more borderline characteristics may jump on that and be like, how dare you? You have no idea what it's like. How could you, how could you possibly understand?

• 1:09:04David Puder?

  But then, you know, what's funny is like, I find AI, sometimes the chatbots will do that. I completely understand what you're going through. And my, my statement back to them is like, you don't understand. You're a stack of cold, hot GPUs in some factory in the middle of, you know, and, and they'll be like, oh, haha, good one. Yes, I am a, I am a, I am a hot stack of GPUs in a factory. You're right.

• 1:09:29Speaker 01

  Yes. So even when it's a, a wet, warm stack of neurons that is facing the client, they're saying you have no idea what I'm going through is accurate because you truly don't. But you can demonstrate your understanding. And if you're doing a good job, they're agreeing with you. So you make a statement, you float an idea, they agree with you, you now know that you've got some empathic connection going on. And when you're wrong, they correct you and you stand corrected, you adapt, and you're building over the course of the conversation, a tighter and tighter connection that's based on your developing through your curiosity and imagination and appreciation of what their experience is.

• 1:10:14David Puder?

  I think there's one, there's one part, if I can read, since I actually did an episode on the bear.

• 1:10:23David Puder?

  We did a full breakdown of the psychology of Carmen and his mother.

• 1:10:29David Puder?

  So you wrote this portion where you you go to season one, episode eight of The Bear, and he's talking, I think, at AA. And you write what he is, what he says, but then you write what you would empathically say to him. So I think this might demonstrate what we're talking about here. So you say, okay, so I'm gonna, my name is Carmen. My brother's an addict. My brother was an addict.

• 1:10:55David Puder?

  And then you write was an addict. It takes a while for the reality of his death to sink in.

• 1:11:05David Puder?

  Carmen goes on, my brother could make you feel confident in yourself. You said, he could build you up. Carmen goes on, you know, like when I was nervous, I was scared. I wouldn't want to do something. He'd always tell me just to face it. And you would say back, you just knew he had your back. So it goes on. It's it's long, but you get, my listeners will kind of get the gist of it. But a lot of good, practical thinking through of how to, I like how you said that you state you state the empathically and you demonstrate it. You demonstrate the understanding. You don't say, I understand.

• 1:11:47Speaker 01

  And demonstrate not only in terms of the word choice, but the affect with which you say it.

• 1:11:53David Puder?

  My mentor, Dr. Tar, would say something like, you can understand in part. You can imagine in part, but you can never understand fully. Right? You can, you can have a glimpse into their world. You can, you can seek to understand. Right?

• 1:12:11Speaker 01

  And, yes, absolutely. And that is the best we can do, and that's a lot. It's, it's that commitment to striving to understand that. There's research that says clients feel more connected with therapists who attempt and fail to make a correct empathic statement than those that would claim that they understand. So they appreciate the fact that we're doing a rest.

• 1:12:38David Puder?

  And then you also talk about, we didn't really talk about the both and empathizing, holding multiple perspectives. Can you mention that briefly?

• 1:12:46Speaker 01

  Yeah, so I've got this experience as a family therapist. You've got two or more family members holding very different ideas, beliefs about the other and about what happened. And family therapists get caught trying to be neutral, not side with one person against the other. And often that can result in them being so bland that they don't connect with either. The alternative, both and emphasizing, is to be able to grab the essence of what one person is saying and say it back to them so that they agree. And then turn to the other person and do the same thing with them.

• 1:13:26Speaker 01

  And those two versions of reality are at odds with one another, and you hold both of them going back and forth between them. So that each person feels like you get them, even though they don't get each other. And that becomes a conduit for developing a different relationship between them.

• 1:13:47David Puder?

  Some good reflectiveness there, to be able to hold all parties, all the pieces of the family, all their different, you know, to empathically immerse yourself in the varying viewpoints and to see, yeah, there is a both and there often. But they can often miss each other in the midst of that, right?

• 1:14:06Speaker 01

  They're in search of some ultimate truth. If only we can both agree that I'm right and you're wrong, then we can go on from here. Each of them are sort of operating from that assumption. And instead, what we're doing is saying, there isn't one objective truth that we're in search of. It's, we're going to honor the fact that you can profoundly disagree and have different versions of reality, and my job is to make sense of each of them, not to be a judge as to which one's right.

• 1:14:33David Puder?

  So good. Well, Dr. Flemons, it's been a pleasure. I think we should probably wrap it up here. Do you have like a website, or are you on social media, or where would you point people towards if they want to learn more about what you have to offer?

• 1:14:48Speaker 01

  Yeah, I have a website, contextconsultants.com.

• 1:14:52David Puder?

  Okay. And we'll put that, we'll put that in the show notes. Great. Yeah. Well, wonderful having you on. So nice to meet you. And we'll leave it there for today.

• 1:15:03Speaker 01

  Lovely to meet you and thanks for the great conversation.