Episode 260: What Is Reflective Functioning? Mentalization, Attachment Theory & RF Scoring with Dr. Miriam Steele
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What is Reflective Functioning? Definition, Link to Attachment Theory & Sensitive Parenting (00:00)
Puder:
All right. Welcome back to the podcast. I am joined today with Dr. Miriam Steele. She's a PhD researcher, psychotherapist, psychoanalyst, who was involved in the early studies on reflective function and the ongoing new studies coming out. Her husband [Howard Steele] was on a prior episode [see episode 213], and they both co-authored with Fonagy the Manual of Reflective Function [Reflective-Functioning Manual]. Today we're gonna be talking about reflective function. We're going to be talking about understanding how it can help us understand ourselves, how to increase compassion for ourselves where some of the gaps can be, and then where we can have some compassion increases as we think through our own journey, think through our own reflective function. So, welcome to the podcast.
Steele:
Thank you very much, David. Very happy to be here.
Puder:
So maybe you could start by just defining reflective function.
Steele:
Okay. So reflective functioning has to do with the capacity to think about thoughts, intentions, and feelings in oneself as well as in another person. And that capacity has been shown to be linked to responsive and sensitive caregiving in terms of parent-child relationships which in and of itself leads to something similar in the child in terms of their capacity to also put themselves in someone else's shoes. And it is becoming apparent more recently that it is perhaps the mechanism of change in psychotherapeutic work. So it started for us looking at the narratives that we prompted from adults in response to the adult attachment interview. And from those interviews that we collected, even before a first baby was born, we could predict something about the nature of that child's tie to each parent. And from there, it's become very popular to think about that specific mechanism not necessarily unlike empathy or insight, but slightly different in this context in terms of the fact that with reflective functioning, we actually have an empirical measure. We have a scale that you alluded to that allows us to rate narratives of many different kinds as well as to listen differently within psychotherapeutic context.
Puder:
Yeah. So how is it different from empathy? How is it deeper than empathy?
Steele:
I think it's deeper in that it is much more specific in terms of one quality of empathy. And empathy I think is a very kind of broad overview. And this is something very specific that contains within it different ramifications as well as different specificities. So, for example, in response to the adult attachment interview question around, “Why do you think your parents behaved as they did during your childhood?” That is one that demands a reflective response. And I think just pure empathy wouldn't get at the specificities. So what we're looking for there is for the individual's capacity to put themselves in their parents' shoes, what was going on for them when they were parenting, early childhood and then beyond, as well as to put themselves in their own shoes. What was it like for them growing up? Do they have a developmental perspective that is putting themselves back there and then into the here and now? And that, that is an example of why it's more than just empathy, because it has these other dimensions to it that are quite specific.
History of Reflective Functioning: Peter Fonagy, John Bowlby, Adult Attachment Interview & London Parent-Child Project (03:47)
Puder:
Okay. And so maybe if we could back up just a little bit and give me a quick history. How did you get involved with Fonagy in the early studies? Tell me about some of the early longitudinal work you did in the London Parent Child Project adoption studies (Steele & Steele, 2005).
Steele:
So we got to London because I very much wanted to undertake psychoanalytic training at the Anna Freud Center. It was kind of the center London of psychoanalytic work and trainings. So that was my first kind of goal to train as a child psychoanalyst. I knew though that I needed a PhD and Peter Fonagy was very close to some of the eminent analysts at the Anna Freud Center, especially someone called Joseph Sandler. So Joe Sandler was a very famous object relations theorist. And my husband, Howard, was signed up to work with him on a PhD. And so looking around, Peter Fonagy seemed to be the best option for me in terms of looking for a supervisor. And so it was kind of this serendipitous moment in terms of what was available and that I wanted to do those two things at once, the child analytic training and the PhD.
Steele:
So I came to Peter and said, “I want to do this study on intergenerational patterns of attachment.” It was 1985, 1986, when this monograph by the Society for Research in Child Development came out with the move to the level of representation, this incredibly paradigm-shifting seminal moment where Mary Main presented to the world some of her unique assessments to do with attachment, including the adult attachment interview. And at that time, Peter turned to me and said, “I don't know anything about attachment. Why don't you go talk to John Bowlby?” And I was a young 25-year-old. I'm like, “I can't go talk to John Bowlby.” And he said, “No, no, no. He's there, at the Tavistock.” So for some of us older folks, you might remember that before email, you actually had to write a letter to someone and wait for their response.
Steele:
So I wrote to his secretary, and she wrote back offering an appointment. And so, the London Parent Child Project, really I do feel has John Bowlby stamp on it in terms of his guidance. Because, as I was going to him to describe what we were intending to do, he said, “Well, Mary Main and Erik Hesse are coming to the Tavistock Clinic in London to train people in the adult attachment interview. I think you should do the training.” So we brought that back to Peter and he understood the potential gold that was in there in terms of doing the training. So the three of us undertook that training all the way through with Bowlby's guiding hand on parts of the research. And so we were aiming to show that even before a baby is born, we could predict the quality of their attachment to each parent.
Steele:
One of the unique features of our study is including fathers all the way through, as much as mothers, which even to this day, is unfortunately not the focus or as much the focus as it should be. And we were able to show that when we collected these 100 interviews from mothers expecting their first babies—so it was the transition to parenthood, which is another important feature. What does it do to your attachment system to go through going from being perhaps an individual or a partner, but not yet a parent? How does that change your own representational world to do with attachment? And then we studied, so we had 100 mothers and their 100 fathers of the partners. And we then followed them up by inviting them to come to University College, London, where we were doing our PhDs so that we could conduct a strange situation assessment, 12 months with mother, 18 months with father that was very much trying to replicate Mary Main's seminal study of trying to find a match between the ways the babies behaved in the strange situation and what was in the minds of the parents who gave rise to those patterns.
Steele:
So Mary Main did it retrospectively. She had parents of six year olds on whom she had strange situations from 18 months and 12 months prior and could make a match between them. We were very interested, could you even get to this before the baby's even born? And we found with about 75% accuracy, we could make those predictions.
Puder:
What percent accuracy?
Steele:
About 75%.
Puder:
And so what kind of predictions were you making?
Steele:
So if the parent delivered a narrative to us in response to the 18 questions of the adult attachment interview which was classified as secure. So one gets a set of ratings. How loving was the parent? How rejecting? How role reversing? That is, turning things upside down so that the child felt some responsibility in even parenting the parent. We looked for a set of scores around idealization derogation, of parent current anger, and then one of the central pieces is coherence. And that's really one of the big names of the game in attachment assessments. How do these different parts of what we're looking at, whether it's the behavior of the infant in the strange situation or the adult in response to the adult attachment interview, does it hang together? Are there contradictions that don't make sense? Is there enough detail in what they're telling us?
How Reflective Functioning Scale Was Born: From Metacognition in AAI to Measuring Resilience Against Trauma (09:37)
Steele:
And within that, it was our reading of these 200 interviews that we discovered reflective functioning. That is, Mary Main had a scale, called metacognition, which wasn't very developed at the time, which is the individual's capacity in the moment of saying something to catch themselves. Kind of a Freudian slip moment. Like, “Oh, wow. I said I died when I was 14 years old, instead of saying my father died.” Those kind of slips without realizing it. We misunderstood actually that scale originally, and we were thinking of it much more in terms of theory of mind, in terms of putting oneself in someone else's shoes. So it was Peter's great delight when Mary Main and Erik Hesse were visiting our London lab, and we told them about the way that we were coding metacognition. And Mary Main said, “That's not what I had in mind. That's not the scale.” We saw Peter smiling, couldn't quite understand it, as the young doctoral students. And when they left, we were like, “Wow, we're in trouble here. Like, what are we going to do?” And he said, “No, this is great. We would call it our own variable.” And that was the birth of reflective functioning.
Puder:
Okay. And so how did reflective functioning compare to some of the other measures of attachment, in the adult attachment interview, that were already there, that you all probably also already also scored? How did reflective functioning uniquely show something?
Steele:
So I think it showed something around how people might have arrived at their classification. So the adult attachment interview is taking into account early childhood experiences, but not just what happened, but what the person makes of those experiences. That's really the key. So individuals who face a lot of adversity, but somewhere along the line where they've learned to process, to metabolize, to come to terms with those experiences. There was something in the way they talked about their childhood, which was so impressive. Sometimes even more impressive than those individuals who had relatively good enough family upbringings. There's something about overcoming and working through possible trauma or trauma that really showed us something about this reflective functioning construct. So we actually divided our sample up into two halves. Those who suffered from adversity. So things like a parent being medically or psychiatrically ill, fathers being out of the family context. Remember we were collecting this data in the 1980s and so that had different kind of meaning than it might have in 2026. Children going off to boarding school before the age of 11. This was before Harry Potter made it very cool to go to boarding school.
Steele:
We included that as a variable. And what we found is if we divided them up into those individuals who face at least two of those adversities versus those who didn't, and they had this capacity of reflective functioning that we coded, there was an overarching response that all of their children were securely attached to them. If an individual faced adversity, but didn't have this capacity of reflective functioning, every single one of them, but one child, was insecurely attached. So that's where the focus became for us. What is going on? How to promote reflective functioning? But it feels like that is one of the keys towards secure attachment in the adult. And very importantly, alongside that, is their capacity to provide sensitive and responsive caregiving to their child, which would result in secure attachment in the child.
Latest Research on Mentalization-Based Treatment (MBT), Transference-Focused Psychotherapy (TFP) & RF Increases, Plus Body Image & Smartphone Effects on Parenting (13:32)
Puder:
Amazing. And I feel like there's been so much research since that early study that has continually proved this to be such an amazing measure that has such strong predictive validity. Right? When I think about if a scale, if a measurement is valid, what is the predictive ability of this measure? And it seems so strong and so black and white, it's not just a 0.2 correlation, like a lot of social sciences are. You know, it's a huge link. Right? How do you feel it's developed since then? What kind of research are you most excited about that has come out since then? And, just let me understand where you feel the field has come since.
Steele:
So if I can just say a few words about the amazing part of that prediction. So when we took our results to John Bowlby and showed him, he was shocked. He said, “You know, we can't even predict the weather. And that we can predict something as nuanced and, as in some ways, elusive to measure, and as sophisticated as a parent-child relationship from what one person says in words to a totally different human being's behavior in the strange situation is rather amazing.” You know, so much of this goes back to some of our central ideas within a psychodynamic psychoanalytic context. That is, the power and the influence of early experience and how that unfolds over time. So it is, but the power comes from having an empirical measure, having some way of measuring that rather than it being, “Oh, we know this to be true.” Or, “We think that this is the case.”
Steele:
It's, in our evidence-based world, hugely important. I think you know some of the exciting work, and Peter Fonagy has really been the one at the forefront of this, is to take the reflective functioning construct that which we measure in something like an interview and think about it in clinical context, often termed “mentalization.” And, in some ways, those are just the same thing. They're not very different. One is just the empirical measure. Mentalization is more of the kind of theoretical or clinical construct that comes with that. And so Peter developed the mentalization based treatment, MBT, first of all, because he was really interested in what goes on with individuals who have a borderline personality disorder diagnosis [see episode 206]. What is going on? And it was his insight to see that they lack this capacity of reflective functioning, or mentalization is very hard for them to accurately put themselves in someone else's shoes or to have an understanding of their own accountability or the way in which their own behavior can be predicted by themselves.
Steele:
So there's a gap. There's some kind of deficit. And so there's now a huge industry around mentalization-based treatments in every kind of flavor, both continuing on with those with borderline personality disorder, but there's versions for children, versions for adolescents. And it has a very strong evidence-based. So that's one place that it's gone. It's also gone in different directions in terms of the research. There are people who are able to find that a psychotherapy intervention, like transference- focused psychotherapy [TFP], that was initiated by Otto Kernberg [see episode 239], John F. Clarkin and Diana Diamond [see episode 250], [and] Ken Levy had his hand in that as well. And it was actually Ken Levy who had initiated a study looking at transference-focused psychotherapy and reflective functioning, and showing that the treatment actually increases RF and that goes hand in hand with better psychiatric outcomes [Levy et al., 2006].
Steele:
So some of those places are very exciting in terms of showing that a psychotherapeutic treatment has an impact on patients’ or clients’ RF. And that, we think, is the mechanism of change. That is what's changing, regardless of the modality. So it doesn't have to be a psychodynamic or attachment-based intervention. Even, you know, purely behavioral intervention or a CBT or a DBT intervention. That's what's changing. It doesn't change, perhaps as dramatically, as something like transference-focused psychotherapy or MBT [metnalization-based therapy] because that is focused exactly on that construct where there are other things going on in those other modalities. So that's one place in our own research. We're doing a lot of work thinking about body representations. It's kind of been left out interestingly, from the attachment literature, both the research and the clinical.
Steele:
And so we use something called the mirror interview that was developed by Paulina Kernberg, the late wife of [Otto] Kernberg, and a colleague in Copenhagen, Bernadette Buhl-Nielsen, looking at the impact of attachment on one's body representation. And so we've got a whole series of studies looking at intergenerational transmission of body representations and attachment from mothers to babies to their toddler girls. We have, and we find some very interesting results in that match. We've done it with a sample of gay men. We've done it recently. We're wrapping up a study looking at individuals with physical disabilities and their adult attachment interviews and body representations. So that's like a unique space that RF is right in the center of. And then we're also doing a study looking at the influence of smartphone use or cell phone use on parent child attachment.
Steele:
So we're collecting adult attachment interviews. What we're, our hunch or hypothesis is those individuals with higher RF or reflective functioning, it's not that they're not going to be using their phones with their kids. That's not possible anymore. The phones are here to stay, but they might do it differently. It might be a buffer against the negative impact of technology because there's more of a sense of putting themselves in their child's shoes or being able to pause themselves in some of the behavior that leads us to pick up our phones when we're with our kids.
Puder:
Amazing. Yeah. I think this is, there's so much good stuff there. I've actually been puzzled. There was an early study where they looked at the reflective function and the scores in people with BPD [borderline personality disorder], and it was about 2.7, and the people with eating disorders was about 2.7 as well. And so, do you, it sounds like you might have a why for that. What would be the “why” for why someone with an eating disorder would have a lower reflective function?
Why Low Reflective Functioning Appears in BPD, Eating Disorders & Borderline Personality Disorder – Clinical Implications (20:35)
Steele:
I think probably, you know, something similar in terms of, you know, the rigidity of a defensive structure, you know, so that it precludes. Right? They're not being very in touch with what's going on with their bodies, the misattribution. Right? So when they look in the mirror and they see someone much larger than themselves, and some of the rudiments that could be connected to aspects of parent-child relationships which have gone askew somewhere along the line leading to dampening down of reflective functioning early on. And so some of the work would be to ignite the curiosity within these patients about what's going on within themselves, both their bodies, as well as their thoughts and feelings. So I think there's something about the shutting down part of reflective functioning that could lead to something as serious as an eating disorder or borderline personality disorder.
Therapist Reflective Functioning Predicts Patient Outcomes: Cologon et al. 2017 Study, Graphs & Why It Matters More Than Modality (21:36)
Puder:
So, I'm sure you're aware of John Cologon, he did an article in 2017 called, “Therapist Reflective Functioning, Therapist Attachment Style Therapist Effectiveness” (Cologon et al., 2017). And he was looking at reflective function in the therapists. And then he looked at the patients that they were treating. They measured the OQ 45 [Outcome Questionnaire 45], which is probably the gold standard for session-to-session changes. And the therapist's reflective function predicted how fast patients would get better. For those of you who are watching this on YouTube or on X, I'll pull up the graph here. So, basically, you have the slope at which people get better. If they're high reflective function it’s much sharper than medium reflective function. And low reflective function, they don't get much better at all. Which is my thesis on bad therapy and kind of the cultural impetus to say, “You know, not all therapy is good.” It's like you could have a low reflective function therapist. This seems to be irrespective of modality [see episodes 36, 186, 205, 206, and 213]. Do you have any thoughts on this? Because, I love mentalization-based therapy. I love transference-focused therapy, but I've been thinking more and more about this, the provider themselves. Right? And their reflective function. Any thoughts on this?
Steele:
Yes. It's kind of, in some ways, can be a very painful realization for those of us quite tied to our modality to learn that it doesn't matter.
Puder:
Well, it matters, but maybe in a different way.
Steele:
Yes. Because all the vast majority of psychotherapy process or psychotherapy outcome research all seems to come down to this point, that it is the person of the therapist that actually accounts for why their therapy works. I think that our modality is really important to us as it gives us a toolbox and a way of working. Right? So I think for, in that realm, it's really, really important. Right? So I think it would be hard for some of us to deliver an intervention that is outside of our modality. And sometimes they have research studies like this with the, you know, the same therapist is asked to deliver a psychodynamic approach and then a CBT approach, because then you have…the person is constant. Except they're not, you know, it's not exactly constant because, you know, that's really forcing someone to think outside of the box to… or to push that envelope, whatever metaphor you want in terms of doing something that doesn't feel so comfortable.
Steele:
I think the issue, you know, it's a bit of a tricky issue. What do we do here about this? You know, do we select therapists? We do something like an AI at an admissions interview for a clinical psychology or social work program, or licensed mental health, or a psychotherapy training. Right? In some ways, we know this, it would make sense that we would want to engage people who are securely attached. On the other hand, most of us are in this line of work, not because we necessarily had the easy, good enough kind of childhood experiences. Somewhere along the line, we became very interested in the psychology of ourselves, the psychology of the other, how things work in people. And so, I think some of that flatlining, you know, will come from individuals who perhaps haven't worked through some of these issues themselves and makes it very hard for them to listen to patients with an accuracy and a compassion that would come from higher RF individuals.
Steele:
But I think there's been some studies, not a lot actually, on that. That study is unique. There were some early studies Mary Dozier did with Roger Kobak on galvanic skin responses in therapy and those kinds of matches showing, which might have better outcomes than others. But I think it's an ethically vulnerable place to go, actually, in terms of impingement on privacy, for example. But it is the person, and I think that that allows both the therapist to be present in a very powerful way, regardless of what they're picking up or saying in words, and it's also how they think and feel about the patient.
How to Increase Reflective Functioning: Lifelong Growth, Self-Compassion & Ethical Limits in Therapy Training (26:17)
Puder:
Yes. So this comes down to my sort of new hypothesis for the cohorts I'm running. It's kind of like, okay, I don't think you can ethically grade people on their reflective function because it is so personal coming into therapy school. Right? And I think the best time to grow is when you don't have the pressure of some outside institution that's saying, “We're going to gatekeep you here.” Right? And then the other thing I've realized is that increasing in reflectiveness or reflective function, it's a life journey. Even in the best studies of transference-focused therapy, they're only increasing about one point per two years. One year of pretty intensive therapy. And so, you know, we're on an 11-point scale, negative one to nine. Nine being the highest. Nine being something you never see, according to yourself.
Steele:
Except for you and I.
Puder:
No. Don't… see that's not true. Well, you know, so this kind of came to how we connected, just to self-disclose, I got my AAI done with Miriam and there were some passages that were lower than others, right? Not all were perfect. And I think that's okay. Right? That's what I've been thinking about. In these cohorts, it's, wherever you start from, that's okay. The goal is to increase. The goal is not to look like it's higher, but to actually do the work so that it gets higher. Right? So you know, I was thinking what we do is make this very practical at this point. And I went back through Abraham Lincoln and I pulled up some passages, and I created some passages. And so we would look at his reflective function to kind of bring this to life a little bit. And so, here we go. I'm going to actually pull up… I put this on PowerPoint. And so I'm going to pull up…. And for those of you who don't know, Abraham Lincoln probably had more of a depressive personality. He had a very harsh internal critic.
Reflective Functioning Scoring Examples: Abraham Lincoln's Grief Letter: Original Low RF vs. Enhanced Mentalization (28:15)
Puder:
So, okay, here's the first passage. So this is an actual letter he wrote to John T. Stewart regarding Anne Rutledge's death, in 1835. Okay? And he wrote this in 1841. So, just to give you a picture, this was six years later. Okay? So he wrote to his friend, “For not giving you a general summary of news, you must pardon me. It is not in my power to do so. I am now the most miserable man living. If what I feel were equally distributed to the whole of human family, there would not be one cheerful face on the earth. Whether I shall ever be better, I cannot tell. I awfully forbode I shall not. To remain as I am is impossible. I must die or be better it appears to me. The matter you speak of on my account, you may attend to as you say, unless you shall hear of my condition forbidding it. I say this because I fear I shall be unable.” So what would you rate this RF?
Steele:
You know, there's many compelling features to his very poetic prose. And one of the things we can really hear in that is his suffering. Right? And his capacity to describe that suffering. Right? I think probably in the…. Well, if you bring it back up.
Puder:
Okay. I can….
Steele:
Bring it back up so we can go through some of the specifics. “So even though you must pardon me…” You know, he's coming into this interview where he has a sense of what it is the interviewer is looking for, and he is asking, he's saying, “I have an understanding of what you're looking for, but you must pardon me.” Right? So there's something somewhat relational in that. And he's saying, you know, “It's not my power to do so. I can't. I can't now.” He says, “I'm now the most miserable man living.” Right? So that's, you know, hyperbole. It's quite extreme. He can't know that he's the most miserable man, but what he's saying is that it's very bad. And then this poetic thing around, “If my misery was distributed among all of humankind nobody would be cheerful.” That's how bad it is.
Steele:
So he does have some sense in using this poetry about the impact of his words. Right? He is speaking to an audience. He's not oblivious and just embedded in his own experience. He's really trying to share what this feels like to him. And he says then, “Whether I shall ever be better, I cannot tell. I awfully forbode I shall not.” Right? So that's just kind of sitting in the depression and more around how it's impossible to remain as he is. He should, he needs to die or be better. And then he is saying that, “Whatever the matter you speak of on my account, you may attend to as you say, because I fear I shall be unable.” Right? So, you know this as well, this vignette did not come in response to obviously an attachment interview question, you know? So here we would ask around his thoughts and feelings around the time of her death, have they changed over time? And looking for semblance of RF in some of that as a way of understanding his grief process. So I think I would give this a three, somewhere around, around there, on RF.
Puder:
Okay. The interesting thing I find in this is that with something that's more poetic, it really can evoke in you an understanding of what's going on inside of me. Right? And I think he does a good job of evoking that he is in a really dark place, and it's a hopeless place. Right? But yeah, it's lacking. It's lacking some things. So what I did was, in my own brain now, and this has never been revealed before, so this is the first time you all are hearing this. I tried to increase it, not completely, but a little bit. Okay? And so we're going to read that now and see where we go from here. Okay? So, “Anne's death initially profoundly overwhelmed me, and I was the most miserable of men. I was so profoundly miserable that if you were to distribute my feelings to the whole human family, there would not have been one cheerful face. I felt incredible guilt for the death, despite my understanding. I could not have prevented it. The guilt was thick. I knew it was irrational, but tied my gut into knots, and left me feeling sour and sick. I, at one point, remember my dad punishing me for my scholarly ambitions. He wanted a farm worker, and I was a reader. And I remember it was better to suppress my anger, to prevent further rage from him. And I would be punitive for my love of reading, but also knowing that I was not bent to be a farmer, I found myself guilty at my fleeting anger towards God. Bitter rageful, pounding my fist into the air, but then pounding my fist on myself as well, for being angry. Likely also remnants of how I had to stuff the anger growing up. I moved through the anger, eventually more to just pure sadness, accepting I had lost the love of my life, a perfect angel. Grief, heavy, thick, but also an air of resoluteness to incorporate the best parts of her, of how I remember her into my way of being.”
Steele:
So well done, David, for increasing Abraham Lincoln's RF here. I think we could go through it and point to the places of a higher RF. One of the things that I didn't mention in the first clip is that there was reference to his mental state, but not much using mental state terminology. And that's where the increases come here. So the “profoundly overwhelm me” already suggests something of that mental state. This next bit, “I was so profoundly miserable that if you distributed my,” is more or less the same. But then he says, “I felt incredible guilt.” Right? So naming that as a mental state, and then he ties it to the death. Right? So there's an understanding of how that mental state came about in terms of what it's tied to as this actual event.
Steele:
And then, he says, “Despite my understanding, I could not have prevented it.” Right? So there's a very highly sophisticated RF piece. Right? So he is saying that, “I have an understanding.” By the way, mental states work. “And despite my knowing, at some conscious cognitive level, that I was not responsible. It went so deep, I couldn't shake it off. I still recognize, I felt that guilt.” Now, if somebody says that they've already done some work on that guilt. Right? It's the person who is unaware of this mechanism or this connection that would be lower RF. Right? So if they could still use the word “guilt”, “I felt really guilty. because I really think that I should have taken better care, or had I not gone on a trip just then.” You know, whatever, without really acknowledging that that guilt is misplaced or that I understand.
Steele:
He's saying, “I understand why I felt guilty. And no matter what I do, I can't shake that,” is a window into his inner world, especially around mental states. The guilt was thick. “I knew rationale, but tied my gut into knots, and that left me feeling sour and sick.” Here's another point that he gets another kind of check on the reflective functioning scale around understanding how a mental state impacts physical, the physical body. Right? So alluding to some kind of mind-body piece it's another way of explaining to the reader, or the audience here, “This is how bad it is.” Right? Like, he's also very in touch with how this might land in terms of, “I'm sharing with you. This is how it felt in my body to let you know how devastating all of this was.”
Steele:
Then he brings in this point around his father punishing him. And the discrepancy between his father's vision for him, which was to be a farmer, and his own individual wishes of what he would be, which is more scholarly. He was a reader. And that he knew himself well enough. He knew that, “I didn't have the bent to be a father, a farmer.” That's an interesting slip. And then he says, “I felt myself guilty at my fleeting anger towards God,” even to the point where he's raising his fist to the air and then raises it to himself. Right? So, he's aware of the process and able to track those feelings. Right? So he's feeling anger. He projects it onto God. I guess for having his father not understanding him from an early age as well as what happened to his wife [sic; first love] and then even understands how he turned that anger onto himself.
Steele:
And that's an early version of how we think of depression within psychotic theory, around its aggression turned against the self. And then he says, “I moved through the anger eventually.” So that's another check on the RF scale. He's giving us some kind of developmental perspective, both in his reference to himself as a child, but also this process. What was it like for him to move through the anger rather than just pure sadness, “Accepting that I'd lost the love of my life.” There's a little bit of idealization there, with a perfect angel that comes in. But then his wish to grieve, grieve in a way that was efficient or accurate and remember her into his way of being. That's also a little bit aspirational. But he is looking to where this might end up.
Puder:
Okay. So what score do you give it?
Steele:
So this one is more, I think, in a five, in the five range.
Puder:
Okay. And yes, I left in a little bit lower RF by some idealization. Right? But I was trying to tie the depression to some deeper developmental themes that were true for Abraham Lincoln. His father notoriously would get really angry at him when he was not farming, and reading instead of farming. So I tied that in. And so yes, it's good. So, okay. This is a five.
Steele:
I think it's a five.
Puder:
This is good, I think. Okay. So here's my attempt to increase this more. I worked on this last night. Okay. “At first I saw her as a perfect angel, and for years I idealized her as perfection.” So just to let the audience know, I'm kind of leaving most of the first part. Right? But this is kind of an add-on. So, imagine that last part was still there, but this is kind of an add-on. Okay? “Eventually, with time I realized she had many strengths. She was intelligent, attractive, and lively. But, in retrospect, a lot of my emotions were based on youthful passions. And I did not know her as well as I might have imagined, which led to project angelic qualities on her. I also think our co-interest in learning contrasted sharply with my father's dismissal and even physical abuse towards my desire to learn. Perhaps her dying before her youthful ideal could grow into loving each other's imperfections.
Advanced Reflective Function Rewrite: Lincoln's Idealization, Developing Self-Compassion & Imagining Others' Mental States (40:20)
Puder:
That ideal twisted the knife of my pain, all the more I can never fully know what she might have felt. The terror of the typhoid fever. I imagine, in part, she was horrified by the prospect of death, sadness of leaving her family, sadness of leaving me before we could have our own family. And seeing her in so much psychic pain was itself misery for me. I am telling you this, I feel some inadequacy to explain how horrible I felt, and worry you might judge me for being so depressed for so long. But now I have compassion for the dark space I was in during that time after her death. She was my first love. I allowed myself to love with my whole and unguarded heart. And I felt life came to an end for a while. I was a ghost wrapped in profound thought, indifferent, going about my work. I also sometimes will meet men who are in a similar place and sit in their profound sadness and feel for them knowing what it was like for myself to go through it. Somehow that brings me meaning to share in their agony.”
Steele:
So, on the one hand, we have some increases, or there's some parts of this where we could point to aspects of higher RF. Although I think, David, you might have gone too far in keeping with the poetic kind of flavor, and that could bring RF down.
Puder:
Right.
Steele:
So, go ahead. So I think that's also important. There's something often very crisp and to the point when someone has very high RF. And so, and you know, this is, you are trying to write in the style of Lincoln way back when in terms of the stature and that way of writing. But one wants to be clear about they're trying to get this message across, and some of the flowery language, the overly poetic, actually, it distances one from his experience as you try and kind of track it.
Puder:
Yes. Walk me through it. Walk me through it.
Steele:
So, I'll walk you through.
Puder:
I want your truth. I don't want your….
Steele:
Yes. Well, I think that it's helpful that it's not just, you know… I'm almost thinking here, like having an AI version, you know. Let's put this bit of prose in, tell ChatGPT, “Increase RF.” It might do something like this. I also think, because I'm thinking about AI in this context a lot, how different it is to say, “Do an AEI,” or to look at some material like this in terms of having it resonate with how we feel, that if you just did the ChatGPT thing, you'd have no access to. So there's something in the pondering of this word versus that word, or this experience versus that experience, that drives our clinical intuition and are some of the ways which we can't even put words to our understanding about another person, but that would be the goal. That’s why a therapist doing something like an AEI might prove so valuable in a therapeutic concept context.
Steele:
So I think the use of, at first in this, does get a check on the mental state side of things, in terms of their orienting you towards time. Right? There's some kind of developmental perspective. “At first” means, “When I first met my wife [sic],” and that he saw her as a perfect angel, and that even moves beyond that first point to the years after, where “I idealized her as perfection.” That's all high RF, that he can now, looking back at what his first impression was, and that it stayed that way, and he uses the word “idealized”. It's kind of a self-derogating word. But he is conveying, “I've gone through some kind of process.” And then he says, “eventually within time”, so there's another reference to a process. “Over time, I realized that she had many strengths”, and he lists them, “intelligent, attractive, blinding, but in retrospect, a lot of my emotions were based on youthful passions.”
Steele:
So he is also saying the impact of those first impressions and who she was changed. Right? And that he's looking back and saying that I can understand myself at that point. I was younger with these youthful passions, but that they might have actually gotten in the way of knowing her. Right? I did not know her as well as I might have imagined. Right? So that's a very sophisticated RF. Right? Saying, because of those youthful passions and that initial rose-colored glasses view. But that actually got in the way of actually knowing who she was.
Steele:
Which led to projected angelic qualities on her. Right? So, yes. I mean, this is what someone who knows something about RF would also go that next mile. Right? How his ideas about her projected onto her. Right? So that he couldn't see her clearly. And then he talks about things they shared in common. The learning. And that was in contrast to his father's own dismissal and even physical abuse towards his desire to learn. So he is now comparing what it was like and why Anne was so important to him, because she was a contrast of the way his father was. So again, he brings in some kind of developmental perspective perhaps for dying before our youthful ideal could grow into loving each other. That sentence I thought was overly poetic and takes us away from the essence of what he's trying to convey. Because it doesn't actually give us more information. He's giving us, he, in fact, goes back to his idealization with this: “That we could grow into loving each other's imperfections.” That ideal, there's something, it doesn't help us in the RF. So we might want to mark that with a bit of, you know, might highlight that with yellow and a question mark. If he continued in this way, with much more of that, it would lower the RF score.
Puder:
Let me justify my attempt here. My attempt was thinking if he had this ideal when she died, I think it almost was a part of the death of the ideal. The grief was not for the real person. It was for part of the ideal, part of the connectedness that he felt with her in the midst of their mutual interest in learning. Which was kind of like a redemptive healing compared to the father's abuse towards him when he was learning. And so I think what I was trying to say here was that could he be imagining that part of her dying, in the midst of the ideal, magnified it. Right? Where, it was the ideal that magnified the pain. Maybe not, though. Maybe that…. Does that make sense?
Steele:
Yes. I mean, I think it gets a little credit in terms of thinking about how he might feel in the future. But it was a little too subtle. And I think that the poetic piece put some distance from being in touch with the mental pain, actually. Like it's a bunch of these images, flowery words “twisted the knife of my pain.” It doesn't add that much more to what was there before.
Puder:
Okay. Fair enough.
Steele:
And then we get, “I can never fully know what she might've felt.” So that's a higher RF point. Right? That the nature of someone else has made mental states are not visible to us. And even puts himself in her shoes when she had this typhoid fever and trying to imagine what she felt like, including her mental states around that. So not just what she would've felt like in terms of the physical part, but the specificity around her sadness, leaving her family, sadness of leaving him before they could have had their own family, and as well as her seeing his sadness would've made her sad. So all of that is higher RF.
Puder:
Okay. Yes, because I was thinking I got to the end of this yesterday, I was like, “You know, I haven't really put my mind into what that was like for her dying.” So it's all about him. And so, what would be the potential reasons that this would be painful for him to see her suffering too. Right? And her losses. He wasn't just having his own loss of her, he was a witness to her loss and losses in the midst of her death.
Steele:
And then, “I am telling you, this feels some inadequacy to explain how horrible I felt.” Right? So he's also letting you in on his mental state around this in terms of, you know, “Even my telling you this, I'm not getting anywhere near how bad this was and were, you might judge me for being so depressed for so long.” Right? So he's also putting himself in your shoes, the interviewer's shoes, by saying, “I'm worried about how you're going to see me with all of this.” He says, “But now I have compassion for the dark space I was in during that time after a death.”
Steele:
So, he's now saying he's got some self-compassion for himself. If that was a period, he'd get more RF points. Because now he's going off into, again, “She was my first love. I allowed myself to love with a whole unguarded heart, and I felt like life came to an end for a while. I was a ghost.” It kind of trails off into almost an absorption with his thinking about her rather than a clarity of being able to say, “Stop.” He said enough, and actually, it detracts rather than adds.
Puder:
Interesting.
Steele:
Yes. And then the reference to the ghost, “I was a ghost.”
Puder:
Here's my thought process. Okay? Let's go back to the good I did here. Okay. “So in telling you, this feels some inadequacy to explain how horrible I felt and worry you might judge me for being so depressed for so long.” You know, first of all, someone with a more depressive personality, they are very acutely sensitive to the person that they're telling the story to. Right? And they may feel a sense of internal judgment and project that judgment onto someone else. Right? That you may judge me. Right? Which probably, the reader is not judging him. But that could be a little bit of a RF mistake. But the higher RF person is actively imagining the experience of the other. Right? Even the person that they're telling the story. So in the example, if someone pauses and imagines what you might be thinking or feeling as the person giving the AEI, that's higher RF. Right?
Steele:
Yes. We also take into account the relationship with the interviewer. Yes. Especially, in including trying to enlist the interviewer's empathy for their perspective and get them on board with it in a way that is doing something for them. You know, “Wouldn't you agree that was a terrible thing for a mother to do?” You know, it is a sign of lower RF, but some sense of an individual never heard your story. So what is it that you wish to share to convey an image in their mind about what it was like for you?
Puder:
Okay, so say this again. So how can you lower your RF by noticing the interpersonal, or by the projection of the interpersonal in the midst of the AEI?
Steele:
So I think, because the beauty of the AEI is paying very, very close attention to the use of language. Right? And that there's a bit around, you know, give evidence for what you say. So evidence isn't just the words, but discrete memories or incidents, is the way to give evidence for what you say and the piece around getting, you know, you are with someone who doesn't know your story. So what's the information you have to give in a very succinct way, right? How clearly can you get your message across in terms of your thoughts, feelings around your childhood experiences rather than adds to.
Puder:
Say that again. I lost you, that last like five seconds.
Steele:
Oh. Okay. So you're in a situation where you have your own mind that incorporates or encapsulates reflective functioning and your attachment story. You're trying to convey that to another person. So being somewhat conscious that they don't know your story, what is it you wish to share with them? And at the same time, we have a whole set of defensive maneuvers that are trying to protect you from being too in touch, perhaps say, with your mental pain. So you have an idea of what happened. Right? He's suffering here from the loss of his wife [sic], but these added words take him somewhere away from being totally in touch with that pain. So it looks like more flowery words about what it was like, is consolidating that image, but it actually takes you further and further away from the crisp beginning bits around what that experience was like. So when you pile on all these other words, it diffuses the message rather than enhances it.
Puder:
Interesting. That's good. Okay. So what would you score this passage knowing all that.
Steele:
I'm pretty stingy with my scoring, often. And we would be looking at a whole interview, not just that, but if we looked at this passage, I don't know that I would go much higher than a six. Okay. Five and a half or six because of that slightly too poetic, taking away from the essence of the meaning.
Puder:
That's good. Okay. I appreciate that. Okay. So next I have some Theodore Roosevelt. I thought I would just look at these little chunks. Okay. And ignore how I scored it. So, okay. “I was a sickly, delicate boy. I had to make my body….” So just that little statement.
Theodore Roosevelt Reflective Functioning: Childhood Fears, Strenuous Life Philosophy & Post-Loss Hypomanic Activity (54:32)
Steele:
I don't think….
Puder:
It's pretty low. Okay.
Steele:
It's low, like two.
Puder:
Okay. “I wish to preach, not the doctrine of noble ease, but the doctrine of the strenuous life, that highest form of success, which comes to the man who does not shrink from danger, from hardship, or from bitter toil.”
Steele:
I'd also not give it more than a one or two.
Puder:
Okay. “And there were all kinds of things of which I was afraid at first, but by acting as if I was not afraid, I gradually ceased to be afraid.”
Steele:
So that's getting a little bit better. I think the lack of specificity or an example about what those kinds of things are and makes it remain very vague, including, “I gradually cease to be like”, I would need a little bit more there in terms of, for example, “I was first afraid of what was going on in the opposition,” or whatever. And then, “I learned that if I would just put forward my views, which I felt to be true, or I ceased to be afraid and that was more efficacious for me.” But I think just the lack of specificity here one doesn't really know exactly what he's talking about, except that he was afraid before and now he's not.
Puder:
So pretty low RF still. Okay.
Steele:
Yes.
Puder:
So there was a death, and then he wrote in his journal a big X, and he said, “The light has gone out of my life.” Okay. There was a death, I think, who was it here? So he wrote, “The life has gone out of my life,” In a diary entry February 14th, 1884, marking the devastating personal tragedy. His wife, Alice Hathaway Lee Roosevelt, and his mother, Martha Bulloch Roosevelt, both passed. His wife died of kidney failure just two days after giving birth to their daughter, Alice. His mother, Martha, passed away earlier the same day from Typhoid Fever. Okay. And so he wrote that in his journal. And so I did my attempt to increase his RF regarding this event. And I think this was the only time I did it. So here we go.
Puder:
“At the moment, I recorded the bleak X, signaling the unbearable grief over losing Alice and my mother. I did not yet grasp why I compulsively thrust myself into relentless activity. But now, reflecting deeply, I understand that distracting myself with activity was forged early in my childhood. Struggling with severe asthma, I learned through my parents’ persistent encouragement, praise, and affection that vigorous action, resilience, and cheerfulness were the surest routes to approval, security, and self-worth. My father's proud insistence that I must overcome weakness through relentless physical effort combined with my family's enthusiastic celebration of courage and optimism shaped my personality to instinctively flee vulnerability through incessant motion and energetic productivity. Thus, when confronted by profound loss and helplessness, I instinctively retreated into ceaseless action, not merely to escape grief, but to unconsciously reaffirm my deepest internal lesson that strength, achievement, and vitality alone could ward off the unbearable fear of weakness, loss, and despair.”
Steele:
We had some very poetic presidents.
Steele:
Yes. So he gets the… there is a lot to give credit. I think, again, the overly poetic language distracts and diffuses the power of the RFness if you want to think of it that way. So he is able to go back in time, “At the moment I recorded that bleak X”, and the bleak X is both commenting on how he perceived it, but perhaps also how other people might perceive that. And he put that together. “That was my way of describing the unbearable grief over losing Alice and Mother.” I would put a period there rather than a comma. Because, the long run on sentences are often indicative of an overactive RF stance that takes, rather than the crisp... So if we put a period there, “I did not yet grasp what I can possibly….”
Steele:
So, “I did not yet grasp” would get high, “why I compulsively thrust myself into relentless activity.” And then you put the word in “reflecting” thinking, oh, “That'll get me some good high RF points”, which it doesn't necessarily. “I understand that distracting myself with activity was forged early in my childhood.” So there's a little bit too much going on here that is like an overactive, you know, trying to make sense of one's experience. But there's just too much there that actually diffuses that capacity rather than shows it even more so. So he's saying that he did link his relentless activity with that being a way of distracting himself and that it came somewhere from childhood. So that's why if we had a period, say, after the activity, and then he explained that part. But, it's like one thought just bridging all the time to yet another element. And then we get to the asthma. It's not, say, the clear, crisp focus that you might want to see in the highest RF, because it's a little overboard.
Puder:
Yes. And that's okay. Because we're not trying to make it perfect.
Steele:
Yes. No, it's all okay. And people speak this way. There are people that, not exactly like this. I think there is something about the….
Puder:
I think what I was trying to do in this passage was to explain kind of that hypomanic personality that he embodied. Right? Which has aspects of denial, but then a thrust into activity. So after the death of his wife and mother he spent, I think, two years just kind of hunting and farming, and really just action. Right? So it's like my attempt to put into words the “why” underneath his behavior.
Steele:
I guess I would almost want to challenge you to rewrite this.
Puder:
Okay.
Steele:
With half the amount.
Puder:
Okay.
Steele:
And pull out of it what you think are the key parts of how he achieved RF. So there is the developmental perspective there. He's saying it's something that is tied to his childhood. He's saying that within himself, his personality around the relentless activity was in response to that. But, for example, “My father's proud insistence,” that, in and of itself, could be unpacked.
Steele:
That would give us more clarity. For example, saying, “I understood that my father was very proud of my perseverance and the way in which I showed that I was really working at overcoming my weakness. And he knew that by my relentless physical effort.” Period. Because then it goes off to combine with “enthusiastic celebration of courage and optimism.” We don't know what that is. In some ways, that’s just words…about what? And then he is saying, “That shaped my personality to instinctively flee vulnerability through incessant motion and energetic….” It's just lacking specificity. We don't know exactly what he's talking about. “That was, it was in that year that I ran my first marathon” or, I don't know, whatever the equivalent would be like something that ties it not to the kind of lofty language, but actual experiences.
Puder:
Right. So, sometimes in the Adult Attachment Interview, it's like you have these words like, “What is the word to describe your relationship between you and your mother? And then what's the example?” Right? And then, the why might be, “Why they might have been behaving that way.” Right. And so, in this, it's too fast, almost. It's like, “Well, what do you mean he was enthusiastic of your courage?” So, if instead, he said, “When I ran a marathon, my father was so enthusiastic that I pushed through the pain and that that was how I got attention from him”, maybe that would be better.
Steele:
Yes.
Puder:
Like how I got connection.
Steele:
Yes. So I think we're looking for more succinct, and the examples really often do illustrate that evidence for that way of thinking. Otherwise, there's a bunch of words and it's very hard for the reader or the person you're talking to, to have a sense of what it was really like for him. One gets a little bit of a sense, but I think with some of those specific examples, you'd get a much deeper sense.
Puder:
Okay. Yes. That's good.
Steele:
But it's often, you know, it's often not done like, giving yourself credit here, or I'm giving you credit for the creativity to look at something in the public domain. Very personal, you know, part of a relational perspective from these two presidents as a way of illustrating this. I don't think that's been done before.
Puder:
Yes. I think it's kind of fun. You know? I think it's kind of fun, because one thing I've realized from reading biographies, after learning this and kind of thinking about it a lot, is a good biographer will increase the RF of the person in a way that the person, maybe their writing wasn't high RF.
Puder:
I don’t know if you've thought about that.
Steele:
Yes. Well, it's through the lens with which you, we see the world. Right? And almost the kind of gestalt where we're putting things together and not realizing what our bias is. Right? So, if you're doing the biography of someone you really admire, you know, that might slip in. Right?
Puder:
Or, maybe the biographer explains the “why” better than the person knew themself. Right? Maybe that's what I'm saying. So it's like they're, the biographer, is pulling together all of the threads of where, how they arrived at, where they arrived in a way that the person themself couldn't have even described. Right?
Steele:
Yes. And, you know, we know that in that kind of writing, there is a lot of bias. Right? And, I think that probably we evaluate those biographies differently. You know, the ones that come out and we don't recognize the person, for example, in that they've gone so far, you know, a little too far, but you can't separate out the writer of the thing from the person. You know, it's part of how they're writing and how they're portraying that person to us. I mean, it'd be interesting to see positive perspectives versus negatives. Because there's also biographies on terrible people and do we then diminish their RF because maybe some of them, you know, have very, very high RF, putting it to evil use, for example. But maybe, know exactly how to get at people because their RF is there. Usually, we think of it as being in the empathy, compassion, the positive features of individuals. But I think some of the, you know, evil people as well, often have an inkling on how to be cruel in that way and that, you know, but we wouldn't want to call that high RF, but there's something of a similar process potentially.
The Dark Side of Mentalization: Pseudo-High RF in Manipulation, Psychopathy, Sadism & Cases Like Jeffrey Epstein (01:06:07)
Puder:
I've been thinking about this. Okay. So let's kind of slow this down right here then. If you were morally bankrupt, it seems like you would score lower on RF just from the self-focus, you being the center of your own language. But do you feel like these are very different, separate domains? Like a sense of morality, evilness, someone who's maybe sadistic, would have a degree of desiring omnipotent control and they would have narcissistic features and Machiavellian features. But would that be high RF?
Puder:
What do you think?
Steele:
I think, for the most part, we would want to maintain that high RF does go with someone with compassion and empathy and being able to put themself in someone else's shoes. And so, the definition of those that are morally bankrupt and doing ill or harm to others is not being able to do that. So we have a paper with Peter Fonagy, from a long time ago, that looked at Adult Attachment Interviews and RF, and individuals who are incarcerated. And the ones that got the lowest of all were those that committed crimes against another human being. Like an assault, like rape, that kind of thing. Versus more kind of white collar crime, or where nobody, in their mind, actually got hurt. Like a theft from somewhere they wouldn't even notice. Or where you're not actually in the moment putting yourself in the other person's shoes, you know, or what's wrong. But to hurt another individual, you can't really do that from a high RF perspective. Like at some level, you can't really put yourself in someone else's shoes and then do terrible things to them.
Puder:
I've been reading about Epstein quite a bit. I'm a little bit down that rabbit hole. And, it seems like I'm…
Steele:
Sorry.
Puder:
Yeah. I feel like I need to cut myself off at this point, actually. Or, I felt that several times in the past week I'm like, “Okay, today I'm done.” I can't, you know? But there were portions where he is telling, for example, Bill Gates, how to run the nonprofit meeting. And he says things to Bill Gates, like, “When you run this and you're talking to these donors, try to listen to what they desire, how they want their money to be spent, and you are facilitating their desires more than you are bringing them into your vision. So it's like, how do you capture their own vision?” So he's in another letter, he's saying to someone, “Did you read the books I recommended on deception?”
Puder:
Now, I couldn't find those books. Right? But then you see him also subtly lying in a way to make himself seem more powerful in emails. He would name drop in ways that he actually wasn't connected to certain people, but he almost inferred that he was pulling the strings to get more sexual control over some females, for example. And so, there's this one email to this female, he's alluding that he has pulled the strings for these two models that are doing so well. And if only she would listen to him and do whatever he says, that's when he will help this person obtain the highest levels of success. Right? So he's pulling the strings. But, to do that, you kind of have to know the mind of another. Right? So is that reflective function, but then also, or does he just know dark psychology? Does he know it? So what are your thoughts there?
Steele:
I was thinking of him. But he, you know, he's now in the public domain and in such a crazy way. And every day we hear of someone else that he's connected to. And some were thinking, “How did he do it?” You know, like, what was it? And I think there was this darker use of being able to understand the other and use that in very horrible and evil ways. Right? So I think somewhere, like if we talked to him, and I think that there was somebody who wrote about how he was not remorseful at all about all that he did. So there we saw the very lack, that kind of callous behavior that we see in extreme criminals, for example. That callousness was also at work.
Steele:
So I think if we look at what it was that he had that RF, but he put it to such an evil use that overall, we would hope that he would get a zero or minus one. But I think in how he got to where he got to often was being able to at least, maybe it was pseudo-RF, but he understood something very important about how powerful it is for people to feel like he understood them, he was on their level, that he had their best interests at heart, all of those. But I don't feel that that's authentic RF, it was using that strategy for evil.
Puder:
Okay. So maybe what you said there makes sense to me in terms of, okay, if he was harming people, and he wasn't experiencing the why of his harming people, I think that would be low RF. So it's like, well, why do you want omnipotent control and why do you want power over these people? And, what is driving you? You know? And instead of that being a conscious thing that he's aware of, it seems like he just acts upon it and continually moves to increase his power. Right? In all circumstances.
Steele:
And couldn't curtail any of it. The absolute ridiculousness of how broad this went. It is just astounding. You know? And I think that's partly why we can't stop looking, as you're suggesting. In going down these rabbit holes, is that there's a wish to understand, and in awe of him at some level as well, that there's no part of our society that he didn't reach, from sports stars to leading academics to high tech. A prince who got arrested yesterday. For the more common folks among us, it's just fascinating.
Puder:
I tweeted out a couple of days ago,”Why is no one arrested?” And finally, we're seeing some. And, for me, it's more of that piece, of where is the justice? Right? I want justice. I mean, for me, I have spent the last 10 years talking to victims of sexual violence and helping them in therapy and helping them break off from narcissistic relationships and trying to heal. And, so for me, it's like this kind of disgust, of like, “This is just like revolting.” I think there is an interest in understanding psychopathy for me, because I feel like so many of my patients have gone through—and in my own journey—I've touched on people with a level of psychopathy. Sadism, in psychopathy, where it's like we so want to help everyone, but I'm not sure we're going to be able to help someone who's psychopathic. Right? And so we need to be able to differentiate in our own practice. How do we identify if someone is psychopathic, and how do we keep some distance? Right?
Steele:
Yes.
Puder:
So, I was talking to a patient this morning, and we were talking about if you can read the room, if you can understand what people want, is it always manipulative to give them what they want? Right? And my thing to her was, “Well, what is the reason to give them what they want? Are you trying to get something in it for yourself, for power?” You know? And there's the spiritual principle of don't let your right hand know what your left hand is doing when you give. Right? So when you give a gift, try to hide it from yourself. Don't give a gift in public to be appreciated by other people. And so, if you give, if you're able to read someone well and know what a good gift is, and you give that gift, you give it not to get something in return, but truly to give it to the other person as to bless them. You know? And then you almost try to forget the inherent goodness of that, that you, yourself, have done this thing. Right? Because that would be kind of… I don't know. Does that make sense?
Steele:
It does make sense. It reminds me, there's an eminent Jewish philosopher, from many hundreds of years ago, Maimonides, who talked about levels of giving. Okay. One of the lowest is somebody asks you, and then you give. Right? And then there's other ones where somebody tells you someone else’s needs, and you give. So they might still know who gave it, but less. And then, the highest is where the person has no idea. Right? And I think it's getting at that space around they have no idea that you were the one who gave. Right? Or, and then there's also you don't know where it went. Like you give and just trust that it'll go to the right kind of people. But that takes away from..somewhere you still, I think, that idea of, “Tell yourself you didn't do this good thing,” it is an interesting one.
Steele:
Can we really do that? Or it's just saying, don't be so in thinking, “Oh, I'm an amazing person because look what I've done.” Right? And you get that when the person knows that it was you and you're expecting a thank you or whatever, but there's something that it is coming through around, you give because you feel that's the right thing to do. I don't know if it makes you feel good. I'm not sure that that's necessarily a bad thing. But there's also so much theory of mind, like, when you give to someone and they don't know who it is, you're putting yourself in their shoes. Like, if you were needy and needed, would you want everybody to know that? No. You're protecting their self-esteem or whatever, by not being kind of public or knowing.
Steele:
So I think there's a lot in our thinking about motivation and why we do the things we do on that positive realm. And then, when we look at Epstein and all those other elite people who did very bad things, you know, there's something so irksome, I think, to the rest of us over, why would you think that this is okay and you can get away with it? And now, we have our government here who's not arresting anyone as far as I can tell, as compared to in Europe, I think in Norway and in England, now, but not here. And whether that's to do with our current context, I'm not so sure. Some of this was available for many years and nothing was done.
Puder:
Yes. I hope that the listener–I'm mentalizing the listener–and I hope that you're not annoyed at me going into my own sort of peculiar interest here with Epstein. But I think it does illustrate this reflective function at its finest. It is both true to yourself, but it's also if it's bent, if the gift of psychological mindedness is bent towards a more of a sadistic, you know, power hungry thing, it could actually be a low reflective function. Right? Flourishing of psychological mindedness. And I think that's the cool thing about reflective function is it catches, actually, a more selfish or self-oriented persona. And then my final thought was I saw this one email between Epstein and this guy, and he's like, “Have you considered GHB for your insomnia, or are you taking GHB?” Which is a date rate pill?
Puder:
So Epstein is alluding that GHB would be a good medication for sleep, and it's a powerful medication for sleep. Actually, they use it in narcolepsy, like very severe cases of narcolepsy. And it made me think, “You know, for some people, even if they're morally bankrupt, they still have issues with sleep.” I tweeted this out and one person tweeted back, like, ”No, morally bankrupt people don't have issues with sleep. They sleep fine.” I actually looked it up. And people higher in Dark Triad traits actually have worse sleep (Akram et al., 2023). There's been studies on this. So, maybe they can be hiding it from themself during the day, but at night, it comes to them in nightmares and in troubling things. And this is where the hiding from themselves during the day is low RF. What do you think?
Steele:
It could be. It'll be hard to know. I hope that they have nightmares at night for what they've done. You know? At least, that would give us some kind of glimmer of hope if there was some level of remorse. Or is it so deeply hidden that they're not even in touch with the connection between what would be disrupting their unconscious and their sleep?
Puder (01:27:39):
Okay. So kind of bringing this to a close here, I know. This has been a great dialogue. I've really enjoyed it. Anything still lingering in your mind that you would want to say?
Applying Reflective Functioning in Therapy: Clinical Tips, Limits of AI/Bots & Upcoming AAI/RF Trainings with Miriam Steele (01:19:53)
Steele:
I think one of the things I would like to say is just knowing about how RF works from the research domain, it is very powerful within your clinical work. So whether you get trained fully on doing the AAI, which we love training clinicians. We have an AAI training institute going on in July of this year on Zoom. But even if you don't do the full AI coding, being aware and familiar with the research and the theory of RF. I think it can really change clinical practice.
Puder:
Yes. I think it has, the more I understand it, the more I dig into it. And I think the other thing is that AI may not be able to be the best at increasing your RF. Right? Because AI, in and of itself, is abdicating your own experience of the visceralness of your emotionality. And the process is necessary to grow your RF. And this is where I think the interpersonal nature of things like transference-focused therapy is something that increases RF, or therapy that has an interpersonal aspect. Right? Group therapy, that kind of thing, as well, where there's an interpersonal piece, will probably be the closest thing because it's an authentic increase. Right?
Steele:
With authentic people. I don't know whether the bots could get so good at delivering therapy that they could do that.
Puder:
It’s sycophantic, right? At the very nature, it's sycophantic. It caters to what people desire to hear. Which is the problem. Okay. Well, I'll post in the show notes links to your training. And I've done the Reflective Functioning training with your husband. I think I might sign up for this AI training as well.
Steele:
Very good. We'd love to have you on board. It’ll be fun.
Puder:
We will leave it there for today. Thank you so much for coming on.
Steele:
Good. Thank you, David.
Further Training: https://mainattachment.org
References
Akram, U., Stevenson, J. C., Gardani, M., Allen, S., & Johann, A. F. (2023). Personality and insomnia: A systematic review and narrative synthesis. Journal of sleep research, 32(6), e14031. https://doi.org/10.1111/jsr.14031
Cologon, J., Schweitzer, R. D., King, R., & Nolte, T. (2017). Therapist Reflective Functioning, Therapist Attachment Style and Therapist Effectiveness. Administration and policy in mental health, 44(5), 614–625. https://doi.org/10.1007/s10488-017-0790-5
Levy, K. N., Clarkin, J. F., Yeomans, F. E., Scott, L. N., Wasserman, R. H., & Kernberg, O. F. (2006). The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy. Journal of Clinical Psychology, 62(4), 481–501. https://doi.org/10.1002/jclp.20239
Steele, H., & Steele, M. (2005). Understanding and Resolving Emotional Conflict: The London Parent-Child Project. In K. E. Grossmann, K. Grossmann, & E. Waters (Eds.), Attachment from infancy to adulthood: The major longitudinal studies (pp. 137–164). Guilford Publications. https://www.guilford.com/books/Attachment-from-Infancy-to-Adulthood/Grossmann-Grossmann-Waters/9781593853815