Existential Psychotherapy Part 3: Isolation

Preston: [00:00:00] That's how I should start the pod. Every time you're like, hello appendages, how are you doing? Tent poles in 

Margaret: the crowd. Thank you for keeping my ego intact 

if I can live another day tonight. 

Preston: You isolated 

We the moon, how to be patient. 

Welcome back to Had We Patient? I know that you have been patiently waiting for another Monday episode and we have delivered part three.

Have 

Margaret: you've been feeling isolated without us listeners? Probably not. 

Preston: Did you miss me? That's what I want to know. That's the real question. 

Margaret: You 

Preston: always gotta make 

Margaret: it a little weirder than I do. 

Preston: it's lonely here inside my mind. 

Margaret: Did, you know, sometimes some of my friends will like, they'll listen mostly to this podcast, but then you'll one, sometimes when either I say something weird or you say something weird and they know that I'm gonna react, they will pause the audio podcast and go to YouTube [00:01:00] just to go to that point to watch it, to see the face.

They're like, I just, I get a kick out of it. I'm like, you like to see me struggle 

Preston: you? I mean, I think, I don't think I rage bait you 

Margaret: purposely, 

Preston: you 

Margaret: rage bait me. 

Preston: I said purposely You rage. I know I rage bait. You me, I bring it up. It's, I precipitate affect. That's why the rage baiting. 

Margaret: That's oh, very, like that one 

Preston: non therapist we watched 

Margaret: a couple 

Preston: weeks ago, you know, so this is all above board.

Guys. We don't rage bait on this podcast. Did you 

Margaret: guys notice? He's mustache now. This is an educational podcast. Yeah. 

Preston: turn on the video. If you're on audio and check out my upper lip. It's, isolated. 

Margaret: It's isolated. 

Preston: So, and, we're making all these puns because the purpose of today's podcast is to discuss the third concern of man in existential psychotherapy or existentialist approach.

Jason, can 

Margaret: we get a foghorn there, [00:02:00] 

Preston: which is isolation, I dunno. So we will be getting into kind of how to define isolation existentially. But before we do that, we are gonna start with today's icebreaker, which is all about relationships. So Margaret, icebreaker to you is to name a relationship that has done nothing for you.

Margaret: This podcast. Next,

Preston: bingo. Okay. 

Margaret: No, Preston did text me this like three days ago and I said, I think quote girl. What, when, you said a, name, a relationship on air that's done nothing for you. 

Preston: Yeah, this is, the rage baiting chat that we've been talking about. 

Margaret: a relationship that has done nothing for me.

I'm trying to not give you an annoying answer. 

Preston: Well, I think it's okay. You can give me an annoying answer because this is an annoying question. [00:03:00] 

Margaret: That's 

Preston: true. And I didn't tell you this over the text, but I was I think the purpose of the question is to like be intentionally like frustrating.

Because it's like, what do you mean this relationship does nothing for me? Why, does it exist if it does nothing for me? You know, 

Margaret: I think that any relationship always does something to an in us. And so, the idea of a re like relating to me is like, inherently eff affects you and so therefore mm-hmm.

If I am in relationship, like the opposite would be like an indifference and having no relationship if I was gonna have no impact. So I think I'm struggling to come up with one because whether like good or bad, I can't think of something someone I was in a relationship with that didn't have any lasting shaping of my, like, interior landscape at all.

Is that an annoying way? That's a re baiting you? [00:04:00] 

Preston: yeah, exactly. Because I, so I asked you a question. You've given a great like Gavin Newsom political style answer. 

Margaret: This is not a Gavin Politic. it's my true answer. I would say this to you off air too, when you know that 

Preston: Yeah, you're right.

Maybe, it's impossible to have a relationship that does nothing for you. I, think, and we'll get into this later in the podcast, but there are relationships where it's as if one person is equipment and the other person is the user. And I think what I was trying to get at is a relationship where you were the piece of equipment.

Margaret: Well, what would your answer? You 

Preston: identify 

Margaret: that? The question? 

Preston: I think in like, there's like one time in high school where. This girl definitely just like, wanted to get back at a, guy that she liked and was scorned by. And so she like asked me to prom and I went with her, but I like didn't as 

Margaret: a feminist.

Preston: Yeah, exactly. And I think like when I was [00:05:00] there I was like, does this do anything for me? And, it, I guess it did. Like, I can't say it did nothing for me because I was like excited to go to the prom, but I felt like I was equipment I guess in that way. Because I was there to serve a purpose for her to achieve some social competition or, to make someone else jealous.

I guess so, 

Margaret: and I guess in my, you know, frustrating political answer, the way that I would think about that would be is it is in relationship and also that like if it, you're, instead of being in the like quote unquote I vow relationship where there's two subjects. It's the I it. And so it's kind of like 

Preston: mm-hmm.

Margaret: Is that a relationship? If you are using someone, 

Preston: ah, I see. So that's, why you're giving the, challenging answer because you, you've already read Buber and, oh, 

Margaret: I, me and 

Preston: Buber go way back. You, she, already knows how to define relationship [00:06:00] properly. So let us waste no more time on this icebreaker, and let's just get into to the loneliness.

So, so to recap some of these, the, axioms or the, fundamental concerns of men, if you, sorry, humans, you know, history, and her story, you know what I mean? 

Margaret: Women's history month, right Now we're recording. 

Preston: So there's, the problem of death, right? That we're all inevitably gonna die.

Classic. And we have to come to terms with them, you know, I mean, most of us are gonna die. I won't obviously, and. You're a new man. It's impossible. The, next, that was sarcasm. I'm gonna die someday, but hopefully not today. The, next one is freedom, so that we're all inescapably free and then therefore have to make our own choices.

Darn it. Right? And then the next one is, that we're alone. And this is episode three. We're talking about being alone. So to get more into it, I, wanna, I guess, let us define three main [00:07:00] types of loneliness. And obviously you can categorize this into a, million different ways, but this is to kind of help us guide the direction of the conversation.

So the first one would be interpersonal isolation. What comes to mind when I say that to you, Margaret? I'm interpersonally isolated. 

Margaret: I think it would be the kind of like usual way, people mean when they talk about loneliness, at least in like modern Western culture of mm-hmm. Kind of feeling disconnected or not having like.

Intimacy emotionally, physically, or otherwise with other people outside of yourself? 

Preston: Yeah, absolutely. Your interpersonal isolation, like you said, it's the classic picture of being isolated. You're literally far from your family. So technically Margaret and I, this is a, virtual podcasts. We're in different time zones.

We are interpersonally isolated, though we can assuage to my interpersonal isolation by communicating through our [00:08:00] fancy technologies. But interpersonal isolation doesn't just have to be geographically. It can also be like via language or culture. So, you know, if I was alone in a foreign city where I don't speak any of the language, even though I'm around a bunch of people, I don't have a way of necessarily relating to them.

That can be a very interpersonally isolating experience. 

Margaret: Yeah. 

Preston: So. This, we're familiar with the effects of interpersonal isolation. I think we've talked about the interpersonal theory of suicide before that like 

Margaret: Yeah, that's what 

Preston: I isolation. 

Margaret: Yeah. The like feeling like when, like the part of the, one of the writings that we talked about with like the theory of suicide was like that sense of being like anonymous or like being totally disconnected and unknown and walking in a city and knowing no one and being totally disconnected, which is sound, is this picture that you're describing for this first one 

Preston: precisely.

It's, that picture and that kind of starts that train of, you [00:09:00] know, I isolation perceived burdensomeness or like thwarted belongingness, which goes in line with interpersonal isolation and then, you know, increased capability for suicide and X, y, z. So this isn't a podcast about the dangers of interpersonal isolation, but it's important to acknowledge that the, next one would be intrapersonal isolation.

Which is, we're getting a little more abstract now. So what, comes to mind when I say that? Number one? 

Margaret: I think usually I would think intro meaning like within the thing itself. So within the person, A sense of loneliness or disconnection from the self. But I don't know if that's what it means here.

Preston: Yeah, no. Is it, isn't understanding English great? Like 

Margaret: we love her words here. 

Preston: Yeah. And I didn't even prime Margaret on this earlier. Yeah. So you're describing it exactly right. It, I'm 

Margaret: sure he's speeding me. My lines, 

Preston: the teleprompters. There's 

Margaret: another video over here that's just no stop saying 

Preston: no. Do it again into British accent.[00:10:00] 

The intrapersonal isolation is laugh harder is, isolation of yourself from some other party yourself. So like how in interpersonal isolation you are separated from other people. It's that the pillars of yourself are, blocked off from each other, which sounds really abstract, but it makes more sense when you get into psychopathology.

So people can have isolation of affect. They don't have access to their affect, they don't have access to their emotions, they're not aware of their desires. ever of a patient come into therapy and say, I don't know what I should do. I don't know what I should want. Yeah. I dunno what I should feel.

Those are all perfect examples of intrapersonal isolation. 

Margaret: Yeah. I think also, like you could think of some dissociation here as well of like 

Preston: absolutely. 

Margaret: Just not just the, like one form of it would be not knowing and having no access to it. But I think even just like the incongruence, which we always, you know, mark on the mental status exam.

[music]: Mm-hmm. 

Margaret: But like a true incongruence where someone can know that in theory they're feeling a lot of grief or [00:11:00] trauma and they're like laughing or they're like dissociated and distant and kind of hovering outside of themselves. So that. They can know what's there as another form of this could be knowing what's there, but still being like unable to put the pieces together and feel them integrate together.

Preston: Yeah, I love that description. Yeah. Putting the pieces together, and I think that's kind of how I picture it too, is that there's fragmented parts of yourself and in a way it's the job of the therapist and the patient to work together to kind of mend those fragments and make it a whole, again, like you're, like, the purpose of therapy, you could argue is to return someone to a congruent state of being.

Margaret: Now you're talking, like, now you're talking like an analyst. Be careful. 

Preston: I know. Surely I'm becoming an analyst. 

Margaret: Slowly it, 

Preston: the thing I swore to destroy is actually like taking over my life. 

Margaret: Like Luke, I am your father. 

Preston: Yeah, no, really, so. The, and, we see this when a, with a lot of [00:12:00] therapies already.

So like manualized therapies like CBT really focus on like helping people return to their congruence because they have incongruence between their feelings, their thoughts and their behaviors. And the same with psychodynamic therapy, where there's like maybe an isolation from your true motives that are hidden somewhere deep in your childhood that you can help uncover to the patient and then like return to their congruence.

So that's, a target of a lot of different therapy relationships, but it's also a little bit different than existential isolation. So we've kind of established the first two existential isolation is, as Irvin Yalom describes it, the deep seated discomfort with the knowledge that you are ultimately alone in the universe.

This can be very intimately related to interpersonal isolation, also related to interpersonal isolation, maybe exacerbated by the two other phenomenon, but it's a separate and distinct phenomenon [00:13:00] that we are ever presently dealing with and always uncomfortable by because you at all times are living with yourself every moment you're awake, and therefore is the reminder of the loneliness or the isolation you have and I shouldn't actually use these interchangeably because they are different.

Isolation is not necessarily loneliness. 

[music]: Mm-hmm. 

Preston: Loneliness is the unmet need or unmet desire for connection. 

Margaret: Mm-hmm. 

Preston: Where isolation is solitude. Yeah. Which doesn't necessarily have that same unmet need. 

Margaret: That's a really good point. I think one of the places, and I agree with you like that, this is kind of what the existentialist would say, I think.

One of the reasons I don't identify as an existentialist therapist, and maybe I just haven't read enough of like modern existentialists, is that in this, to me, in some ways, similar to [00:14:00] like religious arguments or other philosophical arguments, which is where we are right now with this. Mm-hmm. I don't think it's unreasonable to make the statement that we are fundamentally alone.

And you always, wherever you go there, you are like, everyone says this in different ways, right? That you cannot escape the self. And I think there are many philosophies that would view how you kind of draw the boundaries up around the self very differently. What, why are you, what 

Preston: I'm smiling because you are predicting these great segues 

Margaret: already.

Preston: Oh, I'm sorry. So I'm sorry. So when, we come back from this break, there's no need to apologize Margaret. we will get into how we conquer these fears of isolation if it means mending or massaging the boundaries of the ego and where it can go wrong and where it can go, right? So just after these messages,

Margaret: sometimes emotion [00:15:00] regulation looks like sensory comfort. And for all of my sensory comforts, I like Preston, is showing on the video right now, use cozy earth blankets, comforters, and socks. What do you use to comfort yourself, Preston? 

Preston: I mean, I would show you the socks that I'm wearing, but I'm too comfy under this cozy earth cuddle blanket to get up.

I'm actually not sure if I'll ever get up again. I might just live here. 

Margaret: Well, we'll talk about that later. But what you can trust is that there's a hundred sleep guarantee to be able to return any products that aren't fitting with you. But we think you probably won't make many returns and there's a 10 year guarantee.

Preston: So use our code patient. At cozy earth.com and make sure you include us in the post-purchase survey because we did send you, 

Margaret: and in the meantime, we wish you a lot of emotion regulation. You're gonna need it for the rest of this episode, 

Preston: or at least a blanket.

So Margaret teased very well that a lot of isolation comes [00:16:00] from how you define or draw the lines of the self. And that can be one solution. I think what I want to get back to is the, initially, at least the existentialist framework of isolation, which is that you have this thing kind of sitting in the back of your head, I think almost like a hole that's just burning in you at all times.

And you have to find a way to cover it. And if you're not addressing it, it's just hurting in you. And this is different than some of the other existential problems. In a lot of the defense mechanisms we have are denial based for things like death or for freedom. There are times where you can delude yourself into thinking you're not making a choice, and you're like, I don't have to decide right now.

I can do something else. I'm not, don't feel like I'm deciding, or death is so far along the way that, that, to me, it's like, it doesn't exist, but loneliness that's always there unless you're directly like addressing it, you know, anytime you're alone in a hallway or driving alone in a car, like it's a reminder that you really are alone in this world.

So [00:17:00] the ways that humans can conquer this burning hole in their side is through relationships and through redefining the self. That's, just what we are driven to do as humans. It's not psychopath pathologic to pursue a relationship that's, 

Margaret: yeah. In the same way. It's not, 

Preston: I wanna say like, that's, a healthy 

Margaret: human thing to like eat a hamburger when you're hungry.

Like, it's 

Preston: like 

Margaret: this is a probably an evolutionary healthy desire. Or function. Yes. At least genetically speaking. 

Preston: Yeah. Yeah. Genetics speaking philosophically, speaking, romantically speaking, like all like the drive to seek relationship is, like a fundamental human need like eating, drinking, breathing.

It's really the psychopathology comes out and how we pursue those relationships. And so I, guess to start out with, we should probably define the ideal healthy relationship and Margaret kind of mentioned this earlier, which is the I vow [00:18:00] relationship. So to take a step back, Uber, 

Margaret: I vow relationship 

Preston: super smart dude.

He kind of defined two main types of relationship. There's the IB relationship or iu, sometimes it's translated to, and there's the i it relationship. Margaret, how would you differentiate between those two types of relationships? It seems like you're, familiar with, your boy Boober and you all go way back.

Margaret: I took a philosophy. A philosophy of love, the fiction of love and a theology of love class in college. So we're like, me and him are divas together. I mean, I think what we talked about at the beginning, right, the sense of like one, like being used is you're probably the it in the i it relationship at that point.

I think one of the ways that one of my professors used to talk about it was this fundamental idea that the other person, [00:19:00] it's sort of like the real key quote we had in that episode a long time ago is fundamentally always going to be a mystery to you. and some would p call it a mystery and a gift, and that I vow, if you're both subjects, then you're kind of equal in the power and playing field and equally unknowable to each other while still reaching across and trying to make contact.

Whereas I, it would be kind of the like conquering using, not seeing. In one's mind, viewing yourself as a subject and like the other person, sort of as just like a moon that revolves around you. 

Preston: Yeah. How would you define it 

Margaret: though? 

Preston: I like the moon analogy. I like the piece of equipment analogy.

I'm actually going to use Aristotle's, one of his frameworks for, friendships to split it for me because he talks a lot about, like similar concepts. So Aristotle describes three types of friendships. There's friendships of utility, there's friendships of [00:20:00] pleasure, and there's friendships of virtue.

So friendship of utilities, a relationship that is based on like mutual need or support. Friendships of pleasure are, I think self-explanatory relationships where both parties derive some sort of mutual pleasure out of it, whether it's, you know, drinking together, laughing together, having fun together, having sex, like those are all like relationships of pleasure.

And the first two I described are relationships that are a means to an end. I, need food. So I work with you to gather stuff. I need a ride to work. So we carpool, that's a friendship of utility, but I'm ultimately using you as a ride. You are a means to an end. So those first two are the i it type relationship.

Mm-hmm. The friendship of virtue is an end unto itself. Your friends with them because of who they are. And that's, the IU relationship. So one thing that I think is also important about like the IU relationship is that [00:21:00] you are both individuals in this relationship, which means you have to reveal every part of yourself in the same way.

So you can't disclose only like a little bit of yourself and expect it to be an IU relationship where you are showing all that you are while also attempting to see the other person earnestly. And honestly, if you're like kind of hiding those parts of yourself then, that kind of reduces things to the.

It relationship. Mm-hmm. And that can be like a very hard challenge to conquer for someone who's trying to get over their sense of isolation and truly relate to other human beings. And, the core of that. And, I guess flipping it on, 

Margaret: wait, 

Why do you say, I don't disagree with you, but can you like, draw the connection for me that it's hard for someone who's lonely to overcome that?

I don't necessarily disagree with you, but I'm wondering where your brain Yeah. Connected that. 

Preston: So, so there, there's an irony to this. and [00:22:00] in, in the book existential Psychotherapy, they describe it as the rich getting richer and the poor getting poorer, which is that if you have such a need to overcome loneliness, your, yearning for connection starts to turn those relationships into a means, to an end, to assu that yearning for connection.

Then it almost like blockades you from being totally vulnerable and being totally needs leadless with them, because then it's almost like it reduces all of your friendships to a friendship of utility because I'm just using you to not feel lonely, and I can't see you for all that you are because you, have become equipment to me because I'm just so afraid and frazzled and I just wanna not be alone.

Margaret: And I like you, you being an a vow threatens me because like what I'm using you for is so tenuous and I'm so like uncertain and insecure in it that I need you to be [00:23:00] in this like box so that I can like, fit it into the slot that says like, now I have friend, or Now I'm not lonely, or This pain of loneliness won't come back.

Preston: Yeah. And it sounds like what we're describing is really abstract to, maybe some of you listeners. So I'm gonna try to kind of bring this into a simple, like pool analogy. So let's say, both Margaret and I are in the pool and we can both tread water. It's a lot easier for us to have fun in the pool.

We're treading water and talking to each other. And, you know, maybe, we, put our hands together and, you know, make a little teepe for it or something. Or we can like, play with the pool noodles. But like, we can be friends in the pool because we're both knowing how to function there.

But if Margaret doesn't know how to swim, no, actually, sorry. Margaret's an extrovert swimmer. If I don't know how to 

Margaret: swim, I'm not, you can make me not know. Have you holding 

Preston: my 

Margaret: nose if I jump in. 

Preston: She's drowning. She's flailing. You know what I mean? And I'm like, oh, Margaret, you wanna have fun in the pool?

And I swim over to you [00:24:00] and you're being like, oh, thank God. And then you're just jump on me and start like pushing me down. But you're not trying to push me down. You're just trying to get above water. Like, how can we have a good back and forth jolly old time, the pool when you're just using me to not drown the whole time.

You're like a buoy, thank God. And, you're probably in the pool drowning. Be like, anybody, somebody a con, a sense of connection. That's all I need. That's all I want. 

Margaret: Right? How can he expect me to not use him when I'm drowning here in this pool? 

Preston: Mm-hmm. So, so that's the irony of it, is that the person who needs most to learn how to swim and be friends with people is like the person who's least equipped to do that.

Margaret: This reminds me, I know we're not talking about this right now, but it reminds me of like exposure therapy episodes we've done and like some of the things you can run into with that, especially if someone has like social anxiety where there's like a mythology that they get their anxiety builds up from their experience of feeling really anxious and therefore avoidant and then like ruminating around any social things [00:25:00] that happen that like.

The solution for this existential question through CBTR exposure is like spamming somewhat like low to moderately distressing. Like 

Preston: Yeah. 

Margaret: Put to use the metaphor, like kicking your feet in the pool with like a kickboard or whatever. And so it's just interesting to think how, like, this existential question also like we go into the granularity of like clinic next week and like, it's like this is how we're gonna work on this existential question through the lens of ccbt.

Preston: yeah, exactly. And like we're, just spamming kick boarding so that when you can, when you doggy paddle a little bit, you maybe have a chance to like play with somebody else in the pool. 

Margaret: Exactly. 

Preston: You, might not be as strong as a swimmer, but like by God you're not flailing, you know, 

Margaret: no one drowned.

Preston: Yeah, 

Exactly. So, What we're talking about is, a way to achieve what was, in essence a needless relationship where I don't need anything from that person and therefore I [00:26:00] can be vulnerable with them and they can be vulnerable with me. But when you have these need-based relationships, we see them kind of come out into a couple different flavors.

And this doesn't perfectly map, but the way I organized it, I put it in line with people with our categories of interpersonal dysfunction. So the personality disorders ultimately. So the, first one is where you are hoping to avoid isolation. So you essentially surrender your ego and your sense of self, and you try to stick it onto somebody else.

You know, if I am afraid of drowning, 

Margaret: like dependent personality, 

Preston: right? I'll just hop on someone's back, I'll let them swallow me. And that's kind of like the type C or like dependent organization. So, They see themselves as whole or they're the or. You can delude yourself into thinking you're not isolated.

As long as you have someone else to overpower you, make decisions for you. Like give you the direction, give, you where you are. And, I guess you could see [00:27:00] like theories about this almost in like the way people engage with like sad of masochistic, like sexual fantasies. The idea that like someone has like tied you up and they have full control over you in almost like a b DSM setting.

Yeah. It's like, it that probably is, or you could argue, is so cathartic to that person because that's like that confirmation that they are not isolated because like they have completely surrendered their ego and they're now like, you know, someone's slave or something. At least, in this like relationship dynamic.

So it's kinda like one way to look at it. The next one would be where you swallow others. So that's. Basically weaponizing or like an extreme version of like the I it relationship where, you know, I'm in charge of this other person. they're all adore 

Margaret: me as a narcissistic appendage. 

Preston: yeah, exactly.

or even like a histrionic appendage too. Like these, are all my [00:28:00] fans or these are all like, like people that adore me or look up to me. Like they, they are a means to supporting my ego, but, ultimately they're tech 

Margaret: goals and need to start a podcast, 

Preston: right? Yeah, exactly. 

Margaret: They need my me to be in their ears every Monday morning, 

[music]: five 

Margaret: 30.

Preston: That's how I should start the pod. Every time you're like, hello, appendages, how are you doing? Tent poles in the crowd. Thank you for keeping my ego intact. Fucking live another day tonight. Isolated. 

[music]: We capture the moon. 

Margaret: The moon is my fragile sense of salt. Okay, sorry, I interrupted 

Preston: your, I didn't sign up for this.

No, it's good. you, I mean, you hit the nail on the head. So yeah, you can, swallow others. D 

Margaret: always, 

about minions on this podcast, 

Preston: right? Yeah. This is, this is the DMI mommy in that sense. and then the last one [00:29:00] is, essentially almost like the delusional rejection of the need for, interpersonal engagement.

So this would be like the cluster A ones. 

Margaret: Gang So 

Preston: it's like, 

Margaret: lemme avoid, but 

Preston: you don't actually, 

Margaret: what's up? What's up? 

Preston: Don't actually need it after all, I'm just gonna stick my head this sand. Good. And I never need to relate to someone anyways. Yeah, 

Margaret: never needed that. 

Preston: And then, I guess parallel to all of those, there, there are ways that we can, not necessarily in a one-to-one sense, but in a one to all sense, dissolve the boundaries of our ego and then kind of calm that anxiety around isolation.

And this could be in something like joining the military. So 

Margaret: ego, sound accurate, eagle noise here, accurate ego. 

Preston: What is like.

It's a really soft, softer than that grown as podcast that redhawk sound. Yeah. So, so if you go from instead of I to we, that's a great way to make [00:30:00] you feel better about this like, painful isolation that you're experiencing. And, the military does a great job of that. You literally, you shave your head the second you show up, you get rid of all your civilian clothes.

Like, it's a environment that's designed to purposely break down your ego so it can be rebuilt as a unit. And that, that for a lot of people is, it's a healing experience for this like, piece of existential dread. and it's even outside of like military environments. There, there's no denying that.

I think we are as a, at least artistically as a culture, are fascinated by scenarios where humans have melted away a little bit of their ego and act cults together. Cults, 

Margaret: Yeah, 

Preston: yeah. Cults are fascinating 

Margaret: to us. Or like mob mentality. 

Preston: I was even just gonna say hip hop dance too. 

Margaret: Oh. 

Preston: Like, you see 12 people go out on stage and they all look like individuals, but then they dance in sync.

That like their ability to unify as one is like awe inspiring and fascinating to [00:31:00] us. Like we, we like themes of individuals coming together and being we 

Margaret: Yeah. 

Preston: That like flash. 

Margaret: So like a symphony. 

Preston: Yeah, like a symphony. Exactly. So obviously there are, and these aren't pathologic necessarily, but there can, it lives on a spectrum, right?

Where you have to learn how to balance this dialectic of the eye within the we 

[music]: I like that. 

Preston: Yeah. I know. They're everywhere, right? Like, how do you it's like I am, I'm an individual, but I'm also part of a group. And so when you let yourself become completely swallowed by the group, that can be dangerous.

Or when you completely resist and never become a part of the group, that's also dangerous. So 

Margaret: see, this is where I feel like the history of. Psychology and psychotherapy and psychiatry is hindered by our lack of inclusion of other cultures from other parts of the world. Or it's, just not as broad as it could be because like, I'm gonna probably say this word wrong, [00:32:00] but there is a word that I came across a number of years ago.

I'm trying to make sure I'm getting this right. 

Preston: So lemme tell you about my high school's motto while you search that up. It was called Ubuntu. 

Margaret: That's what I was gonna say. 

Preston: Yeah. Kuer High School. Shout out Ubuntu. It, means I am because we are 

Margaret: like, no, literally dead ass. That 

Preston: was like a whole thing.

Search. 

Margaret: I'm literally writing ton and keeps coming up with like, oh, it's a web server type of coding. I'm like, no. 

Preston: Yeah. Linx. Yeah. It's like the tech bros took it over. Stop it guys. I No. 

Margaret: Stop taking good things. T I've heard it like translated as I am me because we are us. 

Preston: Mm-hmm. 

Margaret: Which is like beautiful and like also like in Catholic theology and Christian theology too in many other places.

But like in Catholic theology, the common one we use is like, is this like idea of like, Christ is the head, but then all of us are like within one body and like someone's an eyeball. Someone they, [00:33:00] I don't know if it has to get this like concrete. Mm-hmm. Someone's like the left pinky toe, someone's, you know, whatever.

Like the, and then there's value in all of these different pieces coming together. And actually the wholeness in this case, in the divinity, but also just in general is through the all of us dissolving the selfhood, kind of like you're saying. Which you haven't mentioned religion because I yell at you when you do, but I'll mention religion as another way that we think about this.

Preston: No, and I think that's a great point. And I haven't mentioned religion in the prior episodes, but religion has a lot of great answers to these existential problems. And ultimately some could say like, like religions are invented to answer the existential problems. So like they do a good job of like giving people solace 

Margaret: and for those who are religious, who listen, they also could be ex existential problems and maybe your religion does have the answer and didn't invent them.

So just putting that out there as you know. 

Preston: Sure, 

Margaret: Not just opioid for the masses as, [00:34:00] Marx called it. 

Preston: Yeah, ab absolutely. And it all just depends on where your faith lies. 

Margaret: Mm-hmm. 

Preston: I was gonna say, it reminded me a little bit of attack on Titan when everyone's like a part of what, oh, it's an anime.

So, so basically why these are all, 

Margaret: why do, men always try to get me to watch anime 

Preston: do? if you wanna watch attack on Titan, speed up right now. But basically all the titans are related from the same like birth mother Yame. And so there's like all the descendants live on the island together.

And I was like, oh, like I am because we are, but they're all descendant of the same Titan. You know. 

Margaret: Okay. 

Preston: Through, like Mother Yu. It's pretty interesting. It's, Ubuntu really. Attack on Titan is Ubuntu. 

Margaret: I can't believe that was your high school's motto. 

Preston: Yeah. Yeah. And, our whole thing was like an Impala too.

So I guess like Africa related [00:35:00] adjacent, yeah, gooder high school. Good work guys. The, okay, so we are gonna take another quick break and then when we come back we'll stop talking about all the ways isolation goes wrong and start talking about how we can actually help people overcome isolation. 

Margaret: Love when we do that.

Preston: Can anything be done? Find out after these messages?

Margaret: We know that a lot of people who listen to our podcasts are also therapists and maybe running their own practices. And as someone who is brand new to the game of opening my own private practice, simple Practice has been a really, important tool for me. 

Preston: Simple Practice is an all-in-one EHR that is HIPAA compliant, high trusts certified and built specifically for therapists.

It brings scheduling, billing, insurance, and client communications into one place so you're not juggling multiple systems to run your practice. 

Margaret: And one of the features that I'm really excited for that [00:36:00] can help with the business side of things is automated reminders for your patients to help reduce no-shows as well as other components of billing and insurance to make the business side a little bit less of a heavy lift.

Preston: And if you're just starting out or growing your practice, there's also credentialing service that can take the headache out of insurance enrollment, which can honestly be a huge lift. So if you're ready to simplify the business side of your practice, now's the perfect time to try Simple practice. 

Margaret: Do it with us.

Preston: Start with a seven day free trial, then get 50% off your first three months. Just go to simple practice.com to claim the offer. Again, that's simple practice.com.

So one of the, first ways to bring someone into a healthy relationship is to identify the ways in which they're not fully engaging. And that's kind of like our job as a therapist is say like, what's, like holding this person back from engaging? And a great trick from the book was actually to [00:37:00] ask the question, how many people are in the room right now?

And, we can take a little more abstractly obviously. 'cause it's like, okay, there's two people in the room, or here, there's one person in the room. But like if you're in group therapy 

[music]: mm-hmm. 

Preston: For example, like Dr. Yan uses like a couple anecdotes where there's a patient speaking in a group therapy and.

He would ask himself how many people are in the room? And it, really only ever felt like there was like one person in the room with like, when one of the patients, like Meredith for example, was speaking. 

And so then he would like reflect that back to the patient, Hey, if only it feels like you're the only person in the room when you talk.

You know, like, like you don't engage us, but like you use us as an audience in some way. And if you are doing things that take away from your ability to be present while you're talking with someone, like maybe only thinking about the answer that you're gonna have or if you're gonna say something funny or say something smart, like you are not being present with that person and addressing them.

And I actually wanted to [00:38:00] bring this up because it's something that I feel like I've struggled a little bit in podcasting. I think that when we try to kind of bounce off each other as a host, I am thinking about. All the people that might be listening to this, I'm thinking about, you know, the producers that are listening and how it might be perceived, how you might perceive me, but then that takes all the people out of the room where it's really supposed to be a relationship between you and I, and it keeps me from authentically interacting with you.

So I, was actually reflecting on this a lot. I was like, huh, sometimes when I'm on this podcast, it's like I'm the only person in the room, and that prevents me from achieving this goal of having an eye vow relationship with Margaret. 

So, it's useful. 

Margaret: First of all, I, wanna appreciate that. Like you just said, something quite vulnerable, which is really hard to do.

It makes me quite curious what it felt like when you were the person, like when you [00:39:00] had the solo episode, which is a little bit different in terms of the dynamics. It sounds like you were, I, know you've been reading about existentialism and reflecting on this for like weeks to months, at least now in terms of the, for this podcast.

Mm-hmm. But I do wonder, like when you did the podcast and it was like you, as the main person guiding the conversation, did it feel like you were more present or less present or the same? Was there any difference in the dynamics there? 

Preston: Mm-hmm. I think it was, both and I think there were ways that I was, more present and less present.

I think I, I thought less about the next answer that I was going to give, which, it's not my intention. Like I think a lot of this comes from insecurity, right? I'm trying to put on what I think is a good podcast. I'm not having, I don't have this perfect comfortability being conversational, which I think is natural for anyone who's like getting into the entertainment space and or learning a new [00:40:00] medium.

And I guess I've been doing this for about a year, but. It's almost impossible not to think about how other people might be perceiving you. And that leads you to imagine 'em in the room rather than being present with that person. So, 

[music]: mm-hmm. 

Preston: Where sometimes in our more structured episodes, I'm already thinking about like, where do I want this episode to go?

And that takes away like, 'cause we, because for the audience who's listening, we actually have like outlines or run of shows that we try to do and we try to follow them and sometimes we go off the beaten path in one way or another and one person's having fun going on an anecdote and the other person's like, alright, I need to guide the show to where I wanted to go.

And, like, so it's like self-induced stress because you guys don't actually, you guys don't actually know where the show's supposed to go, but we're like freaking out internally and then it takes away from the amount of people that are in the room, I guess for the purpose of this episode. So with like the am mean episode, I think, I don't think I had as much structure for it, so it was easier not to focus about that.

But then I think I was almost imagining you like looking out on the [00:41:00] episode because it was like me running solo and I'm wonder. What would Margaret think about like how I'm representing the show right now? 

So like that those things like took away from it and not that like I didn't have the utmost intention to be present, but like any one of those things that kind of fill in and become that other person in the room takes away from the two people in the room there.

So yeah, I was like more present in some ways and less present in other ways. 

Margaret: I mean, we'll, get back into the topic, but one, I just appreciate you sharing this. I also think, I mean, I don't know listeners you can tell us, but showing up and one of the things I appreciate about the last episode, or maybe it was, I guess it was two episodes now when you guys were, when you were talking about the meme, was like talking about the showing up concretely and what happens with it on social media.

and then the thing that you and I have talked about, I think maybe on the, Patreon probably before, but like also off, off screen is I think I have this view of you as similar to [00:42:00] like. Or Dr. Glaucomflecken, one of our producers, as you guys know, as like, you do this, you face the camera and you talk to the camera and you do this.

And so I think I've, even though I know that this is not how it works, I think from the beginning, I've always expected you to find it easier than me. But I think because you're used to being in front of the camera and talking to the camera, you have like really high good standards for yourself, but also it can make it feel like really high stakes.

Preston: Mm-hmm. 

Margaret: And so I appreciate your effort in pushing through them and reflecting on them. 

Preston: Oh, thank you. and those stakes make it harder to, they become barriers, you know, themselves. it's like the rich get richer and the poor get poorer. like same thing at figure skating. You know, Alyssa Louw the 

Margaret: exact same thing.

Preston: It's the exact same podcasting is like figure skating, Alyssa Louw, and putting all this pressure on herself. That's why she's out there repping Oakland, spinning to gold. Where the other skaters, they're, cracking under the pressure. And then you [00:43:00] need to be relaxed to put on a, i have heard, I'm not a figure skater 

Margaret: patriotic stuff, 

Preston: but I've heard if you relax and you have fun, you, put up a better program.

Margaret: I'm connected to everything and I'm attached to nothing, as she says. 

Preston: Yeah, I think it's beautiful. So that's, so 

Margaret: we haven't solved loneliness yet, though. 

Preston: We did a little bit. So, and we got at some of it, which is first, identify how many people are in the room, figure out the ways in which someone's holding back and being less vulnerable.

When someone finally does open up, Margaret actually did what you're supposed, not that you're supposed to do anything, but you ask horizontally, revealing questions rather than vertically revealing questions. Or you ask for horizontal disclosure, not vertical disclosure. So to kind of key you in a horizontal disclosure is to be meta about the disclosure itself and say.

Hey, I think that was really hard for you to disclose. What are other times when it's been hard for you to disclose or engage with this, which seemed like this offbeat anecdote, but that's [00:44:00] exactly what Margaret did, which was pause, take a second to acknowledge that Preston was disclosing this thing, and then talk about its, relationship in another context.

Whereas the, I guess the therapeutic mistake in that context would be for Margaret to try to like, push deeper and say like, tell me more about how it's really hard for you to be present with me, and like, what are other things that are like barriers to this? Because, 'cause it, me going down and like revealing kind of some of like the vulnerable innards, like that's already like a hard carve.

So it's like you don't wanna immediately push deeper into the bullet hole. You just kind of wanna ask about what it was like revealing that to you. So, like that's, like, I think a good first practice when you do identify that the patient is speaking to less than, you know, two people in the room and you, they say something profound.

Just, call out that disclosure and kind of. Beat around it. In that way that will help like create the more authentic relationship. 

Margaret: guys, I didn't prepare for this episodes, but you're, just, you're [00:45:00] leading, the horse to water than this year of the horse. You're, 

Preston: she's 

Margaret: prompting We're on the same page today.

Preston: Yeah. It's just, Margaret's just a good therapist. I think that's, all we're learning. 

Margaret: Don't say that 

Preston: on the pod. 

Margaret: You know, I don't like compliments. Don't say that. 

Preston: And, the next one, this is gonna sound so lame, but it's just modeling a healthy relationship with your patient. You don't need to be encouraging them to be vulnerable, you know, need to be digging into all this stuff, but you need to just show that you are being authentic.

So here's where it really sucks, and the fact that you as a therapist need to be going to therapy because like, you have to be able to present your whole self to the patient during that session. If you're trying to model for them a full, needless, healthy relationship, obviously that's never gonna be totally true because there's a couple elephants in the room.

One of those being that you're being paid to be there, like that can't [00:46:00] not be acknowledged or ignored. Also, that, like you, you have a set period of time. What you can do is say for those 50 minutes in this session, you have my utmost attention. You're my utmost priority, and I am like modeling for you right now.

A healthy relationship. 

Margaret: Yeah. That kind of corrective experience of relationship. 

Preston: Absolutely. And the strongest actually evidence we have in psychotherapy. You can correct me if I'm off base on this, is around the psychotherapeutic relationship. So it, so almost no matter what modality you use, whether it's CBT or DBT or anything else, if you have a positive relationship, good rapport with the patient, they have better outcomes.

[music]: Mm-hmm. 

Preston: And actually it folds well into our episode, which is essentially saying if you have a good relationship with the patient, you are treating their isolation. And patients who have successfully treated isolation are gonna get better. Like, I guess that's how I was like [00:47:00] viewing it as I was like prepping this chapter.

Margaret: Well, and I think to the point of it, right, like many people who are isolated, or who struggle with relationships and like for our listeners, like I think that running into like feelings of loneliness or isolation happens to everyone at different points in life. Like the in and of itself, it's not necessarily a pathology.

because I, do think that there can be a modern, like, phobia of loneliness that is like a like more of a phobia of like solitude with your own thoughts. 

[music]: Mm-hmm. 

Margaret: but often people who are struggling to make connections. Have had these emotional experiences or they've had like a drought of emotional experiences where connection was safe, it was warm, it was reciprocal, they weren't being used.

There was attunement and there was like healthy repair and disclosure. And so the therapy when it works [00:48:00] well is like the therapist showing up every week, being kind of glad to see you, which I know we're gonna talk about the humanistic approach, which is one of my favorites, but mm-hmm. Glad to see you.

Curious about what's happening, creative about how to be helpful like that repeated week after week Like it makes sense to me that therapeutic alliance is the thing across therapies that seems to be a huge part in predicting whether the therapy is gonna help and last. And it's because it shows you like a relationship that doesn't have maybe all the shit that the other relationships someone's been through has had.

Preston: Absolutely you're going to see a therapist that has unconditional positive regard for you and is showing you like a needless interaction. It, I wanna say intercourse, but like you're not literally having intercourse, it's just like a discourse between two people. 

Margaret: Yeah. I mean, I think also though like, like long-term therapy, like it is [00:49:00] needless in that it's like very much obviously as you were saying, like professionally pay-wise, power structure wise, it's focused on serving the person in front of you.

But in long-term therapy, eventually, like a need of therapist is also there. So like if you like went on maternity leave as a therapist, like that is the need of the therapist and some of the humanity of the therapist coming into the room and then negotiating. I think that's actually a huge part of also the like helpful part is when there's.

Imperfections, not crimes, but imperfections on the part of the therapist or inability to meet needs. Right? Because I mean, we've all had experiences as like therapists or clinicians where we can't meet a need for whatever reason. And then the ending of the therapeutic relationship as also part of this corrective experience around loneliness and what it means to be close to another person and known even if it doesn't last forever, or if there's like rupture or the needs aren't met.

[music]: mm-hmm. 

Margaret: I just think that like [00:50:00] a lot of times in like dynamic therapy we talk about like, we're really like in business, like we're really doing work when like the client kind of gets mad at you or gets like sad about something and, speaks up and says, Hey, I didn't like that. not every client will present the same way, but like, but that rupture and repair is also part of like the loneliness problem because people are lonely also.

If every time a relationship starts to have depth or has conflict, they like think the relationship is over. And they are doomed to be isolated and alone fundamentally for the rest of their life. 

Preston: Yeah. Have like, modeling a healthy relationship also means navigating conflict with someone. 

Margaret: Mm-hmm. 

Preston: It's, so important.

The, and we will get into the humanistic stuff in a second, that the last kind of part I wanted to add to this is that there's like a, the secret sauce or secret spice, which is almost like the ineffable portion. Irvin Yam describes this as like, what makes your grandma's [00:51:00] Armenian soup recipe so good that you could follow the cookbook perfectly, but you're not gonna make it the way grandma does because she adds just like the, herbs in the right way and does, the little small nuances.

And these are things that are hard to capture and replicate that even if she tried to tell you every exact way to do it, she couldn't. 

Margaret: I'm thinking of Ratitude. 

Preston: He always like, yeah, I, literally watched Ratitude last night. 

Margaret: we are like this right? 

Preston: Ling So, yeah. So instead of going ling weeny, you can just try your best to cook because as Gusto would say, anyone can cook, but it takes someone who's fearless to be great.

And that's what you can do in therapy, which is find those moments to be fearless with your patients. It's, there's a, an interesting, and I'm not saying be unprofessional, but there's an interesting book, called like clinical excerpts and like breakthroughs, that they talk about in existential psychotherapy, which is saying that it really describe, describes all these individual cases where [00:52:00] patients had those like epiphanies or breakthrough moments or there was like some large progression in therapy.

And a lot of them will come from times when like the therapist kind of breaks down and like gets frustrated or exasperated. They show parts of their humanness and like there, there was one scenario in there where the patient had a narcissistic organization. They would come in and they would just. On the therapist.

[music]: Mm-hmm. 

Preston: Like day after day about how like you're probably not gonna help me anyways 'cause you didn't go to good enough school and you're probably too stupid to even figure out what's wrong with me and I'm too complicated and all this stuff. And then one day the therapist just slams his fist and says like, well you stop ragging on me.

Come on. Fun. Like, are we gonna talk about why you can't connect to anyone or figure out your own issues? Or you can just insult me all day because I'm having a terrible day. And like him yelling at the patient like this gets quiet. And then the patient like has this moment like, oh my god. Like that. Like that's what it took for him to have that epiphany.

[00:53:00] And, in a weird way, like you could say Uhoh, like the party was like, oh, you shouldn't be like negative and yell the patient, do all these other things. But the second that therapist like slammed their fists on the table and like was vulnerable, they truly entered the eye vow relationship with the patient and showed their full vulnerability and were present with them.

And you could argue like that moment that like spark was enough to help like break the ice. For that like, sense of isolation. So like 

that's 

Margaret: first of all great acting that out as the therapist. second of all, there's this paper called The Theory of the Crunch by Paul Russell. that is kind of what you're describing, like giving it a, fun name too.

Like this paper starts with, there's one psychiatric condition which presents the appearances of repetitive crises. The life of the individual appears to be chaotic, and crisis strewn relationships are endangered almost as an everyday event. The psychiatric name for this condition is borderline personality disorder.

Again, it doesn't have to be this all the time. I propose the exploration of the emotional crises and the way it becomes woven into the individual's [00:54:00] repertoire of repetition by consideration here. and it's just the, one of the ways we talked about this paper in my, like analyst fellowship thing was like.

Exactly what you're saying, where it's like you come in and eventually the whole world is in the room. Like the whole, of life and every, all their parents and everyone and whatever, and your, you know, stomach ache that day as a therapist. And the thing happens again and again if we really get into the therapy, like this is the core of dynamic therapy is that the thing happening outside eventually comes in and eventually it happened so much.

And then there's this like, true moment of meeting and that true moment doesn't make it so it's like, and now everything's solved. And we had the insight and epiphany and now all these patterns are fixed. But like, it is like the breakthrough moment, like you're saying from this of the, like, it doesn't always look like, okay, well what is it?

But it, it often looks like something like that where there's like two real people in the room, still boundaried, but like [00:55:00] meeting this thing that is kind of the thing that's causing all the problems outside, outside the therapy room. And it's finally come into a reenactment in the room and is being worked out.

And that's why I think you would like dynamic. 

Preston: Yeah. no, I think I would and this is the stuff, I think we capture it in films like, like when people think of the therapist finally snapping and I think 

Margaret: goodwill Hunting 

Preston: Giving. Yeah. Giving the real truth to it. Yeah. Yeah. Like Goodwill hunting, Robin Williams is demonstrating like the I vow relationship when he's, when he goes, you know what, you might have memorized every book in the world, but you don't know what the inside of the Sistine Chapel smells like.

You know why? Because you ain't got experience kid that, that's like the second one, like those two connect, you know. So we're gonna talk a little bit more about like how to engage in these relationships. In the Patreon section, we're actually gonna watch the Eli Manning or the Peyton Manning of humanistic psychotherapy and building a relationship with the patient.

Carl Rogers himself, 

Margaret: [00:56:00] love that guy down a 

Preston: five minute interview and then we'll kind of react to it and talk about it. so if you wanna learn more about that, you can go over to the Patreon. Other than that, 

Margaret: we'll solve your loneliness for the low, cost of $8. 

Preston: It's a latte Patreon. People don't worry about it.

Margaret: We'll, or can ask this for in the Spotify comments, which we always say, 

Preston: I live for the Spotify comments I live. Okay. Off to the Patreon section. Do 

Margaret: you can catch the next part of this on Patreon. 

Preston: It's patreon.com/happy Patient Pod. And you guys missed out on really interesting Carl Rogers discussion.

Feel free, figure things out to check out our other page there. Yeah. I feel so much less isolated. That's, incredible. Anyways, y'all, thank you so much for listening. thanks for all the, I have 

Margaret: some comments for us for 

Preston: comments. Okay. Yeah. 

Margaret: Did pick one, did you pick one also? 

Preston: No, I wanna hear it from you first.

Margaret: So I just wanna take you guys to the Spotify comment section, which is my, again, is our beloved all. It's mostly, honestly, you guys, it's because I didn't know that this existed before we had the [00:57:00] podcast that you could comment in, I think only on podcast episodes. and I just wanna look at the one from the most recent episode, which was Amin episode.

I did comment and said I was in fact on island time, and then someone said, Elliot Usin said, love how you shared your reflection with this school disciplinary action. You're going to build such great rapport with your patients. Last year being the six seven really helped me connect with the littles and create such a laid back environment for them, and they're engaging with healthcare workers.

Amino from the episode said, fire emoji. Michael Wilson said, great episode. Josh Symbo said W episode. so we are in there. and we appreciate you guys being in there. Honestly, every time I check it on like Tuesday or Monday, like afternoon, I, get a kick out of going in there and just collecting so much 

Preston: of all the platforms.

We, we just became sims for the Spotify comment section. [00:58:00] 

Margaret: It's like when you realize you could like message your friend through a Google Doc back in the day and be like, we're commenting on this Google Doc.

Preston: So, 

Margaret: okay, now we're serious. 

Preston: But back to er comments where you can leave them on Spotify. Tell us how the show is, if you're enjoying this series. This is part three of four, so we have our closer coming up soon. I've been contemplating bringing a guest for the last one, but we'll kind of see how it works out For episode four of Psycho of Existential Psychotherapy, meaninglessness Strikes Back, or whatever we are gonna call it, you can chat with us on Instagram, TikTok at Human Content Pods.

I'm at its prerow on Instagram and YouTube. Margarets at Badar every day. And you can also find us at how do We Patient Pod on Instagram? We're there guys, our actual neopet, we're approaching 4,000 followers. If you wanna be 4,002, you know where to go. Ken 

Margaret: Wal. 

Preston: you can always find full video episodes on YouTube and Spotify.

We're also [00:59:00] gonna be on a new platform for MedEd coming soon. Possibly we'll be able announce that later. We're your hosts, Preston Roche and Margaret Duncan. Our executive producers are me, Preston, Roche, Margaret Duncan, will Flannery, Kristin Flannery, Aron Korney, Rob Goldman and Shanti Brook. Our editor and engineer is Jason Bizzo.

Our music is Bio Mayor Ben V to learn about our program. Disclaimer, ethics policy, submit submission, verification, licensing terms, and our release terms. Go to how do we patient pod.com. Reach out to. Reach out to us at how to be patient@humancontent.com with any questions or concerns. How to be patient is a human content production.

Thank you for watching. If you wanna see more of us or if you wanna see, this is [01:00:00] lilac. She's my cat. She's gonna be waving her hand at one of the floating boxes, which will lead to more episodes. Lilac Point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there. They, probably exist for real.

But in the meantime, I'm just gonna pet lilac and then I'm gonna go dance in the background.