A Deep Dive Into The Psychology of BPD, Splitting, Projection, Anxiety and Therapy – Jon Frederickson and Imi Lo

 

Today, we are talking to Dr. Jon Frederickson. He is a therapist with over 25 years of experience, especially specializing in working with people with personality disorders. Jon is also the founder of Intensive Short Term Dynamic Psychotherapy. It is based on psychoanalytic ideas such as transference and defense mechanisms but is renewed into a much more active and pragmatic format than traditional psychoanalysis.  

In this conversation, we dived deep— deeper than ever, into topics such as: Borderline Personality Disorder, complex trauma, defense mechanisms such as splitting and projections, and how relational therapy works to heal your childhood.

Honestly, it was like I was receiving the most insightful supervision from a wise sage! There were also moments in the conversation where I felt quite vulnerable, as I shared my frustrations as a therapist.

You will basically hear two therapists having a frank and in-depth dialogue about the following questions:

— Why your therapist’s blank screen approach does not work?

— What happens if you don’t know what to talk about in therapy?

— Should you or your therapist be in the driver’s seat? 

— Why a ‘diagnosis of Borderline Personality Disorder may not be what you think

— Do most therapists underestimate how much anxiety you have? 

— What is projection? What is splitting? 

— How personality differences with your parents can hurt you

 — Why some of us are afraid of dependency, including dependency on our therapist.

I could talk to Jon about these complex dynamic topics forever, I think I may have to invite him back for a second round!

But for now, I hope you enjoy this deep dive and learn something from it! 

 

ABOUT JON

Jon has taught at the Washington School of Psychiatry since 1988 and has served as chair of the Supervision Training Program, the Advanced Psychotherapy Training Program, and the Intensive Short Term Dynamic Psychotherapy Training Program. He is chair of the ISTDP Institute; faculty, ISTDP Core Training Program at the Laboratorium, Warsaw, Poland, and teaches at the Ersta Hogskole in Stockholm, Sweden. He has run trainings in Denmark, Norway, Sweden, Poland, Lebanon, Italy, India, and Australia. He also runs a private core training program in ISTDP in the Washington, D.C. area. His book, Co-Creating Change: Effective Dynamic Therapy Techniques, won the first prize in psychiatry at the British Medical Association Book awards in 2014.

See www.istdpinstitute.com for details.  

 

A SHORT TRAILER:

 

FULL TRANSCRIPT

Imi: Hi, Jon. Good evening.

Jon: Hi.

Imi: Welcome, and thank you for coming on to the podcast.

Jon: Well, thank you for inviting me.

Imi: So before we dive in, would you mind… I know your background and I was familiar with your work from many years ago, and I’ve read your book throughout the years. It feels pretty surreal to get you on and get to speak to you directly. But for my listeners who don’t know you very well, would you mind telling them who you are and the kind of work that you do.

Jon: Sure. Well, my name of course is Jon Frederickson and I’m a psychotherapist in Washington DC. I got my degree about 40 years ago, and during that time I worked in a clinic and then later have been a teacher at the Washington School of Psychiatry. I’ve written, I guess four books now on a psychotherapy and about 70 articles. These days I spend most my time actually teaching and supervising therapists. I have students around the world and training groups around the world.

Jon: Before COVID I used to travel quite a bit, but now I do all my teaching here by the internet and spend most of my time actually just teaching and supervising psychotherapists using videotape of their work. So we really have an empirical basis to really look at their work and how to help them be more effective.

Imi: You have developed, and you I guess you supervise, a particular approach.

ISTDP, A PATIENT’S WILL

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

Imi: Yes. And that active approach plus the medium to short term is really historically not done in dynamic or old school stereotypical analytic therapy.

Jon: Well, it depends. Actually, Freud was quite active, which is very interesting. And actually two of the members of his early circle came up with an active form of brief therapy, Otto Rank and Sandor Ferenczi. But over time, people adopted a very passive approach and actually misunderstood some of Freud’s ideas. Freud said the patient just had to say what comes to mind. But 1923, he said, “That actually doesn’t work. People can’t keep talking about something that’s troubling. If something’s troubling, they’re going to shift to some other topic.

Imi: Absolutely.

Jon: So we actually have to help him with the defenses that keep them from speaking freely. But people didn’t really quite understand. Freud said and thought, “Well, if we just sit back and let people talk, the magic will happen.” But as many of your listeners know, just sitting and talking while this therapist listens passively, doesn’t always lead to magic.

Imi: No, actually, it can create a lot of anxiety and distress and drop out

Jon: Absolutely.

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

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

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

Jon: Sure.We’ll start and find out what the problem is, the patient would like some help with and then I might just check in, “Is this the problem you want to look at for your benefit?” It’s just to find out is it their will to look at this problem for their benefit? They might say, “Well, I don’t know. What do you think I should work on?” Since this these aren’t my problems, it really can’t be my therapy. So this can’t really be driven by what my will. So we have to find out what you think would be in your best interest here for us to work on. So really making sure that the patient is in the driver’s seat.

Imi: What if they say I don’t know?

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

Imi: Exactly.

Jon: So you might just say, “Well, I appreciate you being so honest.” Because if you don’t know if this is a thing you want to look at, we really have no right to explore. So that lets the patient know, “Oh, I’m not going to push you to look at anything even if you’re uncertain.”

Imi: Yeah. I often have people who want me to be in the driver’s seat. They’ll come to a session and say, “Okay. So what are we going to talk about today, Imi?”

Jon: Exactly. And I’ll just respond, that’s a really good question you’re asking yourself. What is it you would like to work on?

Imi: But then I also understand, it’s that they are confronted with a lot of inner confusion and emptiness. It’s not that they have just given up, it’s just they literally don’t know.

Jon: They don’t know and also insofar as say, what should I work on when they invite you to be in the driver’s seat, that might be a pattern in their life. Maybe they learned, I should always let my father be in the driver’s seat. I should always let my mother be in the driver’s seat. I should always let my boyfriend or husband be in the driver’s seat. So in that way, we’re learning, “Oh, this might be a problem in your relationships and you’re just showing me unconsciously a relational problem that I need to help you with.”

Imi: Bingo. That’s a really good point. And also, that’s really very much how I would like to work, which is relationally the things that are showing up in the session actually probably reflects a lot of what’s happening in people’s lives.

Jon: Yeah, because you could even just say, “Yeah, but if I’m in the driver’s seat, you would just get better being a passenger in life.” And then you wouldn’t be the driver of your life.

Imi: And that may be a familiar place to, be but ultimately it’s not what they want to do. That’s why they’re here for it.

Jon: And then we could just say, “I wonder if something feels risky about saying what you want for yourself in a relationship.” And then say, “I think it does feel risky.” And then we’re on our way. So in that way, even a problem like an answer like I don’t know isn’t really a problem, it’s an opening. “Oh, this is where you need help.”

Imi: That’s wonderful. Thank you. I feel like I’m getting a bit of a supervision here.

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

JON’S RADICAL VIEW OF BORDERLINE PERSONALITY DISORDER

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

Jon: Well, you’re going to hear kind of a radical point of view on this. So let me just offer a couple of thoughts that might be a bit of a surprise for you and certainly for some of your listeners. First of all, what everyone’s listeners should know is that we have these diagnoses from the diagnostics to statistical manual of the American Psychiatric Association or the ICDM which is the manual used in Europe. Now, what most people don’t know outside the field is that these diagnoses are neither statistically reliable nor valid. In other words, if five therapists evaluated the same patient on the same day, the patient wouldn’t get the same diagnosis.

Jon: If you diagnosed a patient six times over the course of a year, the diagnosis would be different.

Imi: Yeah.

Jon: All the psychotherapy researchers will tell you this, this is a really big problem. These diagnoses are not statistically reliable or valid. Now, here’s a radical point. What we call diagnosis is actually not a diagnosis. When we give someone a diagnosis, it’s, for instance, for borderline personality disorder, it just means that a patient has five out of eight traits.

Imi: Exactly.

Jon: So what does that mean? It’s a description. For example, if you had a terribly high temperature that wasn’t coming down, you’d go to the doctor. Now, if the doctor said, “Well, Imi, your diagnosis is fever.” You say, “Doctor, I know I have a fever. That’s my symptom. But what’s causing my symptom?” He’d say, “Oh, you want me to diagnose the cause.” And then he’d be checking is it COVID? Is it a cold? Is it the flu? It could be many different things and then he would diagnose the cause of the symptom.

Jon: In psychotherapy, in psychiatry, psychology, most therapists never diagnosed the cause. A symptom picture doesn’t tell you what’s causing the symptom picture. So what we call diagnosis is actually not diagnosing the cause. That’s why telling someone they have a diagnosis actually doesn’t do any good. Just like a do-no good for a doctor to say to you, “You have a fever,” because you have to diagnose what’s causing that symptom picture, so he could treat the cause.

Jon: So the interesting thing is in in this field of psychotherapy, although we use the term diagnosis to refer to these descriptions, we actually don’t diagnose the cause. And a really good way to put it is that a description is not an explanation. And that’s why when someone says, “Oh, you have this description,” you say, “So what?” Because since it doesn’t explain what is causing your difficulties, you can’t have any realistic way of figuring out, “Okay, how’s therapy going to help me?” And in fact, if your therapist can’t figure out what is causing your symptom picture, your therapist can’t have any kind of reasonable treatment strategy.”

Imi: You think? Well, some people think the cause doesn’t matter, we just treat the behavior.

Jon: Yes.

Imi: That’s not how I work either, but I know some people do.

Jon: Right. And that’s a very important part of the mosaic. But when we look at a mosaic, we understand there are many pieces to the mosaic. And what happens in psychotherapy field, sometimes someone will take one piece out of the mosaic and say, “This is my form of therapy.”

Imi: I know.

Jon: I only pay attention to thoughts, or I only pay attention to behaviors.

Imi: Or the body or the mind.

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

Imi: Yeah. So if we do talk about the courses, I mean, at the center of something like personality disorder or borderline personality disorder, it’s a difficulty in, well, relationships, but also emotional regulation.

Jon: That’s right.

Imi: And both anecdotally, experientially and statistically we know that there is a link between childhood complex trauma or neglect with this type of distress.

Jon: Absolutely.

Imi: What do you think that is? Why would someone being abused or neglect cause problem in emotional regulation?

Jon: Well, one way we could look at it is that every child has emotions that come up and whether it’s a distress because a diaper needs to be changed, the baby is hungry, it fell over and hurt itself whatever. And the mother or father come, they pick up the baby and they soothe the baby. The baby has the experience over time that when it has an emotion it can count on the other person to regulate that emotion to calm the baby, to be a source of calm, and that there’s a dyadic regulation that together we can regulate the feelings and anxiety, right?

Jon: Now, of course what we know happens in trauma is that in a parent through some kind of abuse, triggers, massive feelings in the baby or in the child, but the child has a problem because the person who’s supposed to be the source of safety is actually the source of danger. And the child knows, “Right now you hurt me so I loved you and I feel tremendous anger at you for hurting me. I have these mixed emotions. How do I deal with the fact that I love you and I’m feeling angry, and you are causing danger?”

Jon: So the child learns I actually can’t rely. I can’t depend on a parent for affect regulation. So I have to rely on defenses for affect association. And what the theorist Harry Stack Sullivan said, “The child is actually going to use defenses to regulate the parent.”

Imi: Yeah.

Jon: Right? “Oh my feelings will be too much for my parent. So how much of me do you need me to hide, so you will calm down.”

Imi: Absolutely.

Jon: So we forget that actually the child uses defenses not only to deal with its own feelings, the child initially uses defenses to protect the parent from feeling that would dis-regulate the parent.

Imi: Yes.

Jon: So in that sense like every defense is actually the child’s act of love. How much of my feelings do I need to hide so you could love me. If I turn my anger on myself, can you love me now? If I send the feelings out of myself and I empty myself, can you accept the absence that’s left?

Imi: It’s terribly sad, but very moving when you put it like that. And you’re right, that’s the beginning of the development of what’s Winnicott called false self.

Jon: That’s right. It’s like, “Oh, you can’t deal with who I am, so how much of me do you need me to remove so you could deal with the false self that’s left.”

Imi: Yes.

Jon: The child of course is simply these defenses are just a way of adapting, right? And the earlier these traumas happen, the more severe these defenses have to be, the more severe the trauma are prolonged, the more severe these defenses have to be.

Imi: The more entrenched, yeah. The codependency.

Jon: Well, they’re always going to be entrenched because they’re unconscious, but the earlier, they are, the more likely, they’re going to have splitting. The earlier the trauma, the more likely you’re going to have splitting projection. If trauma happens like after about eight years old, the child is going to have a very different set of defenses.

Imi: Which might be what?

Jon: Anything in isolation of affect where they can just intellectualize, change topics, be vague, rationalize.

Imi: So actually from our clients or patients presentation, we can speculate when the trauma happened.

ANXIETY MANIFESTATION

Jon: Yes. And also to get a sense, you might have a patient where both parents are quite disturbed. So the patient is probably going to have a lot of splitting projection. She might have had one per parent who is disturbed and another person who was less disturbed. So you might see different kinds of defense systems at different times.

Jon: Yeah. The other thing to keep in mind is that you see the earlier trauma happens and the less affect regulation there is by the parent. Then the child’s anxiety never gets regulated. When anxiety doesn’t get regulated, the body doesn’t return to homeostasis. It remains in a permanently elevated level of anxiety that we call allostasis. So very oftentimes if anyone has been diagnosed with borderline personality disorder, the various personality disorders, very often times in the very first session, I’ll just mention are you aware of feeling anxious?

Jon: Sometimes, the patient won’t be aware of feeling anxious, but I’ll ask, “Are you aware of feeling tense?” They may not feel tense, but I’ll ask, “Do you have a sick stomach?” “Oh, yes. I get sick to my stomach a lot.” “Do you suddenly have to go to the bathroom a lot?” “Oh, yes.” “I was diagnosed with irritable bowel syndrome, or I have Crohn’s disease, or I get migraines.”

Jon: Those are all signs of anxiety in the parasympathetic nervous system. Those are very common signs of allostasis in personality disorder. Another group is where anxiety goes into the parasympathetic nervous system even more severely and these are patients where they get dizzy, they get faint, they have blurry vision, they get ringing in the ears, they start to have trouble thinking. They’ll suddenly go very limp. In this model live therapy, we would call that cognitive perceptual disruption.

Imi: But these are very severe forms of anxiety and a lot of patients don’t realize when they’re having these symptoms that they’re actually experiencing severe anxiety because people tend to think of anxiety as just like tension, which is true if anxiety goes into the somatic nervous system. That’s actually the healthiest form of anxiety. So if someone constantly gets tensed up and they sigh or they clench their hands, that’s a sign their anxiety is well regulated.

  Most people who have personality disorders have anxiety that’s chronically elevated and no one has ever identified it or regulated it. So these are people that go through life really tremendously anxious, and they’re not necessarily aware of it. So one of the first things a good therapist would do would be to identify where their anxiety is discharged and help them regulate at that. Do you remember that from my book Co-Creating Change where I had that huge chapter on anxiety identification regulations. Just absolutely essential with this hurt.

Jon: Do you think most therapists neglect to underestimate the role of anxiety?

Imi: Yes, absolutely. Because they really only see it in this diagnostic manner that you suffer from anxiety. But actually it’s present.

Jon: It’s very present. A lot of therapists have great misunderstandings of anxiety. They’ll think that someone says, “I worry a lot.” Well, that would be a thought. So they think of anxieties purely a thought that someone worries a lot or I’m anxious. They’ll hear the thought, but anxiety is actually a biological discharge pattern in the body, and it’s caused by the central nervous system. So if if therapists don’t know how to look at the body and pay attention to the symptoms, they actually won’t be able to assess anxiety adequately.

Imi: Yeah. In what in my line of work, the defenses that I see the most often would be splitting/ projection. I don’t know if you consider dissociation a form of defense, but these are the three that I see the most, which we will definitely go into.

Jon: Absolutely. And here’s a way to think about it. When the baby is is struggling with a parent and is being abused, it’s feeling anger, but it’s feeling anger toward a parent it loves. It’s struggling with mixed feelings and those mixed feelings are triggering tremendous anxiety. 

So later in any relationship, you just think even if a dog was abused, if we went to a dog pound and we walked near a dog of abuse, it’s going to start to bark, it’s going to start to urinate. It might even defecate, right?

Jon: This anxiety will go into the smooth muscles, right? Those are the same anxiety symptoms, and that dog will have sort of a dog transference to us. It’s afraid that on a bodily unconscious level anyone approaching me is going to hurt me. Patients have been abused. They know in their head, I’m coming to see Imi, right? But when they come in, their body has the same reaction their dog would have.

Jon: So we have to remember, yes, with their head, with a higher mind the patient knows it’s you, but the lower mind has another reaction and that reaction takes us for anxiety. Now, what happens is when they’re meeting us, they want a new experience. They already have positive feelings. That’s why they called you. They positive feelings, but the memories of the past are negative feelings.

PROJECTION AND SPLITTING

Jon: So when they meet us, they’re having positive and negative feelings that trigger anxiety. But what happens, their anxiety goes high so fast it’ll cause stomach problems, it’ll cause dizziness, it’ll cause blurry vision, ringing in the ears, cognitive confusion. What happens is that when the anxiety gets too high, the mind splits the two feelings apart to stop the anxiety. Someone could just feel pure rage towards you as an all bad person. At that moment, they’re not anxious.

So what happens when our anxiety gets too high due to these mixed feelings, the mind has to split the feelings apart. Then when it splits them apart, then whatever feeling they can’t tolerate inside, they’ll project outside. So oftentimes the patient can’t tolerate their anger inside, they’ll be afraid that someone outside them is angry with them.

Imi: Like me.

Jon: Yeah, right. Or if they can’t tolerate that it’s their desire to… Every patient comes to you because they have questions. Basically, why am I struggling? Why do I have trouble at work? Why do I have trouble with mood swings? Why do I have trouble in relationships? Patients always come with a question. But when they want to depend on you, and find out answers to questions. That wish to depend makes them so anxious, they may project. They’ll forget I have questions and they’ll say, “So I just feel like you’re wanting me to answer questions I don’t want to talk about.”

Jon: They’re actually projecting their own wish to get to know themselves. So we might just say, “Well, I have no right to ask any questions that you don’t want to look at.” That’s something you’d find out from you, what questions would you like answers to, so that the therapy would give you the information you’re looking for?”

Imi: Well, these are some really great examples of splitting and projection. If we rewind a little bit and explain to our listeners what these mechanisms are in more simplistic term, what’s projection? What’s the difference between projection and projective identification? Quite a bit of jargon.

Jon: Well, let’s just take it actually in sequence because first, we split feelings apart. So a person might come into my office and sit down and say, “I’m anxious. I don’t want to be here.” Now, what he’s forgotten is that he wanted to come here because he’s in my office. The only thing he’s aware of, I don’t want to be here. So I actually have to remind him that actually he came. Not wanting to be here and coming here. Not wanting to be here and coming here. And what’s it like to notice this complexity inside the right now.

Imi: And I guess that’s what we always struggle to hold, these opposites, the love and the hate before us.

Jon: Or a person comes in and says you don’t care about me and so on and so forth. I know it’s because this and this. Then you might say, “Well, really that must be very puzzling because remember last time, you were talking about how you felt I really understood you and that I understood what was going on to your mom? And then now there’s this other thought that I don’t understand you. What’s it like to notice how there’s these two different perceptions that can happen in the same mind? What’s it like for us to notice that together?”

Jon: So in a way, when the patient has trouble tolerating mixed experience, they’ll split them apart and are tasked to help them bear these things, complexity of view and the complexity of feelings. Now, when they split a feeling off, they might project it. So for example, let’s suppose that I’m your patient and I could say, “No, I didn’t want to talk to you tonight, Imi. You made me talk to you tonight because I got that email and I just knew that if I didn’t do it, that you would really be angry with me, right?”

Jon: So in this point, I have forgotten that actually I made the choice to be in contact with you. I made the choice to email you back. I made the choice to click on your Zoom link and I made the choice to converse. But in the heat of the splitting of projection, I project on to you that you wanted me to talk to you and I’ve forgotten that actually I wanted to talk to you as well.

Jon: So in projection, when I have an urge in myself that I can’t tolerate myself, I’ll attribute it to someone else. So I might say, “Oh, no. I’m not angry with my boyfriend. I’m afraid he’s angry with me.” It’s not that I want to talk about my problems. I can just see you, my therapist are wanting me to talk about stuff I’m not comfortable talking about. So when there’s an urge inside that I can’t tolerate inside, I’ll project it outside. So I might project that you’re angry or a psychotic person will project that they think the government is angry with them.

Imi: Yeah. That’s what you meant by people interacting with a projection rather than a real person.

Jon: That’s right. And see projective identification is different. I could project and think that you’re angry with me. In projective identification, I’ll act with you in such a way that you actually start to feel angry with me. So I’ll actually get you to feel something that’s congruent with this projection I attribute to you.

Imi: Human relationship is so messy.

Jon: Exactly. And then when you talk about dissociation, yes, dissociation is a kind of a splitting. It’s a way of saying something of my experience doesn’t belong to me. So it’s like a person can feel I’m not here and they can feel like they’re back against the wall, what we call secondary dissociation or tertiary dissociation is where I think, “Oh, I don’t have this feeling, but I have this personality Mary. And oh Mary is really angry.”

Imi: Yeah. Sometimes I don’t know how to bring the person back because they have left the room. I mean, not literally.

Jon: Yeah. I think oftentimes what we need to be thinking about is what was happening the previous five minutes, because anxiety has risen in some way and I didn’t catch it. At a certain point, when anxiety arises, the patient starts to have this cognitive perceptual disruption where they get a little dizzy and they have trouble hearing, trouble seeing. They have these anxiety problems then they start to split and then they start to dissociate. So the thing is if you can assess their anxiety a little earlier, you can keep working with them before they dissociate. Or if it’s secondary dissociate like they’re back against the wall.

WHAT ACTUALLY HAPPENS IN THERAPY?

Imi: Why is relational co-regulation powerful?

Jon: That’s a really good question. What do you think?

Imi: My thought was the trauma itself happened in the relationship, so it gets healed in the most powerful way in a relational experience, although that’s also the hardest.

Jon: Right. But what was harmed in a relationship must be healed in a relationship. And it must be healed in this relationship.

Imi: Yeah. And not just once, but again and again with [crosstalk 00:32:33].

Jon: Again and again. So an emotional healing, it’s not like head to head, it’s heart to heart, body to body. It’s not like, “Oh, if we just get the right answer that you’re reading a book everything changes inside.” Because in a way, the patient, if you think about it, the patient is regulating you the way she had to regulate her parents. So when you ask about feelings and you work in the relationship, you’re implicitly restructuring her attachment strategy.

Jon: It has to be done relationally because in a way you buy your regulating anxiety, buy your inviting feelings toward you. You’re constantly letting the patient know you don’t have to protect me from your emotions. You’re going to have to protect me from your thoughts. So the patient actually has to experience that they can share forbidden thoughts and feelings with you, and you will still stay regulated and you won’t ask them to put some thought or feeling away to regulate you.

Imi: So much is happening in the relational process. My frustration is sometimes clients don’t see that and they really crave a kind of explicit structure or really obvious quick signs of improvement, which I can fully understand. But it’s also sometimes quite difficult to communicate these subtle, but powerful changes.

Jon: What’s an example you’re thinking of?

Imi: I’m thinking of people who come in and ask for a lot of structure and signs of progress, and a marker of when the process will be completed.

Jon: So let’s think about that. They come in and they’re wanting markers of progress and they’re wanting advice. They want to be told what to do. What do you notice feeling when you’re sort of hearing this that they want markers of progress and they’re feeling that you’re not quite up to…

Imi: Pressured. A bit of frustration. Sometimes irritation.

Jon: Exactly. So what kind of relationship is the patient setting up with you?

Imi: That’s right. It’s almost like inviting me to be critical instructing.

Jon: Well, actually, they’re being a critical parent placing all kinds of demands on you and that you could be dumped at any point unless you meet these demands.

Imi: Oh, absolutely. I do feel undenied.

Jon: And you feel kind of irritated at these demands and pressures.

Imi: Absolutely.

Jon: So when they do that, what does that tell you about their family background.

Imi: That’s probably what they received all their lives.

Jon: And it’s probably a way they treat themselves that they’re probably excessively demanding, that they’re feeling it always should be meeting some expectations and they feel like they’re never quite good enough.

Imi: It’s a really good point. And I would flip from feeling sometimes eager to please like, “Oh, I better come up with some markers and explanations so that this person wouldn’t leave me and stay in the work.” And that must be how they relate.

Jon: Yeah, exactly. So it sounds like you’re having some reactions here when you’re feeling like somehow the therapy isn’t as helpful as you would like. Well, yes, because I think, “So I wonder what feelings are coming up toward me?”

Imi: They may not be brave enough to say that, but it’s-

Jon: Oh, they won’t be.

Imi: … nonetheless a very useful question.

Jon: They won’t be brave enough, but the defenses they’ve used to protect their parents from criticism will come up. Perhaps, they’ll even go to self-attack to protect you from this criticism in which case then you can help them with that.

Imi: Which is what they have done all their lives with their parents. “It’s my fault. It’s me. It’s not you. It’s me that I’m too much, I’m too emotional. My parents have done a fine job.”

Jon: So could this be a critical thought and could that critical thought be making you depressed? Could that critical thought be unfair to you? So I wonder could we look underneath those critical thoughts and see what feelings are coming up here toward me. Because my concern is is that when you go to these critical thoughts, it’s the way you’re hurting yourself in our relationship. And naturally, I’m concerned about anything you would do here that would hurt yourself in our relationship. So could we see what feelings are coming up here with me that would make you hurt yourself this way in our relationship?

Imi: Jon, this is really good. You are really good.

Jon: Of course, you’re making indirectly a comment about how they learn to hurt themselves in order to maintain a relationship with a parent. And protect a parent from anger by going to self-blame.

Imi: Wow.

Jon: Now, you’re saying, “Oh, it’s not just a defense, but oh, it’s a way they are protecting me.” When you turn the anger on yourself, could this be a way that you’re protecting me from these critical thoughts. And then when you protect me this way, could that be hurting you? Could we see what feelings are coming up your door, Imi?

Imi: There’s one more defense that I’m dying to talk about, which is about-

Jon: Oh, excellent.

TEMEPERAMENTAL DIFFERENCES WITH YOUR PARENTS

Imi: Yeah. But before that, I also have more questions about very earlier on like 20 minutes ago you were explaining why people get traumatized with complex trauma or the lack of nurturance from their parents and you said all children have feelings. Do you think some people are born more intense and sensitive than others?

Jon: Oh, yeah.

Imi: Would the temperamental differences with their family be more… There are many cases where siblings with the same parental treatment turn out very different. What do you think?

Jon: Absolutely. There’s a lot of research to support the existence of temperament, obviously. You have children that are very shy, children that are very impulsive, children that are very outgoing. There’s definitely differences in temperament. And almost any set of parents that’s had a number of kids can point to differences in temperament that were visible in the very earliest days.

Imi: Yeah.

Jon: As long as we’re looking at genetic factors like temperament, you also have factors like neurocognitive deficits. If someone has a sensory integration difficulty like they can’t tolerate the feel of certain clothing or tags on clothing. There are certain children that cannot integrate sensory experience from skin that they have trouble tolerating being touched or they have to be touched in a certain way. These kinds of neurocognitive deficits have a very big impact on how they internalize relationships. You’re right that a mother hugging at one child it works, and for another one, it’s just squirmy, wants to get out of her arms.

Jon: The poor kid, it’s not his fault. He’s got this wiring problem and of course the mother could take it personally like he doesn’t like me, not realizing, “Oh, he’s got a lot of skin sensitivity. We have to find another way to make contact.” So I think the role of neurocognitive deficits is very important to keep in mind. I had a patient one time for example where she’d had a number of therapies. Nothing had really helped. And when I was working with her, I noticed there were all these emotional breakthroughs that were happening.

Jon: I thought, “Well, Frederickson you’re good,” but you’re not that good. What’s going on here? But then I noticed a pattern that if I said two sentences, she almost always break into tears. I began to realize this woman had an auditory processing problem. She actually couldn’t keep up with conversation with friends if they spoke rapidly or two people spoke at the same time. Her brain simply couldn’t process auditory information.

Jon: So she had a really hard time maintaining friendships. She couldn’t have friends in a group. She could only have friends individually, and only if they talked kind of slowly. And I began to see too that her processing speed was reflected in kind of a slow speech manner. So I learned to speak as slowly as she did, so she could process what I spoke.

Imi: But that finding, that realization of her unique wiring and what needs to happen, it must be so powerful.

Jon: It totally transformed her understanding of her childhood, right?

Imi: Not all of us are wired in the way that is within the norm. We just have these quirks that require… I’m the kind of person who have the tag problems, this kind of sensitivity and that kind of sensitivity. And actually as a grown-up, it’s more important to own it and then find a place in the world where people will celebrate you.

Jon: That’s right. And I think a lot of times therapists aren’t taught about the role of temperament, the role of neurocognitive deficits. Here’s another kind of important fact within people who have a borderline personality disorder, a significant percentage have had brain injury. Brain injury will affect all kinds of brain function. But when you think about it, when you’ve got trauma, a lot of kids are their heads, they’re going to have head hits or you got car accidents.

Jon: This is something most people don’t talk about and the role of head injury. When we talk about borderline of course, I think about it from a psychological point of view, but I’m also thinking about temperament. And like we talk about our emails, it’s not just the temperament of the child. If you have a parent who understands the temperament of the child, it’s not a problem, but if you have a parent who really hates a particular temperament, it’s going to be a mess.

Jon: If you have a child that’s very shy and if parents are giving the child a hard time, that child is going to really suffer rather than just, “No, she’s shy. She’ll always be shy, but she’ll be able to have a very rich internal life. So on and so forth.” You might have a very-

Imi: Inquisitive, ask a lot of questions, very active child with very introverted, quiet parents.

Jon: I have very close friends, they had a son. He was just incredibly defiant and oppositional as a little boy. His mother was so fantastic in dealing with him. She really was able to give him a lot more freedom. There were always limits, but she could always figure out what the maximum amount of freedom to allow him so that he didn’t have to butt heads so much.

Imi: That’s wonderful.

Jon: He’s doing fabulously well now as an adult.

Imi: It can be done, parents!

Jon: It can be done.

Imi: It’s really hard.

Jon: It’s really hard and parents oftentimes don’t get the advice that they need with something like that.

COUNTERDEPENDENCY AND FANTASY OF OMNIPOTENCE

Imi: Yeah. All right. Thank you. I know your time is valuable, but I really want to talk about counterdependency. You use this really wonderful phrase fantasy of omnipotence, which many of my listeners, it may not sound explicit, immediately obvious what it means. But I kind of look at it. I may be wrong, because I use the word counterdependency a lot in my work in some articles that I’ve written. Is that the same thing why people kind of avoidance of dependency, afraid of being dependent on anyone or even anything, they kind of like to… I’m pulling together a whole lot of traits and the person with counterdependency may not take all the boxes, but maybe they hold a lot of resources.

Imi: They make sure that they’re knowledgeable. They make sure that they can survive in an apocalyptic situation. They may isolate themselves. They may work on overdrive. They may have very little optional relationship or they maybe even deny that they need relationship. They’re just afraid of being dependent including on a therapist or coach.

Jon: Oh, yeah.

Imi: Is that related to what you call fantasy of omnipotence or are they different?

Jon: Well, it can be. I mean, this is a really such a universal conflict, isn’t it? There’s a wish to depend on someone. The anxiety of depending and then the defense of avoiding depending on someone. There’s a whole spectrum of that, right?

Imi: Yeah.

Jon: You can have something as the husband who’s just afraid to share some upset that happened at work with his wife, right? It could be just a small anxiety about dependency, a little minimal defense or whatever. Then you have people where they claim they don’t want to depend on anyone, and that they want to be able to do it all. There yes, then we start to see omnipotence, right? We live in a world of interdependence, right? I rely on my wife, I rely on friends and the most…

Imi: I rely on the farmer to farm, so I can have an apple.

Jon: Farm our food, the fisherman to fish our fish. Yes, farmer to bring apples, right? So we live in a web of interdependency. There’s no way to avoid that. But when people have had an experience of depending where it would… If dependency led to pain, then oftentimes some people will choose the solution, “Well, I just won’t depend on anything on anyone.” So then in a sense they’re afraid of a future apocalypse, so they try to store up all this food. What they fail to realize is that the trauma they fear in the future already happened in the past.

Jon: People who are preparing for future trauma are displacing into the future, the trauma they already had. They’re trying to prepare for trauma, but it’s too late. The trauma actually already happened. So oftentimes with patients, we have to help them see where the real trauma was so we can help them deal with that, so that the rest of their life doesn’t have to be based on this displacement of trauma throughout life.

Jon: Of course, if we can’t tolerate depending on another, then there’s the wish that we could just depend on ourselves and no one else, which means that I would be omnipotent. The British psychoanalyst, Melanie Klein had a funny way to put it. She says every child suckles on a breast that you’ve got that person who thinks he actually is the breast, so he can suckle on himself, right?

Imi: Yeah.

Jon: So the greater the anxiety about depending, then the more extreme these forms will be where people claim not to depend on anyone, or where people will claim that they know everything like in this COVID period. We’ve had some people who read everything thinking that, “If I just know enough, I won’t catch COVID.” Right? Well, if you know enough, you’ll know enough. But knowledge doesn’t necessarily mean lead to omnipotence.

Jon: No matter how much you’ve read, no matter how smart you or I may be, no matter how much we read, we’re not going to be an epidemiologist. We’re not a specialist. We can’t possibly know as much as they know. So we don’t even get omniscience about that area.

Imi: What kind of events or situations would break a person’s fantasy of omnipotence? Is it like a mid-life crisis where suddenly their defenses no longer work or relationship problems maybe?

Jon: Yeah, there has to be some impact where reality bumps against their fantasy, right? If someone actually gets sick from COVID, yes, they may realize, “Oh my god, COVID is not a hoax.” Although, we’ve had a few cases here in the United States where someone was dying of COVID, and they said, “No, this can’t be because COVID is a hoax.” It’s like that denial can be breathtakingly powerful.

Imi: Yeah.

Jon: But the only way someone can get loosened up from denial is it to be reminded of reality that conflicts with their denial.

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

Jon: Promotional regulation, I think one of the best things you could possibly do would be to pay attention to what you feel in your body and just sit still for a while and pay attention to symptoms in your body. Sometimes biofeedback can be extremely useful. So for people who have problems with anxiety, if you don’t have access to a therapist, biofeedback can be an extremely good way to regulate your anxiety.

Jon: There’s different kinds of biofeedback devices that are out there that are really good way to regulate your anxiety just on your own, because we talk about emotional regulation, but actually emotions don’t need to be regulated. We talk about emotions being unregulated because emotion occurs with anxiety and the anxiety is unregulated. If you can regulate the anxiety, the emotion is what it is.

Imi: I like that.

Jon: Yeah. There’s a combination of anger plus way too much anxiety. So if we can regulate the anxiety, yes, someone can be doing a lot better.

Imi: And they can actually deal with a wider scope of emotions rather than trying to make them smaller.

Jon: Yeah. My first book… Well, not my first book, but a couple of books ago Co-Creating Change has a big section on anxiety and it’s written so anyone, even if you’re not a-

Imi: The big yellow book.

Jon: You could understand that chapter. And for people who are working with personality disorders or whatever, my most recent book, Co-Creating Safety really talks a lot about how to work with fragile people, how to regulate anxiety, because in a way for the fragile patient, they have to feel safe in the body as a first step. Therapy can’t be safe if the patient doesn’t feel safe in the body. And you have to regulate anxiety.

Jon: Then you have to deactivate any misperceptions of the therapist so that the patient can feel safe with you. So you actually have to regulate anxiety so the patient feels safe in the body and you have to deactivate projections, so the patient can feel safe with you. And then from that safety, then you can go ahead and do the work of therapy.

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

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

Imi: That’s the one I haven’t got. I’m going to buy it.

Jon: Oh. Well, we’ll have to get together again after you bought that. I hope-

Imi: Oh, I would love to. I would love to talk to you.

Jon: Yeah. Because that’s really designed for the general public, The Lies We Tell Ourselves.

Imi: This is recorded, Jon. I will get you back.

Jon: I’ll look forward to it.

Imi: Oh, wonderful. Okay. Well, I know your time is valuable. I have a few more questions.

Jon: Sure.

Imi: What is your definition of resilience?

Jon: Resilience. There was an interesting statement by a child psychoanalyst many years ago, E James Anthony, because he had studied just thousands of children in his career. He had this kind of funny thing. He said there’s glass children that when they’re dropped, they shatter, they break. And then you have steel children that when you drop them nothing happens. They’re just tough. Then he said, “You have rubber children that when you drop them, they absorb some of it, but they bounce back.” And I think we can all see that.

Jon: The resilience we get is due to the resilience of the parents we had. So oftentimes, if we didn’t get that kind of resilience from them, we’re going to have to get it from a therapist. We’ll have some inborn genetic resilience, which is what I think he talked about. There are children that just true genetics can just seem to be unfazed. Some are like rubber and some shatter. But for those of you who you bounce and you absorbed quite a bit, you don’t feel it, you quite bounce back, then a lot of that resilience, you’re going to gain from therapy and large part through learning about anxiety, identifying it, regulating it, so that once your anxiety is regulated, you’re going to be in a resilient physical state and a psychological state more of the time.

Jon: Then therapists can help you deal with the feelings that other people couldn’t help you with. As you build a certain kind of affect tolerance and ability to tolerate these mixed feelings that had to be split apart in trauma, as you gain the ability to tolerate these mixed feelings at increasing intensities, yes, therapy will build your resilience.

Imi: Thank you. That’s good.

Jon: Thank you.

Imi: Can you share with us a book that has changed your life?

Jon: A book that’s changed my life. Gosh, they’re so… I’ve read so many books, thousands.

Imi: I’m sure.

Jon: Right now, I don’t work out of my office so it’s a very expensive library right now, thousands of books. What’s the book that’s changed me the most? I really don’t know off the top of my head.

Imi: That’s okay. That’s okay.

Jon: There’s so many books, yeah. I just…

Imi: Would you recommend one book to our listener off the top? It doesn’t have to be the book, just anyone. Maybe your own.

Jon: Well, I think for the general listener out there, I would definitely recommend this book, The Lies We Tell Ourselves.

Imi: The Lies We Tell Ourselves, yeah.

Jon: And for anyone out there who’s working with fragile patients, my most recent book, Co-Creating Safety.

Imi: Creating Safety.

Jon: Yeah. It’s unlike a lot of therapy books because it’ll tell you about theory, but it has lots of examples of patient vignettes. So you really get clear examples of how to intervene, how to understand, responses. So it’s very, very helpful when you’re wondering what to do or how to understand situations.

Imi: That’s really useful. All right, final question. I’m going to challenge you a little bit.

Jon: Yeah, sure.

Imi: If you want to sum up your work or your position in one to three messages or just a few lines, what would you say?

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

Imi: That’s wonderful. Sort of profound.

Jon: Yeah. Whatever you were taught to reject in yourself, you must learn to accept yourself and that can happen within a therapy relationship that accepts everything in you.

Imi: Thank you.

Jon: You’re very welcome. Thank you for inviting me.

Imi: I have learned so much. Thank you so much.

Jon: You’re very welcome.

Imi: I can’t wait to get this out.

Jon: Oh, good.

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

Jon: Exactly. It’s so easy for us to misuse our powers of imagination for the purpose of self-torture. It’s so easy to do.

Imi: You are a wonderful force in the field. Please never stop doing what you do. It’s such an honor to speak to you.

Jon: Well, thank you so much. It’s been a pleasure. Take care.

Imi: Bye-bye.

Jon: Bye-bye.