Dr. Jacob | Anger/Rage/Aggression & More Commentary on 1.5 Year Follow-Up Session with BPD Client

i thought we would do a second debrief and the reason that we you and i talked about sort of re-upping this debrief is because it was a good opportunity to respond to some of the feedback and the comments that people are leaving on the channel so one of the things that has come up is tolerating anger and actually the difference between anger and rage so can i um i wonder if it is okay if i reword the word absolutely because i think one of the things that um you and i had been talking about was um a repeated comment about the the recommendation to to sit with anger and the first thing i would say about that is that having a goal of treatment is different than having a goal of the session and the goal of that session in my mind wasn't to in one statement or one session somehow transform charlotte's experience of intense anger and at times rage in a simple tolerated but rather introduce the idea of not avoiding certain emotions anger being one that has come up for her that she talked about the first time i met her and then again so in her acknowledgment of having a range of emotions which is i think a huge sign of progress she also talked about how she was using certain strategies to sort of what i might say distress tolerance emotion intense emotions when they occur and while that actually is not a bad strategy what i hope to introduce was the idea that we have lots of emotions some we're more amenable to than others anger is one particular one that many people have a tough time with and was i think pervasive for charlotte i think an innovative idea is not to distress tolerance anger away but rather to allow it to coexist with other emotions and not spend so much energy disconnecting or distancing oneself as though it's something to be feared and when one fears something like anger that's when i actually think it can build up to something like rage if i was in longer term therapy with charlotte that would be a real point of therapy to actually invite some of these ranges of emotions in so they don't become so scary over time if someone is willing to entertain the idea of inviting those emotions in and exploring how to begin to sit with them or tolerate them like why bother doing like why do it because we have a range of emotions some are as i mentioned some are more tolerable more desired than others it doesn't stop emotions that we don't appreciate from emerging and re-emerging and re-emerging over time being able to acknowledge anger or our own aggression is a challenge in and of itself given that this is not something that's avoidable it's a natural human emotion we know it's going to come up again and again for all people all humans it behooves us to have some exposures to all of these emotions anger being one of them so they don't become these monsters that over time are deeply feared what's the prescription when you feel when someone feels anger i mean i struggle i forever struggle with this you know um how do people make decisions about what to do with it the thing is about something like anger it's not like a choice do we want to experience it or not it's going to happen and the question is are you sort of aware of when it's emerging even at low levels and when it does emerge how do you what is your relationship with your emotions what is your relationship with anger charlotte mentioned that she goes from like zero to hulkish is what she described and the interesting thing even in our session which i didn't point out but might have in longer term treatment is that even in our session she was experiencing frustrations with me and i think another comment that you and i observed that kept on re-emerging was a comment i made about whether charlotte was in fact cheated on and the way i made that comment and why i made that comment which i can speak to in a moment but i think the benefit sort of a silver lining of having made the comment in the way i did was that her frustration was notable and if this was longer term treatment i might have noted hey look at this you feel like you go from zero to hulkish and yet there's something going on here what is that for you to be able to name these lower levels of anger that it didn't blow me up and it didn't blow her up and you would want her to note that because it was sort of an effective expression of it regardless of interpretation absolutely didn't damage anything by her to express it whether um she and i might be aligned and seeing something the same way isn't necessarily for the purposes of this issue around anger the point the the really important part of that interaction at the end of the day this was not intended was that she was frustrated and to be able to be frustrated and actually state that frustration is really good news and should be acknowledged and highlighted there's a difference between a longer term treatment and the interviews with charlotte or the sessions with charlotte and and it's coming to mind that that differential is actually quite important when i met charlotte a year and a half ago it was really trying to understand her world through her eyes and get a sense of what she struggled with what her hopes were what her goals were and what she thought she might want to work on seeing her a year and a half later was really an opportunity to say like how is it gone what's you know changed if anything what did you take in from the session and where do you want to go from here it wasn't really an opportunity to start working on anger per se but rather suggest that these are areas to work on for for longer term treatment so what i might do in a session over a longer term therapy is very different than what i might introduce or what i did introduce in those sessions with charlotte i was going to ask since you brought up that moment that a lot of people have thought about and said things about which is this moment where um i'm not going to be exactly perfect in my quoting but you said if you think that if that is what happened regarding everybody cheated on her cheating on her so i i had my thought about while i was watching it happen i was like oh is karen pointing out or investigating whether charlotte's perception of the event is aligned with what in fact she is saying or was there some mis interpretation of a behavior that led her to make this statement and and the reason that was my read on your comment was like my sort of somewhat static knowledge at this point of like bpd and it being i think in certain ways like a problem of interpretation and perception of interpersonal happenings that lead people to land in [Music] firm decisions about a person or experience that may be off base and then they behave in accordance with that perception and it does a lot of bad it blows up in their face because it is in fact kind of a misperception so i thought you were headed in that direction but it doesn't i think when we talked about it you suggested otherwise so can you talk about what you did i think there was part of that rebbe going on so i'm glad you mentioned it um i believed charlotte had that genuine perspective i really believed she had that perspective and i was challenging her on that perspective having some previous knowledge of charlotte from my conversations with her she comes to the world with a lens based in a long history of relationships that i think she really feels other people have failed her not shown up in ways that where she's failed loved or cared for parents other relationships and when we have these experiences there's a way in which we continue to enter into relationships with a lens based on our experiences so my pressing of the issue was really to sort of better understand what it was that she how she was coming to that assessment there are lots of ways to ask um and there might be more sort of less valence ways of bringing up the same issue i think that's a really good point um but the point of saying something like that is really inquiring what is she really taking in as evidence as an understanding that's leading her to an interpretation therefore responding to relationships in a very intense way with a lot of emotion so no doubt that was her experience but if this was a longer-term therapy i would have explored that more i would have been very curious i sort of backed off a little i could see she was frustrated that wasn't the point to get her frustrated i was actually happy to see that she could show frustration um but to really understand what she was taking in as evidence to to assess the relationship in the way she did because it can actually become a self-fulfilling prophecy so if i'm somebody who has feels like i can't trust people over time i might be really skeptical of my partner i may say and do things that indicate my suspicion or my skepticism that might generate an environment or contribute to an environment of mistrust where my partner then may be responding in kind so it in some ways can become a self-fulfilling prophecy and without one knowing that they may be contributing to this self-fulfilling prophecy and i'm not saying that's what happened with charlotte but it can happen and often happens with folks who struggle with bpd where there are some cognitive distortions at times or paranoia to sort of challenge or explore what am i what am i am i doing anything is there something that i'm doing that might actually be participating in this and the hardest thing is when people don't know where they don't see that aspect it feels very out of control in some ways almost like the world is doing something to them i mean i'm like thinking isn't that essentially transference you're putting something out unawares of what that thing is that someone else is absorbing feeling you're transferring something when you reference transference focused therapy as a potential modality for her to explore let's say the person is not consciously aware that they're bringing this history of distrust into a current relationship that the other person is then absorbing that attitude that they feel toward them so is the purpose of something like a transfer focused therapy to bring to the for that kind of energy attitude perspective that you emit unawares in relationships but you the therapist now is sort of the absorbing point or the the target for it reby it really is about a dynamic that emerges so it's it it's um important to see patterns over time so if you're somebody who says like i don't understand what goes on in my relationships it's actually quite painful it's very painful and yet it's really painful and to repeat these patterns without knowing what's going on it's kind of like you're walking through the world with blinders on and it can be really eye-opening to better understand how that dynamic emerges because if it continues to repeat even with a therapist and that is one of the focuses of tfp transference focused psychotherapy to see these patterns when it's likely to emerge with a therapist and work on those patterns is one reason why i felt for charlotte tfp could particularly be useful at this time in her life but the other thing about tfp and the other recommendation i made around why tfp might be useful for charlotte at this time is it's also a therapy that really really explores aggression and anger it's as a real centerpiece and to notice why is it why does it why do you think it's designed for that you know i i don't want to um purport to be an expert on tfp i certainly know tfp quite well and have been trained in it um so i i have this urge to say i want to double check this with frank yeomans but what i would say about anger in particular and so this is what what made me think about this is that tfp to the best of my knowledge was developed for bpd initially i mean it's really used for personality disorders but one of the hallmark um challenges that somebody with borderline personality disorders experiences is a real difficulty with anger in particular like disavowing anger not wanting to see one's own aggression you know kind of splitting it off because it's too painful to see oneself in that way right and so um you know to me for charlotte both this issue of anger and her difficulty in her own relationship with anger coupled with you know how she experiences relationships in the world make tfp a a good option for her it doesn't mean it's the only option but i think it's a good option for where she is right now in her own process in terms of like you know people splitting off their anger is it just because people feel like they're not good people or something with anger with why would you want to split off and not own your anger what's what's the big deal well i'll use charlotte's example i think anger for her feels like she's a monster that she's going to destroy herself and everyone else around her if she gets angry so it's a lot easier to split off and really try not to see it if it's that destructive to her and those around her especially those that she loves so she's going to try and contain it for totally understandable reasons except the problem is we can't wish anger away it's part of a human emotion that we all have so it's bound to continue re-emerging and creating real challenges for her rather than sort of try and contain it it's really about how i can have a relationship allowing it to be more known seeing when it comes up and seeing that it's actually emerging even in small doses even during my session with her so again i would have pointed some of those things out had this been a longer term treatment is it that people have such a hard time with anger just because everybody has different hard times with different emotions um or if that's a more commonly challenging emotion to figure out how to manage is it that way everywhere or do you think there's i mean i'm asking you to become like a social scientist now for a second but like is that because do you think that's i mean because we just don't have great examples of how to express anger i mean why you know you know i i have the urge to say anger is um one of those emotions that i think can be more challenging of emotions much like shame can be really challenging for people but when you're working with a particular cohort of people who have bpd anger in particular is very difficult to experience to express it's scary i think charlotte described it beautifully it feels like it's going to destroy them or somebody else you know one reason why people have reported to self-harm is because their anger is so extreme i mean certainly there are lots of reasons but this is one they'd rather take it out on themself than somebody else yeah that's interesting i mean shitty but interesting um and just one thing you just said back there you said you know you were happy to see that she was frustrated so i could hear like i can hear the audience without taking you to task for that a little bit saying yeah and um so let's just let's just grab that up now um why don't you say why you were happy because i don't think you were egging her on to be frustrated no it's not about egging her on to be frustrated or celebrating somebody's distress but when you're really in a therapy with somebody it's making room for all emotions particularly the ones that are really scary for somebody to experience to um align with that fear is undermining somebody's process of healing of recovery so when i say i'm happy it's not i'm happy that i upset charlotte i'm happy that she actually has moments of lower levels of anger that she might not even be aware of and that she tolerated without her knowledge so it's actually a moment of success for her that i would have pointed out highlighted i would have been shining a massive light on that moment if this was a different circumstance people you know find charlotte very appealing as a person as a personality right as do i i care i really love and like charlotte you know i enjoy her um it's hard not to like her it's hard not to like hard not charlotte it's hard not to like you yeah when you see this if you see this no um it's hard not to like charlotte and um and so i think we debriefed a little bit about sort of the people pleasing aspect or you know working hard to be appealing and that's clearly been effective and helpful to her in certain ways i mean better to be an appealing person than not absolutely where has that or where could that if she isn't attentive to that instinct put limits on her efforts to get better this ele this people's appealingness the way i think about this actually is somewhat related to say anger or keeping relationships where it feels like there's um minimal conflict even with me we started the session where the first thing she said you know is this apology for um how she when she went back and re interviewed this session herself how she saw herself and it was like trying to join on something with me and um relate and that's actually a a real asset in a lot of ways i would be curious whether that also functions to make it hard for people to confront her if there were problems because she's so likable because she's so appealing what impact that has for other people on bringing up grievances upsets it would be understandable especially given charlotte's fear of conflict or anger and if she really works to be related and appealing it minimizes conflict and anger at least active conflict and anger it doesn't mean that people aren't frustrated or upset in relationships but it may be hard to actually address those things directly right and it probably means for her as well there are under you know i mean none of us say everything we think or feel about a person because if we did probably many of us would be very depleted with who's in our life but um but it seems like she may also then not get out of relationships what she could because she's always working to relate and manage to avoid conflict and so then parts of her that need to get expressed or seen to sort of stand up for some aspect of her authentic self get closed out yeah i don't know i'm guessing anyway there are all sorts of um outcomes related to this um she might not be able to or feel comfortable sharing her frustrations until they become so big right because conflict is so hard so it's bidirectional um what she puts out there is part of who she is but maybe not all of who she is so it limits the sort of intimacy because if she's fearful that somebody really sees outside of her especially if part of that is anger or aggression that she really doesn't want to see in herself then there's part of her that's left unknown and that's actually when people can feel really alone because there's a part of themselves that they fear to be seen and it's again these are very painful experiences for people and you get to them slowly over time through therapy when you have a lot of campaigns to conceal parts of yourself there is a power in that because you know more than the other person you hold something for ransom in a way and there's an aggression to that i could just speak for myself when i it was my power you know i mean i wasn't very happy so i don't know how great that power was but well that's the trade-off right it's a trade-off it's a it's a you have you might have seemingly more control but control over what control over being fully known where does that actually leave you if your hope is to develop an intimate relationship with somebody where you are known right so it's a real conflict you

Channel: BorderlinerNotes

Views: 30,960

Keywords:

Id: ud6soSpJsS4

Length: 24min 48sec (1488 seconds)

Published: Fri Nov 05 2021