Episode 241: Depressive Personality Style with Jonathan Shedler

Transcription and footnotes edited by: Al-Baab Khan, Joanie Burns, Jonathan Nowlin

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An Introduction To Depressive Personality Style (00:00:00)

David Puder:

Okay. Alright. Welcome back to the podcast. I'm joined with Dr. Jonathan Shedler to talk about depressive personality style. He has been on the podcast before talking about narcissism, obsessive compulsive personality, beginning treatment, and psychodynamic psychotherapy. We have no conflicts of interest to report. 

We will be doing a lot of role play today, trying to give a practical understanding of depressive personality dynamics, how it shows up in therapy, and how to start to help the person get in touch with their own needs, desires, and frustrations.  

Individuals with a depressive personality style are often professionally and socially externally “successful” with a warm, engaging, empathic presence, and invested in making other people happy.  Due to adaptive childhood dynamics, they developed an accommodating nature and can get stuck in relationships—even therapeutic ones—where their own needs, desires, and anger remain neglected, disavowed, and largely unconscious.

Depressive personalities are distinct from clinical depression; someone can have a depressive personality without necessarily experiencing clinical depressive episodes. Paradoxically, individuals with this personality style often appear outwardly successful and high-functioning despite inner feelings of inadequacy and chronic dissatisfaction. They typically struggle to experience genuine pleasure or joy.

Within psychodynamic circles, the concept of depressive personality remains influential, particularly through the work of Nancy McWilliams, Otto Kernberg and Jonathan Shedler.  They emphasize underlying dynamics such as internalized self-criticism, unconscious guilt, and enduring interpersonal patterns.

There are common patterns that show up in how they relate to others including:

• Introjection (internalizing negative experiences and anger).

• Turning against the self: engaging in self-directed criticism and punishment.

• Gentle idealization of others: coupled with profound self-devaluation.

Transference may include gently idealizing the therapist while converting dissatisfaction into self-blame and guilt. 

Countertransference reactions involving protective impulses, feeling the patient’s disavowed frustration or feeling their helplessness.  

This concept has a rich historical lineage. Emil Kraepelin first described depressive temperaments, highlighting their stable and chronic nature. Depressive Personality Disorder appeared as a proposed diagnosis in the appendices of both DSM-III-R and DSM-IV. 

Depressive personality style is represented in the DSM-V as Persistent Depressive Disorder. And in ICD-11, as dysthymic disorder. But here we will discuss it as a personality style. 

Can you talk about the historical context on how depressive disorder first came to be included in the DSM?

Shedler:

Yeah. You know, actually you brought up something that might be a useful little digression here, about the impact of DSM on how we understand personality. You know, just to be clear, the concept of personality disorders actually didn't exist in the literature prior to DSM. The way that came about is that the framers of DSM-III – you know, were published in 1980–  were, you know, very determined to produce, you know, like a medical taxonomy of, you know, psychiatric, you know, psychiatric difficulties. So, you know, they made a decision upfront: everything was going to be a disorder. Which plays out in, you know, funny ways, like before DSM-III people were anxious, but the concept of generalized anxiety disorder didn't exist. Anxiety was a state, not, you know, not a disorder you had. So, I mean, it really changed the landscape of how we think about, you know, mental health difficulties. Personality in particular, they left it out entirely. 

It wasn't even on their radar screen. Right. They had basically completed the entire, you know, development of DSM-III without ever taking into account personality. It was gonna go to, you know, gonna go to publication, and apparently very late in the game, somebody said, “Well, what about personality?” And it was added as an afterthought, literally an afterthought. That's why it was Axis-II in DSM, you know, three through, through all the variants of DSM-IV. Right. And since it had to fit in a taxonomy of disorders. They took every, you know, they took the major personality styles that were, you know, familiar to psychoanalytic clinicians at the time, ratcheted them up– ratcheted them up in severity, you know, sometimes to the point of, you know, cartoonish caricature–  called them disorders. And all of a sudden, personality disorders became a thing on, on the map. So a little, a little aside, but maybe relevant here.

Puder:

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

Shedler:

Of course. Everybody has a personality. Every human being has a personality. Every human being has a personality style. And the, I guess, unintended consequence– I'm pretty sure I, by the way, got that story, you know, directly from Bob Spitzer himself– I mean, that, you know, how personality became Axis II, came, comes right from the source. But the unintended consequence of that is: now we have several generations of, you know, psychiatrists, psychologists, mental health professionals who have no concept of, you know, personality– except if it's a disorder. So, you know, I do a lot of speaking and workshops and podcasts, and, you know, and it happens all the time. I'll say something about somebody's personality dynamics or personality style, and the person on the other end will start talking about personality disorders as if that's what I said. And you know, the way I look at it as there are certain kinds of patterns or constellations of personality that we see personality functioning, you know, that we see often enough that we can say, this is a recognized personality, you know, style. And they all fall on a continuum of functioning from, from healthy, high functioning to, you know, really very seriously disturbed. And basically what DSM ended up doing was teaching generations of clinicians: if personality isn't at the extreme of disturbance, it doesn't count, and we don't need to consider it. So we can talk about depression and isolation from, you know, the psychology of the person who has depression. We can talk about anxiety in isolation from the psychology or the person who has anxiety. But that's not really a psychological understanding.

Puder:

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

Depressive Personality Styles: Challenging Diagnosis and Therapy (00:08:55)

Shedler:

Well, yes and no. So, one thing that's important is, so just for the sake of listeners, you know, what is personality really? It, you know, it's, it's consistent patterns of, of functioning, right? That originates, you know, fairly early in life that consolidate, you know, by adolescence. And it subsumes, you know, patterns of how we relate to other people, relate to ourselves, how we cope with difficulties, our defensive processes, our organizing psychological themes, our motivation, basically, everything that we talk about when we talk about somebody's psychological functioning, you know, is, is really in the domain of personality. So when we say a depressive personality style, you know, it's pretty important to understand. It's not the same as clinical depression. You, it often, it often leads to depressive episodes that you could diagnose as depression, but not necessarily. So you could have people with depressive personality styles who are not in fact suffering from clinical depression. In principle, you could see someone with a depressive style who's never had a clinical depressive episode. And, you know, and lots of people have, you know, chronic consistent, you know, recurring depression who don't have depressive personality styles, right? They're, they're somewhat different. They're different things.

Puder:

Okay. So how would you define this?

Shedler:

Depressive personality style?

Puder:

Yeah.

Shedler:

Yeah. So it's a pattern of functioning in the world and a way of experiencing self and others where the characteristic features are, they're people who are very prone to negative affect especially shame, guilt, feelings of failure and, and inadequacy. The most defining hallmark I think of depressive personality is if you were a psychologically sophisticated observer looking at this person from the outside, you might think this person is their own worst enemy. So they tend to be inhibited about seeking and experiencing pleasure, right? Excitement, joy, satisfaction. It's as if there's something inside of them that's squelching their ability to allow themselves to enjoy that. And in some cases, they seem to not consciously, not intentionally, of course, but it's almost as if they're seeking out experiences that are going to cause hardship or suffering or unhappiness.

Right? In that respect, we can say they seem like their worst enemy interpersonally. People with this personality style, right? Actually tend to be pretty high functioning, right? It's generally not a disorder, right? It's, if you think of, you know, a spectrum of person, levels of personality functioning from healthy through neurotic through borderline to the psychotic, you know, they tend to be in the healthy and the, and the neurotic levels of functioning, right? Interpersonally, they often tend to be warm, engaging, empathic, pleasant to deal with. They tend to be people pleasers, right? And when they come into practice and into therapy, clinicians, and this is empirical, this isn't just my opinion. I mean, we have data showing this, clinicians tend to describe them as good patients. They feel really good about working with them. And the, the trap is the, the fact that the clinician feels really good, where, right, they feel good because the patient is easy to deal with.

They're accommodating. They're very appreciative of what the clinician offers, right? Right. So the clinician tends to come out of the session feeling like there's a connection, feeling like they're being helpful to the person. And the danger is, the reason the clinician feels good is actually not a sign of progress, but rather a symptom. And, the symptom is that they end up recreating the patient's relationship or patterns in the therapy relationship. And the patient's relationship patterns are that they're very oriented toward other people's needs and feelings at the expense of their own. So when they enter into a relationship, they tend in one way or another to devote themselves to making the other person feel good about their relationship, but often at their own expense, right? So the other person's needs get met, but their own needs, you know, don't necessarily get met. They come in and they repeat this pattern with the therapist so that the therapist ends up feeling very good about the therapy, right? Even though they both appreciate one another, but the patient doesn't change. That's the trap of treating depressive personality style.

Puder:

It’s Like there can be some gentle idealization of the therapist with, and if they have frustration towards the therapist, they usually turn that towards themself.

Shedler:

Yeah. They're not, right. The typical manifestation in therapy is they're not doing it right. They're not being a good enough patient. You know, they're doing something wrong in therapy. So, and you know, you often see it in therapy in a very direct form, like the therapist makes a mistake, which is inevitable. We all make mistakes, you know, every day. <Laugh> There's no such thing as a therapy session without a mistake, I don't think. And typically the patient who either glosses over it, brushes past it, so that Right. The therapist shouldn't feel bad about it, or the patient actively takes responsibility for it. Oh. Like, you know, it's not your mistake. I, you know, I didn't explain it right. I gave you the move, you know, I gave you the wrong impression. I wasn't forthcoming enough. I didn't tell you the, all the information, right. It's on, it's on me as a patient, not on you. But they don't do it. Right? 'cause they're higher functioning and the healthier, the neurotic, you know, level of functioning. Right? It, it's not, it's not idealization in the sort of icky way that you would see in narcissistic or borderline functioning, right? It, it, it's generally in a very, you know, engaging and appealing sort of way.

Role Play: Exploring The Inner World Of Depressive Personality (00:15:34)

Puder:

Yeah. So we have a role play. I have a, I love it, I have a character. I've been working on this all week. Maybe I've been working on this for years. I don't know. But okay. So, so I was thinking maybe this is like early on in the therapy. Okay. And so we could just start it off. Okay. Okay. Okay. I'm gonna try to get into person here. I like, I like how you said you have to embody something that's real. When you, when we were talking about this, 'cause at first I was thinking about doing Abraham Lincoln, right? And having Shedler do some, some therapy for Abraham Lincoln. 'cause I think he did have depression, real depression episodes, but I think he had a depressive personality. I really, I really think he did. 

Shedler:

Don’t know…

Puder:

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

Shedler:

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

Puder:

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

Shedler:

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

Puder:

Yeah and…You know, I think I think, you know, as a therapist myself. When I'm on, when I'm on vacation, it's like, I appreciate being on vacation. So I think I was just kind of leaning into that a little bit. And then you know, I've had patients who reach out during vacation and you know, sometimes you gotta you gotta talk to him and stuff. But I know, I, I, I just anyways, it's, it's heavy. I mostly for my father, it's weird. Everyone wants me to feel sadness. Everyone wants is like, oh, you must feel so sad. You know? We even had a funeral. It was, it was pretty short. But more, you know, and I would like, kind of, oh, yeah, yeah, I feel sad. And I would, I would kind of tell them that. And, but really what I felt was guilt, that I didn't feel sad. And I felt more like I should feel sad, but I don't feel as sad. So…

Shedler:

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

Puder:

Let's say this is like third or fourth session.

Shedler:

Oh, it's very early on. So I don't know. I don't have a lot of history. We're really just…

Puder:

Yeah. So you can ask, you can ask the history. Yeah. Okay. Yeah.

Shedler:

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

Puder:

Yeah. And I know, I know the first couple sessions when we were meeting, it was mostly about patient issues. And, and I, it's, it's kind of hmm. You know, it's, it's like, in my mind, I don't know why I go there, but I don't, I almost don't wanna burden you with the story of my father. Which I know you've like, consciously in my mind. I know you're, you're, you've been doing this a while,

Shedler:

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

Puder:

Yeah. Yeah. I so, you know, my father I'll, maybe I'll just start. You know, he left our family at around sixth grade. He was kind of in and out of our life afterwards. He was, he had probably true bipolar, you know, I didn't, I didn't know that back then, but I know that now.

Shedler:

Undiagnosed bipolar, then I imagine,

Puder:

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

Shedler:

Miserable. Meaning how, how so?

Puder:

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

Shedler:

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

Puder:

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

Shedler:

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

Puder:

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

Shedler:

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

Puder:

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

Shedler:

At you?

Puder:

At me, spit flying. His face close to mine, you know? Hard to predict.

Shedler:

Was there physical abuse also?

Puder:

Yeah. Yeah. There, there was, yeah. I mean punishment, just punishment that was random. It was chaotic. It was not, it was not like I did anything bad, per se. Or maybe I did, but…

Shedler:

Could, could you give me a a, for instance? 'cause Whatever comes to mind, just now.

Shedler:

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

Puder:

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

Shedler:

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

Puder:

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

Shedler:

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

Puder:

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

Shedler:

It sounds, it sounds awful.

Puder:

Yeah. And I think, you know, I have worked since I was 12. So, I would go to school, I'd work, do sports, go to work, come home at 11. Mom would talk to me from 11 to 1:00 AM

Shedler:

Talk about what? yeah, I'm sorry, go ahead.

Puder:

About her issues–things that have come up in the day, you know, and…

Shedler:

About her issues. You mean her worries, her problems. Things that were bothering her?

Puder:

Her anxieties. Her- the weight that she carries.

Shedler:

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

Puder:

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

Shedler: 

So let me make an aside for the listeners, because, right, I haven't really done much by way of intervening yet. I'm, I'm still getting the lay of the land, the psychological way of the land for, for you, for this patient. But I'm, I'm about to, this is gonna be my first, you know, actual intervention. So I'm just, I'm just sort of flagging this. I'm, you know, I'm about to do something that follows from an understanding of the personality dynamics that I see emerging. So jumping back in you know, I can't help but notice, I, I commented about your experience, you know, the, the burden of being in the role of having to take care of your mother, and your response was about your mother.

Puder:

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

Shedler:

You mean men that she was involved with?

Puder:

Yeah. Yeah. Like…

Shedler:

Romantically or sexually.

Puder:

Oh. Oh, you could hear, you could hear it through the…

Shedler:

This was happening…

Puder:

Holes in the walls. Yeah.

Shedler:

So this was happening right under your nose in your house?

Puder:

Oh, yeah.

Shedler:

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

Puder:

Yeah. And she would, you know, she would meet these men online, they would travel sometimes from cities away, lived for a couple weeks. I mean, these were not like, these were not like my teachers, my coaches, who I, I looked up to, these were men that I hated or just disliked.

Shedler:

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

Puder:

You know, I think I kind of figured it out how to take care of things. I, you know, and I've, I felt a lot of responsibility.

Shedler:

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

Puder:

I mean, I think at around that time, like see, I'm, I feel like I'm like really giving you too much here.

Shedler:

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

Puder:

Well, I mean, I've, you know, I mean, it feels like I'm burdening you too much. I feel like this is gonna be too heavy for you- like, it's gonna be like a lot that like…

Shedler:

I just can't, just as an aside, this is, you know, very fast. I mean, if this were real therapy, this would likely unfold over, you know, more sessions. But, but I wanna be able to, you know, I wanna be able to illustrate working with something here that so, yeah. If this were in real life, this would be pretty abrupt. But you know, I wonder if something is going on here between us that, that is similar or a, a continuation of, you know what you're describing, growing up with your parents, because I mean, your mother was supposed to be taking care of you, you know, taking care of your, your needs physically, emotionally. She would burden you with her problems, her anxiety. She'd keep you up until 11. And I, I get the sense that it felt like your role was to not burden them, right? Not protect them from having to deal with your needs, your feelings, you know, your distress. The little kid having to fend for yourself. You are sort of protecting them from your needs. And I wonder if there's something like that that is continuing here with us when you say, you don't wanna burden me, or it's too much for me.

Puder:

Yeah. I even and I, and I may have misspoke earlier. She would keep, she would keep, I would get home from work at 11. I mean, this was like in high school junior high school. And then I would, I would be listening to 1:00 am I may have misspoke, so I apologize for that. But 

Shedler:

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

Puder:

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

Shedler:

Well, yeah. Well, I mean, the ways that I might be like, or not like them, I mean, I mean, that's something else for us to talk about. But, but just at the moment, what I was really getting at it, it wasn't so much whether I am, you know, like them in reality or not, but I was noticing, you know, your, you know, impulse to wanna protect me, or your feeling that, you know, what you were telling me was, you know, too much, too much of a burden. You know, it brings me, brings me back to where we started, you know, which is your father just passed away, right? I mean, you, you must have very complicated feelings about it, to say the least. And, you know, you felt like reaching out to me, it was the same thing. You shouldn't burden me. I was, you know, I was off, maybe I was on vacation, maybe I was teaching, whatever. But you know, you, you shouldn't, you shouldn't ask for that from me. And Right. And I, I wonder if, if it's of a piece with, you know, you start to tell me about, hey, how difficult things were for you growing up, how alone and uncared for you were, and you know, your, your thoughts go to, it's too much for me. You shouldn't, you know, you shouldn't burden me with this. 

Puder:

Mm-Hmm. Yeah. And, and like, I think…

Shedler:

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

Puder:

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

Shedler:

Well…

Puder:

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

Shedler:

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

Puder:

Yeah. well, like, like I talked to you in the first couple sessions. Like, it's, it's like whenever my patients are doing well, I feel like they're, I, I, I don't feel much, I don't feel much grat–. Like, I, I feel like that's like, okay, that's expected. They're paying me, but when they don't do well, it's like, I really, really ruminate. And…

Shedler:

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

Puder:

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

Shedler:

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

Puder:

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

Shedler:

Yeah. You were even feeling guilty about, about not– about your reaction to caring about your father's death and like, guilty that you weren't sad enough or weren't reacting the way you think you should have.

Puder:

I, I think most of the people who are close to me don't really know much about my childhood. I've kind of kept that in a separate container. Hmm. Because, you know, things are so different now. I think most people, most of my friends, they came from good backgrounds. They wouldn't relate to the squalor, the decaying wood, the holes in the wall, the cockroaches on the ground, the, you know, duct tape. So I, so I think most of them expected me to feel sad when he passed. And so most of them would like, get sad for me, and I would, I think there was a part of me that kind of felt relieved.

Shedler:

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

Puder:

Yeah. He would, you know, he would come visit and he wouldn't really interact that much. It was kind of hard to have a conversation with him.

Shedler:

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

Puder:

Ooh. I would feel, I glad to be rid of him– I I don't know if I'm there yet. I mean, I do feel some relief.

Shedler:

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

Puder:

Yeah. Well, thank you for…Thank you for that Yeah. Letting me have the space to kind of get in touch with what I feel. I, I think, I think it's like okay, so I, I, I haven't told you this about him yet, but he would call me and like, I would get these calls. He would be gone for weeks. I would get these calls from him, he'd probably a payphone or, and then he would be telling me on the, the phone. And you know, now it's kind of like, I think back, was he on drugs back then? I didn't know. Of course. You know, 'cause I'm young and he would say things like, I'm gonna kill myself. And he would keep me on the phone for, you know, and I wouldn't say things even back then, like, I wouldn't say, oh, you're the best dad ever. But I would say, dad, please don't kill yourself. Dad, please don't kill yourself. And so, yeah, there's a weightiness with, with those memories.

Shedler:

Well, what I'm hearing is how you ended up being the emotional caretaker for two parents, you know, like you were trying to be a little kid and trying to be a therapist to both of them at the same time.

Puder:

Yeah, I of course, you know, back then, it's like you never have the right words to say to make them feel better. And so…

Shedler:

It was your job to make them feel better?

Puder:

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

Shedler:

Yeah. But I'm, I'm, I guess I'm wanting to highlight something that I think was implicit in what you said, right? You, you know, you tried and you never could succeed or never could succeed enough. But implicit in that was it, it it just seemed very natural and normal that, you know, it was your job to make them feel better. Right? And now you're going on telling me why you failed at the job. You didn't, you know, you, you never could quite accomplish it or, you know, but it seemed, seems like in the background it's like, like, like the default is, you know, of course it's your job to make them feel better, right?

Puder:

Yeah. And and now I, I do that for my, you know, my work. And yeah. I think the patients that I'm not good at doing it with gets to me. But…

Shedler:

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

Puder:

Yeah. I guess I'd never seen- I guess I should, should have seen it like that, but I've never seen it like that. But that's, that's a, yeah. It's kinda like that.

Aggression In Therapy (00:44:21)

Shedler:

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

Puder:

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

Shedler:

I think you're doing an extraordinarily good job of maybe a little bit over the top in terms of the history, but an extraordinarily good job of, you know, of inhabiting a certain kind of depressive person. You know, and, and what I'm thinking, and I didn't say during the role play, but it's going on, let let you and the listeners into what's going on in the back of my mind, right? So here's a personality dominated by guilt, dominated by a sense that who, that the falling short or, you know, something about them is, is bad, you know, it isn't, isn't good enough. Right. Somebody who had that kind of depriving childhood would feel, right? This is a combination of what we call anaclitic and introjective depression, right? There's two different things going on. I mean, one is the absence, the loss of a real caretaker that every child needs, right?

Shedler:

And that loss, that, that stays with us, right? There's, this is, there's a, you know, it, it that gives rise to a, a, an emptiness within, right? That, that, that's a hallmark of a particular kind of depressive personality, right? That, you know, you, you sort of feel depleted and empty, and you try to fill that hole by, you know, bringing other people into your life and you by connecting with other people, except it doesn't quite fill it. And, and the connections are kind of a one-way street, not because the other person is necessarily requiring that it's a one-way street, but, right, because the patient is making it a one-way street. It's about what can they do for the other person, right? Rather than what can they, what can they get and take in that's meaningful to them? So that would be a kind of anaclitic– we call anaclitic depressive style, where the person is very sensitive to loss and relational disruptions.

Shedler:

But that's half of it, right? The other half that we didn't get to in this role play– which is why I was thinking of skipping ahead, you know, some sessions– is somebody mistreated like that somebody berated, yelled at, you know, the way your father, the way you were, you know, the way you were describing, I mean, it'd be less than fully human to not feel angry, resentful, deprived, you know, enraged about that. Right? It is not just that you feel like you know the other person, not just the other person, you know, the, the, the people that you're supposed to rely on to take care of you. You know, it's not that they just, you know, didn't do right by you. And, and you know, if you, it's not that you feel they didn't care for you well enough, they didn't care for you well enough in this particular, you know, this particular history that you're, you're giving me.

Shedler:

Right? Of course, you know, of course there'd be anger and resentment, and, and I, you know, I think we just heard just a whisper of that when, you know, when your patient said, you know, well, I felt relief when he died. Right? And, and of course, behind that word, relief is a whole universe, right? If you're relieved from something, that means that there was something that you were experiencing as, you know, you know, burden or, you know, as, as burdensome or oppressive or distasteful or, you know, you're relieved from something bad that you don't want. Right? It just hinted at that with the patient. And here's where you did such a good job of being this kind of patient, right? The patient's also very defended against their aggression. So they have a kind of introjective version mm-hmm. Of depression mm-hmm. Right? They have a kind of impossible internal dilemma. And the dilemma is they are angry, but it's not okay to feel or express the anger. Right? So when, in its extreme form, what this looks like in life is that the person ends up becoming a kind of a doormat in other relationships. Not necessarily because they're surrounded by people who wanna take advantage of them, but because they can't tap into, it's say, you know, constructive aggression to, you know, assert, express their needs, their wants, and, and so they go without. 

Puder:

And this is where [Otto] Kernberg's thought, which was so interesting, which I thought I would kind of pull in here, where he said when I asked him what was the main thing therapists need to learn? Yes. And he said, is to get in touch with their own aggression. Yes. And so, and I was thinking like, okay, so I was asking him about depression personality style, like how does that show up? Is that the most common thing he answers with that question? Which is kind of the answer to this person. It's like, where's this person's aggression?

Shedler:

Yeah. So that raises another issue. I, let's definitely make sure we get to talk about this. So do right? I mean, people gravitate toward roles in, in life that, you know, that are consistent with their personality organization and their enduring psychological themes and conflict and defenses. Anyway, that said, depressive personality style is the most prevalent personality style among people in the mental health professions. Right? And, and we'll talk about why, but let, let's, let's, let's stay with your patient for just a moment, and then we can expand to how this plays out in the profession. So the person is in a, a really impossible dilemma, which is they are angry, but it's really not okay to feel it, let alone express it. And, you know, well, what becomes of it? Where does it go? Right? Because the one thing we understand psychologically is you know, out of sight, out of mind doesn't mean gone.

Shedler:

It's still there, it's still having its impact, and you actually, you know, did a beautiful job illustrating it. If you are angry with someone, if you really don't like someone and you're angry and you wanna punish them, you know, what do you do? You treat them really badly, you blame them, you scold them, you shame them for your failings. You find fault with them constantly. Right? You're, you're depriving, you don't, you don't want them to have a good time. You know, if, if something bad is happening, you wanna rub it in, right? You mean basically, you know, if you're really angry with someone and, and you act on it, right? What do we, you treat the person like shit, right? Hopefully, most of us have the capacity, at least professionally, to feel angry, to be aware of the internal experience and not have to act on it.

Shedler:

But, right. If, if you, if you were really angry at someone and, and acted on it, it would do that. And what, what we see in this, what's called introjective version of depression, is the person is treating somebody– The, the, the, the person with depressive style– is treating someone like shit, but it's themselves. Mm-Hmm . And that's where you see the self-criticism, the self deprivation, the self punitiveness, which is empirically the hallmark of this personality style. Right? So it comes up immediately in that role play, but in a very small way. And it, you know, it's not, it's not present and palpable enough yet to, to work within the session. So I let it go by, but, but you wanted to call me. You wanted to call me, right? When you heard your father died, the reality is, for whatever reason, I wasn't there for you.

Shedler:

Right. I took that period off. Right. That wasn't your doing. Sure. I wasn't available to you. And, you know, I could easily, I imagine, I, it's, it's not a capital offense, you know, it's a, it's a small offense, a misdemeanor maybe. But, you know, anyway, I, I could imagine why a patient in that position would feel, you know, upset with me, you know, disappointed or irritated. Why, why am I not available? Right? And then your impulse is you wanted to, you know, reach out to me, you know, email me like, oh no, you shouldn't do that. Right? So, so what happened immediately was the thought, you know, I wasn't doing right by you transformed into, oh, you can't, you can't, you know, contact me, you wouldn't be doing right by me. Right? Mm-hmm. And that's a very, very small instance of, you know, that kind of, you know, criticism or punitiveness directed at the self, right? So if we put it just sort of cast it in high relief, you know, I, I'm doing something not, you know, not that I'm a bad person, but I'm doing something bad to you by virtue of not being available. And in your mind it turns into somehow you're doing something bad to me. And, there's the reversal.

Puder:

Yep.

Shedler:

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

Puder:

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

Shedler:

Yeah. That's why there's a lot here. That's why I thought it might be good to jump forward some sessions. Yeah. But, but the issue is the therapist is going to have all kinds of failings, not necessarily intentionally, perfectly reasonable things. You know, actually I've had interac– I can think of as very specific patient– I've had interactions like this with patients. The most recent one being someone who's also a psychologist, a very good psychologist, by the way. And, you know, and I'm not there when she needs me, expects me. And, you know, she feels bad.

Shedler:

About you know, wanting something from me. And, you know, and we had this discussion that was like lemme see if I can recapture it. It's kind of slipping away as I'm trying to put, as I'm trying to put words to it.

Puder:

It, it, it could have been a little bit dissociated 'cause it was, it was so painful, right? 

Shedler:

Yeah. Oh, it's coming back. No, it is. So I got, you know, got something wrong, you know, I misunderstood something. And you know, I felt short in some way. That was the reality was actually my failing, you know, a small one, you know, lowercase “f.” And, you know, she immediately took responsibility for it like you did in the role of play, you know? Oh, I didn't explain it right. I, you know, say it right. And

Puder:

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

Shedler:

And that's why it's so important that there's a person behind it. Yeah. you know, I realize I'm thinking with my patient, I'm trying to also, you know, protect her confidentiality.

Puder:

Absolutely. Absolutely. Yeah.

Shedler:

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

Puder:

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

Shedler:

So let's say I missed a session or I was late for a session. Or actually, let's use the example that you gave. I was away, I had something else scheduled and I canceled the appointment in advance- a good example. And I wasn't there for her when she wanted to reach out. And you know, when she starts very much like you did, you know, well, I really wanted to reach out to you, but you were away, you know, and I didn't, you know, I didn't wanna bother you. And I said, you know, it must have felt pretty shitty that, you know, I wasn't there when you, you know, otherwise, you know, otherwise, you know, count on me to be there. Oh, well I know you have your own life and you know, you were doing some important thing and you were teaching, and you know, and I understand, and you know, of course you didn't, you know, of course you didn't do it deliberately to, you know, so that you know, you didn't do it deliberately to, you know, not be there for me. Like I understand. And you know, the same thing happened with me and my patients. And, you know, everything you said, I said to her is, you know, everything you said is true. I did have a prior commitment, you know, I did let you know well in advance. Right. Right. It, I was, you know, just taking care of other business. Right. It wasn't meant to harm you or to all of that is true. Yes. I objectively had something else that I had to attend to.

Shedler:

What does that have to do with how it might feel on your end when I wasn't there? Right. All of that is like, you know, your, your conscious, logical, rational mind telling me about external reality, you know, of course there's very, very good– you wouldn't just not show up for a session, you know, just for the hell of it. Or, 'cause you wouldn't feel like, I know you wouldn't do that. You had to have a good reason. Yes, I did. But who says your reactions to that, you know, are like only what's logical and rational and reasonable. Mm-Hmm <affirmative>. Maybe there's some other parts of you in the mix that you harder to hear from, harder for both of us to hear from. So, right. I didn't even bring up anger yet. Right. Just, just, you know, you're giving me a very reality based, rational explanation for why of course it made sense that I would be away and she shouldn't have a reaction to that. But that doesn't subsume, right, the full range of our experience. We have lots of reactions that aren't so logical. And, and, and so what I'm doing is, in working with somebody like this, the aggression, anger and aggression is, is not going to come out naturally. Right. And we really have to very actively go out of our way to invite it in. Yeah.

Shedler:

So an example I use in my chapter is that, I think you read was the therapist is late and the patient says, oh, you know, I understand, you know, if you were running late, it happens, you know. No worries. Oh, I think it even came up in our last role play the one last time I was on your podcast. Right, and, and you know, nine out of 10 times as a therapist is like, you know, the patient's letting 'em off the hook and, you know, let's get onto the real work. That is the real work. The fact that the patient is so ready to let them off the hook and not bring in any other feelings except, you know, their positive feelings. That's the action. That's where the work takes place.

Puder:

Maybe, we can go back into the role play and, and it could be a couple sessions later. It could be the same session. But maybe yeah, I'd be curious to kind of play that out some around the theme of the difficulty of reaching out. Let's go into another session and I'll bring up, kind of another kind of moment between us, and we'll see how you deal with it. Okay.

Shedler:

And, and just to make it crystal clear, this is the essence of depressive personality and the essence of the problem, the challenge that we're trying to address in therapy, that the person is not getting their needs met in life, but the person who's obstructing getting their needs met is, is themselves. Right? Right. It's very, very difficult to get what you need, what you want, if you can't allow yourself to know it to know what you want. Right. This is the essence of the problem. The patient in therapy isn't getting their needs met for, you know, good reasons or bad reasons, realistic reasons are anyway, whatever. We don't hear about their disappointment, their frustration, their resentment, their irritation, we don't hear about it. We have to actively pursue that.

Puder:

Yeah.

Shedler:

Okay.

Puder:

Yeah. Okay.

Role Play: The Betrayal Conflict And Struggling To Name The Harm (01:01:10)

Puder:

Okay. You know, I had a dream between sessions that maybe I'll start out telling you that. Would that be okay? I don't remember a lot about it, but I remember I was in this church. It was kind of felt like it was almost falling apart like an old church, like it was kind of like a ruins of a church. And I go into a confessional and I start talking and then I realize that you're on the other side. And I feel, I feel like you know, maybe watching some of your X stuff, your posts kind of triggered that from the night before. I remember what, I remember reading a couple of them about the frame, about the importance of keeping the frame. And I was like, so I, I went to bed and I had that dream.

Shedler:

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

Puder:

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

Shedler:

Do you mean since you're a therapist too? You're not doing it. Right.

Puder:

Since I'm a therapist. Yeah. Like…

Shedler:

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

Puder:

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

Shedler:

Confess, repent your sins.

Puder:

Repent. Repent my sins. Yeah. So, so yeah, that's what I'm coming in with a little bit this week. And then I know we've been kind of talking about getting in touch with my frustration and anger. And I had one memory that came back to me, which actually felt like a tinge of frustration. I was, I think it was about 14 or 15, and I was getting something from the back of the car– from my mom's car. And I got really close to stabbing myself with a needle. And I'm like, mom, why is there a needle in the back of the car? And she said, oh, I needed the needle for you know, something medical that she was going through.

Shedler:

You mean like a type of, like a syringe?

Puder:

It was a syringe, yeah.

Shedler:

I was picturing a sewing needle for a moment.

Puder:

Oh, a sewing needle. Yeah. No, she, you know so she had picked up HIV at this point. And so when I, when I remembered this, I remembered at the time I had felt immediately like awful that she had HIV and that she had had to deal with that. But in the– when it came to me the other day, like it, I got tight in my chest and I was, 'cause I  was hanging out with my my niece who's about that same age that I was, and I was like, I can't imagine putting them in potential harm's way to get HIV. And somehow that hit me for the first time.

Shedler:

And that she was endangering you.

Puder:

Yeah. Yeah. I mean, I could have, I could have gotten, I could have poked myself like, I was so close to poking myself, you know.

Shedler:

You said at the time that you felt, what did you say? That you… not, not now, looking back. But you said at the time, you felt guilty or…

Puder:

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

Shedler:

You were feeling bad for her.

Puder:

Bad for her, yeah.

Shedler:

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

Puder:

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

Shedler:

You hadn't connected those dots until, until then?

Puder:

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

Shedler:

She was putting your life in danger.

Puder:

And like, as I say that right now, I feel like in some way I'm betraying her, which is a weird feeling, like, but I feel also, like she was kind of betraying me. I mean, it's like, I don't like, and part of me is like, doesn't want to believe that she would be so careless. But then the other part is like, she was so careless.

Shedler:

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

Puder:

Yeah.

Shedler:

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

Puder:

Okay. Okay. So, so, so I got, okay, so let's enter back in. Okay. Because I got…

Shedler:

So I'll, so I'll take responsibility for that. Right.

Shedler:

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

Puder:

Well, okay. Yeah. And patients do that, right? So that's like, of course...

Shedler:

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

Shedler:

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

Puder:

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

Shedler:

Yeah.

Puder:

And so I had this thought that I think connects the two. There's a verse in the Bible, and it says if you hate your brother, you commit murder. And I've always it's, it's it's, it's always been like a part of my ethic to not hate anyone, you know? And so I think after I had that thought about my mother that was, that was the same day that the dream came after. And I thought, like, I'm gonna tell you about this. 'cause I had some frustration towards my mother. But then I think for some reason that that sort of thought process comes through my mind that it's something bad, you know, to have any anger or like hatred, or, I'm not saying I hated her, of course. I'm just for some reason that that thought comes to my mind.

Shedler:

Comes to mind in connection with me?

Puder:

Yeah. Because in the confessional, I would be confessing that I murdered my mother with my hatred. That would, that's the connection I'm drawing.

Shedler:

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

Puder:

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

Shedler:

It's easier to be angry on your niece's behalf than on your own. Your niece wasn't the one being harmed and having, you know, and you know, who could've jabbed herself with a, you know, HIV positive needle, right? I mean, it was you, it is, it is easier to feel, it was easier to be upset on her behalf. And, and just so we don't lose this, because it, I feel like it keeps slipping away and, and maybe we both have a role and, and it slipping away that, you know, that the starting point from this was, was you feeling scolded, you know, by something I posted on social media or, you know, or, you know, feeling you were being, you know, told you were bad. And it's in the context of, you know, actually, you know, you are the one who's been wronged, who feels wronged. You know, I, I think there may be more to this than, than meets the eye that, you know, that social media post really didn't sit very well with you.

Puder:

Yeah. And I think hmm. Well, and I, I, I feel bad even for snooping on social media…

In between sessions, you know, I feel like I'm complicating the work here. I feel like I should be…

Shedler:

Another transgression on your part. 

Puder:

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

Shedler:

No, I'm not saying that you– I'm not, I'm not saying it's a transgression. I'm saying that you are treating it, you are talking about it as if it's a transgression. Right. It's a transgression that my post didn't sit very well with you. It's a transgression that you were even looking at my social media.

Puder:

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

Shedler:

I guess we'll have to see.

Puder:

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

Shedler:

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

Puder:

I, I feel like me sharing that would, would make you upset. Like, I'm blaming you for something that you haven't done. Like, I'm accusing you…

Shedler:

You’re worried that I would get angry, that I would berate you or explode at you. Sharing that is…

Puder:

That feels dangerous to me.

Shedler:

Is what? 

Puder:

It feels, it feels, dan– it feels dangerous.

Shedler:

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

Puder:

Mm. It feels, it feels like maybe I'm blaming you for accusing you of something, or…

Shedler:

Well, like, that's a possibility. You might be, you know, worried or expecting something that you know, isn't really so much about me. It's also possible you're picking up on something about me. You know, something about me in the background that we haven't talked about explicitly. Maybe there is something you're picking up on.

Puder:

Are, are you secretively angry at me between sessions?

Shedler:

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

Puder:

And I feel crazy even saying these things out loud, because I know that you're professional and you're, you know, you're an expert. I'm sure you don't dislike your patients. And I have no evidence to support that. And I, I also realize, like there's a, well, I, I may be laying this on too thick, you know, and I may be laying on too much of my, my own…worries.

Shedler:

I, I get you're working, I get the sense that you're working so very hard to be, you know, very reasonable and very fair. And what if you weren't so reasonable and fair with me?

Puder:

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

Shedler:

You think I'd wanna be rid of you.

Puder:

Yeah.

Shedler:

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

Puder:

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

Shedler:

Well, I think that's a very comfortable. We both know, we've talked about this, you know, it's a very comfortable and familiar role. You were training from it for you for that role since early childhood. Right. What I'm starting to understand, you know, in a different way now, is there's something about being here with me as a patient that that's very fraught for you. That you didn't say this in my words, not yours. So if, if I'm not getting it right, I mean, I hope you'll correct me, but that there's a, it seems to me like there's a way you're sort of walking on eggshells here, that, that at any moment, you know, I might explode at you or, you know, punish you or, or throw you out treatment entirely. And I know it not hasn't been in the forefront of your mind. It's not like you're, you know, you know, editing and censoring, you know, we are curating your thoughts is, you know, every moment to, you know, be careful not to, you know, not to offend me or not to say the wrong thing. But it seems like that's been with us in the background.

Puder:

Yeah. And I think for most I think that, that this is different 'cause You know, I think with my, like teachers, my coaches, that I got good things from, of course, you know, I'd, I'd find that that thing that they're interested in you know, and read a couple books on it, become an, you know, be able to dialogue on the thing that they're into. And I think that…

Shedler:

Your role was to be, you know, a very good student or athlete or, you know, and be very appreciative.

Puder:

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

Shedler:

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

Puder:

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

Shedler:

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

Puder:

I think there was something like very hypervigilant about me when I was young, to like, be in that role with my dad, with my mom. It’s hard…

Shedler:

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

Puder:

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

Shedler:

Yeah. Almost like it was, you know, your failing or your pathology, that you had to be vigilant in the way you were, the ways that you were, you know, rather than you were growing up with two angry, volatile, neglecting parents, you know, who could explode. Certainly your father, you know, at any moment or just disappear and, you know, and leave you to fend for yourself for weeks on end, as they both did. And Right. And it's like there's, you know, the sort of two parts of your right. I mean, there's the adult rational mental health professional who thinks about things in very, you know, rational and, and you know, and careful and accurate way. But then in the background, it's like, there's, as part of you that's expecting the same treatment from me, and, you know, feels like you have to be just as careful and just as cautious about Oh, you could say or do the wrong thing. And, you know, I wouldn't be here for you either. At best. I wouldn't be here for you either. I mean, at worst, I would actively attack you, or I should say, I would actively attack you too.

Puder:

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

Shedler:

Necessary to, I think that we were doing the best you could to survive that.

Puder:

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

Shedler:

Yeah, I think you're a hundred percent right. Right. There's no question about it. Right? It, it's, it's kind of your superpower. But, you know, like all superpowers, it also comes with a huge cost, right? Which is, you were focused on what you think the other person needs and wants and, you know, and your needs and wants go on the back burner, or don't get on any burner at all. Now, this was the place, if, if we had started with the first session and we had kind of gone through the process of we, why is the patient here? What is the purpose of our therapy? What are we trying to accomplish here together? Right? We would've done all of this beforehand. Right? This would be a place that I would refer back to that, you know, that's why you're here in therapy, or I'm just making it up.

Shedler:

'Cause We didn't have that conversation. But, you know, but you know, by objective, you know, external criteria, you're doing pretty well in your life, you know, good practice, successful in your career, you know, married, wife, family, but things feel empty and, you know, dark and sad and joyless on the inside, you know, that's why you're here. And I would exp– I mean, if that was the reason I, there could be many, many reasons if that was the reason, right? I'd wanna make a very explicit link between what we're talking about. Now. This is the sort of little micro instance of, you know, this superpower, I'm very, very, very good at accurately reading and responding to other people. I don't wanna take that away from him, right? It's true. Right? I mean, that's why a lot of people with this personality style are drawn to the therapy professions.

Shedler:

Right? And right. They have a kind of hypertrophied capacity for empathy, which can serve them very well, in Right. As a psychiatrist or as a therapist. But it can also come with a terrible price. So what we wanna do at this point is link it specifically back and say, you know, here's your superpower. You're very, very good at reading and responding to what other people need, but it comes at this terrible cost, right? That we don't, when I say we, I mean both of us, we don't always get to hear from what you need and want. Right? What would make, what would make an interaction or make life, you know, feel satisfying, meaningful, you know, allow for pleasure and joy for you. Right? So I'd link, right? Because they're flip side to the same coin. There's the superpower and, you know, and a real, you know, liability, not a liability that affects other people so much, but that gets in the way of you being able to live a, you know, a life that you can enjoy. Whatever the, you know, whatever we agreed on as, you know, this is what we're trying to do in therapy, which would have to do with, you know, why you came in the first place. What was your, you know, you came to for– I would take advantage of this opportunity to make the link, you know, this is why we're here.

Puder:

Yeah. Yeah. And I think and I, I, I think when I hear I should, it's, it's interesting because I know that I need to get in touch with my own feelings and desires. And I think that was one of our initial goals that kind of, we identified. And also kind of, you know, why am I extending myself too much at work? Maybe. Yeah. But I think part of the, the conflict is I've always had the, the philosophy of serving others has intense value. And, and and to kind of like put myself second, or to diminish my own ego and the importance of it.

Shedler:

Yeah. The– you had the philosophy. You know, a lot of people find meaning, you know, deep meaning in living their lives, in choosing to live their lives that way. Right. That's an option. What I'm concerned about, I think what we're both concerned about for you is it's not clear as of now, how much that's really a choice versus something that happens, you know, in an automatic, obligatory way. You know, like for instance, you know, you saw a social media post of mine, you didn't like it, it felt critical. It makes you concerned about, you know, well, maybe you're not in the right hands after all. Maybe I could be…

Puder:

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

Shedler:

Oh, no, I'm, I'm saying it

Puder:

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

Shedler:

Well, what I was getting at is, I, I'm not sure if it were so that you were upset by the post, or it made you worried about me. I, I'm not sure it would've felt okay just to say so. In fact, I'm pretty sure it felt not okay to say so. And right to, you know, to respond to what you said about, you know, your philosophy of, you know, how to live your life when I say, you know, it's a valid choice, but for you just, just here and now, I'm not sure how much choice there's been. And I think that's why you came to therapy in the first place. Right? It, it, it's entirely different to say, you know, here's something I, you know, here's the thing I want for myself. Here's something I desire. But, you know, there's other things that are more important to me that, you know, that preclude that. And, you know, and I'm, I'm going to make a choice, and I know this is something I want, but I'm gonna choose something else that's more important to me that, that, that's different than not being able to want it in the first place.

Puder:

I, when I, when, when I hear this, what I think about is I think about a quote that I've memorized from Dostoevsky: “I'm not worthy of happiness. My life is a series of errors, and perhaps this misery is what I must endure to atone for them.” I, I don't know why, but that resonated back in the day, like in college, and I memorized it. It's, it's interesting 'cause I feel like if I, like did I reincarnate from like, some awful person to, to, to go through what, you know, some of the suffering I going

Shedler:

Through it, it resonated because in very important way, I think it speaks to the story of your life, right? This, this was the family you were born into, you know, your role was to suffer and bear the suffering for all of your parents' failings. And, you know, to feel like that was your lot and what you deserved.

Puder:

Yeah. Yeah. And so I think this is, it's like something is shifting there. And maybe that's, oh, you know what? That's kind of come back to the dream. It feels like that that kind of ruinous building that I was in it feels like something is shifting. You know, like, like maybe maybe I can kind of look at things a little bit differently or maybe it that makes me…

Puder:

Go ahead.

Shedler:

Well, and make, when you said you, you, the ruinous building that you were in, in the dream, it seems like you just linked that right? Was right on the heels of my, you know, just saying directly how ruinous your childhood was. It seems like you just connected those dots that you were literally living in ruins in childhood with holes in the walls and cockroaches and hypodermic syringes and car seats and right? Your, your childhood and your family was the ruins. And in the dream, the dream depicts you as, oh, here you are enduring this and confessing your sins, right?

Puder:

Oh, yeah. Somehow it's, I still am blaming myself in the midst of that. Like, I'm like, like…

Shedler:

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

Puder:

Which part, which part? I think you're being hard on yourself here part about. I think it think is really good. 

From Obligation To Freedom: Therapy’s Role In Personal Choice (1:35:03)    

Shedler:

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

Puder:

Oh, really?

Shedler:

And a little, I thought so, yeah.

Puder:

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

Shedler:

People adopt a philosophy that solves…

Puder:

That solves their personalities,

Shedler:

Psychological conflict. Oh yeah. Right. Your choice of career, your choice of partner, your choice of, you know, lifestyle is a compromise.

Puder:

And that, and that's not to negate if a philosophy being true or not true 'cause It still could be true.

Shedler:

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

Puder:

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

Shedler:

And this is ultimately the goal of psychodynamic or psychoanalytic therapy. And I would say of all good therapy that's aimed at self-understanding, the goal is to expand freedom and choice so that things that were previously automatic or experienced as obligatory, right. No choices. Right. Become a matter of choice. That's the goal of the work. To expand, you know, to expand freedom and life options. And the person might, well, you know, in any given circumstance, make the decision to do whatever they would've done before therapy. But now it's a decision. Yeah. It's a decision made freely. And I'm a little mindful of the time– I wanna make sure we get this out that we haven't named it explicitly, but you and I are describing and working on the role play. Like this is really the essence of, of this depressive personality style that we're speaking about. That typically, typically a child growing up is deprived or mistreated in some way. Neglected, you know, in, in the most extreme case, you know, maybe actively abused, you know, more common cases, neglected, even more common cases. Like if you were looking from the outside in like a social worker, you know, his parents are adequate, maybe not neglected in any obvious, you know, externally obvious way, but emotionally neglected. But the child's experiences, they're not getting what they need, right? Because the parents aren't coming through. The parents are inadequate in meeting the child's needs, but it's an incredibly, incredibly dangerous thought for small child, small child simply cannot think this. Pretty damn rare, think I have bad parents. My life and my wellbeing is in the hands of people I can't count on. Right? Like, like, you know, this is not a thought a three year or a four year-old could wrap their heads around.

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

If the child thinks, you know, my wellbeing and my survival is in the hands of people, I can't count on that. That's just devastating. Right? So that's the essence of this personality style. Yeah. Yeah. And then it comes out, you know, a light year later, you know, in therapy and, you know, the therapist had to miss a week and isn't available when your father died, for god's sakes. Right? And your thought is, oh, I don't wanna burden him. Right? You, we could draw a line from that childhood experience. I'm not getting what I need and it's because I am bad. We can draw a line right? To, I shouldn't call my therapist. That would be a burden.

Puder:

Mm-Hmm <affirmative>. Yeah. So it's like the, the, the, the anger is turned into guilt. The, the transference is set up so that there's a, a gentle idealizing, and the anything bad from the therapist goes on to themself.

Shedler:

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

Puder:

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

Shedler:

Yeah. So we…

Puder:

<Crosstalk> Anything we haven't covered,

Shedler:

We have to recognize the core enactment, which is that the patient is going to treat the therapist in a way that feels good to the therapist. And now it's easy to enter this, you know, I'm just making this up as I go, but this kind of like therapy pseudo paradise where we both feel so good about each other and we're so appreciative and the patient is so appreciative of us, and we're happy for the patient because they work so hard in therapy and they pay their bills on time without fail, and they come on time without fail. And they're always appreciative of me and right. And, I feel so competent and so helpful, like such a good therapist when I'm with them. And what slips away unnoticed is the patient isn't actually changing in their life outside of therapy. Right? That's the issue.

Shedler:

And, you know, to get biblical about it, if we've created this sort of an elusory paradise in therapy, you know,  we need to invite the snake into the paradise, right? It's really not a paradise, it's an illusion of paradise. We need to get the patient's anger and aggression into the therapy, right? Because it's actually already there. It's just not there in a form that's being recognized and acknowledged. We need to make it possible. What do we have to do to make it increasingly possible for the person to bring in an, you know, increasingly larger range of their emotional experience, which of course has to include the whole, you know, spectrum of human emotions, right? Anger, resentment, rage, envy, you know, punitiveness, vindictiveness, right? These are all human emotions, but the, you know, person with a depressive personality style doesn't experience it that way, right? Like, well, maybe they're human emotions for other people, not for, not for me. I would never be that way. We wanna make it possible for them to experience and integrate a fuller, you know, fuller range of their emotional life.

Puder:

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

Shedler:

Exactly. And, and here's this is, this is the enactment. And there's where, this is where exactly where therapists, you know, go where therapy goes south in, in treating patients with a depressive personality style, right? Because the therapists are very likely to have a depressive personality style, right? It's a perfect mesh. And you, you think about it, I mean, the therapy professions are like, like an invitation you can't refuse to somebody with this personality style. What, what do you get if you go into the mental health profession, what does it give you the opportunity to do? Well, you, you get to focus, you know, intensely on other people's needs, right? Not that that's bad in its own right, that's the job. But you get to focus on intensely on other people's needs at the expense of your own. You get to constantly fault yourself, you know, however good you get at the work. Not, you know, perfection isn't attainable. Like I said earlier, you know, we're, we're all making mistakes in every session all the time. You get to fault yourself perpetually for falling short of some, you know, unrealistic, unattainable, you know, internal standard, right?

Puder:

A Jonathan Shedler, super ego

Shedler:

Right. You put your own needs on the back burner. And here's where I see this, just all the, I'm so glad you brought this up 'cause I see this all the time: the misuse of empathy as a defense for the therapist against the therapist's own aggression, right? So what happens in therapy is, the therapist is very, very, very empathic to the patient's hurt feelings, broken feelings, you know, the sort of needy child-like feelings needing to be taken care of, right? Empathy for that part of the patient, no empathy whatsoever for their envy, their anger, their aggression, their resentment, their vindictiveness, their competitiveness, their rivalry. All of those things are there. How do I know those things are there because they're human, right? But the therapist has zero empathy for that, right? So it's empathy, I would say pseudo empathy as a defense, both against the patient's aggression and maybe more importantly, as a defense against the therapist's aggression.

Puder:

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

Shedler:

And it makes a world of difference, right? Because that's information, it's information in the interaction, it's information in the counter transference. We don't wanna shut down that counter, right? There's,  three major channels of communication going on in therapy. This, I don't think you talked about this, but this really comes from Otto Kernberg’s writings, right? You know, one is the content of what the patient says, right? The other is the nonverbal things they express, you know, through facial expression, body language, tone of voice. That's the second channel. The third channel is the counter transference, what they evoke in us. We shut down that channel, or we should shut down, you know, important information that otherwise should come through that channel. And we're, you know, really, really limiting our effectiveness as a therapist, right? Yeah. We're having these reactions in therapy for a reason. It's information.

Puder:

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

Shedler:

Very serious looking person here.

Puder:

But do you see the down and together of the eyebrows? Like, it's like one 10th of a second. Yes. Boom. That's the micro expression of anger. Yeah.

Shedler:

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

Puder:

They saw something. Yeah.

Shedler:

And that's a good place to say, you know,  just to slow down there and say, you know, something just happened here. Yeah. I saw, you know, a reaction. You know, and so like, we went, well, you know, well, your, your expression changed. I wonder if we could just slow down here and notice what might come up. So we, right. So we notice, we notice what it evokes in us, and then we use that, that becomes a signal to us to invite the patient to slow down and notice.

Puder:

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

Shedler:

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

Shedler:

Kernberg is a living legend, you know, for a reason. I mean, I, I could just, <laugh> almost did actually in real life, but I, I should say, sit at his feet and just listened to him and take it in. Oh, yeah. And that actually happened, but I, I wasn't sitting, sitting at a dining table, but my experience was I could just sit here forever. Oh, man. And I mean, I think Frank Yeomans is one of the gifted master clinicians who, you know, who's publicly out there and, and teaching. And it just, I mean, every time I hear him, it's a pleasure. And I learn something every time. Yes. So I was very acutely aware, like, like <laugh>. This is, these are the people I'm following on your podcast. 

Puder:

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

Shedler:

<Laugh>. Yeah. It was kind of scary. <Laugh>,

Puder:

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

Shedler:

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

Puder:

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

Shedler:

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

Puder:

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

Shedler:

I highly recommend it.  For whoever's listening.

Puder:

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

Shedler:

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

Puder:

Alright, we'll leave it there for today.

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