Disavowed Anger and Positive Emotions with Paul Wachtel

All right, welcome back. I am joined with Paul Wachtel. He is a return guest. He has written a book on therapeutic communication and the disavowed emotions. And today I thought I would ask you more about disavowed anger and we'd kind of go from there into other aspects of the disavowed maybe we'll get to disavowed disgust we'll talk about maybe how to talk to patients in such a way that the disavowed becomes avowed yeah and and i and i think you know as as we're talking even this actually hadn't occurred to me though it's a kind of rhyming or clang association of sorts the disavowed is also the disallowed the things that the feelings and perceptions and desires that in the course of growing up we learned were not permissible even if they were organically part of us and so we needed to push them away and they don't completely disappear. That's why I kind of like the idea of thinking of them as disavowed rather than simply repressed. You know, we're not able to completely make them either disappear or even be invisible to us, but we can push them aside to such a degree that we really lose touch with some of our own most vital experiences desires emotions both positive and negative and you know kernberg was on my podcast uh a couple months ago and he said that the thing that therapists most need to understand is their own anger so i i i think there's something about therapists in particular myself maybe included where disavowed anger is a normal part of our development. And yes, I think this would be a good conversation today. So tell me more about disavowed anger. How has it been disavowed? What are some examples that come to your head? Well, I'd like to first, since you mentioned that comment by Kermberg, I think I would not completely go along with what he's saying. I do think that because we try to be in a facilitating relationship with the person, we're often not comfortable when we have more negative feelings. So I would agree with him in that respect. But I think that some of what many therapists experience as disavowed anger is actually an artifact. And it's an artifact of not really sufficiently thinking in terms of disavowed emotions. And that's kind of cryptic, so let me try to spell out what I mean by that. Part of what made me increasingly interested in this concept of the disavowed is that I was thinking about the way psychoanalytic formulations in particular, but we'll probably get to talk later about how other points of view in our field have also adopted this, kind of began with the idea that we deceive ourselves, that we fool ourselves, that we create a pretty story about what we're really like, but deep down the picture is really kind of uglier in a way. And I think that was a core kind of implicit assumption and that the therapist's role is to kind of rip away the illusions and force the person to come to grips with the reality. And I don't approach therapy from that vantage point, even though I am looking at very much the same phenomena. I approach it from the vantage point that in the course of growing up, Because we are so dependent on our attachment figures, every nuance of how they see us or don't see us, love us or don't love us, respond to us or don't respond to us, we are especially sensitive to early in life. And we kind of build a kind of picture of ourselves and of who we are and who we're allowed to be that is almost inevitably restricting. And I'll probably come back to that later. But in one way or another, almost all of us, some part of us, some important parts of us, get pushed away. don't get fully acknowledged, fully elaborated, and yet they don't disappear because they are important. And so I see our job as therapists to help the person recover those feelings, reintegrate them into a fuller sense of who we are. And I think when you have that perspective, that you're not ripping away illusions, you're not trying to, you know, get through a facade of a false self or a false presentation, but instead are trying to help the person expand their sense of who they are, you're much less likely to be in an adversarial relationship with the person. so that, for example, when I think of Kronberg's approach or the general approach of transference-focused psychotherapy, which there's a lot in it that I value, there's a lot in it that I think is really important, but there is a way in which it tends to retain that kind of adversarial stance that is embodied in the very term resistance. You know, the idea that the patient and the therapist are almost in a kind of battle over who's going to define what's real. And I don't encounter that much, quote, resistance, though I think I see the phenomena that get called resistance. What I encounter is anxiety, discomfort, a kind of difficulty in the person feeling able to accept one aspect or another of their experience. So that it feels to me like I get into less adversarial ways of interacting and so have less, not totally none, but less need to disavow anger because I'm more on the patient's side, I think. I think that when you're thinking of the disavowed rather than the repressed, so to speak, of the disavowed and the disallowed rather than the hidden and secret, you are more able to be on the patient's side and it becomes less adversarial in that sense. i can resonate with this idea that there are parts of us that we were not allowed to be there are other parts of us that we're allowed to have and so there's like an you're trying to rather than deconstruct the whole sense of personhood it's like you're trying to pull in aspects that were disallowed or disavowed. Yeah. I think in my conversations with Yeomans and Karnberg, I don't necessarily, I mean, I think I thought it would be more caustic or more adversarial. I don't know if I experienced that from Yeomans when I talked to him one-on-one about supervision it's like he's he'll see the interpersonal exchange and he'll focus in on like a small moment of emotion that's there that's between the client and him but i i think that i could see how i don't know i think kernberg definitely has uh a lot of energy that's a nice word a nice way to put it yeah and and i don't want to be in a position because i'm not of just disavowing, as it were, in a different sense of the term, everything in their approach, because I think there's a lot that's enormously valuable. But when you say that Kornberg says, you know, the central struggle for the therapist is dealing with their disavowed anger, I think that's somewhat of an artifact of the kind of relationship that gets set up. And my guess is that, you know, if you compare, say, Kernberg and Yeomans, I could easily imagine that Yeomans has less trouble with struggling with that. You know, we each have our points of vulnerability. But certainly I must have my own. And I put it as must have rather than have because the very nature of those vulnerabilities is we kind of sweep them away from our line of vision. So we're less in touch with them. But I'm not presenting myself as I'm without them by any means. is anger in a way uh linked to drive and movement forward and you know could you see it as like you said like it's it's not that it doesn't take place but maybe there isn't the words around it right and i see this in my early life like i was an athlete uh i think in my conscious interactions with people i don't know if i felt anger a lot but i felt anger in sport, right? And that's the place where I was allowed to feel it. Yeah. And anger, I want to be very clear. I'm not trying to sort of whitewash anger, you know, from the human repertoire. Anger is both often valuable in various situations where if we're not angry, we're likely to be taken advantage of. And anger is one of the central kind of experiences that people are conflicted about. And indeed, much of many of the cases that I've described, you know, in the course of, you know, illustrating my ideas over, you know, various books and articles and so on, are people who struggle with anger. So So I'm by no means saying disavowed anger is not of great importance. It is. And we may very well be spending a lot of time in today's discussion talking about disavowed anger. That's not something I disavow, so to speak. But I was responding just to your initial comment that Kernberg had framed it as if that's sort of the core struggle of the psychotherapist. And I don't find that to be necessarily accurate. I think that the most amiable way of describing what he was talking about was that if you're naturally very empathic and you can feel other people's emotions quite a bit and you are in a place because of that that you like to peace keep and you like people to be happy, sometimes your own anger may get in the way of that. and so to have a voice to be able to keep you know a frame be able to to have boundaries all of this may be things you have to learn in adulthood if you have disavowed anger in your childhood not that we can't learn those things but i think we may need to get away from his statement of it and just get into right like what it means for you but any thoughts on those things that I put forth. Well, my association to a number of the things we were just talking about, and maybe this is a usefully clarifying thing as well, is that people who have disavowed anger, who disavow their anger, are not necessarily people who aren't angry a lot, in the sense that part of the irony, one of the other important framing ideas that for me goes with understanding disavowed emotions and perceptions and motivations and so forth is that we get caught in vicious circles in our lives. This is what I call the cyclical psychodynamic point of view, where the nature of what our internal states are, the wishes, conscious and unconscious, the anxieties, the conflicts, lead us to act in the world in certain ways. and then other people respond to the way we act in the world and that feeds back to either maintain or change our internal state. And one of the things that often happens when people don't make room for their anger because we can't thrive in the world unless we're permitted to be angry. You know, just like we can't thrive unless we're permitted to be loving, unless we're permitted to be dependent, unless we're permitted to be competent. You know, all the things people can struggle with. Anger is important in that way. And when we disavow anger and we have to always be the opposite, You know, the old-fashioned term, not old-fashioned, but long-standing term, reaction formation, you know, where the angrier you get, the nicer and sweeter and more helpful and cooperative you are to push the anger down. When that happens, that sets things up that we get taken advantage of in various ways. And the result is it's likely then, ironically, to stir still more anger, which we then have to once again disavow, push down, push away. And sometimes the frustrations of those experiences can lead us to explode so that somebody who has disavowed anger can also be problematically, explosively angry at times and then humiliated, ashamed, guilty and rededicated to pushing that back away. So it's not always so simple as it's either there or it's not. It's that in a way, the more comfortable you are with being angry rather than being an angry person, but having access to anger when it's more or less appropriate actually enables you also to be more effective when you express anger and more appropriate. Not being in a way excessively angry, but being effectively angry. when it's integrated. Yeah, I think it's like what I'm hearing is that when you don't have conscious words for the anger, it gets acted upon, reaction formation, so maybe someone goes and cleans the house instead of being angry. And then resents being stuck cleaning the house. That's another important part of it. You know what I mean? Because then the anger gets refed and then the house keeps getting very clean, but the person inside is feeling more and more frustrated. Right. Yeah. So that's an example. Other people, patients I've had, you know, I ran a psychosomatic intensive outpatient program for about 10 years. A lot of the patients had chronic or chronic psychosomatic issues from the anger. Right. I myself, when I suppressed anger in the past, could get migraines. So there's like different things for different people that they store it or they act it out. They're not usually, when I think of disavowed anger, I don't think of someone yelling. Are you in the same boat? They're not like fighting or yelling. That's not the type that we're talking about. Generally, that's true. I think the reason I was adding that example of sometimes there being outbursts is that I didn't want to sort of have a picture of it's all just buried. You know, it's a continuously, it being any human experience, is continuously ongoing, evolving, interacting with how other people are responding to us. And so there are what I wanted to just highlight was that somebody where it would really be diagnostically accurate to say that one of their central issues is that they are enormously uncomfortable with being angry and keep trying to push it away. that somebody can have that struggle and yet every once in a while be inappropriately angry, look very angry. They don't always have to be a kind of milquetoast, quiet person, though often, I mean, that's sort of the most common presentation. And even for the kind of person I was just describing, they will often be overly nice and overly cooperative. But then every once in a while, there's this explosion. I've been so nice to you. I've done everything for you. And they're reeling off the list of all the things they did kind of under internal duress that maybe even the other person didn't ask for, but that they were excessively providing. And then every once in a while, they get really pissed off about that and that the it's not inconsistent with disavowed anger to for there also to be occasional you know expressed anger but what usually is the case is it's not effective expressed anger yeah i i'm associating to this kind of thought that women tend do not like to date nice guys, right? And what are we really saying? I think we're saying that women don't like to date guys who have disavowed anger issues, who appear nice externally, right? But maybe don't have that part of themselves integrated. Any thoughts on that? Well, I think being a man, I'm in the position most men are of not, I have to confess, not fully understanding how the world looks to women. Obviously, I try to, and I think I'm as good at it as most men are, you know, the average man. But I think there are mysteries, you know, we each have about each other. And I think some piece of it probably is, you know, whether it's biological or whether it's just the way our society has structured things, there is certain kinds of strength and assertiveness have been associated with masculinity. It's something that's in the process of being reexamined and changing. And there are all sorts of I certainly don't want to be stating those kinds of stereotypes as just the reality. But I think the perception when I've encountered women patients, for example, who are frustrated that they seem to always get involved with the wrong kind of man, so to speak, who tends to be a tough guy who is attracting them and they are not attracted to the nice guy and so on. That at least one piece of that is that the tough guy is more of a, seen as more of a protector, more of someone who will kind of create a safe, expansive environment. You know, there are all sorts of things that complicate these things. But I certainly don't want to be put in the position of explaining, you know, why women are attracted to certain kind of men. And I'll leave that to the women to say. I told stories that I think famously that every unhappy family is unhappy in their own unique way, right? Right. And so I imagine there's a number of issues. If a woman is attracted to dysfunctional men over and over again, yeah, I think it would be reductionistic to think that there's a singular thing. I think my comment is just that I think that sometimes not having conscious awareness of anger and the positive uses of anger. What would you say are some of the positive uses of anger? Well, I think, again, that we would be almost helpless without anger. You know, that that and anger, for example, there have been lots of kind of studies from the vantage point of evolutionary psychology and certain perspectives in social psychology that that talk about ways in which being angry. when it works best doesn't actually have to need have to lead to violent acts or even aggressive acts you know that that when we so much of what goes on between people includes signaling that neither party is fully even aware of. You know, that if somebody is doing something that bothers me and I begin to just sort of start to have reactions that are the precursors, so to speak, of getting angry, In good circumstances, the other person picks that up and retreats a little bit. In other words, I think that probably 90% of the interactions that involve being angry, the other person backing off when it's effective, occur without either party even noticing it, so to speak. They're the sort of small mini transactions. So anger is not just the big blow up It the subtle signaling to ourselves and to the other person When more angry behavior is necessary because the cues haven been picked up or the other person doesn't want to back off. You know, again, anger is a part of the human repertoire and we can't survive without it. But it also is often a symptom, you know, and I think this is consistent with things you were sort of implicitly pointing to a little while ago. It's also a symptom of frustration, A symptom of not living well, not feeling good about where my life is, what's going on in my life, how I feel about myself. The better we feel about ourselves, probably in most instances, the less angry we tend to be. But we can still encounter something that appropriately evokes anger. right so okay well you said that last that last line if if we're not where we want to be in life then anger may be the energy to get there or to overcome the obstacle i see it as like we're headed towards a goal as long as we're headed towards the goal we're not angry it's when there's an obstacle towards the goal that we get angry so just like an infant you know has a goal of getting fed, when they're not fed, they can get angry. They can reach out for mother. If mother misattunes and thinks, oh, they really want something else other than food, they'll continue to be angry until they get the food, right? And that's an interesting example. And I think it sort of also points to further interesting ways that the disavowal of anger can develop. Because if you, you know, babies are going to cry, you know, a lot and sometimes very vigorously. And even whether that vigorous crying is seen by the parent as anger itself is somewhat of a perceptual phenomenon. Is the child being vigorous and assertive or strong, or is the child being angry and annoying? You know, the exact same behavior on the part of the infant who doesn't have that many subtle variations in behavior. The parent's perception of it kind of begins to be fed back both verbally and non-verbally and sort of shaping. One parent sees a child screaming and kind of embraces that and thinks of, my kid is going to grow up to be a really strong person. And another parent seeing the exact same behavior is, this kid is really annoying and is going to put people off. and he's got to tone it down. And it's the same behavior. But one kid learns that this part of me is valued and heard and another learns this part of me is something I need to get rid of if I'm going to make any connection with the people I need to make connections with. And this happens, I'm putting it in words, but it happens much earlier than words and not in words. And I think in some way, one of the things we get wrong as therapists is that we try to put into words more than words can do, so to speak, in the sense that it is useful, obviously, and it's our stock and trade as therapists to articulate and put into words. But we also, a lot of what we do occurs outside of the words, at the side of the words, non-verbally, procedurally, implicitly. And that makes sense because a lot of what we learn about what is who we are and what is acceptable in us, that learning begins long before we have words. And I think when psychoanalytic therapists and other more developmentally oriented therapists point to that, to those very early origins, I think they're on to something really important. I think where it can go wrong is in then thinking that if I now tell you where it came from, that will somehow change it. And the only thing I think that really can contribute to changing it is more experiential, which is equivalent to how it was learned in the first place. okay yeah there's a couple things you picked up there one was my my labeling of the infant wanting the milk as anger could be in our culture seen with a moral attribution of negative this is a negative word um when i think of anger i think of something very different i don't think of it as positive or negative, like, or you could say, oh, the parent is upset at the anger and then subtly is then informing the child to maybe disavow that anger, right? The micro-expression is more what I'm zooming in on when I look at the infant. So with my kids, you know, I had already become an expert on reading micro-expression. So when they had disgust, when they had anger, you know, quick down and together their eyebrows, like I was reading that on their face. so i i wasn't necessarily putting a a moral attribution on it in my own experience of having kids but i can see why if a parent was doing that it would subtly inform the child in a non-verbal way because the child doesn't have a verbal linguistic ability to put words to these things yet, right? And so I appreciate that sort of non-verbal, pre-verbal neglect or trauma or stuff. It's like, how do you get to that as a therapist? And I agree with you that it's the experience of the patient in the room with you that will be taken away. you know do they feel held by your words so to speak do they feel like you've decreased their shame they're decreased their experience of what's going on is is really rotten or bad and the labeling of that as bad and and as i think another part of that is do they feel that what they are experiencing, whether they can put it into words or not, is engaged by the therapist. In other words, I think that in a way, if the therapist isn't able to see if the patient is angry, whether the patient acknowledges it or not, if the therapist kind of puts too positive a gloss on it, so to speak, and helps the patient, you know, sort of erase that part of their experience altogether, that limits the therapy. Sometimes what the patient may experience as most affirming is not even necessarily approving of their anger, if they're angry, but just seeing it, not pretending it isn't there. Because that kind of contributes to their having a part of themselves become invisible and unintegratable. You know, so we have to find a way to engage whatever the person is experiencing, you know, and to do that through our own filters because, you know, we're not just seeing reality raw and direct. We're seeing it through our own needs as well. Yeah, I like how you put that. And so it's like the therapist, are they seeing the fullness of the person in front of them or are they restricting what they see and glossing over what they see as like, oh, this person is not capable of any negative emotion ever, right? I almost remember, it makes me think of like the AI sycophantic chatbots, right? Where they repeat back to you only the positive about you, right? And they're trained, they're actually, you know, trained by humans and humans are like, oh, I like that response better than the first response. And the response they usually choose is a little bit, a little bit narcissistically inflating, you know, it's like a little bit negating of the, any negative aspects of the person. So, yeah. And what you're saying is interesting, and it makes me think of ways in which the idea of the corrective emotional experience, for example, is often misunderstood and constrained in exactly the way that you were just pointing to, you know, and illuminating. that very often when people think of the corrective emotional experience, they are mainly thinking of the patient's parents were critical and abusive and restrictive, and so the therapist will be kind and encouraging and open and so on. And sometimes that is very helpful for people. But if, for example, somebody grew up in a family where part of what went on is that the parents couldn't bear to even see their child as being angry at all and so just never related to that, the therapist engaging the anger and not glossing over it and maybe even clashing a little bit. can actually be a corrective emotional experience because it sort of relates to more of the whole of the person. And that was what was missing in the course of their growing up. I like it. Franz Alexander, corrective emotional experience. He was a mentor of one of my mentors. I see. And my analytic therapist, he was the analyst of that person. And so there's some linkages to myself there as well. I appreciate the idea of corrective emotional experience. I think also it links back to this sort of pre-verbal stuff that you're talking about, where it's like experientially something needs to take place, which is another reason why AI therapy will never work. If the therapist is too positive and is not seeing the fullness of the person, that this person could have anger, could have upsetness and that this is part of their experience, they may be, in a way, having an enactment to what the parents were like. The parents could not see that their child was ever angry or maybe could not tolerate their child's anger. Right, right. And neither of us are advocating therapists be angry in the room and nasty and so on, but we are, I think, both saying, a grounded response to as much of the reality of the other person in the room as we can and responding in our fullness to their fullness, even as we are also sort of stepping a little outside of it and thinking about what is good for the patient in a way that we don't require them to think in terms of what's good for us. So, again, if they're totally, you know, if you have a patient who is constantly canceling sessions, constantly, you know, doing all sorts, you know, not paying their bills, whatever it is, you know, then it's appropriate for us to think about they're not thinking enough about us, you know, that we're not saints. And if we were saintly, we would be ineffective. You know, that's another part of that, that if the patient is acting in ways that really are hostile and inappropriate, you know, just criticizing them is not going to be terribly helpful. but engaging it and countering it and taking ourselves seriously enough that we often, that's a way that we can model a healthier way of dealing with displeasure with somebody else's behavior. You know, that if we always have to be just sort of blandly warm and accepting no matter what's coming at us, that's a pretty poor lesson for the patient because that's not what we want for the patient. We want for the patient to be able to be self-protective and considerate of other people, not just one or the other. Right. There's a bit of what Nancy McWilliams has talked about, moral masochism, where we can suffer and see the suffering as endlessly helpful. For example, if the patient was no-showing and not paying for no-shows, something like that. But yeah, so there are ways that the patient can act out devaluation type of things towards us. And I'm curious, like, what do you do? How do you verbalize that to a patient? Like, let's say I'm someone who is behind on paying you. What would you say to me? Well, I would first just point it out sort of factually, you know, in the sense of, you know, I sent you a bill last month and it had already a past due amount and it hasn't come yet. and I would see what the patient says about that. If that is sufficient, then it's sufficient, so to speak. If it still continues, so we've talked about this now a number of times and the payment hasn't come, what's going on? I would first still phrase it, in, you know, relatively positive terms, not abusive terms, but kind of upping the ante a little bit. And then if it still doesn't happen, then I think I'd say, you know, I don't know if we can continue or, you know, is this your way of saying we need to stop because we can't just keep going this way. And then I would be likely, and this has sometimes been helpful with a couple of patients to sort of step back for myself and think about how does this person interact with other people in the world and what have been the consequences for his life of treating other people this way. I might say I'm beginning to have the feeling that you're treating me the way you were treating your wife when she left you, or that you're treating me the way you, in the kind of flippant way that you've, you know, interacted with your boss where your job has been in jeopardy. There's something in the way you get into these patterns with people, and now it's happening right here with me that not only gets the other person really annoyed, and I am feeling annoyed now, I have to acknowledge that, but ultimately makes your own life really difficult. So let's take a look at, you know, if you're not paying me because there's something about what's going on between us that you're pissed off about, let's talk about that. Let's see, what am I doing that you're pissed off about? Obviously, exactly what I would say would depend on what was actually going on. Because each person is different. I feel like if we broke into a role play at this point, I think it might actually serve the audience well. Uh-huh. We can try that. You know, I would, you know, we have to tip the audience off, so to speak, that not only they, but I am coming in in the middle of the movie. So I don't know, you know, ordinarily when this would have been going on, we would have had a history together, which would inform how I would respond. But let's try it and let's say, yeah. And if you're one of the small percentage of my listeners who don't like role plays, I encourage you to voice your frustration towards me in the comment section. No more role plays. And if you love the role plays, then you can voice yourself as well. Okay. Well, Paul, I will say that I don't think there's anything going on. You know, I'm just busy and I've forgotten to pay you now for a month and a half and I'm going to. Yeah. And how much confidence do you actually have when you say that? Take a second and look inside you and say, you know, is this just something you're saying to get me off your back? Or does it feel truly grounded in you? And take a second to look at it. Hmm. Well, there's a part of myself that thinks I could get busy again and could forget. But I'm hearing from you today that this is very important, that I may not be able to see you anymore if I don't pay you. And so I feel very confident that I'll be able to pay you. Well, let's just think about something that may be possible. Because, you know, when I reached a point of frustration that was probably greater than I intended, but it was genuine and you saw it and you felt it. and I talked about our possibly having to stop, you looked almost like there was some part of you that felt some almost relief at that. And I'm wondering, is there something that might otherwise, if we were really digging into things, that might otherwise be coming up, that if we stopped, won't come up. Yeah, it's interesting. You caught that I felt some relief. I think there's a part of me that doesn't think you would care if this ended. that's a big thing that's a really big thing yeah I'm not sure what else is there um well maybe so I think when I saw that you were potentially going to end things it kind of showed me that, yeah, maybe you are okay if this ends. So you were concerned maybe I would feel some relief also if we stopped. Yeah. I think it's hard. I think it's like there's a part of me that says this is not something you really want to do. and you know as I'm thinking about that and I'm paying attention to my own experience that I would actually feel very disappointed if we had to stop I'm I'm thinking that in some way you have a sense that there's there are sides of you like being the guy who's just not paying his bills, that you want to know if I can accept that and relate to that. And, you know, we have this kind of paradox here of sorts where I've got to pay the rent. So concretely, I do need to be paid. But that doesn't mean that I can't bear being with the guy who's got a lot of feelings that maybe you think don't belong in some way. That there's, you know, stuff you're feeling and you're not sure I'm the guy who can bear what you're feeling. I don't know if anyone, it's not like I'm sitting here, Paul, thinking, oh, there's another person out there that could bear this better. Maybe no one can bear it. Yeah, I think, you know, I think that sometimes is how it feels to you. No one can bear it. Yeah. I'm not sure. yeah, it feels weighty. Like coming, telling you all the stuff I've told you, it feels like, well, I almost feel bad that I haven't paid now. Thinking about how it must feel to both receive it and then not be paid would feel even worse. Well, I don't think either of us have as our goal for you to feel bad. and I would like you to pay the bill. I don't have, I'm not wanting you to feel bad about not paying the bill. I'm wanting you to, first of all, start paying it, but secondly, and more important even in some way, to get a sense of what was keeping you from doing it. You know, I think in some way, this moment, which we're still trying to figure out our way through right now, this kind of hard moment between us, that that's maybe what not paying the bill was trying to figure out. That what's it going to be like? You know, like I was pissed off at you. That was real. That was real. So what it like to be with me when I a little pissed off at you and I actually still here and still talking to you Do I look at me right now? Do I look like I'm withdrawing from you or like I'm just letting you know what I'm feeling? You're not withdrawing. yeah you you uh are letting me know what you're feeling and it makes sense and i honestly like i don't know if i was aware like i think i wasn't even thinking about not paying it was like it was not something that i was going about my day thinking about um but i think that the thing that comes to me is uh yeah I think I don't want to be too weighty to anyone there's something about that say more about that what would be too weighty uh well I guess I'm just confused on why that would keep me from paying the bill. Well, let's not so much try to figure something out here as just let's try to make room for what you are having a hard time really believing I can stay engaged with. I mean, I can tell you have stayed engaged, which is a little bit surprising. but then something in my experience says that it's uh that that may change or something in my i i i i get the sense that that may change at some point Yeah. All right. That's really important. And now we got to do one more thing to see if we can feel together like we're not bullshitting each other. And that is not in your head, but from inside, what could make that change? What could make me withdraw? And don't think it, but feel it and half do it. I mean, if I didn't pay, you would withdraw. Like, that would be... That's the simple one, so to speak. That's the simple one. And we can both sort of attribute it to what our accountants are telling us, but that's not what's important right this moment. you sensed that you had almost like dared to trust me a little bit and that then made you think i better not and you had some inkling of okay i'm with you so far but i sure wouldn't be if you took the next step okay i see yeah i think that there's a thought if i continue eventually and you really see me you you will withdraw and if and you'll see what in particular uh i'm not even sure parts of me that i hide from maybe parts that i don't even want to see parts that I know but don't want to say out loud? Well, see if you can say it out loud. Hmm. This is where I feel like we need to pause it. Right, yeah, no, because after all, you're still David, and I'm talking to the hypothetical patient, and so you don't know him any better than I know him, so to speak. I would be... Yeah. well i i think that there's um i mean i first of all i used your first name on purpose and i you know like i imagine that that was like um being a little bit too casual of a pay for i don't know patients usually probably call you dr rock rock towel right no actually most of my patients do call me paul okay and in fact i'm often struck when a patient doesn't they they And they do it even without my telling them to. They sort of pick it up somehow in my style. So almost all of them do. Okay. I think that a lot of what we talk about before this role play is kind of theoretical, but I really do enjoy this mock role play. It feels to me like I can understand how you do therapy. And I think you're modeling that you can't have emotion, right? And that that then may allow the patient to feel like they can have their experience. Yeah. No, I think you're right. And I think that's important that I don't, it's not often in my practice that I say to a patient, I'm pissed off at you. I mean, that's certainly not what I teach my students as the first, you know, here's how you do therapy. You tell the patient you're pissed off at them. That's unusual. And I think I was doing it in a way to model a certain kind of getting real with each other. because I think the way I had constructed this scenario, again, without really knowing the patient, was that the not paying was a way of avoiding something else. It was a way of expressing something, certainly, but it was also a way of avoiding something, especially because he was describing why he didn't, I just get distracted, I'm busy, etc. He wasn't owning it as anything intentional. And so I was sort of role-playing it as somebody who is struggling with feelings that could be intense and generally unacceptable, so to speak, that would just be sort of written off blandly as I just was busy. I didn't get around to it. And so I was trying to make sure I was engaged with the person and trying to create a kind of a little bit of a hothouse at that moment where he felt both called upon to come out with a little bit more, but also to notice if I was engaged or withdrawing from him. You know, in a, you know, in a quote, real case, so to speak, the specific might be different. I mean, at this point, I was, you know, we were both creating a fictional character, so to speak, so we don't know for sure what was relevant. But what I think maybe a different way of putting it is that, and it came up at one point when you, as the patient were saying something like, well, maybe I just don't accept me or something like that, which is a kind of an abstraction. It's kind of a terminology that we kind of learn verbally. And that what I was trying to do was to get him to come out with it, by which I didn't, I wasn't thinking out with it in terms of let's reveal the secret, but out with it in the sense of let's experientially interact with whatever it is he was avoiding. In that sense, I was trying to invite him out into the interaction more. And so I'm curious how it felt experientially at the other end. i think experientially i think this it's interesting with you in particular with these role plays i find myself being able to act very poorly and instead i pull from like my own experiences more um which i think uh and i think you start picking up on little threads uh of my own experience i think last time it was we talked we were talking about chess and um the disavowal of aggression that the father may have had uh by flipping the board uh and allowing the kid to not lose right which i had never thought about before but that's that's possible right so i think the trouble with continuing to go it's like it's like um there you know it gets into like it's it gets like uncomfortable in the way that it would be comfortable one-on-one with you i think it's uncomfortable doing it in front of 20 000 or 50 000 people yeah and and and especially where on top of all that, there's this ambiguity of what's you and what's this hypothetical Maydard patient. Yeah, yeah, yeah. And there's a mixture sometimes, right? And that makes it even more real. I did a very long role play with Shedler and it was like a role play of one of my best friends and all of the stories I've heard from him. But mixed in some of my own experiential aspects, you know, as probably all actors do. But yeah, it's fun, but it's also like, it's getting a little bit too hot for me. Yeah. And it's, you know, it's interesting because I, right at this moment, I feel in my body a certain like exhaustion, like I've, you know, like because I was into, I was in a sense almost, It's odd because I was being myself, but I was also role-playing myself. It wasn't necessarily what would actually have happened in my office, because it obviously would depend on exactly who the person was and what our history was and so on. But I was getting into, I guess, a certain, you know, a role, an interactive role that was also designed to illustrate something. And I think what I was trying to illustrate is the difference between kind of asking a question, trying to get an answer versus trying to promote an experience. so that I was not trying to get the patient to reflect so much and be able to verbalize, though at other points that might have been also something that I would be trying to do, but trying to create circumstances where he could come out a little bit of wherever he had retreated to. You know, because people can be very forthcoming as a way of retreating also. You know, that what was the part of him that he sensed just maybe even just peripherally he was keeping under wraps. And it was the aim is not so much for him to know what it was. Obviously, that's also a value. but to experience actually feeling it, expressing it in relation to another person. And then I was also at that moment calling his attention to watch me and see whether I'm withdrawing or whether I'm still engaged. because he was feeling, you know, if he was really himself, I would disengage. So I hear that there was something about it that was exhausting for you, you said? Yeah. Fatiguing. Yeah. I mean, not in a... Like in a counter-transferential way? In a counter-transferential way, but also in a way that it's like, you know, there's a kind of exhaustion, let's say, like after an athletic event, and it's a positive exhaustion. Okay. You know what I mean? There's another kind of exhaustion where when you can't reach, what I find is when I can't reach the patient, when there's a kind of blandness and the person is two or three steps behind who they are, I can get exhausted. I can get tired because it's sort of like nothing's coming. There's a dissociation away from all of their experience. A lot of their experience. So you feel, yeah, I feel that too sometimes. Yeah. And that exhaustion, that's a negative exhaustion. This was a kind of positive exhaustion. It was like, you know, the exhaustion after an athletic event. You know? No, I appreciate that. And I think good therapy is, it's, doing good therapy is, it should it is exhausting in a unique way and i i appreciate the differential there and it can be in a good way you know like i can feel very exhausted by the friday night it's funny um i play a lot of chess nowadays my son my son is really into chess so i've gotten back into it and i play in the morning and i'll have these winning streaks of like five games in a row on chess.com and i have a certain score so they're putting me against like people of my score and then I play at night and I'll lose like five games in a row. These are short games. And, you know, the work that we do is exhausting, right? In its own way, it can be good at the same time. Yeah, like you would feel good at the end of a sports match. Yeah, so I like how you put that. Yeah, and I think one of the things that both came up in the role play and that we're talking about as well and reflecting on the role play is that engagement is a very central part of what we try to do. And that itself creates these complexities and paradoxes where there are certain patients where I have to learn in a way to be less engaged. You know, that I have to learn that I have to be more subtle in my engagement, that too much engagement can feel threatening. Like I can think of a patient, for example, who every once in a while when we were talking about something relatively important, he would turn away. He would turn to the side like this. And I was very aware that some therapists, some schools of therapy would interpret that, would point that out because it was a defensive effort. And I instead made a very definite decision that I would not comment on it. I eventually did much later in the work when it felt like he was ready. But it felt like to comment on it would be like I was being the smart-ass therapist who was showing what I had noticed. And that would have been counter-therapeutic. He needed those breaks. he needed not quite as much engagement you know it was a different kind of engagement because i was attuned to him enough to not comment on it but i had to let him sort of take his breaks so to speak and then he could get back into it and i think if i had commented on it it would have made him retreat and it would have been less productive. So engagement is a complicated thing also because sometimes we engage best by not being so manifestly engaged. Yeah, I think what you're noticing is there's an intuition that develops on what you should comment or not comment on, some things that you comment on may be shame-inducing. And him needing that space from looking at you right in the eyes, I think gave you that sort of signal that maybe he, if I comment on it, it'll heighten his experience of shame that he might already be having. Right, exactly. Which might cause him to disavow more, right? Because I think there's an assumption that we should reduce shame to allow for the disavowed or the disallowed to come forth. Yeah, and shame and also even, also potentially intrusion. You know, that if, sometimes I think a patient can feel almost too well understood, and we sort of, even if we are understanding it, we have to kind of keep it, you know, unstated so much because in a way, shame would have been part of it, especially if I called attention to it because, you know, it's behavior that's nominally avoidant, etc. But what he was also, I think, experiencing and why he needed to turn away was he was feeling, and he actually, I remember at least one occasion, I remember him talking about feeling really understood by me. And as he was talking about that, that was one of the times he turned away. And so in a certain sense, you know, another one of these paradoxes is, I was now understanding even his need to turn away But if I had expressed that, that would have felt like still more of an intrusion. Yeah, I'm thinking about this, you know, I have a perceptive son, and he, when playing him chess the other day, he beat me. How old is he? He's nine. um it's pretty good yeah he's he's getting good and he's he's got a brain for this you know and he could tell that i was upset you know and um and he pointed that out and there was part of me that was like yeah he's seeing this accurately but there's another part of me that's like i don't want to be upset. You know, like I want to be happy. I want to be purely happy for him, which I am. I'm like actually in, um, we got him a chess coach and the thing that I put in the intro thing as the goal is for him to beat me. Um, like what is Luke, what is my son's goal to beat his dad? You know? So I don't, I, I, I think I said something to him like, well, I think there's a mixture of things going on in me. I'm both very proud of you for beating me. And I also don't like losing you know but that doesn't mean i'm going to stop playing you one of the other nice things about that is that then he knew you know in contrast to the the father and son that we had talked about the last time that you were bringing up just before about knocking over the chessboard he knew that he had beaten you when you were really trying to win you know which makes the victory even sweeter so to speak yeah i think um i think it's like this this thing of you know i've thought about this with this chess coach like what what would it feel like for the chess coach to lose you know like it would be very like difficult yeah But at the same time, like, isn't that the goal of the coach to see their students surpass them? And so, yeah, I don't know how this, I think it relates to our idea of disavowed anger with this kind of like allowing, you know, our own kids to have a place of positive aggression. You know, like, yeah, it's okay to want to beat someone and that's good. And that's a part of life, right? is to compete and to do your best. And when he lost the other day at a tournament, I said to him something like, well, you know, I'm in it for the process. We're learning from our mistakes and we're trying to grow and, you know, it's a process, right? And so I think inevitably it's like, okay, how do we help our patients in that process as well? Not be overcome by their defeats to a place that they stop trying, but also not being afraid of being in the arena. Yeah. You know, what also occurs to me, because you were coming back again to the disavowed anger, and it made me think about something that I hadn't fully thought about until this conversation, which is that when I think about, As I first began developing the point of view that informs my work, looking back many, many years now, I think the examples that I mostly would offer in workshops or in things I wrote were some version of, I didn't call it then disavowed, I didn't use that terminology until relatively recently, but basically some version of disavowed anger. That that was what I mostly was initially focusing on. Obviously not exclusively, but a lot. And I don know how much that had to do with issues I was struggling with or how much it was that that a bad feeling It one of these affects or motives that are generally not so socially encouraged And what I'm aware of is that in recent years, more of my illustrations of disavowed feelings or motives or experiences have been disavowed positive feelings. feelings people who have trouble in wanting to be admired or wanting to be loved or wanting to be helped or even wanting to be understood in some ways that that those are actually often more subtle forms of disavowal like i'm thinking of i've had i've i've been particularly interested in recent years and can think of a number of people where this was the case, where they kind of learned early that wanting too much love or contact or understanding or affection, that that was what was most dangerous. And so they learned to be more or less self-sufficient, very independent people, go-getters and so on. But the need and the wish that we all have also for love and even protection and help and support and all of those things, those never go away. away they can be disavowed but they never go away and that what often happens in those instances is that the person starts to express it you know again because it doesn't just disappear so the person thinks they are asking for affection, for, you know, let me know how you feel, I feel very warmly toward you, whatever it might be, they think they're expressing it, but because it's been such a source of discomfort and anxiety, they express it in a kind of hesitant way that the other person misses. So an example that I was just writing about the other day, and I still haven't got the passage completely worked out, but was describing an interaction with a patient or telling me about his interactions with his girlfriend. And there was something that he was, he was both wanting more contact from her, more sense of feeling her caring about him, and also was worried about something in particular and wanted to run it by her and have her help him with it. And he said to her, and she, you know, like the hypothetical patient we role-played who was very busy, you know, she was busy. And in fact, part of what his early growing up was like is his parents had been very busy. They were nice people, but they weren't really that connected with him. They were always just busy with things. So that's part of how he early learned to be self-sufficient. So he said to her something like, boy, it's really beautiful out today. I think I'm going to go for a walk. I know you're busy, but if you want to come with me, it's nice out. and he thought he was basically his experience as we explored it was he was emotionally he thought I was he was saying to her I really want you to come with me I really need you to come with me she was hearing I know you're busy but if you feel like it you can come with me. So she said no, picking up on that side of his message. He then later felt crushed that she had rejected him. And then in these vicious circles that happen with people, having been crushed that way, he would be more likely the next time again to express it in a very hedged, hesitant, you know, I know you're busy kind of way. That would make it likely he would meet with the same response. So that for him, there, the wish for connection, understanding, help, affection, that was the disavowed feeling. Even though those are, quote, socially acceptable feelings, for him and his life experience, those were the feelings that were dangerous ones. And I've been aware that in recent years, maybe because I had given so many examples earlier in my writing about disavowed anger, I've been more thinking about and writing about these kinds of disavowals in recent years. I really like that. I really like that. I think that the wanting connectedness, but not knowing how to express it in a way to get it, and then it kind of gets reinforced by the way he asks it in a kind of hedged, non-assertive way. yeah that's really good i think i think more of the dismissing attachment style personas have a lot of this they're dismissing of the need for attachment superficially uh a lot of the times but it's like very important for them and they may not even be able to verbalize how important it is for them right right i think that i think i think putting in those attachment terms is very apt. I think you're absolutely right. And then I think what I would add to the way attachment is often discussed is that the dismissing attachment style or any especially insecure attachment style is not only an internal working model, but it's a working model that leads to behavior in the world that has consequences that then feed back again to very often contain that model. There's kind of a, oh, it's almost like a trope at this point. There's a bunch of funny videos of this trope that, you know, the male partner should never express any vulnerability to the female partner. And there's these kind of comedic sketches where the female partner is getting opened up to the first time and is then thinking inside of their head, like really negative things like, oh, I'm going to bring this out when I break up with this guy. And the comment section though is like, absolutely never express yourself. you know never say anything vulnerable to your partner and like just like hundreds of these comments you know so this there is a real belief that what you're talking about is like a conscious belief of wanting too much affection expressing it this kind of thing it's it's it's not only believed but it's been reinforced the point that people are seeing this as kind of like a trope yeah yeah and and i think as as is also implicit in what you were saying and it went back to something we talked about a little bit earlier as well that these things then become part they become crystallized in the culture and then that becomes a sort of another independent source of pressures you know that that we have cultural images of what men and women are like and and so forth that uh kind of become themselves self-fulfilling prophecies yeah i i think that um when i brought this up with sue johnson on an earlier podcast episode before she passed sadly um she was like naughty naughty that is a naughty belief and um i could see through through eft and uh through this kind of like you know putting to deeper words and vulnerable situations it often starts with frustration from one of the usually the pursuer partner and then underneath that is deeper emotions of fear and sadness but sometimes you don't get to that deeper fear and sadness without first experiencing consciously the anger and expressing the frustration yeah and and there are i think very few instances where it really is like just one emotion you know like there's this single latent content to the dream that that idea right yeah uh and you know i think dreams almost never have a single latent content that's that was freud's you know artistry and storytelling but dreams are in our a whole entangled set of all of the threads in our thinking and our emotions that sort of are loosened up when we're asleep but it's not really like you get to the singular motivation and you're you're sort of highlighting okay that's true and when we're awake too here here's coming full circle to what you're talking about. Earlier in your career, you talked about disavowed anger, and then you found underneath it, or maybe deeper, once you get through the disavowed anger, there's disavowed yearning for attachment, yearning for connection. And I'm seeing that in patients as well, and in couples in particular. It's like they wouldn't have the anger if this wasn't the most important person in the world to them. but in the midst of the anger, they're usually not going to be able to hold that at the same time as the anger, right? Well, I think the way I would think about it, it would be slightly different. I mean, I basically am resonating with what you're saying, but I think rather than thinking of one as beneath the other, I'm thinking of them all entangled with each other so that the anger can generate feelings of neediness, can impact the... The anger can be a defense against wanting affection and wanting affection can be a defense against anger. You know, that all of the discomforts are like a kaleidoscope, and they vary at different moments. So that the model of what... Certainly it is, I completely agree that at any given moment, one feeling can be beneath another. You know, one can be defended against another. But at a different moment, it can be the actual reverse. What's the constant is, is our comfort or discomfort at any given moment with a particular feeling. Yeah. I resonate with that. And I would resonate also with the thought that one who did not love would not also have anger. right because it's like you have to protect that which you love um and so there is this kind of like yin and yang mutuality idealization devaluation this merging of these different aspects of oneself and the cohesiveness that follows i think that's what you're talking about as like the goal of good psychotherapy and the goal of us as therapists to bring forth in our clients we have to embody that ourselves in our own journey um and i would add in i think that this all kind of like speaks to another thing i've been playing around with for a year or a couple years is reflective function and the the this this idea that our ability to speak to the attachment and to speak to these attachment dynamics can increase with good therapy and can increase when we get in touch with the disavowed yeah yeah i mean that's that's i think that's another good way of describing the aim of what we're we're doing and there there are you know i think you you referred a couple of times to tropes and i think that's that's that's a useful way to refer to it because we're dealing with tropes. We're dealing with a reality that is so multifaceted that we're mostly getting angles on what's happening. We're not sort of, it's not like, you know, we dig deep down and we get the nugget out and this is what it really is. It keeps changing especially because not only do our feelings keep changing but the circumstances our feelings are creating keep changing and the people we interact with change you know so that uh with two different people for example i you know with one person i may have greater access to one feeling and much less to another. And with another person, it could be just the reverse. You know, with one person, I can be easily aggressive in a sense, but it's harder to be sort of sincere and soft. And with another person, it's very easy to be, you know, kind of the warm, good person, but it's really hard to find how do I fit in the aggressive side of myself. And I think we all have that experience. that the very configuration of our personality is not a constant. It's contextually related, which doesn't mean it doesn't exist. It doesn't mean we're all just a product of the other. I think that's been a serious misunderstanding sometimes offered of relational psychoanalysis as if, you know, because it highlights a two-person point of view and that the experience in the room is co-constructed. Some people have read that as meaning the patient doesn't have an independent personality that they had before they even walked into the room. And that's clearly not what relational psychoanalysis means, and that's not what I'm saying, but this contextualization of it, I think, is really important. Are there any personality types? I think you talk about this a little bit before, this kind of idea that not all therapists will treat the same personalities, and there's some personalities that may not be a good fit. Are there certain personality types for you that you have realized are not a good fit, and you refer them elsewhere? are well um it's it's it's interesting here i am declaring to thousands of people who i don't work well with but uh it'll help future referrals right right uh but i uh i would say One thing that comes to mind most readily is I'm not very good with addiction kinds of problems and addictions of all sorts, not just somebody who's addicted to heroin or whatever. that I tend not to be that addictive a personality. I've gotten by other problems, but that one isn't one of them. And I don't mean just substances. I mean, like, for example, I'm aware that I can do better without my phone around than most people I know. People talk about being addicted to their phones. And again, I'm not presenting myself as a superior person. I've got my own problems. It's which of the things. It's harder for me to empathize with a kind of an addictive dimension. And I find even like my taste in movies. I love movies. But when I read a review and it sort of is a movie about addiction in one sort or another, I think it's probably, obviously there are exceptions, but it's probably not one that will be one that will really draw me in. so if that's a prominent part of the presenting problem that would be an example of someone were probably much better for me to refer the person i i also think and this is much harder i think for our profession as a whole the in a way almost like the next great advance if we do make any further advances, is likely to lie in the realm of referral. You know, that if the standard way of beginning a therapy relationship started with you're seeing someone just for two or three sessions, just for an evaluation, not of your problems, but of who you might work best with. And if we all became better at referring people, rather than just taking people into our practices, you know, because I think, You know, apropos what you were saying before about AI can't do the job, you know, that there's something in the chemistry between people. We don't just have technical skills that AI can sort of learn. But we're human beings with an emotional response to another person. and just the way we can't you know successfully marry or have a love affair with just anybody or and we can't even really become a good friend just anybody that's there are ways that pairing makes a difference i think we need to sort of learn more about that process because i think That's probably at the heart of when psychotherapy goes best is when the pair is right. It probably doesn't matter that much what kind of therapy the person practices as whether the pairing is right, as long as they're not practicing something rigidly. Okay. Yeah, I think that there's value there. I think I've gotten better at, after one session, having a gut feeling if this is going to be a good fit for me or not. I think that will continue to improve, hopefully. But I think as well, as a psychiatrist, I don't always have to see someone for therapy. They're often coming to me for medication. Right. And so I've had the joy of trying to think who they would be a really good fit for. and I kind of like, you know, as I get to know, like a dozen therapists in the community, you kind of have an idea. Oh, I think this person would be a really good fit. And I get excited when I hear like six months later from the therapist, like, oh, great fit, great referral. Yeah. And some psychiatrists refer to me, not because I'm going to be a great fit, but because they have no desire to treat this person anymore. or they're, yeah. So I don't know. I think good referrals are something we should talk about more and thinking about how to maybe think through that. That'd be good. Maybe a future episode. I think we should wrap this up, our time. Is there anything else that's kind of like on your mind still that you wanted to get out before we kind of wrap it up? I think we've sort of done a pretty nice job of going around the different dimensions. And I think, you know, the role play was interesting as a kind of a core event in the middle of it that probably gives further meaning to what we talked about both before and after it. So I'm feeling relatively content that we did a nice job together. Good. Yeah. I think hopefully people who are listening to this can get some more acceptance for their own disavowed emotions, experiences, both positive and negative. I think that positive focus was great at the end. I think that'll resonate with a lot of people as well. And yeah, if this was helpful, let me know, and I'll be happy to pass on a word to Paul, or you could reach out to Paul directly. Go ahead. What did you want to say? Yeah, no, I was just, you actually touched on what I was going to say, which is that I would be very interested, you know, people who want to contact me directly can, but also know, because you were referring to it earlier, that you get lots of comments on these. And if you get comments on our discussion, I would be very interested in just passing them along to me. I'd love to see them. Likewise, yeah. I know last time you said some colleagues who you didn't even know were listening reached out to you and said they had heard you and previous students. That's fun. And so if you're one of those people, reach out, send Paul an email. we don't like to only get negative emails we like positive emails as well but if somebody's got a complaint or a correction let me put it more positively a correction I am interested in hearing that too because I could probably learn from it yeah okay we'll leave it there for today very good thank you David Thank you.