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Rupture and Repair with Dr. Soe Thein
117 Plays16 days ago
In today's episode of Doorknob Comments, Grant and Fara are joined by Dr. Soe Thein, a board-certified child and adolescent psychiatrist and the founder of the Good Enough Psychiatrist YouTube channel. On his channel, Dr. Thein creates animated videos that explain psychodynamic therapy concepts for a general audience and has won numerous awards for his work. Together, they discuss moments of rupture that can occur in relationships and the importance of repair. They emphasize that occasional ruptures are a normal part of any healthy relationship; what truly matters is how the individuals involved address these breaks and work together to mend what has been damaged.
We hope you enjoy.
Resources and Links
Doorknob Comments
https://www.doorknobcomments.com/
Dr. Soe Thein
https://downtownpsychiatry.com/about-soe-thein-md
Good Enough Psychiatrist YouTube Channel
Why Conflicts Make Relationships Stronger - Video
Dr. Fara White
Dr. Grant Brenner
Recommended
Transcript
The Nature of Unsolicited Advice
00:00:00
Speaker
Instead of good advice, I feel like people, as in the people, not only, people I say people in a way that like humans naturally don't like advice that they don't ask for. In fact, some ways, like ah when you give advice to someone, you know, like ah you did it does surprise, ah you know, in some way cause a rupture.
Introduction of Hosts and Podcast Purpose
00:00:21
Speaker
Hello, I'm Dr. Farrah White. And I'm Dr. Grant Brenner. We're psychiatrists and therapists in private practice in New York. We started this podcast in 2019 to draw attention to a phenomenon called the doorknob comment. Doorknob comments are important things we all say from time to time, just as we're leaving the office, sometimes literally hand on the doorknob. that's Doorknob comments happen not only during therapy, but also in everyday life.
00:00:45
Speaker
The point is that sometimes we aren't sure how to express the deeply meaningful things we're feeling, thinking, and experiencing. Maybe we're afraid to bring certain things out into the open or are on the fence about wanting to discuss them.
00:00:58
Speaker
Sometimes we know we've got something we're unsure about sharing and are keeping it to ourselves. And sometimes we surprise ourselves by what comes out.
00:01:08
Speaker
Hi,
Guest Introduction: Dr. So Thay
00:01:09
Speaker
welcome to Doorknob Comments. I'm your co-host Grant here with Farrah White. And today we're joined by child and adolescent psychiatrist, So Thay. So is a board certified adolescent and adult psychiatrist practicing in New York with a clinical interest in integrating psychotherapy, medication management, and interventional psychiatry in his care approach.
00:01:31
Speaker
He earned his BS in neuroscience and behavioral biology from Emory University, followed by a research fellowship at the National Institutes of Health, where he studied brain plasticity in response to stress.
00:01:43
Speaker
He received his MD from the University of California Irvine School of Medicine, graduating with distinction in the arts and humanities, and receiving honors for his contributions to LGBTQIA plus health.
00:01:56
Speaker
He completed his psychiatry residency and a child and adolescent psychiatry fellowship at UC Davis Medical Center, and also pursued a two-year psychodynamic therapy training at the San Francisco Center for Psychoanalysis University.
00:02:10
Speaker
finishing in 2024. He remains on faculty at UC Davis, supervising and teaching psychiatry trainees.
The 'Good Enough Psychiatrist' Concept
00:02:17
Speaker
Dr. Thain is also founder of the Good Enough Psychiatrist YouTube channel, where he creates animated videos explaining psychodynamic therapy concepts for a general audience.
00:02:29
Speaker
This channel has won numerous awards, including American Academy of Child and Adolescent Psychiatry Psychotherapy Education Award and the AACAP Leatherman Drell Ritvo Award for Advancing Psychodynamic Therapy for Child and Adolescent Psychiatry.
00:02:44
Speaker
He is currently a psychoanalytic candidate at Columbia University Center for Psychoanalytic Training and Research. It's a real pleasure to have you on the podcast today. um And Good Enough Psychiatrist YouTube channel, I guess that refers to Winnicott's idea of needing to be a good enough but not a perfect mom.
00:03:04
Speaker
um And today we're going to be talking about whatever we want really, but focusing on a concept called rupture and repair, which I think is related to being good enough. Right, totally.
00:03:15
Speaker
i think it feels so, i feel so passionate about this, you know, topic and hence my channel named Good Enough Psychiatrist. And I feel like this kind of serve as like a North star on like my values and how I want to practice psychiatry.
00:03:34
Speaker
in a way of like coming from a humble place that I really don't know perfectly what the patients are going through, but I ah will make mistakes. But like ah the important thing is that the process of trying to understand.
00:03:47
Speaker
And if I were to make mistakes, repairing, those making new reparations, I feel that ultimately just that relational approach is what' what's healing. So that might be a little different from what people might imagine they want, right? they might ah They might imagine that they want someone who gets it right 100% of the time.
00:04:09
Speaker
I know, Farah, my sense is that that's how most people feel about your work. but So how do we reconcile that? um And if if you don't mind. saying I think being too perfect as a parent, as a psychiatrist, actually deprives the other person of the opportunity to get mad and rage out at you, right which can sometimes be therapeutic.
00:04:41
Speaker
or to sort of have that understanding, be compassionate towards you and say, hey, looks like you forgot your keys. You know, no problem. I'll meet you back here in five minutes or whatever little things happen. i do think um those are all opportunities. I agree with you so that it's really how we help people grow.
00:05:04
Speaker
Yeah. um And I wonder if you could talk to us a little bit about some of your if you're comfortable talking about some of your experiences with that and how it became you know important to how you work.
Lessons from Burma: Community and Relationships
00:05:19
Speaker
So, you know, I grew up in Burma. It's like a ma majority, half of my life, you know, and I grew with like a pity pretty big family. i would say like 20 people in the same house. Like ah in Burma, it's kind of customary for people to live with extended family.
00:05:36
Speaker
So like, ah you know, one thing learned is like, there is the individuals, but like there's also like a group cohesion and community, you know, ah better for the kind of like a quote unquote community in some sense.
00:05:54
Speaker
It always feels like ah the relationships, what i perceive and grew up with, feels like I'm not supposed to make any disruptions in relationships.
00:06:09
Speaker
Because like ah if there's a disruption in relationship between individuals, then like ah the group or the 20 people, if everyone is making disruption in a relationship, it's kind of hard to function in some way.
00:06:24
Speaker
So like ah my parents too, they are very kind of not that confrontational. They are pretty, like ah in some way, like flexible with each other and with like my aunts, uncles.
00:06:39
Speaker
like ah and and i when i When I first started therapy in residency, I was telling you know ah telling my therapist, that is it weird that I have never seen my parents fight?
00:06:50
Speaker
not not even raise voice to each other. and then, and which is like opposite of like, ah you know, a lot of the narrative I heard here.
00:07:02
Speaker
So like, ah and and in some way, like I was really proud of myself. Like ah I, you know, before my current relationship, I had like a two long relationships before.
00:07:13
Speaker
In some way, I was really proud in those relationships that I actually never fought with my partners. And then like a dad was like, you know, done and then like, but at the same time, the relationship feels very stifled in that like there is, that ah you know, there is not that much spark aliveness. And I also feel like it's pretty like ah sterile in some way.
Understanding Rupture and Repair
00:07:38
Speaker
So the ah when I started doing therapy, I and you know i kind of uncovered that there is, ah i I have an end, almost like an intermediate belief that if there were to be disruptions in the relationships, that the relationship could you know break and and it could and it would be in jeopardy.
00:08:04
Speaker
And I was introduced the i idea rupture and repair in that when I started the group therapy. In a group therapy, I realized that like, when I have you know have difficult conversations with like a group members,
00:08:22
Speaker
and able to walk through this, I feel much closer to the person. And then like, ah in some way, like, a it makes me wonder like, oh my gosh, is the relationships actually secure if you actually have not tested out?
00:08:38
Speaker
Right? It's like you're trying so hard to not test it out. How do you know the relationship secure? You only know the relationship secure only when you test it out. So that's like, ah you know, the the conceptions of the my the how I really came to understand the idea rupture and repair at a personal level.
00:08:59
Speaker
Yeah. Do you think there's an underlying fear, like that if there is any conflict, it won't be survivable or something? Yeah. i Yes, I think it was like a, well, I think and for me, it's like a two for one is certainly this.
00:09:14
Speaker
The other one is i I think I was always like a worry about like ah how it will affect the the group. So like ah if it is like a family, less even like a small family, right? A nuclear family, not 20 people, even like three, four people, I would wonder like, okay, because I had a conflict with this one, ah you know, with my partner, how will it affect like other people in the group?
00:09:37
Speaker
so there's like a this mentality. Oh, yeah. I think like ah the second one scares me more like growing up. Yeah. My understanding that also varies a lot culturally. I'm i'm not I'm no sociologist, but i've I've read a fair amount about one of the differences sociologists talk about is the difference between communal and individualistic cultures.
00:10:01
Speaker
And so the concern for the wellbeing of the group, I think, is generally a very good thing that maybe we don't think about enough, but it can also it can also be problematic.
00:10:14
Speaker
I think um that kids, like one big part of their development is pushing boundaries, right? And seeing what types of behavior, they are just naturally provocative in how they explore the world.
00:10:31
Speaker
And a lot of times people will hear, oh well, you know, your kid is just follows instructions and does a great job at school, but that kid comes home and falls apart.
00:10:45
Speaker
Right. And part of it might be because they feel really secure at home and that's where they're testing out. The will you still love me if I, you know, jump out of the bath and run around or, you you know, um and I think that we all replay some versions of that in our most intimate relationships.
00:11:07
Speaker
Yeah, though, alternatively, it can be stifling to be well behaved all day long at school. Right. And then it kind of comes out later on. Right. And then you have a problem if the parents are too controlling and the school is so controlling, right? And kids have to sit at desks and it's not natural and there's no nature for them.
00:11:26
Speaker
But I also think that I'm glad, this is why i'm glad we're talking about it because a lot of times what we perceive as someone being confrontational or someone or a child not listening or a partner, you know, being aggressive or in some way is really important.
00:11:49
Speaker
That's part of what makes the relationship strong, the ability to like move through that. And I think if people knew that, then they would be a little bit more relaxed. you know It's not like, oh, we had a fight and now it's over. It's we had a fight and now we see how the other person responds.
00:12:10
Speaker
Mm-hmm. Yeah, it's like ah if you if you cannot have like this difficult conversation, so go through like challenging moments with an intimate partner, how do you know the relationship is strong?
00:12:24
Speaker
If your relationship is only presence when things are good, is it actually strong? You know, you really don't know. Who knows? Exactly. Especially when stuff gets worse later in life and you face real challenges together.
00:12:40
Speaker
Yeah. And like of what I like about the, you know, the rupture repair idea is that is it's actually we are innately drawn to it. So like it's not that like ah a skill, it's like ah almost like an innate capacity to want to walk through rupture repair.
00:12:59
Speaker
I mean, we all, you guys probably have seen like a distilled phase experiment that like ah electronics have made. It's like they are showing about the, a baby and then like a mom and then like ah in the beginning the baby is like smiling and mom is smiling, they kind of being playful and ah you know suddenly experimenter asked moms to turn around and turn back with like a very still face.
00:13:27
Speaker
And there was a moment of like a disconnection and the baby instantly felt the anxiety. And so like what the baby does is like, ah these are nonverbal babies, by the way, they they they cannot talk yet. So they try to get attention from mom.
00:13:44
Speaker
They will try to like wave it and then make cooing sound. The mom is like, still kind still face. So it kind of actually escalated and at the, you know, in one of the videos, the baby actually started like ah really dysregulated and they started a biting themselves.
00:14:01
Speaker
So like ah in some way, like a disconnection can be really as painful that it can induce like self-harm in air areas. In a good enough environment, of course, like the mom is always not attuned.
00:14:15
Speaker
But like a day in day they even have a study that you only need to be attuned to the your babies about 30% of the time. The rest of the 70%, you're just kind of ah stepping on each other's toes and you're just kind of repairing.
00:14:30
Speaker
And this repair process is what teaches the, you know, cement the baby neurobiology that this is what a relate realistic relationship should be. there will be repair, but then that you can survive it, you know there will be another person that is willing to ah make it right for you.
00:14:48
Speaker
The idea of the still face experiment's very disturbing to
Impact of Parental Absence on Children
00:14:51
Speaker
watch these videos, because the baby, they tend to flip out. The mom is warm and then is detached. And unfortunately, that happens a lot in real life, with trauma, with alcoholism, with depression.
00:15:04
Speaker
i know people whose parents were not present because of depression. And kids were kind of wired as human beings to need relationships, right? Just as much as we need food and water and air.
00:15:17
Speaker
And so kids will do just about anything to try to secure the relationship, even if it means it's at the expense of their own development. Yeah, kid kid people can be self-harming, but they can also really sacrifice their own developmental needs and kind of learn.
00:15:34
Speaker
right to put aside what their needs are because their survival is based on being dependent on their parents. And so they can really shape themselves.
00:15:45
Speaker
And then as adults, those people are really have a lot of difficulty in any kind of ah relationship, personal, professional, then they'll often come in. And I'm curious what you think about this and talk about being like conflict avoidant, which I sort of hear as intimacy avoidant. Mm-hmm. So I'm curious what you think about that and whether it might be helpful if you could give listeners a little bit of an overview of the concept of rupture and repair, which I think also goes back to Donald Winnicott, right?
00:16:18
Speaker
me Yeah. Farah, you want to start? Yeah. Sure. um I think that a lot of times when kids are sent the message one way or another, and i I'll sort of answer but first part of the question, when they get the sense that they have to stay in line in order to take care a parent, because that They sense either a fragility, ah sometimes it's a depression and anxiety, any type, I think, of volatility, right, that is confusing to them because kids who are at a certain age, like,
00:17:04
Speaker
A parent might come home having had a really difficult conversation with their boss, but most kids, until they have that higher level reasoning, are going to assume that they did something wrong, that they are the cause of someone else's displeasure.
00:17:23
Speaker
And who then I think it puts a sort of burden on them not to explore, not to act out. Sometimes the opposite can happen where they try to become a distraction to sort of like if the parents are fighting too much, then maybe the kid all of a sudden starts to unravel.
00:17:42
Speaker
And then the parents come together and take care of the kids. So all of these family dynamics change. I think are the foundation of how we go out into the world and form our own relationships.
00:17:54
Speaker
And so a lot of times when people say like, I know this isn't good for me because they've sort of grown up, maybe they've had some therapy and they learn that this is not healthy for them.
00:18:09
Speaker
And yet they can't stop doing it. It's because they haven't yet had that experience, that rupture repair.
Therapeutic Techniques: Rupture and Repair
00:18:17
Speaker
Right. And so part of my work with them might be to say, listen, you can be really mad at me is I know it's annoying.
00:18:26
Speaker
I am changing around our appointments. I am running late. And it's like, That is sometimes their first introduction. Yeah. And I will even say that I think sometimes having that repair together is really therapeutic and important, but sometimes they might even need to fire me.
00:18:49
Speaker
to really fully like for their own development and to be able to say, hey, this isn't working for me. yeah And that actually is kind of a weird thing for, I guess, a therapist to say, but like i I would feel like if someone fired that maybe I did ah pretty good job.
00:19:11
Speaker
Well, or maybe you're too busy and there's a wish there. No, I think it's a matter of being able to say, hey, this is actually not right for me. or The first step is I don't like this.
00:19:23
Speaker
Let's try to fix it. And then the second step is this isn't right for me, whether it's a relationship, whether it's the therapy treatment, you know. ah So I think that those are that's how I sort of see it. But we can talk more about the analytic theory behind it.
00:19:41
Speaker
I don't know if you think that would be interesting for people. Yeah. Yeah. You know, the, your anecdotes on like, ah you know, being fired, it makes me think of like the famous clip from like Carl Jung.
00:19:53
Speaker
I don't know if you've seen it. Like there was the interview, one of his patients, And then like, Carl Yong said something ah really true about herself. At the same time, she got really hurtful.
00:20:06
Speaker
So essentially she fired him. And then the next few years, like ah she was really mad at him. And then one day she realized what he said was so true.
00:20:18
Speaker
So she called him from office and then like his receptionist was like, oh yeah, Dr. Yong said you might be calling. ah One of these days, I was like, oh, you know, like even after a break, my point is that even after the rupture, like the young really has the hope that they will be repaired, even after two years.
00:20:40
Speaker
Like and when a patient comes back, you really continue to work on it and then they reconnect. He also knows how people work. Yes.
00:20:50
Speaker
So one thing I've noticed is, you know, in psychoanalysis, they it sounds worse than it was intended, but, you know, we call it resistance. But it's not a criticism. Resistance is actually a good thing.
00:21:02
Speaker
And so a lot of times when you're talking with someone, you know, they push back on what you're saying. And, you know, we can talk about whether there may be other approaches rather than getting into the confrontation when you don't need to.
00:21:16
Speaker
But people tend to be that way, right? they We all have kind of different views on things. And if you're confronted by someone else, there's a good chance you're going to kind of push back But then we also know that later on people kind of mull stuff over.
00:21:31
Speaker
They don't feel like they have to defend themselves. Of course, you could say that people in therapy shouldn't feel they're defending themselves. It's a matter of the therapist's approach also.
00:21:42
Speaker
But yeah, people think about stuff. And I think if you're Carl Jung, you know, you kind of know what is going to happen because you've done it a hundred times. Yeah. And so you you kind of know that people may make connections.
00:21:55
Speaker
That's kind of what what happens often in therapy is that people don't make the connection in the room with you. They talk to a cab driver who says, you look like you had a rough day. And then they have an epiphany. That's the story I've heard.
00:22:08
Speaker
And then they come in and they're like, why didn't you tell me I was depressed? The cabbie picked up on it. And then you have a rupture. Why did you let me down? right So how do how do you think about it? Because you're you're really the child and adolescent psychiatry expert.
00:22:24
Speaker
I know we all know a lot. But what what what is rupture and repair? you have Can you tell us a little bit about how Winnicott came up with that term? I'm also thinking about his paper, Hate in the Counter-Transference. I'm wondering if that's part of it too, is tolerating hate hate hateful feelings.
00:22:40
Speaker
Well, I think like ah first, like a definition of rupture itself is like, a what what is it? I think definition range from like many things. like ah It can be from the moment to moment, like mis-achievement in therapy sessions.
00:22:56
Speaker
For example, a patient might be And a play therapy is actually like a much more like ah obvious than a talk therapy. In a play therapy, like a a kid might say, like ah oh, you know but look at what I made. And then he will be very excited.
00:23:12
Speaker
And then like ah you might miss the excitement. You're like, oh, like ah ah and and that is a ah no minor rupture. or it can be really big as like a betrayal, like ah in a relate intimate relationships, like ah you know being cheated on. like that would be you know it can The rupture can range from like a ah long spectrum.
00:23:34
Speaker
At the same time, like ah the repair, you know there's also like a certain components of like ah repairs that makes a repair. and like i'm I'm sure you could all have thought about like what makes a what makes it repair like effective or is there any or why some repairs feel so like flat and fake because like they actually don't meet all the criteria for repair.
00:24:02
Speaker
So like ah to me like ah you know at least like you have to meet like a four criteria to really make an impactful repair. First, what people are really good at is recognition that like something, the rapture has happened.
00:24:15
Speaker
If you cannot acknowledge this, then like there's you know you cannot do anything about it. And then like ah the, you know, the second point is like, a then you have to take the accountability, like ah from the person, even though you, you know, you have different intentions, but the fact that what you did has an impact on another a person by being able to see that, you know you messed up or like something didn't feel right.
00:24:39
Speaker
That's also important. And then like ah the third one is that, you know, know curiosity and empathy, like a Of course, like ah if you think about from your own psychology, of course, you will only see your point.
00:24:54
Speaker
But if you really wonder another person with their own psychology and with their own background, you may you may realize ah why they feel the same way based on their history.
00:25:07
Speaker
I mean, like a many of the times, like ah actually like ah when I was in group therapy, these three outcomes easy. But the fourth is the hardest part, actually. The fourth is really making a commitment for yourself to not repeat this.
00:25:24
Speaker
Because if you don't do it, the first three, only if you continue to the first three, how is it different than someone doing a narcissistic abuse? Right? you are that You are just giving a four promises after four promises.
00:25:38
Speaker
And is this what the narcissist do? They were like, oh, you know, like, oh, yeah, like, ah you know, you're right. Like, a you know, there's a flowers for you. Then you don't make any commitments.
00:25:48
Speaker
So like the fourth one is just as committed as you have to be very mindful how in that impact, how you had on another person. and it really deeply hurt them.
00:26:00
Speaker
And then you try your very best to not to repeat this. So I think if you hit all of these four, whether in your personal relationships or the therapy relationships, this can be really healing. Even like, ah of course, that you have we are not perfect in my therapy session too. Sometimes like, ah from like a dynamic reasons, right? It may be reenacted.
00:26:22
Speaker
The fact that I catch it and I was, okay, I just repeated something that what that happened a few months ago. And then just talking about this can also be like ah really healing.
00:26:33
Speaker
So at least i i think about rupture and repair in like a oh personal and like a therapy sessions. Yeah, that's it's very thought-provoking and heartfelt. I think about the role of compassion toward oneself and others here, and also the deep sense of shame and stigma that people feel that what might seem like an ordinary rupture that happens in the course of relationships, for someone who's more narcissistically vulnerable, what for another person may seem like...
00:27:07
Speaker
not that big a deal, feels like a trauma, right? And we live in a time where kind of every little thing is labeled as a trauma.
00:27:19
Speaker
Now a traumatologist, and I think that trauma is deeply under-recognized in many cases. And we were talking about the role of social media before we came on. And yeah, like,
00:27:30
Speaker
Not everything you don't like is a trauma. So, you know, that's what comes to mind for me is just this kind of need to be more resilient in order to tolerate rupture and in order to embrace repair.
Commitment to Repair
00:27:45
Speaker
And like you said, that motivation. So I'm curious for either of you, like, well, how do people make that commitment? You know, how do they get to that point? Because a lot of times,
00:27:56
Speaker
it seems like you would be sacrificing your own kind of justice or integrity to kind of let someone get away with mistreating you. I think that's such a good question and it comes up a lot, I think, when people really want to be their most authentic selves, right?
00:28:15
Speaker
So if they are trying to show up in that way and someone does something that they don't like, they might express it maybe in a way that doesn't land well with the other person, like, hey, this was very insulting or this hurt my feelings and here's why.
00:28:32
Speaker
and if that person isn't receptive because they themselves either don't think they did anything wrong, can't see what they did wrong, or feel a need to be perfect all the time and just can't tolerate it, then I think it leaves this other person who feels like they built up this nerve to confront someone and it doesn't go So I do think that so much has to be in place for people to be able to to do it. And the person who feels victimized in the first place, you're right, they shouldn't have to think about how or when they're sort of standing up for themselves.
00:29:15
Speaker
But I love to tell people, strike while the iron is cold. you know, after there's been maybe a tense dinner or a tense moment and you didn't like how someone spoke to you, the time to do that is when their defenses are down and things are relaxed and people will always say, well, then things are good for the moment. So I don't want to talk about it.
00:29:37
Speaker
And I'm like really not trying to ruin their night, but I'm saying that the way there is a a way to discuss these things that I think can go better for for both people.
00:29:50
Speaker
Oh, I love that practical tips on strike when the iron is cold. I agree. it's like you have to pick the right time, the right place, but you don't get in a really like busy, like a time square. right i would How would you do it?
00:30:06
Speaker
Yeah. Yeah. Well, it's a guarantee for an unconstructive conflict, right? There's constructive and there's destructive conflict and people hate that advice.
00:30:18
Speaker
Well, because it feels like you want to say in the moment, right? email Yeah. Like, what was that supposed to mean? Right. And like at a dinner table full of people, that's probably not the time you're not going have a rupture that leads to repair in that. Right.
00:30:36
Speaker
But why don't people take that obvious good advice? Any thoughts? I think it requires a presence of mind and like an overall balance that sometimes people don't have.
00:30:48
Speaker
To me, it's about impulse control and believing that they're doing the right thing because they're finding finally standing up for themselves. And ah grant if I understand your questions, you're like, why don't people tend to pick the the right time setting and then like ah we pick like a setting that is conducive or constructive repair.
00:31:14
Speaker
Yeah, and and specifically, like let's say you or Farah, a patient says, like this happened, and we keep getting in fights. And you say, well, why don't you wait until like you've had a chance to think through it? You know what happens?
00:31:27
Speaker
And the two of you, like, yeah, it's a form of intimacy to be fighting. And maybe fighting is the way you merge with each other and you become this, like, one, you know, fighting identity together, which feels more intimate. And maybe it's a substitute for other forms of inti intimacy. My question for you is, why don't people take good advice?
00:31:49
Speaker
It goes back to the question that I had asked when you said that people need to make the commitment to... Yeah. So I'm curious what you think, because that's the hardest part.
00:31:59
Speaker
Well, like instead of good advice, I feel like people as in a people, not only people I say people in a way that like, ah you know, humans like naturally don't like advice yeah that they don't ask for.
00:32:16
Speaker
So like ah is in some ways like ah when you give advice to someone, you are actually not listening. you know like ah you did It does surprise you know in some way cause a rupture.
00:32:29
Speaker
So this, whenever there is a rupture and disconnections, and if it is not repaired, it shores off the defenses. you know we We talk about like ah ideal scenarios in a therapy where patients just say, like oh, and you make me mad, right?
00:32:44
Speaker
I would say that is like 1%.
00:32:48
Speaker
99% in a therapy is that I look for other signs like where there may be a rupture or disconnection. So it might it might look something like they you know they suddenly become quiet or they can become fidgety or like they start bringing up the you know deep conversations.
00:33:08
Speaker
or like, ah you know, the go to your, the name of your podcast on the doorknob, they might can make cancellations or like ah they suddenly forgot your appointments.
00:33:19
Speaker
So like ah these are, you know, all signs of like ah ruptures that um I kind of, you know, think about rather than like, a you know,
00:33:32
Speaker
someone saying directly that I'm i'm mad at you. So like ah to answer your questions, I think sometimes advice can, in the sessions, can cause like a minor ruptures that can go and and acknowledge.
00:33:48
Speaker
Because it's experienced as like an empathic failure. Yes. Because you're trying to fix the problem rather than being supportive or something. So would you say to someone,
00:33:59
Speaker
Is now a good time to talk about other ways to handle it or do you need something else from me? Or would we be too like trying too hard to avoid the rupture? Like a lot of therapists might try to avoid ah rupture.
00:34:13
Speaker
i wouldn't say you know try to cause conflict in order to produce a repair, but it kind of happens no matter what you do. Yes. ah But how how would you approach that to be more constructive than maybe trying to alleviate, you know, our own anxiety as therapists by offering advice? Because everyone wants advice, but no one takes it, right?
00:34:37
Speaker
Yeah, go ahead, Power. I think it feels good to not have to take advice. You know, I think some people really pull forward. You know, they're like, oh, tell me what to do. Tell me what to do.
00:34:49
Speaker
And then the reason is they want to be able to not do it and to reject the advice. And that I think is really important for some people.
00:35:01
Speaker
I don't necessarily i think people are conflicted about wanting be. make certain changes or change the way that they relate to others. Maybe it's that they want everyone else to do that work, right? That's why they're coming in That's why they're going to be family holidays. They're hoping that other people will come in and take care of them in that way and do the work for them, maybe because they feel so overworked already.
00:35:31
Speaker
So I don't know. i I don't know if it's as simple as like, They don't, people don't want what's good for them. I just think there's just like so many factors.
00:35:44
Speaker
Yeah. I think the concept of ambivalence that you brought up, Farah, is it is really interesting. That is true. Like ah whenever there's a change, right? This is ah the core of like motivational interviewing. Whenever someone is considering change, they are in ambivalent positions.
00:36:01
Speaker
and there's a pros and cons in their head. And the moment you give advice and take a position, naturally, any humans will swing the other So before, i guess like to answer your questions, Grant, before you give advice, the preparatory work has to be to resolve the ambivalence, like to,
00:36:26
Speaker
whether it is through listening more or through motivational interviewing or like a value settings, like a two really and a resolve to resolve the ambivalence. It's almost like, a you know I'm also Buddhist, so there is always an emphasis in the ah right time.
00:36:45
Speaker
So like the right time and the right setting is really important. Sometimes you can say that the right thing, but if you deliver it wrong, even at the most empathic thing can be really kind of perceived as like a cruel reckless.
00:37:01
Speaker
Or like in ah ah on contrary, you can say something cruel and reckless, but at the right timing, it can come across really empathic. It really is that, you know, being in the relationship in a settings and really knowing another person.
00:37:17
Speaker
Yeah, feeling safe. It's very different if you kind of trust the person and you have a track record. And I know we we're running out of time for today. It's been really interesting. um I'm thinking of rupture and repair as also um in terms of oh in terms of ambivalence. you know I think another way to think about it is is to imagine we have different parts of ourselves. I'm a multiple self-state guy. So if you have this idea that you can have internal contradiction and that's to be expected, then there's less polarization.
00:37:47
Speaker
um You have like a ah kind of like a ah container for yourself as is what someone called it beyond. But in terms of rupture and repair, I like the metaphor, because Farah, you talked about striking while the iron is cold, which is a reference to striking while the iron is hot. Right.
Rupture and Repair: A Metallurgical Metaphor
00:38:03
Speaker
which is an old psychoanalytic idea that you need to make the right interpretation at the right time, which is much more of a perfectionism-based model of psychoanalysis, just as an academic note.
00:38:14
Speaker
So there's an idea, of course, striking something is from blacksmith, is from metallurgy. Striking while the iron is hot is like if you need to shape you know a sword, you have to you have to strike while it's hot, so it's malleable.
00:38:30
Speaker
um However, if you look at strengthening steel, it's through a process of heating and cooling that maximizes or optimizes the structure of the metal so that it's both strong and flexible or resilient, um which is a concept we tend to like a lot.
00:38:47
Speaker
And that process is and is a metaphor for development, human development, which is called annealing. you know If you watch a show about metallurgy, like blacksmithing, it's when they heat it and cool it and heat it and cool it.
00:39:02
Speaker
And I think there's a way where rupture and repair is kind of like that. But you have to be able to withstand the rupture in the first place. You can't be too brittle. Interesting. Yeah.
00:39:14
Speaker
That's a good visual metaphor. Yeah, I lifted it from, um to give proper credit, Robert Gallitzer Levy wrote a a book where he he uses, actually that was from a paper, but that he uses annealing as a metaphor for development from a a complexity theory point of view, um which is my favorite thing. And I think complexity theory and Buddhism have a lot of overlap, or maybe Taoism.
00:39:40
Speaker
But anyway, any any final thoughts? And then we'll ask where listeners can find you.
Resources on Psychodynamic Therapy
00:39:46
Speaker
i that i If you like more about this like a rupture repair ideas, on my YouTube channel, there is a video on it's okay to have a conflict. an animations video. is on like ah you know It's like a five, six minutes on like a Winnicott fundamental sort of like a rupture and repair and a good enough mother.
00:40:08
Speaker
yeah The Good Enough Psychiatrist on YouTube, it's it's fantastic. You're an amazing artist and creator, so thank you for that as well. And where else can folks find you if they want to reach out to speak with you professionally?
00:40:22
Speaker
Yeah, you you know I have a practice in Tribeca. It's called Downtown Psychiatry, and you can go to my website, downtownpsychiatry.com, and yeah to reach out if you to work with me.
00:40:35
Speaker
oh Thank you so much for being here. It was great to meet you today. And yeah, we will link to your your YouTube channel. people would be really interested in seeing that. Yeah, check it out. Thank you so much for having me, guys. I had such a pleasure at talking to you guys. Pleasure is all ours. Thank you. Remember, the Doorknob Comments podcast is not medical advice.
00:41:01
Speaker
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