Understanding Mature Defense Mechanisms in Psychotherapy: Nancy McWilliams Framework with Clinical Examples from the Tuesday Cohort

In this episode, Dr. David Puder and the Tuesday 2025–2026 Psychotherapy Cohort explore mature and neurotic defense mechanisms through the lens of Nancy McWilliams' influential framework. Building upon the previous discussion on primitive defenses, they provide an in-depth look at how higher-level defenses such as regression, repression, compartmentalization, isolation of affect, intellectualization, rationalization, moralization, undoing, displacement, reaction formation, and sublimation operate in both everyday life and clinical practice. Filled with rich clinical examples drawn from outpatient psychiatry, emergency settings, trauma work, grief, OCD, and private practice, the cohort discusses the adaptive value as well as the potential costs of these defenses, offering practical insights for recognizing and working with them effectively in psychotherapy. By listening to this episode, you can earn 2.0 Psychiatry CME Credits. https://www.psychiatrypodcast.com/cme-program Link to blog https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/episode-266-understanding-mature-defense-mechanisms-in-psychotherapy-nancy-mcwilliams-framework-with-clinical-examples-from-the-tuesday-cohort Link to YouTube video https://youtu.be/ID7_hTnKO4I

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

• 0:14David Puder?

  Welcome back to the Psychiatry and Psychotherapy Podcast. I'm your host, Dr. David Pooter. Today, I am thrilled to be joined by an outstanding cohort, my Tuesday cohort, the 2025 to 2026 group of talented clinicians who spend a full year with me, deepening their psychodynamic skills and reflective function. In our last episode, we explored primitive defenses. Today, we're moving into neurotic and mature defenses. Kicking us off is the compassionately discerning and quietly authoritative Dr. Jason Mallow. He is an outpatient psychiatrist and director of an outpatient psychiatric clinic at Maine Health, Maine Medical Center in Portland. He is deeply passionate about psychotherapy

• 0:58David Puder?

  and will be kicking us off, talking about regression and then later, turning against the self. Next, we will have the nuanced integrator and psychologically astute Dr. Olga Kuznetsova. She is a psychiatrist working in two academic hospitals in Boston, originally trained in internal medicine in Russia. Olga now excels as an emergency and consultative liaison psychiatrist, while also seeing patients for therapy in psychopharmacology. She's a dedicated CrossFit athlete and will be covering compartmentalization and later, repression. Next up, we have the gracefully observant and finely attuned Dr. Jeanette

• 1:41David Puder?

  Hotelling. She is a psychiatric mental health nurse practitioner in Montana, who lives right by Glacier National Park. After years of medical surgical RN work, she has had a powerful journey into mental health, an avid hiker, skier, backcountry adventurer. She'll be talking about isolation of affect.

• 2:07David Puder?

  Then we will have the genuinely inquisitive and equanimous presence, Jason Kent, a licensed professional counselor, who I would recommend in Charlottesville, Virginia. After 15 years of advertising for major brands, he transitioned into practicing psychotherapy and now worked extensively with addiction and failure to launch cases he will be presenting on intellectualization and displacement. Next, we'll have the subtly illuminating and warm, Dr. Dina Golden. She is a nationally certified family and psychiatric mental health nurse practitioner and clinical professor at the Florida International University in Miami.

• 2:48David Puder?

  She is the author of Fast Facts for Psychopharmacology for Nurse Practitioners, which I have a copy. Dina will be covering rationalization. Then we will hear from the courageous and compassionately discerning Dr. Katia Rene. She's a psychiatrist with a deeply psychotherapy-based practice in Washington State. Katia grew up speaking three languages and has lived in multiple countries. She's an avid skier, hiker, swimmer, dancer. She will be discussing moralization. And in the second half, we have the sagacious and clinically luminous, Dr. Natalie Dreyfus.

• 3:32David Puder?

  She is a psychiatric nurse practitioner, founder of Dockside Psychiatry Clinic in Seattle. She works with adolescents and adults and also does psychotherapy and has a special interest in psycho-oncology. She brings a strong psychodynamic foundation along with somatic and holistic approaches. She will be presenting on undoing. Then we will have Chris Diodana, who is a heart-centered and authentically attuned licensed mental health counselor, working in Orlando, Florida. He is deeply passionate about real-life transformations he witnesses every day in therapy. He will cover reaction formation.

• 4:16David Puder?

  Then Dr. Amanda Seki Jimma, the finely attuned and developmentally precipitant child and adolescent psychiatry fellow at the University of Louisville, brings a rich background in movement, language, and cross-cultural experiences. She is presenting on identification and will close the episode with reversal. Finally, Dr. Latal Meldnick, a viscerally resonant and psychologically astute psychiatrist who works in an adolescent day treatment program in New York while maintaining a private practice and teaching fellows at Columbia, will bring us a memorable Batman example when she presents sublimation. I hope you enjoy the episode.

• 5:00David Puder?

  If you leave a comment on YouTube, I will be happy to share it with the people that are presenting today. And let's start the episode. Jason Mallow, take us off with regression.

• 5:14Speaker 01

  Yeah, last night I was watching this documentary and I just had to share this example because it really stood out to me. So it's a documentary on Mel Brooks. And yeah, he once played this love doctor on a dating show. And the interviewer asked him something like, when can a heterosexual woman know when it's an appropriate time to get married? And his response was something like, oh, when their boyfriend puts down their rattle.

• 5:45David Puder?

  Okay. I don't know.

• 5:49Speaker 01

  That was fitting. But regression is, so it's a defense mechanism. Where people seem to return to an earlier stage of development. It's definitely like a backtracking to an earlier way of coping with stress. That can be psychological and or environmental. And, you know, our psychology does develop in stages. We've all heard of Freud's oral anal phallic. And for the parents out there, we definitely know kids don't, don't progress in a straight line. There's an ebb and flow to development, but there is a progression.

• 6:32Speaker 01

  And typically with aging, this gets less dramatic.

• 6:37David Puder?

  Yeah.

• 6:38Speaker 01

  Regression, I mean.

• 6:39David Puder?

  Yeah, I've seen it with kids when they get sick, they'll regress to earlier stages. You know, all of a sudden, they'll lose abilities that they had before. Yeah, so it's normal with kids to regress. Yeah, how do adults do that? How do adults regress sometimes?

• 6:55Speaker 01

  Yeah, it totally happens with kids. Like, you know, I know firsthand about like sleep regressions. But yeah, it happens with adults too, of course. And it can be natural and adaptive for adults. It's not always, you know, pathological. And, you know, you can think of like romantic relationships where you'll hear, you know, partners talk with each other and like baby, like voices. You know, like smoochy, woochy, cutie pie, that sort of stuff.

• 7:26David Puder?

  Everyone else cringes, right? That's not a part of that regression.

• 7:31Speaker 01

  No, and yet, like, we do it as human beings. And you're like capable, well-functioning adults. I mean, you can all probably imagine someone going back to their, the home they grew up in and then just like suddenly becoming like, you know, infantilized by a parent or like a little kid feeling like criticized or getting into sibling rivalry, that sort of stuff. But then it can be maladaptive too. I'm thinking of patients throwing full-blown tantrums in the office, stomping their feet, getting that fetal position on the floor. And, you know, Nancy McWilliams has pointed out that like somatization can be a form of regression.

• 8:18Speaker 01

  And you know, it reminds me of how Freud wrote about like the ego first being like a body ego. And so like the ultimate regression may be a somatic experience.

• 8:32Speaker 01

  In the body somewhere.

• 8:34David Puder?

  Yeah, that's good. Or like a like finally common pathway to dissociation, right? And just kind of, but in that, sometimes the regression, it feels like they're regressing to an earlier developmental time, right? And that's, and so we may notice that as providers, we may be curious about it. What do you do? What do you tend to do, Jason, if someone regresses in your office?

• 9:04Speaker 01

  Well, you know, it can be, it can come in the form too of like, you know, patients who've made strides with becoming more autonomous or just like having, having healthier behaviors, self-agency, and yet like backsliding, right? And then someone's like drinking again, or getting into problematic relationships again. I think the good news is, is that with, with this, this defense mechanism is that people typically don't lose what they've achieved. It's just at like where they're at right now, it's just overshadowing temporarily. And I think helping patients recognize that and become more cognizant of it can, and normalizing it too,

• 9:49Speaker 01

  can help support, support them actually having some greater control over time.

• 9:56David Puder?

  That's good. Yeah, it's like, it's like that maybe their coping mechanisms have gotten more advanced. But then in the regression, they go back to old habits. And so kind of, I love your positive view on that, that you have gained the ability to jump out of that faster, maybe. Yeah, I like that.

• 10:15Speaker 01

  Yeah, and it might be just like you have to temporarily be somebody that kind of holds on to their past successes until they can get to a point of recognizing it. But like you'll hold on to it for them and help them with like grounding and stuff like that to to get out of it.

• 10:31David Puder?

  But that's good. Thank you, Jason. Let's talk about compartmentalization. Olga.

• 10:39Speaker 02

  Okay, um, so I got confused, you know, about compartmentalization. Uh, at first because there is one that is commonly known, right? And we use it sort of like in everyday life and it almost feels like it's a good thing to compartmentalize. And so it's um, just kind of like a definition is an act of mentally separating different parts of your life, thoughts or identities. So they don't conflict with each other. So for example, and we all do it, like a doctor who focuses or even a therapist, you know, who has some personal problems at home. But he can focus on sort of like problems of their patient, you know, and not be sort of like emotionally disturbed, you know, maybe during the session, right?

• 11:24Speaker 02

  Another example that I had is therapist who leaves work stressed at the office and is fully present with family at home. But we all kind of know that's not realistic. We all come home and kind of, you know, we feel like we need some time, you know, for to ourselves, uh, right? So, yeah, it's very challenging.

• 11:47David Puder?

  We can, we can regress to earlier stages once we get home, right? Cause it's a safe place.

• 11:52Speaker 02

  Yeah, and I think it's normal, right? Um, yeah, and so as a defense mechanism, um, it's more like the ability to keep conflicting beliefs, emotions or behaviors separated.

• 12:08Speaker 02

  So that they don't sort of like interact with each other and now person is not sort of like feeling anxiety about it. And it's kind of similar to hypocrisy, which was new to me when I read, you know, um, Nancy McWilliams about it. So for example, person who cheats in business, right? But at the same time, you know, sees himself as a very moral and kind person, right? But at the same time, kind of like do something, yeah, uh, bad. And or a person who acts lovingly towards family, but abuses others and thinks it's it's okay, you know?

• 12:48Speaker 02

  So the other thing that I wanted to point out that it's similar to splitting two, right? And so there's this tension between, you know, those two sort of like different beliefs. And it's not integrated. And I think in therapy, I don't know, I was thinking about how I would approach it. I'm sure it naturally came up during my therapy, maybe just kind of wonder, you know, gently why person sort of like act certain way. I don't know, maybe somebody has other suggestions on how to manage this kind of defense in therapy as well.

• 13:25David Puder?

  Well, I I see it as like largely adaptive, right? I mean, there was this guy who came on my podcast talking about Ordinary Men. And a lot of the times he was very cognitive. Um, and Katya, I know this is one of your favorite books.

• 13:38Speaker 02

  Yes.

• 13:40David Puder?

  And he was very cognitive and very emotionally distant. And then there was this one part where he was talking about this early discovery. He was in Germany and he found these files and he understood what he found. And he made this connection and he starts getting very emotional. And it's like he couldn't hold that compartmentalization anymore, right? Where it was probably very adaptive for him to get to be very intellectual.

• 14:10David Puder?

  And separate the emotionality when he was really trying to just

• 14:16David Puder?

  find the facts and the details would have this horrendous thing, right? So it'd be totally overwhelming to like, fully grapple what that was like for the Jewish people to be murdered as they were by the German military officers. So yeah, compartmentalization can be very adaptive. And so if it's happening, it's happening for good reason.

• 14:40Speaker 03

  I think about compartmentalization too, old guy. I like how you separated it with like this, the tool that we use. And I remember working as a nurse on the floor during COVID. And, you know, walking into a patient's room who I distinctly remember, you know, this older gentleman. And both were, there were two patients on my panel and both of them were COVID positive. One of them was not doing well, not at all, thinking. And it was when visitors also couldn't be in the hospital. And so, holding that space for this patient in the distress and then walking outside the room, kind of putting, gathering myself together.

• 15:25Speaker 03

  And then I go into the next room where this other patient is also COVID positive, not showing any symptoms, pretty happy-go-lucky. He's able to talk to his family. And I think it was, when I was reading about this, I'm like, oh, okay. That makes a lot more sense to me in that I needed that tool to be able to do that work and like, be present.

• 15:51David Puder?

  Yeah, and I have, talking about regression and kind of mixing these two together. I don't know if y'all have ever had this experience where you feel sick, you know? Maybe you have like a stuffy nose, a little virus. And you were, it's harder to compartmentalize, right? So I'm with a patient and instead normally I can compartmentalize. I can be fully present with that person. Now it's like other stuff from previous patients is leaking in. Stuff from my home life is leaking in. You know, and it's, it's like a little bit harder to control the affect that I made. The second arrow of critique towards those things creeping in, you know? Yeah, so.

• 16:28Speaker 02

  Yeah, I have that happen when I switch from one patient to the other. Sometimes it's really hard, you know, when there's something stressful just happened, you know, you can't really get back to yourself and put it away right away. And so sometimes it takes time to kind of like, yeah, that's interesting.

• 16:43David Puder?

  Yeah.

• 16:44Speaker 02

  I see that happen. Yeah.

• 16:47Speaker 04

  I was thinking about the idea of like integration, like helping someone be able to handle integration more and more. And specifically, the example that came to mind was like helping someone who's an addict, who is part of a spiritual community, where they keep those two parts of their lives completely removed. But I've seen like real change happen when you're able to help that person get to the point where they can find a safe person to share this other part of their life. And when that integration happens, I think there's a strength that comes with that, that starts to heal some of like the maladaptive parts.

• 17:31David Puder?

  Yeah. It reduces the shame, right? That person is holding to, if someone can hold that part of them. Yeah. Okay, let's go to turning against the self. Turning against the self. Jason Mallow, you're up again.

• 17:48Speaker 01

  Yeah, this was me again. You got me again. Yeah, turning against the self. So this one describes a unique kind of displacement where an individual becomes their own substitute target for negative emotions about another person. And it's like, what the ego does is it literally like reverses direction of things. It does a 180 of external, you know, blame to self-blame. And it can present itself in so many different ways. Self-criticism, self-harm, feelings of real, like, real, like, shame, feeling fundamentally flawed.

• 18:32David Puder?

  Knowing this, right, as a therapist, as for you, Jason, as a psychiatrist, knowing this, has it helped you become conscious of it when you do it towards yourself? Like have any of you caught yourself doing this now that you're conscious of it?

• 18:49Speaker 01

  Oh, yeah. Like, I, I, oh, yeah. I think so. You know, I, I think it's, it's, there's some irony and, and sometimes, you know, I'll catch up after the fact. It's, it's really nice when you catch it when, when it's happening, but you know, I find myself so maybe flustered or frustrated by a patient I'm working with. And, you know, for, for those of us and all of us who, who work with patients who have severe mental illness, it's inevitable. Like, we're gonna have strong feelings about them. And so, anyway, uh, it's, it's just ironic when, when that comes up and I'll find myself like going out of my way to like, maybe help a patient or, or call them or spend extra time with them or something like that.

• 19:32Speaker 01

  And it's like, wait, wait, what am I doing? Like, I was so frustrated, angry, and where did that go? And what did I turn this into? And now I'm meeting with this patient three times this week and, but, but yeah, wh- wh- when, when you catch it, it's, uh, it's super nice. And I think, I think being in a place where like we have good, good supervisors or maybe colleagues we can trust in, or maybe, you know, David, David, we're part of a group supervision, like your, your group supervisions where, where you can process some of that stuff. I think it helps you get ahead of it.

• 20:09David Puder?

  Yeah, it's really, it's really painful, right? When you take that anger, maybe the injustice, and you point it at yourself, right? It's like, yeah, it's, it can be very uncomfortable. Okay, what would we say to, to a patient? Who we see them maybe take some anger and point it at themselves?

• 20:32Speaker 01

  Um, you know, I, I think one ta- ta- tactic here could be something like, um, getting your patient to ju- try to get, get their observing ego online.

• 20:45Speaker 01

  And think about like somebody else in a similar scenario. Like, think about a friend of yours or a family member of yours who they're in the same exact scenario that you're in. How might they respond to it? How might you feel about them? How, what, what, would you have compassion for them? Would you, would you critique them as harshly? You know, an example could be something like you've got this patient who um, maybe, maybe they've got a boss who's, who's super critical of them. But, but then they find themselves being really critical of themselves and feeling like, I need to work harder. Um, I'm like, I'm not doing enough. I gotta, I gotta step it up.

• 21:28Speaker 01

  And then they're offered maybe promotions or something and they give credit to somebody else and, and you're seeing this happening. It, you know, I, I think you could, you could ask them to reflect on imagining somebody in the same scenario that's not them and what would you advise them to do or imagine how you'd feel for them and?

• 21:48David Puder?

  Yeah. That's great. I love that.

• 21:51Speaker 05

  You know, I've, I've also found that the turning against the self sometimes functions in trauma survivors who have experienced a great deal of powerlessness. And if they make it about them, it creates the illusion that if it's about them, then there might be something they can do or something they can fix. And so it, it sort of attenuates that feeling of powerlessness.

• 22:16David Puder?

  Which is tricky because if you're the provider and you try to take away this defense too quickly, it can make them feel powerless, which, and dissociate even more.

• 22:25Speaker 05

  Right, right.

• 22:27David Puder?

  Hmm, yep. Like, I'm the perpetrator. It could also be like, um, anger, guilt towards themselves for being, putting themselves in this situation, not speaking up, not telling the person to stop more. It also could be like blaming themselves for future stuff. So like, I've had patients who say, like, every time I masturbate, I am abusing myself. So they're, they, they're continually turning against themselves with what would be like a normal thing. So you could be from the trauma. So it's a trauma-based perpetuation.

• 23:09David Puder?

  So, okay. Shall we, uh, shall we keep going? We're going to regression with Olga again. Wait, repression, repression with Olga.

• 23:19Speaker 02

  Repression, yeah, yeah. Yeah, so repression is unconscious blocking of distressing thoughts, memories, impulses, so they don't enter consciousness. And unlike suppression, which is conscious, repression is automatic. Outside awareness happens kind of very quickly. And the other thing is that the person is not choosing to forget something again. It again, happens automatically. And I want to talk about example, repressed anger toward a parent. And I see it all the time in therapy. And I don't know if that's related to repression or maybe something else is involved here as well.

• 24:01Speaker 02

  Sure, but when a patient say that says that they have a perfect childhood and describe like parent as wonderful, you know, yet sort of like, maybe you know, a little bit of sort of like story to it. And then the patient has some symptoms, you know, could be some somatic symptoms, you know, headaches, or it could be some sort of like anxiety or debility with authority figures, right? So that anger could be repressed and it's really, you know, I guess frightening to the patient to imagine that, you know, their parent is not perfect, right? So maybe there's also some regression links here. So that kind of like interesting example.

• 24:47Speaker 02

  So, but the emotion will still leak out, right? Whatever is repressed, it's going to find its way out, but it's not going to be that sort of like obvious, right? I think that our job as therapists just try to link it, you know?

• 25:01David Puder?

  Yeah, so repression in your example, the person is repressing any negative feelings towards their parent. They're unconsciously pushing them down. It happens automatically outside of awareness. As McWilliam notes, something must first register at some level before it is cosigned to unconsciousness.

• 25:24David Puder?

  Denial is the more primitive form where memory or reality doesn't even come to the surface at all. Denial is more of a wholesale refusal to acknowledge something. Repression is different. Something may register briefly. A fleeting thought or feeling is distressing, but it gets automatically barred from consciousness. That is what gives repression its neurotic level quality. It's more sophisticated than denial, but it keeps the material out of awareness, often leading to indirect leakage. In your example, it's great because the adolescent or the adult is having some passive aggressive anger come out towards authority figures,

• 26:08David Puder?

  maybe even towards you, Olga. I can see that sometimes as a compliment because you are the safest person of the room, the one whom they can begin to allow the repressed material to surface in the transference. That's often where the real therapeutic work begins.

• 26:27Speaker 02

  Yeah, and I think, you know, maybe part of why they are not comfortable expressing the anger towards parent because they're anticipating the parent is going to react a certain way, you know, that will be distressing to them. And I think your job as a therapist is to kind of like be neutral and contain the anger, right?

• 26:48David Puder?

  Yeah, what about with grief? How can repression be a part of grief?

• 26:53Speaker 02

  Yeah, that after losing a loved one, someone reports feeling completely fine, everything is okay, and shows no sadness. And months later, they develop depression or unexplained fatigue, for example. I just had a patient today, actually, in therapy that lost his best friend to cancer when he was eight. And when he got the news, his mom actually told him, it was his mom, you know, my patient and his sister who barely knew that person who passed. And so when she told him that she passed, you know, Mom and sister, they burst out in tears.

• 27:36Speaker 02

  And he says, um, I really, I, I, I didn't cry. I couldn't express any kind of emotion. And um, there was, I didn't expect her to die so suddenly. Right. And so years later, what we've been working in therapy, he um, has trouble. Um, being there for someone who is grieving, you know, his girlfriend recently lost her cat. And she was, you know, um, had extreme sadness. She was crying. Um, and he said, I was really uncomfortable sitting next to her, you know, while she was crying. And I wasn't sure what I could do and I really wanted her to stop. And I'm not in a mean way or anything. I just didn't know what to do with it, you know?

• 28:20Speaker 02

  And we kind of like went back to that, you know, when he was eight and I think he sort of like um, dissociate from that, you know, repress the grief and kind of like didn't learn how to maybe grieve in his own way. So we worked around that. I think it was interesting, you know, how he repressed it throughout his life. And it still kept coming out, you know, in a way of this weird feeling that he was experiencing when somebody was grieving, you know?

• 28:46David Puder?

  Yeah, yeah, yeah. Somebody, somebody else is grieving. I'm feeling anxious. I want to repress their emotions too. And you'll see parents who maybe don't have as much insight as your patient. They'll say things like, stop, stop crying, don't cry. You, you need to cry, you're done crying, you know, don't be angry.

• 29:09David Puder?

  Like.

• 29:09Speaker 02

  But if you're not crying, it's, it's also strange, you know? So it has to be like a norm, you know what I mean? Like if the kid is not crying when it's supposed to cry, something sad happens that also, you know, parents are worried.

• 29:21David Puder?

  Yeah.

• 29:23Speaker 04

  There, there was a time when I was repressing some sadness and grief. And uh, I luckily I had a therapist who was really helpful, just giving me space, right? But there were also other relationships I was in where I felt like people wanted me to feel. And there was like a pressure in that. And one of the things I found helpful with working with repressed sadness, repressed grief is. Sometimes I'll just tell people, like, there is no pressure to cry here. You don't have to cry. I don't think any differently of you. Just, I would just love for whatever comes up to let it come up. I've found that to be really helpful, like, in my own life, but also for, for clients, to let them know, like, I'm not looking for a specific response.

• 30:08Speaker 04

  Like, repression makes sense in your story. So let's just let whatever comes up, come up. And if it's tears, it's tears. If it's not, then, fine.

• 30:17Speaker 02

  Uh huh, uh huh. In our session today, actually, tears come up, you know, and a couple of times he couldn't really speak, you know, because of, yeah. But I like your, you know, approach, too.

• 30:28Speaker 04

  Yeah.

• 30:29David Puder?

  Yeah. I think, I think it's like, whatever they're feeling shame for, if you can lessen the shame somehow. So it could be dissociation. I feel guilty that I feel so numb and I don't feel anything. It's like, I want to be with you in the numbness. It's okay to be where you're at. There's good reason for why you're feeling this. Um, let's be curious about it. Let's try to understand it. Let's see if we could put more words to it, right? So let's see if anything, other thoughts or other images come up. But, yeah, I think the key point is, like, people are feeling what they're feeling. They're having these defenses for various reasons. Probably reasons that we don't fully understand.

• 31:10David Puder?

  If we fully understood, maybe we would have more compassion. Maybe, maybe they would have more compassion for themselves. Okay.

• 31:19David Puder?

  Let's go on to the next one. Isolation of affect, Jeanette.

• 31:24Speaker 05

  Right. I actually think this is kind of a cool one. Isolation of affect is just what the, the word says. Basically, it isolates feeling from knowing. In other words, it operates by altering internal processing and associative functions so that thoughts are accessible. You can see what's going on. You can reason it through. You can make good decisions. You can still function. But the emotional significance of what's going on is actually blocked. And so you might observe someone that the content of their speech might be emotionally significant. But that isn't coming through, like, the emotion is absent or incongruent with what they're actually talking about.

• 32:09Speaker 05

  It's a super useful. Adaptive function for anybody that needs to be able to maintain competence in the face of really overwhelming situations that would otherwise be disabling, you know, medical professionals. I think we've probably all experienced that we needed to use this defense in order to stay competent and coherent with our patients without being overwhelmed by what we're actually seeing or hearing or being involved in. First responders use it a lot. You know, combat military members definitely use that a lot in order to stay competent without being overwhelmed. And so it can be hugely adaptive and functional.

• 32:54Speaker 05

  But when it becomes maladaptive is when it becomes rigid or pervasive or chronic. And you know, you're out of the crisis and you can't shift out of that. You can't start then feeling the emotional significance or, you know, processing that. It can show up then in trauma contexts where, you know, emotional numbing is one of the main symptoms of PTSD. And so isolation of affect can lead to that where people just can't feel what they feel or, you know, feel what it was like to experience it. At the most more extreme level, it can contribute to dissociation.

• 33:38Speaker 05

  It's also in terms of personality style or personality disorder. It tends to show up with the obsessive personalities. You know, where they've done some studies that show there's that people with OCPD have an attenuated access to their emotional states and they might be able to reason about them, but they can't actually experience it. And so, you know, there's the benefit that people are protected from emotional flooding, but it can be at the cost of feeling alive and being able to actually participate and experience, you know, life and liveliness.

• 34:16Speaker 05

  As an example, I have this, I have a, I have a patient that I see on a weekly basis. Um, fifty year old guy who went through just really extreme domestic violence when he was a kid. And he watched his dad break his mom's arm and he stepped into the role of protector. And his mom would always side with his dad anyway. And just a lot of horrific stories like that. And he talks about it. He can describe how terrible he feels, but he doesn't actually feel it. It's like, it's very, it's very mechanical in how he talks about it, very rote.

• 34:55Speaker 05

  Somewhat pressured, but the affect there, being able to feel the grief, the fear, the, the loss, the betrayal, all of that. He can't access that. Um, it's very hard for him even to, you know, to taste his food. Or see colors when he walks outside, you know, a sunset or a sunrise. To be able to just enjoy a sensory experience or an experience of relational pleasure. Um, and so, yeah, it has come at a great cost to him.

• 35:28David Puder?

  Hmm.

• 35:30David Puder?

  Yeah, really, really articulate. Thank you. Thank you for sharing the story and the details on isolation of affect. Yeah. And is it, does it bring up any other thoughts for anyone else?

• 35:42Speaker 02

  I was gonna ask you, so you're saying that this patient could not taste food, you know, enjoy sort of like an outside, you know, certain things. Is it because it kind of spread that isolation of affect, you know?

• 35:56Speaker 05

  And it's, yeah, it seems like it's, he's kind of globalized it.

• 36:01Speaker 02

  Right.

• 36:01Speaker 05

  And I think it's, you know, it's contributed to some alexithymia for him. Um, also.

• 36:08Speaker 05

  It probably, probably, you know, connects with anhedonia somewhere too, like, but yeah, for him to experience feeling or, you know, of emotion or even sensory experiences, like, has become threatening to him.

• 36:25David Puder?

  Yeah.

• 36:26Speaker 05

  And he's forgotten how to do it.

• 36:29David Puder?

  He's more, he's more.

• 36:29Speaker 05

  That's something we work on, you know?

• 36:32David Puder?

  Yeah, it's, it's, it sounds like, almost like a dissociation. I mean, it's a slight, it's dissociative to dissociate away from your emotions. It's also very adaptive. The member that came to me was when I went to Haiti as a medical student between my first and second year. There was, I followed an orthopedic surgeon and within one week we did like 50 surgeries. And I remember just feeling very like robotic towards the end, you know? I mean, no painkillers in Haiti, you know? The wards are all open, so the beds are like two feet from each other. It's a very different experience than in the US. And I came back and I had video that I shot.

• 37:17David Puder?

  I shot video the whole time, so I had like eight hours of video. And I spent a lot of time going through the video and I felt emotions in a way that I wasn't able to feel it then. And I think this is, like, that was therapy for me to go back to the video and edit, make a documentary or a little mini documentary.

• 37:38David Puder?

  It's, it really helped me kind of come to more of the emotional experience, try to evoke the emotions in other people watching the video, maybe that were hard for me to even feel. And yeah, I think that it can be very adaptive as a first responder, right? To be able to claim that, I saw this a lot in COVID, in like nurses that worked in COVID units. You know, it's like in, in health professionals.

• 38:09David Puder?

  And there was a connectedness between first responders as well that I saw, like, because, you know?

• 38:16David Puder?

  Because of the harshness of the conditions at times and the, you know, there was a shortage because a lot of people were sick. And there was, you know, an unknown of how deadly it was when it first came out. Right. And a lot of fear. So I, yeah, I think these are examples of like, it can be very adaptive to isolate the affect.

• 38:38Speaker 03

  It's so interesting too, David, that you, I mean, when you were saying that with your experience from being able to, I've never been able to conceptualize it until you were talking about it with kind of then feeling these emotions after watching the experience that you had with the surgeries. When I was in, working within like psycho oncology, we work with patients going through treatment like chemotherapy and or transplant and things like that. And they were not able to verbalize what was happening. Or they could not even, you know, they wouldn't work with a psychologist on our staff because they were not in the mental space to be able to do that.

• 39:19Speaker 03

  But they, we got a lot of referrals to our team after treatment was completed. When they have gone into remission or when they have completed their treatment courses or gone through transplant, because then now they're able to really focus. And now they're feeling all of these overwhelming emotions of grief and overwhelm and distress. When they were so kind of hyper aroused in a state during their treatment.

• 39:47David Puder?

  Yeah.

• 39:50David Puder?

  Yeah.

• 39:51Speaker 06

  I was going to say that as a, as a therapist, I think it's important to really pay attention with how contagious the isolation of affect can be because it's very easy to dissociate with people like this. Right. They're so separated from their emotions. And they, they might even talk about emotions, but in a really flat way that feels as a therapist, it feels really very boring and deadening. And so it can be a challenge to just stay awake and alive. And to really actually encourage the feelings and not just sort of this distant talking about.

• 40:33Speaker 06

  What happened?

• 40:34David Puder?

  Yeah.

• 40:34Speaker 06

  Right. Without actually feeling.

• 40:37Speaker 05

  Yes.

• 40:38Speaker 01

  Katya, I, uh, I was just, you were just reminding me of, um, uh, clinically how this can come up where we're working with relationships or couples. And this, this feeds into a, a, a gender stereotype, but like, like where one of the partners could be more of a fixer or doer and the other one more emotional and, and really trying to give some education or encourage each of the, the people in the relationship to see the other person's point of view. You know, I, I think it comes up in relationships where one could be holding, not being more of the, I'm gonna, I'm gonna stuff these emotions and the other being, I'm gonna, I'm gonna take action here.

• 41:23David Puder?

  Right. The pursuer, withdrawer, dyad, you know, like the pursuer is putting their emotions right out. The withdrawer says, if, if I share these emotions that I'm having, it may be dangerous to the relationship. I'm gonna hold these in. And the pursuer hears that as like, they're lonely, they feel disconnected, they don't know where their partner's at. And, and the partner gets the message, I'm doing it wrong. And then they get in this dance, this, and the dance becomes the attachment dysphoria, the attachment. So, okay, let's, let's keep moving so we can get through, get through half of this. Uh, intellectualization, Jason.

• 42:06Speaker 07

  All right. Um, so intellectualization involves, um, retreating into abstract thinking, analysis, theorizing to avoid the experience of the emotional weight of a situation. So the person thinks about feelings rather than feeling them. Think of that as like a, a left brain fortress against emotional right brain experiences. Nancy states that intellectualization is like the, a higher order version of what we just talked about. So the intellectuals, the isolation of affect. So the, the difference being person using isolation of affect typically report like kind of just reports no feelings. While the intellectualizer talks about feelings in a way that

• 42:49Speaker 07

  this kind of strikes us as emotionless, like kind of like reading a weather report.

• 42:55David Puder?

  Yeah, or or they could just move into the theory of emotion, right?

• 43:00Speaker 07

  Right, right.

• 43:00David Puder?

  Like, let me let me tell you about the micro expression that I just might have flashed on my face.

• 43:07Speaker 07

  I made an example of trying to engage in an emotional experience of someone with grief, you know, and they were like, well, I know there's five stages and I think I'm make sense that I'd be in the depression stage right now, you know, sort of just in this detached way.

• 43:23David Puder?

  Or or there's there's five stages of grief according to the first theory, but I actually prefer the new theory where there's actually seven stages. And let me tell you why I think that's actually more advanced.

• 43:37David Puder?

  Yeah, that's good.

• 43:38Speaker 07

  Sometimes there's a there for me, at least, it gets like I get kind of allured to like, I get I get like drawn into their, you know, intellectualization sometimes. And, you know, you want to like banter with them, but.

• 43:51David Puder?

  You okay, so yeah, it could be a distraction.

• 43:54Speaker 07

  Right, right.

• 43:55David Puder?

  A distra it's a wonderful way of avoidance for the anxiety of feeling, right? Yeah.

• 44:04Speaker 07

  Probably common with obsessive compulsive or high functioning depressive personalities. You know, it's like a really good, you know, allows, you know, it's like a CEO, right? It allows goal progress in the face of sort of emotional weight or like public opinion. A lawyer, it's adaptive as long as the feeling is postponed, not eliminated.

• 44:30Speaker 07

  Obviously, it's maladaptive and like, you know, you feel like it. You feel like a lack of connection with these people with these people.

• 44:40David Puder?

  People that go on dates with someone that's a heavy intellectualizer may say like, he was very smart, he's very articulate, but I don't I didn't feel a connection. I didn't I don't even know a sense of who this person is really. Latah, what do you think?

• 44:58Speaker 03

  I was thinking that's a really nice.

• 45:02Speaker 03

  Example of actually a defense, right? This guy is so smart, but he's defended and it's protecting himself, but it's actually totally a barrier. So I love your example in that way. It is a defense. You're trying to protect yourself from an experience and what you're actually feeling. But in your protecting, you're hurting yourself.

• 45:23David Puder?

  Yeah.

• 45:24Speaker 05

  Would this be considered intellectualization? So I had a therapy patient that was stage four cancer. So we talked a lot about death, dying. And he was talking about who he wanted to make decisions for him in the end. And he ranked family members like, okay, well, I will say my son first because he's in the army and he's seen a lot of things like he's seen combat and so he knows death. And then number two, you know, my wife, because she knows me well. Number three, my daughter, because she's a social worker. So she knows these sorts of things and, you know, gave a weatherman report on analysis

• 46:09Speaker 05

  on family.

• 46:12David Puder?

  It does sound like intellectualization. Yeah, it sounds like, and not all intellectualization is bad. I mean, he may be making a good decision based on that. It's like sometimes you have to have that like intellectual process and then like, well, what is your like guts say, right? What do your emotions say? So it's like a mixture of, of the mind, right? Cognitive process and the emotional mind, wise mind. Yeah.

• 46:44Speaker 05

  It feels really close to that isolation of affect. Really similar.

• 46:49David Puder?

  Yeah, it does, doesn't it? Isn't that interesting?

• 46:52Speaker 05

  Is it a matter of degree that makes the difference or?

• 46:57David Puder?

  This is where I think the affect is missing in the isolation of affect. In the intellectualization, it's more of what they're doing. They're developing theories and ideas around the emotions, or to even take themselves further from the emotions. So in one of our groups, Latale was giving examples of emotions in like game theory and stuff like that. And I was thinking about it afterwards, and I was like, well, this is not intellectualization, because it's a way of trying to communicate her emotional experience, right? So I feel like intellectualization actually moves people further from understanding your experience of emotions,

• 47:41David Puder?

  because it's so heavily intellectualized. You know, a lot of philosophy that's like very dry, or it's very like, it's like people who have, it's like if they have strong erotic drives, the intellectualization of eroticism might not be anything erotic. You know, it could take them further away, whereas sublimation would take them into maybe dancing or doing something that resembles erotic. But the intellectualization, I feel like, can get someone further distant. So that's the way I understand it.

• 48:20Speaker 06

  That protects you from your feelings. I think even reading, you know, deep psychodynamic texts, right? Psychanalytic literature, you might be thinking about really interesting and intellectual, even philosophical ideas that are actually quite far removed from the emotions.

• 48:39David Puder?

  Yeah, absolutely, especially if the people are talking about like, oh yeah, this is the Oedipal Triad. And it has nothing to do with the Oedipal Triad. It has nothing to do with like, but sometimes the big words almost distract, right? Or it's like the reaction formation and the egosyntonic feelings of this person. You know, and when I listen to all of those words compiled together. I don't even, it's like, I don't even understand it. I'm, I've like, read a lot of this stuff. So it's like, do they understand, you know? And if they don't understand, then is it like, is it a way of detaching from the distress?

• 49:22Speaker 06

  Maybe they understand, but they don't feel it.

• 49:25David Puder?

  Maybe, yeah, there you go.

• 49:26Speaker 06

  That's, that's the whole defense, right?

• 49:28David Puder?

  Yeah.

• 49:30David Puder?

  Yeah.

• 49:31Speaker 07

  Thinking equals safety, you know?

• 49:35Speaker 01

  I'm thinking about those patients who come in and use some medical jargon or the DSM lingo. And, you know, someone was in my office the other day, like telling me all about, like, I was manic. And all I, I, I kept on coming back to this, like, just take me through more details here. Where were you? Like, I just need more context here. And I worry, like, yeah, jargon can be, or diagnostic jargon can be picked up and used this way. Intellectually.

• 50:07David Puder?

  Yeah, and, and I could intellectualize using the very words that we're talking about today to disconnect from the emotional experience, you know? Like, if I was, you're just, oh, what you're doing right here, Jason, is you're intellectualizing. And that's really what's going on.

• 50:25Speaker 06

  Is that a regressive voice, David?

• 50:29David Puder?

  This is my regression into nerd-dom. When I was, when I was not an athlete.

• 50:39David Puder?

  And I avoided PE.

• 50:44Speaker 06

  Right, those nerds are coming back when they're, when they're lawyers.

• 50:47David Puder?

  You got me, Lata, you got me blushing here. Oh, my gosh. I'm like, oh. I feel like what that felt like fifth and sixth grade, you know? Awkwardness. Okay. Dina, let's talk about rationalization.

• 51:03Speaker 02

  Okay, so rationalization is essentially a cognitive distortion where someone would reframe their actions or thoughts to protect themselves from painful realities or unconscious conflict. So the motive of feeling is unconscious, but the person creates a conscious, socially acceptable, logical explanation to make themselves feel better or to protect themselves. And it's used

• 51:34Speaker 02

  For protection from an unacceptable, maybe impulse or cognitive dissonance, internal conflict, to deflect responsibility for actions or outcomes. And also for someone experiencing anxiety or shame. So there's a few different ways that rationalization works. So for the, one of them is, it's known as sour grapes, right? So that's when a, when a person devalues what they can't have or can't achieve. So they'll say something like, I didn't want that promotion anyway.

• 52:14Speaker 02

  Or if they, if they wanted, let's just say, a house that they didn't get, they would say, or they couldn't afford. They would say, well, that house is too big for us anyway. And the sour, sour grapes comes from Aesop's fable, the fable. Aesop's fable that where the fox was like reaching for the grapes and wasn't able to get the sweet grapes. So the fox just says, like, I don't want them anyway. Right? So that's just an example of one way of using rationalization. Another is known as sweet lemons.

• 52:53Speaker 02

  And this is where it's a kind of self deception where a person like to, to obtain comfort and accept reality, they use a more optimistic approach, right? So they'll, that's when something bad happens and then they'll, something bad will happen and then they'll, they'll make it okay. So for example, something bad happens and they'll respond like, well, that was a learning, you know, that was a learning experience. Or if they break up in a, have a breakup in a romantic relationship, they'll say that, that breakup was great. I didn't really like that person very much anyway, or we were very different. Something like that.

• 53:35Speaker 02

  Rationalization also can be used to justify a behavior or to put meaning to a behavior. So it can be good or bad. So oftentimes someone won't be able to maybe justify doing something good, right, for themselves, or unless they give themselves good reasons. To do it, or they can do something not good, like for example, someone that, a parent that hits a child and has a lot of aggression and says, well, it's good for the, it's good for the child, what I'm doing. Or let me think what else. They can, they can eat junk food, for example, and say, oh, life is short.

• 54:19Speaker 02

  I deserve to enjoy what I'm eating. So they'll justify what they're doing. As far as a defense, you know, it's considered more mature because although it's unconscious, it does involve some contact with reality and logic and reasoning. And also to understand like what's socially acceptable. They have to have some insight to do that. As far as clinically, it can be a way of not, you know, can be used to not take responsibility. Let's just say a client that comes, that misses appointments

• 54:59Speaker 02

  or is resistant during sessions, defense, sometimes defensiveness. So that they don't ever have to really explore

• 55:09Speaker 02

  the core issue. It can impact, you know, trust. And then also it's very important as the clinician to not start to believe, like if you start, if you start to like, you'll use the rational, the ration, the rationalization, it can also not help the patient because it's like they're not going to get to where they need to go and what they're trying to, the, the internal root issue. So it's important as the clinician to maybe notice patterns and bring that up. Um, or to, you know, explore the underlying

• 55:53Speaker 02

  conflict or something like that, if that should happen. So the, the defense can operate benignly when it allows someone to make the best of a difficult situation. But the drawback is that it's a defense strategy that virtually anything can can be and has been rationalized. So it's it's good and bad, like the sweet and the and the sour. So that's.

• 56:21David Puder?

  Too much and too little.

• 56:23Speaker 02

  It's a lot.

• 56:24David Puder?

  The soup is the soup is too hot or too cold.

• 56:27Speaker 02

  Right.

• 56:28David Puder?

  Um, yeah. Yeah, and I I great job, by the way, great job going through that. Really like how you separated that with Aesop's fables and stuff. That's good. And you could see how someone would be pulled into this. You could see how like we all are, we all rationalize. I was even thinking, you know, with the breakup thing of like, oh, you know, it was a learning experience. It's like, yes, I mean, maybe it was. And maybe that's worth emphasizing. Thinking about what are the things that have been learned from it?

• 57:04David Puder?

  Or or after like a kid's sporting thing, after one of my kids sporting thing is like they lost and they're disappointed. It's like, well, okay, here's the things that went well. And here's like, you know, it takes time to get better. And so we're going to work on this. We're going to work on this. And, you know, like, I don't know, is that a rationalization? Maybe that's not quite a rationalization. Or maybe if the rationalization would be lessening the blow of the loss, you know, instead of like sitting in my kids disappointment. It'd be like, no, this was great. You learned so much.

• 57:38Speaker 02

  Yeah, that would be rational. Yeah, it was a learning experience like you can. Even though you you feel bad, you lost, it was a learning experience.

• 57:48Speaker 05

  I've I've heard sometimes someone will say to someone after a really bad breakup like, well, dude, you you you dodged a bullet, you know, count yourself lucky. Seems like a little bit of the sour grapes.

• 58:00David Puder?

  But maybe they did dodge a bullet.

• 58:03Speaker 05

  Right.

• 58:04David Puder?

  Maybe they did.

• 58:06Speaker 02

  It might be true.

• 58:08Speaker 06

  Yeah. Well, I think the point is to not have it repress the feelings, right? So it isn't that it's a problem to have to use one's intellect, right? To make sense of it or to make the best of a bad situation. But the problem is if you're trying to fast forward the feeling, right? The disappointment, the pain, the hurt, the tears, all of that. And then jump straight to, oh, don't worry about it. You know, you dodge a bullet, right?

• 58:39David Puder?

  That's great. I was rationalizing the rationalizing and Katia just cut it to the core of like.

• 58:45Speaker 06

  I cut you that.

• 58:46Speaker 05

  Good job, Katia.

• 58:47David Puder?

  She.

• 58:48Speaker 06

  Thank you, thank you.

• 58:49David Puder?

  She went straight into the higher reflective function position of like, no, you gotta like sit with the grief. You gotta sit with the emotion.

• 58:58Speaker 02

  I thought Nancy McWilliams, she gave a really good example in her book where a therapist is insensitive and raises a patient's fee and then rationalizes the greed by deciding that by paying more, it'll benefit the patient's self-esteem.

• 59:16David Puder?

  Yeah, the patient, the patient will feel better about themselves.

• 59:21Speaker 06

  What?

• 59:23David Puder?

  Oh, the patient will feel better. Go ahead, Katia.

• 59:26Speaker 06

  Well, Dina, I was also thinking about how I'm going to be talking about moralization. And it's a really specific kind of rationalization. You touched on some of the of the issues where it could be a sort of a moral issue like, oh, well, actually, this is going to be good for the patient, right? When actually, you know, you just want to raise your fee.

• 59:47Speaker 02

  Right. Or like if you're morally corrupt, you then would rationalize.

• 59:52David Puder?

  Why don't, because they're so similar, Katia, why don't you go through moralization now?

• 59:58Speaker 06

  Sure. I'd be happy to. It's a, yeah, we've warmed up. And it really is a very specific type of rationalization. So there's quite a lot of overlap. It, it really, the, the point of it, well, like a lot of unconscious processes are to protect from painful feelings like shame of behaving in a way that's hurtful to, to, or selfish. And to maintain a narrative that one is not a villain. So a benign example would be similar to what Dina was saying, you know, like I, I steal my roommate's leftover birthday cake and I'm like, oh, it's for his own good. He's on a diet. He didn't really want to eat it.

• 1:00:39Speaker 06

  It's for his own good. So, you know, this sort of relieves a little mild guilt. It justifies a little misconduct, but it's all fine. But then there's really much more traumatizing ways of using this moralization defense. And so jumping straight from the benign, a little funny is, you know, it's a really typical example of justifying sexual assault. And so from a perpetrator's perspective, you know, the unconscious moralization would be, this would be the stance. It would be something like saying, well, this is socially acceptable. And so for instance, a man feels entitled to claim that a behavior, a sexual assault

• 1:01:23Speaker 06

  is normal or ordinary or understandable because, for example, you know, I, I paid for the, a, a date. We went out for dinner. Of course, I'm, I'm entitled to, to, to have sex. Or, you know, the shifting blame to the victim, that's another type of way of say, of moralizing one's behavior and saying, well, she, she clearly invited it. She participated. She actually wanted it. It's almost like it's for her own good. I mean, she, she was wearing what she was, you know, provocative clothes. I, I just did what she wanted to. Almost, almost like justifying to himself, and I'm using himself, but because,

• 1:02:08Speaker 06

  because that's usually what happens, justifying that it's almost, almost a favor. Or another type of moralization is to say, well, I

• 1:02:18Speaker 06

  Is to not have a malignant intent. And so saying, well, things got carried away, but I didn't mean to hurt her. Um, I, you know, I, I thought she was into it. Um, the, the other really big one is, is a, a moralization by saying, well, everybody does it. Right. A group, a group thing type of mentality. And so, um, for a pedophile to say, well, it's normal for grown men to like younger women or even underage girls. And so to justify that or, um, horribly in wartime sexual assault. It's, you know, that type of, of behavior is so pervasive that it can be explained away.

• 1:03:02Speaker 06

  So the treatment for that, um, type of moralization behavior, whether it's more, more benign, you can kind of let it go and have a laugh. But if it's more severe, you have to really try to get to, to, to, to the shame and to address some of these ways of splitting off, um, well, a lot of emotion, but, but also the splitting of good and bad, which is a part of moralization. And, and to, to really, um, shine a light on the shame. And then ideally to, to understand and accept it so that, uh, uh, amends can be made, some type of amend.

• 1:03:43David Puder?

  Yeah. I, I was thinking about the, the pedophilia one. We did an episode on this with Cummings a while back, another episode with some forensic guys. Some of the, some of the beliefs that they have is like, oh, you know, the kid, kids enjoy sex, kids are sexual creatures. It's a form, you know, kids want to connect through sex. And it's like these cognitive, um, lies, these moralization lies allow them to maybe exculpate their own guilt, right? And so it's like, no, that is not reality. Like that is a lie and you should, guilt is actually some, teaching you something, right?

• 1:04:28David Puder?

  About your values and that you don't really value doing that. And so the guilt is underneath. The guilt is sometimes hidden. And sometimes they, you know, people turn to alcohol or drugs or heavy benzo use or heavy sleeping medications to deal with the guilt. So they can cope with the guilt and it doesn't really quite ever leave them. So they have to numb it somehow. So something I've been thinking about, uh, you know, it's quite possible that. Yeah. Anyways, I could go on, but. So moralization, any of you guys, anyone else have any thoughts? Come through your mind as Katya wonderfully goes through moralization.

• 1:05:12Speaker 01

  I don't think this really adds to the discussion much, but I just think of the moral. With, with abusing, physically abusing kids. One, one thing I've come across, uh, heard of is, is people defending it by saying like, oh, I'm teaching this kid how to fight for themselves and to be, be stronger. It's, it's, it's, it's, it's just building their strength.

• 1:05:36David Puder?

  Yeah, there's no data to support that, unfortunately, you know? So.

• 1:05:40Speaker 01

  Yeah.

• 1:05:41David Puder?

  Unfortunately for that, for that person that's lying to themselves with that moralization. Or they'll use like some spiritual verses to support their, you know, actions or whatnot, but they're, they're cherry picking, you know, whatever spiritual discipline that they're going through. So, yeah, I, I've, I've had debates with people who believe like it's, it's, it's the best parenting method to spank your kids. And, um, you know, I've debated them and said, no, the data doesn't really show that. That's not, that's not actually like the best way of doing it, you know? Like corporal punishment doesn't really work.

• 1:06:24Speaker 05

  Or sometimes they'll use it to, they'll shame somebody, right? They'll shame a, like they'll shame someone and then let's just say how, what they're eating or something like, oh, I'm doing it because I'm helping that, you know, I'm helping them with.

• 1:06:39Speaker 01

  Eating healthy, you know, but like if something comes out and it doesn't go well, I'm a mill.

• 1:06:46David Puder?

  Yeah, no, actually, studies show if you shame an alcoholic, they drink more alcohol. They don't drink less alcohol, right? If you shame someone with, shame doesn't move people towards mental health.

• 1:07:01Speaker 01

  No, but I'm saying the person like that would do that, they can use moralization to justify like what they just did.

• 1:07:08David Puder?

  Absolutely. Yeah, I know. I'm agreeing with you. I'm agreeing with you. I know you're not validating that method.

• 1:07:14Speaker 01

  Yeah, no, no.

• 1:07:18David Puder?

  When I was reading about motivational interviewing, I read that they did this study about like shame-based alcohol reduction. It actually drove people to further drink, you know? And, um, yeah, it doesn't work. It's like, if you're depressed, I could shame you out of your depression. No, that's not going to work. That's actually going to push someone further into the depression, probably.

• 1:07:44David Puder?

  Natalie Dreyfus, can you tell us about undoing?

• 1:07:48Speaker 03

  Yes. So undoing is a defense mechanism where a person performs behaviors or mental acts to symbolically negate, reverse, or undo a previous thought, feeling, or action that led to some affect. Usually this is anxiety, guilt, or shame. Undoing primarily affects observable behavior rather than internal perceptions, making it distinct from something like reaction formation in that undoing is performing an external action after the fact to magically erase what happened, trying to cancel out this feeling versus reaction formation, which attempts to transform feelings internally, trying to mask the feeling.

• 1:08:32Speaker 03

  So I like this example because it just really simply put this. When we think about undoing, it can be thinking about trying to unsend a text message, except the person believes that if they perform the right ritual, they can take back not just the message, but the thought or feeling behind it.

• 1:08:52Speaker 03

  Undoing exists on a spectrum. So it is a normal human experience, but it can be problematic when it becomes rigid, time-consuming, or causes distress. And we see it, and it's most clinically relevant in things like obsessive-compulsive disorder and borderline personality disorder. Treatment like psychotherapy can help develop more flexible, adaptive ways of managing anxiety. And the goal in treatment isn't to eliminate the defense. Because again, this is a normal human experience, but rather shift it towards more mature ones like suppression or humor.

• 1:09:30David Puder?

  Great. So reverse, cancel out, neutralize a disturbing thought, impulse, feeling, or action that causes guilt, anxiety, or shame. Anyone have like an example that comes to their mind of this in BPD? Or go ahead.

• 1:09:48Speaker 02

  Oh, sorry, I had an example. I thought it was in Nancy McCall's book, or maybe somewhere else. The husband sort of cheating on his wife, or flirting with someone coming home and kind of showering her with, you know, love and care. And sort of like, you know, yeah, is that that?

• 1:10:04David Puder?

  Okay, yeah, so maybe it could be a lot simpler. It could be like they have like some attraction to some other person, right, that feels overwhelming. And then they come home and to undo it, they, to cancel it out, to reverse it, to neutralize it. They do this kind of behavior towards their wife, maybe bring her flowers.

• 1:10:28Speaker 03

  Right.

• 1:10:29David Puder?

  Or some ritual.

• 1:10:31Speaker 03

  Yep, Olga, it was like this, they had the conflict the night before. And then the husband, the spouse was coming back and giving them flower, giving the wife flowers, trying to undo this conflict or feeling guilty for having this big altercation.

• 1:10:48Speaker 02

  Mm-hmm, mm-hmm.

• 1:10:50David Puder?

  So, okay, like how about in OCD?

• 1:10:55Speaker 03

  So OCD is undoing is the actual compulsion. So it's that compulsion, the ritualistic behavior that temporarily relieves obsessional anxiety. And so thinking about OCD, there can be like a 45 year old accountant who has fear of contamination. It's a common one. But after touching a doorknob, the patient washes his hands in specific sequence. So he will apply soap three times, water temperature is adjusted to lukewarm, he rubs his hands together for 30 seconds, and then dries his hands with exactly four paper towels. Now, if any of these steps feel wrong, the entire sequence must be repeated.

• 1:11:38Speaker 03

  And the washing ritual, so it's unrelated to the actual hygiene of washing his hands. It's the washing ritual is undoing the fear of contamination and that anxiety around contamination.

• 1:11:49David Puder?

  So someone with like a pure O, like a pure OCD, primarily obsessional, they feel the need to mentally, behaviorally reset their day after they've had some sort of bad thought that's contaminated it. So they may do this by repeating prayers, mentally erasing the thought, starting routines from the beginning to achieve a clean state. So that's another example.

• 1:12:18Speaker 03

  And that would be also considered undoing, right? Because it's not just because it's not externally.

• 1:12:25David Puder?

  Right, yeah.

• 1:12:27Speaker 03

  A behavior, okay.

• 1:12:28David Puder?

  I think so. Okay, Jason Kent, let's talk about displacement.

• 1:12:34Speaker 07

  Right. So displacement's the defense in which a feeling of impulse, drive, or behavior is redirected from its original target to a safer or less threatening substitute. So it's kind of unconsciously saying, I can't direct this feeling here, so I'm going to direct it there. And why do we do that? It's sort of directing the motion towards the original target would produce anxiety or fear, potentially of retaliation or abandonment, maybe like a, you know, you might have anger towards a parent, but...

• 1:13:09Speaker 07

  Might not feel safe or guilt, guilt for being angry at someone you love, or perhaps some helplessness. So a classic example, which Nancy puts in there too, is the individual has a bad day at work, is yelled at by his boss, goes home and yells at his spouse, who turns, in turns scolds the kids, who kicked the dog, and the dog takes it out on a toy. Just constant displacement down the line. But maybe more appropriate example for,

• 1:13:41Speaker 07

  for therapy, you know, maybe someone's processing or experiencing a great deal of grief, but they're, they've, they've targeted the, the hospital or the doctor, the healthcare system. Nancy points out to the, maybe when there's been a infidelity in a relationship, the betrayed partner will direct the anger at the, the, the other person instead of the unfaithful partner.

• 1:14:07David Puder?

  Hmm. I've seen that, yeah.

• 1:14:09Speaker 07

  Yeah.

• 1:14:12Speaker 07

  And then the, like the family, she, she mentions the, but when family systems, the idea of the triangulation, so maybe the tension between parents gets just shifted to the, to, to a third, the child, which of course happens quite a bit. And then there's the sexual displacement or like this, uh, sometimes the fetish of, of like a fixation on feet is a redirected erotic interest from the genitals that might have evoked anxiety from historical fears of castration or, you know, maybe a parent like made that part of their body fearful.

• 1:14:50David Puder?

  Hmm. Interesting.

• 1:14:54Speaker 01

  Does, um, is scapegoating applied here? I could see how it would. The, the way, you know, you're describing it, Jason, that like, you know, when people are unhappy with whatever life circumstances, pick out the, the faulty party and, and blame that. Um, I could think like on an individual level or even like societal, like, like, oh yeah, like things are really bad. If we just took care of this group of people.

• 1:15:24David Puder?

  Mm-hmm, mm-hmm.

• 1:15:25Speaker 01

  Like, everything would be better.

• 1:15:28Speaker 07

  Right, right. Like a very safe target, right? It's not, you don't, you don't have to, no consequences there.

• 1:15:36David Puder?

  I think that would fit because you're displacing a feeling, impulse, drive, or behavior from the original target to a safer, less threatening substitute. Right? So the scapegoat is the goat. The goat is, takes the blame rather than the person for their wrongdoing. Right? So yeah, I think that would work.

• 1:16:04Speaker 07

  It can show up too, like just in a session where maybe, maybe someone's, maybe a client's actually kind of angry with you, but they're not sharing that. They're pointing out their anger at like all these other people.

• 1:16:17David Puder?

  Or they could be displacing their angry from other people onto you.

• 1:16:21Speaker 07

  Right, right, right. Probably more common.

• 1:16:24David Puder?

  Yeah, so maybe like, maybe you deserved 3% of the anger of their, but you got 100%

• 1:16:31Speaker 07

  Right.

• 1:16:32David Puder?

  directed at you.

• 1:16:33Speaker 07

  Good opportunity for noticing the transference.

• 1:16:38David Puder?

  Yeah. Yeah, I've seen it from like, the boss example, like guy gets, you know, gets beat up by his boss, comes home and just tears into his wife. It's just really, really nasty displacement. Just awful. So obviously very maladaptive in that text and in that sense. Okay, what about reaction formation? Chris, talk to us about reaction formation.

• 1:17:06Speaker 04

  Yeah, well, reaction formation is when someone is dealing with an emotion unconsciously that might feel threatening to their self-image or to an important relationship, and they turn it into the opposite feeling. Right? So probably like a classic example would be

• 1:17:28Speaker 04

  Someone harboring a lot of anger and resentment towards a coworker. Right, kind of undealt with, disavowed underneath the surface, but on the surface, it looks extremely kind, like overly accommodating, right? So, almost to the point where it feels fake. I was even thinking about, you know, a recent client that I had and just the, when they first came in, they were describing their marriage, right? And it almost seemed too good to be true, right? It's like everything they said about their spouse was, everything was perfect. Right, and so it put me in a weird position where I'm thinking like, this doesn't seem, something doesn't feel right here, right?

• 1:18:12Speaker 04

  So this is like the classic alarm that reaction formation is present when things just feel too good to be true. Sure enough, after about a month or two, this person starts to uncover some deep resentment and anger and rage they had towards their spouse. And so much so that they felt like they wanted a divorce. Right, so three months difference started with, this person's perfect, right? They could do no wrong. Three months later, it's like, I want to divorce this person. Right, because for the first time, they're uncovering all of this anger that had been sitting under the surface, right?

• 1:18:53Speaker 04

  So the reaction formation was from idealization, right? They were hiding the anger with idealization.

• 1:19:02David Puder?

  Yeah. And, and when it comes out, it can come out very, it can swing the other direction sometimes, right? Where it can go from 100% love to 100% hate.

• 1:19:17Speaker 04

  Yes, yeah. Yeah, in a way, thinking about like the way to actually work with someone who is displaying reaction formation is to just give them space, right? So I didn't really have to do much with that client. It was just giving them the space to really open up and figure out what might be underneath the idealization, right? I didn't tell them, right? You have the defensive reaction formation. I noticed it, but kind of let them wrestle with it a bit and kind of guided the sessions to the point where it became clear they didn't feel like they could hold this, these good

• 1:20:00Speaker 04

  feelings they had towards their spouse with the angry feelings they had towards their spouse. So they had to just hang out in the idealization area.

• 1:20:09David Puder?

  I think, I think also it could be like a momentary thing, like so maybe a more normal neurotically oriented person would have like some anger towards their spouse. And instead of, you know, being angry, they would go kind of clean the dishes, right? They would go clean. It's a loving thing to do potentially, and they're doing it in the midst of anger, which is kind of counterintuitive, but that's, that's a reaction formation as well. Yeah, any of those simple ones that you guys think of when you think of reaction formation?

• 1:20:45Speaker 05

  I always think of like the little kid who's super jealous of their sibling and really wants to shove them, but instead goes to hug them, right? Because it's like unacceptable to shove your little brother or sister.

• 1:20:57David Puder?

  But sometimes it's not the nicest hug either. Or sometimes it's like too much hug.

• 1:21:02Speaker 05

  Too much hug.

• 1:21:03David Puder?

  You know, it's like the hug that never ends.

• 1:21:07David Puder?

  Olga, what was your thought?

• 1:21:09Speaker 02

  Someone who's attracted to this, you know, same sex, sort of like, you know, it's like this classic example, and then kind of like repressing, you know, their own homosexuality, basically. And so that in a way that they're opposed, you know, and sort of like maybe join some kind of like anti, you know, homosexual movement or stuff like that, you know, and kind of like very vocal about, you know, not supporting it, but kind of like deep down, they're actually attracted, you know, to, you know, same sex. So I was thinking that that was reaction formation too, a kind of.

• 1:21:47Speaker 02

  Very extreme form, I guess.

• 1:21:49David Puder?

  Hmm. Oh, I think about like the, I mean, there's been some public cases of pastors who like are, who yell vehemently against, you know, homosexuality.

• 1:22:01Speaker 02

  Right.

• 1:22:01David Puder?

  And then it's like, that is the reaction formation against the desire, right?

• 1:22:06Speaker 02

  Hmm.

• 1:22:08David Puder?

  That is, you know, and the further unconscious these things are, the more dangerous they are. Right? So if someone is very unconscious of it, then, and they're acting out it with very low insight, that's when they can then impulsively go the other direction in a way that could blow up their life, rather than it just be like, holding, holding a fantasy and then holding the fantasy of both sides, you know, like, because that person is, is acting upon it in a way that's very destructive, sometimes, if that makes sense.

• 1:22:48Speaker 04

  Yeah, instead of just allowing a feeling to be present, it's like you, you can't handle that, right? So you have to keep it out of your awareness and allow the opposite to, to take precedent. Like you're saying, it's like homophobia versus saying, I have an attraction to the same sex. It's like you can't admit that, so it turns into homophobic tendencies.

• 1:23:13Speaker 02

  It's like you're undoing it in a way, you know? Sort of like, yeah, like extreme, you know, way of undoing it.

• 1:23:20David Puder?

  Maybe the undoing would be going on X and posting a mean, hateful tweet, you know?

• 1:23:28Speaker 02

  Yeah.

• 1:23:29David Puder?

  To show, to show how much you don't align with this.

• 1:23:33Speaker 02

  Hmm.

• 1:23:34David Puder?

  Issue.

• 1:23:35Speaker 03

  It was, it was interesting, because when I was looking at, like, undoing and then reaction formation and the distinctions between them, I was reading up on, and I forget where I saw it, but there was a school thought of like, some individuals or some providers think that reaction formation is the first hoping mechanism or secondary, or first defense. And then when that fails, undoing can become the one that they rely on.

• 1:24:04Speaker 05

  And I think like we're we're gonna just be distinct that this is like unconscious, right? Because if you know that you're putting something out there that is harmful to a person or a group of people, then then you know it and it's no longer this defense, right? Once it's a conscious action, like you can't just be like, oh, I'm self-hating. Or I just bow this part of myself because now you're conscious. So you don't get to fall back on kind of like defenses, your your reasoning. Like, once you know it, you know it.

• 1:24:39Speaker 04

  Yeah, reaction formation is is unconscious. You you you um. So, yeah, I don't know. What do you guys think? Would it make sense then, like, if you know you have attraction to the same sex? Could that be?

• 1:24:52Speaker 05

  Well, because once you know and you're doing it, if you're conscious, and I don't think it counts. Like, you just. You can be a self-hating gay, like.

• 1:25:04David Puder?

  Well, maybe you don't hate that part of yourself.

• 1:25:08Speaker 05

  Right, it's um, but i- if you're now just like kind of bullying other people or punishing other people for how you feel about yourself and you know this.

• 1:25:18David Puder?

  Then then that is then that is acting upon with a hate hateful hatefulness. Yeah, I agree.

• 1:25:26David Puder?

  Yep.

• 1:25:28David Puder?

  Um, okay, let's keep going. Identification, Amanda. Yeah, I was actually gonna. One of my examples for identification, I'm actually, I was gonna tack on to Chris's um, reaction formation. Because Stockholm syndrome, and I'll get more into the identification with the aggressor. But I was thinking, is that a form of reaction formation?

• 1:25:53David Puder?

  Uh, Stockholm syndrome's complex. I mean, I imagine there's a lot of defenses at play there. There's denial, right? True. Um, there is, it is, it is kind of a more psychotically oriented reaction formation of like. It's there's a lot going on there, right? It's it's a complex behavior. So Stockholm syndrome is like if someone was like abused and then goes back to the abuser. Right. And so sometimes I've I've heard this this happen and then the person feels a lot of guilt.

• 1:26:29David Puder?

  Well, maybe, why did I do that? I don't understand why I did that. So they're unconsciously driven sometimes back to the abuser. And so it's like, well, why? Why were they driven back to the abuser? And in that way, it's like maybe the hatred towards the abuser turns into love.

• 1:26:50David Puder?

  Right? That would be the reaction formation. But I think that there's a lot of other primitive things there too dissociation. They could dissociate the bad out, the bad memories out. They could deny the bad memories. They could remember only the positive if there was positive.

• 1:27:08David Puder?

  There could be a so there could be like an idealization. You know, like an abusive sadistic person demands a level of idealization or the person is very much abused. And so there could be like a forced kind of like a programmed idealization of the abuser.

• 1:27:30David Puder?

  There could also there could also be fear of death, fear of like something bad is going to happen. If I don't, right? So there could be like a sometimes abusive people in a way programmed people to believe that bad things will happen if they ever say anything or if they ever leave the person or you know, like. So there's also like going to the most feared object. The most feared object is the object to be worshipped in some people's psychology. So if they feel that the abuser is the most powerful person in the world type of like belief, it's a belief, right? It becomes a belief out of the trauma, then they could want to join the abuser

• 1:28:13David Puder?

  until until like they wake up to that. Not being not being reality, not being the case, not not being helped, you know, it's so toxic for them that they are psychologically falling apart.

• 1:28:29Speaker 05

  I'm thinking of that case. What was the I'm having a brain fart right now. The case years ago with the young girl that was kidnapped by the two. It was like a couple. I can't. I'm blanking on her name.

• 1:28:42David Puder?

  I don't know. I even in the Epstein files is I've I've heard of this happening in the Epstein files. And so this is where it's really

• 1:28:50David Puder?

  convoluted. Like, is this person someone who was abused? Or is this person who was helping Epstein? Now hurt other people? Like, are they helping other Epstein abuse other people consciously? Or is it? Is it because they were in kind of like a trauma like state? Where they were fearing for their life, you know? So this is this is that kind of like complexity. Jason, you were nodding your head?

• 1:29:19Speaker 01

  Well, I was wondering if you might be referring to, I think it's smart, like.

• 1:29:23Speaker 05

  Yeah, yeah, yeah.

• 1:29:25Speaker 01

  Really smart. And a documentary was released. I'm one of it's streaming somewhere right now, recently released. And what was fascinating about it is they interview her a bunch and she's she's on this. She goes, she's on the presenting circuit. But anyway, I was I didn't get the impression that Stockholm syndrome actually applied to her, but it was at risk of that happening. And but it's almost like a compartmentalization sort of happened. And this woman like survived disappearing for a couple of months with a two abusers who took her from her home. And she was found, but

• 1:30:08Speaker 01

  she her her identity didn't seem to be super rattled. And my hunch is she got she got a bunch of good psychotherapy.

• 1:30:16Speaker 05

  What were her feelings towards her kidnappers? I'm actually really curious. I'm gonna look that up after this.

• 1:30:23Speaker 01

  Yeah, you gotta stream it. It's all in there.

• 1:30:26Speaker 05

  Okay.

• 1:30:27Speaker 01

  But I reminds me of turning against the self a little bit too. Like, this is such a complex thing. I appreciate it where to like, yeah, if you can't if you can't win, beat the aggressors, like a possible outcome that could be like you beat you beat up on yourself instead and you just become defeated.

• 1:30:47Speaker 05

  Yeah, so many of the defenses are just so intertwined, it's so complex. But anyways, we kind of went deep into some of identification, but in the most simplest terms, identification is the ability to identify with another person or aspects, traits of another person. And like any other defense, it's an inherently neutral process and it can have positive or negative effects depending on who is this, the object of identification. So, um, I think like in mainstream language, you know, we say, I, I identify with this

• 1:31:29Speaker 05

  person that's a mentor, that it's usually in a positive light. But psychoanalytically, we usually, we usually think of identification that's more motivated by the, the need to avoid anxiety, grief, shame, any of the painful affects in order to restore that sort of threatened sense of self and promote self cohesion and self esteem. And in Nancy McLean's book, she talks about how Freud, he was the first one that defined a non-defensive versus a defensive identification. So the positive and the negative, then I'll go into the negative. We kind of did a sneak peek with the Stockholm syndrome.

• 1:32:15Speaker 05

  But he, he basically said, there's elements of both, like a straightforward of that taking in what is loved, like you identify with your parents, your primary attachment figures initially. And, you know, it's very simple, like I want to be like mom or dad and you want to achieve closeness. And then a more defensive operationalization of that would be kind of what Dr. Peter was saying, like I become the feared object. If I become them, their power will be inside me rather than outside me. So I possess that.

• 1:33:03Speaker 05

  Since I'm a child psychiatrist fellow, I'm always thinking developmentally. So I kind of think of identification. I'll explain it chronologically through through the lifespan. So like I was saying, first identifications when you're a child with your primary attachment figures and you kind of become like this hybrid person, kind of taking little bits of people that you like mentors throughout your life. And so it becomes kind of like a nuanced mosaic person that you become is how I think about it. And it positively, it's if you think about it, it's a basis of empathy, being able to identify with others.

• 1:33:47Speaker 05

  And Nancy McWilliams gives the excellent, the biggest example of therapy. So the the propensity of the patient and to identify with the therapist is what is the magic secret sauce in therapy. And having that reparative relationship with the therapist. So those are the positive examples. I'll go into the kind of Stockholm syndrome we're talking about. So that is what Anna Freud first described as identification with the aggressor. And I never understood that term until this class. I had heard it and then it finally stuck.

• 1:34:30Speaker 05

  So that that's kind of the defensive identification where you identify with the bully, the aggressor, you consume them, you become them, you take it inside, you internalize that representation of them become them. And so like an example is like the child abuse, like parent abuses kid, kid goes and bullies kids at school and then grows up and becomes or and then abuses their kids subsequently. So it's the mechanism of which like intergenerational abuse continues.

• 1:35:12David Puder?

  Which I'm actually doing an episode on like kids that were sexually abused and the rates of future sexual abuse. And it's actually, it's like, it can be as low as like 3% in some studies. So this is, it could also be, abuse could also be stemming more from other personality pathology that's unrelated, like sadism and psychopathy and, you know, stuff like that.

• 1:35:40Speaker 05

  They were talking about psychopathy, how I read somewhere where it's like a failure of identification, or you don't identify with the values of society or something, then you be, that's kind of a trait of that psychopathic personality.

• 1:36:00David Puder?

  Right, the, the people they maybe look up to are the least savory people.

• 1:36:08Speaker 05

  Yeah.

• 1:36:09David Puder?

  But identification with the aggressor, I'm so glad that you figured that one out.

• 1:36:14Speaker 05

  I know.

• 1:36:15David Puder?

  Very, very helpful.

• 1:36:17Speaker 05

  Yeah.

• 1:36:18David Puder?

  Adopt and imitate, internalize aspects of the aggressor, internalize, you know, adopt parts of them, like the, the bad things that they're doing, they see themselves as either doing the bad things in fantasies of their mind, or in actuality, right? Or like, I am, I am the abusive person.

• 1:36:42Speaker 06

  I feel like you see it a lot in therapy with, you know, somebody who's maybe grown up in a very critical environment, and the person goes and really internalize that, that aggression. And then what you see in, in practice is somebody who's always feeling guilty about anything, and always kind of really hard on themselves, criticizing themselves. And, you know, I'm thinking a lot of times it's, it's a raw identification of the aggressor, they've really sort of internalized that, that critical voice, and they're constantly putting themselves down, putting, you know, making themselves sort of pay.

• 1:37:21David Puder?

  Katya, amazing, yeah, very good.

• 1:37:26Speaker 05

  Yeah, because they it was adaptive when they were younger or necessary for them to survive. Yeah.

• 1:37:34Speaker 06

  Mm hmm. Totally adaptive.

• 1:37:37Speaker 05

  Yeah.

• 1:37:37Speaker 06

  And it's actually adaptive even as adults, right? Because people who are following the rules and doing everything right are generally widely beloved, right? But they suffer internally.

• 1:37:49Speaker 05

  Good point.

• 1:37:50David Puder?

  You'll see this sometimes, like, um, I've read some stories of true crime, like you'll get like someone who's doing a lot of criminal activity at a very young age, seventeen, eighteen, nineteen, and their dad was a con artist, you know, as they're watching their dad do this their whole childhood, right? They're sort of absorbing that, they identify with it, they go on in that criminal sort of behavior, criminal acts, right? You can see it in cults. I think, Amanda, are you going to talk about that at all?

• 1:38:17Speaker 05

  Mm hmm. Oh, yeah, cult. So, um, that's a big example that Nancy McWilliams adds, um, how others, I kind of spoke about this defense is used to kind of build that self cohesion, that ego identity. And so people that are more eas- easily influenced by others or have some like identity confusion, um, are prone to, you know, joining cults. Um, and go, yeah, going back to kids, like from an Ericssonian perspective, like that time when their adolescence is when they're developing their identities and their ego identity. And so

• 1:38:59Speaker 05

  adolescence are really impressionable i- in that regard.

• 1:39:05David Puder?

  Yeah, it's like people with the identity diffusion, they're like, almost like stem cells for, if they're put in a good environment, you know, they may, they may adopt a lot of that good if they're put in with like some very abusive person, they could become the counterpart of that abusiveness, you know? And so, yeah, it's really.

• 1:39:32David Puder?

  Yeah, what makes me think of it like

• 1:39:34Speaker 05

  The stones will

• 1:39:35David Puder?

  It's like in pop culture, you hear, you hear like some very narcissistic, grandiose personas online. It'll be like, oh, yeah, I like to date girls when they're like super young and blah, blah, right? Like, and they'll, they'll say, so I can mold them how I want them to be. And that like, and, and, and they have a track record of, you know, a wake of destruction behind them interpersonally, right? So it's like, it's cringe for me because I'm like, yeah, and then I'm going to be this therapist trying to put together, but put these people back together, you know, or like training therapists that are putting these people back together.

• 1:40:15David Puder?

  So, yeah, the identification is dangerous, right? When you're young, when you're impressionable. Um, and I think talking about it, putting it out there, developing a knowledge of it gives us power. Right? Think twice when we think about who we want to consume, who we want to kind of like allow into our brainwaves, right?

• 1:40:41David Puder?

  Yeah.

• 1:40:43Speaker 05

  One thing I wanted to ask everyone is the difference between interjection versus identification. I couldn't, Nancy kind of mentions it in the book, but I, I can't figure out the nuanced difference. I think she described interjection as like the precursor to identification. But it sounded similar to me, like interjecting, like taking internal representations of others when you're younger. Kind of consuming that. So are they interchangeable?

• 1:41:21David Puder?

  So I, the way that I see it is that interjection is a much more primitive version in which you swallow whole, all of the things of the other person, their ideas, attitudes, judgments, standards, values, all of them. You, you, you, you treat it as if it's your own reality, your own voice, your own values. So I think, I think the identification you, you adopt.

• 1:41:50David Puder?

  Portions, right?

• 1:41:52Speaker 02

  Yeah.

• 1:41:52David Puder?

  Uh, becoming like, like, uh, I have a lot of identification with Dr. Tar. I differed in some things, right? If I was, um, maybe more primitively oriented, I, I would interject and I would almost sound like Dr. Tar in all of my answers, you know? Instead, I, I, I take in little pieces from different mentors throughout my life, right? I interject, I, I, and identification, I have identification with various mentors. And that's a good thing. Some mentors I know in person, some I don't know in person.

• 1:42:32Speaker 04

  That's a really good example of like, what it looks like from a healthy perspective and from, from an unhealthy dysfunctional perspective. It's like when people become almost the other person, like you said, like their tone of voice, everything, that's the defense.

• 1:42:51David Puder?

  Also, like, I think interjection, you end up with a lot of these like shoulds, right? And it, it's like a super ego structure. So for example, if you, if you had a strong interjection of, of a Jonathan Sheddler, anytime you broke the, the frame, you would be crippled with guilt for days, right? Because you've, you've gone against your, your, your, your favorite interjection guru. Whereas there's like, uh, you know, the, the good side would be to adopt a lot of the good and to appreciate the good from different people and different, different styles, right? So when I, when I would watch video of residents, I never expected them to have the same verbiage, the same style as me. I wanted them to have empathy.

• 1:43:36David Puder?

  I wanted them to have, you know, but for, for different people, that looks differently.

• 1:43:42Speaker 02

  For some reason, it came to my mind, I don't know if you know Josh Shapiro, who's like governor of Pennsylvania, who sounds and acts just like Obama. Clearly is the same like, you know, phrases, just like Obama, you know? It's like, so definitely kind of interject, you know, interjecting a lot of Obama.

• 1:44:03David Puder?

  And then sometimes I think to myself.

• 1:44:06David Puder?

  What's going on with America?

• 1:44:10David Puder?

  And I pause like this every couple of seconds. You know, and if you do that, you know how to capture someone's attention. You string like words together just the right way. We're not blue states or red states. We're the United States.

• 1:44:27David Puder?

  I haven't practiced that, so I'll practice.

• 1:44:30David Puder?

  We could do a role play. I'll be Obama.

• 1:44:34David Puder?

  You be a therapist who's pretending to be. Yeah, okay.

• 1:44:41David Puder?

  Yeah, it's like. It's hard to know, like, okay, does this guy just love Obama? And he's like, listen to Obama on repeat. Hundreds and hundreds of hours, right? So. Sublimation, Lethal.

• 1:44:57Speaker 05

  Okay. I actually want to take a pause because we're doing mature defenses and I want to. Uh, recognize that these are, these drives, these negatives self-states that um.

• 1:45:11Speaker 05

  We can see without any distortion. So we're working on them or trying to work through them, but we're doing it clearly. So different than some of the examples, we can be totally aware with mature defenses. And sublimation falls into that category. Consciousness. And so now that I'm fully mature, I want to start with an illustration of a guy we all think of as. Like really well put together. And I wanted to just start with Batman.

• 1:45:47Speaker 05

  For those of you who. Don't know who Batman is, he's a superhero without any superpowers, living in the city of Gotham, which is in. Comic book land. And he has a really traumatic childhood where he witnessed his parents being murdered. Right? And.

• 1:46:07Speaker 05

  Right there, we feel his helplessness, he feels helplessness, lack of control. As that develops, you can imagine rage building with this guy. We can imagine like a desire for vengeance, totally brewing with that kind of loss and that kind of circumstance. And rather than identifying with the aggressor or totally falling apart with this loss, he's able to sublimate it, right? He's able to take it and focus it into something that is ultimately considered to be pro-social. And that is taking out bad guys.

• 1:46:50Speaker 05

  So the lack of control. He is so regimented about these workouts. If you ever see a Batman movie, this guy's working out, no matter whose adaptation. He is all about the science, has to have the best tools, the best weapons, costumes, whatever it is. He wants to make sure he is not going to let this happen again. And that rage also comes out. We see him throwing guys through brick walls. We see him destroying lots of Gotham City. But the thing behind it is to try to make the city better and life safer for people. Like, that is the sublimation aspect of it.

• 1:47:34Speaker 05

  And that really connects to what Freud saw about this defense is that it can actually bring civilization forward, not just the individual forward. So it's not unique to Batman to feel rage, to feel that the world around you needs to be put in order. And Freud kind of credits sublimation with a lot of government, with religion. Like, these are ways that people have taken these similar feelings and not just themselves, so it moved everyone around them forward. And I kind of want to go back to like, I picked Batman because we can see him in a

• 1:48:19Speaker 05

  black and white world. Like, in his representation, none of these bad guys have their own trauma history. They are all just like, bad guys. Like, no one had absent parents, no one's like hungry and doing crime for that reason. Like, we can just-

• 1:48:35Speaker 03

  See it as moving society, but we don't have to see it complex. That was my example thinking. And so we are transforming like potentially very harmful, potentially very devastating drives into something that is progressive.

• 1:48:52David Puder?

  Yeah, like dancing, sexual tension, right? And a young person becomes dancing, something like that.

• 1:49:02Speaker 03

  Right. I think like the classic examples are always like you have this desire to hurt and you become a surgeon or a dentist. Like that's usually what we see in like the board review books. We see that come up a lot, right? And that's.

• 1:49:15David Puder?

  Hmm. It's kind of dark. Not everyone who wants to become a surgeon does that.

• 1:49:20Speaker 03

  Not everyone. No, no, no.

• 1:49:22David Puder?

  The, but I love, I love your example of Bruce Wayne and Batman. That's such a good example. It's such a good example of like turning that like anger into like, I'm going to make the world a better place. I'm going to fight for justice. Yeah, that's good.

• 1:49:39Speaker 02

  That's connected to because his parents, I didn't know that part, by the way, that died from the criminals, right? So he's kind of like trying to, yeah, undo that a little bit.

• 1:49:51Speaker 03

  Yeah, there was some undoing in there. There's a ton of defenses and they go through.

• 1:49:58Speaker 05

  When I think of, I think of like some groups, like there's this support group that of mothers who have lost kids to overdose with drugs and then they unite to develop a support group for other parents who lose their kids. That feels like a really good example of sublimation too, of taking, you know, that grief and loss and anger and then turning it into something that can help to breed support and healing for other people.

• 1:50:31David Puder?

  That's wonderful. Or like someone who's had a bad childhood and knows what it's like to suffer as a child will go in and become a child psychiatrist to try to help other people. Or that become a researcher to solve, you know, maybe their mother died of cancer, they'll go become a researcher and spend their life trying to solve that specific type of cancer. These are like, the world is a better place for this. And actually, sometimes with patients, I'll kind of try to encourage a good, a good sublimation. Viktor Frankl wouldn't see it fully as a defense. He would see it as actually like the path of meaning and meaningfulness.

• 1:51:14Speaker 05

  It seems like it ties into reflective function, right? Like, why are we doing what we're doing?

• 1:51:20David Puder?

  I think most, yeah, a lot of us told our stories of why we're doing what we're doing. A lot of it had to do with, for, for good reason, right? A sublimation of sorts.

• 1:51:35Speaker 05

  So if we're doing well, we can identify this in ourselves in some way.

• 1:51:42Speaker 05

  Okay.

• 1:51:43David Puder?

  Yeah, absolutely.

• 1:51:46David Puder?

  And also humor, right? Tell us about humor.

• 1:51:49Speaker 05

  So tempted to come on here with a Batman mask, but I just didn't.

• 1:51:52David Puder?

  Oh, that's awesome.

• 1:51:56Speaker 05

  The point is. I would have been humorous. Because I could pull it off, you know?

• 1:52:02David Puder?

  I've just gotten into like, I just bought some Batman comic book, like, there's just like omnibus is, I never knew, like, you could like, go back and research different, different like decades, and then they like, package them all together. It's like amazing. So.

• 1:52:20Speaker 05

  Right. I think humor is more Spider-Man, though, like, and that's like, both in crime fighting and talking to girls. Like, if we remember Spider-Man, he's always like, nervously telling a joke, and it's to lessen the tension. It's not to avoid it, but it is so he can move forward, right? Going back to the ex-superhero, but there's this movie called The Avengers, where he meets all the other superheroes and he's like this high school kid, like, brand new to his powers and he just doesn't have that, like, experience. And so, they're all introducing themselves and he said, "Oh, like, we're using our made-up names,

• 1:53:02Speaker 05

  like, I'm Spider-Man, right?" So he just tells a joke to lessen his nervousness and his anxiety, but he can do it, right? He can still stand up with all these digger guys and show up. So, yeah, humor lessens the feeling and allows us to move forward. I actually wanted to give a personal example as opposed to a patient example. I was recently at a memorial for a friend who passed. And it was just like, I couldn't even imagine, like, starting to speak. I was, like, frozen, just, like, overwhelmed with grief and sadness.

• 1:53:42Speaker 05

  And it was my turn and I just, like, I went to telling a humorous story, right? Like, this was a very straight-laced dude.

• 1:53:52Speaker 05

  And I shared about a moment where we, like, jumped a fence in Costa Rica to, like, explore some river as a contrast to, like, his very Batman-regimented style. And, like, everyone laughed and, like, allowed me to have my walls come down and allowed me to actually face the stress and face the sadness that I was feeling. And that was, like, me using humor.

• 1:54:17David Puder?

  Hmm. So good.

• 1:54:20Speaker 05

  And then, like, I heard this quote the other day and I wrote it down so I didn't get it wrong. Like, I don't know if you guys have heard of Victor Berge? He was like a composer, but hi- his line is like, laughter is the closest line between two people.

• 1:54:37Speaker 05

  And I think like that reflects like in that moment, like that allowed me to transform the distance from anyone else in the room. And it also is like a good line to myself. Like if I know I'm just like cracking a joke in the setting, sometimes it is because of nervousness or sadness and allows me to to come into it. So laughter is like this great like step into like confronting or seeing other emotions and working through them and facing them. And if you want the the board review example, it's somebody coming to their primary care doctor's office with like erectile dysfunction and like cracking

• 1:55:19Speaker 05

  a sex joke to to break the ice. So I'm giving you the textbook example as well.

• 1:55:25David Puder?

  Well, they probably wouldn't be breaking much ice. Okay.

• 1:55:32Speaker 05

  I got you.

• 1:55:33David Puder?

  Yeah. So the yeah, I love I love the the idea that the only one who could speak truth to to a king is the is the comic, right? So you have like this, the the jester is the only truth teller of the king. Everyone else is a sycophant. Everyone else is telling the king exactly what the king wants to know. And the jester comes up and says what everyone else is feeling or thinking. And then it's just like, it's it's funny. So it works. He can get away with it, right? He can give away with saying things that no one else can say.

• 1:56:07Speaker 05

  It's like this truth telling that can happen to humor that like even brings down the other person's guard, right? Like, not only is his guard down, everyone else in the room and like the person hearing it.

• 1:56:17David Puder?

  And you think about how much like humor is based on forbidden impulses, wishes, right? And it's kind of like that. Or even sarcasm, sarcasm can be like a sense of humor, but it can also carry a little bit of truth.

• 1:56:33Speaker 04

  I'm thinking about specific comedians, Littol. One, two people that keep coming to mind is Chris Farley. I don't know if you're familiar with. And I think about like the self deprecating. I mean, he was hilarious. But you think about it from this point of view, it's like very maladaptive. But then I think about someone like Bill Burr. Do you know who that is?

• 1:56:53Speaker 05

  I don't know.

• 1:56:55Speaker 04

  He's more like, um, he's more in like higher RF. He's like in touch with his own humor and how he covers up things with his humor. And there's, there's actually a different type of funny, I feel like, that comes along with that. Where it's less maladaptive. I don't know. Do you, do you guys, are you guys familiar with Bill Burr at all or comedians like him?

• 1:57:16Speaker 02

  Yeah.

• 1:57:18Speaker 04

  Yeah. But he knows it. Yeah. Yeah. Boston. He's got the Boston accent.

• 1:57:24Speaker 02

  I so love him. I think he's great. Yeah.

• 1:57:27Speaker 04

  I do too.

• 1:57:28Speaker 07

  I was thinking of, um, Conan O'Brien was on the podcast with, uh, like Jason Bateman. And, you know, his, his parents had died, both parents died. Like in the last year, and he just went and told this elaborate funny joke about how, you know, Bateman had killed his parents and it was, it was, you could just see that was his way of dealing with the uncomfortableness of that story. It was.

• 1:57:52Speaker 04

  Yeah, I heard that one. And yeah, he, uh, and all his friends went along with it because they knew that he was dealing with it in this way.

• 1:58:00David Puder?

  That's good.

• 1:58:01Speaker 05

  I also think humor can be really useful in really stressful situations. Like I have a number of combat veteran friends who talk about when they were under fire. Humor, they would crack jokes and that helped them diffuse the stress and just stay focused on what they needed to do. Or when I used to work in ICU, sometimes situations would get really stressful or tense or sad or whatever. You know, a, a few jokes really helped to kind of just lighten the mood so that you could carry on and do what you needed to do.

• 1:58:32Speaker 02

  Network with Spider-Man.

• 1:58:34Speaker 05

  Yes.

• 1:58:36David Puder?

  Yeah, sometimes therapists can have some dark humor. And, uh, I tend, I, you know, I, I try not to do any patient directed humor on this podcast. Or, or, you know, or in real life, I don't think Chris has heard me do too much patient directed humor, just because like it's better just to get in touch with the real emotions underneath, you know, and process them. But, yeah. So humor. Okay. And we got, we got one more reversal. Amanda. Okay. So reversal is, it, it's a really interesting one. So.

• 1:59:12Speaker 06

  Um, base, basically what happens is it you transfer form a passive position into an active um, position. So from switching passive to active, like victim to victimizer, you you basically shift the power aspects of a transaction with another object that you're interacting with in order to deal with that sort of psychological threat in your situation. So the example, I'm always gonna give the the therapy example since it's relevant for us as therapists. But Nancy McWilliams gave the example of how therapists

• 1:59:55Speaker 06

  are uncomfortable, not all therapists, but a lot of therapists are uncomfortable with their own dependency needs. And they actually yearn to be cared for, um, and they vicariously are cared for through the care that they provide to their patients. And so they unconsciously identify with that person's gratification. Um, so that's the the more adaptive version. You know, altruism is a good, a good, simple example. The more maladaptive examples is like fraternity hazing

• 2:00:38Speaker 06

  or like any hazing, abusive rites of passage, like, um, where you are switching from that passive position, getting hazed, and then when you're the upperclassman, being in the active transformation, but with that own or with that soul transformation, you, the affect around it changes. You're more, um, it's a more positive thing. And, um,

• 2:01:06Speaker 06

  I I was actually thinking about that example. I was like, oh, yeah, I remember getting hazed in sports when I was younger. And it was the worst thing when you're going through it. But then the next year, you're like, oh, yeah, this is this is so awesome.

• 2:01:20David Puder?

  And I'm like, whoa, okay, I haven't even thought about that until I I had to do reversal for for um the podcast. But yeah, repressed memory unlocked. And so I understand reversal.

• 2:01:35David Puder?

  What other anyone else have any other examples that come to their mind of reversal? Could it could also be positive, like, uh, you're you're being taught and then you become the teacher. Right?

• 2:01:48Speaker 04

  Think you see it sometimes in sports where someone's extremely nervous, but they don't seem that way. They push through, they become overly confident. And sometimes I think it they actually might be better in that fearful state.

• 2:02:05David Puder?

  Or kind of going back to um the tall sublimation, doing that positive switch, you know,

• 2:02:16David Puder?

  from a a more like helpless position, a powerless position to a more in using that pain to go to a more powerful position, like how you were giving the example, Dr. Peter, where people go into medicine because of that reason. And what experience experience when they're younger? Yeah, so maybe maybe when they were a child, they were abused, they felt powerless. Now they're having a reversal where they are powerfully helping someone overcome it. So they're in a position of power in the therapy office, helping someone through the trauma that they themselves,

• 2:02:54David Puder?

  you know, got through. This is a a really wonderful, wonderful ripple effect of positivity, right? It's like, we need more of that. So I, yeah, that's where I kind of get into this is no longer almost it's not a defense mechanism. It's not like there's something underneath it that's better, right? It it is the good. Now, if if they maybe were working a hundred hours a week and couldn't stop and like, you know, crossing boundaries with patients, like, maybe that would be a place of like,

• 2:03:30David Puder?

  necessary supervision or some direction outside of that, where they can live life and not feel in a compulsory position to always help, right?

• 2:03:44Speaker 06

  I don't know if this is another example of reversal, but I think of, you know, people who have survived food insecurity or an eating disorder who grow up to become a chef or a dietitian. And, you know, there's a therapist component, but there's also even the dependency for food that we, you know, that, of course, you have and to, to reverse that, that hunger into literally feeding somebody else.

• 2:04:16David Puder?

  Yeah. Or you'll see like someone who's very high in disgust, high in order, go into infectious disease and they're fighting off the disgust and the, you know, the putridness of bacteria and viruses. Yeah. Infectious disease doctors always have the longest, most detailed notes, right? Which is part of orderliness. Yeah, that's a good example, Khatia.

• 2:04:44Speaker 01

  I wonder if this might apply. It might be a stretch, but I saw someone present recently who was a fabulous speaker in, in front of others. And they, they, they spoke about their, their nervousness and anxiety with public speaking. And I, I just, I, I'm thinking of performers who, who can experience, I imagine a number do not, maybe not everybody, but a number have a lot of anxiety and just psychological tension. And then you head out onto the stage and it's like an escape, maybe, maybe there's some euphoria that comes with it. But I wonder if, like, is, is there where that could apply here?

• 2:05:30David Puder?

  Yeah, I think they're, they're mastering that fear, right? And they're switching from a place of weakness or fear into strength and like success. And I think that can, that could feel very gratifying. All right, guys, I think that is where we will end. I don't know, maybe before we end, does anyone have any last thoughts on what this was like? Any, any thoughts on what it was like to present? What defenses were coming up for you in the midst of it?

• 2:06:08Speaker 03

  I really liked it and I, it inspired me. I want to give lectures to my residents, you know, over defenses and they seem to be very excited about it and want that. So I, we're definitely gonna go over all the defenses, you know? We don't have two hours, but at least, you know, maybe in an hour. So, um, they're like, yeah.

• 2:06:30Speaker 03

  So, thank you. Yeah, I think it can be very helpful.

• 2:06:33David Puder?

  Great. And, uh, you know, if you're listening to this, if, if, if your biggest takeaway is just to, when a patient starts having a defense, just to blurt out, that's a defense of blah, blah, blah, you know?

• 2:06:47David Puder?

  Go back and listen to it again, uh, listen to some other episodes as well.

• 2:06:55David Puder?

  That's, that's a really nice identification there. Um, so, yeah.

• 2:07:00Speaker 07

  Intellectualization.

• 2:07:02David Puder?

  Yes, that would be, that would be a very nice intellectualization.

• 2:07:07Speaker 02

  Yeah, I second what Jason was saying. I'm seeing the defenses all over the place. I was like, whoa, I must have been missing all of these, like, I, I knew all the board examples that Lutal was giving, like, as a med student, but, I mean, I've had such a deeper nuanced understanding just going through this with you all. So, things like clicked, like, fin- finally, and I might, like, I can make deeper formulations, like, everything. So, I appreciate y'all.

• 2:07:36Speaker 03

  And I second that as well. Um, I feel that just in my, I have like a self note section when I'm charting or when I'm talking with a client, and I think I've been able to just pick up on some of these things and I've noted it down in my self notes of, okay, like, let's come back to this. And being able to walk through this and, you know, teach it to go through it, it just helps to solidify the understanding. So this has been a, a great experience.

• 2:08:04Speaker 06

  I'm enjoying using it even in day to day, reading the news and just kind of reflecting on what might be going on. And of course, we can never really know because, first of all, it's unconscious and a lot of times you don't really know these actors because they're not, they're not in therapy. But I do find it interesting and helps to, to reflect on things on a deeper level.

• 2:08:29David Puder?

  Okay, we'll bring it to a close here. Thank you, guys.