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Transcript

4 Ways Personality Disorders Can Disrupt Even the Best Treatment Plans. And what we Can Do About It. · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:05
  back,
• 0:06
  my
• 0:06
  friends,
• 0:06
  to
• 0:06
  another
• 0:07
  episode
• 0:07
  of
• 0:07
  Pearls
• 0:08
  and
• 0:08
  Prep.
• 0:08
  Npz.
• 0:09
  Here
• 0:09
  your
• 0:10
  preceptor
• 0:10
  in
• 0:10
  your
• 0:10
  pocket
• 0:11
  your
• 0:11
  go
• 0:11
  to
• 0:11
  place
• 0:12
  for
• 0:12
  pearls
• 0:12
  that
• 0:13
  prep
• 0:13
  you
• 0:13
  to
• 0:13
  practice.
• 0:15
  Now,
• 0:15
  my
• 0:15
  friends,
• 0:15
  there
• 0:16
  are
• 0:16
  four
• 0:17
  key
• 0:17
  ways
• 0:18
  that
• 0:18
  personality
• 0:19
  disorders
• 0:20
  are
• 0:20
  sinking
• 0:21
  your
• 0:22
  ship
• 0:22
  in
• 0:23
  treatment.
• 0:24
  And
• 0:24
  you
• 0:24
  may
• 0:25
  have
• 0:25
  not
• 0:25
  known
• 0:25
  about
• 0:26
  them.
• 0:26
  Maybe
• 0:26
  you
• 0:27
  underestimated
• 0:27
  them.
• 0:28
  But
• 0:28
  if
• 0:28
  we
• 0:28
  stop
• 0:29
  and
• 0:29
  think,
• 0:29
  they
• 0:29
  are
• 0:30
  real
• 0:30
  problems
• 0:30
  and
• 0:31
  yet
• 0:31
  there
• 0:31
  are
• 0:31
  real
• 0:32
  things
• 0:32
  we
• 0:32
  can
• 0:32
  do
• 0:33
  to
• 0:33
  prevent
• 0:33
  this
• 0:33
  from
• 0:34
  happening
• 0:34
  and
• 0:35
  to
• 0:35
  stop
• 0:35
  this
• 0:35
  in
• 0:35
  its
• 0:36
  tracks.
• 0:37
  So
• 0:37
  let's
• 0:37
  talk
• 0:37
  personality
• 0:38
  disorders.
• 0:39
  Let's
• 0:39
  talk
• 0:39
  treatment.
• 0:40
  I
• 0:40
  think
• 0:41
  you're
• 0:41
  going
• 0:41
  to
• 0:41
  love
• 0:41
  this
• 0:41
  one.
• 0:42
  Now,
• 0:43
  it's
• 0:43
  really
• 0:43
  important
• 0:43
  we
• 0:44
  define
• 0:44
  what
• 0:44
  a
• 0:44
  personality
• 0:45
  disorder
• 0:46
  is
• 0:46
  for
• 0:47
  you
• 0:47
  to
• 0:47
  really
• 0:47
  understand
• 0:48
  it
• 0:48
  and
• 0:48
  appreciate
• 0:48
  it.
• 0:49
  And
• 0:49
  the
• 0:50
  best
• 0:50
  way
• 0:50
  to
• 0:50
  conceptualize
• 0:51
  this
• 0:51
  is
• 0:51
  really
• 0:52
  the
• 0:52
  APA's
• 0:53
  definition,
• 0:54
  which
• 0:55
  is
• 0:55
  an
• 0:55
  enduring
• 0:56
  pattern
• 0:56
  of
• 0:56
  inner
• 0:57
  experience
• 0:57
  and
• 0:58
  behavior
• 0:58
  that
• 0:59
  deviates
• 0:59
  markedly
• 1:00
  from
• 1:00
  cultural
• 1:01
  norms.
• 1:01
  Now,
• 1:02
  it
• 1:02
  also
• 1:03
  leads
• 1:03
  to
• 1:03
  distress
• 1:03
  and
• 1:04
  impairment.
• 1:04
  Remember
• 1:05
  that
• 1:05
  if
• 1:06
  your
• 1:06
  patient
• 1:07
  just
• 1:07
  has
• 1:07
  odd
• 1:08
  personality
• 1:08
  quirks
• 1:09
  or
• 1:09
  you
• 1:10
  have
• 1:10
  an
• 1:10
  odd
• 1:10
  personality
• 1:11
  quirk
• 1:11
  that
• 1:12
  might
• 1:12
  be
• 1:12
  a
• 1:12
  little
• 1:12
  paranoid
• 1:13
  or
• 1:13
  suspicious
• 1:13
  or
• 1:14
  manipulative
• 1:15
  or
• 1:15
  domineering
• 1:16
  or
• 1:16
  histrionic,
• 1:17
  that
• 1:17
  doesn't
• 1:17
  necessarily
• 1:18
  mean
• 1:18
  you
• 1:18
  have
• 1:18
  a
• 1:18
  personality
• 1:19
  quirk
• 1:19
  disorder.
• 1:20
  It
• 1:20
  just
• 1:20
  means
• 1:21
  that
• 1:21
  we
• 1:22
  all
• 1:22
  live
• 1:22
  on
• 1:23
  some
• 1:23
  kind
• 1:23
  of
• 1:23
  a
• 1:23
  spectrum.
• 1:24
  It
• 1:24
  becomes
• 1:24
  pathological
• 1:25
  when
• 1:26
  it
• 1:26
  leads
• 1:26
  to
• 1:26
  significant
• 1:27
  distress
• 1:27
  or
• 1:28
  impairment.
• 1:28
  Okay?
• 1:29
  And
• 1:29
  we've
• 1:30
  seen
• 1:30
  this
• 1:30
  with
• 1:30
  a
• 1:30
  lot
• 1:30
  of
• 1:31
  our
• 1:31
  patients,
• 1:31
  right?
• 1:31
  We
• 1:32
  all
• 1:32
  have
• 1:32
  a
• 1:32
  little
• 1:32
  bit
• 1:33
  of
• 1:33
  rejection,
• 1:34
  sensitivity
• 1:35
  and
• 1:35
  fear
• 1:35
  of
• 1:35
  abandonment.
• 1:36
  But
• 1:36
  when
• 1:37
  we
• 1:37
  are
• 1:38
  sending
• 1:38
  out
• 1:38
  text
• 1:39
  messages
• 1:40
  to
• 1:40
  our
• 1:40
  loved
• 1:41
  ones
• 1:41
  saying
• 1:41
  we
• 1:41
  might
• 1:41
  end
• 1:42
  our
• 1:42
  lives
• 1:43
  after
• 1:43
  we
• 1:43
  get
• 1:43
  a
• 1:44
  bad
• 1:44
  text
• 1:44
  from
• 1:44
  our
• 1:44
  boyfriend,
• 1:46
  that's
• 1:46
  a
• 1:46
  little
• 1:46
  different,
• 1:47
  right?
• 1:47
  If
• 1:47
  we're
• 1:47
  so
• 1:48
  paranoid
• 1:48
  that
• 1:48
  we
• 1:48
  can't
• 1:49
  hold
• 1:49
  a
• 1:49
  job
• 1:49
  because
• 1:50
  we
• 1:50
  read
• 1:50
  into
• 1:50
  everybody's
• 1:51
  motives
• 1:52
  malignantly,
• 1:53
  then
• 1:53
  that's
• 1:54
  also
• 1:54
  a
• 1:54
  problem,
• 1:54
  right?
• 1:55
  So
• 1:55
  in
• 1:55
  personality
• 1:55
  disorders,
• 1:56
  these
• 1:57
  personality
• 1:57
  features
• 1:58
  are
• 1:58
  very
• 1:58
  pervasive.
• 1:59
  They're
• 2:00
  inflexible.
• 2:01
  They
• 2:01
  begin
• 2:02
  in
• 2:02
  adolescence
• 2:02
  or
• 2:03
  early
• 2:03
  adulthood.
• 2:04
  They're
• 2:04
  pretty
• 2:04
  stable
• 2:05
  over
• 2:05
  time,
• 2:06
  and
• 2:06
  they're
• 2:07
  pretty
• 2:07
  ingrained.
• 2:08
  And
• 2:08
  so
• 2:09
  they
• 2:10
  are
• 2:10
  a
• 2:10
  huge
• 2:11
  feature
• 2:11
  of
• 2:11
  your
• 2:12
  therapeutic
• 2:12
  relationship
• 2:13
  with
• 2:13
  that
• 2:13
  patient.
• 2:14
  Right?
• 2:14
  They're
• 2:14
  not
• 2:15
  coming
• 2:15
  to
• 2:15
  you
• 2:16
  because
• 2:16
  they
• 2:17
  have
• 2:17
  a
• 2:17
  personality
• 2:18
  disorder.
• 2:18
  I
• 2:18
  don't
• 2:18
  think
• 2:18
  I've
• 2:19
  ever
• 2:19
  had
• 2:19
  anybody
• 2:20
  come
• 2:21
  to
• 2:21
  my
• 2:21
  clinic
• 2:21
  and
• 2:22
  say,
• 2:22
  I
• 2:22
  need
• 2:22
  treatment
• 2:23
  because
• 2:23
  I'm
• 2:23
  a
• 2:23
  narcissist.
• 2:24
  It
• 2:25
  just
• 2:25
  never
• 2:25
  happens.
• 2:26
  I
• 2:26
  need
• 2:27
  treatment
• 2:27
  because
• 2:28
  I
• 2:28
  have
• 2:28
  antisocial
• 2:29
  personality
• 2:29
  disorder.
• 2:31
  Doesn't
• 2:31
  happen.
• 2:32
  But
• 2:32
  you
• 2:32
  will
• 2:32
  often
• 2:33
  see
• 2:33
  that
• 2:33
  the
• 2:34
  patients
• 2:34
  you
• 2:34
  do
• 2:34
  treat
• 2:36
  have
• 2:36
  personality
• 2:37
  disorders.
• 2:39
  Unbeknownst
• 2:39
  to
• 2:39
  them
• 2:40
  may
• 2:40
  be
• 2:40
  unbeknownst
• 2:41
  to
• 2:41
  you
• 2:42
  when
• 2:42
  they
• 2:42
  walk
• 2:42
  into
• 2:42
  your
• 2:43
  clinic.
• 2:43
  And
• 2:43
  it's
• 2:44
  really
• 2:44
  important.
• 2:45
  Um,
• 2:45
  I
• 2:46
  Came
• 2:46
  across
• 2:46
  a
• 2:47
  shocking
• 2:47
  pearl
• 2:48
  during
• 2:48
  one
• 2:48
  of
• 2:48
  my
• 2:48
  recent
• 2:49
  pearl
• 2:49
  dives
• 2:50
  that
• 2:50
  I
• 2:50
  do
• 2:50
  for
• 2:50
  you
• 2:50
  guys,
• 2:51
  and
• 2:52
  I
• 2:52
  couldn't
• 2:52
  believe
• 2:52
  it.
• 2:53
  It's
• 2:53
  so
• 2:53
  shiny.
• 2:54
  The
• 2:54
  pearl
• 2:54
  was
• 2:55
  so
• 2:55
  shiny,
• 2:55
  it
• 2:55
  blinded
• 2:56
  me.
• 2:56
  Okay,
• 2:57
  I'm
• 2:57
  wearing
• 2:57
  sunglasses
• 2:58
  right
• 2:58
  now.
• 2:59
  45%.
• 3:01
  Up
• 3:01
  to
• 3:01
  45%
• 3:02
  of
• 3:02
  your
• 3:02
  patients
• 3:02
  with
• 3:02
  major
• 3:03
  depressive
• 3:03
  disorder
• 3:04
  have
• 3:04
  a
• 3:04
  comorbid
• 3:05
  personality
• 3:05
  disorder.
• 3:06
  I've
• 3:06
  been
• 3:06
  in
• 3:07
  this
• 3:07
  game
• 3:07
  a
• 3:07
  long
• 3:07
  time.
• 3:08
  I've
• 3:08
  been
• 3:09
  around
• 3:10
  folks
• 3:11
  with
• 3:11
  mental
• 3:11
  illness
• 3:12
  since
• 3:12
  I
• 3:12
  was
• 3:13
  very
• 3:14
  young
• 3:14
  at
• 3:14
  the
• 3:14
  hospital
• 3:15
  as
• 3:15
  a
• 3:15
  volunteer,
• 3:16
  passing
• 3:16
  out
• 3:16
  newspapers
• 3:17
  to
• 3:17
  them,
• 3:18
  playing
• 3:18
  bingo
• 3:19
  with
• 3:19
  them.
• 3:20
  And
• 3:20
  I
• 3:20
  would
• 3:21
  have
• 3:21
  guessed
• 3:21
  that
• 3:22
  the
• 3:22
  number
• 3:22
  was
• 3:22
  10
• 3:22
  or
• 3:23
  20%.
• 3:23
  Definitely
• 3:24
  not
• 3:24
  a
• 3:24
  coin
• 3:25
  flip
• 3:25
  or
• 3:25
  near
• 3:25
  a
• 3:25
  coin
• 3:26
  flip.
• 3:27
  So
• 3:28
  the
• 3:28
  stakes
• 3:28
  are
• 3:29
  raised,
• 3:29
  right,
• 3:30
  in
• 3:30
  light
• 3:30
  of
• 3:30
  that,
• 3:31
  that
• 3:31
  almost
• 3:31
  half
• 3:32
  of
• 3:32
  every
• 3:32
  patient
• 3:33
  in
• 3:33
  your
• 3:33
  clinic
• 3:34
  who
• 3:34
  has
• 3:34
  mdd,
• 3:34
  which
• 3:35
  is
• 3:35
  a
• 3:35
  ton
• 3:35
  of
• 3:35
  patients
• 3:36
  in
• 3:36
  your
• 3:36
  clinic,
• 3:37
  are
• 3:37
  going
• 3:37
  to
• 3:37
  have
• 3:37
  comorbid
• 3:38
  personality
• 3:38
  disorders.
• 3:39
  And
• 3:39
  those
• 3:40
  can
• 3:40
  absolutely
• 3:41
  torpedo
• 3:42
  your
• 3:42
  treatment
• 3:43
  in
• 3:44
  four
• 3:44
  distinct
• 3:45
  ways.
• 3:45
  And
• 3:45
  that's
• 3:45
  what
• 3:45
  we're
• 3:45
  going
• 3:46
  to
• 3:46
  go
• 3:46
  over
• 3:46
  today.
• 3:47
  So
• 3:47
  this
• 3:47
  is
• 3:47
  a
• 3:47
  super
• 3:48
  important
• 3:48
  episode.
• 3:49
  You
• 3:50
  need
• 3:50
  to
• 3:50
  send
• 3:51
  this
• 3:52
  to
• 3:52
  everyone
• 3:53
  in
• 3:53
  your
• 3:53
  contacts
• 3:54
  list,
• 3:54
  because
• 3:55
  chances
• 3:55
  are
• 3:56
  almost
• 3:57
  all
• 3:57
  of
• 3:57
  them
• 3:58
  either
• 3:58
  have
• 3:58
  a
• 3:59
  personality
• 3:59
  disorder
• 4:00
  or
• 4:00
  know
• 4:00
  somebody
• 4:01
  with
• 4:01
  a
• 4:01
  personality
• 4:01
  disorder.
• 4:02
  Now,
• 4:02
  notice
• 4:02
  I
• 4:02
  didn't
• 4:03
  say.
• 4:04
  I
• 4:04
  didn't
• 4:04
  just
• 4:04
  stop
• 4:04
  and
• 4:04
  say
• 4:05
  that
• 4:05
  everyone
• 4:05
  in
• 4:05
  your
• 4:06
  contact
• 4:06
  list
• 4:06
  has
• 4:06
  a
• 4:06
  personality
• 4:07
  disorder.
• 4:08
  I
• 4:08
  added
• 4:09
  a
• 4:09
  very
• 4:09
  important
• 4:09
  caveat
• 4:10
  that
• 4:11
  or
• 4:11
  they
• 4:11
  know
• 4:12
  somebody
• 4:13
  with
• 4:13
  a
• 4:13
  personality
• 4:14
  disorder.
• 4:14
  Okay?
• 4:15
  So
• 4:16
  I
• 4:16
  kind
• 4:16
  of
• 4:16
  saved
• 4:17
  myself
• 4:17
  there.
• 4:18
  It
• 4:18
  was
• 4:18
  not
• 4:18
  offensive.
• 4:19
  Now,
• 4:21
  my
• 4:21
  friends,
• 4:22
  we
• 4:23
  have
• 4:23
  to
• 4:23
  be
• 4:23
  on
• 4:23
  guard
• 4:24
  about
• 4:24
  this
• 4:24
  because
• 4:25
  it
• 4:26
  goes
• 4:26
  without
• 4:26
  saying,
• 4:26
  but
• 4:27
  I'm
• 4:27
  going
• 4:27
  to
• 4:27
  say
• 4:27
  it
• 4:27
  anyway.
• 4:29
  Your
• 4:29
  personality
• 4:30
  and
• 4:30
  your
• 4:30
  patient's
• 4:31
  personality
• 4:32
  are
• 4:34
  fundamentally
• 4:35
  critical
• 4:36
  in
• 4:36
  your
• 4:36
  ability
• 4:37
  to
• 4:38
  secure
• 4:38
  a
• 4:39
  healthy
• 4:39
  attachment
• 4:39
  together,
• 4:41
  right?
• 4:41
  And
• 4:41
  if
• 4:41
  one
• 4:42
  or
• 4:42
  both
• 4:42
  of
• 4:42
  your
• 4:42
  personalities
• 4:44
  is
• 4:44
  dysfunctional
• 4:46
  or
• 4:46
  distrusting
• 4:47
  or
• 4:48
  erratic,
• 4:50
  unsteady,
• 4:51
  hostile,
• 4:52
  well,
• 4:53
  you
• 4:53
  are
• 4:53
  not
• 4:53
  going
• 4:54
  to
• 4:54
  be
• 4:54
  able
• 4:54
  to
• 4:54
  communicate
• 4:55
  in
• 4:55
  an
• 4:56
  authentic
• 4:56
  way,
• 4:56
  and
• 4:56
  you're
• 4:57
  not
• 4:57
  going
• 4:57
  to
• 4:57
  be
• 4:57
  able
• 4:58
  to
• 4:59
  achieve
• 4:59
  treatment
• 5:00
  outcomes
• 5:00
  together.
• 5:01
  And
• 5:01
  that
• 5:01
  is
• 5:01
  a
• 5:02
  very,
• 5:02
  very
• 5:02
  big
• 5:03
  problem.
• 5:03
  And
• 5:04
  that
• 5:04
  leads
• 5:04
  to
• 5:04
  the
• 5:04
  first
• 5:04
  mechanism,
• 5:05
  how
• 5:05
  personality
• 5:06
  disorders
• 5:06
  break
• 5:07
  your
• 5:07
  treatment.
• 5:07
  And
• 5:08
  that's
• 5:08
  the
• 5:08
  alliance
• 5:09
  rupture.
• 5:10
  Your
• 5:10
  alliance
• 5:11
  will
• 5:11
  be
• 5:11
  ruptured
• 5:12
  if
• 5:12
  you
• 5:13
  don't
• 5:13
  get
• 5:13
  a
• 5:13
  hold
• 5:13
  of
• 5:13
  this,
• 5:14
  okay?
• 5:16
  Now,
• 5:17
  there
• 5:17
  are
• 5:17
  experts
• 5:17
  in
• 5:18
  the
• 5:18
  field
• 5:19
  that
• 5:19
  frame
• 5:20
  personality
• 5:20
  disorders
• 5:21
  as
• 5:21
  a
• 5:21
  disorder
• 5:22
  of
• 5:22
  social
• 5:22
  communication,
• 5:23
  okay?
• 5:24
  The
• 5:24
  patient
• 5:24
  can't
• 5:24
  really
• 5:24
  learn
• 5:25
  from
• 5:25
  you
• 5:26
  because
• 5:26
  they
• 5:26
  cannot
• 5:27
  trust
• 5:27
  that
• 5:28
  you
• 5:28
  are
• 5:28
  authentic
• 5:29
  rather
• 5:29
  than
• 5:29
  manipulative,
• 5:30
  okay?
• 5:31
  And
• 5:31
  so
• 5:32
  they
• 5:32
  will
• 5:32
  withdraw
• 5:32
  from
• 5:33
  you
• 5:33
  or
• 5:34
  they
• 5:34
  will
• 5:34
  confront
• 5:34
  you,
• 5:35
  okay?
• 5:36
  And
• 5:37
  typically
• 5:38
  in
• 5:38
  cluster
• 5:39
  A
• 5:40
  personality
• 5:40
  disorders,
• 5:41
  the
• 5:42
  schizotypal
• 5:42
  or
• 5:43
  schizoid
• 5:43
  disorders,
• 5:44
  they
• 5:45
  will
• 5:45
  be
• 5:45
  a
• 5:46
  little
• 5:46
  silent
• 5:46
  and
• 5:47
  alienated.
• 5:48
  From
• 5:48
  you.
• 5:48
  They
• 5:49
  view
• 5:49
  other
• 5:49
  people
• 5:50
  as,
• 5:50
  and
• 5:50
  attachments
• 5:51
  more
• 5:51
  broadly
• 5:51
  as
• 5:52
  kind
• 5:52
  of
• 5:52
  threatening.
• 5:52
  They
• 5:53
  prefer
• 5:53
  not
• 5:53
  to
• 5:53
  be
• 5:53
  around
• 5:54
  people
• 5:54
  as
• 5:54
  much.
• 5:55
  They're
• 5:55
  emotionally
• 5:56
  disengaged.
• 5:57
  Okay,
• 5:57
  but
• 5:57
  then
• 5:57
  you
• 5:58
  also
• 5:58
  have
• 5:58
  maybe
• 5:58
  the
• 5:59
  cluster
• 5:59
  B
• 5:59
  folks,
• 6:00
  you
• 6:01
  know,
• 6:01
  the
• 6:01
  histrionic,
• 6:02
  the
• 6:02
  narcissist,
• 6:03
  the
• 6:03
  antisocial,
• 6:04
  borderline
• 6:05
  personality.
• 6:06
  Personality
• 6:07
  constructs,
• 6:07
  they
• 6:08
  can
• 6:08
  be
• 6:08
  more
• 6:08
  hostile
• 6:09
  and
• 6:09
  angry,
• 6:10
  they
• 6:10
  can
• 6:10
  reject,
• 6:10
  they
• 6:11
  can
• 6:11
  complain,
• 6:11
  they
• 6:12
  can
• 6:12
  challenge,
• 6:12
  right?
• 6:13
  And
• 6:13
  so
• 6:16
  these
• 6:16
  personality
• 6:17
  archetypes
• 6:17
  have
• 6:18
  been
• 6:18
  organized
• 6:18
  for
• 6:19
  a
• 6:19
  very
• 6:19
  distinct
• 6:19
  reason.
• 6:20
  And
• 6:20
  this
• 6:20
  is
• 6:21
  why
• 6:21
  we
• 6:21
  have
• 6:21
  to
• 6:21
  have
• 6:21
  compassion
• 6:22
  for
• 6:22
  our
• 6:22
  friends
• 6:23
  who
• 6:23
  have
• 6:23
  personality
• 6:24
  disorders.
• 6:24
  They
• 6:25
  didn't
• 6:25
  just
• 6:25
  wake
• 6:25
  up
• 6:26
  and
• 6:26
  choose
• 6:26
  from
• 6:27
  like
• 6:27
  a
• 6:27
  menu
• 6:28
  that
• 6:28
  they
• 6:28
  wanted
• 6:29
  to
• 6:29
  be
• 6:29
  narcissists
• 6:30
  or
• 6:30
  they
• 6:31
  wanted
• 6:31
  to
• 6:32
  have
• 6:32
  borderline
• 6:33
  personality
• 6:33
  disorder.
• 6:34
  These
• 6:34
  were
• 6:34
  very
• 6:35
  deliberate
• 6:36
  constructions
• 6:38
  that
• 6:38
  made
• 6:38
  a
• 6:38
  lot
• 6:39
  of
• 6:39
  sense
• 6:40
  when
• 6:40
  they
• 6:40
  were
• 6:40
  adolescents
• 6:41
  or
• 6:41
  young
• 6:42
  adults
• 6:42
  and
• 6:42
  served
• 6:43
  them
• 6:43
  very
• 6:43
  well.
• 6:44
  Because
• 6:45
  usually
• 6:46
  this
• 6:46
  is
• 6:46
  more
• 6:46
  my
• 6:46
  interpretation,
• 6:47
  but
• 6:47
  I
• 6:47
  do
• 6:47
  think
• 6:48
  it
• 6:48
  is
• 6:48
  probably
• 6:48
  backed
• 6:48
  by
• 6:49
  the
• 6:49
  science.
• 6:50
  Usually
• 6:50
  it's
• 6:50
  because
• 6:51
  there
• 6:51
  was
• 6:51
  some
• 6:52
  rupture
• 6:53
  in
• 6:53
  their
• 6:53
  attachment
• 6:54
  with
• 6:54
  mom
• 6:55
  or
• 6:55
  dad
• 6:55
  or
• 6:55
  very
• 6:55
  significant
• 6:56
  figures,
• 6:57
  right?
• 6:57
  So
• 6:58
  they
• 6:58
  had
• 6:58
  to
• 6:58
  adapt
• 6:59
  and
• 7:00
  they
• 7:00
  had
• 7:00
  to
• 7:01
  concoct
• 7:01
  unique
• 7:02
  personality
• 7:02
  traits
• 7:03
  to
• 7:03
  secure
• 7:03
  their
• 7:03
  needs
• 7:04
  that
• 7:04
  they
• 7:04
  couldn't,
• 7:05
  they
• 7:05
  couldn't
• 7:06
  acquire
• 7:06
  through
• 7:07
  ordinary
• 7:07
  ways,
• 7:08
  right?
• 7:08
  Maybe
• 7:09
  you
• 7:09
  have
• 7:09
  a
• 7:09
  secure
• 7:09
  attachment,
• 7:10
  you
• 7:10
  had
• 7:10
  a
• 7:10
  loving,
• 7:11
  predictable
• 7:11
  mother
• 7:12
  and
• 7:12
  father
• 7:13
  that
• 7:13
  gave
• 7:13
  you
• 7:13
  pattern
• 7:14
  consistent
• 7:14
  affection
• 7:15
  and
• 7:15
  attention
• 7:16
  for
• 7:16
  some
• 7:16
  other
• 7:16
  folks.
• 7:17
  Maybe
• 7:17
  they
• 7:17
  had
• 7:17
  to
• 7:18
  resort
• 7:18
  to
• 7:18
  very
• 7:18
  extreme
• 7:20
  behaviors
• 7:21
  to
• 7:21
  secure
• 7:22
  those
• 7:22
  attachments.
• 7:23
  Maybe
• 7:24
  some
• 7:24
  of
• 7:24
  those
• 7:25
  adaptive
• 7:25
  personality
• 7:26
  behaviors
• 7:26
  meant.
• 7:27
  I'm
• 7:27
  going
• 7:27
  to
• 7:27
  withdraw
• 7:27
  entirely,
• 7:29
  right?
• 7:29
  And
• 7:29
  I'm
• 7:30
  going
• 7:30
  to,
• 7:32
  I'm.
• 7:32
  I'm
• 7:32
  going
• 7:33
  to
• 7:33
  confer
• 7:34
  personalities
• 7:35
  onto
• 7:39
  trash
• 7:39
  bags
• 7:39
  and
• 7:40
  random
• 7:40
  inanimate
• 7:41
  objects
• 7:41
  because
• 7:41
  I
• 7:41
  don't
• 7:42
  trust
• 7:42
  people,
• 7:42
  right?
• 7:42
  That's
• 7:43
  the
• 7:43
  schizotypal
• 7:44
  presentation.
• 7:44
  I'm
• 7:45
  going
• 7:45
  to
• 7:45
  withdraw
• 7:45
  altogether
• 7:46
  a
• 7:46
  little
• 7:46
  more
• 7:46
  schizoid,
• 7:47
  right?
• 7:47
  Where
• 7:47
  I
• 7:47
  don't
• 7:47
  really
• 7:48
  trust
• 7:48
  people
• 7:49
  in
• 7:49
  general,
• 7:50
  okay?
• 7:51
  I
• 7:51
  might
• 7:51
  devalue
• 7:52
  people
• 7:52
  and
• 7:53
  idealize
• 7:53
  people.
• 7:53
  Like
• 7:54
  borderline,
• 7:54
  right?
• 7:55
  Where
• 7:55
  you're
• 7:55
  the
• 7:55
  greatest
• 7:56
  person
• 7:56
  one
• 7:56
  minute,
• 7:57
  you're
• 7:57
  horrible
• 7:58
  the
• 7:58
  next.
• 7:58
  Because
• 7:59
  the
• 7:59
  world's
• 7:59
  a
• 7:59
  lot
• 7:59
  safer
• 8:00
  when
• 8:00
  it's
• 8:01
  not
• 8:01
  in
• 8:01
  a
• 8:01
  gray
• 8:01
  area
• 8:02
  when
• 8:02
  I
• 8:02
  can
• 8:02
  capture
• 8:03
  you
• 8:03
  or
• 8:03
  when
• 8:03
  I
• 8:04
  can
• 8:04
  characterize
• 8:04
  you
• 8:05
  in
• 8:05
  one
• 8:05
  dimension
• 8:06
  rather
• 8:06
  than
• 8:07
  six
• 8:07
  confusing
• 8:08
  ones
• 8:09
  that,
• 8:09
  that
• 8:09
  give
• 8:10
  me
• 8:10
  way
• 8:10
  too
• 8:10
  much
• 8:11
  anxiety,
• 8:11
  right?
• 8:12
  So
• 8:12
  again,
• 8:12
  these
• 8:12
  are
• 8:13
  very
• 8:13
  adaptive
• 8:14
  personality
• 8:14
  traits
• 8:15
  that
• 8:16
  were
• 8:16
  evolved
• 8:17
  to
• 8:17
  survive
• 8:18
  and
• 8:18
  to,
• 8:18
  I
• 8:19
  think,
• 8:20
  cope
• 8:20
  with
• 8:20
  some
• 8:21
  form
• 8:21
  of
• 8:21
  disordered
• 8:22
  love
• 8:22
  is
• 8:23
  a
• 8:23
  good
• 8:23
  way
• 8:23
  to
• 8:23
  put
• 8:23
  it,
• 8:24
  right?
• 8:25
  I
• 8:25
  think,
• 8:25
  I
• 8:25
  think
• 8:25
  it
• 8:25
  was
• 8:25
  towards
• 8:26
  the
• 8:26
  end
• 8:26
  of
• 8:26
  his
• 8:26
  life
• 8:27
  where
• 8:27
  Freud
• 8:27
  and
• 8:28
  Carl
• 8:28
  Jung
• 8:28
  wrote
• 8:28
  a
• 8:28
  letter
• 8:29
  to
• 8:29
  each
• 8:29
  other.
• 8:29
  And
• 8:29
  I
• 8:29
  think
• 8:30
  it
• 8:30
  was
• 8:30
  Freud
• 8:30
  that
• 8:30
  basically
• 8:31
  said,
• 8:31
  like,
• 8:31
  hey,
• 8:31
  at
• 8:31
  the
• 8:32
  end
• 8:32
  of
• 8:32
  the
• 8:32
  day,
• 8:33
  everything
• 8:33
  we're
• 8:33
  doing
• 8:33
  here
• 8:34
  has
• 8:34
  to,
• 8:34
  has
• 8:34
  to.
• 8:35
  It
• 8:35
  involves
• 8:35
  love
• 8:36
  on
• 8:36
  some
• 8:36
  level,
• 8:37
  right?
• 8:38
  Like
• 8:38
  every
• 8:38
  psychiatric
• 8:39
  problem
• 8:39
  and
• 8:40
  in
• 8:40
  some.
• 8:40
  On
• 8:40
  some
• 8:41
  level,
• 8:42
  ultimately
• 8:42
  stems
• 8:43
  from
• 8:43
  disordered
• 8:44
  love.
• 8:44
  I'm
• 8:44
  butchering
• 8:45
  his
• 8:45
  words,
• 8:45
  but
• 8:45
  not
• 8:45
  very
• 8:46
  much.
• 8:46
  It's
• 8:46
  basically
• 8:47
  what
• 8:47
  he
• 8:47
  said,
• 8:48
  and
• 8:48
  I
• 8:49
  would
• 8:49
  agree
• 8:49
  with
• 8:49
  that.
• 8:49
  Right.
• 8:49
  And
• 8:50
  so
• 8:50
  this
• 8:50
  is
• 8:50
  how
• 8:50
  you
• 8:50
  have
• 8:51
  personality
• 8:51
  archetypes
• 8:52
  that
• 8:52
  develop.
• 8:53
  And
• 8:54
  so
• 8:55
  they're
• 8:55
  coming
• 8:55
  to
• 8:56
  you
• 8:57
  with
• 8:57
  the
• 8:57
  assumption
• 8:58
  that
• 8:59
  social
• 8:59
  relationships
• 9:00
  are
• 9:00
  dangerous
• 9:00
  or
• 9:01
  unpredictable
• 9:01
  or
• 9:02
  not
• 9:02
  worth
• 9:02
  it.
• 9:03
  And
• 9:03
  so
• 9:03
  how
• 9:04
  are
• 9:04
  you
• 9:04
  going
• 9:04
  to
• 9:04
  build
• 9:04
  an
• 9:05
  authentic,
• 9:05
  trusting
• 9:06
  relationship
• 9:06
  with
• 9:06
  someone
• 9:07
  who
• 9:07
  has
• 9:08
  this
• 9:08
  blueprint
• 9:08
  for
• 9:09
  the
• 9:09
  world,
• 9:09
  and
• 9:10
  yet
• 9:10
  you
• 9:10
  have
• 9:10
  to
• 9:10
  provide
• 9:11
  them
• 9:11
  psychoeducation
• 9:12
  about
• 9:13
  how
• 9:13
  their
• 9:13
  medications
• 9:14
  work
• 9:14
  and
• 9:14
  how
• 9:15
  often
• 9:15
  they
• 9:15
  need
• 9:15
  to
• 9:15
  take
• 9:16
  them.
• 9:16
  And
• 9:16
  you
• 9:17
  need
• 9:17
  to.
• 9:19
  You
• 9:19
  need
• 9:19
  to
• 9:19
  establish
• 9:20
  that
• 9:20
  you
• 9:20
  care
• 9:20
  about
• 9:21
  them
• 9:22
  genuinely
• 9:23
  and
• 9:23
  you
• 9:23
  want
• 9:23
  to
• 9:23
  learn
• 9:24
  from
• 9:24
  their
• 9:24
  experience.
• 9:24
  And
• 9:25
  they
• 9:25
  already
• 9:25
  don't
• 9:26
  trust
• 9:26
  that
• 9:26
  caregivers
• 9:27
  actually
• 9:27
  do
• 9:27
  that
• 9:28
  because
• 9:28
  everything
• 9:29
  they
• 9:29
  know
• 9:29
  in
• 9:29
  their
• 9:29
  lives
• 9:30
  is
• 9:30
  predicated
• 9:31
  on
• 9:31
  the
• 9:31
  fact
• 9:31
  that
• 9:31
  their
• 9:32
  caregivers
• 9:32
  actually
• 9:33
  didn't
• 9:33
  care
• 9:34
  and
• 9:34
  weren't
• 9:35
  involved
• 9:35
  and
• 9:35
  were
• 9:36
  manipulative
• 9:36
  at.
• 9:37
  At.
• 9:37
  At
• 9:38
  worst
• 9:38
  and.
• 9:39
  Or
• 9:39
  even
• 9:39
  violent.
• 9:40
  So
• 9:40
  you're
• 9:40
  walking
• 9:41
  into
• 9:41
  a
• 9:41
  situation,
• 9:42
  my
• 9:42
  friends,
• 9:43
  where
• 9:43
  you're
• 9:44
  going
• 9:44
  to
• 9:44
  be
• 9:44
  projected
• 9:45
  upon
• 9:46
  very
• 9:46
  severely,
• 9:47
  and
• 9:48
  that
• 9:48
  alone
• 9:48
  can
• 9:49
  make
• 9:49
  the
• 9:49
  alliance
• 9:50
  very
• 9:50
  challenging.
• 9:51
  This
• 9:51
  is
• 9:51
  why
• 9:51
  we
• 9:52
  have
• 9:52
  to
• 9:52
  have
• 9:52
  unconditional,
• 9:53
  positive.
• 9:53
  Regardless.
• 9:54
  This
• 9:54
  is
• 9:54
  why
• 9:54
  it's
• 9:55
  a
• 9:55
  really
• 9:55
  bad
• 9:55
  idea
• 9:56
  for
• 9:56
  anyone
• 9:56
  to
• 9:56
  go
• 9:56
  into
• 9:57
  this
• 9:57
  field
• 9:57
  who
• 9:58
  is
• 9:58
  extremely
• 9:58
  judgmental
• 10:00
  and
• 10:00
  doesn't
• 10:00
  understand
• 10:01
  people
• 10:01
  on
• 10:01
  a
• 10:01
  more
• 10:01
  human
• 10:02
  level.
• 10:02
  The
• 10:03
  textbooks
• 10:03
  can
• 10:03
  help
• 10:03
  you.
• 10:04
  They
• 10:04
  really
• 10:04
  can.
• 10:04
  I
• 10:05
  mean,
• 10:05
  that
• 10:05
  some
• 10:05
  of
• 10:05
  this
• 10:06
  is
• 10:06
  learnable,
• 10:06
  I
• 10:07
  think.
• 10:07
  I.
• 10:08
  I
• 10:08
  don't.
• 10:08
  I.
• 10:08
  I
• 10:08
  think
• 10:08
  that,
• 10:09
  you
• 10:09
  know,
• 10:09
  even
• 10:09
  if
• 10:09
  you're
• 10:10
  kind
• 10:10
  of
• 10:10
  a
• 10:10
  grouchy
• 10:11
  person
• 10:11
  who
• 10:11
  doesn't
• 10:11
  really
• 10:12
  love
• 10:12
  people,
• 10:13
  I
• 10:13
  don't.
• 10:13
  I
• 10:14
  do
• 10:14
  not
• 10:14
  suggest
• 10:14
  you
• 10:14
  go
• 10:15
  into
• 10:15
  this
• 10:15
  field.
• 10:15
  But
• 10:16
  I
• 10:16
  also
• 10:16
  think
• 10:16
  the
• 10:17
  more
• 10:17
  you
• 10:17
  understand
• 10:18
  why
• 10:19
  people
• 10:21
  can
• 10:21
  kind
• 10:21
  of
• 10:21
  stray
• 10:21
  away
• 10:22
  and
• 10:23
  become
• 10:23
  suspicious
• 10:24
  and
• 10:25
  manipulative
• 10:26
  and
• 10:27
  maybe
• 10:28
  flashy,
• 10:28
  like
• 10:28
  histrionic
• 10:29
  and
• 10:29
  want
• 10:30
  attention.
• 10:30
  If
• 10:30
  you
• 10:31
  understood
• 10:31
  that,
• 10:31
  maybe
• 10:31
  you
• 10:32
  won't
• 10:32
  have
• 10:32
  as
• 10:32
  much
• 10:32
  judgment
• 10:33
  towards
• 10:33
  those
• 10:33
  people.
• 10:34
  I
• 10:34
  know
• 10:34
  that's
• 10:34
  really
• 10:34
  helped.
• 10:34
  For
• 10:35
  me,
• 10:35
  the
• 10:35
  more
• 10:35
  I
• 10:35
  understand
• 10:36
  these
• 10:36
  personality
• 10:37
  disorders,
• 10:38
  the
• 10:38
  more
• 10:38
  compassion
• 10:39
  I
• 10:39
  have
• 10:39
  for
• 10:39
  these
• 10:40
  folks.
• 10:40
  And
• 10:40
  that
• 10:41
  lets
• 10:41
  you
• 10:42
  be
• 10:42
  consistent.
• 10:43
  Right.
• 10:44
  And
• 10:44
  so
• 10:44
  your
• 10:44
  alliance
• 10:45
  won't
• 10:45
  rupture
• 10:45
  if
• 10:45
  it's
• 10:46
  consistent,
• 10:46
  and
• 10:46
  then
• 10:46
  they
• 10:47
  might
• 10:47
  be
• 10:47
  able
• 10:47
  to
• 10:47
  open
• 10:48
  a
• 10:48
  door
• 10:48
  and
• 10:48
  trust
• 10:49
  you.
• 10:49
  Right.
• 10:49
  But
• 10:50
  I
• 10:50
  can't
• 10:50
  emphasize
• 10:50
  enough,
• 10:51
  my
• 10:51
  friends,
• 10:52
  that
• 10:53
  the
• 10:54
  alliance
• 10:54
  has
• 10:55
  to
• 10:55
  be
• 10:56
  strong
• 10:57
  if
• 10:57
  your
• 10:58
  patient
• 10:58
  is
• 10:58
  going
• 10:59
  to
• 10:59
  succeed.
• 11:00
  It's
• 11:01
  really
• 11:01
  that
• 11:01
  simple.
• 11:02
  Right.
• 11:03
  They're
• 11:03
  going
• 11:03
  to
• 11:03
  have
• 11:04
  to
• 11:04
  trust
• 11:04
  you
• 11:04
  every
• 11:05
  single
• 11:05
  ounce
• 11:06
  of
• 11:06
  progress
• 11:07
  that
• 11:08
  is
• 11:08
  derived
• 11:09
  from
• 11:10
  your
• 11:10
  work
• 11:11
  together
• 11:11
  ultimately
• 11:12
  hinges
• 11:12
  on
• 11:12
  a
• 11:13
  trusting,
• 11:14
  healthy
• 11:14
  relationship
• 11:15
  between
• 11:16
  both
• 11:16
  of
• 11:16
  you.
• 11:17
  Right.
• 11:17
  It's.
• 11:17
  It's
• 11:17
  the
• 11:17
  difference
• 11:18
  between
• 11:18
  them
• 11:18
  adhering
• 11:19
  to
• 11:19
  your
• 11:19
  medication
• 11:20
  regimen,
• 11:20
  listening
• 11:21
  to
• 11:21
  what
• 11:21
  you
• 11:21
  have
• 11:21
  to
• 11:21
  say,
• 11:22
  trusting
• 11:23
  that
• 11:23
  you're
• 11:23
  saying
• 11:23
  it,
• 11:25
  coming
• 11:25
  back
• 11:26
  and
• 11:26
  opening
• 11:26
  up
• 11:27
  to
• 11:27
  you
• 11:27
  and
• 11:27
  tolerating
• 11:28
  more
• 11:28
  and
• 11:28
  more
• 11:28
  anxiety
• 11:29
  and
• 11:29
  not
• 11:29
  being
• 11:29
  as
• 11:29
  avoidant
• 11:30
  and
• 11:31
  being
• 11:31
  open
• 11:31
  to
• 11:32
  insight
• 11:32
  so
• 11:32
  they
• 11:32
  can
• 11:33
  change.
• 11:34
  That
• 11:34
  is
• 11:34
  all
• 11:35
  predicated
• 11:35
  on
• 11:35
  their
• 11:36
  ability
• 11:36
  to
• 11:36
  trust
• 11:36
  you.
• 11:37
  If
• 11:37
  you
• 11:37
  don't
• 11:37
  have
• 11:37
  that,
• 11:38
  that
• 11:38
  trust
• 11:38
  and
• 11:39
  compassion,
• 11:40
  the
• 11:40
  alliance
• 11:40
  will
• 11:41
  rupture.
• 11:41
  And
• 11:41
  you're
• 11:41
  coming
• 11:42
  in
• 11:43
  with
• 11:43
  the
• 11:44
  cards
• 11:44
  stacked
• 11:44
  against.
• 11:45
  You
• 11:45
  were
• 11:46
  paddling
• 11:46
  upstream
• 11:47
  because
• 11:47
  of
• 11:48
  the
• 11:48
  fact
• 11:48
  that
• 11:48
  they
• 11:48
  have
• 11:48
  a
• 11:49
  disordered
• 11:49
  personality.
• 11:50
  So
• 11:50
  that's
• 11:50
  the
• 11:50
  first
• 11:51
  mechanism.
• 11:51
  Ruptured
• 11:52
  alliance.
• 11:53
  Watch
• 11:53
  out
• 11:53
  for
• 11:53
  it.
• 11:54
  Be
• 11:54
  on
• 11:54
  guard
• 11:55
  and
• 11:55
  be
• 11:56
  ready
• 11:56
  for
• 11:56
  it.
• 11:56
  Okay?
• 11:57
  The
• 11:57
  next
• 11:58
  way
• 11:58
  that
• 11:58
  personality
• 11:59
  disorders
• 11:59
  can
• 12:00
  torpedo
• 12:01
  your
• 12:01
  treatment
• 12:02
  is
• 12:02
  that
• 12:03
  a
• 12:03
  lot
• 12:03
  of
• 12:04
  the
• 12:04
  symptoms
• 12:04
  that
• 12:05
  you
• 12:05
  think
• 12:06
  you're
• 12:06
  treating
• 12:06
  through
• 12:07
  depression
• 12:07
  or
• 12:07
  burnout
• 12:08
  or
• 12:08
  anxiety
• 12:08
  disorder
• 12:09
  are
• 12:09
  actually
• 12:10
  personality
• 12:10
  traits.
• 12:11
  And
• 12:11
  they're
• 12:11
  not
• 12:11
  necessarily
• 12:13
  those
• 12:13
  disorders.
• 12:14
  Or
• 12:14
  at
• 12:14
  least
• 12:14
  they're.
• 12:15
  They
• 12:15
  take
• 12:16
  up
• 12:16
  a
• 12:16
  much
• 12:16
  greater
• 12:17
  piece
• 12:17
  of
• 12:18
  the
• 12:18
  pie
• 12:18
  than
• 12:18
  you
• 12:18
  think.
• 12:19
  You
• 12:19
  know,
• 12:19
  Here
• 12:20
  you
• 12:20
  are
• 12:20
  thinking
• 12:20
  this
• 12:20
  is
• 12:20
  treatment
• 12:21
  resistant
• 12:21
  depression.
• 12:22
  You're
• 12:22
  giving
• 12:22
  them
• 12:23
  multiple
• 12:23
  SSRIs,
• 12:24
  SNRIs
• 12:24
  through
• 12:25
  the
• 12:25
  years,
• 12:26
  and
• 12:27
  now
• 12:27
  you're
• 12:27
  starting
• 12:27
  them
• 12:27
  on
• 12:28
  ketamine
• 12:28
  and
• 12:28
  tms
• 12:29
  and
• 12:29
  nothing's
• 12:29
  getting
• 12:29
  better.
• 12:30
  Well,
• 12:30
  that
• 12:30
  should
• 12:30
  be
• 12:31
  a
• 12:31
  big
• 12:31
  red
• 12:32
  flag
• 12:32
  to
• 12:32
  you
• 12:32
  that
• 12:33
  there
• 12:33
  might
• 12:33
  be
• 12:33
  an
• 12:33
  underlying
• 12:35
  personality
• 12:35
  component
• 12:36
  that
• 12:36
  is
• 12:36
  not
• 12:37
  best
• 12:37
  served
• 12:37
  with
• 12:38
  SSRIs.
• 12:38
  There
• 12:39
  is
• 12:39
  no
• 12:39
  SSRI
• 12:39
  that's
• 12:40
  FDA
• 12:40
  approved
• 12:41
  for
• 12:41
  any
• 12:41
  personality
• 12:42
  disorder.
• 12:43
  Zero.
• 12:43
  Right.
• 12:44
  There's
• 12:44
  none.
• 12:45
  But
• 12:45
  there
• 12:45
  is
• 12:45
  DBT.
• 12:46
  There's
• 12:46
  dialectical
• 12:47
  behavioral
• 12:47
  therapy.
• 12:47
  There's
• 12:48
  CBT
• 12:49
  for
• 12:49
  depression,
• 12:50
  for
• 12:50
  anxiety,
• 12:51
  for
• 12:51
  social
• 12:51
  anxiety.
• 12:52
  Right.
• 12:52
  CBT
• 12:52
  is
• 12:53
  especially
• 12:53
  important
• 12:53
  for
• 12:54
  anxiety.
• 12:55
  Right.
• 12:55
  So
• 12:56
  you
• 12:56
  might
• 12:56
  be
• 12:56
  just
• 12:56
  throwing
• 12:57
  the
• 12:57
  kitchen
• 12:58
  sink
• 12:58
  at
• 12:58
  your
• 12:58
  patients
• 13:00
  who
• 13:00
  are
• 13:00
  coming
• 13:00
  to
• 13:00
  you
• 13:01
  saying
• 13:01
  that
• 13:02
  they
• 13:02
  have
• 13:02
  burnout
• 13:03
  and
• 13:03
  depression.
• 13:03
  And
• 13:04
  here
• 13:04
  we
• 13:04
  go.
• 13:04
  And
• 13:04
  we
• 13:05
  didn't
• 13:05
  realize
• 13:05
  that
• 13:05
  they
• 13:05
  have
• 13:06
  O,
• 13:06
  C,
• 13:06
  P,
• 13:06
  D,
• 13:07
  which
• 13:07
  is
• 13:07
  the
• 13:07
  most
• 13:07
  common
• 13:08
  personality
• 13:09
  disorder.
• 13:09
  Actually,
• 13:10
  it's
• 13:10
  the
• 13:10
  most
• 13:10
  pervasive.
• 13:11
  So
• 13:11
  O,
• 13:11
  C,
• 13:11
  P,
• 13:11
  D.
• 13:12
  They're
• 13:12
  just,
• 13:13
  they.
• 13:13
  They're
• 13:14
  overly
• 13:14
  rigid,
• 13:15
  they're
• 13:15
  overworking,
• 13:15
  and
• 13:16
  they're
• 13:16
  burning
• 13:16
  out.
• 13:16
  And
• 13:16
  it
• 13:17
  looks
• 13:17
  like
• 13:17
  depression
• 13:17
  and
• 13:17
  exhaustion.
• 13:18
  Now
• 13:19
  you're
• 13:19
  getting
• 13:19
  a
• 13:19
  TSH,
• 13:20
  you're
• 13:20
  getting
• 13:20
  a
• 13:20
  V,
• 13:21
  vitamin
• 13:23
  D,
• 13:23
  a
• 13:24
  B12,
• 13:24
  a
• 13:24
  folate,
• 13:25
  your
• 13:25
  ferritin.
• 13:27
  Ferritin's
• 13:28
  a
• 13:28
  great
• 13:28
  med,
• 13:28
  Great
• 13:29
  lab
• 13:30
  to
• 13:30
  get,
• 13:30
  by
• 13:30
  the
• 13:30
  way,
• 13:31
  if
• 13:31
  you
• 13:31
  want
• 13:31
  to
• 13:32
  go
• 13:32
  back
• 13:32
  to
• 13:32
  our
• 13:32
  previous
• 13:32
  episode
• 13:33
  on
• 13:33
  that,
• 13:34
  one
• 13:34
  of
• 13:34
  my
• 13:34
  favorites,
• 13:34
  Ferritin,
• 13:35
  Ferritin,
• 13:35
  Ferritin.
• 13:36
  But
• 13:36
  Here
• 13:37
  you
• 13:37
  are
• 13:37
  doing
• 13:37
  this
• 13:37
  workup
• 13:38
  and
• 13:38
  you
• 13:39
  underestimated
• 13:40
  the
• 13:40
  fact
• 13:40
  that
• 13:40
  maybe
• 13:40
  they
• 13:41
  have
• 13:41
  OCPD
• 13:42
  this
• 13:42
  whole
• 13:42
  time,
• 13:43
  right?
• 13:43
  And
• 13:43
  if
• 13:43
  you
• 13:44
  had
• 13:44
  steered
• 13:45
  them
• 13:45
  in
• 13:45
  the
• 13:45
  direction
• 13:45
  of
• 13:46
  psychotherapy,
• 13:46
  we
• 13:47
  can
• 13:47
  get
• 13:47
  to
• 13:47
  those
• 13:47
  underlying
• 13:48
  mechanics,
• 13:48
  maybe
• 13:49
  soften
• 13:49
  them,
• 13:50
  maybe
• 13:50
  catalyze
• 13:50
  some
• 13:51
  change,
• 13:51
  which
• 13:52
  could
• 13:52
  result
• 13:52
  in
• 13:52
  less
• 13:53
  burnout,
• 13:53
  less
• 13:54
  depressive
• 13:55
  like
• 13:55
  symptoms.
• 13:56
  And
• 13:56
  now
• 13:57
  you're
• 13:57
  not
• 13:57
  labeling
• 13:58
  them
• 13:58
  treatment
• 13:58
  resistant
• 13:59
  depression,
• 13:59
  slapping
• 14:00
  magnetic
• 14:00
  coils
• 14:01
  on
• 14:01
  their
• 14:01
  head
• 14:01
  while
• 14:02
  they
• 14:02
  sit
• 14:02
  in
• 14:02
  a
• 14:02
  chair
• 14:03
  five
• 14:03
  days
• 14:03
  a
• 14:03
  week
• 14:03
  doing
• 14:04
  TMS
• 14:05
  when
• 14:05
  the
• 14:05
  root
• 14:05
  cause
• 14:06
  was
• 14:06
  a
• 14:06
  personality
• 14:07
  driven
• 14:07
  issue.
• 14:08
  So
• 14:08
  beware
• 14:08
  of
• 14:09
  that.
• 14:09
  That's
• 14:09
  a
• 14:09
  big
• 14:09
  deal.
• 14:10
  Okay?
• 14:11
  Same
• 14:11
  thing
• 14:11
  with
• 14:12
  avoidant
• 14:12
  personality
• 14:13
  disorder.
• 14:13
  You
• 14:14
  know,
• 14:14
  patients
• 14:14
  who
• 14:14
  feel
• 14:14
  they're
• 14:15
  inadequate
• 14:15
  and
• 14:15
  they
• 14:15
  kind
• 14:16
  of
• 14:16
  withdraw
• 14:16
  because
• 14:16
  they
• 14:17
  feel
• 14:17
  like
• 14:17
  they're
• 14:17
  not
• 14:17
  worth
• 14:17
  it
• 14:18
  and
• 14:18
  they
• 14:18
  shouldn't
• 14:18
  participate
• 14:19
  in
• 14:19
  things
• 14:19
  because
• 14:19
  they're
• 14:20
  just,
• 14:20
  they
• 14:20
  have
• 14:20
  a
• 14:20
  low
• 14:20
  self
• 14:20
  esteem.
• 14:21
  You
• 14:21
  might
• 14:22
  misconstrue
• 14:22
  that
• 14:22
  as
• 14:23
  a
• 14:23
  severe
• 14:23
  social
• 14:23
  anxiety
• 14:24
  disorder.
• 14:24
  That's
• 14:25
  super
• 14:25
  treatment
• 14:25
  resistant.
• 14:26
  And
• 14:26
  now
• 14:26
  you're
• 14:27
  jacking
• 14:27
  up
• 14:27
  their
• 14:28
  Prozac
• 14:28
  all
• 14:29
  the
• 14:29
  way
• 14:29
  to
• 14:29
  80
• 14:30
  and.
• 14:30
  And
• 14:30
  it's
• 14:30
  like,
• 14:31
  okay,
• 14:31
  whoa,
• 14:31
  whoa,
• 14:31
  whoa,
• 14:31
  slow
• 14:32
  down.
• 14:32
  There's
• 14:32
  a
• 14:33
  reason
• 14:33
  that
• 14:33
  something
• 14:33
  may
• 14:34
  not
• 14:34
  be
• 14:34
  working
• 14:35
  right.
• 14:35
  You
• 14:35
  know,
• 14:36
  there's,
• 14:36
  there
• 14:36
  could
• 14:36
  be
• 14:36
  a
• 14:37
  medical
• 14:37
  etiology,
• 14:38
  look
• 14:38
  at
• 14:39
  substance
• 14:39
  use,
• 14:40
  look
• 14:40
  at
• 14:40
  the
• 14:40
  way
• 14:41
  they
• 14:42
  metabolize
• 14:42
  the
• 14:43
  medications.
• 14:43
  Maybe
• 14:43
  they're
• 14:44
  a
• 14:44
  hyper
• 14:44
  metabolizer,
• 14:45
  but
• 14:45
  maybe,
• 14:45
  just
• 14:46
  maybe,
• 14:46
  they
• 14:47
  have
• 14:47
  a
• 14:47
  personality
• 14:48
  disorder.
• 14:49
  So
• 14:50
  you
• 14:50
  are.
• 14:50
  The
• 14:51
  second
• 14:51
  way
• 14:51
  you
• 14:51
  get
• 14:52
  torpedoed
• 14:53
  here
• 14:54
  is
• 14:55
  that
• 14:55
  your
• 14:55
  personality
• 14:56
  traits
• 14:56
  look
• 14:56
  like
• 14:57
  symptoms
• 14:57
  and
• 14:57
  their
• 14:57
  personality
• 14:58
  traits.
• 14:59
  So
• 14:59
  watch
• 15:00
  out
• 15:00
  for
• 15:00
  that.
• 15:01
  Slow
• 15:01
  down
• 15:01
  before
• 15:02
  you
• 15:02
  get
• 15:02
  too
• 15:03
  trigger
• 15:03
  happy
• 15:03
  with
• 15:03
  your
• 15:04
  prescription
• 15:04
  pad
• 15:04
  and
• 15:04
  say,
• 15:05
  is
• 15:05
  my
• 15:05
  prescription
• 15:05
  pad
• 15:06
  even
• 15:06
  necessary?
• 15:07
  I
• 15:07
  think
• 15:08
  some
• 15:08
  of
• 15:08
  the
• 15:08
  biggest
• 15:09
  mistakes
• 15:09
  we
• 15:09
  make
• 15:09
  in
• 15:09
  psychiatry
• 15:10
  are
• 15:10
  that
• 15:11
  we
• 15:11
  have
• 15:11
  that
• 15:11
  hammer
• 15:12
  and
• 15:12
  we
• 15:12
  look
• 15:12
  for
• 15:12
  that
• 15:13
  nail,
• 15:13
  right?
• 15:13
  We
• 15:13
  have
• 15:13
  the
• 15:14
  prescription
• 15:14
  pad.
• 15:14
  That's
• 15:15
  what
• 15:15
  differentiates
• 15:15
  us
• 15:16
  from
• 15:17
  some
• 15:17
  of
• 15:17
  our
• 15:17
  counterparts
• 15:18
  in
• 15:18
  the
• 15:18
  field.
• 15:19
  But
• 15:19
  that's
• 15:19
  not
• 15:19
  necessarily
• 15:20
  a
• 15:20
  good
• 15:20
  thing.
• 15:20
  It
• 15:20
  can
• 15:20
  be
• 15:20
  a
• 15:21
  curse
• 15:21
  because
• 15:22
  you're
• 15:22
  not
• 15:23
  always
• 15:23
  well
• 15:24
  served
• 15:24
  to
• 15:24
  write
• 15:25
  that
• 15:25
  prescription.
• 15:25
  I
• 15:25
  think
• 15:26
  we
• 15:26
  need
• 15:26
  to
• 15:26
  be
• 15:26
  a
• 15:26
  little
• 15:26
  more
• 15:27
  conservative.
• 15:28
  Find
• 15:28
  the
• 15:28
  medical
• 15:28
  etiologies,
• 15:29
  run
• 15:30
  the
• 15:30
  labs,
• 15:30
  look
• 15:31
  at
• 15:31
  personality,
• 15:31
  and
• 15:32
  remember,
• 15:32
  45%
• 15:33
  of
• 15:33
  your
• 15:33
  personality
• 15:34
  disorder
• 15:34
  and
• 15:35
  major
• 15:35
  depressive
• 15:36
  disorder
• 15:36
  patients
• 15:36
  have
• 15:37
  personality
• 15:38
  disorder.
• 15:38
  So
• 15:39
  that's
• 15:39
  a
• 15:39
  big
• 15:39
  deal.
• 15:40
  Now,
• 15:40
  the
• 15:40
  third
• 15:40
  mechanism
• 15:41
  by
• 15:41
  which
• 15:43
  personality
• 15:43
  disorders
• 15:44
  thwart
• 15:45
  treatment
• 15:46
  is
• 15:47
  that
• 15:48
  quite
• 15:49
  simply,
• 15:49
  your
• 15:49
  patients
• 15:49
  are
• 15:50
  less
• 15:50
  likely
• 15:50
  to
• 15:50
  adhere
• 15:51
  to
• 15:51
  what
• 15:51
  you're
• 15:51
  doing
• 15:52
  because
• 15:52
  they
• 15:52
  just
• 15:52
  don't
• 15:53
  trust
• 15:53
  you.
• 15:53
  Cluster
• 15:54
  A
• 15:54
  patients,
• 15:54
  right?
• 15:55
  Paranoid
• 15:55
  personality
• 15:56
  disorder.
• 15:56
  They
• 15:56
  just
• 15:56
  don't
• 15:57
  trust
• 15:57
  you
• 15:57
  or
• 15:57
  they
• 15:58
  don't
• 15:58
  value
• 15:58
  your
• 15:58
  relationship.
• 15:59
  Schizoid,
• 16:00
  right?
• 16:01
  Or
• 16:01
  they
• 16:01
  incorporate
• 16:02
  their
• 16:02
  meds
• 16:03
  into
• 16:03
  magical
• 16:03
  Thinking
• 16:04
  like
• 16:04
  schizotypal
• 16:05
  patients
• 16:05
  might
• 16:05
  think
• 16:05
  their
• 16:05
  pills
• 16:06
  have
• 16:06
  a
• 16:06
  special
• 16:06
  dark
• 16:07
  energy
• 16:07
  and
• 16:07
  they
• 16:07
  don't
• 16:08
  take
• 16:08
  them.
• 16:08
  Right.
• 16:09
  So
• 16:09
  the,
• 16:09
  the
• 16:10
  personality
• 16:11
  actually
• 16:12
  drives
• 16:12
  the
• 16:12
  non
• 16:12
  adherence
• 16:13
  sometimes.
• 16:13
  Right.
• 16:14
  You
• 16:14
  have
• 16:14
  the
• 16:14
  cluster
• 16:14
  B
• 16:15
  per
• 16:16
  borderline
• 16:16
  folks,
• 16:17
  right.
• 16:17
  Who
• 16:18
  they
• 16:18
  might
• 16:18
  be
• 16:18
  so
• 16:19
  interpersonally
• 16:19
  unstable.
• 16:20
  Well,
• 16:20
  that
• 16:20
  kind
• 16:21
  of
• 16:21
  trickles
• 16:22
  into
• 16:22
  their
• 16:22
  ability
• 16:23
  to
• 16:23
  adhere
• 16:23
  to
• 16:23
  medications.
• 16:25
  Medications
• 16:25
  too.
• 16:25
  They
• 16:26
  might
• 16:26
  have
• 16:26
  weeks
• 16:26
  and
• 16:26
  months
• 16:27
  where
• 16:27
  they're
• 16:27
  perfectly
• 16:28
  compliant
• 16:28
  and
• 16:29
  then
• 16:30
  they
• 16:30
  might
• 16:30
  have
• 16:30
  weeks
• 16:30
  or
• 16:31
  months
• 16:31
  where
• 16:32
  they
• 16:32
  just
• 16:32
  abruptly
• 16:32
  discontinue
• 16:33
  it
• 16:33
  and
• 16:33
  think
• 16:34
  meds
• 16:34
  are
• 16:34
  awful.
• 16:34
  Meds
• 16:35
  are
• 16:35
  the
• 16:35
  problem.
• 16:35
  Right.
• 16:36
  They
• 16:36
  think
• 16:36
  in
• 16:36
  black
• 16:36
  and
• 16:37
  white
• 16:37
  terms.
• 16:38
  And
• 16:38
  so
• 16:39
  we've
• 16:39
  got
• 16:39
  to
• 16:39
  be
• 16:39
  very
• 16:40
  careful
• 16:40
  again
• 16:40
  that
• 16:41
  what
• 16:41
  we
• 16:41
  do
• 16:41
  drives
• 16:44
  for
• 16:44
  personality
• 16:45
  disorder.
• 16:45
  They
• 16:46
  can
• 16:46
  drive
• 16:46
  non
• 16:46
  adherence
• 16:48
  directly
• 16:48
  into
• 16:49
  our
• 16:49
  goals
• 16:49
  for
• 16:49
  them,
• 16:50
  irrespective
• 16:50
  of
• 16:51
  the
• 16:51
  alliance
• 16:51
  necessarily
• 16:52
  we
• 16:52
  have
• 16:52
  with
• 16:52
  them.
• 16:53
  But
• 16:53
  just
• 16:54
  their
• 16:54
  own
• 16:54
  personality
• 16:55
  construct
• 16:56
  can
• 16:56
  make
• 16:57
  the
• 16:57
  treatment
• 16:58
  itself
• 16:58
  difficult
• 16:58
  to
• 16:59
  adhere
• 16:59
  to.
• 17:00
  Right.
• 17:01
  And
• 17:01
  so
• 17:01
  that
• 17:01
  can
• 17:02
  be
• 17:02
  very
• 17:02
  pro.
• 17:02
  Problematic
• 17:03
  too.
• 17:03
  Your
• 17:04
  OCPD
• 17:04
  patients
• 17:05
  can
• 17:05
  be
• 17:05
  very
• 17:05
  rigid.
• 17:06
  They
• 17:07
  can
• 17:07
  be
• 17:07
  very
• 17:07
  uncompromising
• 17:08
  at
• 17:08
  times
• 17:08
  as
• 17:09
  nature,
• 17:10
  you
• 17:10
  know,
• 17:10
  kind
• 17:11
  of
• 17:11
  the
• 17:11
  nature
• 17:11
  of
• 17:11
  their
• 17:11
  diagnosis,
• 17:12
  which
• 17:12
  also
• 17:12
  you
• 17:13
  can
• 17:13
  imagine
• 17:13
  would
• 17:13
  be
• 17:13
  very
• 17:14
  difficult
• 17:14
  when
• 17:14
  you
• 17:15
  are
• 17:15
  trying
• 17:15
  to
• 17:18
  lay
• 17:18
  down
• 17:18
  a
• 17:19
  foundation
• 17:19
  of
• 17:20
  care
• 17:20
  and
• 17:20
  treatment.
• 17:21
  And
• 17:21
  they
• 17:21
  see
• 17:21
  things
• 17:22
  in
• 17:22
  a
• 17:22
  very
• 17:22
  rigid,
• 17:23
  very
• 17:23
  particular
• 17:23
  way.
• 17:24
  So
• 17:24
  that's
• 17:24
  a
• 17:24
  big
• 17:24
  deal.
• 17:25
  Now
• 17:25
  the
• 17:25
  fourth
• 17:26
  mechanism
• 17:26
  by
• 17:26
  which
• 17:27
  personality
• 17:27
  disorders
• 17:28
  can,
• 17:28
  can
• 17:29
  deteriorate
• 17:29
  your
• 17:29
  treatment
• 17:30
  is
• 17:30
  counter
• 17:31
  transference.
• 17:31
  And
• 17:31
  this
• 17:32
  probably
• 17:32
  deserves
• 17:32
  its
• 17:33
  own
• 17:33
  episode.
• 17:33
  I'd
• 17:33
  love
• 17:34
  to
• 17:34
  share
• 17:34
  my
• 17:35
  own
• 17:35
  experiences
• 17:35
  with
• 17:36
  this
• 17:36
  because
• 17:36
  I've
• 17:36
  learned
• 17:37
  a
• 17:37
  hell
• 17:37
  of
• 17:37
  a
• 17:37
  lot
• 17:37
  of.
• 17:38
  I
• 17:38
  think
• 17:38
  it
• 17:38
  can
• 17:38
  be
• 17:38
  very
• 17:38
  helpful
• 17:39
  to
• 17:39
  share
• 17:39
  them
• 17:39
  with
• 17:39
  you.
• 17:40
  I
• 17:40
  probably
• 17:40
  will
• 17:42
  soon.
• 17:43
  But
• 17:43
  you've
• 17:43
  got
• 17:43
  to
• 17:44
  manage
• 17:44
  countertransference,
• 17:45
  my
• 17:45
  friends,
• 17:45
  because
• 17:46
  they're
• 17:46
  coming
• 17:47
  to
• 17:47
  you
• 17:47
  to
• 17:47
  be
• 17:48
  the
• 17:48
  1
• 17:48
  unbiased
• 17:49
  person
• 17:49
  in
• 17:49
  their
• 17:50
  lives
• 17:50
  who's
• 17:50
  going
• 17:50
  to
• 17:50
  hear
• 17:51
  their
• 17:51
  story
• 17:52
  nonjudgmentally
• 17:53
  with
• 17:53
  compassion,
• 17:54
  root
• 17:54
  for
• 17:54
  them,
• 17:54
  be
• 17:55
  consistent
• 17:56
  and
• 17:56
  allow
• 17:56
  them
• 17:57
  to
• 17:57
  transcend
• 17:57
  their
• 17:57
  limitations.
• 17:58
  There's
• 17:58
  a
• 17:58
  reason
• 17:58
  they're
• 17:59
  sitting
• 17:59
  in
• 18:00
  front
• 18:00
  of
• 18:00
  you.
• 18:00
  And
• 18:01
  so
• 18:01
  the
• 18:01
  worst
• 18:01
  thing
• 18:02
  we
• 18:02
  can
• 18:02
  do
• 18:02
  is
• 18:02
  reinforce
• 18:04
  they're
• 18:04
  already
• 18:04
  suspicious
• 18:05
  worldview,
• 18:06
  they're
• 18:06
  already
• 18:06
  critical
• 18:07
  worldview,
• 18:07
  that
• 18:07
  it's
• 18:08
  all
• 18:08
  about
• 18:08
  good
• 18:08
  versus
• 18:09
  bad
• 18:09
  or
• 18:09
  that
• 18:09
  people
• 18:09
  can't
• 18:10
  be
• 18:10
  trusted
• 18:10
  and
• 18:10
  that
• 18:11
  they're
• 18:11
  unreliable.
• 18:12
  Right.
• 18:12
  Or
• 18:13
  that
• 18:13
  they're
• 18:13
  judgmental.
• 18:14
  The
• 18:14
  worst
• 18:15
  thing
• 18:15
  we
• 18:15
  can
• 18:15
  do
• 18:15
  is
• 18:16
  reinforce
• 18:17
  that
• 18:17
  because
• 18:18
  we
• 18:18
  are
• 18:18
  supposed
• 18:18
  to
• 18:18
  be
• 18:19
  the
• 18:19
  gatekeepers,
• 18:19
  the
• 18:19
  healers.
• 18:20
  And
• 18:20
  if
• 18:20
  the
• 18:21
  healers
• 18:21
  are
• 18:21
  still
• 18:21
  judging
• 18:22
  them
• 18:22
  and
• 18:23
  criticizing
• 18:23
  them
• 18:24
  or
• 18:24
  being
• 18:25
  domineering
• 18:25
  or
• 18:25
  manipulative
• 18:26
  with
• 18:26
  them
• 18:26
  and
• 18:27
  react
• 18:27
  against
• 18:28
  them,
• 18:28
  then
• 18:28
  what
• 18:29
  luck
• 18:29
  were
• 18:29
  they
• 18:29
  going
• 18:30
  to
• 18:30
  have
• 18:30
  outside?
• 18:31
  It's
• 18:31
  going
• 18:32
  to
• 18:32
  be
• 18:32
  very
• 18:32
  Difficult.
• 18:32
  Right.
• 18:33
  So
• 18:33
  our
• 18:34
  ability
• 18:34
  to
• 18:34
  manage
• 18:35
  our
• 18:35
  own
• 18:35
  emotions
• 18:36
  with
• 18:36
  patients
• 18:36
  is
• 18:37
  very
• 18:37
  important.
• 18:37
  I
• 18:38
  know
• 18:38
  for
• 18:38
  me,
• 18:38
  I'm
• 18:39
  very
• 18:39
  triggered
• 18:39
  by
• 18:40
  antisocial
• 18:41
  personality
• 18:41
  disorder
• 18:42
  presentations.
• 18:43
  I
• 18:43
  do
• 18:43
  not
• 18:43
  like
• 18:43
  being
• 18:44
  lied
• 18:44
  to.
• 18:44
  I
• 18:44
  do
• 18:45
  not
• 18:45
  like
• 18:45
  being
• 18:45
  manipulated.
• 18:46
  It
• 18:46
  invokes
• 18:47
  a
• 18:47
  lot
• 18:47
  of
• 18:47
  anger
• 18:48
  in
• 18:48
  me.
• 18:48
  And
• 18:49
  rather
• 18:50
  than
• 18:50
  make
• 18:50
  that
• 18:51
  a
• 18:51
  bad
• 18:51
  thing,
• 18:51
  it's
• 18:52
  the
• 18:52
  anger
• 18:53
  I
• 18:53
  feel
• 18:53
  in
• 18:53
  session
• 18:54
  is
• 18:54
  a
• 18:54
  constructive
• 18:55
  signal
• 18:55
  whereby
• 18:56
  I
• 18:56
  can
• 18:56
  say,
• 18:56
  all
• 18:57
  right,
• 18:57
  npz,
• 18:58
  time
• 18:58
  to
• 18:58
  cool
• 18:59
  off.
• 18:59
  Remember,
• 19:00
  go.
• 19:01
  Go
• 19:01
  down
• 19:01
  your
• 19:02
  own
• 19:02
  mental
• 19:02
  algorithm
• 19:03
  and
• 19:03
  understand
• 19:03
  that
• 19:03
  this
• 19:04
  person
• 19:04
  did
• 19:04
  not
• 19:04
  choose
• 19:05
  to
• 19:06
  have
• 19:06
  an
• 19:06
  antisocial
• 19:07
  personality
• 19:07
  disorder.
• 19:08
  And
• 19:08
  sure
• 19:09
  enough,
• 19:09
  you
• 19:09
  know,
• 19:09
  you
• 19:09
  dig
• 19:09
  in
• 19:10
  their
• 19:10
  history,
• 19:10
  and
• 19:10
  their
• 19:10
  parents
• 19:11
  were
• 19:11
  very
• 19:11
  unpredictable,
• 19:12
  often
• 19:12
  violent
• 19:13
  or
• 19:14
  punishing.
• 19:15
  And
• 19:15
  so
• 19:16
  they
• 19:16
  had
• 19:16
  to
• 19:16
  almost
• 19:16
  lie
• 19:17
  and
• 19:17
  manipulate
• 19:18
  their
• 19:18
  way
• 19:18
  out
• 19:18
  of
• 19:18
  situations
• 19:19
  habitually
• 19:20
  just
• 19:20
  to
• 19:21
  feel
• 19:21
  like
• 19:21
  they
• 19:21
  could
• 19:21
  get
• 19:21
  a
• 19:22
  fair
• 19:22
  shake.
• 19:22
  And
• 19:23
  so
• 19:23
  they're
• 19:23
  doing
• 19:23
  it
• 19:24
  to
• 19:24
  you,
• 19:24
  but
• 19:24
  they
• 19:24
  don't
• 19:25
  mean
• 19:25
  to
• 19:25
  do
• 19:25
  it
• 19:25
  to
• 19:25
  make
• 19:25
  you
• 19:26
  feel
• 19:27
  bad,
• 19:27
  necessarily.
• 19:28
  Not
• 19:28
  consciously,
• 19:29
  but
• 19:29
  they're
• 19:29
  doing
• 19:29
  it
• 19:29
  because
• 19:30
  it's
• 19:30
  the
• 19:30
  only
• 19:30
  way
• 19:30
  they
• 19:30
  knew.
• 19:31
  And
• 19:32
  they
• 19:32
  do
• 19:32
  feel
• 19:32
  like
• 19:33
  victims.
• 19:33
  This
• 19:33
  is
• 19:34
  my
• 19:34
  experience.
• 19:34
  Right.
• 19:35
  I'm
• 19:36
  closing
• 19:36
  my
• 19:36
  textbook
• 19:37
  for
• 19:37
  a
• 19:37
  moment
• 19:37
  here
• 19:37
  and
• 19:37
  just
• 19:37
  talking
• 19:38
  to
• 19:38
  you
• 19:38
  off
• 19:38
  the
• 19:38
  record.
• 19:38
  But
• 19:39
  I
• 19:39
  feel
• 19:39
  like
• 19:40
  those
• 19:40
  folks
• 19:40
  have
• 19:41
  been
• 19:41
  wronged
• 19:41
  so
• 19:41
  much,
• 19:42
  so
• 19:42
  often
• 19:43
  that
• 19:43
  they
• 19:43
  do
• 19:43
  feel
• 19:43
  like
• 19:44
  they're
• 19:44
  the
• 19:44
  victims.
• 19:44
  And
• 19:45
  perpetually
• 19:46
  they
• 19:46
  manipulate
• 19:47
  and
• 19:47
  they
• 19:47
  don't
• 19:48
  have
• 19:48
  a
• 19:48
  lot
• 19:48
  of
• 19:48
  empathy,
• 19:49
  in
• 19:49
  my
• 19:49
  view,
• 19:50
  because
• 19:50
  they've
• 19:50
  already
• 19:51
  felt
• 19:51
  like
• 19:51
  they're
• 19:52
  the
• 19:52
  victims
• 19:52
  from
• 19:52
  a
• 19:53
  young
• 19:53
  age.
• 19:53
  That's
• 19:54
  a
• 19:54
  broad
• 19:54
  stroke
• 19:54
  that
• 19:54
  may
• 19:55
  not
• 19:55
  apply
• 19:55
  to
• 19:55
  everyone
• 19:56
  with
• 19:57
  aspd,
• 19:58
  but
• 19:58
  I
• 19:58
  do
• 19:58
  find
• 19:59
  enough
• 19:59
  situations
• 20:00
  where
• 20:01
  I
• 20:01
  am
• 20:01
  at
• 20:01
  least
• 20:02
  able
• 20:02
  to
• 20:02
  mitigate
• 20:03
  my
• 20:03
  countertransference
• 20:04
  because
• 20:05
  I
• 20:05
  realized
• 20:05
  they
• 20:06
  didn't
• 20:06
  just
• 20:06
  choose
• 20:06
  this.
• 20:07
  This
• 20:08
  isn't
• 20:08
  anything
• 20:08
  about
• 20:08
  them
• 20:09
  that's
• 20:09
  inherently
• 20:09
  bad.
• 20:10
  They
• 20:10
  had
• 20:10
  a
• 20:11
  unique
• 20:11
  set
• 20:11
  of
• 20:11
  circumstances
• 20:12
  that
• 20:12
  brought
• 20:13
  them
• 20:13
  to
• 20:13
  where
• 20:13
  they
• 20:13
  were.
• 20:14
  So
• 20:14
  you
• 20:14
  have
• 20:14
  to
• 20:15
  check
• 20:15
  your
• 20:15
  counter
• 20:15
  transference,
• 20:16
  because
• 20:17
  if
• 20:17
  your
• 20:17
  ex
• 20:18
  boyfriend
• 20:19
  was
• 20:19
  super
• 20:20
  manipulative
• 20:21
  and
• 20:21
  domineering
• 20:22
  and.
• 20:23
  And
• 20:23
  an
• 20:23
  awful
• 20:24
  to
• 20:24
  you,
• 20:24
  and
• 20:24
  I'm
• 20:25
  sorry
• 20:25
  if
• 20:25
  that
• 20:25
  happened,
• 20:27
  right?
• 20:27
  We've
• 20:27
  all
• 20:27
  had
• 20:28
  really
• 20:28
  bad
• 20:28
  experiences
• 20:29
  at
• 20:29
  times
• 20:29
  in
• 20:30
  our
• 20:30
  relationships.
• 20:30
  But
• 20:30
  if
• 20:31
  that
• 20:31
  is
• 20:31
  not
• 20:31
  resolved
• 20:32
  yet,
• 20:32
  and
• 20:32
  then
• 20:32
  a
• 20:32
  patient
• 20:33
  comes
• 20:33
  into
• 20:34
  your
• 20:34
  office
• 20:34
  who
• 20:34
  looks
• 20:35
  like
• 20:35
  your
• 20:35
  ex
• 20:36
  and
• 20:36
  acts
• 20:36
  like
• 20:36
  your
• 20:37
  ex
• 20:37
  and
• 20:37
  even
• 20:37
  starts
• 20:38
  to
• 20:38
  humiliate
• 20:38
  or
• 20:39
  disrespect
• 20:39
  you,
• 20:40
  maybe
• 20:40
  they're
• 20:40
  narcissistic
• 20:41
  and
• 20:41
  they
• 20:41
  cut
• 20:42
  you
• 20:42
  down
• 20:42
  or
• 20:43
  make
• 20:43
  styled
• 20:44
  remarks
• 20:44
  about
• 20:44
  you.
• 20:45
  Um,
• 20:46
  you.
• 20:46
  If
• 20:46
  you
• 20:46
  have
• 20:47
  not
• 20:47
  resolved
• 20:48
  that
• 20:48
  hostility
• 20:48
  towards
• 20:49
  your
• 20:49
  ex,
• 20:50
  there
• 20:50
  might
• 20:50
  be
• 20:50
  this
• 20:51
  tendency
• 20:52
  even
• 20:52
  subconsciously,
• 20:53
  to
• 20:54
  enact
• 20:54
  that
• 20:55
  hostility
• 20:56
  back
• 20:56
  into
• 20:57
  the
• 20:57
  therapeutic
• 20:57
  relationship.
• 20:58
  And
• 20:58
  now
• 20:58
  you
• 20:59
  are
• 20:59
  reinforcing
• 21:00
  everything
• 21:00
  the
• 21:01
  narcissist
• 21:01
  believes
• 21:02
  about
• 21:02
  other
• 21:02
  people.
• 21:03
  Um,
• 21:03
  no
• 21:04
  one's
• 21:04
  getting
• 21:04
  healed
• 21:05
  in
• 21:05
  that
• 21:05
  session.
• 21:05
  Nobody's
• 21:06
  moving
• 21:06
  forward.
• 21:07
  So
• 21:07
  really
• 21:07
  think
• 21:07
  about
• 21:08
  that.
• 21:08
  This
• 21:08
  is
• 21:09
  why
• 21:09
  all
• 21:09
  therapists
• 21:10
  at
• 21:10
  some
• 21:10
  point
• 21:11
  should
• 21:11
  probably
• 21:11
  get
• 21:12
  therapy
• 21:12
  themselves
• 21:13
  so
• 21:13
  that
• 21:13
  they
• 21:13
  don't
• 21:14
  unwittingly
• 21:15
  ruin
• 21:16
  their
• 21:16
  own
• 21:16
  therapeutic
• 21:17
  relationship
• 21:18
  with
• 21:18
  their
• 21:18
  patients.
• 21:19
  Very
• 21:19
  important.
• 21:20
  Okay,
• 21:20
  so
• 21:20
  that's
• 21:21
  the
• 21:21
  fourth
• 21:21
  mechanism.
• 21:23
  Now,
• 21:23
  what
• 21:23
  are
• 21:23
  the
• 21:24
  key
• 21:24
  pearls
• 21:24
  here
• 21:25
  or
• 21:25
  takeaways
• 21:26
  that,
• 21:27
  that
• 21:27
  we
• 21:27
  need
• 21:27
  to
• 21:28
  think
• 21:28
  about?
• 21:28
  Well,
• 21:28
  I
• 21:28
  think
• 21:28
  the
• 21:29
  first
• 21:29
  one
• 21:29
  is
• 21:29
  that
• 21:29
  we
• 21:29
  should
• 21:30
  assess
• 21:30
  personality
• 21:31
  pathology
• 21:32
  really
• 21:33
  all
• 21:33
  the
• 21:33
  time.
• 21:33
  I
• 21:33
  mean,
• 21:34
  that
• 21:34
  should
• 21:34
  be
• 21:34
  standard
• 21:34
  care.
• 21:35
  I
• 21:35
  know
• 21:36
  that
• 21:36
  we
• 21:36
  are
• 21:36
  looking
• 21:36
  for
• 21:37
  MDD
• 21:37
  and
• 21:38
  GAD
• 21:38
  and
• 21:38
  panic
• 21:38
  and.
• 21:39
  But.
• 21:40
  But
• 21:40
  the
• 21:41
  personality
• 21:41
  pathologies
• 21:42
  in
• 21:42
  the
• 21:42
  DSM
• 21:43
  too.
• 21:43
  It's
• 21:44
  common
• 21:44
  enough
• 21:45
  that
• 21:45
  we
• 21:46
  ought
• 21:46
  to
• 21:46
  really
• 21:47
  stop
• 21:47
  and
• 21:48
  think
• 21:48
  about
• 21:49
  what
• 21:49
  dynamics
• 21:50
  in
• 21:50
  front
• 21:50
  of
• 21:50
  us
• 21:50
  might
• 21:51
  be
• 21:51
  a
• 21:51
  threat
• 21:51
  to
• 21:51
  the
• 21:51
  therapeutic
• 21:52
  alliance
• 21:52
  and
• 21:52
  our
• 21:53
  treatment
• 21:53
  plan
• 21:53
  as
• 21:53
  a
• 21:53
  whole.
• 21:54
  So
• 21:54
  assess
• 21:56
  all
• 21:56
  of
• 21:56
  your
• 21:56
  patients
• 21:56
  for
• 21:57
  this.
• 21:57
  Obviously,
• 21:58
  especially
• 21:58
  though
• 21:59
  in
• 21:59
  the
• 21:59
  treatment
• 21:59
  resistant
• 22:00
  cases.
• 22:01
  You've
• 22:01
  really
• 22:01
  got
• 22:02
  to
• 22:02
  back
• 22:02
  up
• 22:02
  in
• 22:02
  those
• 22:02
  cases
• 22:03
  and
• 22:03
  ask
• 22:04
  yourself,
• 22:04
  wait
• 22:04
  a
• 22:04
  minute,
• 22:05
  you
• 22:05
  know,
• 22:06
  what
• 22:06
  could
• 22:07
  be
• 22:07
  missing
• 22:07
  here?
• 22:07
  I'm
• 22:08
  not
• 22:08
  saying
• 22:08
  that
• 22:08
  every
• 22:08
  treatment
• 22:09
  resistant
• 22:09
  case
• 22:10
  is
• 22:10
  gonna
• 22:11
  be
• 22:11
  this
• 22:11
  magic
• 22:11
  bullet
• 22:12
  where
• 22:12
  you
• 22:12
  go,
• 22:12
  oh,
• 22:12
  my
• 22:12
  God,
• 22:13
  how
• 22:13
  could
• 22:13
  I
• 22:13
  have
• 22:13
  not
• 22:14
  known
• 22:14
  they
• 22:14
  had
• 22:14
  such
• 22:14
  a
• 22:14
  low
• 22:15
  ferritin
• 22:16
  or,
• 22:16
  or
• 22:16
  B12.
• 22:17
  Oh,
• 22:18
  my
• 22:18
  God.
• 22:18
  Paranoid
• 22:19
  personality
• 22:19
  that
• 22:19
  was
• 22:20
  sitting
• 22:20
  here
• 22:20
  the
• 22:20
  whole
• 22:20
  time.
• 22:20
  I
• 22:21
  had
• 22:21
  no
• 22:21
  idea.
• 22:22
  I'm
• 22:22
  not
• 22:22
  saying
• 22:22
  that
• 22:23
  that's
• 22:23
  always
• 22:23
  gonna
• 22:23
  be
• 22:23
  the
• 22:24
  case,
• 22:24
  but
• 22:24
  it
• 22:24
  is
• 22:25
  in.
• 22:26
  In
• 22:26
  essential
• 22:27
  that
• 22:27
  you
• 22:28
  back
• 22:28
  up
• 22:29
  and,
• 22:29
  and
• 22:29
  don't
• 22:29
  label
• 22:30
  someone
• 22:30
  treatment
• 22:31
  resistant
• 22:31
  unless
• 22:31
  you
• 22:31
  are
• 22:32
  absolutely
• 22:33
  sure
• 22:33
  they
• 22:34
  are
• 22:34
  treatment
• 22:34
  resistant.
• 22:35
  Okay?
• 22:36
  Those
• 22:36
  are
• 22:36
  fighting
• 22:37
  words.
• 22:37
  Those
• 22:38
  words
• 22:38
  are
• 22:38
  as
• 22:38
  fighting
• 22:39
  as
• 22:39
  the
• 22:40
  words
• 22:40
  malingering.
• 22:42
  Right?
• 22:42
  Those
• 22:43
  are
• 22:43
  not
• 22:43
  terms
• 22:43
  we
• 22:44
  want
• 22:44
  to
• 22:44
  just
• 22:44
  casually
• 22:45
  heap
• 22:45
  on
• 22:45
  a
• 22:45
  patient
• 22:46
  because
• 22:46
  they
• 22:46
  involve
• 22:47
  a
• 22:47
  very
• 22:47
  distinct
• 22:48
  algorithm
• 22:49
  of
• 22:49
  interventions
• 22:50
  and
• 22:50
  treatments
• 22:51
  that
• 22:51
  may
• 22:51
  be
• 22:51
  completely
• 22:52
  inappropriate
• 22:53
  because
• 22:53
  we
• 22:54
  didn't
• 22:54
  really
• 22:54
  assess
• 22:55
  if
• 22:55
  they
• 22:55
  actually
• 22:56
  had
• 22:57
  a
• 22:57
  therapeutic
• 22:58
  trial
• 22:58
  for,
• 22:59
  you
• 22:59
  know,
• 22:59
  eight
• 22:59
  to
• 23:00
  12
• 23:00
  weeks
• 23:00
  at
• 23:01
  a
• 23:01
  therapeutic
• 23:02
  dose
• 23:02
  or
• 23:03
  we
• 23:03
  didn't.
• 23:03
  We
• 23:04
  didn't
• 23:04
  accurately
• 23:04
  assess
• 23:05
  their
• 23:05
  personality
• 23:06
  structure
• 23:07
  or
• 23:08
  we
• 23:08
  didn't
• 23:08
  accurately
• 23:10
  understand,
• 23:12
  you
• 23:12
  know,
• 23:12
  whether
• 23:12
  or
• 23:13
  not
• 23:13
  this
• 23:13
  was.
• 23:13
  Had
• 23:13
  a
• 23:14
  medical
• 23:14
  etiology
• 23:15
  or
• 23:15
  something.
• 23:15
  Right.
• 23:16
  So
• 23:16
  definitely
• 23:17
  back
• 23:17
  up
• 23:17
  and
• 23:18
  assess
• 23:18
  this
• 23:19
  for
• 23:20
  every
• 23:20
  patient,
• 23:20
  but
• 23:20
  especially
• 23:21
  treatment
• 23:21
  resistant
• 23:22
  cases.
• 23:23
  The
• 23:23
  second
• 23:23
  pearl
• 23:24
  to
• 23:24
  take
• 23:24
  away
• 23:24
  with
• 23:24
  this,
• 23:24
  my
• 23:25
  friends,
• 23:25
  is
• 23:25
  to
• 23:25
  prioritize
• 23:26
  psychotherapy.
• 23:27
  Right?
• 23:27
  You
• 23:27
  have
• 23:27
  a
• 23:28
  prescription
• 23:28
  pad,
• 23:28
  but
• 23:29
  it
• 23:29
  is
• 23:29
  not
• 23:30
  a
• 23:30
  magic
• 23:30
  wand
• 23:31
  either.
• 23:31
  Don't
• 23:32
  treat
• 23:32
  it
• 23:32
  like
• 23:33
  it
• 23:33
  is.
• 23:34
  Sometimes
• 23:34
  it's
• 23:36
  more
• 23:36
  than
• 23:36
  appropriate
• 23:37
  to
• 23:37
  steer
• 23:37
  your
• 23:38
  patients
• 23:38
  into
• 23:39
  psychotherapy
• 23:39
  and
• 23:40
  prioritize
• 23:40
  that
• 23:41
  as
• 23:41
  a
• 23:41
  way
• 23:42
  to
• 23:42
  soften
• 23:43
  this
• 23:43
  whole
• 23:43
  thing
• 23:44
  and
• 23:44
  make
• 23:44
  it
• 23:44
  easier
• 23:45
  and
• 23:45
  more
• 23:45
  fluid
• 23:46
  for
• 23:46
  both
• 23:46
  of
• 23:46
  you
• 23:47
  so
• 23:47
  they
• 23:47
  can
• 23:47
  get
• 23:47
  to
• 23:48
  those
• 23:48
  underlying
• 23:48
  personality
• 23:49
  dynamics
• 23:50
  and
• 23:50
  do
• 23:50
  even
• 23:50
  better
• 23:51
  in
• 23:51
  the
• 23:52
  chair
• 23:52
  in
• 23:52
  front
• 23:52
  of
• 23:52
  you.
• 23:53
  And
• 23:53
  then
• 23:53
  the
• 23:54
  third
• 23:54
  pearl
• 23:54
  I
• 23:54
  want
• 23:54
  you
• 23:55
  guys
• 23:55
  to
• 23:55
  think
• 23:55
  about
• 23:55
  is,
• 23:56
  treat
• 23:56
  your
• 23:56
  therapeutic
• 23:57
  relationship
• 23:57
  with
• 23:57
  your
• 23:57
  patient
• 23:58
  like
• 23:58
  a
• 23:58
  vital
• 23:59
  sign,
• 23:59
  okay?
• 24:00
  Almost
• 24:00
  like
• 24:00
  when
• 24:00
  you
• 24:01
  get
• 24:01
  a
• 24:01
  blood
• 24:01
  pressure
• 24:01
  every
• 24:02
  visit,
• 24:02
  you
• 24:02
  should
• 24:03
  also
• 24:03
  be
• 24:04
  checking
• 24:04
  in
• 24:04
  with
• 24:04
  yourself.
• 24:05
  Is.
• 24:05
  Is
• 24:05
  this
• 24:06
  relationship
• 24:07
  being
• 24:07
  steered
• 24:07
  in
• 24:07
  the
• 24:08
  right
• 24:08
  direction?
• 24:08
  How
• 24:08
  are
• 24:08
  we
• 24:09
  doing?
• 24:09
  Do
• 24:09
  they
• 24:10
  seem
• 24:10
  forthcoming?
• 24:11
  Do
• 24:11
  they
• 24:11
  seem
• 24:12
  at
• 24:12
  ease?
• 24:13
  Um,
• 24:13
  is
• 24:14
  the.
• 24:14
  Does
• 24:14
  this
• 24:14
  feel
• 24:14
  authentic?
• 24:15
  Does
• 24:15
  it
• 24:15
  feel
• 24:16
  connected?
• 24:16
  Is
• 24:16
  there
• 24:17
  an
• 24:17
  elephant
• 24:17
  in
• 24:17
  the
• 24:17
  room?
• 24:17
  What.
• 24:18
  What
• 24:18
  is
• 24:18
  my
• 24:18
  patient
• 24:19
  not
• 24:19
  saying?
• 24:20
  And
• 24:20
  I
• 24:20
  will
• 24:20
  tell
• 24:20
  you
• 24:21
  the
• 24:22
  number
• 24:22
  one
• 24:22
  most
• 24:23
  important
• 24:23
  piece
• 24:23
  of
• 24:24
  the
• 24:24
  therapeutic
• 24:24
  relationship.
• 24:26
  Not
• 24:26
  only
• 24:26
  is
• 24:26
  it
• 24:27
  the
• 24:27
  right
• 24:27
  thing
• 24:27
  to
• 24:28
  have
• 24:28
  a
• 24:28
  good
• 24:28
  relationship,
• 24:28
  and
• 24:29
  it's
• 24:29
  the
• 24:29
  human
• 24:29
  thing.
• 24:29
  Okay,
• 24:30
  that's
• 24:30
  true.
• 24:31
  But
• 24:31
  diagnostically,
• 24:32
  you
• 24:33
  will
• 24:33
  not
• 24:33
  be
• 24:33
  able
• 24:33
  to
• 24:34
  diagnose
• 24:34
  and
• 24:34
  treat
• 24:34
  your
• 24:35
  patient
• 24:35
  well
• 24:35
  if
• 24:36
  you're
• 24:36
  not
• 24:36
  eliciting
• 24:38
  good
• 24:38
  information
• 24:38
  out
• 24:39
  of
• 24:39
  them.
• 24:39
  And
• 24:40
  you
• 24:40
  will
• 24:40
  not
• 24:40
  elicit
• 24:41
  good
• 24:41
  information
• 24:41
  out
• 24:42
  of
• 24:42
  them
• 24:42
  if
• 24:42
  they
• 24:42
  don't
• 24:43
  trust
• 24:43
  you
• 24:43
  and
• 24:43
  they
• 24:43
  don't
• 24:43
  like
• 24:44
  you.
• 24:45
  And
• 24:45
  so
• 24:46
  it
• 24:46
  all
• 24:46
  comes
• 24:46
  full
• 24:47
  circle,
• 24:47
  right?
• 24:47
  Building
• 24:48
  that
• 24:48
  relationship
• 24:49
  is
• 24:49
  going
• 24:49
  to
• 24:50
  open
• 24:50
  the
• 24:50
  door.
• 24:50
  It's
• 24:50
  going
• 24:51
  to
• 24:51
  pave
• 24:51
  the
• 24:51
  way
• 24:51
  for
• 24:52
  every
• 24:52
  other
• 24:52
  good
• 24:52
  thing
• 24:53
  that
• 24:53
  can
• 24:53
  happen,
• 24:54
  right?
• 24:54
  They
• 24:54
  open
• 24:54
  up
• 24:55
  to
• 24:55
  you,
• 24:55
  they
• 24:55
  trust
• 24:55
  you.
• 24:55
  You
• 24:56
  get
• 24:56
  valuable
• 24:56
  clinical
• 24:57
  information.
• 24:58
  You
• 24:58
  can
• 24:58
  then
• 24:58
  use
• 24:58
  that
• 24:59
  information
• 24:59
  to
• 25:00
  pair
• 25:01
  it
• 25:01
  to
• 25:01
  a
• 25:01
  treatment
• 25:01
  plan,
• 25:02
  and
• 25:02
  boom,
• 25:03
  boom,
• 25:03
  everybody's
• 25:04
  happy.
• 25:05
  Depression
• 25:05
  goes
• 25:06
  away,
• 25:06
  personality
• 25:07
  disorders
• 25:08
  start
• 25:09
  to
• 25:09
  melt,
• 25:09
  and
• 25:10
  we
• 25:10
  have
• 25:10
  real
• 25:11
  human
• 25:11
  progress
• 25:12
  and
• 25:12
  achievement.
• 25:13
  That's
• 25:13
  what
• 25:13
  we
• 25:13
  need.
• 25:15
  My
• 25:15
  friends,
• 25:15
  if
• 25:16
  you
• 25:16
  enjoyed
• 25:17
  this
• 25:17
  episode
• 25:18
  and
• 25:18
  you
• 25:18
  want
• 25:19
  to
• 25:19
  take
• 25:19
  your
• 25:19
  practice
• 25:20
  to
• 25:20
  the
• 25:20
  next
• 25:20
  level,
• 25:21
  the
• 25:21
  best
• 25:22
  thing
• 25:22
  you
• 25:22
  can
• 25:22
  do,
• 25:22
  my
• 25:23
  friends,
• 25:23
  is
• 25:24
  go
• 25:24
  into
• 25:24
  our
• 25:25
  show
• 25:25
  notes
• 25:25
  and
• 25:26
  become
• 25:26
  a
• 25:26
  Patreon
• 25:27
  member.
• 25:28
  I
• 25:28
  cannot
• 25:28
  emphasize
• 25:29
  it
• 25:29
  enough
• 25:30
  how
• 25:30
  important
• 25:31
  it
• 25:31
  is
• 25:32
  for
• 25:32
  you
• 25:32
  to
• 25:33
  do
• 25:33
  that.
• 25:33
  My
• 25:33
  friends,
• 25:34
  I
• 25:34
  built
• 25:34
  a
• 25:35
  whole
• 25:35
  Patreon
• 25:36
  library
• 25:37
  full
• 25:38
  of
• 25:38
  visually
• 25:38
  sticky,
• 25:39
  awesome
• 25:42
  teaching
• 25:43
  points,
• 25:43
  lectures.
• 25:44
  There's
• 25:45
  rap
• 25:45
  songs,
• 25:45
  there's
• 25:46
  stickers
• 25:46
  that
• 25:47
  you
• 25:47
  can
• 25:47
  share
• 25:47
  with
• 25:47
  your
• 25:48
  peers
• 25:48
  that
• 25:49
  help
• 25:49
  you
• 25:49
  all
• 25:49
  just
• 25:50
  get
• 25:50
  this
• 25:51
  a
• 25:51
  lot
• 25:51
  easier
• 25:51
  and
• 25:52
  faster
• 25:52
  and
• 25:52
  more
• 25:52
  visually
• 25:53
  and
• 25:53
  more
• 25:53
  beautiful.
• 25:54
  I
• 25:54
  can't
• 25:54
  emphasize
• 25:55
  it
• 25:55
  enough,
• 25:55
  right?
• 25:56
  Because
• 25:56
  it's
• 25:57
  not
• 25:57
  enough
• 25:57
  that
• 25:58
  we
• 25:58
  just
• 25:58
  press
• 25:59
  buttons
• 25:59
  in
• 25:59
  this
• 26:00
  field
• 26:00
  and
• 26:00
  memorize
• 26:01
  meds
• 26:01
  and
• 26:01
  diagnoses.
• 26:02
  Understanding
• 26:03
  the
• 26:03
  how
• 26:03
  and
• 26:04
  the
• 26:04
  why
• 26:04
  is
• 26:04
  how
• 26:04
  you're
• 26:05
  going
• 26:05
  to
• 26:05
  truly
• 26:05
  transform
• 26:07
  that.
• 26:07
  Your
• 26:07
  relationships
• 26:08
  with
• 26:08
  your
• 26:08
  patients
• 26:08
  and
• 26:09
  your
• 26:09
  practice.
• 26:10
  And
• 26:10
  that's
• 26:10
  what
• 26:10
  our
• 26:11
  library
• 26:11
  intends
• 26:12
  to
• 26:12
  do.
• 26:13
  So
• 26:13
  go
• 26:13
  to
• 26:14
  patreon.com
• 26:15
  pearls
• 26:16
  and
• 26:16
  prep.
• 26:16
  Go
• 26:17
  to
• 26:17
  our
• 26:17
  show
• 26:17
  notes.
• 26:18
  Click
• 26:18
  the
• 26:18
  link.
• 26:19
  You
• 26:19
  will
• 26:19
  not
• 26:19
  be
• 26:19
  disappointed.
• 26:20
  We
• 26:20
  would
• 26:20
  love
• 26:20
  to
• 26:21
  have
• 26:21
  you.
• 26:21
  Until
• 26:21
  next
• 26:22
  time,
• 26:22
  my
• 26:22
  friends.
• 26:23
  Take
• 26:23
  care
• 26:23
  of
• 26:23
  yourselves
• 26:24
  and
• 26:24
  each
• 26:25
  other.