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The Borderline Personality Disorder Insight I Wish Someone Had Taught Me Earlier · Pearls and Prep

• 0:00
  Foreign.
• 0:05
  Welcome
• 0:06
  back,
• 0:06
  my
• 0:06
  friends
• 0:07
  to
• 0:07
  another
• 0:07
  episode
• 0:07
  of
• 0:08
  Pearls
• 0:08
  and
• 0:08
  prep
• 0:09
  npz
• 0:10
  Here
• 0:10
  your
• 0:10
  preceptor
• 0:11
  in
• 0:11
  your
• 0:11
  pocket,
• 0:12
  your
• 0:12
  go
• 0:12
  to
• 0:12
  place
• 0:13
  for
• 0:13
  pearls
• 0:14
  that
• 0:14
  prep
• 0:14
  you
• 0:14
  to
• 0:15
  practice.
• 0:16
  Now,
• 0:16
  my
• 0:16
  friends,
• 0:17
  the
• 0:17
  purpose
• 0:17
  of
• 0:17
  today's
• 0:18
  discussion
• 0:19
  is
• 0:20
  going
• 0:20
  to
• 0:20
  be
• 0:21
  to
• 0:22
  articulate
• 0:23
  the
• 0:24
  path
• 0:24
  by
• 0:24
  which
• 0:25
  a
• 0:25
  patient
• 0:26
  develops
• 0:26
  borderline
• 0:27
  personality
• 0:28
  disorder.
• 0:28
  And
• 0:28
  in
• 0:28
  doing
• 0:29
  so,
• 0:29
  the
• 0:30
  goal
• 0:30
  is
• 0:30
  to
• 0:31
  foster
• 0:32
  empathy
• 0:32
  and
• 0:32
  understanding
• 0:33
  in
• 0:34
  you
• 0:34
  and
• 0:34
  in
• 0:34
  me
• 0:35
  so
• 0:35
  we
• 0:35
  can
• 0:36
  treat
• 0:36
  these
• 0:37
  patients
• 0:38
  with
• 0:38
  more
• 0:38
  compassion
• 0:39
  and
• 0:39
  we
• 0:40
  can
• 0:40
  open
• 0:40
  up
• 0:40
  more
• 0:40
  space
• 0:41
  for
• 0:41
  them
• 0:41
  to
• 0:41
  heal.
• 0:42
  And
• 0:42
  that's
• 0:42
  really
• 0:43
  the
• 0:43
  goal
• 0:43
  here.
• 0:43
  And
• 0:43
  I
• 0:43
  think
• 0:43
  it's
• 0:44
  a
• 0:44
  beautiful
• 0:44
  goal.
• 0:45
  It's
• 0:45
  one
• 0:45
  worth
• 0:45
  achieving.
• 0:46
  And
• 0:46
  we're
• 0:47
  going
• 0:47
  to
• 0:47
  learn
• 0:47
  this
• 0:47
  through
• 0:48
  a
• 0:48
  mock
• 0:48
  patient
• 0:49
  named
• 0:49
  Haley.
• 0:50
  25
• 0:51
  year
• 0:51
  old
• 0:51
  mock
• 0:52
  patient
• 0:52
  named
• 0:52
  Haley
• 0:53
  who
• 0:53
  has
• 0:53
  borderline
• 0:53
  personality
• 0:54
  disorder.
• 0:55
  Okay?
• 0:55
  And
• 0:55
  I'm
• 0:56
  going
• 0:56
  to
• 0:56
  walk
• 0:56
  through
• 0:56
  just
• 0:57
  key
• 0:57
  areas
• 0:58
  of
• 0:58
  her
• 0:58
  development
• 0:59
  so
• 0:59
  that
• 0:59
  you
• 0:59
  can
• 0:59
  connect
• 1:00
  the
• 1:00
  dots
• 1:00
  and
• 1:00
  understand
• 1:02
  how
• 1:02
  the
• 1:03
  DSM
• 1:03
  5
• 1:04
  symptoms
• 1:05
  map
• 1:05
  very
• 1:05
  cleanly
• 1:06
  to
• 1:07
  her
• 1:07
  environment
• 1:07
  and
• 1:07
  make
• 1:08
  perfect
• 1:08
  sense.
• 1:08
  And
• 1:08
  again,
• 1:09
  I
• 1:09
  think
• 1:09
  this
• 1:09
  kind
• 1:10
  of
• 1:10
  exercise
• 1:10
  really
• 1:11
  helps
• 1:11
  me
• 1:11
  breed
• 1:12
  a
• 1:12
  lot
• 1:12
  of
• 1:14
  empathy,
• 1:14
  understanding
• 1:15
  and
• 1:15
  patience
• 1:16
  in
• 1:17
  patients
• 1:17
  who
• 1:17
  are
• 1:17
  otherwise
• 1:18
  quite
• 1:18
  challenging.
• 1:19
  And
• 1:19
  so
• 1:19
  I
• 1:20
  hope
• 1:20
  you
• 1:20
  enjoy
• 1:20
  this
• 1:22
  and
• 1:22
  I
• 1:22
  think
• 1:22
  you're
• 1:22
  going
• 1:22
  to
• 1:23
  really
• 1:23
  love
• 1:23
  this.
• 1:24
  Okay,
• 1:25
  so
• 1:25
  here
• 1:25
  we
• 1:25
  go.
• 1:25
  So
• 1:26
  Haley's
• 1:26
  25
• 1:26
  years
• 1:27
  old.
• 1:27
  Her
• 1:28
  mom
• 1:28
  had
• 1:29
  a
• 1:29
  lot
• 1:29
  of
• 1:29
  unresolved
• 1:30
  trauma,
• 1:31
  a
• 1:31
  lot
• 1:32
  of
• 1:32
  depression
• 1:32
  that
• 1:33
  wasn't
• 1:33
  really
• 1:33
  treated.
• 1:34
  You
• 1:34
  know,
• 1:34
  a
• 1:34
  lot
• 1:34
  of
• 1:35
  these
• 1:35
  older
• 1:36
  generations,
• 1:36
  your
• 1:37
  patients
• 1:37
  and
• 1:37
  their
• 1:37
  parents,
• 1:38
  they,
• 1:38
  they
• 1:38
  didn't
• 1:38
  really
• 1:38
  believe
• 1:39
  in
• 1:39
  mental
• 1:39
  health.
• 1:40
  So
• 1:40
  there's
• 1:40
  not
• 1:40
  a
• 1:40
  lot
• 1:41
  of
• 1:41
  actual
• 1:42
  treatment
• 1:42
  happening.
• 1:42
  They're
• 1:43
  just
• 1:43
  kind
• 1:43
  of
• 1:44
  white
• 1:44
  knuckling
• 1:44
  their
• 1:45
  trauma
• 1:45
  and
• 1:45
  their
• 1:45
  depression.
• 1:47
  And
• 1:47
  that's
• 1:47
  what
• 1:47
  happened
• 1:47
  with
• 1:47
  Haley's
• 1:48
  mom.
• 1:48
  Okay,
• 1:49
  so
• 1:49
  some
• 1:49
  nights,
• 1:49
  Haley's
• 1:50
  mom
• 1:50
  would
• 1:50
  cuddle
• 1:50
  her
• 1:50
  on
• 1:51
  the
• 1:51
  couch
• 1:51
  and
• 1:51
  say,
• 1:51
  haley,
• 1:52
  you're
• 1:52
  the
• 1:52
  best
• 1:53
  thing
• 1:53
  that's
• 1:53
  ever
• 1:53
  happened
• 1:54
  to
• 1:54
  me.
• 1:54
  And
• 1:54
  then
• 1:54
  other
• 1:55
  nights,
• 1:55
  mom
• 1:55
  would
• 1:55
  come
• 1:55
  home
• 1:56
  from
• 1:56
  work,
• 1:56
  slam
• 1:56
  the
• 1:57
  door
• 1:57
  and
• 1:57
  scream,
• 1:57
  haley,
• 1:58
  I
• 1:58
  can't
• 1:58
  deal
• 1:58
  with
• 1:58
  you
• 1:58
  right
• 1:59
  now.
• 1:59
  Just
• 1:59
  go
• 1:59
  to
• 2:00
  your
• 2:00
  room.
• 2:01
  Okay?
• 2:02
  Haley's
• 2:02
  dad
• 2:02
  was
• 2:02
  in
• 2:03
  jail
• 2:03
  half
• 2:03
  the
• 2:03
  time.
• 2:04
  He
• 2:04
  was
• 2:04
  thief.
• 2:05
  He
• 2:05
  was
• 2:05
  a,
• 2:06
  he
• 2:06
  was
• 2:06
  a
• 2:06
  petty
• 2:07
  car
• 2:07
  thief.
• 2:08
  Okay?
• 2:09
  He
• 2:09
  wasn't
• 2:09
  really
• 2:10
  home
• 2:10
  all
• 2:11
  the
• 2:11
  time.
• 2:12
  Okay.
• 2:12
  It
• 2:13
  wasn't
• 2:13
  emotionally
• 2:13
  or
• 2:14
  physically
• 2:14
  available
• 2:15
  other
• 2:15
  than
• 2:15
  like
• 2:16
  a
• 2:16
  1,
• 2:16
  800
• 2:16
  number
• 2:17
  to
• 2:17
  the
• 2:17
  jail,
• 2:17
  which
• 2:18
  is
• 2:18
  not
• 2:18
  really
• 2:19
  an
• 2:19
  ideal
• 2:20
  form
• 2:20
  of
• 2:20
  attachment
• 2:21
  for
• 2:21
  anyone.
• 2:23
  So
• 2:23
  when
• 2:24
  Haley
• 2:24
  would
• 2:24
  cry,
• 2:25
  sometimes
• 2:26
  her
• 2:26
  mom
• 2:26
  would
• 2:26
  hold
• 2:27
  her
• 2:27
  and
• 2:27
  cuddle
• 2:27
  her
• 2:27
  and
• 2:27
  tell
• 2:28
  her
• 2:28
  how
• 2:28
  amazing
• 2:28
  she
• 2:28
  was.
• 2:29
  And
• 2:29
  sometimes
• 2:29
  she
• 2:29
  was
• 2:29
  just
• 2:30
  told
• 2:30
  to
• 2:30
  grow
• 2:30
  up.
• 2:30
  If
• 2:31
  her
• 2:31
  mom
• 2:31
  was
• 2:31
  in
• 2:31
  a
• 2:31
  depressed
• 2:32
  state
• 2:32
  of
• 2:32
  depression
• 2:33
  or
• 2:33
  overwhelm,
• 2:34
  sometimes
• 2:35
  she
• 2:35
  just
• 2:35
  ignored
• 2:35
  Haley
• 2:36
  entirely.
• 2:36
  So
• 2:37
  at
• 2:37
  the
• 2:37
  end
• 2:37
  of
• 2:37
  the
• 2:37
  Day.
• 2:37
  This
• 2:38
  was
• 2:38
  a
• 2:38
  really
• 2:38
  invalidating
• 2:39
  environment
• 2:39
  for
• 2:40
  Haley
• 2:41
  where
• 2:41
  her
• 2:41
  emotional
• 2:41
  experiences
• 2:42
  became
• 2:43
  really
• 2:43
  confused,
• 2:45
  often
• 2:45
  dismissed
• 2:46
  or
• 2:46
  even
• 2:46
  punished,
• 2:47
  and
• 2:47
  sometimes
• 2:48
  embraced.
• 2:48
  But
• 2:48
  otherwise,
• 2:49
  it
• 2:49
  was
• 2:49
  extremely
• 2:50
  confusing.
• 2:51
  Okay?
• 2:52
  Now
• 2:52
  the
• 2:53
  problem
• 2:53
  here,
• 2:53
  my
• 2:53
  friends,
• 2:54
  is
• 2:54
  that
• 2:54
  when
• 2:55
  we
• 2:55
  are
• 2:55
  growing
• 2:56
  up
• 2:57
  as.
• 2:57
  As
• 2:57
  children,
• 2:58
  young
• 2:58
  children,
• 2:59
  we're
• 2:59
  building
• 3:00
  a
• 3:00
  working
• 3:00
  model
• 3:01
  of
• 3:01
  the
• 3:01
  world,
• 3:01
  a
• 3:01
  mental
• 3:02
  blueprint
• 3:02
  of
• 3:02
  the
• 3:02
  world,
• 3:03
  and
• 3:03
  essentially
• 3:04
  we're
• 3:04
  trying
• 3:04
  to
• 3:05
  understand
• 3:05
  what
• 3:05
  we
• 3:05
  can
• 3:05
  expect
• 3:06
  from
• 3:06
  people
• 3:07
  and
• 3:07
  who
• 3:07
  am
• 3:07
  I
• 3:08
  in
• 3:08
  relation
• 3:08
  to
• 3:08
  other
• 3:09
  people,
• 3:09
  okay?
• 3:10
  The
• 3:10
  problem
• 3:11
  with
• 3:11
  Hayley's
• 3:11
  environment
• 3:12
  is
• 3:12
  that
• 3:12
  her
• 3:13
  mom
• 3:13
  was
• 3:14
  not
• 3:14
  consistent.
• 3:15
  So
• 3:16
  Haley's
• 3:16
  internal
• 3:17
  working
• 3:17
  model
• 3:18
  is
• 3:18
  basically
• 3:19
  like,
• 3:19
  hey,
• 3:19
  people
• 3:20
  are
• 3:20
  unreliable.
• 3:21
  Love
• 3:21
  is
• 3:21
  very
• 3:22
  conditional.
• 3:22
  It
• 3:22
  can
• 3:23
  be
• 3:23
  withdrawn
• 3:23
  at
• 3:23
  any
• 3:24
  moment.
• 3:24
  I'm
• 3:25
  only
• 3:25
  as
• 3:25
  valuable
• 3:26
  as
• 3:26
  I
• 3:26
  am,
• 3:27
  maybe
• 3:27
  useful
• 3:27
  to
• 3:28
  someone
• 3:28
  else.
• 3:28
  Like,
• 3:28
  if
• 3:28
  I'm
• 3:28
  too
• 3:29
  much
• 3:29
  of
• 3:29
  a
• 3:29
  nuisance,
• 3:29
  mom's
• 3:30
  going
• 3:30
  to
• 3:30
  shut
• 3:30
  down
• 3:31
  and
• 3:31
  not
• 3:31
  want
• 3:31
  me,
• 3:32
  so
• 3:33
  I'm
• 3:33
  not
• 3:33
  intrinsically
• 3:34
  lovable.
• 3:35
  All
• 3:35
  of
• 3:36
  that
• 3:36
  can
• 3:36
  come
• 3:36
  and
• 3:36
  go
• 3:37
  in
• 3:37
  a.
• 3:37
  In
• 3:37
  a
• 3:37
  moment.
• 3:39
  And
• 3:40
  so
• 3:41
  if
• 3:41
  you
• 3:41
  think
• 3:41
  about
• 3:42
  how
• 3:42
  difficult
• 3:42
  it
• 3:42
  would
• 3:43
  be
• 3:43
  to.
• 3:45
  To
• 3:45
  develop
• 3:46
  in
• 3:47
  an
• 3:47
  emotionally
• 3:47
  healthy
• 3:48
  way
• 3:48
  at
• 3:48
  that
• 3:48
  point,
• 3:48
  when
• 3:49
  that
• 3:49
  is
• 3:49
  a
• 3:49
  consistent,
• 3:50
  patterned
• 3:50
  way
• 3:50
  that
• 3:51
  you're
• 3:51
  being
• 3:51
  dealt
• 3:51
  with
• 3:51
  as
• 3:52
  a
• 3:52
  child,
• 3:53
  then
• 3:55
  you
• 3:55
  have
• 3:55
  a
• 3:56
  really
• 3:56
  tough
• 3:56
  time
• 3:57
  growing
• 3:57
  up.
• 3:58
  Okay?
• 3:58
  And
• 3:58
  the
• 3:58
  literature
• 3:59
  even
• 3:59
  suggests
• 4:01
  that
• 4:02
  emotional
• 4:02
  abuse
• 4:04
  and
• 4:04
  neglect
• 4:05
  carry
• 4:06
  the
• 4:06
  strongest
• 4:07
  associations
• 4:07
  with
• 4:08
  BPD,
• 4:09
  okay?
• 4:12
  38
• 4:12
  times
• 4:13
  the
• 4:13
  likelihood
• 4:13
  you'll
• 4:14
  develop
• 4:14
  BPD
• 4:15
  with
• 4:16
  emotional
• 4:16
  abuse,
• 4:17
  17
• 4:17
  times
• 4:18
  with
• 4:18
  neglect,
• 4:19
  which
• 4:20
  far
• 4:20
  exceeds
• 4:21
  even
• 4:21
  physical
• 4:21
  or
• 4:22
  sexual
• 4:22
  abuse.
• 4:22
  So
• 4:23
  this
• 4:23
  is
• 4:23
  a
• 4:23
  very
• 4:23
  damaging
• 4:25
  problem.
• 4:27
  Okay?
• 4:27
  This
• 4:27
  is
• 4:28
  a
• 4:28
  very
• 4:28
  damaging.
• 4:28
  When
• 4:28
  you're
• 4:29
  trying
• 4:29
  to
• 4:29
  navigate
• 4:29
  the
• 4:29
  world
• 4:30
  and
• 4:30
  you
• 4:30
  don't
• 4:30
  really
• 4:31
  know
• 4:31
  what
• 4:31
  to
• 4:31
  expect
• 4:31
  of
• 4:32
  people.
• 4:32
  Imagine,
• 4:33
  of
• 4:33
  course,
• 4:33
  you're
• 4:34
  going
• 4:34
  to
• 4:34
  grow
• 4:34
  up
• 4:34
  and
• 4:35
  be
• 4:35
  frantically
• 4:36
  trying
• 4:37
  to
• 4:37
  avoid
• 4:37
  abandonment.
• 4:38
  It's
• 4:38
  terrifying
• 4:39
  to
• 4:39
  you,
• 4:39
  right?
• 4:39
  Because
• 4:39
  when
• 4:39
  you
• 4:40
  were
• 4:40
  young,
• 4:40
  your
• 4:41
  mother
• 4:41
  pulled
• 4:42
  away
• 4:42
  love
• 4:43
  on
• 4:43
  a.
• 4:43
  On
• 4:44
  a
• 4:44
  moment's
• 4:44
  notice,
• 4:44
  out
• 4:45
  of
• 4:45
  nowhere,
• 4:45
  with
• 4:45
  no
• 4:45
  context.
• 4:46
  You're
• 4:46
  a
• 4:46
  kid.
• 4:46
  You
• 4:46
  don't
• 4:47
  understand
• 4:47
  why
• 4:48
  that's
• 4:48
  happening.
• 4:48
  You
• 4:48
  immediately
• 4:49
  assume
• 4:49
  it's
• 4:49
  you
• 4:50
  and
• 4:51
  that
• 4:51
  there's
• 4:51
  something
• 4:51
  wrong
• 4:51
  with
• 4:52
  you.
• 4:52
  Sound
• 4:53
  familiar?
• 4:53
  Right.
• 4:54
  Right.
• 4:54
  You
• 4:54
  grow
• 4:54
  up
• 4:55
  with
• 4:55
  this
• 4:55
  void
• 4:55
  or
• 4:55
  this
• 4:56
  feeling
• 4:56
  that
• 4:56
  you're
• 4:56
  just
• 4:57
  a
• 4:57
  nobody
• 4:57
  and
• 4:57
  you
• 4:58
  have
• 4:58
  low
• 4:58
  self
• 4:58
  esteem,
• 4:59
  low
• 4:59
  self
• 4:59
  worth.
• 5:00
  Right?
• 5:01
  But
• 5:01
  that
• 5:01
  it
• 5:01
  can
• 5:02
  be
• 5:02
  taken
• 5:02
  from
• 5:02
  a
• 5:02
  moment's
• 5:03
  notice.
• 5:03
  You're
• 5:03
  going
• 5:03
  to
• 5:03
  be
• 5:03
  constantly
• 5:05
  hypervigilant
• 5:06
  so
• 5:07
  that
• 5:07
  you
• 5:07
  don't
• 5:08
  lose
• 5:08
  someone
• 5:09
  or
• 5:09
  that
• 5:10
  they
• 5:10
  don't
• 5:10
  abandon
• 5:11
  you.
• 5:12
  That's
• 5:13
  a
• 5:13
  really
• 5:13
  big
• 5:14
  deal.
• 5:14
  And
• 5:14
  you're
• 5:14
  going
• 5:14
  to
• 5:14
  want
• 5:14
  to
• 5:14
  avoid
• 5:15
  that
• 5:15
  all
• 5:15
  of
• 5:15
  the
• 5:15
  time
• 5:16
  if
• 5:16
  you
• 5:17
  can,
• 5:17
  because
• 5:18
  people
• 5:18
  are
• 5:18
  not
• 5:19
  always
• 5:20
  reliable.
• 5:21
  Okay?
• 5:23
  And
• 5:23
  when
• 5:24
  you're
• 5:24
  that
• 5:24
  young,
• 5:24
  you
• 5:25
  really
• 5:25
  have
• 5:25
  no
• 5:25
  other
• 5:26
  explanations
• 5:26
  for
• 5:26
  it.
• 5:27
  You'll
• 5:27
  blame
• 5:27
  yourself.
• 5:28
  I
• 5:29
  mean,
• 5:29
  that's
• 5:29
  what'll
• 5:29
  happen.
• 5:30
  Okay?
• 5:32
  Now,
• 5:34
  the
• 5:34
  fact
• 5:35
  that
• 5:35
  love
• 5:35
  can
• 5:35
  disappear
• 5:36
  at
• 5:36
  any
• 5:36
  moment
• 5:36
  for
• 5:37
  her
• 5:37
  gives
• 5:38
  her
• 5:38
  that
• 5:38
  internal
• 5:39
  alarm
• 5:39
  system.
• 5:40
  And
• 5:40
  so
• 5:40
  she's
• 5:40
  going
• 5:40
  to
• 5:40
  always
• 5:41
  scan
• 5:41
  for
• 5:41
  signs
• 5:42
  that
• 5:43
  someone's
• 5:43
  about
• 5:43
  to
• 5:43
  leave
• 5:44
  her.
• 5:44
  And
• 5:44
  that
• 5:44
  when
• 5:44
  she's
• 5:44
  older,
• 5:45
  that
• 5:45
  can
• 5:45
  come
• 5:45
  out
• 5:45
  in
• 5:46
  the
• 5:46
  form
• 5:46
  of
• 5:46
  a
• 5:46
  late
• 5:46
  text
• 5:47
  reply,
• 5:48
  a
• 5:48
  change
• 5:48
  in
• 5:48
  someone's
• 5:49
  tone
• 5:49
  of
• 5:49
  voice.
• 5:50
  Maybe
• 5:50
  somebody
• 5:50
  cancels
• 5:51
  plans
• 5:51
  on
• 5:51
  Haley.
• 5:52
  Okay?
• 5:53
  Because
• 5:53
  her
• 5:53
  attachment
• 5:54
  system
• 5:54
  from
• 5:54
  a
• 5:54
  young
• 5:55
  age
• 5:55
  had
• 5:56
  to
• 5:56
  be
• 5:56
  especially
• 5:57
  hyper
• 5:57
  vigilant
• 5:58
  or
• 5:58
  hyperactivated
• 5:59
  to
• 5:59
  assess
• 6:00
  those
• 6:00
  tunes,
• 6:02
  to,
• 6:02
  to
• 6:03
  assess
• 6:03
  the
• 6:04
  emotional
• 6:04
  tone
• 6:05
  in
• 6:06
  her
• 6:06
  environment.
• 6:06
  Remember,
• 6:07
  my
• 6:07
  friends,
• 6:07
  this
• 6:07
  is
• 6:07
  more
• 6:07
  than
• 6:08
  just,
• 6:08
  oh,
• 6:08
  mommy
• 6:08
  doesn't
• 6:09
  love
• 6:09
  me.
• 6:09
  Oh,
• 6:09
  mommy's
• 6:10
  angry.
• 6:10
  When
• 6:10
  you're
• 6:11
  a
• 6:11
  child,
• 6:11
  you
• 6:11
  depend
• 6:12
  on
• 6:12
  your
• 6:12
  mother
• 6:12
  and
• 6:13
  father
• 6:13
  for
• 6:13
  physical
• 6:14
  survival,
• 6:15
  making
• 6:15
  sure
• 6:15
  you
• 6:16
  have
• 6:16
  enough
• 6:16
  water
• 6:16
  and
• 6:16
  food
• 6:17
  and
• 6:17
  clothing.
• 6:18
  Kids
• 6:19
  don't
• 6:19
  think
• 6:19
  like
• 6:19
  you
• 6:20
  and
• 6:20
  me.
• 6:20
  They
• 6:20
  don't
• 6:20
  automatically
• 6:21
  assume
• 6:21
  that
• 6:22
  those
• 6:22
  things
• 6:22
  are
• 6:22
  going
• 6:22
  to
• 6:23
  be
• 6:23
  perpetually
• 6:23
  taken
• 6:24
  care
• 6:24
  of.
• 6:24
  It's
• 6:25
  encoded
• 6:25
  in
• 6:25
  their
• 6:26
  fight
• 6:27
  or
• 6:27
  flight
• 6:27
  system
• 6:27
  that
• 6:28
  if
• 6:28
  they
• 6:28
  have
• 6:28
  a
• 6:28
  caregiver
• 6:29
  who's
• 6:29
  unreliable
• 6:29
  and
• 6:30
  suddenly
• 6:30
  unresponsive
• 6:31
  to
• 6:31
  their
• 6:31
  needs,
• 6:31
  it
• 6:32
  is
• 6:32
  a
• 6:32
  physical
• 6:33
  biological
• 6:33
  threat
• 6:34
  ingrained
• 6:34
  for
• 6:35
  millions
• 6:35
  of
• 6:35
  years
• 6:35
  in
• 6:35
  our
• 6:36
  DNA.
• 6:36
  Right?
• 6:36
  It's
• 6:37
  like,
• 6:37
  wait
• 6:37
  a
• 6:37
  minute,
• 6:37
  Mom's
• 6:37
  not
• 6:37
  attuned
• 6:38
  to
• 6:38
  my
• 6:38
  needs.
• 6:39
  The
• 6:39
  subconscious
• 6:40
  message
• 6:40
  I
• 6:40
  think
• 6:40
  on
• 6:41
  a
• 6:41
  biological
• 6:41
  level
• 6:42
  would
• 6:42
  be,
• 6:43
  well,
• 6:43
  what
• 6:43
  if
• 6:43
  I'm
• 6:43
  thirsty
• 6:44
  tomorrow?
• 7:39
  Right?
• 7:39
  The
• 7:39
  child's
• 7:40
  not
• 7:40
  rationalizing
• 7:40
  this
• 7:41
  like
• 7:41
  an
• 7:41
  adult,
• 7:41
  but
• 7:42
  it's
• 7:42
  encoded
• 7:42
  in
• 7:42
  their
• 7:43
  system
• 7:43
  to
• 7:44
  be,
• 7:44
  to
• 7:44
  watch
• 7:44
  out.
• 7:45
  Because
• 7:46
  human
• 7:46
  relationships
• 7:47
  are
• 7:47
  deeply
• 7:48
  encoded,
• 7:49
  biologically
• 7:49
  encoded
• 7:50
  in
• 7:50
  our
• 7:50
  system.
• 7:50
  When
• 7:51
  there's
• 7:51
  an
• 7:51
  attachment
• 7:51
  rupture
• 7:52
  in
• 7:53
  the
• 7:53
  old
• 7:53
  days,
• 7:53
  we
• 7:54
  could
• 7:54
  die
• 7:54
  from
• 7:54
  that,
• 7:55
  right?
• 7:55
  You
• 7:55
  don't
• 7:56
  have
• 7:56
  your
• 7:57
  mother
• 7:57
  or
• 7:57
  father
• 7:57
  protecting
• 7:58
  you
• 7:58
  anymore
• 7:58
  in
• 7:58
  the
• 7:59
  savannah,
• 7:59
  you're
• 7:59
  going
• 7:59
  to
• 7:59
  get
• 7:59
  eaten
• 8:00
  by
• 8:00
  lions.
• 8:00
  You
• 8:01
  don't
• 8:01
  have
• 8:01
  the
• 8:01
  tribe,
• 8:01
  the
• 8:02
  community
• 8:02
  that
• 8:02
  has
• 8:02
  your
• 8:03
  back,
• 8:03
  the
• 8:03
  reciprocity,
• 8:05
  the,
• 8:05
  you
• 8:06
  know,
• 8:06
  shared
• 8:06
  resources.
• 8:07
  You
• 8:07
  will
• 8:07
  die.
• 8:07
  You
• 8:07
  will
• 8:08
  either
• 8:08
  starve,
• 8:08
  you'll
• 8:09
  be
• 8:09
  eaten
• 8:09
  by
• 8:09
  a
• 8:09
  predator,
• 8:10
  right?
• 8:11
  And
• 8:11
  so
• 8:11
  as
• 8:11
  a
• 8:11
  child,
• 8:12
  if.
• 8:12
  Imagine
• 8:12
  how
• 8:13
  terrifying
• 8:13
  it
• 8:13
  is
• 8:14
  that
• 8:15
  your
• 8:15
  family
• 8:16
  is
• 8:16
  not
• 8:16
  consistently
• 8:17
  reliable
• 8:18
  with
• 8:18
  you.
• 8:19
  And,
• 8:20
  and
• 8:20
  so,
• 8:20
  of
• 8:20
  course,
• 8:21
  you
• 8:21
  would
• 8:21
  develop
• 8:21
  a
• 8:22
  hyper
• 8:22
  vigilant
• 8:23
  biological
• 8:24
  response
• 8:24
  that
• 8:25
  is
• 8:25
  very
• 8:25
  taxing,
• 8:26
  but
• 8:26
  it
• 8:26
  helps
• 8:26
  you
• 8:26
  survive
• 8:27
  in
• 8:27
  the
• 8:27
  moment
• 8:27
  to
• 8:27
  scan
• 8:28
  every
• 8:28
  little
• 8:28
  thing
• 8:29
  you
• 8:29
  can
• 8:29
  to
• 8:30
  determine
• 8:30
  if
• 8:30
  that
• 8:30
  person's
• 8:31
  going
• 8:31
  to
• 8:31
  leave
• 8:31
  you
• 8:31
  or
• 8:31
  not
• 8:31
  so
• 8:32
  that
• 8:32
  you
• 8:32
  can
• 8:32
  respond.
• 8:33
  And
• 8:33
  the
• 8:33
  problem
• 8:34
  with
• 8:34
  borderline
• 8:34
  personality
• 8:35
  patients
• 8:35
  is
• 8:35
  they
• 8:35
  don't
• 8:36
  really
• 8:36
  outgrow
• 8:36
  this
• 8:37
  because
• 8:37
  it
• 8:37
  worked
• 8:37
  so
• 8:37
  well
• 8:38
  for
• 8:38
  them
• 8:38
  back
• 8:38
  then.
• 8:39
  It
• 8:39
  was
• 8:39
  so
• 8:39
  necessary
• 8:40
  for
• 8:40
  them
• 8:40
  back
• 8:40
  then
• 8:41
  to
• 8:41
  understand
• 8:41
  the
• 8:42
  tone
• 8:42
  in
• 8:42
  their
• 8:42
  mom's
• 8:43
  voice
• 8:43
  or
• 8:43
  their
• 8:43
  dad's
• 8:44
  voice?
• 8:44
  Are
• 8:44
  they
• 8:44
  withdrawn?
• 8:45
  Are
• 8:45
  they
• 8:45
  engaged?
• 8:46
  Are
• 8:46
  they
• 8:46
  anxious?
• 8:47
  How
• 8:47
  do
• 8:47
  I.
• 8:48
  How
• 8:48
  do
• 8:48
  I
• 8:48
  keep
• 8:48
  them
• 8:49
  in
• 8:49
  my
• 8:49
  orbit?
• 8:49
  What
• 8:50
  do
• 8:50
  I
• 8:50
  do
• 8:50
  here?
• 8:51
  Right?
• 8:52
  So
• 8:52
  it's
• 8:53
  a
• 8:53
  really
• 8:53
  big
• 8:53
  problem,
• 8:54
  and
• 8:55
  I
• 8:55
  think
• 8:55
  that
• 8:56
  it
• 8:56
  makes
• 8:57
  perfect
• 8:57
  sense
• 8:57
  why
• 8:58
  they
• 8:58
  would
• 8:59
  be
• 9:00
  so
• 9:00
  hypervigilant
• 9:02
  right
• 9:02
  in.
• 9:03
  In
• 9:03
  the
• 9:03
  face
• 9:03
  of
• 9:03
  that.
• 9:05
  Now.
• 9:06
  It's
• 9:06
  also
• 9:06
  very
• 9:07
  confusing
• 9:07
  to
• 9:07
  a
• 9:07
  patient
• 9:08
  like
• 9:08
  Haley,
• 9:08
  right?
• 9:10
  When
• 9:10
  mom
• 9:10
  is
• 9:11
  one
• 9:12
  minute
• 9:12
  saying,
• 9:12
  I
• 9:12
  love
• 9:13
  you,
• 9:13
  sweetie.
• 9:13
  You're
• 9:13
  the
• 9:14
  best
• 9:14
  thing
• 9:14
  ever.
• 9:14
  And
• 9:14
  then
• 9:15
  she
• 9:15
  screams
• 9:15
  at
• 9:15
  her
• 9:15
  for
• 9:16
  spilling
• 9:16
  juice
• 9:16
  the
• 9:16
  next
• 9:17
  day
• 9:17
  and
• 9:17
  calls
• 9:18
  her
• 9:18
  useless,
• 9:18
  just
• 9:18
  like
• 9:19
  her
• 9:19
  dad.
• 9:20
  Same
• 9:20
  person,
• 9:22
  24
• 9:22
  hours
• 9:23
  apart.
• 9:23
  And
• 9:23
  Haley's
• 9:24
  brain
• 9:24
  as
• 9:25
  a
• 9:25
  child
• 9:25
  can't
• 9:25
  really
• 9:26
  make
• 9:26
  sense
• 9:26
  of
• 9:26
  that,
• 9:27
  so
• 9:27
  she
• 9:27
  does
• 9:27
  something
• 9:27
  called
• 9:28
  splitting.
• 9:28
  Okay?
• 9:29
  There's
• 9:29
  a
• 9:29
  good
• 9:29
  mom
• 9:29
  and
• 9:30
  a
• 9:30
  bad
• 9:30
  mom
• 9:30
  as
• 9:31
  two
• 9:31
  separate
• 9:31
  people
• 9:32
  in
• 9:32
  her
• 9:32
  mind,
• 9:32
  because
• 9:33
  holding
• 9:33
  it
• 9:34
  all
• 9:34
  in
• 9:34
  her
• 9:34
  mind
• 9:34
  as
• 9:35
  one
• 9:35
  construct,
• 9:35
  like,
• 9:36
  mom
• 9:36
  is
• 9:36
  kind
• 9:37
  of
• 9:37
  good
• 9:37
  at
• 9:37
  times,
• 9:38
  but
• 9:38
  she's
• 9:38
  going
• 9:38
  through
• 9:38
  depression.
• 9:39
  Like,
• 9:39
  children
• 9:40
  don't
• 9:40
  understand
• 9:40
  that
• 9:41
  deep
• 9:41
  context
• 9:41
  that
• 9:42
  we
• 9:42
  can
• 9:42
  understand
• 9:42
  a
• 9:43
  person
• 9:44
  more
• 9:44
  holistically.
• 9:44
  Children
• 9:45
  don't.
• 9:45
  So
• 9:45
  it's
• 9:46
  like
• 9:46
  good
• 9:46
  man,
• 9:46
  good
• 9:46
  mom,
• 9:46
  and
• 9:47
  bad
• 9:47
  mom,
• 9:48
  okay?
• 9:48
  The
• 9:48
  problem
• 9:48
  is,
• 9:48
  she
• 9:48
  also
• 9:49
  carries
• 9:49
  that
• 9:49
  into
• 9:49
  adulthood,
• 9:50
  okay?
• 9:52
  So,
• 9:53
  you
• 9:53
  know,
• 9:53
  Haley
• 9:53
  will
• 9:53
  make
• 9:54
  a
• 9:54
  new
• 9:54
  friend,
• 9:54
  and
• 9:54
  that
• 9:54
  friend
• 9:55
  is
• 9:55
  the
• 9:55
  most
• 9:55
  amazing
• 9:55
  person
• 9:56
  she's
• 9:56
  ever
• 9:56
  met.
• 9:56
  It's
• 9:57
  that
• 9:57
  idealization,
• 9:58
  right?
• 9:58
  But
• 9:58
  the
• 9:59
  moment
• 9:59
  the.
• 10:00
  Her
• 10:00
  friend
• 10:00
  cancels
• 10:01
  dinner
• 10:01
  plans
• 10:02
  to
• 10:02
  the
• 10:02
  Cheesecake
• 10:02
  Factory,
• 10:03
  they
• 10:03
  suddenly
• 10:04
  become
• 10:04
  someone
• 10:04
  who
• 10:04
  never
• 10:05
  really
• 10:05
  cared
• 10:05
  about
• 10:05
  her,
• 10:06
  right?
• 10:06
  And
• 10:06
  there's
• 10:07
  that
• 10:07
  same
• 10:07
  splitting
• 10:08
  dynamic
• 10:08
  she
• 10:08
  had
• 10:08
  with
• 10:08
  her
• 10:09
  mom,
• 10:09
  because
• 10:09
  as
• 10:09
  a
• 10:09
  child,
• 10:10
  it
• 10:10
  was
• 10:10
  too
• 10:11
  cognitively
• 10:12
  taxing,
• 10:13
  and
• 10:13
  it's
• 10:13
  too
• 10:14
  cognitively
• 10:14
  sophisticated
• 10:15
  for
• 10:15
  a
• 10:15
  child
• 10:15
  to
• 10:16
  think
• 10:16
  in
• 10:17
  gray
• 10:17
  areas
• 10:17
  like
• 10:18
  that,
• 10:18
  okay?
• 10:19
  And
• 10:20
  so
• 10:21
  instead
• 10:21
  of
• 10:22
  integrating
• 10:22
  that
• 10:22
  complexly
• 10:23
  and
• 10:23
  taxing,
• 10:24
  the
• 10:24
  young
• 10:24
  brain,
• 10:24
  which
• 10:25
  is
• 10:25
  already,
• 10:26
  you
• 10:26
  know,
• 10:26
  not
• 10:27
  sophisticated
• 10:27
  enough
• 10:28
  to
• 10:28
  really
• 10:28
  integrate
• 10:29
  that
• 10:29
  on
• 10:29
  a
• 10:29
  higher
• 10:29
  level.
• 10:30
  It's.
• 10:31
  It's
• 10:31
  a
• 10:31
  splitting
• 10:32
  defense
• 10:32
  where
• 10:32
  it's
• 10:33
  all
• 10:33
  good
• 10:33
  or
• 10:33
  all
• 10:33
  bad.
• 10:34
  And
• 10:34
  it's
• 10:34
  also
• 10:35
  a
• 10:35
  survival
• 10:35
  instinct
• 10:35
  for
• 10:36
  Haley,
• 10:36
  because
• 10:36
  it's
• 10:37
  much
• 10:37
  safer
• 10:37
  if,
• 10:37
  you
• 10:38
  know
• 10:38
  the
• 10:38
  snake
• 10:39
  is
• 10:39
  all
• 10:39
  bad.
• 10:40
  There's
• 10:40
  not
• 10:40
  some
• 10:40
  good
• 10:40
  snakes,
• 10:41
  because
• 10:41
  if
• 10:41
  there's
• 10:41
  some
• 10:41
  good
• 10:42
  snakes
• 10:42
  and
• 10:42
  you're
• 10:42
  kind
• 10:42
  of
• 10:43
  wrong,
• 10:43
  and
• 10:43
  maybe
• 10:44
  one
• 10:44
  of
• 10:44
  those
• 10:44
  good
• 10:44
  snakes
• 10:44
  is
• 10:45
  actually
• 10:45
  a
• 10:45
  bad
• 10:45
  snake
• 10:45
  with
• 10:46
  venom,
• 10:46
  the
• 10:46
  bad
• 10:46
  snake's
• 10:47
  gonna
• 10:47
  kill
• 10:47
  you.
• 10:47
  So
• 10:48
  it's
• 10:48
  much
• 10:48
  easier
• 10:48
  and
• 10:49
  safer
• 10:50
  from
• 10:50
  a
• 10:51
  fight
• 10:51
  or
• 10:51
  flight
• 10:51
  perspective
• 10:52
  to
• 10:52
  just
• 10:52
  say,
• 10:53
  categorize.
• 10:53
  All
• 10:54
  snakes
• 10:54
  are
• 10:54
  bad.
• 10:55
  You
• 10:55
  know,
• 10:55
  all
• 10:56
  bunny
• 10:56
  rabbits
• 10:56
  are
• 10:56
  good,
• 10:57
  right?
• 10:57
  It's.
• 10:58
  It's
• 10:58
  cleaner.
• 10:59
  It's
• 10:59
  easier.
• 10:59
  If
• 10:59
  you're
• 10:59
  going
• 11:00
  through
• 11:00
  a
• 11:00
  crisis,
• 11:01
  that
• 11:01
  gray
• 11:01
  area,
• 11:02
  it's
• 11:02
  extra
• 11:02
  taxing.
• 11:03
  The
• 11:03
  brain
• 11:03
  gobbles
• 11:04
  up
• 11:04
  25%
• 11:04
  of
• 11:05
  your
• 11:05
  metabolic
• 11:05
  energy,
• 11:06
  okay?
• 11:07
  It's
• 11:07
  most
• 11:07
  of
• 11:07
  your
• 11:08
  energy.
• 11:08
  So
• 11:09
  you.
• 11:09
  It
• 11:09
  does
• 11:10
  it
• 11:10
  by
• 11:10
  nature,
• 11:10
  wants
• 11:11
  to
• 11:11
  take
• 11:11
  shortcuts.
• 11:12
  It
• 11:12
  doesn't
• 11:12
  want
• 11:12
  to
• 11:13
  be
• 11:13
  cognitively
• 11:14
  taxed
• 11:14
  in
• 11:14
  such
• 11:15
  a
• 11:15
  way.
• 11:15
  And
• 11:16
  it's
• 11:16
  no
• 11:16
  different
• 11:16
  in
• 11:16
  Haley's
• 11:17
  brain.
• 11:17
  So
• 11:17
  she
• 11:17
  develops
• 11:18
  this
• 11:18
  splitting.
• 11:19
  And
• 11:19
  we
• 11:19
  hear
• 11:19
  that
• 11:19
  all
• 11:20
  the
• 11:20
  time
• 11:20
  in
• 11:20
  borderline
• 11:21
  personality
• 11:21
  disorder,
• 11:22
  right?
• 11:22
  All
• 11:22
  good,
• 11:23
  all
• 11:23
  bad.
• 11:23
  And
• 11:23
  that's
• 11:24
  why
• 11:24
  they
• 11:24
  have
• 11:24
  these
• 11:24
  very
• 11:25
  all
• 11:25
  or
• 11:25
  nothing
• 11:26
  ways
• 11:26
  of
• 11:26
  categorizing
• 11:27
  the
• 11:27
  world
• 11:27
  or
• 11:27
  people.
• 11:28
  And
• 11:28
  you
• 11:28
  can
• 11:29
  be
• 11:29
  the
• 11:29
  best
• 11:30
  psychiatric
• 11:31
  provider
• 11:31
  one
• 11:32
  day
• 11:32
  and
• 11:32
  the
• 11:32
  worst
• 11:32
  one
• 11:33
  the
• 11:33
  other
• 11:33
  day.
• 11:34
  And
• 11:34
  that's
• 11:34
  not
• 11:34
  because
• 11:35
  they're
• 11:35
  crazy
• 11:36
  or
• 11:36
  they're
• 11:36
  trying
• 11:37
  to
• 11:37
  give
• 11:37
  you
• 11:37
  a
• 11:37
  hard
• 11:37
  time
• 11:38
  or
• 11:38
  be
• 11:38
  a
• 11:38
  thorn
• 11:38
  in
• 11:38
  your
• 11:39
  side.
• 11:39
  It's
• 11:39
  because
• 11:40
  they
• 11:40
  had
• 11:41
  very
• 11:41
  challenging
• 11:42
  environments
• 11:42
  as,
• 11:43
  as
• 11:43
  children
• 11:44
  that
• 11:45
  necessitated
• 11:46
  that
• 11:46
  defense
• 11:47
  mechanism
• 11:47
  of
• 11:47
  splitting
• 11:48
  and
• 11:48
  worked
• 11:49
  for
• 11:49
  them
• 11:49
  and
• 11:49
  allowed
• 11:49
  them
• 11:49
  to
• 11:50
  navigate
• 11:50
  the
• 11:50
  world
• 11:51
  in
• 11:51
  a
• 11:51
  sane
• 11:51
  way
• 11:52
  under
• 11:52
  extraordinary
• 11:53
  circumstances.
• 11:54
  And
• 11:54
  they
• 11:55
  just
• 11:55
  never
• 11:55
  unlearned
• 11:56
  that.
• 11:56
  And
• 11:56
  why
• 11:56
  would
• 11:56
  they?
• 11:57
  Because
• 11:57
  that
• 11:57
  was
• 11:57
  their
• 11:57
  blueprint
• 11:58
  of
• 11:58
  the
• 11:58
  world,
• 11:58
  right?
• 11:59
  So
• 11:59
  that's
• 12:00
  really
• 12:00
  key.
• 12:00
  Now,
• 12:01
  another
• 12:01
  thing
• 12:01
  with
• 12:01
  borderline
• 12:02
  is
• 12:02
  a
• 12:03
  lot
• 12:03
  of
• 12:03
  your
• 12:03
  patients,
• 12:04
  they
• 12:04
  have
• 12:04
  an
• 12:05
  identity
• 12:05
  disturbance,
• 12:05
  right?
• 12:06
  They
• 12:06
  don't
• 12:06
  really
• 12:06
  know
• 12:06
  who
• 12:06
  they
• 12:07
  are.
• 12:07
  They
• 12:07
  feel
• 12:07
  very
• 12:08
  empty,
• 12:08
  there's
• 12:08
  a
• 12:08
  void.
• 12:09
  They
• 12:09
  just
• 12:10
  don't
• 12:10
  really
• 12:12
  have
• 12:12
  any
• 12:12
  sense
• 12:13
  of
• 12:13
  who
• 12:13
  they
• 12:13
  are.
• 12:13
  And
• 12:13
  they
• 12:13
  make
• 12:14
  radical
• 12:14
  changes.
• 12:14
  They
• 12:15
  get
• 12:15
  tattoos
• 12:16
  or
• 12:16
  they
• 12:16
  develop
• 12:17
  the
• 12:17
  politics
• 12:18
  of
• 12:18
  their
• 12:18
  girlfriend
• 12:19
  or
• 12:19
  boyfriend
• 12:19
  that
• 12:20
  they
• 12:20
  meet
• 12:21
  overnight.
• 12:22
  They're
• 12:22
  just
• 12:23
  kind
• 12:23
  of
• 12:23
  like
• 12:23
  chameleons.
• 12:24
  They
• 12:24
  can
• 12:24
  change
• 12:24
  very
• 12:24
  quickly
• 12:25
  and
• 12:26
  engage,
• 12:26
  almost
• 12:26
  looks
• 12:27
  impulsive
• 12:28
  in
• 12:28
  how
• 12:28
  quickly
• 12:28
  they
• 12:29
  can
• 12:29
  change
• 12:29
  as
• 12:29
  people
• 12:30
  and
• 12:30
  adopt
• 12:31
  a
• 12:31
  whole
• 12:31
  new
• 12:31
  lifestyle.
• 12:32
  And
• 12:32
  that's
• 12:32
  because
• 12:33
  at
• 12:33
  their
• 12:33
  core,
• 12:33
  they
• 12:34
  don't
• 12:34
  have
• 12:34
  this
• 12:34
  core
• 12:35
  identity.
• 12:36
  And
• 12:36
  it
• 12:36
  makes
• 12:36
  perfect
• 12:37
  sense
• 12:37
  why
• 12:38
  they
• 12:38
  don't
• 12:38
  have
• 12:38
  that.
• 12:39
  Because
• 12:40
  as
• 12:41
  children,
• 12:42
  they
• 12:42
  didn't
• 12:43
  get
• 12:43
  proper
• 12:43
  mirroring.
• 12:44
  Okay?
• 12:45
  Children
• 12:45
  really
• 12:46
  learn
• 12:46
  who
• 12:46
  they
• 12:46
  are
• 12:47
  through
• 12:47
  mirroring,
• 12:48
  right?
• 12:48
  A
• 12:48
  caregiver
• 12:49
  reflecting
• 12:50
  back
• 12:50
  what
• 12:50
  the
• 12:50
  child
• 12:50
  is
• 12:51
  feeling
• 12:51
  in
• 12:51
  a
• 12:51
  very
• 12:52
  attuned
• 12:52
  way.
• 12:52
  Okay?
• 12:53
  So
• 12:53
  when
• 12:53
  the
• 12:53
  toddler,
• 12:54
  when
• 12:54
  Hayley
• 12:54
  falls
• 12:55
  and
• 12:55
  cries
• 12:55
  as
• 12:55
  a
• 12:55
  three
• 12:55
  year
• 12:56
  old,
• 12:56
  a
• 12:57
  good
• 12:57
  mom
• 12:57
  would
• 12:57
  say,
• 12:58
  oh,
• 12:58
  Hayley,
• 12:58
  you
• 12:58
  know,
• 12:58
  that
• 12:58
  hurt.
• 12:59
  That
• 12:59
  was
• 12:59
  scary.
• 13:00
  And
• 13:00
  so
• 13:01
  the
• 13:01
  child
• 13:01
  learns,
• 13:01
  what
• 13:01
  I
• 13:02
  feel
• 13:02
  is
• 13:02
  real
• 13:02
  and
• 13:02
  it
• 13:03
  makes
• 13:03
  sense.
• 13:04
  But
• 13:04
  Hayley
• 13:04
  never
• 13:05
  got
• 13:05
  that
• 13:05
  right
• 13:05
  when
• 13:05
  she
• 13:06
  was
• 13:06
  sad.
• 13:06
  Sometimes
• 13:07
  her
• 13:07
  mom
• 13:07
  would
• 13:07
  say,
• 13:08
  you
• 13:09
  know,
• 13:09
  come
• 13:09
  over
• 13:09
  here,
• 13:09
  let
• 13:10
  me
• 13:10
  help
• 13:10
  you.
• 13:10
  I
• 13:10
  love
• 13:10
  you.
• 13:11
  Other
• 13:11
  times
• 13:11
  she'd
• 13:12
  just
• 13:12
  say,
• 13:12
  you're
• 13:12
  being
• 13:12
  ridiculous,
• 13:13
  stop
• 13:13
  it.
• 13:13
  Or
• 13:14
  she
• 13:14
  wouldn't
• 13:14
  even
• 13:14
  pay
• 13:14
  attention
• 13:14
  to
• 13:15
  Hailey.
• 13:15
  So
• 13:16
  she
• 13:16
  never
• 13:16
  really
• 13:16
  got
• 13:16
  a
• 13:17
  consistent
• 13:17
  answer
• 13:17
  to
• 13:18
  the
• 13:18
  question
• 13:18
  of,
• 13:19
  what
• 13:19
  am
• 13:19
  I
• 13:19
  feeling
• 13:20
  right
• 13:20
  now?
• 13:20
  And
• 13:20
  is
• 13:21
  it
• 13:21
  okay
• 13:21
  to
• 13:21
  feel
• 13:21
  it
• 13:22
  Right.
• 13:22
  It
• 13:22
  was
• 13:22
  this
• 13:22
  chaotic
• 13:23
  jungle
• 13:23
  of,
• 13:23
  like,
• 13:24
  no,
• 13:24
  sometimes
• 13:24
  it's
• 13:24
  not
• 13:24
  okay
• 13:25
  to
• 13:25
  feel
• 13:25
  that
• 13:25
  you
• 13:26
  should
• 13:26
  feel
• 13:26
  guilty
• 13:26
  for
• 13:26
  feeling
• 13:27
  that
• 13:27
  you're
• 13:27
  a
• 13:27
  nuisance.
• 13:28
  Sometimes
• 13:28
  it
• 13:29
  is
• 13:29
  okay
• 13:29
  to
• 13:29
  feel
• 13:30
  that.
• 13:30
  And
• 13:30
  I
• 13:30
  love
• 13:30
  you,
• 13:31
  and
• 13:31
  sometimes
• 13:32
  I'm
• 13:32
  not
• 13:32
  even
• 13:32
  paying
• 13:32
  attention
• 13:33
  to
• 13:33
  you,
• 13:33
  so
• 13:33
  you
• 13:33
  better
• 13:33
  feel
• 13:34
  something
• 13:34
  way
• 13:34
  worse
• 13:35
  and
• 13:35
  get
• 13:35
  hurt
• 13:36
  a
• 13:36
  lot
• 13:36
  more
• 13:36
  for
• 13:36
  me
• 13:37
  to
• 13:37
  even
• 13:37
  pay
• 13:37
  attention
• 13:37
  to
• 13:38
  you
• 13:38
  because
• 13:38
  I'm
• 13:38
  so
• 13:38
  disengaged.
• 13:39
  Right.
• 13:41
  That's
• 13:41
  another
• 13:42
  big
• 13:42
  thing.
• 13:42
  Right.
• 13:42
  I
• 13:42
  noticed
• 13:43
  that
• 13:43
  a
• 13:43
  lot,
• 13:43
  anecdotally,
• 13:44
  as
• 13:44
  an
• 13:44
  RN
• 13:45
  back
• 13:45
  in
• 13:45
  the
• 13:45
  day
• 13:46
  on
• 13:46
  a
• 13:46
  psych
• 13:47
  unit
• 13:47
  where,
• 13:48
  um,
• 13:48
  I
• 13:49
  found
• 13:49
  that
• 13:49
  borderline
• 13:50
  patients,
• 13:51
  in
• 13:51
  many
• 13:51
  ways,
• 13:52
  they.
• 13:52
  They
• 13:52
  did
• 13:53
  act
• 13:53
  in
• 13:54
  a
• 13:54
  cry
• 13:54
  for
• 13:54
  attention,
• 13:55
  but
• 13:55
  you
• 13:55
  couldn't
• 13:56
  blame
• 13:56
  them
• 13:56
  at
• 13:56
  all
• 13:56
  because
• 13:57
  it
• 13:57
  was
• 13:57
  the
• 13:57
  only
• 13:58
  thing
• 13:58
  that
• 13:58
  got
• 13:58
  their
• 13:59
  parents
• 13:59
  attention.
• 14:00
  Right?
• 14:00
  Just
• 14:00
  normal.
• 14:01
  Every
• 14:02
  day
• 14:02
  I'm
• 14:03
  sad
• 14:03
  today
• 14:04
  doesn't
• 14:04
  really
• 14:04
  get
• 14:05
  their
• 14:05
  patient's
• 14:05
  attention.
• 14:05
  They're.
• 14:06
  They're.
• 14:06
  They're.
• 14:06
  They're.
• 14:07
  Doesn't
• 14:07
  get
• 14:07
  their
• 14:08
  parents
• 14:08
  attention.
• 14:08
  Their
• 14:08
  parents
• 14:09
  don't
• 14:09
  sit
• 14:09
  them
• 14:09
  down
• 14:09
  and
• 14:10
  say,
• 14:10
  oh,
• 14:10
  why
• 14:10
  are
• 14:10
  you
• 14:10
  sad?
• 14:10
  Let's
• 14:11
  talk
• 14:11
  about
• 14:11
  it.
• 14:11
  It's
• 14:12
  normal
• 14:12
  to
• 14:12
  be
• 14:12
  sad.
• 14:13
  How
• 14:13
  can
• 14:13
  we,
• 14:14
  you
• 14:14
  know,
• 14:14
  make
• 14:14
  this
• 14:14
  better?
• 14:15
  Instead
• 14:15
  of
• 14:15
  sitting
• 14:16
  down
• 14:16
  in
• 14:16
  an
• 14:16
  attuned
• 14:17
  way,
• 14:18
  in
• 14:18
  a.
• 14:18
  In
• 14:19
  a
• 14:19
  real
• 14:19
  way,
• 14:19
  and
• 14:20
  navigating
• 14:20
  emotions
• 14:21
  clearly
• 14:21
  and
• 14:22
  safely,
• 14:22
  and
• 14:23
  instead
• 14:24
  of
• 14:24
  having
• 14:24
  that
• 14:24
  done
• 14:25
  for
• 14:25
  Haley,
• 14:25
  she
• 14:26
  was
• 14:26
  shamed
• 14:26
  or
• 14:27
  ignored,
• 14:27
  so
• 14:27
  she
• 14:27
  had
• 14:27
  to
• 14:28
  raise
• 14:28
  the
• 14:28
  bar
• 14:28
  and
• 14:28
  say,
• 14:28
  okay,
• 14:29
  well,
• 14:29
  well,
• 14:29
  will
• 14:29
  you
• 14:30
  pay
• 14:30
  attention
• 14:30
  to
• 14:30
  me
• 14:30
  now
• 14:30
  when
• 14:31
  I'm.
• 14:31
  When
• 14:31
  I'm
• 14:31
  cutting
• 14:32
  and
• 14:32
  when
• 14:32
  I'm
• 14:32
  potentially,
• 14:33
  you
• 14:33
  know,
• 14:33
  when.
• 14:33
  When
• 14:34
  things
• 14:34
  are
• 14:34
  getting
• 14:34
  really
• 14:35
  drastic?
• 14:36
  And
• 14:37
  again,
• 14:38
  just
• 14:38
  intuitively,
• 14:39
  you
• 14:39
  can
• 14:39
  look
• 14:39
  at
• 14:39
  that
• 14:39
  as
• 14:40
  a
• 14:40
  very
• 14:40
  sensical
• 14:42
  behavioral
• 14:43
  demonstration
• 14:44
  from
• 14:44
  a.
• 14:44
  From
• 14:45
  a
• 14:45
  little
• 14:45
  child
• 14:46
  or
• 14:46
  a
• 14:46
  teen.
• 14:46
  Right.
• 14:47
  It's
• 14:47
  like,
• 14:47
  is.
• 14:48
  How
• 14:48
  are
• 14:49
  my
• 14:49
  caregivers
• 14:49
  actually
• 14:50
  responsive?
• 14:50
  Well,
• 14:50
  I
• 14:51
  can't
• 14:51
  tell
• 14:52
  by
• 14:52
  doing
• 14:52
  normal
• 14:53
  things.
• 14:53
  Like
• 14:53
  getting
• 14:53
  a
• 14:54
  D
• 14:54
  in.
• 14:54
  In
• 14:54
  algebra
• 14:55
  wasn't
• 14:55
  enough
• 14:55
  to
• 14:56
  make
• 14:56
  dad
• 14:56
  or
• 14:56
  mom
• 14:56
  care
• 14:57
  or
• 14:57
  pay
• 14:57
  attention.
• 14:58
  So,
• 14:58
  like,
• 14:58
  are
• 14:58
  they
• 14:59
  going
• 14:59
  to
• 14:59
  care
• 14:59
  if
• 14:59
  I
• 14:59
  really
• 15:00
  need
• 15:00
  them?
• 15:00
  And
• 15:00
  so
• 15:01
  do
• 15:01
  I
• 15:01
  wait
• 15:01
  for
• 15:02
  that
• 15:02
  time
• 15:03
  when
• 15:04
  I
• 15:04
  might
• 15:04
  be
• 15:04
  super
• 15:04
  vulnerable
• 15:05
  and
• 15:05
  they
• 15:05
  just
• 15:05
  ignore
• 15:06
  me,
• 15:06
  or
• 15:06
  do
• 15:06
  I
• 15:06
  cut
• 15:07
  myself
• 15:07
  now
• 15:08
  and
• 15:09
  test
• 15:09
  whether
• 15:09
  or
• 15:09
  not.
• 15:10
  Now,
• 15:10
  I'm
• 15:10
  not
• 15:10
  saying
• 15:10
  that's,
• 15:11
  like,
• 15:11
  the
• 15:12
  motive
• 15:12
  behind
• 15:12
  why
• 15:14
  all
• 15:14
  four
• 15:14
  line
• 15:15
  patients
• 15:15
  cut.
• 15:15
  Okay?
• 15:16
  But
• 15:16
  it's
• 15:17
  just
• 15:17
  an
• 15:17
  anecdotal
• 15:18
  observation
• 15:18
  I've
• 15:19
  noticed.
• 15:19
  That
• 15:19
  makes
• 15:19
  perfect
• 15:20
  sense
• 15:20
  to
• 15:20
  me.
• 15:20
  It's
• 15:20
  very
• 15:21
  elegant
• 15:21
  and
• 15:21
  very
• 15:21
  consistent.
• 15:22
  It's
• 15:22
  very
• 15:22
  internally
• 15:23
  consistent
• 15:23
  with
• 15:24
  their
• 15:24
  experiences
• 15:25
  in
• 15:25
  their
• 15:25
  childhood
• 15:25
  and
• 15:26
  what
• 15:26
  they
• 15:26
  tell
• 15:26
  me
• 15:26
  to
• 15:27
  my
• 15:27
  face.
• 15:27
  Right?
• 15:28
  It's.
• 15:28
  It's.
• 15:29
  And
• 15:30
  it
• 15:30
  just
• 15:30
  makes
• 15:30
  perfect
• 15:30
  sense.
• 15:31
  Right?
• 15:31
  It's
• 15:31
  like.
• 15:32
  And
• 15:33
  of
• 15:33
  Course,
• 15:33
  cutting
• 15:34
  is
• 15:34
  a
• 15:34
  lot
• 15:34
  more
• 15:34
  than
• 15:34
  that.
• 15:35
  It's
• 15:35
  a
• 15:35
  outlet.
• 15:36
  There's
• 15:36
  an
• 15:36
  endorphin
• 15:37
  release.
• 15:38
  It
• 15:38
  helps
• 15:39
  patients
• 15:39
  feel
• 15:39
  a
• 15:40
  lot
• 15:40
  less
• 15:40
  numb,
• 15:41
  you
• 15:41
  know,
• 15:42
  helps
• 15:42
  them
• 15:42
  feel
• 15:42
  more
• 15:43
  real
• 15:44
  at
• 15:44
  a
• 15:44
  time
• 15:44
  when
• 15:44
  they
• 15:44
  usually
• 15:45
  disassociate
• 15:45
  and
• 15:45
  always
• 15:46
  feel
• 15:46
  kind
• 15:46
  of
• 15:46
  unreal.
• 15:47
  So
• 15:47
  there's,
• 15:48
  you
• 15:48
  know,
• 15:48
  that's
• 15:48
  very
• 15:48
  loaded.
• 15:49
  There's
• 15:49
  a
• 15:49
  lot
• 15:49
  of
• 15:49
  reasons
• 15:50
  people
• 15:50
  self
• 15:50
  harm.
• 15:50
  But
• 15:51
  my
• 15:51
  greater
• 15:52
  point
• 15:52
  is,
• 15:52
  can
• 15:53
  you
• 15:53
  blame
• 15:53
  them
• 15:54
  for
• 15:54
  self
• 15:55
  harming
• 15:55
  in
• 15:56
  a
• 15:56
  way
• 15:56
  to
• 15:56
  subconsciously
• 15:57
  understand
• 15:58
  whether
• 15:58
  or
• 15:59
  not
• 15:59
  their
• 15:59
  parents
• 15:59
  even
• 16:00
  are
• 16:00
  engaged,
• 16:01
  because
• 16:02
  they
• 16:02
  normally
• 16:02
  aren't.
• 16:03
  Right.
• 16:03
  It's
• 16:04
  just
• 16:04
  like
• 16:04
  a
• 16:04
  way
• 16:04
  of
• 16:04
  being
• 16:04
  attuned.
• 16:05
  Again,
• 16:05
  it's
• 16:06
  this
• 16:06
  subconscious
• 16:07
  way
• 16:07
  of.
• 16:07
  Of
• 16:08
  trying
• 16:08
  to
• 16:08
  attune
• 16:08
  back
• 16:09
  to
• 16:09
  your
• 16:09
  parents
• 16:09
  who
• 16:09
  are
• 16:10
  incapable
• 16:10
  of
• 16:10
  it.
• 16:11
  Okay,
• 16:11
  but
• 16:11
  the
• 16:12
  greater
• 16:12
  thing
• 16:12
  here,
• 16:12
  we
• 16:13
  talked
• 16:13
  about
• 16:13
  the
• 16:13
  identity
• 16:13
  disturbance
• 16:14
  at
• 16:15
  the
• 16:15
  start
• 16:15
  of
• 16:15
  this.
• 16:16
  And
• 16:16
  so
• 16:16
  they
• 16:16
  don't.
• 16:16
  They
• 16:16
  grow
• 16:17
  up.
• 16:17
  You
• 16:17
  know,
• 16:17
  people
• 16:17
  like
• 16:17
  Haley
• 16:18
  grow
• 16:18
  up
• 16:18
  not
• 16:18
  really
• 16:18
  knowing
• 16:19
  who
• 16:20
  they
• 16:20
  are.
• 16:21
  Right?
• 16:22
  Because
• 16:23
  mom
• 16:24
  mirrors
• 16:24
  her
• 16:24
  own
• 16:25
  distress
• 16:25
  at
• 16:25
  Haley
• 16:26
  instead
• 16:26
  of
• 16:26
  Haley's
• 16:27
  distress.
• 16:28
  Okay?
• 16:29
  So
• 16:30
  it's,
• 16:30
  it's
• 16:31
  really
• 16:31
  mom's
• 16:31
  anxiety
• 16:33
  that
• 16:33
  Haley
• 16:34
  is
• 16:34
  internalizing.
• 16:35
  Mom's
• 16:35
  rage,
• 16:36
  Mom's
• 16:36
  despair,
• 16:37
  okay?
• 16:38
  It's
• 16:38
  kind
• 16:38
  of
• 16:38
  like
• 16:39
  developing
• 16:39
  inside
• 16:40
  of
• 16:40
  Haley
• 16:40
  like
• 16:41
  a
• 16:41
  foreign
• 16:41
  body.
• 16:41
  This
• 16:42
  is
• 16:42
  like
• 16:42
  an
• 16:42
  alien
• 16:42
  self,
• 16:43
  okay?
• 16:44
  And
• 16:44
  it's
• 16:44
  not
• 16:44
  really
• 16:45
  hers.
• 16:45
  She's
• 16:45
  never
• 16:46
  been
• 16:46
  in
• 16:46
  touch
• 16:46
  with
• 16:46
  her
• 16:46
  emotions
• 16:47
  because
• 16:47
  she
• 16:47
  never
• 16:47
  got
• 16:47
  to
• 16:48
  sit
• 16:48
  down
• 16:48
  and
• 16:49
  sort
• 16:49
  them
• 16:49
  out
• 16:49
  or
• 16:50
  have
• 16:50
  them
• 16:50
  validated
• 16:51
  as
• 16:51
  real.
• 16:51
  They
• 16:52
  were
• 16:52
  dismissed,
• 16:52
  ignore.
• 16:53
  So
• 16:53
  she
• 16:53
  doesn't
• 16:54
  even
• 16:54
  really
• 16:54
  know
• 16:54
  who
• 16:54
  she
• 16:54
  is.
• 16:55
  Okay?
• 16:56
  That's
• 16:56
  the
• 16:56
  identity
• 16:56
  diffusion
• 16:57
  you
• 16:57
  see
• 16:58
  in
• 16:59
  borderline
• 17:00
  personality
• 17:00
  disorder.
• 17:01
  Okay?
• 17:01
  It's
• 17:01
  pretty
• 17:01
  scary
• 17:02
  and
• 17:02
  pretty
• 17:02
  understandable
• 17:03
  too.
• 17:03
  We
• 17:04
  also
• 17:04
  see
• 17:04
  impulsivity.
• 17:05
  Right?
• 17:07
  Which
• 17:08
  makes
• 17:08
  a
• 17:08
  lot
• 17:08
  of
• 17:08
  sense,
• 17:09
  actually.
• 17:10
  Okay.
• 17:10
  Haley
• 17:11
  never
• 17:11
  had
• 17:11
  a
• 17:11
  mom
• 17:11
  who
• 17:12
  said,
• 17:12
  let's,
• 17:12
  you
• 17:13
  know,
• 17:13
  let's
• 17:13
  talk
• 17:13
  about
• 17:14
  this.
• 17:14
  I
• 17:14
  see
• 17:14
  that
• 17:14
  you're
• 17:14
  really
• 17:15
  upset.
• 17:15
  Let's
• 17:15
  take
• 17:15
  some
• 17:15
  deep
• 17:16
  breaths.
• 17:16
  Let's
• 17:17
  prove
• 17:17
  to
• 17:17
  you
• 17:17
  that
• 17:17
  we
• 17:17
  can
• 17:18
  control
• 17:18
  these
• 17:18
  feelings
• 17:18
  together.
• 17:19
  We
• 17:19
  can
• 17:19
  co
• 17:19
  regulate,
• 17:20
  we
• 17:20
  can.
• 17:20
  We
• 17:21
  can
• 17:21
  get
• 17:21
  to
• 17:21
  a
• 17:21
  better
• 17:21
  place.
• 17:22
  She
• 17:22
  never
• 17:23
  had
• 17:23
  that,
• 17:24
  right?
• 17:24
  She
• 17:24
  never.
• 17:24
  In
• 17:24
  fact,
• 17:25
  she
• 17:25
  had
• 17:25
  the
• 17:25
  opposite.
• 17:25
  She
• 17:25
  had
• 17:25
  a
• 17:26
  mom
• 17:26
  who
• 17:27
  would
• 17:27
  drink,
• 17:27
  maybe
• 17:28
  to
• 17:28
  numb
• 17:28
  anxiety.
• 17:29
  She
• 17:29
  had
• 17:30
  a
• 17:30
  mom
• 17:30
  who
• 17:30
  would
• 17:30
  get
• 17:31
  into
• 17:31
  rages
• 17:32
  or,
• 17:32
  or
• 17:32
  slam
• 17:33
  the
• 17:33
  door
• 17:33
  and.
• 17:34
  And
• 17:34
  to
• 17:34
  sit
• 17:35
  at
• 17:35
  sleep
• 17:35
  under
• 17:35
  the
• 17:35
  covers
• 17:36
  all
• 17:36
  day.
• 17:36
  So
• 17:37
  if
• 17:37
  anything,
• 17:38
  she
• 17:38
  was
• 17:38
  taught
• 17:38
  that
• 17:39
  big
• 17:39
  emotions
• 17:39
  are
• 17:39
  scary
• 17:40
  and
• 17:40
  dangerous
• 17:40
  and
• 17:41
  need
• 17:41
  to
• 17:41
  be
• 17:41
  drowned
• 17:41
  out
• 17:42
  and
• 17:42
  are
• 17:42
  not
• 17:43
  okay
• 17:43
  to
• 17:43
  express.
• 17:44
  So
• 17:44
  she
• 17:44
  bottles
• 17:45
  them
• 17:45
  up
• 17:45
  all
• 17:46
  of
• 17:46
  the
• 17:46
  time
• 17:47
  and
• 17:47
  doesn't
• 17:47
  deal
• 17:47
  with
• 17:48
  them.
• 17:48
  Right?
• 17:49
  And
• 17:50
  so
• 17:50
  that's
• 17:50
  a
• 17:50
  really,
• 17:51
  really
• 17:52
  big
• 17:52
  problem.
• 17:53
  Okay?
• 17:55
  But
• 17:55
  when
• 17:55
  you
• 17:56
  have
• 17:56
  these
• 17:56
  big
• 17:56
  feelings
• 17:57
  and
• 17:57
  you
• 17:57
  don't
• 17:57
  know
• 17:57
  what
• 17:57
  to
• 17:58
  do
• 17:58
  with
• 17:58
  them,
• 17:59
  then
• 17:59
  you're
• 17:59
  going
• 17:59
  to
• 17:59
  want
• 17:59
  to
• 18:00
  impulsively
• 18:00
  get
• 18:01
  rid
• 18:01
  of
• 18:01
  these
• 18:01
  big
• 18:01
  feelings
• 18:02
  immediately
• 18:02
  because
• 18:03
  it's
• 18:03
  unbearable.
• 18:03
  And
• 18:04
  you
• 18:04
  want
• 18:04
  the
• 18:04
  feelings
• 18:04
  to
• 18:05
  stop,
• 18:05
  and
• 18:05
  you
• 18:05
  don't
• 18:05
  know
• 18:05
  how
• 18:05
  they
• 18:06
  can
• 18:06
  stop.
• 18:06
  They've
• 18:07
  never
• 18:07
  really
• 18:07
  stopped
• 18:08
  in
• 18:08
  the
• 18:08
  past.
• 18:08
  That's
• 18:08
  another
• 18:09
  key,
• 18:09
  right?
• 18:09
  They
• 18:10
  weren't
• 18:10
  ever
• 18:10
  sat
• 18:11
  down
• 18:11
  with
• 18:11
  and
• 18:11
  talked
• 18:12
  through
• 18:12
  and.
• 18:13
  And
• 18:14
  resolved.
• 18:15
  So
• 18:15
  this
• 18:15
  is
• 18:15
  a
• 18:15
  really
• 18:16
  unbearable
• 18:16
  feeling
• 18:17
  that
• 18:17
  needs
• 18:17
  to
• 18:17
  stop.
• 18:18
  And
• 18:18
  for
• 18:18
  all
• 18:18
  you
• 18:19
  know,
• 18:19
  in
• 18:19
  your
• 18:19
  childhood,
• 18:19
  they
• 18:20
  never
• 18:20
  stopped.
• 18:20
  And
• 18:20
  so
• 18:21
  that's
• 18:21
  why
• 18:21
  patients
• 18:21
  will
• 18:21
  start
• 18:22
  drinking
• 18:22
  heavily
• 18:23
  or
• 18:23
  they'll
• 18:23
  spend
• 18:24
  impulsively
• 18:25
  to
• 18:25
  create
• 18:25
  a
• 18:25
  rush
• 18:26
  of
• 18:26
  dopamine
• 18:26
  that
• 18:26
  fills
• 18:27
  that
• 18:27
  emptiness
• 18:27
  even
• 18:28
  for
• 18:28
  an
• 18:28
  hour.
• 18:29
  Hooking
• 18:29
  up
• 18:29
  with
• 18:29
  a
• 18:29
  stranger
• 18:30
  for
• 18:30
  30
• 18:30
  minutes,
• 18:32
  just
• 18:32
  wanting
• 18:32
  to
• 18:32
  feel
• 18:33
  close
• 18:33
  to
• 18:33
  someone,
• 18:34
  okay?
• 18:34
  It's
• 18:34
  not
• 18:35
  being
• 18:35
  irresponsible.
• 18:36
  It's
• 18:37
  like
• 18:37
  a.
• 18:37
  Haley's
• 18:38
  kind
• 18:38
  of
• 18:38
  doing
• 18:38
  emergency
• 18:39
  surgery
• 18:39
  on
• 18:39
  her
• 18:40
  emotions
• 18:40
  with
• 18:41
  the
• 18:41
  only
• 18:41
  tools
• 18:41
  she's
• 18:42
  ever
• 18:42
  been
• 18:42
  given.
• 18:42
  Right?
• 18:43
  And
• 18:43
  so
• 18:43
  that's
• 18:44
  kind
• 18:44
  of
• 18:44
  the
• 18:44
  deeper
• 18:44
  layer
• 18:45
  here,
• 18:45
  is
• 18:45
  that
• 18:45
  these
• 18:45
  are
• 18:46
  overwhelming
• 18:46
  emotions.
• 18:47
  She.
• 18:47
  She's
• 18:48
  never
• 18:48
  learned
• 18:49
  what
• 18:49
  to
• 18:49
  do
• 18:49
  about
• 18:49
  them,
• 18:50
  and
• 18:51
  she
• 18:51
  needs
• 18:51
  to
• 18:51
  get
• 18:51
  rid
• 18:52
  of
• 18:52
  them
• 18:52
  quickly.
• 18:53
  And
• 18:53
  words
• 18:53
  never
• 18:54
  really
• 18:54
  helped
• 18:54
  because
• 18:55
  her
• 18:55
  mom
• 18:55
  never
• 18:56
  brought
• 18:56
  words
• 18:56
  to
• 18:56
  her.
• 18:57
  Okay?
• 18:57
  Reassurance
• 18:59
  never
• 18:59
  really
• 18:59
  resonated
• 19:00
  with
• 19:00
  her
• 19:00
  either.
• 19:01
  Okay?
• 19:01
  And
• 19:01
  even
• 19:01
  if
• 19:02
  it
• 19:02
  did
• 19:02
  for
• 19:02
  two
• 19:03
  times
• 19:03
  that
• 19:03
  her
• 19:03
  mom
• 19:03
  did
• 19:04
  it,
• 19:04
  it
• 19:04
  was
• 19:04
  nullified
• 19:05
  by
• 19:05
  the
• 19:05
  times
• 19:06
  mom
• 19:06
  then
• 19:06
  was
• 19:06
  very
• 19:06
  inconsistent
• 19:08
  and
• 19:08
  basically
• 19:08
  did
• 19:08
  not
• 19:08
  reassure
• 19:09
  her
• 19:09
  and
• 19:09
  even
• 19:10
  scolded
• 19:10
  her.
• 19:11
  So
• 19:11
  now
• 19:11
  when
• 19:11
  she's
• 19:12
  being
• 19:12
  reassured,
• 19:12
  she
• 19:12
  doesn't
• 19:13
  trust
• 19:13
  that.
• 19:13
  It's
• 19:13
  like,
• 19:13
  wait
• 19:14
  a
• 19:14
  minute.
• 19:14
  I.
• 19:14
  How
• 19:15
  can
• 19:15
  I
• 19:15
  trust
• 19:15
  you?
• 19:16
  You
• 19:16
  were.
• 19:16
  You
• 19:17
  reassured
• 19:17
  me,
• 19:17
  and
• 19:17
  then
• 19:18
  two
• 19:18
  minutes
• 19:18
  later,
• 19:18
  you
• 19:18
  scolded
• 19:19
  me.
• 19:19
  So
• 19:20
  clearly,
• 19:20
  my
• 19:20
  emotions
• 19:21
  don't
• 19:22
  really
• 19:22
  matter
• 19:22
  and
• 19:23
  they
• 19:23
  don't
• 19:23
  make
• 19:23
  sense.
• 19:24
  And
• 19:24
  now
• 19:24
  I
• 19:25
  have
• 19:25
  no
• 19:25
  clue
• 19:25
  what
• 19:25
  they
• 19:26
  mean
• 19:26
  in
• 19:26
  context,
• 19:26
  because
• 19:27
  the
• 19:27
  two
• 19:27
  people
• 19:28
  who
• 19:28
  are
• 19:28
  supposed
• 19:28
  to
• 19:28
  teach
• 19:28
  me
• 19:29
  what
• 19:29
  they
• 19:29
  mean
• 19:30
  and
• 19:30
  how
• 19:31
  they
• 19:31
  translate
• 19:31
  are
• 19:32
  certainly
• 19:32
  not
• 19:32
  helping
• 19:32
  me.
• 19:33
  Right?
• 19:33
  So
• 19:33
  you
• 19:33
  get
• 19:34
  confusion.
• 19:34
  You
• 19:35
  don't
• 19:35
  know
• 19:35
  who
• 19:35
  you
• 19:35
  are.
• 19:36
  You
• 19:36
  become
• 19:36
  impulsive
• 19:37
  because
• 19:37
  these
• 19:37
  emotions
• 19:38
  get
• 19:38
  so
• 19:38
  overwhelming,
• 19:39
  you
• 19:39
  have
• 19:39
  to
• 19:39
  do
• 19:39
  something
• 19:40
  about
• 19:40
  it.
• 19:40
  You
• 19:41
  certainly
• 19:41
  don't
• 19:41
  trust
• 19:41
  people.
• 19:42
  You
• 19:42
  don't
• 19:42
  trust
• 19:43
  what
• 19:43
  they
• 19:43
  say,
• 19:43
  you
• 19:44
  don't
• 19:44
  trust
• 19:44
  what
• 19:44
  they
• 19:44
  do,
• 19:45
  you
• 19:45
  don't
• 19:45
  trust
• 19:45
  what
• 19:45
  they're
• 19:45
  going
• 19:45
  to
• 19:46
  do
• 19:46
  next,
• 19:46
  and
• 19:46
  you're
• 19:46
  always
• 19:46
  going
• 19:47
  to
• 19:47
  be
• 19:47
  on
• 19:47
  guard
• 19:47
  about
• 19:48
  losing
• 19:48
  them.
• 19:49
  Hence
• 19:49
  the
• 19:50
  core
• 19:51
  features
• 19:51
  of
• 19:51
  borderline
• 19:52
  personality.
• 19:52
  An
• 19:53
  intense
• 19:53
  fear
• 19:53
  of
• 19:54
  being
• 19:54
  abandoned.
• 19:55
  Right.
• 19:55
  So
• 19:55
  it
• 19:55
  all
• 19:55
  makes
• 19:56
  sense
• 19:56
  in
• 19:56
  Haley's
• 19:57
  portrait
• 19:58
  here,
• 19:58
  doesn't
• 19:58
  it?
• 19:59
  Um,
• 19:59
  the
• 19:59
  impulsivity.
• 20:00
  It
• 20:00
  looks.
• 20:01
  You
• 20:01
  know,
• 20:01
  as
• 20:01
  a
• 20:01
  clinician,
• 20:02
  you
• 20:02
  get
• 20:02
  overwhelmed,
• 20:03
  and
• 20:03
  you
• 20:03
  go,
• 20:03
  oh,
• 20:03
  my
• 20:03
  God,
• 20:03
  is
• 20:03
  This
• 20:04
  bipolar,
• 20:04
  why
• 20:04
  is
• 20:04
  she
• 20:05
  doing
• 20:05
  this?
• 20:06
  This
• 20:06
  is
• 20:06
  all
• 20:06
  over
• 20:06
  the
• 20:07
  board.
• 20:07
  Oh,
• 20:08
  my
• 20:08
  God.
• 20:08
  I
• 20:08
  don't
• 20:08
  want
• 20:08
  to
• 20:08
  treat
• 20:09
  this
• 20:09
  patient
• 20:09
  right.
• 20:09
  This
• 20:10
  is
• 20:10
  so
• 20:10
  overwhelming.
• 20:11
  Where
• 20:11
  do
• 20:11
  I
• 20:11
  start?
• 20:11
  No
• 20:12
  med
• 20:12
  I'm
• 20:12
  prescribing
• 20:13
  is
• 20:13
  even
• 20:13
  helping
• 20:14
  here.
• 20:14
  Well,
• 20:15
  yes,
• 20:15
  yes,
• 20:15
  yes.
• 20:15
  Okay.
• 20:16
  All
• 20:16
  of
• 20:16
  that
• 20:16
  is
• 20:16
  fair
• 20:17
  countertransference,
• 20:18
  Fine.
• 20:19
  But
• 20:19
  if
• 20:19
  you
• 20:19
  think
• 20:20
  about
• 20:21
  the
• 20:21
  sweet
• 20:22
  little
• 20:22
  girl
• 20:22
  that
• 20:22
  she
• 20:22
  was,
• 20:23
  and
• 20:24
  she
• 20:24
  wanted
• 20:24
  a
• 20:25
  shot
• 20:25
  just
• 20:25
  like
• 20:25
  you
• 20:26
  got,
• 20:26
  and
• 20:27
  she
• 20:27
  wanted
• 20:27
  to
• 20:27
  grow
• 20:27
  up
• 20:27
  in
• 20:28
  a
• 20:28
  warm,
• 20:28
  nurturing
• 20:28
  environment,
• 20:29
  she
• 20:29
  didn't
• 20:29
  have
• 20:29
  it.
• 20:29
  And
• 20:29
  she
• 20:30
  just
• 20:30
  doesn't
• 20:30
  know
• 20:30
  what
• 20:30
  to
• 20:30
  do
• 20:31
  with
• 20:31
  these
• 20:32
  big
• 20:32
  feelings.
• 20:33
  She
• 20:33
  literally
• 20:34
  was
• 20:34
  never
• 20:34
  taught
• 20:34
  the
• 20:34
  most
• 20:35
  elemental
• 20:36
  parts
• 20:36
  of
• 20:36
  being
• 20:36
  a
• 20:36
  human.
• 20:37
  It's
• 20:37
  like,
• 20:37
  how
• 20:37
  do
• 20:37
  you
• 20:37
  deal
• 20:38
  with
• 20:38
  your
• 20:38
  emotions?
• 20:39
  Right?
• 20:39
  And
• 20:39
  then
• 20:39
  modeling
• 20:40
  what
• 20:41
  you
• 20:41
  do
• 20:41
  when
• 20:41
  you
• 20:41
  are
• 20:42
  angry.
• 20:42
  You
• 20:42
  know,
• 20:43
  mom
• 20:43
  never
• 20:43
  sat
• 20:43
  there
• 20:43
  and
• 20:44
  took
• 20:44
  deep
• 20:44
  breaths.
• 20:46
  And
• 20:46
  so
• 20:46
  it
• 20:47
  also
• 20:47
  makes
• 20:47
  sense
• 20:47
  why
• 20:48
  Haley
• 20:49
  may
• 20:49
  self
• 20:49
  harm
• 20:50
  or
• 20:50
  have
• 20:50
  suicidal
• 20:51
  behavior.
• 20:52
  Because
• 20:54
  when
• 20:54
  she
• 20:54
  had
• 20:54
  emotional
• 20:55
  pain
• 20:55
  in
• 20:55
  the
• 20:55
  past,
• 20:56
  and
• 20:56
  it
• 20:56
  was
• 20:56
  enormous,
• 20:57
  she
• 20:57
  had
• 20:57
  nowhere
• 20:58
  safe
• 20:58
  to
• 20:58
  turn
• 20:58
  to.
• 20:59
  Right?
• 20:59
  She
• 20:59
  can't
• 20:59
  go
• 20:59
  to
• 20:59
  mom.
• 21:00
  Mom's
• 21:01
  unpredictable,
• 21:01
  emotional,
• 21:02
  depressed,
• 21:03
  traumatized.
• 21:03
  Dad's
• 21:04
  in
• 21:04
  jail.
• 21:05
  Okay?
• 21:05
  She
• 21:05
  had
• 21:06
  no
• 21:06
  language
• 21:06
  for
• 21:06
  what
• 21:07
  she
• 21:07
  was
• 21:07
  feeling
• 21:07
  because
• 21:08
  no
• 21:08
  one
• 21:08
  would
• 21:08
  help
• 21:08
  her
• 21:09
  with
• 21:09
  those
• 21:09
  emotions.
• 21:10
  So
• 21:11
  what
• 21:11
  happens?
• 21:12
  She
• 21:12
  learns
• 21:13
  through
• 21:13
  time
• 21:14
  that
• 21:15
  maybe
• 21:16
  self
• 21:16
  harm
• 21:17
  is
• 21:17
  one
• 21:17
  way
• 21:17
  to
• 21:18
  bring
• 21:18
  regulate
• 21:18
  her
• 21:19
  emotions.
• 21:19
  Right.
• 21:20
  It's
• 21:20
  not
• 21:20
  attention
• 21:20
  seeking.
• 21:21
  It's
• 21:21
  actually
• 21:21
  the
• 21:21
  opposite.
• 21:22
  It's
• 21:22
  usually
• 21:22
  done
• 21:22
  in
• 21:23
  private.
• 21:23
  Patients
• 21:23
  are
• 21:23
  usually
• 21:24
  very
• 21:24
  ashamed
• 21:24
  of
• 21:24
  it.
• 21:25
  Right.
• 21:25
  But
• 21:26
  that
• 21:26
  physical
• 21:26
  pain
• 21:27
  can
• 21:27
  trigger
• 21:27
  an
• 21:27
  endorphin
• 21:28
  release
• 21:29
  that
• 21:30
  really
• 21:30
  should
• 21:30
  have
• 21:30
  been
• 21:31
  released
• 21:31
  when
• 21:32
  her
• 21:32
  mom
• 21:32
  made
• 21:33
  her
• 21:33
  giggle
• 21:33
  and
• 21:33
  laugh
• 21:34
  and
• 21:34
  helped
• 21:35
  her
• 21:35
  feel
• 21:35
  relieved
• 21:36
  from
• 21:36
  her
• 21:36
  emotions
• 21:37
  at
• 21:37
  a
• 21:37
  young
• 21:37
  age.
• 21:37
  But
• 21:37
  she
• 21:38
  wasn't
• 21:38
  there
• 21:39
  to
• 21:39
  regulate
• 21:39
  her
• 21:40
  daughter.
• 21:40
  And
• 21:41
  so
• 21:41
  what
• 21:42
  does
• 21:42
  regulate
• 21:42
  it?
• 21:43
  Well,
• 21:43
  endorphins
• 21:43
  will
• 21:43
  do
• 21:44
  it.
• 21:44
  And
• 21:44
  unfortunately,
• 21:44
  endorphins
• 21:45
  are
• 21:45
  released
• 21:46
  through
• 21:46
  physical
• 21:47
  pain
• 21:47
  triggers.
• 21:48
  Okay.
• 21:49
  And
• 21:49
  that
• 21:49
  activates
• 21:50
  a
• 21:50
  neural
• 21:50
  circuit
• 21:51
  that
• 21:51
  can
• 21:51
  temporarily
• 21:52
  override
• 21:52
  that
• 21:52
  emotional
• 21:53
  agony.
• 21:53
  It's
• 21:53
  very
• 21:54
  dysfunctional
• 21:54
  way
• 21:54
  to
• 21:55
  do
• 21:55
  it.
• 21:55
  It's.
• 21:56
  It's
• 21:56
  a
• 21:57
  very
• 21:57
  destructive.
• 21:58
  Patients
• 21:58
  know
• 21:58
  that
• 21:59
  they're
• 21:59
  again,
• 21:59
  very
• 22:00
  deeply
• 22:00
  ashamed,
• 22:00
  usually
• 22:01
  about
• 22:01
  that.
• 22:03
  But
• 22:04
  she's
• 22:04
  using
• 22:05
  whatever
• 22:05
  tool
• 22:05
  she
• 22:06
  can
• 22:06
  to
• 22:06
  overcome
• 22:07
  these
• 22:07
  excessively
• 22:08
  big
• 22:08
  feelings.
• 22:09
  Right.
• 22:09
  These
• 22:09
  are
• 22:09
  bigger
• 22:09
  feelings
• 22:10
  than
• 22:10
  you
• 22:10
  and
• 22:10
  I
• 22:10
  deal
• 22:10
  with,
• 22:11
  typically
• 22:11
  if
• 22:11
  you
• 22:11
  don't
• 22:11
  have
• 22:11
  borderline.
• 22:12
  Right.
• 22:13
  So
• 22:13
  it's
• 22:13
  easy
• 22:14
  for
• 22:14
  us
• 22:14
  to
• 22:14
  judge
• 22:14
  someone
• 22:14
  and
• 22:15
  say,
• 22:15
  oh,
• 22:15
  my
• 22:15
  God,
• 22:15
  you're
• 22:15
  cutting.
• 22:16
  That's.
• 22:16
  That's
• 22:16
  whack
• 22:16
  a
• 22:17
  doodle.
• 22:17
  Why
• 22:17
  would
• 22:17
  you
• 22:17
  cut?
• 22:18
  But
• 22:18
  we're
• 22:18
  also
• 22:19
  saying
• 22:19
  that
• 22:21
  based
• 22:21
  off
• 22:21
  of
• 22:21
  a
• 22:22
  secure
• 22:22
  attachment,
• 22:23
  and
• 22:23
  maybe
• 22:23
  they
• 22:24
  didn't
• 22:24
  have
• 22:24
  that
• 22:24
  secure
• 22:24
  attachment.
• 22:25
  Right?
• 22:26
  So
• 22:26
  their
• 22:26
  pain
• 22:27
  or
• 22:27
  their
• 22:27
  emotional
• 22:27
  overwhelm
• 22:28
  is
• 22:28
  Markedly
• 22:29
  different
• 22:29
  than
• 22:29
  ours,
• 22:30
  where
• 22:30
  cutting
• 22:31
  is
• 22:32
  much
• 22:32
  more
• 22:32
  appealing
• 22:33
  to
• 22:33
  them
• 22:33
  than
• 22:33
  it
• 22:33
  would
• 22:33
  be
• 22:34
  for
• 22:34
  us.
• 22:35
  You
• 22:35
  know,
• 22:35
  when
• 22:36
  we
• 22:36
  can
• 22:36
  get
• 22:36
  endorphins
• 22:37
  from
• 22:38
  connecting
• 22:38
  with
• 22:39
  our
• 22:39
  neighbor
• 22:39
  over
• 22:39
  a
• 22:40
  sports
• 22:40
  game
• 22:40
  that
• 22:41
  we
• 22:41
  both
• 22:41
  saw
• 22:41
  on
• 22:41
  Sunday.
• 22:42
  Haley
• 22:43
  can't
• 22:43
  necessarily
• 22:44
  do
• 22:44
  that.
• 22:45
  And
• 22:45
  so
• 22:45
  there's
• 22:45
  this
• 22:46
  inner
• 22:46
  void,
• 22:47
  right?
• 22:47
  And
• 22:48
  sure
• 22:48
  enough,
• 22:48
  it
• 22:49
  is
• 22:49
  an
• 22:49
  inner,
• 22:49
  chronic
• 22:50
  void,
• 22:51
  right?
• 22:52
  You
• 22:52
  know,
• 22:52
  this
• 22:53
  chronic
• 22:53
  emptiness
• 22:53
  that
• 22:54
  happens
• 22:54
  as
• 22:54
  a
• 22:54
  result
• 22:55
  of
• 22:55
  borderline
• 22:55
  personality.
• 22:56
  And
• 22:56
  the
• 22:56
  real
• 22:57
  reason
• 22:57
  is
• 22:57
  obvious
• 22:58
  to
• 22:58
  you
• 22:58
  by
• 22:58
  now.
• 22:58
  But
• 23:00
  we
• 23:01
  achieve
• 23:01
  inner
• 23:01
  fullness
• 23:02
  as
• 23:02
  humans
• 23:03
  feeling
• 23:03
  like
• 23:03
  real,
• 23:03
  whole
• 23:04
  people
• 23:05
  from
• 23:05
  our
• 23:05
  relationships,
• 23:06
  right?
• 23:07
  Consistent,
• 23:08
  warm,
• 23:08
  healthy
• 23:09
  relationships
• 23:10
  with
• 23:10
  our
• 23:10
  parents
• 23:10
  and
• 23:11
  loved
• 23:11
  ones
• 23:11
  and
• 23:11
  neighbors
• 23:12
  and
• 23:12
  best
• 23:12
  friends.
• 23:13
  Feeling
• 23:14
  loved
• 23:15
  is
• 23:15
  how
• 23:15
  we
• 23:15
  feel.
• 23:16
  How
• 23:16
  we
• 23:16
  feel
• 23:17
  full
• 23:17
  and
• 23:17
  confident
• 23:18
  and
• 23:18
  hopeful
• 23:18
  for
• 23:18
  the
• 23:19
  future
• 23:19
  and
• 23:19
  connected,
• 23:20
  right?
• 23:20
  But
• 23:20
  Haley's
• 23:21
  relationships
• 23:22
  were
• 23:22
  too
• 23:22
  chaotic
• 23:22
  and
• 23:22
  inconsistent
• 23:23
  to
• 23:24
  internalize
• 23:24
  a
• 23:24
  sense
• 23:25
  of
• 23:25
  fullness,
• 23:25
  okay?
• 23:26
  So
• 23:26
  she
• 23:26
  ended
• 23:26
  up
• 23:27
  becoming
• 23:27
  very
• 23:27
  empty,
• 23:28
  very
• 23:28
  hollow
• 23:29
  much
• 23:29
  of
• 23:29
  the
• 23:29
  time,
• 23:30
  okay?
• 23:30
  It's
• 23:30
  not
• 23:31
  really
• 23:31
  boredom.
• 23:31
  It's
• 23:32
  not
• 23:32
  really
• 23:32
  depression
• 23:32
  either.
• 23:33
  It's
• 23:33
  just
• 23:34
  like
• 23:34
  a
• 23:34
  missing
• 23:34
  foundation.
• 23:35
  And
• 23:36
  Haley's
• 23:36
  trying
• 23:36
  to
• 23:37
  fill
• 23:37
  that
• 23:37
  impulsively,
• 23:38
  as
• 23:38
  we
• 23:38
  talked
• 23:38
  about,
• 23:39
  with,
• 23:39
  you
• 23:39
  know,
• 23:40
  binge
• 23:40
  eating
• 23:41
  or
• 23:41
  substance
• 23:42
  use
• 23:42
  or
• 23:42
  overspending,
• 23:44
  right?
• 23:45
  Random
• 23:45
  sex,
• 23:46
  social
• 23:46
  media
• 23:47
  scrolling.
• 23:47
  She's
• 23:47
  constantly
• 23:48
  empty
• 23:48
  because
• 23:48
  she
• 23:48
  never
• 23:49
  had
• 23:49
  those
• 23:50
  relationships
• 23:50
  that
• 23:50
  fulfilled
• 23:51
  her
• 23:51
  in
• 23:52
  an
• 23:52
  authentic
• 23:52
  way,
• 23:52
  in
• 23:53
  a
• 23:53
  consistent
• 23:53
  way,
• 23:54
  okay?
• 23:55
  And
• 23:57
  so
• 23:57
  it
• 23:57
  makes
• 23:57
  perfect
• 23:57
  sense
• 23:58
  that
• 23:58
  she's
• 23:58
  extremely
• 23:59
  empty
• 24:00
  and
• 24:00
  it's
• 24:00
  sad
• 24:01
  again,
• 24:01
  at
• 24:01
  the
• 24:01
  end
• 24:01
  of
• 24:01
  the
• 24:01
  day,
• 24:02
  it's
• 24:02
  like
• 24:02
  very
• 24:02
  sad.
• 24:04
  And
• 24:04
  I
• 24:05
  think
• 24:05
  we
• 24:05
  should
• 24:05
  have
• 24:06
  a
• 24:06
  lot
• 24:07
  of
• 24:08
  compassion
• 24:09
  for
• 24:09
  her,
• 24:10
  okay,
• 24:11
  that,
• 24:11
  that
• 24:11
  she
• 24:12
  has
• 24:12
  these
• 24:12
  big
• 24:13
  emotions.
• 24:13
  She
• 24:13
  doesn't
• 24:14
  know
• 24:14
  where
• 24:14
  to
• 24:14
  put
• 24:14
  them.
• 24:15
  As
• 24:15
  a
• 24:15
  result,
• 24:15
  she
• 24:16
  impulsively
• 24:16
  tries
• 24:17
  to
• 24:17
  get
• 24:17
  rid
• 24:17
  of
• 24:17
  them
• 24:17
  very
• 24:18
  quickly
• 24:18
  in
• 24:19
  the
• 24:19
  form,
• 24:19
  in
• 24:19
  the
• 24:19
  form
• 24:19
  of
• 24:20
  destructive
• 24:20
  habits,
• 24:21
  maybe
• 24:21
  self
• 24:21
  harm,
• 24:22
  impulsive
• 24:23
  behaviors.
• 24:23
  She
• 24:24
  always
• 24:24
  feels
• 24:24
  empty
• 24:24
  because
• 24:25
  those
• 24:25
  relationships
• 24:26
  were
• 24:26
  so
• 24:26
  hollow
• 24:26
  and
• 24:26
  they
• 24:27
  were
• 24:27
  missing.
• 24:28
  And
• 24:29
  so
• 24:29
  she's
• 24:29
  not
• 24:29
  regulated,
• 24:30
  you
• 24:31
  know,
• 24:31
  on
• 24:31
  a
• 24:31
  personal
• 24:31
  or
• 24:32
  interpersonal
• 24:32
  level.
• 24:33
  And
• 24:33
  she's
• 24:34
  probably
• 24:34
  going
• 24:34
  to
• 24:34
  make
• 24:35
  for
• 24:35
  a
• 24:35
  very
• 24:35
  difficult
• 24:36
  partner
• 24:36
  because
• 24:38
  she's
• 24:38
  not
• 24:38
  regulated
• 24:39
  and
• 24:39
  she
• 24:39
  doesn't
• 24:39
  feel
• 24:39
  safe
• 24:40
  and
• 24:41
  she's
• 24:41
  reaching
• 24:42
  for
• 24:42
  other
• 24:42
  things
• 24:44
  to
• 24:44
  feel
• 24:45
  whole
• 24:45
  again.
• 24:45
  And
• 24:45
  she
• 24:46
  has
• 24:46
  this
• 24:46
  intense
• 24:46
  anger
• 24:47
  that's
• 24:47
  been
• 24:48
  bottled
• 24:48
  up
• 24:48
  for
• 24:48
  decades
• 24:49
  because
• 24:49
  mom
• 24:49
  never
• 24:50
  gave
• 24:50
  her
• 24:50
  a
• 24:50
  safe
• 24:50
  outlet
• 24:51
  and
• 24:51
  dad
• 24:51
  didn't
• 24:51
  give
• 24:51
  her
• 24:51
  any
• 24:52
  outlet.
• 24:53
  It
• 24:53
  never
• 24:53
  disappeared.
• 24:53
  It
• 24:53
  just
• 24:54
  accumulated,
• 24:55
  right?
• 24:55
  And
• 24:55
  so
• 24:55
  this
• 24:56
  anger
• 24:56
  has
• 24:56
  to
• 24:56
  go
• 24:56
  somewhere.
• 24:57
  Unfortunately,
• 24:57
  it's
• 24:57
  going
• 24:58
  to
• 24:58
  go
• 24:58
  towards
• 24:58
  your
• 24:58
  partner
• 24:59
  because
• 24:59
  that's
• 24:59
  usually
• 25:00
  the
• 25:00
  person
• 25:00
  you
• 25:00
  feel
• 25:00
  most
• 25:01
  comfortable
• 25:01
  with.
• 25:01
  So
• 25:02
  there
• 25:02
  goes
• 25:02
  your
• 25:02
  new
• 25:02
  relationship,
• 25:04
  right?
• 25:04
  And
• 25:04
  then
• 25:04
  now
• 25:05
  you're
• 25:05
  in
• 25:05
  despair,
• 25:06
  okay?
• 25:07
  And
• 25:07
  you
• 25:07
  zone
• 25:07
  out,
• 25:07
  you
• 25:08
  disassociate,
• 25:08
  just
• 25:08
  like
• 25:09
  you
• 25:09
  did
• 25:09
  when
• 25:09
  you
• 25:09
  were
• 25:09
  young,
• 25:09
  right,
• 25:10
  because
• 25:10
  you.
• 25:10
  You
• 25:11
  couldn't
• 25:11
  escape
• 25:11
  the
• 25:12
  bad
• 25:12
  circumstances
• 25:13
  at
• 25:13
  home,
• 25:14
  the
• 25:14
  screaming,
• 25:16
  dad
• 25:16
  in
• 25:16
  jail,
• 25:17
  feeling
• 25:17
  alone
• 25:18
  and
• 25:18
  terrified,
• 25:18
  not
• 25:18
  knowing
• 25:19
  where
• 25:19
  your
• 25:19
  next
• 25:19
  meal
• 25:19
  would
• 25:20
  come.
• 25:20
  And
• 25:21
  so
• 25:21
  you
• 25:21
  disassociate,
• 25:22
  because
• 25:22
  if
• 25:22
  you
• 25:22
  can't
• 25:23
  leave
• 25:23
  physically,
• 25:23
  you
• 25:23
  gotta
• 25:23
  leave
• 25:24
  mentally
• 25:24
  and
• 25:25
  emotionally.
• 25:26
  And
• 25:26
  so
• 25:26
  that's
• 25:26
  why
• 25:26
  borderlines
• 25:27
  will
• 25:27
  disassociate.
• 25:28
  And
• 25:29
  that's
• 25:29
  yet
• 25:29
  another
• 25:29
  symptom
• 25:30
  we
• 25:30
  see
• 25:31
  with
• 25:31
  borderline.
• 25:32
  The
• 25:32
  disassociation,
• 25:33
  right?
• 25:34
  And
• 25:34
  that's
• 25:34
  why
• 25:34
  they
• 25:34
  cut
• 25:35
  a
• 25:35
  lot
• 25:35
  of
• 25:35
  times
• 25:35
  to
• 25:35
  feel
• 25:36
  again,
• 25:36
  because
• 25:36
  disassociation
• 25:37
  is
• 25:37
  so
• 25:38
  foreign
• 25:39
  and
• 25:39
  abstract
• 25:39
  and
• 25:40
  you're
• 25:40
  not
• 25:40
  part
• 25:40
  of
• 25:40
  this
• 25:40
  world.
• 25:41
  And
• 25:41
  cutting
• 25:41
  is
• 25:41
  concrete,
• 25:42
  and
• 25:42
  you're
• 25:42
  back
• 25:42
  in
• 25:42
  the
• 25:43
  moment,
• 25:43
  right?
• 25:43
  So
• 25:44
  it
• 25:44
  all
• 25:44
  makes
• 25:44
  sense,
• 25:44
  right?
• 25:44
  The
• 25:45
  splitting,
• 25:47
  the
• 25:47
  lack
• 25:47
  of
• 25:48
  an
• 25:48
  integrated
• 25:48
  self,
• 25:49
  the
• 25:49
  emptiness,
• 25:50
  the
• 25:50
  impulsivity,
• 25:52
  the
• 25:52
  emotional
• 25:53
  dysregulation,
• 25:54
  the
• 25:54
  lack
• 25:54
  of
• 25:54
  trust
• 25:55
  in
• 25:55
  people
• 25:55
  staying
• 25:56
  in
• 25:56
  your
• 25:56
  life
• 25:57
  and
• 25:57
  how
• 25:58
  jarring
• 25:58
  that
• 25:58
  can
• 25:58
  be
• 25:59
  and
• 25:59
  how
• 25:59
  unsettling.
• 25:59
  It's
• 26:00
  a
• 26:00
  really
• 26:00
  brutal
• 26:00
  personality
• 26:01
  disorder.
• 26:02
  And
• 26:03
  it's
• 26:03
  even
• 26:03
  more
• 26:03
  brutal
• 26:04
  that
• 26:04
  we
• 26:04
  equate
• 26:04
  them
• 26:05
  with
• 26:05
  that
• 26:05
  personality,
• 26:06
  because
• 26:08
  it's
• 26:08
  not
• 26:08
  their
• 26:08
  personality.
• 26:09
  If
• 26:09
  you
• 26:09
  think
• 26:10
  about
• 26:10
  it.
• 26:10
  This
• 26:10
  is
• 26:11
  like
• 26:11
  armor
• 26:12
  or
• 26:12
  a
• 26:12
  mask
• 26:13
  that
• 26:13
  they
• 26:13
  had
• 26:13
  to
• 26:13
  wear
• 26:14
  just
• 26:14
  to
• 26:14
  survive.
• 26:15
  It's
• 26:15
  like
• 26:15
  a
• 26:15
  costume
• 26:16
  almost,
• 26:16
  rather
• 26:17
  than
• 26:17
  a
• 26:17
  personality.
• 26:18
  And
• 26:18
  you
• 26:18
  could
• 26:18
  argue
• 26:19
  all
• 26:19
  personalities
• 26:19
  are
• 26:20
  costumes.
• 26:20
  That's
• 26:20
  a
• 26:20
  different
• 26:21
  kind
• 26:21
  of
• 26:21
  different
• 26:22
  conversation.
• 26:22
  But
• 26:23
  it's
• 26:23
  double
• 26:24
  tragic
• 26:24
  that
• 26:24
  we
• 26:24
  as
• 26:25
  healthcare
• 26:25
  providers
• 26:26
  have
• 26:26
  countertransference.
• 26:27
  And
• 26:27
  we
• 26:28
  sometimes
• 26:29
  can't
• 26:29
  help
• 26:29
  but
• 26:29
  judge
• 26:30
  some
• 26:31
  of
• 26:31
  these
• 26:31
  folks
• 26:31
  who
• 26:32
  come
• 26:32
  into
• 26:32
  our
• 26:32
  office
• 26:33
  with
• 26:33
  personality
• 26:34
  challenges,
• 26:34
  because
• 26:35
  this
• 26:35
  is
• 26:35
  fundamentally
• 26:36
  not
• 26:36
  who
• 26:36
  they
• 26:36
  are.
• 26:36
  They
• 26:37
  had
• 26:37
  to
• 26:37
  do
• 26:37
  this
• 26:37
  to
• 26:38
  survive
• 26:39
  really
• 26:39
  dysfunctional
• 26:39
  circumstances.
• 26:41
  And
• 26:41
  it's
• 26:41
  tragic
• 26:42
  because
• 26:42
  at
• 26:42
  the
• 26:43
  end
• 26:43
  of
• 26:43
  the
• 26:43
  day,
• 26:43
  these
• 26:43
  people
• 26:43
  weren't
• 26:44
  loved
• 26:44
  enough.
• 26:45
  They
• 26:45
  weren't
• 26:45
  loved
• 26:46
  enough
• 26:46
  consistently.
• 26:47
  And
• 26:48
  the
• 26:48
  last
• 26:48
  thing
• 26:49
  we
• 26:49
  should
• 26:50
  do
• 26:50
  is
• 26:51
  abandon
• 26:51
  them
• 26:52
  again.
• 26:53
  And
• 26:54
  the
• 26:54
  first
• 26:54
  thing
• 26:55
  we
• 26:55
  should
• 26:55
  do
• 26:55
  is
• 26:55
  hold
• 26:55
  compassion
• 26:56
  and
• 26:56
  space
• 26:56
  for
• 26:57
  them.
• 26:57
  And
• 26:57
  I
• 26:57
  think
• 26:58
  that's
• 26:58
  a
• 26:58
  great
• 26:58
  opportunity.
• 26:59
  Through
• 27:00
  this
• 27:00
  portrait,
• 27:01
  through
• 27:01
  talking
• 27:01
  about
• 27:02
  Haley
• 27:03
  and
• 27:03
  what
• 27:03
  she's
• 27:04
  been
• 27:04
  through.
• 27:04
  And
• 27:05
  I
• 27:05
  know
• 27:05
  it's
• 27:05
  made
• 27:05
  me
• 27:05
  a
• 27:05
  better
• 27:06
  provider.
• 27:06
  Now,
• 27:07
  my
• 27:07
  friends,
• 27:08
  if
• 27:08
  you
• 27:08
  want
• 27:08
  to
• 27:09
  go
• 27:09
  deep,
• 27:09
  if
• 27:10
  you
• 27:10
  want
• 27:10
  to
• 27:10
  be
• 27:10
  the
• 27:10
  kind
• 27:11
  of
• 27:11
  clinician
• 27:11
  that
• 27:11
  doesn't
• 27:11
  just
• 27:12
  press
• 27:12
  buttons
• 27:12
  and
• 27:12
  memorize
• 27:13
  meds,
• 27:14
  then
• 27:15
  you
• 27:15
  need
• 27:16
  to
• 27:16
  go
• 27:17
  to
• 27:17
  patreon.com
• 27:19
  pearlsandprep
• 27:20
  Again,
• 27:21
  that's
• 27:21
  patreon.com
• 27:22
  pearlsandPrep
• 27:23
  it's
• 27:23
  in
• 27:23
  the
• 27:24
  show.
• 27:24
  Notes
• 27:25
  to
• 27:25
  click.
• 27:26
  But
• 27:27
  if
• 27:27
  you
• 27:27
  want
• 27:28
  to
• 27:28
  be
• 27:28
  that
• 27:28
  kind
• 27:28
  of
• 27:28
  clinician
• 27:29
  that
• 27:29
  gets
• 27:29
  the
• 27:29
  how
• 27:29
  and
• 27:30
  the
• 27:30
  why,
• 27:31
  your
• 27:31
  patients
• 27:32
  will
• 27:32
  smell
• 27:32
  it
• 27:32
  a
• 27:32
  mile
• 27:33
  away.
• 27:33
  You'll
• 27:34
  be
• 27:34
  able
• 27:34
  to
• 27:34
  explain
• 27:35
  why
• 27:35
  you're
• 27:36
  switching
• 27:36
  medications,
• 27:37
  why
• 27:37
  your
• 27:37
  patient
• 27:38
  is
• 27:38
  sweating
• 27:39
  and
• 27:39
  not
• 27:39
  just
• 27:39
  suggest
• 27:40
  a
• 27:40
  med
• 27:40
  off
• 27:41
  the
• 27:41
  top
• 27:41
  of
• 27:41
  your
• 27:41
  head.
• 27:41
  And
• 27:41
  you
• 27:41
  don't
• 27:42
  know
• 27:42
  why.
• 27:43
  That's
• 27:43
  why
• 27:43
  we
• 27:43
  built
• 27:44
  this
• 27:44
  library.
• 27:45
  Psychiatry
• 27:46
  becomes
• 27:47
  sticky
• 27:48
  and
• 27:48
  visual
• 27:49
  and
• 27:49
  beautiful
• 27:50
  and
• 27:50
  incredible.
• 27:51
  And
• 27:51
  psychiatry
• 27:52
  is
• 27:52
  going
• 27:52
  to
• 27:52
  just
• 27:52
  click.
• 27:55
  And
• 27:55
  we'd
• 27:55
  love
• 27:55
  to
• 27:55
  have
• 27:56
  you.
• 27:56
  So
• 27:56
  if
• 27:56
  there's
• 27:57
  one
• 27:57
  thing
• 27:57
  you
• 27:57
  don't
• 27:57
  forget
• 27:57
  by
• 27:57
  the
• 27:58
  end
• 27:58
  of
• 27:58
  the
• 27:58
  night,
• 27:59
  go
• 27:59
  to
• 27:59
  Show
• 27:59
  Notes,
• 28:01
  join
• 28:01
  our
• 28:01
  page.
• 28:02
  We
• 28:03
  would
• 28:03
  love
• 28:03
  to
• 28:03
  have
• 28:03
  you.
• 28:03
  And
• 28:04
  thanks
• 28:04
  again
• 28:04
  for
• 28:04
  listening
• 28:05
  to
• 28:05
  another
• 28:05
  episode
• 28:06
  of
• 28:07
  Pearls
• 28:07
  and
• 28:07
  Prep.
• 28:08
  Bye.
• 28:08
  Bye.