Okay, welcome back to the podcast. I am joined today 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, psychodynamic psychotherapy. We have no conflicts of interest to report for this episode. We will be doing a lot of role play, 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 frustration.
Individuals with depressive personality style are often professionally and socially externally successful, with a warm, engaging, empathic presence, and invested in making other people's lives happy. Due to the adaptive childhood dynamics that they faced, how they adaptively responded to hardships, these people developed an accommodating nature and 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 a 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, especially the works of Nancy McWilliams, Otto Kernberg, and Jonathan Shedler. They emphasize underlying dynamics such as internalized self-criticism, unconscious guilt, and enduring interpersonal problems, which makes this meaningful to understand and address. There are common patterns that show up in how they relate to others, including introjection, which means internalizing negative experiences and anger. There's a turning against the self, engaging in self-directed criticism and punishment, and there's a gentle idealization of others, coupled with, you know, when they do have frustration at others, they usually turn that on themselves and have this self-devaluation. So as they idealize the therapist, they may be covertly dissatisfied, but then turn that into self-blame and guilt. Countertransference could include protective impulses, a feeling of desire to rescue. There may be feelings that you pick up of their disavowed frustration, and you may feel the frustration that it's hard for them to feel. And there also may be feelings of helplessness that they feel, and that therefore you also feel, and these things will be addressed in this role play and in our discussion. And this concept has a rich historical lineage. Emil Kraepelin first described depressive temperaments, highlighting the stable and chronic nature of this. People like even Freud discussed in Mourning and Melancholia depressive dynamics, and depressive personality first appeared as a proposed diagnostic category in the DSM-III-R and DSM-IV in the appendix. Depressive personality styles represented in DSM-5 as persistent depressive disorder and in ICD-11 as dysthymic disorder. But we are here to discuss this as a unique personality style. And so, Jonathan Shedler, talk to us about the historical context on how depressive personality disorder first came to be included in the DSM.
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, 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 up front 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, right? 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 going to go to, you know, going to 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, 3 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 of the time, ratcheted them up, ratcheted them up in severity, you know, sometimes to the point of, you know, cartoonish caricature, called them disorders, right? And all of a sudden, personality disorders became a thing on on the map. So a little a little aside, but maybe relevant here.
Yeah, and I think it's so important in my mind to have empathy for clients, to understand our reaction of clients or 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 that everyone has a personality style. 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 I got that story, you know, directly from Bob Spitzer himself. I mean that you know how personality became Axis II 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 podcast, 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 is 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 I mean 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 in isolation from, you know, the psychology of the person who has depression. We can talk about anxiety in isolation from the psychology of the person who has anxiety. But that's not really a psychological understanding, right? We're we're talking about today someone who has psychological defenses that are in 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?
Well, yes and no. So, so one thing that's important is, so just for the sake of listeners, you know, what is personality really? You know, it's it's a consistent patterns of of functioning, right, that originate, 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. It often it often leads to depressive episodes that you could diagnose as depression, but not necessarily. So you can 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 style, right? They're they're somewhat different. They're different things.
Okay. So, how would you define this depressive personality style?
Yeah. Yeah. So it's a pattern of, you know, of functioning in the world and a way of experiencing self and others where, you know, the characteristic features are there people who are who are very prone to negative affect, especially shame, guilt, feelings of failure and inadequacy. The most defining, you know, the hallmark I think of depressive personality is if you were a psychologically sophisticated observer, you know, of like 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 it's as if there's something inside of them that's squelching, you know, their ability to allow themselves to enjoy that. And in some cases, they seem to, you know, not consciously, not intentionally, of course, but it's almost as if they're seeking out, you know, experiences that are going to be, um, you know, that are going to cause hardship or suffering or, you know, unhappiness, right? In that 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 it's generally not a disorder, right? It's if you think of the, you know, a spectrum of 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, which mean we have data showing this, clinicians tend to describe them as good patients. They feel really good about working with them. And the trap is the fact that the clinician feels really good, where 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 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 they enter into a relationship, they tend in one way or another to devote themselves to making the other person feel good about the 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 therapy, right? They both appreciate one another, but the patient doesn't change. That's that's the trap of treating depressive personality style.
There there it's like there can be some gentle idealization of the therapist. If they have frustration towards a therapist, they usually turn that towards themselves.
Yeah. They're not right. The 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 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, right? There's no such thing as a therapy session without a mistake, I don't think. And typically the patient either glosses over it, rushes past it so that, right, the therapist shouldn't feel bad about it or the patient actively takes responsibility for it. Like, you know, it's not your mistake. I, you know, I didn't explain it right. I gave you the, you know, I gave you the wrong impression. I I wasn't forthcoming enough. I didn't tell you all the information, right? It's on it's on me as a patient, not on you. But they don't do it, right? Because they're higher functioning in the healthy or 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's generally in a very, you know, engaging and appealing sort of way.
Yeah. So, we have a role play. I have 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 I was thinking maybe this is like early on in the therapy. Okay. And so we could just start it up. 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 we were talking about this because at first I was thinking about doing Abraham Lincoln, right? Having Shedler do some some therapy for Abraham Lincoln. Because I think he did have real depression episodes, but I think he had like a depressive personality. I really I really think he did. Don't know. I've been reading reading some the biography on him. Okay. But I will not be Abraham Lincoln. I will be and the reason for this is that when we treat patients of our own or we draw on, you know, our own immediate personal experience, if you have a patient in mind, we 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's 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, 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. Well, 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.
Well, I mean, I'm I'm hearing two things. 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.
I think, you know, as a therapist myself, you know, when I'm 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 got to you got to talk to them and stuff but I know I I I just anyways it's it's heavy. Mostly for my father it's weird. Everyone wants me to feel sadness. Everyone wants it's like oh you must feel so sad. You know we even had a funeral. 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, just stepping out of the role play for a second, how long have we been in treatment? How well do do I know this patient?
Let's say this is like third or fourth session.
Very early on. Well, I don't know. I don't have a lot of history. We're really So, you you can ask you can ask the history.
Yeah. Okay, so that's all I needed to know. So, let me jump back in. I gather you must have had a complicated relationship with your father.
Yeah. And I know I know the first couple sessions when we were meeting it was mostly about patient issues. And I it's it's kind of 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 want to burden you with a story of my father. Which I know you've like consciously in my mind you've been doing this a while but something in you feels like it would be a burden to me to hear about it, to listen to you.
So you know my father, I'll maybe I'll just start, you know, he left our family at around sixth grade. He's 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. Undiagnosed bipolar then, I imagine. 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 pancreatitis, end up in the hospital. So inevitably he became sober and when he was sober he was very miserable and miserable.
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.
When you say he was miserable, 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 gathering, in ways that made you feel miserable.
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.
You think he wished that that she had aborted you?
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.
He blamed you for he blamed you for his difficulties or his instability.
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 at you at me, spit flying, his face close to mine, you know, hard to predict.
Was there physical abuse also?
Yeah. Yeah, there there was. Yeah. I mean a 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 could.
Could you give me a for instance just whatever comes to mind just now? So I just so I can get a better idea when you say there was there was punishment, so I get an idea of, you know, what you're just what you mean.
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.
It was your responsibility when you were nine or 10 to clean the clean the whole house.
Well, and you know, my mother was at that point so heavy that she couldn't get out of the couch very easily. And so she and 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 I'm assuming if she was too heavy or too weak to take care of to take care of the household, assuming she wasn't really able to take very good care of you either.
Yeah. And this is I mean I I hate to even get into this but we we would live in 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.
Yeah. And I think, you know, I worked since I was 12, so I would go to school, I'd work, do sports, go to go to work, come home at 11:00. Mom would talk to me from 11:00 to 1:00 a.m.
What? I'm sorry. Go ahead.
About her issues. Things that have come up in the day, you know, and about her issues.
You mean her worries, her problems, what was things that were bothering her?
Her anxieties. Her the weight that she carried.
So I mean you're like 9 or 10 years old. It sounds like Well, you're a therapist, too. I mean 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.
She she had a lot of reasons. She had a lot of anxieties, you know, and I I I think it it she needed someone to talk to.
And so 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, this psychological lay of the land for for you for this patient, but I'm I'm about to this is going to 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.
Yeah. And I think I think you got to understand like how hard it I mean 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 I would hear them, you know, at first nice noises, giggling men that she was involved with.
Oh. Oh, you could hear you could hear it through the holes in the walls. Yeah.
So, this was happening right under your nose in your house.
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, you know, there's something that doesn't quite add up for me. You know, she's overweight and, you know, too, you know, too heavy or too depleted to 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.
Yeah. And she would, you know, she would meet these men online. They would travel sometimes from cities away, live 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 or just disliked.
So so who who was taking care of you? It 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?
You know, I think I think I kind of figured it out how to take care of things, you know, and I've I felt a lot of responsibility.
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.
I mean, I think at around that time, like, see, I'm I feel like I'm like really giving you too much here.
What do you mean? What do you mean giving me too much?
Well, I mean, I've, you know, I mean, it feels like I'm burdening you too much. I feel like this is going to be too heavy for you. Like it's going to be like a lot that like 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 want to be able to, you know, I want to be able to illustrate working with something here. So yeah, if this were in real life, this would be pretty abrupt. That you know I wonder if something is going on here between us that that is similar or a continuation of 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 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. Little kid having to fend for yourself and you were 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 want to burden me or it's too much for me.
Yeah, I even and I may have misspoke earlier. She would keep she would keep I would get home from work at 11:00. I mean, this was like in high school, junior high, high school, and then I would I would be listening to 1:00 a.m. I may have misspoke. So, I apologize for that. But,
Well, there it is again, actually. So, you assume that you misspoke rather than that I misheard or I misunderstood.
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.
Well, yeah. Well, I mean, the ways that I might be like or not like them, I mean, that's something else for us to talk about, but but just at the moment, I what I was really getting at, it wasn't so much whether I'm, you know, like them in reality or not, but I was noticing, you know, your, you know, impulse to want to protect me or your feeling that, you know, what you were telling me was, you know, too much, too much of a burden. It brings me brings me back to where we started, you know, which is your father just passed away, right? I mean, 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, you know, if if it's of a piece with, you know, you start to tell me about really 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.
Yeah. And and 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.
Yeah. And I think I think that.
I I guess I'm getting confused. It's like I know logically I should not feel like I'm burdening you. Well, and somehow I I 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, what it brings up I take it it's bringing up more for you.
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 don't feel much I don't feel much grat like 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 when it's when they're doing well.
It doesn't speak to your 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 when they're feeling bad, it's your fault.
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 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.
You mean just here just now between us or are you referring to other things also?
Yeah, I'm I'm I'm feeling like guilty in the 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. You know, you were even feeling guilty about, about not about your reaction to hearing about your father's death. You like guilty that you weren't sad enough or weren't reacting the way you think you should have?
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, um, 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. Um, 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.
Yeah, I could imagine. I, I was, you, you got there first, but I was about to say maybe you don't feel sad.
Yeah, he would, you know, he would come visit and he wouldn't really interact that much. Um, it, it was kind of hard to have a conversation with him.
And so, I mean, I imagine there's a lot of feelings in the mix. Well, you said there are complicated feelings, but among the mix of feelings, you know, I imagine there's a part of you that must be glad to be rid of him. You, you therefore the relief.
I would feel glad to be rid of him. I, I don't know if I'm there yet. I mean, I do feel some.
Maybe I jumped the, the gun. Maybe tell me more about the feeling of relief. I jumped the gun and put words in your mouth that don't fit.
Yeah. Well, thank you for, thank you for, um, that. Yeah, letting me have the space to kind of get in touch with what I feel. Um, okay, so 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, probably a pay phone, and then he would be telling me on the, the phone. And, um, 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 going to 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.' Uh, and so yeah, there's a weightiness.
Um, with, with those memories, 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.
Yeah, of course, you know, back then it's like you never have the right words to say to make them feel better. And so it was your job to make them feel better. 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?
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 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 to tell me, well, you failed at the job, you didn't, you know, you, you never could quite accomplish it, or, you know, but I mean it seems like in the background it's like, like the default is, you know, of course it's your job to make them feel better, right?
Yeah, and, um, and now I, I do that for my, you know, my work. And, um, yeah, I think the patients that I'm not good at doing it with gets to me.
But 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 in making them feel better.
Yeah, I guess I never seen, uh, 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 kind of like that.
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, um, how do you, how do you feel it's going?
I think you're doing an extraordinarily good job, 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, right? You know, and, and what I'm thinking, and I didn't say during the role play, but 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, oh, that they're falling short or, you know, something about them is, is bad, you know, it isn't, isn't good enough. Um, 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, there's two different things going on. I mean, one is the absence, the loss of a real caretaker that every child needs, right? And that loss, that, that stays with us, right? This is, there's a, you know, that gives rise to an emptiness within, right? That, that, that's a hallmark of a particular kind of depressive personality, right? That, you know, you sort of feel depleted and empty, and you try to fill that, 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, what we call anaclitic depressive style where the person is very sensitive to loss and relational disruptions. But that's half of it, right? The other path 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 by your father, the way you were, you know, the way you were describing. I mean, you'd be less than fully human to not feel angry, resentful, deprived, you know, enraged about that, right? It's not just that you feel like, you know, the other person, not just the other person, you know, 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, 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, right? Of course, you know, of course there'd be anger and resentment. And, 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, the 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, you're relieved from something bad that you don't want. It just, it just hinted at that. But 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 of depression, 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? Um, 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 want to take advantage of them, but because they can't tap into, say, you know, constructive aggression to, you know, assert, express their needs, their wants, and so they go without.
Yeah, and this is where like Kernberg's thought, which was so interesting, which I thought I would kind of pull in here, where he said, um, when I asked him what was the main thing therapists need to learn, and he said is to get in touch with their own aggression. And so, and I was thinking like, okay, so I was asking him about, um, 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 is this person's aggression?
Yeah, so that raises another issue. Let's definitely make sure we get to talk about this. So, dep, right, I mean people gravitate toward roles in life that, you know, that are consistent with their personality organization, and there are enduring psychological themes and conflicts 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'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 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. It's still there. It's still having its impact. And you actually, you know, did a beautiful job illustrating it. If you're angry with someone, if you really don't like someone and you're angry and you want to 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 want to rub it in, right? You mean basically, you know, if you're really angry with someone and, and you act on it, what do we, you treat the person like, 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, right? If, if you, if you were really angry at someone and, and acted on it, you 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 person with depressive style is treating someone like, but it's themselves. And that's where you see the self-criticism, the self-deprivation, the self-punitiveness, which is, you know, empirically the hallmark of this personality style, right? So it comes up immediately in our 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 with in the session. So I let it go by, 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, right? I took that period off, right? That wasn't your doing. I wasn't available to you. And, you know, I could easily imagine, it's, it's not a capital offense. You know, it's a, it's a small offense. It's 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 impulses, you wanted to, you 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? And that's a very, very small instance of, you know, that, that kind of, you know, criticism or punitiveness directed at the self, right? So if we put it, just sort of cast it in higher 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, and there's the reversal. Yeah. And it takes a lot of doing in therapy. And I was thinking about this before the role play. It's very hard to illustrate because it doesn't happen in a, in a single, you know, compressed segment. But I, I was thinking, man, we could, we could stretch this out for hours, right?
Yeah, that's why, that's why I thought it might be good to jump forward some sessions.
But the issue is that the therapist is going to have all kinds of failings, not necessarily intentionally, perfectly reasonable things. You know, actually, I've had inter-, I can think of a 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, um, I'm not there when she needs me, expects me, and, you know, she feels bad about, you know, wanting something from me. And, and, you know, and we had this discussion that was like, um, let me see if I can recapture it. Um, it's kind of slipping away as I'm trying to put, as I'm trying to put words to it. Um, it, it, it could have been a little bit dissociated because it was, it was so painful, right? Um, oh yeah, oh, it's coming back. Um, you know, so I got, you got something wrong. You know, I misunderstood something, and, um, you know, I fell 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 play, you know, oh, I didn't explain it right, I, you know, say it right. And, um, 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 been thinking about this case a lot, and a lot of it actually is very true, and it's not, it's not, not a patient. Um, it's not myself. Um, but it's a very close, it's been a close person to me that I know their story very well. So I, I, 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, and that's why it's so important that there's a, a person behind it. Um, you know, I realize I'm, I'm, uh, I'm thinking with my patient, I'm trying to also, you know, protect her.
Sure, absolutely. Yeah. So let me, let me just make up a kind of an equivalent example. Um, and, and I'll, I'll say for the record, I got permission from my, my person. So let's say I missed a session or I was late for a session. Um, or actually, let's use the example that you gave. I, I was, I was away. I had something else scheduled and I canceled the appointment in advance.
And I wasn't there for her when she wanted to reach out. And, um, you know, and she starts very much like you did, you know, well, I really wanted to reach out to you, but you were away. I didn't, you know, I didn't want to bother you. And, um, I said, you know, it must have felt, 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, um, 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. 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 re-, you wouldn't just not show up for a session, you know, just for the hell of it or because you didn'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? Maybe there's some other parts of you in the mix that, you know, was harder to hear from, harder for both of us to hear from. So 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, the full range of our experience. We have lots of reactions that are so logical and, and, and so what I'm doing is in working with somebody like this, the, 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, an example I use in my chapter that, you know, I think you read was, um, the therapist is late and the patient says, 'Oh, you know, I understand. You know, you were running late. It happens. You know, no worries.' Oh, I think it even came up in our last role play when last time I was on your podcast, right? And, and, you know, nine out of ten times a therapist is like, you know, the patient's letting them off the hook, and, you know, let's get on to 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.
Maybe let's, can we 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.
But I, yeah, let's go into another session, and I'll bring up kind of another, yeah, kind of moment between us, like another, and we'll see how you deal, deal with it. Okay, you ready? 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 know 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, or anyway, whatever. We don't hear about their disappointment, their frustration, their resentment, their irritation. We don't hear, everybody, like we have to actively pursue that.
Yeah. Okay. Yeah.
Okay. You know, I had a, um, a, a dream between sessions. Maybe I'll start out telling you that. That'd be okay. I don't remember a lot about it. But, um, I was, uh, I remember I was in this church. It's kind of like it was almost falling apart, like an old church, like it was kind of like a ruins of a church. And, uh, I go into a confessional, and, um, I start talking, and then I realize that you're on the other side. And, um, I, I feel like, uh, you know, maybe watching some of your ex stuff, your posts kind of triggered that from the night before. I remember what I, I remember reading a couple of them about the frame, about the importance of keeping the frame, uh, and, um, I was like, so I, I went to bed and I had that dream.
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?
