SPEAKER_01 0:11

Yeah, I published an article in the Skeptical Inquire. The title was Why Bad Beliefs Don't Die. And my premise there is that a belief system is actually not designed to change by data, it's designed to be a long-range sensory system. Like you're sitting here, if you drove here, you have to believe your car is in the parking lot. You can't see it. So our bel if so if I were, it's not designed to change by because your car's not in the room. So my saying about that, the reason I did that was that skeptical people can get very demeaning of people with beliefs that are kind of screwy. And my point was don't do that. Be compassionate. The beliefs have a hard time changing, it's very threatening. Boy, did I get hate mail over that article. I have never had such angry responses. But it was a lot of fun because they sent the author the responses, and then in the next edition, you get a respond to the letters, and I got to be sarcastic and hostile and nasty and demeaning in my responses, and that was really fun. So no, it was. You should read it. I was really very clever in terms of you know it's I got a nasty letter from uh one of the editors of Money Magazine in the thing, you know. Well, it wasn't too nasty. I mean, I like him, but anyway, shut up, Greg. So okay, so what Sister and Paul and I are gonna do today, you guys, is we're going to talk to you about what's called clinical conversations. Now I want to warn you guys, some of you are likely to not going to like what I'm gonna say. And here's why. The first principle, clinical principle, is that a clinical conversation is not an advocacy conversation. Here's why. Policy and personality work completely differently. An advocacy or policy conversation works by things like making a case. Proving you're right. So if you're being interviewed on the news, having an advocacy conversation for life, absolutely. Make your case. Show them that, show them the sonograms. Okay? Show them the pictures. Talk about what she was talking about in that wonderful session before this, about the pain. About 80% of people having post-abortion kinds of stuff. Tell them that. Make your case for it. And that is not how it works with a client. Because the principle clinically is in personality, what is resisted persists. So in our work, resistance equals persistence. So if you find yourself talking the same way to a client that you talk to the news, you're in trouble. You want the outcome, yeah. But when it comes to working with personality, there's no other area in the universe where there's more irony, paradox, and contradiction than in personality. People have belief systems. I do, you do, right? Do people violate their belief systems? All the time. Do people do things that they think are wrong? Yeah, you bet. So advocating, making a case, proving you're right, is not your best chance of getting someone to not have an abortion. Look, I'm a I'm a shrink. I work with personality disorders. I work with suicidal behaviors. Talking someone out of committing suicide doesn't work. Do I want my patients to kill themselves? Of course not. But advocating for staying alive, do you already not know they think the reasons to stay alive? That's not how you diminish suicidal behaviors. Okay? So what I want you to get, what we're going to talk about today, is your best chance of getting the outcome you're seeking, and that's not necessarily talking to encourage the outcome you're seeking. It might be, but not necessarily. Okay. How many times have you changed your mind because of an argument? I've never had Rachel Maddow change my mind. I watch her just so that I can make fun of her in my head. Oh, don't write me angry letters. Hey, politically I hate them all. I'm a libertarian. Did you know libertarians are pro-life? Do you know that? Oh, we are. We are the most staunch pro-life of all the political parties. See, people don't know that, libertarians. You know why? Because we believe in the Declaration of Independence. We're endowed by our creator with certain inalienable rights, the first one of which is life. We are totally pre-life in the Libertarian Party. Yeah, I had dinner with the guy who started the Libertarian Party, David Nolan at Colorado Springs. He's since passed away. Anyway. So we're gonna talk about clinical conversations. So I want you to know that some of the ways we're gonna tell you to talk are gonna be different than you're gonna talk in terms of your advocacy. Okay? Uh you know, I have my uh physical next Thursday at Dallas, and I'm I it's a big deal because they put you on the treadmill to exit, it's terrible. Sorry, so I've dread it for months. In public health policy, in terms of public health, there is no evidence that doing more than monitoring your blood pressure and your lipids is worthwhile. Okay? Well, this physical I take have every year takes six hours. Okay, they measure everything under the sun. And I asked my physician one time, I said, but but the policy is you should only those two things. He said, Greg, there's a very important difference between public health policy and personal health prevention. I'm like, oh, that makes sense. Okay. So the group statistics are one thing, and then what you do individually is another. So the policy you have legally, ethically, morally in the world, yeah, that's one thing. And working with a client to get an outcome, that's a different thing. Okay? All right, so remember, there's irony, there's paradox, and there's contradiction in personality. And you'll have to work with that to get the best chance of getting the outcome that you're trying to get. Like, I want to keep my patients alive, not kill themselves. You want you want your clientele to not have abortions in order to have life? Outstanding. So, what we're gonna talk about are the ways you talk that enhance your ability to do that. Okay, you got the point? Yeah, good. Okay. Number two. Clinically speaking. The meaning of a communication is the response. Okay. I get that. It doesn't work clinically. Your point is to watch your client. And what response are you getting to what you're saying? See, this is why, like in marital therapy, why arguing doesn't work in marriages? Because when you argue, what's the response? What do they do? They argue back. Okay? So my arguing actually reinforces your arguing. Okay? So you have couples come in and they bitch that they argue? Yeah, well, if you're gonna argue, they're gonna argue back at you. Okay, so the first thing we have to do is have them get that the meaning of my arguing is your arguing. Okay? Now, arguing's not inherently wrong. I actually kind of like to do it sometimes, but in terms of what you're trying to get, so you don't want to pay attention to your attention. You don't want to pay attention to your meaning, hmm. You want to pay attention to what response you're getting from it. Okay. So, number one. Advocacy conversations are important and they have a place. I'm not an advocate. Okay? I'm a clinician. A clinical conversation is different. Policy works by logic, reason, making a case, proving you're right. Personality doesn't work that way. Freud found this out early on. When you confront a defense, it grows in your face.

unknown 10:23

Okay?

SPEAKER_01 10:23

If someone tells you you're wrong, what do you want to do? Tell them you're right, they're wrong. Okay? So notice that doesn't work. You know, you know how I found Sister Paula, you know, I tell this story every year because I can remember it like it was yesterday. Do you know why I'm here? We were presenting a conference together, and she got up and she said, the reason the societal conversation about abortion isn't working is that it's entirely a defensive conversation. I thought, oh my God, she's right. You know, defense in a Freudian term. You know what a defensive conversation is? It is the conversation in the loser's locker room. How can you win a game with the conversation in the loser's rocker room? You can't. I'm like, oh my God, she knows what she's talking about. I never heard anyone talk like that. A nun, especially, talk like Freudian terms, you know what I mean? So that's why I'm here. I still remember that. It was at Vicky Thorne's Conference. You remember that? We were in Wisconsin. So, the meaning of the communication is the response, not your intention. Okay? Now, how are we doing here? I'm gonna turn it over to her in a second here. I'm getting to personality disorders, okay? Well, we have found number three. The fundamental key to a successful life, do you know what it's called? Flexibility and adaptability. Did you see the study that came out a couple years ago? The show the single biggest correlate to success in life is the number of connections you have in your brain. Life, is life messy and unpredictable? Absolutely. Why do you think your clientele come to you? The pregnancy wasn't in their plan, was it? Well, guess what? They have to be about that. Flexible and adaptive. That means they have to change their mind about their future, don't they? My wife has a very cute plaque. It says, Life is all about how you handle plan B. Isn't that cute? She's so good. We have a plan B for everything. No, we now have a plan B or for if an electromagnetic pulse takes down the power grid and I'm traveling how I get home. I'm not kidding. I have survival stuff in my equipment back to I got food, I got weapons, don't worry, I don't have any guns, but I don't travel with guns, you know. No, the worst mistake of my life. I have odd hobbies. One of my hobbies, I'm a ham radio operator because of service. We work with the Salvation Army and the Red Cross and do emergency communications, right? I dragged my wife to the ham radio conference in Keystone, Colorado last year. Made the terrible mistake of taking her to a session on electromagnetic pulse weapons. I should never have done that. An electromagnetic pulse is they detonate a nuclear bomb in the upper atmosphere and it takes out everything electrical. We know it works. In 1962, Starfish Prime at the Johnson Atoll in in in uh the Pacific, they detonated a nuclear bomb 242 miles in the upper atmosphere. You know what it did? 800 miles away, it blew out 800 streetlights in Honolulu. It just it exploded them. Destroyed all the microwave communication between the islands and Ruin6 satellites. So Pam's now convinced, since North Korea is planning it, we're gonna all be taken down by that. So we have all the survival stuff, because I took my wife to, she's on the Federal EMP Commission now. She had to have an FBI background check. Oh, shut up, Greg. So the more flexibility and adaptability you have about your life, the better your life is gonna be. Now, what you'll notice, what is the big thing personality sort of people are missing? Flexibility and adaptability. They have one way to be. And this is all they ever do with everybody all the time everywhere about everything. So you do not need to be diagnosticians and worry specifically about how do you diagnose one versus the other. We're gonna talk about the different kinds and how you talk. What you need to worry about is that they don't have flexibility, they don't have adaptability, and they can't see life through possibilities and alternatives. They have a very rigid outlook, and you're talking into a system in a human being that's limited. We can even see in their brains they are missing neurons. Did you know that? They don't have parts of their brains wired in that you have. You can think flexibly and adaptively. You can dance with life. They can't do it. So when you're talking to this clientele, you're talking to people whose resources for living are limited and deficient. Okay? So we're gonna talk about clinical conversations. They're gonna have irony and paradox to them, they're gonna have incongruity, it's not gonna be like advocating. You gotta pay attention to how they're responding. Okay? And number three, this is the toughest clientele because they're missing the flexibility and adaptability that you inherently have and expect in human beings. Okay? It's not wrong to be self-righteous if you know what you're doing. But it doesn't work to be grandiose if you're a beginner. So narcissist have a terrible time starting things because they act like they know what they're doing all the time. They have no idea what they're doing. You know, being submissive is fine if, you know, like I said, if you're the private and the general gives you an order. But if you're in a cult and your leader tells you to kill yourself, you should probably decline. You know what I mean? So, what we're gonna do is we're gonna talk about these and the limited nature of them and how you can talk with them in ways that can enhance the flexibility, adaptability, and get good good results, like no abortion, in my case, no suicides, that kind of thing. Okay. So Sister Paula's gonna start with it, and she's gonna start with which which one did you gonna start with? The what? The histrionic. Oh, histrionics. Oh god. She's gonna do it because I can't stand them. They make me crazy. So she's really good with them. Okay. Come tell them about histrionics. I don't mind most of these, but histrionics make me crazy.

SPEAKER_00 16:50

I'm laughing because it is true. It is true, they drive you nuts. In fact, that's kind of the ways you know you've got a personality distorted because they drive you nuts. You say, how do you how are you feeling about your client? Okay, I'm gonna describe two of them. One was a man and one was a woman. Trying to do this real quick, then I'm gonna go through their characteristics, how they got that way, and what you do, and what you don't do. Okay, I once knew a man in the pro-life movement many years ago as a worker in the pro-life movement. Charming guy, really nice. Everybody liked him. He was really, really good, hard worker, except he kept doing very emotional things that were real judgmentally good and stuff. So I kind of moved him out of working with me a little closer. But I knew his background had been he had gotten a girl pregnant some years before, and she had had an abortion. And he was devastated by that. He was very, very upset about that and knew it was a terrible mistake and it would never happen again, and went through all the classes and learned everything and was so grateful for that. He was so upset about that woman having the abortion, his child. So he was helping, but he wasn't, he just his judgments weren't real good, so I kind of filtered him out a little bit. And maybe a little while after that, he called me and he was really upset, really upset, because somebody else had gotten pregnant. I said, I mean, you got somebody else, but yeah, I got somebody else pregnant. And she had an abortion. He was devastated, absolutely devastated, so upset and didn't know what to do, and so on, and so we talked about it, got him back to church and everything. And you know, he he didn't exactly know how it happened. I mean, he he couldn't tell me, he just it was something that just happened, and he was upset about it. Dr. Stop laughing, Dr. Lester. Anyway, um we just couldn't backtrack it. We couldn't backtrack it, whatever happened. So then time passed, probably four or five years, literally. And I saw him again, I said, hey so-and-so, how's it going? He said, Oh, he said, my life is going really well. And then I met this girl, and I got her pregnant, and she had an abortion. I said, You're kidding. And he was devastated again, crying, I mean, literally crying, upset, etc. And how did this happen? What happened? I don't know, it just happened. You know, these things just happened. I don't know how it happened. Personality disorder. Okay. Another example. Uh, this was very early on in my career. This young woman, uh, I was working in an adoption agency. This young woman was trying to decide whether she was gonna place her baby for adoption. But when she came in, she was so upset by all the stuff that was going on in her family and all the upset that's going here. So we spent the first interview trying to figure out how she was gonna handle her alcoholic father, how she could clear her mind so she could even think about the adoption. She was everything was upset, so I thought, I'll calm her down. I'm a very calm person, I'll calm her down so we talk about things. So we talked about how to handle things and so on. And then she came in for the next interview, and she had to handle the last thing that we talked about, but then we talked about the other uncle and the aunt and such, and everything was another problem, and it was all upset there, and so we talked about that and calming her down. I couldn't get her focused, you know. She was just so then after that, uh, she came in a third time, and again we handled another upset. I mean, it's like her whole family was upset, it was just a mess. And when she left, I said, I've got to do a case study here. So I took out my notes. And you know, I couldn't write down how that girl felt. All I knew was that she was upset. I couldn't tell you whether she was jealous, whether she was angry, or whether she felt, I couldn't tell you how she felt. And I knew that I had just missed her completely. And I also knew that I didn't want to talk to her again. And then the other thing that made me think about it is she said I had sent her to Dr. So-and-so, who was one of our reliable doctors, to get her work up. And she came back and she said, Oh my God, it was a terrible experience. I said, What happened? And she said, Well, it was the way he examined me. I said, Well, how did he examine you? And he said, Oh, it was just awful. It was so awful. I just felt creepy. He was just creepy. I said, He was, Dr. So-and-so. She said, Yes. He said, It was awful. What did he do? Well, it was just the way he did it. And when he looked at me, it was just awful the way he did it. So I couldn't get anything much more specific than that. And then the following week that she came, or a couple weeks later, she had gone to a her her school. And um she was in the front row of her school, her lecture, and the doc the professor came along, and as she was sitting there, he walked along besides everybody in the front row. row and look down her dress. Because she was leaning over, she said, and he looked down her dress. It was awful. At that point I said histrionic personality disorder. That did it. Okay, let's talk about those are two examples. Let's talk about histrionic personality disorder. They are a dependent personality disorder. They're one of the two dependent personality disorders. Which means that they rely on other people. They need other people to give them attention. They are attention getters. They know how to get attention and they rely on other people for protection and for the rewards of life and for their self-image. Other people are necessary. Consequently they're very sociable. You like them. They're good in parties. They're lively they're fun. You like histrionic personalities, you really do. They require a lot of attention and a lot of affection. And at first glance they seem to express their thoughts and feelings with great ease. They have a flair for the dramatic and they draw attention to themselves. But it's a kind of a short-lived capriciousness. They're very intolerant of frustration and they're also very sexually provocative. But you know what? They don't know it. They genuinely don't know it. They're also not very good in bed. They're not very good lovers. But they're very provocative. And they have no idea that they are they really don't um their self what is their self-description they describe themselves as very sociable but they cannot admit any kind of inner turmoil. They can say they're upset but any kind of weakness or depression or hostility or anything like that they can't really admit because they don't know they have it. They avoid introspection. They avoid thinking about themselves they're always out there with something else somewhere else depending on you to give them attention and affection and image they do not know how they feel that's how I didn't know how she felt because it's all out there they seek approval stimulation and attention now how do they get that way what's the etiology now Dr. Lester talked about how much is biological they were probably a constitutionally alert baby an alert baby and they relied on external stimulation when they were babies. They were probably bright and alert and looking at things and they may have had many different caretakers and they provided them with immediate satisfaction immediate attention and they may have learned very young that getting attention depended on looking pretty and doing things and getting getting doing things that caused attention. They may have had parents who gave the minimal negative reinforcement minimal negative reinforcement they they rarely punished them and they distributed rewards for what they they um they addressed as being pretty and doing well. So they may have done very well in school too but they failed to reward the child when the child behaved normally so it created a personality that demands attention seeks attention and is self into themselves. Now probably the parents themselves were histrionic probably both parents or at least one so can you imagine a family with a histrionic parent and historianic child everything was stirred up all the time in the family. There was always an activity something was molehills were mountains everything was stirred up and nothing was quite right ever. Because they simply don't learn like my friend with three getting three women pregnant and then not knowing how it happened you know I just they don't introspect. What is the prognosis on this group? Actually it's reasonably good. It's one of the better ones of all of the personality disorders the prognosis is better but because they possess motivation and they possess skills to maintain relationships which is not true of all the personality disorders they rarely seek therapy rarely seek therapy because they don't need it they don't have a problem they only seek therapy if there's a period of social disapproval like in if their parent or their their wife is upset with them which she probably will be after a while but they're never responsible this is why possibly the only chance they're going to get help is in a crisis setting with us as the helpers in a crisis setting. So it has to be short-lived and has to be in a crisis. So you have to help them make a good decision at a time of crisis. This group does well in a group because they can't identify their feelings but if they can be with a group of other women and they're talking about what it means to be an unwed mother what it means to have this baby or how it means to handle a baby right now they can listen to other people express those feelings and it helps them to get in touch with how they're feeling and what and ways of doing things. They do respond to training you do it this way you do it that way you have to do this with your baby you have to do that because they they they seek that because it doesn't come that way naturally you do not put them in a sheltering home I don't know how many of you have sheltering homes where where you've got somebody who needs a place to stay and so on so you put them with a nice family a nice pro-life family and they stay for you know during the pregnancy or whatever you do not place them in sheltering homes because I guarantee before very long a loving father of a sheltering home will be misunderstood. And you don't want to put a family through that I wish I could think of some example that do you remember Clarence Thomas do you remember the Clarence Thomas case? Now it's not professional to diagnose somebody when you never see them or anything but do you remember the woman that accused Clarence Thomas of all kinds of sexual stuff and none of the other women in his his group could think of anything that he did and didn't couldn't think of anything. And um in fact one of the women had the courage to say you know she's kind of you know provocative herself I don't think you know couldn't imagine what he did anything. One of the at that time that he was going before the hearings before he was accepted as Supreme Court justice, one of the women in my volunteer group that lived with me had come from Washington to spend a year in Los Angeles. They were friends of the of the Thomas family and she was absolutely horrified by that situation because she knew him as such a distinguished and wonderful man. And there was absolutely nothing that could be done. I can't remember the woman's name but she became very famous in the woman's meme but for standing up for women's rights and against men who are predatory men. So you have to be careful about that in kind of placing each other. They will do well in a group but they have to be with a good group leader otherwise they'll take over the group they will respond to you and actually they'll follow your suggestions they really will. In fact you have to give them suggestions you have to direct them. This is a group that you have to be directed with you have to tell them what to do and they will do it. Remember this is a dependent personality type she will do what you want and you have to direct her in a positive kind of way she will need help from other people that to go through and have that baby because you have to pay attention to who she's getting attention from from her boyfriend from that guy who got her pregnant so on so you want to get her involved with people with her family or other people that are going to support her. You have to provide and you have to see her regularly regularly so that she becomes more dependent on you temporarily I mean you're not going to see her on a long-term basis but she's going to need support and she will follow through and like my friend the gentleman she will feel very she will she will accept what you say about the birth life of the baby and she'll very badly if she has a baby she really will afterwards if she has an abortion I mean she'll feel very badly afterwards. So this is a woman that needs direction she needs direct statements she doesn't need a lot of non-directive stuff she needs your support and you need to be careful with her. Okay. Do you have anything else to add? Okay I'm going to turn it over to you so you guys gotta change it.

SPEAKER_01 32:21

There we go thanks so I want you to notice a couple things as Mr Paula said so so effectively number one notice personality disordered people live a one thing led to another life third pregnancy I don't know how it happened really kamikaze sperm flying down the hallway I mean really you think she's making this up these people really do say gee it's the third time woman I've gotten pregnant and I don't know how it happened. Seriously see we used to think they were psychotic because their disconnect from reality is so profound but now we know it's not that they misperceive reality it's they overlook reality. So notice this guy was blah blah blah oh God pregnant blah blah blah oh god pregnant blah blah blah oh god pregnant so notice that okay notice an example of the the the woman she gave uncomfortable blah blah blah uncomfortable blah blah blah well is it like she said jealousy is it anger is it fear blah blah blah uncomfortable blah blah blah uncomfortable okay notice number three what Sister Paula taught you there was the way you get with this population get flexibility adaptability is they're open to suggestions. So notice she said you can make suggestions and they'll do it you get a response do this with your baby and they do it okay good then tell them what to do. There are other people you tell what to do they won't do it. But this population will so no she just taught you that she taught you that yeah make suggestions give them advice tell them what to do they'll do it because they're dependent enough to listen and to need somebody to tell them what to do. They're needy in that sense so notice that she just taught you about somebody who is limited as a repetitive style of doing things that doesn't work out well and a clinical conversation with them has to do with suggestions and advice of group group works with them because they get all these different inputs what do you think the value of a group is you guys you get all kinds of different ideas all kinds of different possibilities so notice that she told you very effectively when you've got somebody who's very theatrical very needy very showy etc oh okay well they're kind of limited to that and they live a one thing led to another life hmm okay well we need to make some distinctions about what the discomfort is and then let's make some suggestions about what to do with that. See how that works? Yeah. So that was you know she's very good with them. I'm not I don't think I don't like about histrionics is they have conniption fits. We call them hissy fits. Where'd you think the name hissy fit came from they're they're brats you know they throw temper tantrums you know Pam and I have this cup we used to hang with and it was always stressful to me because his wife has histrionic disordered and she's embarrassing. She's loud she's obnoxious she never shuts up she undresses herself in public metaphorically speaking and and but it they were fun so I tolerated it because we'd go you know play miniature golf and ski and have fun. And then she had a hissy fit in the middle of a ski lodge threw a stomped her feet shook her fist screamed and yelled shrieked and cried and I said that's it no more and then Pam told me last week oh by the way she's spending the night at our house Sunday night okay I'm out of here okay so the good thing about them like Sitchpa was saying is that it's pretty you can do pretty straightforward suggestions advice. Yeah so you can do that as well are you gonna which one what are you gonna do next you're gonna do the dependent what do you want to do? You're gonna do dependent next so I'm gonna leave that for her because uh she's gonna do that one. Okay so some of the other ones don't respond that well to advice and to suggestions you don't get the response so you're gonna do dependent let me okay I'm gonna what I you know what I'm gonna do I'm gonna lump some of these together because you guys aren't gonna be diagnosticians. Okay so I'm gonna take this off so I can use it again hang on you guys sorry just give me one sec here wee okay so okay so in practical terms what flexibility and adaptability look like the name we give it is problem solving okay life throws us things we don't expect and we experience those as a problem and let's face it an unwanted pregnancy is considered a problem why do you think the girl comes to you right okay now I know it may be uncomfortable for you to think of a life as being a problem but that's how it's experienced. And so what you're gonna want to do is you want to engage in in general this is a problem solving process to come up with good solutions for handling what life's thrown at you right and as Sister Paula said if you've got somebody very showy very needy very adaptive uh very kind of seductive the histronic okay one of the ways you can problem solve with them is make suggestions okay one of the way you can problem solve with them is put them in a group where they get advice from people. Yeah that's that's that's very good. That's very nice. So that can work with that. So think of this as a problem solving process okay in fact you want the best example I've ever seen of that my wife's a sci-fi nut drags me off all these sci-fi movies she dragged me off to one last year that was so good I've watched it six times on cable it's called The Martian it's about a man who's stranded on Mars and how he problem solves to survive. And the movie was directed by Ridley Scott, my favorite director it's in the book I read the book too because Pam had that Matt Damon who I don't even like plays Mark Watney who's an astronaut accidentally stranded on Mars and it's how he problem solves to survive. And he comes back to Earth and it doesn't hurt the movie to know that. And Ridley Scott adds a scene at the end of the movie to conceptualize what it was about it's not in the book. Matt Damon walks into NASA into a classroom with a group of young adults who want to be astronauts like you guys know. And he walks in and he says so here's the question I get asked when I was stranded up there by myself did I think I was going to die and the answer is yes absolutely and you better get used to it because it's going to happen to you. This is space it does not cooperate. At some point it's all going to go south on you and you're gonna say this is it this is how I end. And here's what you do you either surrender to that or you do the math you get to work and you solve a problem. And when you solve that problem you solve another problem and when that's solved you solve another one and if you solve enough problems you get to come home. And you watch him what's his problem food. How's he gonna eat? It's a very important plant he's a botanist he figures out food that's done. Now I got to communicate with NASA how do I do that? Oh I figured out how to do that okay that's done. Now I got to get to where they can rescue me how can we get across the planet to get there okay that's done. Problem solve problem solve problem solve the problem with personal disordered people is they don't problem solve how can that man the sister Paula so effectively presented problem solve oh my god she got pregnant okay how are you going to prevent that next time well if it's an oh my god one thing led to another there's no way to prevent it so the key to the whole thing here you guys is that personality disorder people are lousy problem solvers. John Livesley says a personality disorder is a human being who persists in a behavior in the face of clear evidence it's inappropriate and ongoing bad consequences. Lensberry's definition of a personality disorder is just a human being with a profound deficiency in their ability to problem solve. So one of the things that we do in this psychiatric world is we look at how to induce problem solving when they're limited and keep doing one thing over and over again. And what Sister Paula told you with somebody who's hysteric and theatrical needy and showy, you put them in a group you give them advice you make suggestions because they can listen because they're dependent now the problem with some of them she'll talk to you about in a minute with dependent dependents is they'll do everything everyone says so what you say won't stick. Nevertheless you got a problem you saw okay so with with the other ones who are resistive look a paranoid suspicious of you they're not gonna listen to you anymore than listen by anybody else you're gonna tell them something they're gonna think you're of an ulterior motive you know what I mean and schizoids just don't care and schizotypals are just gonna be weird you know antisocials are just trying to figure out how to steal your car borderline is gonna just scream at you narcissist they know better than you do avoidance are just never going to show up she's gonna talk about dependence and obsessive compulsives are going to tell you you're your the the things on your wall are crooked you know your your picture needs to be straightened you know what I mean so a problem solving process has these parts number one identify a problem that's not a problem for you guys because nobody comes to you without having identified the problem pregnancy right okay and I'm sorry I'm calling it a problem but that's how they experience it number two create possible alternative solutions number three evaluate number four choose and implement a solution number five evaluate the outcome and make refinements to it to adjust it. Okay and so what you find in the personality disorders are different ones of them don't do a step here. See and Sister Paula's good example of the histrionic they've identified a problem being pregnant they can't come up with alternative solutions. So you put them in a group and people give them suggestions you give them ideas and then they're willing to implement so they're their stuck spots here. So that's easy to work with but you get an obsessive compulsive they can come up with a thousand alternatives but they'll never choose one. They'll just go over them and over and over and over and over and over and over and Over and over and over. I could do this, I could do that. Well, maybe I should do this. I think maybe that'd be good. But the problem with this is no, there's the problem with that. Well, I think maybe this, maybe that. So again, to actually do anything, this is your this is your stuck spot. This is where you're gonna have to coerce them into actually taking action on something rather than endless think endlessly thinking it. A narcissist won't evaluate. They put every solution down. No, that won't work, no, that won't work, no, that's not gonna work, no, this isn't gonna work. Why are you suggesting that? I've tried that three times. That's no good. Why are you saying that? That's stupid. I can't believe you're telling me that. You're an idiot. Can I see you again this week? You know that's what borderlines do. They're like, I hate you. Can I call you on the phone this afternoon? You don't know what you're doing. Will you see me twice this week? You're the biggest idiot I ever saw, and I have to talk to you again. You know, it's like, what? Irony, paradox, and contradiction run personality. Okay? So what you're doing with all of them is you're trying to get this. And as I like to say, listen, no one who has clear problem solving would have an abortion. Because the the downside of that solution is so severe compared to other possible solutions. So you gotta get there's a glitch in people's problem solving who end up choosing that alternative. Now, okay, I'm gonna do one last thing, I'm gonna turn it back over to her. The reason I went over this is I'm lumping a bunch of the other ones into this so that you can see at some point they get stuck in the process. I'm not gonna she's gonna do the ones you she's talking about the ones you see kind of the most because she knows your specific population. I'm just a garden variety shrink, so I see all kinds of other stuff. So I'm lumping the ones that don't listen kind of in that way into here so you can see this is the process you're trying to engage in. Okay? And they're gonna get stuck in one of these spots. So let me say one last thing, and I'm gonna turn it back over to her for the next part. Here's something that's gonna be hard for you, okay? When you have problem, when you're doing problem solving with someone, you're listening for where they're stuck. One of the things that you're gonna have to do in order for this, this this is how you want it to work. What we found is as long as you're engaged in a problem solving process, your life's gonna work out. And once you don't, you end up in what's called drama. And there I do a whole thing in my training about drama versus problem solving, and all the different these different categories create different kinds of dramas. This is a retaliatory drama, this, etc. So where they get stuck is where you want to address it. Now, the one I want to talk about with the other ones is evaluating solutions. You have to get them fluid in this process, keep problem solving, problem solving, just like the Martian. Problem solve, problem solve, problem solve. Where people get stuck is on a solution because they see the upside of it and the downside of all the other ones. Okay? And I'm sorry. I'm gonna say this, okay? Is there an upside to having an abortion? Absolutely. You don't have to change your mind about your future, do you? You don't have to be worried about someone else. I mean, there's an advantage that. Is it worth it? Of course not. Am I saying that makes it fine? Of course not. But you guys, if you're not willing to acknowledge the benefit of every possible solution, you will stick them. And you have to look at the downside of all the ones they're not seeing the downside of. Is there a downside to having an abortion? Oh, you betcha. Is there a downside to having a child? Yeah. If that's not your view of life, it's not what you expected. The downside is you have to change your mind about it. Hey, is there an upside to killing yourself? Absolutely. You don't feel this bad anymore. You know, I blackmail suicidal patients. Ow. I say, you do know the reason you want to kill yourself is you think once you're dead, you'll feel better. What if you don't? What if you feel just like this after you're dead? Show me the data you're using to show you feel better when you're dead. Oh, you don't have any? And you're gonna take that chance? Doesn't that seem a little stupid? And then I say, and I want you to remember, if you kill yourself, treatment won't work. I say that with a straight face, they go, I never thought of that. But do I have to acknowledge that there's there's there's a benefit to killing yourself? Yeah, because if I don't, what's gonna happen? They're gonna argue that there is, and I mean there's not, and they're gonna argue that there is, and I'm gonna argue that there's not. But if I say, yeah, I get it, I wouldn't, I wouldn't want to live like this either. We got better solutions than that. Yeah, having a child. Listen, I was a child, I was a pain in the neck. When I became an adult, I apologized to my parents about what I was like as a teenager. I did. I said, I get it now. I'm sorry. Then I made a mistake. I said, You want to hear all the stuff I got away with? Oh, I should never have done that. I didn't know my parents could turn those colors, you know. So, you guys, when you're involved in a problem-solving process with somebody who's really resistive, somebody who thinks you're an idiot, somebody who is not gonna follow instructions or rules, you've got to be willing to say, yeah, I I can get why you want to do that. There's an upside to that, yeah. And you know, there's a downside to this other one. But you know, there's also a downside to that, what you're thinking about. You're aware of that one, right? Yeah, good. And there's an upside to this other one you're not thinking about. The benefit to this is that. See, see how different this is from an advocacy conversation? A political, legal, or advocacy conversation, you never give an inch. You never acknowledge one positive thing about the opposite side. Never, ever, ever do you give them credence for anything except malevolence and death, disaster, destruction, and the end of life as we know it. You don't have that in a clinical conversation. Okay, so no, Sister Paula didn't tell you to with the with the histogram to advocate. Come on, but you should make suggestions. Give some advice, put them in a group. Okay? So, what I want to tell you about the resistive ones is one of the important things to keep them into this process is for you to be willing to acknowledge the pros and cons of every alternative of handling things. Do I want my patients to kill themselves? No. I've had two suicides, I don't want more. But does it stop suicide by saying there's no downside, there's no upside to it? No. Okay. Okay, good. So I'm gonna turn back over to Sister Paul, who's gonna get back to the specifics of some of the major coins you see, which is dependence, and that's why they ended up in the situation that we ended up.

SPEAKER_00 51:52

Okay, this one's a little bit more difficult because, in a sense, we see many women that come to us dependent, dependent sounding, don't we? We really do. In fact, we can scratch our heads and say, My God, what happened to the women's liberation movement, you know? Um, okay, um, dependent personalities have a marked need for social approval and affection, and a marked willingness to live in accordance with the desires of other people, markedly. The center of gravity is not themselves, it's other people. They live according to how other people want them to live. And they avoid asserting themselves, they don't want to be seen as aggressive, they adapt their behavior to please whoever it is they're dependent on, and they are exceedingly sensitive to criticism and disapproval, so they avoid it, they do anything to avoid criticism. Their self-esteem is dependent on the encouragement of other people. They arrange their lives to ensure a constant supply of nourishment and encouragement. They are self-affazing, agreeable, and they search for support. They subordinate their desires to other people, and they will submit to abuse and intimidation to avoid isolation. Now, if you could open up this woman's head and you could look it up to bring it open, you looked inside of it, you would see her image of herself as a little bitty little thing in there. And you would see her image of everybody else's big and tall and wise and powerful and knowledgeable and much smarter than she is, much better than she is. So she's little, and everybody else is more knowledgeable and better than she is. So she really has to depend on them because she doesn't, she's not big in her eyes. They tend to evoke sympathy and attention from other people, and they tend to be very sweet and Pollyanish in interpersonal strain. They're terrified of their own hostile or angry feelings because they're afraid it might endanger their security, so they put them down. So any feelings of anger or hostility are whether they just put down out of place, because they might endanger their dependence on somebody else. They don't want their persons getting mad at them. They don't want you getting mad at them at them, so they they won't offend you or they won't do anything that you don't want them to do. They'll be very careful about that. Um they're very satisfying at first to have as clients. You love them because they love you, and they're doing everything they can to please you, and they think you're wonderful, and they'll present their problems to you, and they just think you're the best counselor they ever had, have the best suggestions. They know how to please people. They've spent their life doing that. So they will please you, and you will suggest, you will give them all the reasons not to have an abortion, and they say, Oh, that's right, that's right, that's true, and they'll believe it. And they do have sympathy for their baby. They do, they they will have that, they will believe that, and they will have feeling for their baby. Then they'll go out and they'll talk to their boyfriend or their mother, whoever is the person that they're most dependent on, whoever is the biggest image in their head, and they'll tell them that that nice lady in there said I could have the baby, and we could do this and this and this, and their boyfriend will say, Oh, honey, you don't want to do that. That's it's much better to have an abortion because of this, this, and this. So we'll we'll just go ahead and have the abortion. And they'll say, Okay. And that's it. And they may suffer post-abortion guilt after. They may suffer that. Because they will listen to what you say. But they will do what the person that they are dependent on does. So one of the key things that you have to realize in counter in counting a dependent child woman is that you have to talk to the decision maker. And she is not the decision maker. So I I really I I noticed that some of the service centers are there's kind of a pattern. We talk to the woman and not the man. And there's always two people involved in a decision. Because even women come in who are not necessarily totally dependent, they don't have a lifelong pattern of dependency. But temporarily they're young and they're in their first relationship and they want to please the guy, and they're gonna do what he wants, and they're gonna submerge their own attitudes. They may not be a dependent personality, but it may be a situational kind of thing where their desire is I have to please him, I have to have the abortion for his sake, because I will lose him. And what am I then? I've had my first sexual experience, I'm dependent on him, I have to have the abortion. So it's very important to have the guy in and talk to him also. And if you sense that this is a lifelong pattern of dependency with the woman, you may not always know that on the first interview. But it's very important to have, be sure that that she comes in, she has him come in, invite him in, or meet them at a coffee shop or something or other. But get them together because he will be the one who will decide, or her mother will be the one who will decide about the abortion. And with guys, you know, you can talk to them, say, well, you can't do a girl, give them all the reasons. Guys are there that want to be protective of the girlfriend. And, you know, women like this can get very involved with a horrible guy who will um beat them or do all kinds of bad things with them because she's dependent, she'll take anything, she'll allow herself to be hit and then come back because he'll say he's sorry the next time, and she'll explain that you know he didn't really mean it. And remember, they have a Pollyanna attitude. Everything can be made okay. So he may he may be hitting her, but he'll she'll still go back to him. So um he's the one that's a decision maker, but you can't assume that that's how he is. He could also be a pretty nice guy who got this really nice girl, and she's really affectionate with him, and she likes him a lot, and she does everything he says, and that's really flattering. And he thinks, wow, this is the perfect wife, and um he may be now get her pregnant. Now, all of a sudden he's starting to notice that she's kind of dependent on him, and that's very wearing the person. That's very, very wearing. And after a while, he'll be saying to you, Well, I thought she'd make some decision about where she wanted to go, but she didn't. I have to decide where to go, I have to decide what to do, I have to decide where to go, you know, blah, blah, blah, blah, blah. And it may be wearing on him, and now she's saying she's pregnant. Now he's faced with having her and a baby. I mean, it may be just too much for him. So you need to get him in and talk with him and find out how he feels and talk with him separate from her. Separate from her. Because he can't afford to be less strong in front of her. So when you're doing this kind of thing you can talk to them together, yes, but be sure you talk to him individually. How is this going for you? How's the relationship going for you? Ask the same questions you would ask of the girl and be very supportive of him. Because if she if you if you can convince her to have, if you can convince him to have the baby, he has to be convinced to support that baby and support her. Or pull the mother in again and get them involved again. You know, you have to see. She ha she's gonna be dependent on somebody. So where are what are your options? What are your planning? How do you plan for this family? But involve him and it and the mother and everybody else. Don't just talk to the girl. And that's true of many of your cases. Because even a lot of the cases where the woman appears when where where she's in first experiences, this is her first experience of pregnancy and sex and everything else, she can be pretty dependent, not personality disorder dependent, but she can be blocked out about what she's thinking and how she's thinking. Now, um this is another case where you have to be very directive with her. Very, very directive, because she will do exactly what you say, and she'll report back to you. Because that's what she does, that's her whole life pattern. So be directive, but call in the people that she's dependent on, or else she can't she can't make the relationship. I I can give you an example. I once had a woman that I dealt with for two years, very dependent, and the guy kept doing these horrible things with her, couldn't get her to move out, couldn't get her to move out. Finally, the family stepped in and she moved in with the family, and that was the only way she was able to get away from him. So you have to provide something else. This this personality disorder is also one of the meanable for progress because she also possesses an ability to relate, to relate to you. And if you can get her working, get her feeling independent, getting some money, getting her to make a little independent, get her own job, get her own house, get her own apartment, get her own whatever, maybe have the baby, start getting into support groups to have it for mothers and so on. She will grow. She will grow. If she's in the right setting, she will progress. Um, she may not be a most assertive person, but she will be able to manage with help if you can provide that for her. And I think I'm out of time. And thank you very much. This has been wonderful. Thank you. God bless you all.