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In addition to her private practice Dr. Feinblatt also works at Westside Treatment, an intensive outpatient program for addiction & mental illness. Dr Feinblatt (who is also a BetterHelp therapist) can be reached at:

Dr. Feinblatt shares her experience as a therapist in working with co-dependent clients; how is co-dependency defined, what are some characteristics and how can it be treated or managed? She also shares about the importance of codependents learning about setting, enforcing and respecting boundaries.

Episode notes:



This episode is sponsored by BetterHelp online counseling. To experience a free week go to www.BetterHelp.com/mental

In addition to her private practice Dr. Feinblatt also works at Westside Treatment, an intensive outpatient program for addiction & mental illness. Dr Feinblatt (who is also a BetterHelp therapist) can be reached at:

www.drnataliefeinblatt.com

https://www.instagram.com/drnatalief/

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https://www.betterhelp.com/natalie-feinblatt/

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Episode Transcript:



Transcription services donated by Accurate Secretarial LLC. You can find them at www.AccurateSecretarial.com.

Welcome to Episode 330 with my guest Dr. Natalie Feinblatt. I'm Paul Gilmartin. This is the Mental Illness Happy Hour, a place for honesty about all the battles in our heads, from medically diagnosed conditions, past traumas and sexual dysfunction to everyday compulsive negative thinking. This show is not meant to be a substitute for professional mental counseling. I'm not a therapist. It's not a doctor's office, though we do have a doctor as a guest today. Yeah, this is more like a waiting room.

And the Web site for this show is Mentalpod.com. Go there, fill out a survey. Read a blog. Browse the forum. Donate to the show. Do whatever you want. We're going to talk a lot about codependency today. We're going to talk about boundaries. And we are going to talk about how to get the most out of therapy, because Dr. Feinblatt is a therapist.

A note about this episode, we mention some 12-step programs in this, and this is not an endorsement necessarily of any particular 12-step program. We used it to talk about some of the characteristics of codependency, so I just kind of wanted to make that clear, because 12-step programs, one of their traditions is, it should be something not to be promoted through the media, rather something that, yeah, anyway, I'm overexplaining myself now.

But let's see. Oh, how can I, how can I almost skip talking about BetterHelp.com? I talk about it every week. I love it. It's working for me. I think you should try it. It's online counseling, BetterHelp.com/mental. That's the portal to go for, so they'll know that you're one of our listeners.

So, go to BetterHelp.com/mental. Fill out a questionnaire. You'll get matched with a BetterHelp.com counselor. You get to experience a free week of counseling to see if online counseling is right for you. You've got to be over 18, and it's great. We touch base, my therapist and I, sometimes midweek. Normally our session is video to video Fridays at 5:00, but sometimes we'll check in midweek, and it's great. It's really great. So, BetterHelp.com/mental.

This is an Awfulsome Moment, and I want to read this. This was filled out by Zoloff Her Rocker, and she writes, at the exact time when my depression was getting better, my mother's was getting worse. Whereas I at my lowest would cry in the shower or alone in the car on the way to work, my mother's mental illness sometimes manifests itself in fits of rage and a general ticking-time-bomb condition.

One day, starting to feel well enough to actually take care of myself, I decided to prepare myself a meal. Cooking yourself delicious and healthy meals is supposed to be a form of self-care, right? However, almost immediately after I had finished eating whatever it was I decided to make, my mother exploded into a fit about the fact that I had gotten some cooking spray on the stovetop that she had just cleaned.

Did I have any idea how long it took her to make that stovetop spotless? Did I even care that this was making her horribly depressed? Did I care that I was ruining her day? Did I care about anything or anyone but myself? I apologized and offered to clean up my mess, but she refused my offer. Per usual, I didn't respond. I shut down and probably locked myself in my room or left the house, and I definitely cried.

Later, after ignoring each other for a little while, we once again ran into each other in the kitchen. She opened her arms, initiating an embrace. I accepted, though I stood in her arms for those few moments stiff as a board. I wanted to let myself melt into her arms but I couldn't bring myself to do so. I could only linger in her embrace and feel a few pathetic tears trickle down my cheek.

This was the moment I was waiting for. This was my apology, my peace. This was her admitting her mistake of blowing up at me. She held my gaze for a moment longer, touched my shoulder and said, I forgive you.

[Show intro]

PAUL: I'm here with Dr. Natalie Feinblatt, who I met at a really, really cool thing, a luncheon that was put on by a health care provider and they invited a bunch of psychiatrists and psychologists and people in the mental health field, and one jackass named me.

NATALIE: No [chuckles].

PAUL: And I met so many cool people there and you were one of them, and we talked about all kinds of subjects, but today, I put some, I asked the listeners to ask questions of you that you tend to focus on more in your practice.

NATALIE: Right.

PAUL: Because you're a clinician.

NATALIE: Mm-hmm. That's what I do. I work with people.

PAUL: We're going to talk about codependence and how to get the most out of therapy--

NATALIE: Yeah, the process of therapy.

PAUL: --and we're going to talk about boundaries, obviously--

NATALIE: Oh, yes.

PAUL: --which you can't talk about codependency without boundaries.

NATALIE: No [chuckles], no, you can't.

PAUL: Should we just dive right in with some of the questions, or is there anything you'd like to say first?

NATALIE: Yeah. No, I mean, I have the notes that you wanted me to, the points you wanted me to hit. I'm sure we're going to weave some of those in there, and I tend to be hyper-organized, so I may start crossing stuff off the list as we talk about it [chuckles].

PAUL: No worries, no worries.

NATALIE: But, yeah, we can go ahead and start.

PAUL: Okay. I put it out to Twitter and Facebook for people to ask questions, and the first one is, can you explain the difference between codependency and, quote, normal attachment.

NATALIE: That's an excellent question. I'll try not to say that too much, because I think most of them are pretty good questions.

So, one of the problems I think with codependency is, well, it's kind of a double-edged sword. The good side is that over the last like, I don't know, 20-something years, it's kind of exploded in popularity and recognition and there's been books and Web sites and blogs and things like that, which I'm all about raising awareness so I think that's great.

The downside, though, has been that it's kind of an amorphous topic. People say the word codependency, but then when it's time to define it, they're kind of like, I [questioning tone], you know, it's kind of vague, you know.

PAUL: Mm-hmm.

NATALIE: So, the one thing that I really like to point to, and I've looked at it enough that I have some of it by rote memory, but the program Codependents Anonymous is a 12-step program, obviously for people who struggle with codependency, and on, it's one of their pieces of official literature, they have a list of codependent traits and characteristics. And it's free on their Web site, CODA.org. You can find it somewhere on there, and it's a great way to kind of really nail down what codependency looks like.

And it's not that you have to have every single trait, because there's a lot [chuckles], to be codependent, but if you have more than not, then the odds are that you have some issues with codependency.

PAUL: People generally, if they're open-minded, will know if their bell has been rung.

NATALIE: Yes, indeed.

PAUL: And what is the difference between CODA and Al-Anon? It's Al-Anon, I know it's for the loved ones of somebody who is an alcoholic, but I always thought that Al-Anon was really about codependency.

NATALIE: It is. And I say this as someone who has great love for both programs. They're not super different. Al-Anon, the differences the way that I see them is that Al-Anon is specifically for people who have a loved one in their life who is an addict or alcoholic, using or sober, whereas CODA, you don't have to have an addict in your life.

It can be problems in any relationships with any kind of people in your life. So, it's kind of, they're kind of the same thing, except Al-Anon has a more specific focus, but you're right, it's a lot of the same stuff, a lot of the same stuff.

PAUL: Another program that I hear good things about is ACoA, Adult Children of Alcoholics or dysfunction.

NATALIE: Yeah.

PAUL: Some people I know that have tried that have really found a lot of help there.

NATALIE: Yeah, yeah.

PAUL: And I just want to point out, you know, there is a tradition in 12-step programs to not personally identify yourself as a member of one when you're speaking in media.

NATALIE: Right.

PAUL: And that is why I, because I'm not a member of these specific 12-step groups that we're talking about, it's why I feel it's okay for me to talk about it.

NATALIE: Yes, understandable, understandable.

PAUL: And for people that don't know why that is a big deal if the person who is a member in that 12-step program is okay with people knowing about it. It's really to protect the program, and a lot of people don't understand that, because if somebody is bad representation, talking really publicly about belonging to a particular 12-step program, that may negatively affect people's image--

NATALIE: Oh, yes.

PAUL: --and likelihood of going to attend that program, so that's really what, and if you see somebody in the public media saying, I’m a member of such-and-such and this, that person is not obeying one of the traditions--

NATALIE: Yes.

PAUL: --which is there's 12 steps and then there's 12 traditions.

NATALIE: Well stated. And to just kind of get more of a fine point on that original question, so, the way that CODA has the list of codependent traits and characteristics is they have it broken down into, I believe, five categories, and let's see if I can remember. Low self-esteem patterns. Compliance patterns. Control patterns. Oh, goodness [chuckles]. I might have to pull it up on my phone.

And the way that they have it broken down is that codependency is different from normal attachment, because codependency either leaves you and/or the other person feeling kind of icky about the relationship.

Healthy attachment, which, you know, I wish that we could all aim for 100% healthy attachment all the time, that would be lovely, but I don't know that that's possible, but generally, healthy, secure attachments don't feel uncomfortable on a regular basis, don't feel like a huge effort on a regular basis, whereas codependent relationships do. There aren't these huge emotional ups and downs in healthy attachment relationships. There's maybe the occasional issue, but codependency is like a roller coaster.

PAUL: And usually I think some of the red flags are aching, obsessing--

NATALIE: Oh, yes.

PAUL: --constant fantasy, fear of speaking up for yourself, lest that person stop loving you.

NATALIE: Oh, goodness, yes. And the thing, it's funny because some people might hear me say control patterns and be like, well, what was that about, because it's been my experience that, more often than not, especially in the beginning of their recovery, people who are dealing with codependency identify with the compliance patterns, like being a people pleaser, not speaking up for yourself, etc., etc., and the control patterns is kind of like, well, I don't do that, I'm not a control freak, I don't try to control other people [chuckles].

PAUL: That seems like the big surprise to people that get into codependency support groups.

[Chuckling]

NATALIE: Yes, yes. And it's oftentimes, okay, the CODA Web site isn't working for me right now. But, it's just CODA.org.

PAUL: Okay. I'll look it up.

NATALIE: And you can hopefully find it from there. It's just bugging me what those other two categories are. But it's my experience that the more people dig into their recovery from codependency, the more they come to realize that they actually do have a lot of controlling traits, because ultimately, if you really take people-pleasing to its logical conclusion, yes, you're trying to make the other person happy and that's a form of control [chuckles].

[Chuckling]

NATALIE: You know, you're doing it so they won't get mad at you, right?

PAUL: Yes, because you're pushing your idea of what a good life looks like to you onto them.

NATALIE: Right, exactly. So, on the surface level, it looks like it's more about them, which there's a part of it that is, but if you really start digging deep into it, it's also a form of trying to control your environment, you know. So, that's kind of a lengthy answer to that question.

PAUL: Is it, what is codependency, is that it--

NATALIE: I think so, yeah.

PAUL: Yes. Would you like me to just read, tell you what the three--

NATALIE: What are the five categories, can you--

PAUL: Denial patterns.

NATALIE: There we go, that's the one, it's so funny to forget denial. Yes.

PAUL: Low self-esteem patterns. Compliance patterns. Control patterns. And avoidance--

NATALIE: Avoidance, okay, I forgot denial and avoidance.

PAUL: You avoided avoidance patterns.

NATALIE: I did, I avoided it--

PAUL: [Whispering] What's that about, Natalie?

[Chuckling]

NATALIE: Paul, I don't know what you're talking about. Throw in a little denial there for you as well. Thank you for that.

PAUL: So, if you could kind of, without us saying what each one of these are--

NATALIE: Just give you a little summary?

PAUL: Yeah--

NATALIE: Okay.

PAUL: --maybe, so denial patterns.

NATALIE: Denial patterns, that's one that a lot of people first come into recovery with, which is like, I don't know who I am, I don't know what I like, I don't know what I'm feeling or when I'm feeling it, and/or, if I'm having negative feelings, I'm doing everything I can to not acknowledge my negative feelings. Sorry, let me go back.

I'm very picky about words [chuckles]. My clients can tell you this.

PAUL: I think that's great.

NATALIE: I don't believe in negative or positive feelings. I believe in like painful or comfortable feelings. So, if I'm having painful feelings, I'm doing everything I can to try to not have those painful feelings. So, it's either complete unawareness of your feelings or actively trying to like shove them somewhere.

PAUL: When somebody has the latter, how often is that related to that person having been raised in an emotionally invalidating environment?

NATALIE: I mean, I don't like to say always or never, but it's [chuckles], it's a pretty high likelihood, because, just to go off on a little bit of a tangent, you know, there's been a ton of research, like neuroscience research in the last 10, 15 years, probably a little bit more than that, around these things called mirror neurons that are present in like primates and humans.

And to boil it down, also because I don't know the intricate scientific ins and outs of it, when we are very tiny, like infantile, our brains need the faces of our caregivers to mirror what we are going through, and that's not to say that if a baby is crying the parent should start crying with them [chuckles], but the parent should look concerned and be like, oh, you're sad, I'm so sorry you're sad, right?

PAUL: So, to feel seen and safe.

NATALIE: Right, because that teaches you that you exist, right, that you're real. But unfortunately, so many people do not get that as the response, or if they're angry, their parent is like, oh, you're really angry, I see that you're upset, you know, I can understand why it's that way. It's, don't feel that way, or let me--

PAUL: So the first one is good, that you said.

NATALIE: Yeah. And the other, you know, the other option is, you know, either don't feel that way, which isn't good, or let me drown you out with my anger, which is also not good. So--

PAUL: Or let me distract you to this other part of your life here that you should be grateful for--

NATALIE: Right, right, right. Yeah, so all that invalidation can absolutely lead to somebody growing up and being like, I have no idea what I'm feeling when I'm feeling it.

PAUL: And would it be fair to say that the person that comes in saying that and thinking that is really, really good at surviving by knowing who they think they need to be in any given situation--

NATALIE: Oh, 100%.

PAUL: --to please other people or succeed or whatever their idea of survival looks like.

NATALIE: Absolutely, yeah. People with codependency are usually very, very good at reading other people and at adapting, you know, but often at the expense of the self.

PAUL: And would you say that that's probably why it's so often linked to having a parent who is addicted or abusive--

NATALIE: Mm-hmm, oh, 100%.

PAUL: --because that kid has to survive, has to go, is this the day that Dad's going to beat everybody or--

NATALIE: Mm-hmm, yep, 100%. Yeah, that's more often than not where it comes from.

PAUL: There was one other thing about codependency that I wanted to, about denial. Give me an example of an environment that somebody was raised in, things that were said to them or an environment that would go underneath most people's radar as being something that would set somebody up for having difficulty recognizing their own feelings.

You know, we talked about somebody saying, you know, don't feel that way or replace the anger with their anger. Would you say that somebody where they weren't actively dissuaded but it just wasn't modeled for them, is that enough?

NATALIE: I, well, yes, I see what you're getting at, and I think that for some people, if, you know, if the parent is kind of doing a do-as-I-say-not-as-I-do type thing, where it's like, I'm going to do my best to be emotionally healthy with you, but I'm not going to be healthy with myself or with my partner that I'm raising you with, it can cause less damage but, I mean, it's still going to cause damage. There's only so far that do as I say, not as I do can go [chuckles], you know what I mean.

And something that came up for me in terms of an example, and it just came right into my head because I've thought about it a lot, because when I saw the movie I thought that was a perfect exchange, the movie Black Swan with Natalie Portman, which is just a good depiction of, you know, deteriorating mental health in general, but there's a scene closer to the start of the movie, you know, in the movie, and I'm not spoiling anything for anyone. I mean, it's an old movie, come on, you should have seen it by now.

[Chuckling]

NATALIE: And there's a scene where Natalie Portman gets the lead role in this ballet and, you know, but she had to do some stuff to get it that she wasn't feeling real great about, and, you know, her mom comes home with this huge strawberry cake, you know, and this girl is obviously, you know, has some sort of an eating disorder, you know, because she's a ballerina and that happens a lot and she's, you know, she's not in the business of eating cake all the time.

But her mom brings this big cake home and she's like, oh, my God, I'm so happy, you know, here, let's have, it's your favorite cake, I'm going to make it for you, or we're going to eat it, and Natalie Portman is just kind of feeling really mixed about the whole thing, so she's like, yeah, I don't, I don't really think I'm going to have any.

And her mother immediately changes, gives her this look and she goes, well, fine, then I can just throw it away. You know, and then of course she's like, no, no, no, no, I'll have a piece, I'll have a piece, it's okay, it's okay. But that little exchange is such a great example of emotional invalidation and manipulation and having to, you know, be the caretaker--

PAUL: And the parent making it about them--

NATALIE: Exactly.

PAUL: --but presenting it as if they, it's about the child.

NATALIE: Yeah. And that's one where it's like, well, nobody hit anybody, like it can't be that bad, but a lifetime of those little moments messes people up.

PAUL: And I assume that we're going to touch on, at some point, the anger of stuffing feelings.

NATALIE: Oh, yes, oh, 100%, yes, yes.

PAUL: Okay, and how that is let out. Okay, so we talked about denial patterns. Anything else on denial patterns?

NATALIE: Not that I can think of, no.

PAUL: Okay.

NATALIE: Maybe I'm just denying it.

[Chuckling]

PAUL: Low self-esteem patterns. And, by the way, to the person who's going to go check out this Web site, it's C-O-D-A, CODA, dot org, and there's probably 10 under each list of, each heading of a pattern, so it would probably be worth it for somebody interested in this to go check it out on their own.

NATALIE: Oh, absolutely. I literally, and it's funny because, just to bring this up, is BetterHelp still a sponsor on the show?

PAUL: They are.

NATALIE: Okay. So, I work on BetterHelp, too. It's like my little side gig, you know.

PAUL: Oh, cool.

NATALIE: And I really enjoy it. And it's so funny because I cannot count the number of times I have sent the link that you are looking at to somebody on BetterHelp, like, why don't you just look at this--

[Chuckling]

PAUL: Yes.

NATALIE: It's a really good concrete list of things that I think you might be dealing with, let me know what resonates for you.

PAUL: The CODA.org.

NATALIE: Yeah, at CODA.org, that very link, I have sent it to quite a few of my clients on BetterHelp, more than not of whom have been like, oh, my God, this is, this is everything that I, you know. It's like, yeah, I had a suspicion.

So, the low self-esteem patterns, you know, that one's a little self-explanatory, but I want to touch on one that has been a question for people in the past, which is, one of the traits on there, one of the little bullet points, is believing that you are better than other people. And I've had a lot of people say to me, well, that's not low self-esteem. Like, what does that mean? Like, if you think you're better than other people, you have like really high self-esteem.

And good self-esteem is believing that you're equal to other people, right, that you're not better or worse than anyone and no one else is better or worse than you. So, the idea that you're seeing yourself as superior to others most likely means that in reality there's a big part of you that believes you're inferior to others.

PAUL: I see. So, your ego is trying to make things safe by saying, no, you're actually, we're better, it's going to be okay--

NATALIE: Yes, yes, yes [chuckles]. And I've heard addiction and codependency described as diseases of extremes, and I, you can curse on this show, correct--

PAUL: Oh, yeah, yeah.

NATALIE: Oh, good. So, because I will, but one of the things I love about that is you can swing between the extremes of, I'm the shit and then I am shit, right, and so that's the high and the low self-esteem, neither one of which is healthy.

PAUL: Yeah.

NATALIE: Right, you just want to be like we're all on the same level here [chuckles].

PAUL: The day that it occurred to me that wanting to be better than other people and get attention for being spectacular would not bring me closer to other people.

NATALIE: I know.

[Chuckling]

PAUL: The way to get closer to other people is to be one of many and relate, find your similarities, not set yourself apart so people could marvel at you.

NATALIE: No. Right. And it's not that we're saying like people can't be special. Everybody is unique and special and has their own awesome talents, but nobody is better or worse than anybody else, yeah.

PAUL: Right, trying to make that your goal, is to--

NATALIE: Right, no, no.

PAUL: --well, tell me, what would the difference between wanting to be the best at something, number one in the world, or being, doing it to the best of your ability?

NATALIE: Well, I think you kind of said it, which is that if you, you should be wanting to be the best at something for your own recognition, right, and maybe for some smaller degree of recognition, but if you're doing this for the point of beating other people, if you're doing this for the point of getting love and adulation, that's not going to work out for you in the long run.

It's like the idea that money can make you happy. Money can't make you happy. How many celebrities do we see in the tabloids every day are doing miserable stuff despite having all the money and attention in the world, right?

So, it's about doing, whether it's, you know, an athleticism or a talent you have, it's about doing it to the point where you're like, wow, I feel really good about my abilities in this area, versus I'm doing this to win an Oscar and that's my only reason, you know. It's like, that's going to make you feel happy for like a second, you know.

PAUL: Yeah. Sometimes when young stand-up comedians or podcasters will come up to me and ask for advice, the thing I always say is, ask yourself why are you getting into this, and if you're getting into it to become famous or become a millionaire, that's, that's not good.

NATALIE: No.

PAUL: That is not good for your mental health. If you were getting into it because you love the craft and you want to be creative and--

NATALIE: Hopefully make a living at it, if you're lucky--

PAUL: --hopefully make a living at it, that is an awesome way to approach something.

NATALIE: Agreed.

PAUL: So, could we then say that staying out of the result of this effort that you put forward is an important component of being mentally healthy while also trying your best.

NATALIE: I would agree, yeah. Absolutely.

PAUL: Okay. Anything else on the low self-esteem? This, I think this one's really important, have difficulty making decisions.

NATALIE: Yeah. That's one that I know a lot of people can identify with, just, and for a lot of different reasons. One of them might be the denial thing, of like not knowing what the heck you want in any given situation. One of them might be you don't want to make decisions for fear of picking the, quote, unquote, wrong thing, as if there is a wrong thing, right, because you might get in trouble because maybe that's what happened in your family, you know.

PAUL: Or you might be successful.

NATALIE: Oh, yeah, and that would challenge--

PAUL: Talk about that, fear of success.

NATALIE: --that would challenge the low self-esteem, yeah [chuckles].

PAUL: Is there a component of low self-esteem that is comforting to people, because they--

NATALIE: Oh, absolutely.

PAUL: --it gives them a sense of self, well, at least I know who I am?

NATALIE: Yes, yes. And that's one of the reasons that I think change and going into treatment can be so difficult, is that, you know, humans by and large really like to be comfortable, right, so even if what you're used to and what's comfortable is horrible, a lot of times people prefer that to something that makes them uncomfortable, right, and that's--

PAUL: Or new.

NATALIE: Or new, exactly, and that's a large reason why a lot of people stay out of treatment for addiction for so long. It's like, well, yeah, being an addict is, my life is terrible, but at least I kind of know what to expect and I, it's familiar to me, you know, challenging that, even though it seems really counterintuitive, like wouldn't you want things to be better, challenging that, doing stuff that's new can be really, really threatening for some people.

PAUL: Talk about listening to your body.

NATALIE: Hm. In regard to making-decisions feelings?

PAUL: Yeah, just in general, in terms of codependence, you know, which, in my opinion, is about regaining autonomy and finding the authenticity within yourself.

NATALIE: Absolutely, yeah.

PAUL: And maybe this is just me putting my personal stuff into it, but for me, the biggest change happened when I stopped numbing myself by doing things addictively, and gave weight to what it was I was feeling in any given moment and didn't listen to the part of my head that was saying, well, you're an asshole for feeling annoyed by being around this person. What if there really is something--

NATALIE: Yeah, how about that?

PAUL: --that is not healthy in this relationship. So, by that I mean listening to, I guess my feelings, your body, your feelings, when rage comes up, when--

NATALIE: Yes, absolutely. Well, that's something that I've worked with a good number of people on, both in individual therapy and I've also done it in group settings a good deal of time, which is, because I work mostly in addiction, which codependency is very tied to, which another, you know, we'll get to that in a little bit, but--

PAUL: They're the Thelma & Louise of mental health.

[Chuckling]

NATALIE: Oh, yes, that's a great way of putting it. If you don't get treatment, you will be going off that canyon cliff.

PAUL: But you'll have a loved one.

NATALIE: Yes, you will. You won't be alone.

[Chuckling]

NATALIE: So, a lot of people, either through codependency or substance use, their connection to their thinking has been so altered and changed that they really can't tell what they're feeling. That's where your body can really come in handy, because usually your physical sensations can give you a good idea.

And it's not like there's a formula, like, oh, tight chest equals fear. Like, that might feel like fear for some people. Other people might feel it in their stomach or their hands and their feet might start to tingle, whatever it is, the idea is that, okay, you don't know what you're feeling, why don't you describe to me what's going on in your body and maybe that'll give us some clues as to what you might actually be feeling.

And then, you can start to know that when you get that tingly, you know, hand-and-foot thing, then you know, oh, I must be scared of something, what's going on here, right, so that can be a really good step for people who are really disconnected from their feelings.

PAUL: How do you know when you are listening to your body and giving weight to what is happening in the moment, and you actually, it actually being a product of your distorted thinking and the threat isn't real?

NATALIE: Hm. That's an excellent question, and this is something I'm probably going to say multiple times during this interview, but this is where getting outside help can be invaluable, and I don't mean necessarily going to therapy. That's one way of getting outside help.

But talking to people in your life that are healthy or talking to your therapist or, you know, whoever it is, getting outside of your own head is super important in making change, right, because odds are you can't, what is it, you can't, you know, fix the problem with the mind that created it, most of the time. So, if you're really stuck in your head and you're like, I don't know if this is legit or if it's based on old information or what's going on, that's when you need to start talking to people.

PAUL: And because this is so complex.

NATALIE: Mm-hmm.

PAUL: It's not going to be fixed by going to some place for a week--

NATALIE: Oh, God, no.

PAUL: --and you will, you'll be changing for the better as you're doing this, and then your perception of things will be changing.

NATALIE: Absolutely.

PAUL: And different challenges will become presented. Anything else on the low self-esteem?

NATALIE: Not that I can think of.

PAUL: The next grouping is compliance patterns.

NATALIE: These are kind of the classic ones that people think of when they think of codependency, you know, people-pleasing, going along with what others want, even if you want something different, not saying no, you know, this is kind of the classic stereotypical codependence stuff, which most codependent people will have some of these, not necessarily everybody, but most of them should be able to identify with at least a few of these.

You know, having a really hard time stating your preferences because you're scared the other person is going to be like, I don't like that, and then you're going to be like, oh, my God, you know. Pretending that you like things just because it's what somebody else likes, when in reality you're like, I don't really like that, you know, just having trouble being an autonomous person.

PAUL: And authentic.

NATALIE: Authentic, autonomous person, yeah.

PAUL: And would you say that this is where a lot of the rage is built in?

NATALIE: Oh, yes. Oh, my goodness. People-pleasers are probably some of the angriest people that I work with, understandably so, you know.

PAUL: That's a lot of steam to bottle up.

NATALIE: Mm-hmm. And I like to conceptualize it as kind of like a number line, where there's two, again, coming back to the theme of extremes, one extreme is passivity, right, which is compliance, which is just going along with what everybody wants regardless of what you want. The other extreme is aggression, right, which is trampling over other people and probably hurting them in the process.

In the middle, the balance is assertiveness, right, which is being able to be authentic without trampling on other people. And the problem with being passive is that that, people can only build up so much anger and passivity before it explodes into aggression.

PAUL: Passive aggression, right?

[Chuckling]

NATALIE: Yeah, yeah, exactly.

PAUL: Because you got to hide it, because otherwise it looks like you have needs and opinions.

NATALIE: Yeah, exactly. Oh, heaven forbid [chuckles]. Yeah.

PAUL: Anything else on compliance patterns?

NATALIE: Nh-nuh.

PAUL: Okay. Control patterns.

NATALIE: Hm, these are the ones, again, like I said before, that people, a lot of people have a hard time identifying with at first, and understandably so because often, a lot of times codependents get into relationships with controlling people and that's the last thing they want to think about, about themselves, like, I'm not like that, I'm not a controlling person.

But like we were saying, you know, a lot of codependency is about managing other people, right? And yeah, you're doing it to meet their needs, but you're meeting their needs to meet your needs [chuckles], right, if that makes sense.

PAUL: And probably also to not have to look at yourself.

NATALIE: Oh, absolutely, absolutely. So, and that's kind of the Al-Anon angle to things, where it's like, if I can just spend all my focus on trying to manage this other person, I don't have to look at myself because they're like a full-time job, right? Yeah.

PAUL: How often does a marriage become volatile once one of the partners sobers up and then the--

NATALIE: Oh, my gosh, yeah.

PAUL: --and then the codependent doesn't have something to fixate and criticize.

NATALIE: Oh, my gosh, I could talk about this for a very long time [chuckles]. It's huge. I mean, so many people, whether it's parents or spouses, think that once the other person gets sober everything is going to be okay. And once the other person gets sober, things are going to be a lot better, but new issues are going to emerge, one of them being that you're not going to be able to focus on managing them all the time. What are you going to be doing with yourself, you know?

PAUL: Your pain is still going to be there.

NATALIE: Yeah, absolutely. And the place where I work, the intensive outpatient program where I work, because I have my practice and then I work there, we do a lot of family work, and I'm not one of the family people, but obviously most of my clients have a family, so we have a separate family person and we all coordinate together.

And it's really [sighs], it's probably good that I'm not the family person [chuckles], because I get really opinionated with families, but it's really amazing to me how often so many families, parents, spouses are push, push, pushing the person in recovery to do the work on themselves, and then when the family coordinator is like, well, let's talk about your work on yourself, it's like, what? Me? No, no, no, no, no. You know what I mean?

And sometimes it becomes like legitimate, really difficult resistance. You know, Al-Anon, I don't have time for that. Therapy, that costs money, I'm not doing that. But they're doing all these things that are continuing to make the relationship difficult, even though their loved one is, you know, newly sober. So, it's really challenging when both people or every member of the system, the immediate system, doesn't do their own work.

PAUL: It seems often with the couple where one is an addict and the other is codependent, that one person is addicted to substances and the other person is addicted to being self-righteous and victimized and--

NATALIE: Yep, yep, absolutely. And just like the addict needs outside help for their addiction, those people need outside help for their issues, too.

PAUL: Anything else on control patterns?

NATALIE: Nope.

PAUL: Then the last grouping is avoidance patterns.

NATALIE: Yeah, avoidance, that can be a big one. It's interesting because oftentimes people think of codependency as like somebody who wants to glom on to everybody, and that can be part of it, but there's also a lot of people who identify as being codependent who are, who isolate a lot, who avoid social interaction a lot, oftentimes because their relationships tend to be so painful and messy that sometimes they just don't want relationships at all, right, which, again, is an extreme.

Right, you have a choice, you don't have these enmeshed codependent relationships or isolation, right, there's a happy middle ground in there. But until you get into some sort of recovery, you can swing back and forth between these two extremes of crazy-messy relationships and then I'm a hermit, you know.

PAUL: It sounds very similar to, you know, a lot of sex abuse survivors have social and sexual anorexia, or they withdraw--

NATALIE: Very similar, very similar.

PAUL: --from things that are nurturing and supportive to them. Why would those, why would they both have that characteristic? Is it because trust was difficult?

NATALIE: It could be because trust was violated at some point. It could be because, I mean, you know, I, when you work in addiction, you can't avoid becoming somewhat skilled at working with trauma, because so many people with addiction have a trauma history.

And obviously, when it comes to sexual abuse, the trauma is very obvious, what happened, but when it comes to codependency, for people who maybe don't have any history of sexual abuse or physical abuse, there can still be emotional trauma that happened in their lives that never got treated, and trauma tends to cause people to swing to extremes.

And the way that we talk about it in the field, which I'm not crazy about. I've been meaning to research if there are different ways to put this, but the idea is that there's big-T trauma and little-t trauma, and I kind of don't like that because the little-t kind of sounds like diminutive in some way. It's not meant that way, but that's just how I interpret it.

PAUL: We've talked about that on the show, actually--

NATALIE: Oh, have you? Yeah, yeah, okay. So, big-T trauma is like the stuff that pretty much everybody can recognize as trauma--

PAUL: You were held hostage . . .

NATALIE: Right, you know, you were in an earthquake, you were sexually assaulted, you were the victim of domestic abuse, stuff like that. Little-t trauma is mostly like the emotional and verbal stuff that maybe 20, 30 years ago and, you know, earlier, it was like, well, that's not a big deal, like it's only a big deal if something like physical happened to you. Now we realize, no, that stuff can be just as damaging long term as the big-T trauma.

So, I think that the similarity between the sexual abuse and the codependency swinging to the extremes is that there's probably a lot of at least emotional or, you know, verbal abuse-type trauma that codependents have been through, and they're just, you know, that seems to be the human response to, the untreated response is to just go to these extremes as ways to try to fix it, you know.

PAUL: And would emotional neglect, just being raised in an emotional desert be something that could cause trauma?

NATALIE: Absolutely. Severe emotional neglect can be trauma, is trauma.

PAUL: So, for instance, if you were raised in a family where success was the only thing that was prized and having messy emotions was discouraged, is that--

NATALIE: Oh, yeah, definitely.

PAUL: I think, I feel like that is one of the most rampant things that you see, for instance, in the north shore of Chicago. It's called the suicide belt--

NATALIE: Oh, I've heard of that, yeah, yeah.

PAUL: --by psychologist. Very, very wealthy, and I think it's, it's just so many people don't realize that, like you said, money is not solely going to make you happy. And I'm sure the parents are well meaning, but--

NATALIE: Yeah, exactly, but emotional neglect can be huge.

PAUL: Yeah. It's like they're fear.

NATALIE: Yeah.

PAUL: You know, fear that their child isn't going to make it. And I think that's one of the things, one of the biggest mistakes that parents make is they think they are guiding their child, but they're actually stifling and controlling them.

NATALIE: Oh, 100%, yeah.

PAUL: How could you elaborate on that and talk about how you would know when it's stifling and controlling and when it's guiding and healthy?

NATALIE: I'll tell you what. I was listening to an episode, and I can't, I don't remember what episode it was, but you were reading a listener survey, and one of them was from a woman who had been really badly abused when she was younger, and was talking about how she was raising her daughter and she was trying so, so hard to make sure that her daughter didn't go through any of the things that she went through, which, when it comes to abuse, that's great. You should protect your child from that.

But she said something that you picked up on, and that I would say is the answer to this question, which is she said, you know, I'm trying to protect my daughter from ever having any sadness or bad days. And it's like, whoa, whoa, whoa, whoa, whoa. Now we're talking about two different things here [chuckles].

PAUL: You are guaranteeing her sad days by doing that.

NATALIE: Right, exactly. Protecting your child from abuse is totally fine, is an admirable quality, but trying to protect your child from ever having discomfort, from ever being upset--

PAUL: Disappointed, failing.

NATALIE: Disappointed, exactly, that is pretty controlling and pretty stifling, because you're teaching that kid, when they are angry, depressed, sad, that when you try to sweep in there and make them feel better, you are probably not saying this, but one of the messages they're getting is it's not okay for me to feel like this.

And that's not a good message to be giving, right? It's okay to give the message like, it must hurt to feel like this, I'm so sorry you're feeling like this, is there anything I can help you, you know, any way I can help you to get through feeling like this, but don't feel like this? Eh, that's, that's on the stifling/controlling side of things.

PAUL: Okay.

NATALIE: Yeah, you can't protect somebody from all negative feelings, nor should, painful feelings, nor should you.

PAUL: Yeah. And that's, I think, where most of life's growth happens, is--

NATALIE: Mm-hmm.

PAUL: --by failing, being disappointed.

NATALIE: Yeah, uh-huh, yep.

PAUL: You know, we wouldn't self-reflect if we always won.

NATALIE: Absolutely.

PAUL: That's why I've never won.

[Chuckling]

PAUL: That's why I'm so magnificent.

NATALIE: There you go.

PAUL: Okay. So, let's go to some of the questions, or did you have something else. So, we talked about support groups, kind of defining what codependence looks like.

NATALIE: Yes. I don't, I think the, some of the other questions are going to get to some of the stuff that I have put down here.

Actually, there is one thing I can talk about which wasn't on our kind of list, but it's something I feel really strongly about and I feel like it ties in to what we've just discussed, and then we can get on to the next question, which is, this is a theory that I have, and it's, whenever I tell clients this, it's like, it's a theory [chuckles]. I'm not stating this as a fact.

You are free to disagree with me on this. I'm just throwing it out there in case it might be helpful, which is that I come from, one of the things that I was trained in and that I practice a lot is cognitive behavioral therapy, CBT. And in CBT, they're big on the distinction between thoughts, feelings and behaviors, right? And my, do you want me to say what that is--

PAUL: Yeah, yeah.

NATALIE: Okay, because I have a nice trick for that, which is, and I did not come up with this. I can't take credit for it, but I don't--

PAUL: Well, then, why bother?

NATALIE: I know [chuckles].

PAUL: Then why bother?

NATALIE: But I can't remember who taught me this, so I'm sorry that I can't give credit, but thoughts and feelings, people get thoughts and feelings mixed up all the time. I do it myself still sometimes, which is that feelings are one or two words, happy, sad, pissed off, stressed out, excited, jubilant, etc., etc., those are feelings. If it's more than two words, it's a thought.

PAUL: Wow, that's great.

NATALIE: Okay [chuckles].

PAUL: In therapy, my therapist used to say, what are you feeling right now, and I would say, well, you know, I feel like, you know, the world is coming to an end--

NATALIE: That's a thought.

PAUL: --and she would say, no, that's not a feeling. What are you, that's a thought.

NATALIE: Yeah, exactly.

PAUL: And I couldn't, it made me so fucking angry. I was like, oh, I'm angry.

[Chuckling]

NATALIE: Yeah. And it's important to know the difference because you can't change your feelings until you change your thoughts, so if you can't tell the difference, it's going to take a while [chuckles].

You know, so anything, and something I like to tell people is, just because you start a sentence with I feel doesn't automatically make what comes after it a feeling, right, because the example you just gave, I feel like that guy's being a big jerk and I don't understand what's going on, that's all thinking, right? What are the thoughts? The thought is, the feeling is upset--

PAUL: I'm pissed.

NATALIE: Pissed, angry, agitated. The thought is, I don't like what that guy is doing and I don't understand it, nah, nah, nah, nah, right. They go together, but they're separate, okay.

So, my theory is that we have no control over our feelings, a good deal of control over our thoughts, and total control over our behavior.

PAUL: Even addiction?

NATALIE: Um, you might have caught me on that one [chuckles]. But addiction isn't just behavior. Addiction is also thoughts and feelings.

PAUL: And physical reaction--

NATALIE: Oh, that, too, yeah--

PAUL: --allergic reaction.

NATALIE: Absolutely. So, what I mean by that is that I don't think that we should judge ourselves for having feelings. I don't think feelings are good or bad, positive or negative.

PAUL: I completely agree.

NATALIE: Yeah. And feelings can be completely rational. Like, you can have a feeling and be like, I totally understand why I'm having that feeling. You can have feelings where you're like, where on Earth is this coming from?

PAUL: Why do I want to punch the mailman?

NATALIE: Right, exactly. So, I encourage people, don't, it's okay even if they make no sense and they're irrational, don't worry about your feelings. Like, feel your feelings. What we can work on is how you think, and then what we can really work on is how you behave, right, and just because you have a feeling doesn't mean you're obligated to behave on it in a certain way, right?

PAUL: And it's no judgment on your morals or your ethics.

NATALIE: Nh-nuh, nh-nuh. No.

PAUL: And the thoughts that pop into your head are no reflection of your morals or your ethics.

NATALIE: No, absolutely not.

PAUL: Somebody said one time, I can't control whether or not a bird lands on my head, but I can control whether or not I let it build a nest.

NATALIE: There you go. I like that.

PAUL: So, would it be fair to says, then, in CBT, that's where you say, take the action to swipe the bird away from your head?

NATALIE: Right. And a saying that I like very much is you can't think your way into right acting, but you can act your way into right thinking. Okay, and the idea is that, if you are exploding with anger, you actually do have a choice as to how you act on that.

I don't think you can change the anger itself, but you can punch somebody in the face, probably not a constructive way of dealing with it, or you can call somebody and ramble about it and then maybe journal about it, probably a more constructive way of handling your feeling, right. But the feeling itself, no judgment around that. It's just about how you choose to act on it, if you choose to act on it at all, that can be the issue.

PAUL: One of the tools that started to help me when I would become frustrated, when I was married and my wife and I would disagree about something, because what I would do is I would usually shut down. I would avoid conflict, and then it would build up and I would become cold or emotionally withholding.

NATALIE: Right, yeah.

PAUL: And sometimes, if prodded, an outburst of yelling for about five or 10 seconds. And I learned that I, that it's okay to share what I'm feeling if it's not projected at her.

NATALIE: Yeah, absolutely.

PAUL: And so, one time we were disagreeing about something, and I felt rage come up in my chest. My face got hot. My scalp was tingling. And I, and I knew yelling at her was not the right thing to do, so I said, I am so fucking angry right now, I want to put my fist through a wall. And it helped dissipate the anger--

NATALIE: Yeah.

PAUL: --and it invited her into what I was feeling so she could help me instead of being the brunt of my anger.

NATALIE: Right. I mean, there's a huge difference between yelling at someone, fuck you, and I'm angry. Right?

PAUL: I'm frustrated.

NATALIE: Yeah [chuckles].

PAUL: One of the things I said was, I can't even put into words right now why I'm so fucking angry--

NATALIE: Beautiful.

PAUL: --but I am so fucking angry [with aggression].

NATALIE: Yes, instead of like a verbal diatribe against the other person.

PAUL: Right. Yes.

NATALIE: Absolutely, yep.

PAUL: So, yelling at the sky is actually a good thing.

[Chuckling]

NATALIE: It can be. I have, and occasionally people will look at me like I'm nuts, but I have advised clients to scream into pillows. It's like, if that's what you need to do, then you do it. That's fine.

PAUL: And especially for those of you that can't get out of bed, it's perfect.

[Chuckling]

NATALIE: Yeah, it's just right there.

PAUL: Because you're there already, you're already there.

One of the things that I am most proud of that my wife and I, even though we're not together anymore, that we worked on is we learned how to disagree and how to communicate with each other, and it was, hands-down, the most important tool that I learned in my life, because I learned to separate my feelings from my thoughts from my actions.

NATALIE: Yep, that's huge.

PAUL: And I wouldn't have gotten there without therapy and support groups.

NATALIE: Yeah. More questions?

PAUL: Anything else, or do you want to continue with questions?

NATALIE: Let's keep going with the questions.

PAUL: Okay.

NATALIE: There were a lot of really good ones.

PAUL: Can codependency patterns truly be broken?

NATALIE: I, again, with my pickiness about words, I would take issue with the word broken. What I would say is, and I don't just say this from theory. Like, I've seen it happen with people, that codependency patterns can be eliminated, and even if some of them can't be eliminated, the volume can be turned way, way, way down on them. Your defaults can change, in other words.

So, if codependency patterns are your defaults, I don't know that they will ever stop popping into your mind as an option, but they won't be the first thing anymore. Do you know what I mean?

PAUL: So, would it be safe to say that your hardwired impulses can be managed--

NATALIE: Yes, mm-hmm.

PAUL: --by separating your feelings from your thoughts from your actions.

NATALIE: Absolutely, absolutely. And I don't, you know, I don't like to give people false hope and be like, yes, one day you will be cured of your codependency 100%, right? Maybe.

And I'm sure there's a small percentage of people that that happens for, and awesome for them, but for most people, things can, you know, if you identify with like half the list, let's say like half of those things might go away entirely and the other half, the volume will just be turned way down and it won't be your first impulse [snaps fingers] anymore to do those things.

PAUL: And suddenly your life is manageable and enjoyable and you feel freedom and clarity.

NATALIE: Yeah. And I've heard people describe like they'll have an impulse to behave in a codependent way and they'll be like, oh, no, I'm not going to do that. You know, like they get to a place where they're like, oh, that's funny, no [chuckles], you know, I don't do that anymore.

PAUL: How often do codependency and addiction occur together?

NATALIE: So, I have another one of my theories [chuckles] on this. My theory is that not all codependents are addicts but that all addicts are codependents. And I'm sure people will disagree with me on that, and that's totally fine.

I noticed on the Web site that there's forums for this show that I'm definitely not going to visit because [chuckles] I do my best to not get into heated Internet debates with people, for my own mental health.

PAUL: For the most part, they're really loving--

NATALIE: I would hope so, I would hope so, yeah.

PAUL: --really, yeah, diplomatic people.

NATALIE: But, and people are free to disagree with me. It's totally fine. But it's been my experience that the vast majority of people who get sober from, well, I was going to say from a chemical addiction, but really from even process addictions, whether it's gambling or eating or other stuff, once they get a good degree of recovery, not just abstinence or sobriety, but legitimate recovery, that they start to see their relationships in a really different way and they start to go, oh, I'm not doing super-healthy stuff in some of my relationships.

PAUL: That was the case with me.

NATALIE: Yeah.

PAUL: I have a theory.

NATALIE: Mm-hmm.

PAUL: --did the audio just cut out or something? I just heard a noise.

I have a theory, that I believe all codependents are addicts but their addiction is a person.

NATALIE: I don't disagree with you on that, yeah. I think it's just about how you maybe define addiction, but yeah, that's, to me, they co-occur far more often than not.

PAUL: And I guess you could probably lump them all into the category of compulsive behaviors that degrade the quality of your life.

NATALIE: Mm-hmm, yep.

PAUL: Or those around you.

NATALIE: Right.

PAUL: Let's see what the next one is.

How do you set boundaries when you don't trust yourself or your judgment? That's such a great question.

NATALIE: That's an excellent question, and I'm going to answer it in two parts. I'm going to answer it specifically and then kind of in a broader way about boundaries.

So, how do you set boundaries when you don't trust your judgment? I'm going to go back to the thing I said I would say several times, which is, ask other people, right, whether it's--

PAUL: Who you trust emotionally.

NATALIE: --who you trust, healthy, safe people, whether it's your therapist or your friends or if you're in a program, your sponsor, whatever, if you've gotten to the point, which is commendable, to get to the point where you're like, my thinking isn't always the best [chuckles], which is good when we can get to that point.

If you've gotten to that point and you know that you're not, your thinking isn't always to be trusted, that's when you need to start asking other people, say, here's a boundary I'm thinking about setting, what do you think about this? And then be open to their feedback on it.

PAUL: Can I interject one thing?

NATALIE: Sure, of course, yeah.

PAUL: Hold your thought. And anybody who thinks that that means that you aren't an intelligent person, it has nothing to do with intelligence.

NATALIE: No, no.

PAUL: It's about emotional experience.

NATALIE: And it's incredibly intelligent to know when you need help.

PAUL: Yes.

NATALIE: Right [chuckles]?

PAUL: Isn't a good general somebody that knows when to bring in reinforcements?

NATALIE: Yes, absolutely. I'm scared of people who think they don't need help with anything. That's, eh, that's not a good sign, you know. I know when I need, I mean, I like to think I know when I need help with stuff. I still get caught up occasionally, but I've come far enough, I think, in my own work that it's like, okay, yeah, I need to get somebody to help me out with this because I don't know what I'm doing [chuckles].

PAUL: And very often, I think some of the most beautiful moments you have in your life is when you lower your walls and you invite somebody in to have that intimate exchange of, can you help me here?

NATALIE: Yes, yes.

PAUL: And that person, you're giving them a great chance to feel useful, purposeful.

NATALIE: Oh, absolutely, 100%, yeah. And so, to kind of take the scope of that question back a little bit and make it a little more broad, because this is one of the things we wanted to talk about, was just boundaries in general, which is, this is another topic I feel pretty passionate about, and I, because it's often misunderstood.

And again, I'm going to preface this by saying that I'm not saying that this is the way to set boundaries [chuckles]. I'm saying this is a way to set boundaries. If you find other ways that work for you, that's great, but I find that this is a good way of explaining it to people who are really not clear on the whole boundary situation, which is that a lot of people think that boundaries are about telling other people what to do.

So, an example is, and I use this example whenever I talk about it, just because it's really clear cut and I think it's pretty easy to understand, which is like, let's say that you're in the midst of a breakup with somebody and you've asked them, you know, please, I nee-, you know, maybe we'll be able to be friends one day, I don't know, but I just need some space right now, can you please stop calling me, right, I just need some space.

And so a lot of people think that's saying, stop calling me, is a boundary. It's actually not, and I'll tell you why, because when you're making the boundary about telling somebody else what to do, you have no control over that, because that's an attempt to control another person's behavior, which none of us are capable of doing, right? So, you're kind of setting yourself up for a potential failure by thinking you can tell somebody what to do and that they're going to do it, right?

PAUL: What if you say to that person, though, I need no contact for a period of time, so please don't call me, if you do, here is a consequence that I will have to take.

NATALIE: You're taking the wind out of my sails, Paul.

[Chuckling]

NATALIE: No, it's okay, it's okay. I can tell that you've done a lot of work on this, because that is what you can control, right? So, if you tell somebody, stop calling me, you can get one of two answers, right. They could be like, no, screw you, I'm going to keep calling you, right, in which case, what are you going to do, you know. Or they'll be like, oh, okay, yeah, no, I totally understand, and then a week later they're blowing up your phone, right?

So, here's how to set boundaries. Make boundaries about what you can control, which is you, which is what you were saying about the boundaries.

So, the way that I encourage people to set boundaries is to say, you know, I really need some space, you know, I'd appreciate it if you didn't call me or message me or do whatever. If you do, I will not be, like let's say, if you call me, I will not be picking up the phone, I will not be listening to voicemails. If you text me, I'm going to delete it without opening it. And if you e-mail me, I'm going to delete it without opening it, right, because that's what you can control. You can't control if this person calls you. What you can control is looking at your phone and going, oh, oh, no, it's this person--

PAUL: God damn them.

NATALIE: Right. I'm not going to pick it up, right, which is hard [chuckles]. It's really hard, but that's a good boundary because you can control and enforce that boundary, right?

And what I tell people is, setting the boundary is 50% of the work. The other 50% is maintaining the boundary, because you can set a boundary all you want, like if you call me I'm not going to pick it up, and then if they call and you pick it up, you know, you're teaching somebody that you don't mean what you say.

PAUL: And you're actually doing that person a disservice because they don't get to truly see that their actions affect other people in ways that aren't positive.

NATALIE: Yeah. So, the basic kind of boundary you set up is like, here's what I want from you, here's what I'm going to do if I don't get it, and then you actually doing that if push comes to shove.

PAUL: And I imagine most people probably have felt the way I did when I first started setting boundaries, which was I felt overly sensitive, needy, petulant, selfish. Is that pretty common?

NATALIE: That's very common, especially for people in recovery from codependency. Setting, go ahead.

PAUL: So, what do they tell, what do you tell them to think or do when they're in agony that, if I don't call that person back, they're going to think I'm dead or--

NATALIE: Yeah [chuckles], I've heard that.

PAUL: --I’m a horrible person and they're going to talk to other people and say that I'm horrible?

NATALIE: Yeah. Usually two things. Like one is, if it's really going to cause somebody a ton of distress to not pick up that phone and to not listen to that voicemail, then I would usually dip into some dialectical behavior therapy, distress tolerance skills, which I'm sure you've, you probably have talked about DBT on the show before.

PAUL: We have.

NATALIE: Because those are really good for in-the-moment stuff.

And then the other thing that I would say is, new behavior feels really fucking weird for a while, like really weird, you know what I mean, whether it's setting a boundary or something else. Practicing, it's kind of like, it's kind of like opposite-land, where like up is down, good is bad, you know what I mean, like you know intellectually that you're being healthy, but it feels icky at first, and that's just because it's that new, uncomfortable element of the behavior.

And the idea is, you've become so used to something that's actually unhealthy that it feels comfortable, right, and doing something unhealthy feels really, or doing something healthy feels really uncomfortable.

PAUL: And it brings in the unknown, which is usually your disease in its glory, because it's telling you all the lies.

NATALIE: Yeah, oh, God, yes [chuckles], all those old messages that you got from your caregivers or who else, you know, you're selfish, you're awful, you're this, you're that. And something that I like to tell people, and a lot of people say that it makes sense to them, so I'll say it now, is that, you know, back in the day, back in the, you know, infancy of psychology and psychiatry and neuroscience, you know, the idea was that they used to think that the brain stopped developing at a certain point early in life, you know.

And over the years, up to date, they've thankfully come to discover that the brain really never stops changing. It slows down as you get older, but it doesn't ever stop, which is really good news in regard to mental health stuff, because it means that just because you're 20, 30, 40 and you've got this mental health issue, it's not like, well, I'm hardwired this way, now I’m stuck, right?

And the way that I like to describe it to people, because I'm kind of a visual person and this makes sense to me, is think about the pathways in your brain, like the neural pathways in your brain, like hiking trails.

Like, when you go to, you know, we're in L.A., you go to Runyon or whatever, you know, you can identify the hiking trails that thousands of people have gone down before, and that's the pathway in your brain that your brain has gone down a thousand times before. You know, all the grass is worn down. It's just dirt. It's very flat and patted down. There's no branches or bushes in the way. It's a very clear path. It's so easy to go that way.

PAUL: Very little resistance.

NATALIE: Right, there's no resistance. It's super easy to walk that way.

So, even if you know that that path is going to take you to a shitty destination, it's so easy, you know, [chuckles] it's so easy to walk that way. The good news is that you can create new neural pathways in your brain, and setting a boundary is that new behavior, right, but it's going to be hard at first. You are creating a new pathway, a new hiking trail in a forest where there wasn't one before. You're going to be stepping on shit. You're going to need to get your machete out and like, you know, chop away at the branches and the bushes and there's going to be spider webs, you know, like it's going to be a mess. It's going to be really hard to go that way.

But the more you walk down that new trail, the grass starts to get stamped down and the bushes start to grow away, and then the less you go down that old trail, the grass starts to grow out of the ground and the trees start to grow over. And luckily, we have that ability to change our brains like that. It just takes a lot of work.

PAUL: And I have experienced that, and the feeling of satisfaction when you look at that old path and you start to go down it, you recognize it as not healthy, and you choose not to because you recognize that it doesn't feel good. It's so worth every hour of therapy--

NATALIE: Oh, gosh, yeah [chuckles].

PAUL: --every hour of support groups, and especially when you see the results of how much better your life is because you're not making it worse through acting--

NATALIE: Yeah, and to take like two or three steps and then go, oh, actually, I'm going to back out slowly [chuckles], you know, start going down that other path, yeah.

PAUL: I had this, I played, I was telling Natalie I played hockey before I came here tonight and there was a guy who was just really in a fucking mood, that I was playing against, and I--

NATALIE: Is this the guy who said something about your Prius once?

PAUL: No. He was playing on my team tonight--

NATALIE: Okay, okay, gotcha.

PAUL: Yeah, he was actually good, but he also wanted to kick this guy's ass tonight. And this guy said to me, I took a shot on goal and he said to me, that was weak, and I said, what? And he said, you know, coming in behind our defense, cherry-picking. I said, well, they call it cherry-picking when you, how do I describe this, you go behind their defense.

NATALIE: Okay, okay.

PAUL: Assuming that you're not, we don't play off-sides in our pick-up games. So, I said, well, then cover me.

NATALIE: Yeah.

PAUL: And he said, oh, I don't believe in playing the game that way. And I said, well, that's your opinion. And then every like interaction we had was a little extra physical in front of the net and stuff like that.

NATALIE: I'm sure.

PAUL: But I didn't go, I was very conscious of the fact that I can't change this guy. All I can do is speak up for myself, play within the rules, and I kind of wished I would have said something afterwards, like, hey, are we okay, are we good, can we leave it out there? And I didn't, but, you know, maybe next time I see him, but that, to me, is growth, because--

NATALIE: Oh, 100%, yeah.

PAUL: --I would have wanted to be a victor.

NATALIE: Yeah [chuckles], right. You were taking the new path.

PAUL: Yeah. How do you create, was there anything else on that?

NATALIE: Nh-nuh.

PAUL: How do you create boundaries with a parent after covert abuse or emotional incest and still maintain a relationship with them? Wow, is that a complicated--

NATALIE: Yeah, whoo, boy, that's--

PAUL: Important question.

NATALIE: --very complicated, very important. I'm going to do my best to answer it in, you know, without taking the entire rest of our time. But something I wanted to toss in there real quick, and maybe you know about these books. Maybe you've mentioned them before.

But I wanted to throw them out there, just because we hadn't discussed them before, and I, I'll say that I really appreciate how vocal you are about covert incest because I think it's something that a lot of people experience and don't have a word for. It's kind of like what we were talking about earlier, about big-T trauma versus little-t trauma, like back in the day, little-t trauma was like, that's not trauma, what are you talking about?

And I think a lot of people have that feeling about covert incest versus overt. It's like, and I don't mean people around, I mean the people it happened to, they're like, well, like my dad watched pornography in front of me, but like he never touched me, so I guess it's not a big deal, and it's like, no, that's a really big deal, like that's incest. It just wasn't involved touching. So, I really appreciate that you're so vocal about that.

Two really good books about it, because I know you've mentioned a few on the podcast, The Emotional Incest Syndrome by Dr. Patricia Love. Are you familiar with that book?

PAUL: Mm-hmm, yep, a great one.

NATALIE: That's an amazing book. And also, The Drama of the Gifted Child by Alice Miller.

PAUL: I have to read that. You're the 100th person who has told me to read that.

[Chuckling]

NATALIE: Yeah, it's amazing. And I think the title puts some people off, because it's like, is this about like kids who do well in school? Like, what is it? It's a translation, and I don't think the translation came through quite as clearly as it could have. This is a book about emotional incest. I mean, it's a book about a lot of stuff, and it's a tiny book. It's really not that big.

But it's an amazing book about children who, essentially what she means by the drama of the gifted child is the gifted child is the child who is super emotionally attuned to their unstable parents [chuckles], and they are really good at handling them, but it causes them so much pain, that's what the book is about.

PAUL: Ah.

NATALIE: And it's amazing. It's one of those ones where you like read a page and then you're like, I'm going to put this down for a little bit because that was a lot [chuckles], you know what I mean. So, I just wanted to throw those out there.

PAUL: Thank you, thank you.

NATALIE: So, you're welcome.

PAUL: And Silently Seduced is another amazing book.

NATALIE: Yeah, that's another really good one.

PAUL: Yeah.

NATALIE: So, setting boundaries with a parent who was covertly incestual or emotionally incestual, I mean, I would fall back on what we already discussed about how to set boundaries, and I guess it really, a lot of it hinges on if the parent has any awareness of what they did, because, as we know, there are plenty of parents who are overtly sexually abusive and deny what they did. There's probably just as many who were covertly abusive and deny what they did.

But you know what, you can uphold your boundaries whether they are in denial of reality or not. So, let's say, let's say you have a parent who throughout your whole childhood and your adult life, they have over-shared about their sex life with your other parent, which is not something you should ever talk about with your child, right, and can definitely be a form of covert incest.

PAUL: Yes.

NATALIE: You can set a boundary with that parent and say, okay, I don't want you to talk to me about your sex life again. If you start to talk to me about your sex life, I'm going to be ending the conversation. I'll either be hanging up the phone or physically leaving and being out of your space.

And they could be like, what, I never talked to you about that, or, oh, it's not that big of a deal, and you can be like, okay, whatever, I'm just letting you know [chuckles], right? They can try to rationalize or deny or whatever. And then the next time they do it, you're on the phone, oh, you know what, I got to go, bye, right. Or, you know what, you know, we brought the kids and we're here, but you know what, we're leaving because I told you about this boundary and now we've got to go, bye.

PAUL: And that, there's a good chance that parent will also, if they do it again, try to justify why--

NATALIE: A hundred percent, mm-hmm.

PAUL: --they get you to make the exception because their why made sense to them and to which I would say, it doesn't matter why.

NATALIE: No. It does not matter. It does not matter.

PAUL: Anything else on that question?

NATALIE: No. The only other thing I would say is that, if you have a parent who you don't have to be in contact with and is continuing their attempts to abuse you covertly, I mean, I have strong feelings about, you know, the fact that you don't have to be in contact with your family [chuckles] or certain family members. Some people, that's kind of abhorrent to them, the idea that they would cut off a family member.

If a person is still abusing you, you have every right to cut them out of your life. I mean, it's tricky if they may be financially supporting you. That's a whole other, like if you're young or whatever, but if there's no, if the only repercussions, and I don't mean only like in a diminutive way, but if the repercussions are going to be solely emotional, you can cut this person out of your life.

You might get shit for it. You might whatever. But if it means that you're not being abused by this person anymore, consider it.

PAUL: And the thing that you can't anticipate or feel yet is how strong and proud of yourself you will feel once you've done that--

NATALIE: Oh, yes. Oh, goodness, yes.

PAUL: --and notice how differently you view the world after you do that.

NATALIE: Oh, yes.

PAUL: What about the kid, the 15-year-old kid, here's a textbook one that I get e-mails about or read from the surveys. Fifteen-year-old kid whose parents won't, parent or parents, don't allow locks on the door, walks in on them, coincidentally, a lot when they're changing or showering, calls them into the bathroom when the adult is bathing, and the child has said, you know, I don't feel comfortable when you do that or can you please leave the room, and the parent says, I'm your parent.

NATALIE: Yeah, oh, boy, yeah.

PAUL: What does that kid do?

NATALIE: Well, I mean, when you're a minor your options are limited, and you can still try to set boundaries. I mean, you know, boundaries have no age limit on them. The problem when you're a minor is that your parent can really start to get pretty threatening in terms of kicking you out of the house or, you know, doing things that would make your life radically different and worse, but I would encourage you, the first line of defense, to set boundaries.

If your parent continues to call you into the bathroom when you know that they're naked and it's not making you comfortable--

PAUL: Or walking around the house naked, that's another one.

NATALIE: Right, that's another one. You can do your best to physically separate yourself from them until they get some damn clothes on, you know. Even if it's just by literally closing, you know, if they're insisting on it, you can put your hands over your eyes and say, I'm not, we're not doing this, you know.

And I know that that's, [sighs] that is so hard--

PAUL: That's one of the things that kills me the most about doing this show, is knowing how many kids are trapped in these fucked-up situations.

NATALIE: Yeah. And I would say, I mean, a lot of abusive parents, whether it's overt or covert, will often slip in threats about, you know, well, if you tell somebody about this they're going to take you away and you're going to be in a foster home and nah, nah, nah, nah, nah.

PAUL: I put food on the table.

NATALIE: Right, exactly, all that stuff, and it's like, well, you know what? They may or may not take you away. They just might do an investigation and maybe you'll have to go to some classes, Mom or Dad [chuckles], you know, or some therapy.

But I would say, if it's bad enough, you should call, I mean, here in California it's DCFS, but, you know, the authorities, you should call the authorities. And I realize that, I'm not saying that like that's an easy thing to do, oh, just call the authorities, it'll change your life, no big deal. But, I mean, if it's come to that breaking point, that's what they're there for. They're there to try to protect you from people who, sadly, shouldn't be hurting you but are.

PAUL: And should be protecting you from the very thing that they are doing to you. And so many of these kids, their solution is suicide. That's what they think about all the time.

NATALIE: Or substances.

PAUL: Yeah.

NATALIE: Because substances get them out for a little bit, you know. Yeah.

PAUL: That was light, huh?

[Chuckling]

NATALIE: Light and breezy. How about them Dodgers?

[Chuckling]

PAUL: Can one be codependent and single?

NATALIE: Yes. Resounding yes [chuckles]. That's funny, I get this one a lot. Codependency isn't actually, people think that relationships are codependent. It's people that are codependent, right. And so, if you're somebody who struggles with codependency, you can be single, married, a hermit, like you will struggle with codependency.

PAUL: You can spot somebody who's codependent by the way they get change at the grocery store.

NATALIE: Mm-hmm, yes, precisely. So, you can absolutely be codependent and single. You can be codependent and dating. And it's more about how you interact with people. These people don't have to be your romantic partners.

The list of codependent traits and characteristics that we were referring to earlier, those apply to all relationships. That's another misnomer, is that codependency is about romantic relationships. It can be. It doesn't have to be. It can be about family relationships, friends, co-workers, nah, nah, nah, nah, nah, I mean, relationships, no modifier, relationships.

PAUL: When you're afraid of letting people down and having needs . . .

NATALIE: Yep. That's, yeah, exactly.

PAUL: And obsessed with what everybody thinks of you.

NATALIE: Uh-huh.

PAUL: Let's see. That is it as far as the codependency questions. Anything else you want to touch on?

NATALIE: Okay, let me see. I don't think so, no. That was all the codependency-related stuff I had written down, yeah.

PAUL: So, we're going to move from codependence and we're going to take a couple of questions from listeners about therapy. And this person asks, how can a patient make the most of their therapy sessions?

NATALIE: I love that question. I am so glad that somebody asked that question.

PAUL: It's so important.

NATALIE: So, something that I, my boss at the IOP where I work, Dr. Adam Silverstein, he's just, that guy is a genius. I've never had a better boss, I don't think. But he's just got a very, he's a psychologist and he's got a very unique way of communicating with people that's super effective but also a little weird and quirky, which I like.

But he gets, he goes through phases, and right now he's in a phase of talking about people being teachable, and that's what I'm going to kind of bring up in response to this question, is I think one of the best things that you can be in a therapy session is teachable, and I don't mean like, as the therapist I'm the teacher and I'm like wagging my finger at you and lecturing you.

What I mean by teachable is, if I try to offer you an insight or an idea or an alternative way of thinking about things, to actually consider it for a minute [chuckles].

PAUL: So, open-minded.

NATALIE: Yeah, open-mindedness, instead of just dismissing it. I'm not saying you have to agree with it. I would never want to set up a relationship where my clients felt they had to agree with me on everything. Just consider what I'm saying, consider that it might be true, consider that it might be at least a little bit true. The idea is that, if you come into therapy with your mind made up about stuff, I don't know what we're going to do. Do you know what I mean? Like, there's not a whole lot--

PAUL: What a great point.

NATALIE: --we're going to be able to accomplish.

PAUL: Because then they're trying to control the session.

NATALIE: Yeah. Speaking of BetterHelp, I had a client on BetterHelp the other day write to me and say, you know, I am miserable in this relationship but I really have no desire to change it. And I wrote back and I said, then honestly, I don't know, I think it's kind of a waste of your money to be on this service.

And I said, I'm not saying this in like a, because it's hard when it's written. I'm like, I'm not saying this in like a judgmental way. I'm legitimately telling you, I don't know that you should be spending your money on this, on this therapy [chuckles] if--

PAUL: Yeah, I'm drowning but I don't really, I hate swimming.

NATALIE: Yeah, exactly. And it's like, I don't, you know, I don't know what I can help you with. But to come into a session with an open mind and to consider that ways other than the ways that you've been thinking about things might have some merit is huge, is absolutely huge.

And another thing I would say is a really good thing to get the most out of your therapy sessions is to get vulnerable.

PAUL: Couldn't agree more.

NATALIE: Get vulnerable.

PAUL: I highly recommend laying it all out there in the beginning instead of letting that fear that, oh, my God, am I going to be judged if--

NATALIE: Yeah.

PAUL: Therapists didn't get into therapy to judge people.

NATALIE: Oh, my goodness, no [chuckles].

PAUL: They got into it to bring comfort and insight and healing to people.

NATALIE: Yeah. I can't tell you how many clients have apologized for crying in my office. And I will tell them, if you can't cry in a therapist's office, something is really wrong. This is where you're supposed to be able to do this. If you're not, you know, I love the work of Brene Brown, vulnerability creates relationships. We're not going to have much of a relationship, I'm not saying you have to bare your soul to me in the first 50 minutes, but if you're not able to get really real with me, we're not going to make as much progress.

And I think I told you this at the luncheon that we met at, where it wasn't a client of mine but it was a colleague's client at the IOP where I work, and this client had been in the program for like three months, and it was during this person's discharge session that they had their, you know, discussion and signed all the paperwork and da, da, da, da, da, and they just had like a couple minutes left over, and they were kind of sitting in that like awkward silence, and the client goes, you know what, can I get real with you finally? And it was like, now?

[Chuckling]

PAUL: Three minutes left.

NATALIE: Yeah, it's like after three months of being in this program, you're going to get real now? You should have been getting real three months ago. What? You know, it's like, and then I'm sure this is the type of person who would leave and be like, yeah, I didn't like that program. And it's like, I'm not saying our program is flawless, but if you didn't get real the whole three months you were there, no program is going to work for you.

PAUL: You know, I feel like, I look at support groups and therapy as a gym, and if you don't get into emotional fitness, it is not a reflection of, I believe, the gym.

NATALIE: Agreed.

PAUL: You may have to switch trainers. You may have to go to a different gym because the trainers are better there. But it is, you have to make sure that you're going there three days a week and doing the machines.

NATALIE: Absolutely.

PAUL: Anything else on that question?

NATALIE: Nope.

PAUL: How do they handle transference? Talk about transference. What, for the listener that has never heard of it, what is transference?

NATALIE: So, transference and countertransference are pretty old-school concepts but are still very much, they're a real thing. And, but they just go way back in the history of therapy. So, the idea is that the patient or the client can have transference toward the therapist and then the therapist can have countertransference toward the client, and I'll explain what that means.

So, sometimes, in the course of therapy, the client, and this is an unconscious process, at least at first, might start to respond to the therapist as if the therapist is someone else in their life, as if the therapist is their mother, their father, their boss, their wife, and, you know, they'll be responding to the person in a way that really isn't about that person. They're kind of projecting that person on to them and acting like that toward them.

PAUL: And usually having very strong feelings around it.

NATALIE: Oh, yes, usually it's very strong, yeah.

PAUL: Describe some of the feelings that come up when, with clients.

NATALIE: Well, oftentimes the clients will, you can usually recognize transference if it's like super strong and super out of proportion to the reality of the situation.

And this isn't to say, and I want to make this clear, that if a therapist does something bad and a client gets mad at them, if the client is mad, oh, that's just transference. It's like, no, no, no [chuckles]. Like, you can make legitimate mistakes and the client can get mad at you for it. That's not about their stuff. That's about the relationship and you. So, I don't want to pretend like, well, any, you know, negative thing is just about transference. That's not the case.

But if the client is having a super-strong reaction, like, for instance, I've had situations where I have had interactions with clients, and the client maybe had a very shaming parent, and my behavior toward them was not at all shaming, but their response was to feel shamed and to be like, you're trying to hurt me, you're trying to shame me, and I was very clear on my end that that was not part of what I was doing.

And so, we can bring that into the session and I can, again, suggest, do you think that this might be about what I said, but it might also be about you kind of putting your mom in this situation and seeing things as if she was telling them to you versus the way that I told them to you. So, that's transference.

PAUL: And how have some clients reacted when you've said that?

NATALIE: Most of the time, they will either get it in the moment and be like, oh, you're right, crap. Or they'll get upset and then get it later. And I'm not saying I've nailed it every time [chuckles]. Like, you know, but the times where it has been accurate, I haven't had a client who just flat-out denied it and would never agree with it. Maybe like the way that I saw it was slightly different, and then the way that they came back with it was like, okay, maybe you were like on target a little bit but a little bit off, usually there is something there.

And then, I always like to say this, too, there's the countertransference, which is like the client is not the only person in the room, like I'm the therapist, I'm also a person with my own history and issues, and so oftentimes what countertransference is, is when the therapist is responding to the client in a way that's not about the client. It's about the client reminds them of someone [chuckles], the client is triggering something for them, right.

So, you handle transference by figuring out a way to point it out to the client in a constructive manner. You handle countertransference by bringing it to your colleagues or supervisor.

PAUL: And that's why when a therapist is in training they're supervised, correct?

NATALIE: Oh, yes. Oh, yes.

PAUL: One of the things about transference that I think a lot of clients shame themselves for is having, is sexual attraction to their therapist. Can you talk about how common that is?

NATALIE: It is some, I mean, it's decently common. I mean, I would say that, and this is the same sort of thing I think in 12-step programs, with the whole sponsor thing, that therapeutic relationships breed a ton of emotional intimacy, and sometimes it's easy to mistake that for romantic feelings, especially if you have been sexually abused or, you know, covert or overt incest. It can be very easy for you to get those things confused.

So, it's really, and this is something I say to clients all the time, you need to tell me what's going on in here [chuckles]. In other words, like if you're having feelings about me and I don't just mean romantic feelings, most of the time I'm like, if you're upset with me or not happy with something, you need to let me know about it, because the longer this festers, and this can include the romantic thing, the less helpful this relationship is going to become.

PAUL: And I think, I'd say three of the therapists I've had in my lifetime I had those feelings toward, and it was temporary.

NATALIE: Mm-hmm, yeah.

PAUL: And I'm glad that I knew enough about the therapeutic process to share it with them in a way where I said, this is not me hitting on you, this is letting you into my brain so that we can add this to the mix in you trying to help me, but I'm feeling strong sexual feelings right now and I don't, there, there it is.

NATALIE: Exactly. And what I also tell clients when I tell them that you need to tell me what's going on, is that please trust that I have enough training and experience to where if you tell me something that you think might upset me, I'm not going to have, you know, I'm a trained professional.

Like, I tell people, like, you know, if you are thinking that this relationship isn't working for you, that it's not a good fit, that you want to try to see another therapist, if you tell me that, I'm not going to burst into tears [chuckles], you know what I mean.

PAUL: Any good therapist wants the best for their client.

NATALIE: Yes.

PAUL: Including finding a better fit.

NATALIE: And also, I'm not going to get angry, what do you mean, you know?

PAUL: Which would make you a terrible therapist, which would mean they should leave you--

NATALIE: Exactly, exactly. But it's like, you know, please trust that I have enough training and experience to not have an overtly negative response to this. You know, I have, even if, you know, and especially this happens early in training, but occasionally it can happen later in your career, maybe you're having a bad day or whatever, you know, shit's going on in your life that your clients don't know about and this is kind of a little bit of a straw that broke the camel's back, that this client is saying, now I want to see a different therapist, please trust that I have enough training and experience to where I can keep that in a compartment until you leave [chuckles].

Do you know what I mean? And then I can take care of myself, you know what I mean, that even if I'm not in a good place, that I can hold it together with you in a professional and hopefully helpful-to-you way and then I can take care of my own shit on my own time, you know.

PAUL: Anything else on countertransference or transference?

NATALIE: No.

PAUL: Any other thing on codependency or making the most of therapy?

NATALIE: No. That's the only stuff I can think of. I mean, I have some general stuff, like some informational stuff--

PAUL: Let's hear it.

NATALIE: --that I think is important. You wanted me to talk about the difference between like a psychiatrist and a psychologist and like there's different types of psychologists, and this is something that so many people get mixed up on and I'm happy to talk about it because I feel like I explain it a lot [chuckles].

PAUL: Start from the what requires the least amount of schooling, what the thing is called, and what they are qualified to do and if they need to get a license for it.

NATALIE: Oh, goodness. Do you mind if I do it in the opposite direction--

PAUL: Not at all.

NATALIE: --if I go from the highest to the lowest, okay.

PAUL: Yes.

NATALIE: And I, that's just how I usually explain it, but I also have a reason for it. So, first psychiatrist, and I totally get it. The word psychiatrist and the word psychologist sound extremely similar. They're just like a few letters off. I get it, but they're actually two very different things.

So, if we're going from kind of the grand mucky-muck, that's the psychiatrist. A psychiatrist is a medical doctor, that is, an MD, that is someone who has been to medical school, right. They prescribe medication. They're the people you get your psych meds from.

Now, by and large, at least on the West Coast, it's my understanding that things are a little different on the East Coast. At least on the West Coast, most psychiatrists do not do talk therapy.

PAUL: And most that do don't do it as well as most therapists, in my experience.

NATALIE: I'm going to say no comment to that one. So, just leave that one hanging in the air, but [chuckles]--

PAUL: And therapist being a psychologist.

NATALIE: So, they are not somebody that you sit and talk to for 50 minutes. Some of them do, most of them don't, okay. Those are the people that you see and you get your medications from. You have usually, usually the first session is longer and then after that it's brief appointments, right.

PAUL: And they have not generally been trained in talk therapy the way a clinician has.

NATALIE: Very true, very true. They've been to medical school. They've done a psychiatry rotation or several, but they haven't necessarily gotten training in talk therapy.

PAUL: Yes. And we use the terms clinician, clinical psychologist, therapist, counselor interchangeably, social worker. There's a lot of overlap between those.

NATALIE: Yes, there is.

PAUL: And there's some of them, there's differences, but generally, all of the, the ones that I just mentioned, can do therapy if they have taken the right curriculum, for instance, a social worker that isn't going to be an administrative social worker but is going to be--

NATALIE: Right, exactly. Yeah, and I'll get to social workers in a minute, because they're going to be next, or soon on the list.

PAUL: Yes, because as I was throwing the terms around, clinician, therapist, I thought, oh, we need to help them understand that--

NATALIE: Yeah. No, I agree, yeah. So, generally, psychiatrists are never referred to as like a therapist. Most psychiatrists don't go by the term therapist.

Everybody that I'm going to talk about from this point forward, therapist, clinician, counselor, even, those words are kind of interchangeable for them, okay. So, first we had the psychiatrist. Now we have psychologist, which is what I am, right.

PAUL: And nobody from here on down has a medical degree.

NATALIE: No [chuckles].

PAUL: Even though you are a doctor, it's not a medical doctor.

NATALIE: No. It's not a medical doctor.

PAUL: It's a psychology doctorate.

NATALIE: Yes. So, psychologists have a doctorate, but not an MD. We are people who have a Ph.D. or a Psy.D., and I'm going to, let's wrap up on the discussion of all the different levels and then I'll do the Ph.D./Psy.D. thing, because I feel like that's a little bit of a nerdy side conversation, at least for me [chuckles].

So, we are people who like, we have a doctorate. We've written a dissertation. And we are people who we do not prescribe medications, okay. You do not get medications from a psychologist.

Now, in some states, there have been pushes for psychologists to be able to prescribe medications after taking a certain graduate course or certification thing. That is not a national thing at this point. Just consider it that psychologists do not prescribe medication.

What we do is the talk therapy. What psychologists specialize in is doing talk therapy and psych testing, okay. So, we do the sit-down-and-talk-for-50-minutes thing or running-groups thing, and then the thing that kind of is special, if you will, about psychologists is that we receive a lot of training in doing psych testing, so this can be educational testing or personality testing, stuff like that.

PAUL: So you're Scientologists.

[Chuckling]

NATALIE: Don't get me started. That's for another episode, to be recorded at a later date. I'm not a Scientologist.

So, we do that, and we have both a master's and a doctorate. So, when you see us for therapy, we have extra years of training and experience in how to do this with you, okay.

So then the next level down is a little complicated because it's different in different states, so I can talk, it's like, why can't we all get on the same page, but I'll talk about California, but the next level down is like an MFT, right, and that's a marriage and family therapist. So, these are people that have a master's degree in doing talk therapy with people. Again, they do not prescribe medications, and they do not do testing, okay.

So, in California, this is an MFT. In some other states, it's like MFCC, marriage, family and child counselor. I would also lump into this like clinical social workers, you know, these are all people who have a master's degree in doing therapy with people and you do talk therapy with them.

And then the last thing that I wanted to say is I wanted to add one on to the bottom here, because it's a little PSA that I like to do, and I talk about it with my clients, too, are coaches, life coaches, right.

So, there are some people in the field of mental health who have a very negative opinion of life coaches. I am not one of them. What I advocate is that you need to be really well educated and careful when it comes to working with life coaches, and I'll tell you why.

Because psychiatrists, psychologists and like marriage and family therapists, people with masters' degrees, these are all protected terms, okay, meaning that they are legally protected. If we all--

PAUL: There's a standard.

NATALIE: Yes. We all have a license from a governing board. We all had to go through like rigorous processes to get this license. If we muck up, there's a lot of things that could happen to us, up to and including losing your license, right. We have oversight, right.

And if somebody was to advertise themselves to be a psychologist or a psychiatrist and they weren't, they could get sued into oblivion.

PAUL: And s