Episode 71 Transcription: Understanding Over-Controlled and Under-Controlled Personalities

Welcome to the Mind Dive Podcast, brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, Dr. Bob Boland…

 

And Dr. Kerry Horrell. Monthly, we explore intriguing topics from across the mental health field and dive into hidden realities of patient treatment.

 

We also discuss the latest research and perspectives from the minds of distinguished colleagues near and far.

 

So thanks for joining us. Let's dive in!

Welcome back to the Mind Dive Podcast. We are thrilled today to have Dr. Ellen Astrachan-Fletcher,  on with us today. Dr. Astrachan-Fletcher, PhD, FAED, CEDSS. We're going have to, I'm going to have to come back to you and hear some of what those mean because I actually don't know. But Dr. Astrachan-Fletcher,  PhD  I'm familiar with, has a wealth and breadth of experience treating adults and adolescents with mood anxiety and eating disorders. She has over 30 years of clinical and teaching experience in the field of eating disorders and women's mental health issues, during which time she taught and supervised psychiatry residents and fellows, as well as clinical psychology, interns and externs. She is a senior clinician in the Radically Open DBT (Dialectial Behavior Therapy) therapy, which is RODBT, which we're going to focus on today, training directly under its developer, Tom Lynch. And she is a nationally recognized expert in the field of DBT and family-based therapy, a frequent presenter at national eating disorder conferences. Dr. Astrachan-Fletcher has co-authored books and workbooks that are widely used at eating disorder treatment facilities throughout the country. Currently, she's the owner of EAF Recenter and a lecturer at Northwestern University's Department of Psychiatry and Behavioral Sciences and an associate professor of Clinical Psychology at the University of Illinois at Chicago. So thank you again for being here. Can I ask what some of the credentials are behind like FAED?

 

Yeah, I'm assuming that one's means. Absolutely. And by the way, thank you so much for having me. I'm really looking forward to talking with you both today. FAED is Fellow to the Academy for Eating Disorders.

 

That makes sense.

 

And CEDS is Certified Eating Disorder Specialist, with it's now a “C” after, which means I'm a consultant. Used to be an “S” for supervisor.

 

Okay, great.

 

Well, that's actually a nice introduction into where we usually like to start with our podcast, which is always just to hear a little bit about yourself and tell us a little bit about your career. Um, obviously, you have a wealth of different expertise areas, obviously, including eating disorders, women's mental health, and DBT. And maybe you can tell us a little bit about kind of how you've come to particularly land on RODBT as what you're working on now.

 

Absolutely. Yeah. So long career. I'm old. No, I'm just joking. I've had, you know, 30 plus years in the field. When I was early on in my career, there were two kind of main camps. There was the psychodynamic camp and there was the cognitive behavioral therapy camp. And I didn't fit into either. And at that time, what I was referred to, it was like a dirty word, uh, eclectic. So, I was considered an eclectic therapist. And basically, when people in the psychodynamic camp or the CBT camp couldn't figure out how to move their patients or how to help them, they would refer their patients to me. And so, you know, with that evil eclecticism. Fast forward, Marsha Linehan came around in 1993. She develops DBT, which, you know, from my experience was basically eclecticism standardized. And I was just overjoyed. I was like, this validates everything I've been doing. This is so wonderful. So, I jumped on the DBT bandwagon very quickly. And so really spent about a decade focused highly on DBT. And then, FBT was also a big part of it, certainly focusing with eating disorders. And then I read an article. Actually, a good friend of mine, Laura Efflin, suggested I read this article. I read the article on uh Radically Open DBT in eating disorders. And I was blown away. I was just like, this is the answer to those clients I could not figure out how to help. You know, DBT helps a lot of people. And then there's this certain group where they know all the coping skills and for some reason, they don't use them. And so, you know, when I learned about Radically Open DBT, I said that this rounds it out. And so, the beautiful thing is DBT and Radically Open DBT fit together because they're basically dialectics, meaning it's a big bell curve in this theory. And the bell curve goes from over-control, and this is emotional over -control, to emotional under- control. In the middle of the bell curve, most of us exist, meaning we are over-controlled or under-controlled, but in that middle of the bell curve, we have flexible control, so we can pull on traits from the other side. Make sense? It's only on the tail ends of the bell curve that it's problematic. So, in this theory, you can move up and down your side of the bell curve, but you never flip sides. So, I'll just start by saying, and you might even get this idea pretty quickly, I am emotionally under-controlled. Okay. So, really, I'm fine with emotion, I'm fine with vulnerability, I will tell you everything and anything you ever wanted to know about me without ever worrying that you're going to hurt me with that. Right? So, I am really under-controlled. Now I can tell you, if you met me in my 20s, you would have been like, holy moly, this woman is never going to have a career because I would emote all the time. If I was frustrated, if I was angry, if I was sad, I was emoting. And over the years, college, graduate school, getting married, having a family, having a career, I've moved so far up my side of the bell curve that sometimes at work, people think I'm over-controlled. But you better believe the second I get home, and pajamas go on my body, I am as under -controlled as ever. You said I am UC for life.

 

That is, that's where I stay. I'm loving this introduction so much for a few reasons. One, I really resonate with the idea of not quite fitting into well, can still feel like these kinds of camps where you kind of have to be one or the other. We've wrestled with that on the podcast of course. We've had people from all over the spectrum come on.

 

I also like the flexibility that you can change in different situations as would be appropriate. Yes, which I imagine is a measure of maturity, but yeah.

 

I mean, actually, one of the things that this theory says is it's a measure of emotional wellness. So, one's ability to be flexible, one's ability to take in feedback, and one's ability to develop at least one true connection, which I'll explain to you in a little bit. That is what makes a person emotionally well in this theory. And by the way, the one true connection. So, people can have lots of friends and be in a room full of friends and feel totally alone or be surrounded by people who say that they love you and yet they feel unlovable. And this is like a dilemma of the over-controlled, the emotionally over-controlled. So, the question is: how does a person get to that place where they're surrounded by friends, but they feel totally alone? Or they're being told that people love them, but they feel unlovable.

 

Yes.

 

And the general idea is if you can say to yourself, “If they really knew me, if they really knew what I thought, if they really knew what I felt, they wouldn't love me and they wouldn't be my friend.” So, then you go, “Okay, what's the solution to that?”  You actually have to start learning to be vulnerable, meaning sharing those things that when people are more on that emotionally over-controlled side, they do not feel comfortable sharing. Make sense?

 

So we're kind of getting into what Radically Open DBT is, but can you tell us more about it and how it addresses this?

 

So how the treatment actually addresses that emotional loneliness is that it?  Yeah.

 

Maybe also you hinted at this, just as like a tag onto that question, that DBT was first and then ROT RODBT happened. Can you say a little bit more about the history of it?  How we got to another flavor to go alongside with DBT?

 

Absolutely, very cool story. So, Tom Lynch, the developer of Radically Open DBT, actually spent the first half of his career doing DBT. So, if you research him, you will see he was actually in Marsha Linehan's inner circle. So, he was very big in DBT, and he started to think about the dialectic about this. He ended up moving overseas. So, he now lives in France. And when he moved overseas, he started doing more research (which, by the way, in the beginning was fully supported by Marsha Linehan) of this idea, this concept of people viewing control as a wonderful thing. You know, our society says the more control, the better. You know, keep controlling, you will be successful. And so Tom Lynch started asking the question: is it possible you can have too much of a good thing? And he started researching this other side. Now, when you think about it, most treatments that exist today exist for people like me, the under-controlled. Right. Why? Well, one, because our society says control is good. So why would you want to treat it? The second reason is, you know, and I'll just ask you, how would you know someone like me is in distress?

 

I think that you know someone who's kind of under-controlled in distress because you see it. They're probably… it's all on their tone of voice, their face, their body language. It's something you can witness, just behave. You got it.

 

Exactly. I'm going to show it. Yeah, and someone who's under-controlled will be demanding treatment. “ I need help. You need to help me. Help me.” Right? Right now, someone who is over-controlled tends to have the belief that I shouldn't need help, that I should be able to handle this on my own, that the best thing for me to do is control and contain. So people who are over-controlled don't quickly get into treatment. And by the time they get into treatment, it has taken so long, and they are struggling so much. that they are actually doing what we call in our O DBT emotional leakage, meaning you hold it in, you hold it in, you hold it in, what has to happen? Eventually, you explode, right? And this we call emotional leakage. And by the way, emotional leakage can look like an explosion, it can also look like “no,” that's an example of emotional leakage, right? For someone who never expresses themselves. So, they have these big emotional leakages, and then they go,” I need treatment.”  And what do you think they want? “Help me keep that under control even more.” Exactly. In other words, what they want to do is learn to control and contain. And by the way, that's what most treatment programs teach. Here's how you control and contain. And guess what happens to a person who already knows how to control and contain and is leaking, and you teach them how to control and contain. Guess what happens? The leakage keeps happening, you get it, and in probably more and more profound ways.

 

Or they start using alcohol or substances.... That is exactly to increase the control.

 

Yeah, you got it, all of that, yes, and so what over-controlled people need to learn is not how to control more, they need to learn how to slowly let it out, they need to learn a release valve, yeah. And part of that is learning to be vulnerable with people, which when people are over-controlled, because they are perfectionists who believe they need to appear perfect, and they believe they need to strive to be perfect, but they never believe they're good enough, don't want to ask for help because that would imply they're not perfect.

 

You know, one of the areas that I  tend to be very interested in and talk about a lot is shame. And one of the cycles of shame that goes along with this that I talk to my patients about is, you have the over-controlled person, they are holding it down. Like I often give the example of holding a beach ball underwater. It's taking more and more energy to push it even farther down, and then it comes flying up to the surface. And usually, the way the emotions come out, because of the way that's held down to the person, is even more proof that this is why we don't let emotions out. So, they have the moment where they say no, or they get a little bit more, like it leaks out. That to them is proof, this is why I don't let emotions out. Even more of a sense that this is a shameful thing to be pushed down.

 

Well, it's kind of "therapy made me worse".

 

Exactly. And it's like why would I do this when I have let my feelings out? I feel horrible about myself. It pushes people away. And so, I think so often, helping people to even get the buy-in that letting your feelings out can be healthy, help you feel better, help your relationships. Like that's so the first part. Cause I tend to find over-controlled people saying, “no, it's only hurt me before.”

 

Yes, absolutely. You're totally right. And one thing I do want to make crystal clear, because sometimes when people hear about this theory, they hear the word over-control and they immediately go, “that's a terrible, horrible thing.” And I want to make it clear, actually, people who are over-controlled are really pro-social. They care, they want right, they want good things in the world, right? They are detail focused, they are, you know, frankly, if it weren't for over-controlled people, we would never have gotten to the moon. We would never have built bridges, right? I mean, it's not because sometimes people hear the word over-control, and they think: “ I have a controlling personality.” That's not what we're saying. Okay, it is not controlling, like a jerk kind of personality. It means that they are over-controlled in the way that they cope. Okay. I really want to clarify that.

 

I'm okay. One more thing. And then we'll hop to the question. I just want to say I so relate to that because I actually think being in the world of therapy, so often I have an understanding of control that I've become so comfortable with that I forget that sometimes you throw that word out to a patient, you watch them flinch. Like I have a patient who's incredible, I mean, truly so kind, so empathic, so concerned about others. And one time I said, “You're really control-oriented.” And I just watch this person go, ”What?” It took me a second to realize they thought I was saying they were controlling. And I was like, “Oh no, no, I just mean that you're like incredibly disciplined and regimented because like this makes you feel in control.” And, yeah, I think that's such a good, good point.

 

Yeah. And by the way, you mentioned this kind of personality style. That is one of the styles we talk about. Sometimes we refer to them as the nicest person I ever didn't get to know. And you wonder, how does that person, how do they end up depressed? They’re so nice and everybody loves them. Well, here's the deal, and that is an over-controlled personality style. When you are so nice and you only worry about others, and you only take care of others' needs, and you never ask for help and you never want to burden anyone, what happens to you? You end up not getting your needs met. And that person who doesn't get their needs met, do they have feelings about that? Yes, they feel angry, resentful. How do you think the nicest person you ever didn't get to know feels about the fact that they have anger and resentment? They hate themselves. So, it becomes this dynamic where they're super nice, super giving, they don't get their needs met, understandably have anger and resentment, but then hate themselves for the anger and resentment.

 

Yeah. I'm curious. Uh I mean, it's clear that when you know people pretty well, you can kind of know where they fall in the spectrum. But when you first encounter a patient, like how do you introduce this and how do you assess them for this? You can't just ask them because these are such charged words. And oh, for sure.

 

Yeah. So, we talk about biotemperament. Biotemperament is the biological basis of emotion that impacts two things. One, how we perceive the world, and two, how we regulate emotion, right? And so, we look at the biotemperament as different for over-controlled people and under-controlled. And we explain this. So, for example, what are the biotemperamental traits? The first one is threat sensitivity. Threat sensitivity is how easily do I feel threatened in my environment. So, for example, imagine passing someone in the hallway every day. Someone at work, someone at school, your acquaintances, you always do the polite smile and nod. “Hi, how are you?” One day they pass you in the hallway and they have a flat face like this. What's your first thought?

 

Well, yeah, just want to know what's going on with them today.

 

Okay, so first thought, huh? I wonder what's going on with Ellen. Looks like she might be having a hard day.

 

Yeah, since it's unusual.

 

Any other thoughts? As a as somebody who teaches and really cares about mentalizing, I would try to take a mentalizing approach, which is I can tell something might be going on with Ellen, but I don't know. I'd be curious to see what's going on for her.

 

Yeah, but I feel like you're looking for something more. Yeah.

 

I mean, I do I do think I'm the kind of person who would be like, “Ellen, are you okay?” Like I would say something. I probably wouldn't just let it go.

 

So let me ask you, what do you think someone who perceives threat in the environment might think with someone?

 

Well thinks that they're coming at them angry or that you did something wrong or you got it.

 

And it would freak them out. It'd be like, oh no, like especially if you can't read what's going on for them and you've had experience with that in the past, it could feel like that person could end up being explosive or upset, and that's scary.

 

I mean, typically the higher threat sensitive response is “Oh my God, what did I do? Ellen's mad at me. I must have done something wrong.”  Right? In other words, they're taking a relatively neutral stimuli that they don't know what's going on and they perceive threat from it, right? So, if we're in a room and there's a big window and we hear lots of loud noise outside, we go running to the window. We see tons of people gathering in the street. A threat-sensitive response is, “Whoa, that's a mob.” A more reward response is,” Ooh, is that a parade?” Right? And so this is in us from the beginning. As a young child, we might ask someone, when you were in the park, were you more likely a child who would notice the beautiful flowers all around? Or were you a child who might have noticed the thorns and the bugs? When you were a child and you went to a park, were you the type of child who would run out and play with any other child who was there? Or were you more likely to stick close to your caregiver and only play games that you knew you'd be good at? Right? These are some of the questions that we ask early on, because signs of biotemperament show up as early as ages four or five. So, you can see that child who's more threat sensitive sticking closer to their caregivers versus the child who is more reward sensitive running out to play, right? And so we ask about these biotemperamental traits. So there's that threat sensitivity. Do I perceive threat in my environment? There's reward sensitivity, right? Which is how excited do I now when I do that in front of someone who's over-controlled, they usually look at me like I have two heads. In other words, people who are more over-controlled have super low reward sensitivity, meaning they are not easily impressed. It takes a ton of reward for them to feel rewarded. By the way, what does this tell us about treatment? Rewards don't work for people who are over-controlled. And a lot of our treatments are reward-based. Okay. So, someone who's over-controlled is going to be like, “Yeah, sure, I don't care if you give me that.” No, that's not going to motivate me to change, right? Where someone under-controlled is very reward motivated. The next thing we talk about is detail-focused versus globally- focused in our processing. Any guesses, which is which?

 

Can you say it one more time?  Yeah, go over that again.

 

Yeah. Detail focused versus globally focused in our processing. Who do you think is detail-focused and who do you think is globally-focused?

 

I would think the controller is detailed.

 

OC's got to be detail, UC's got to be, in other words, someone who's over-controlled will see every vein on every leaf on every tree. I will run smack into that tree because I am looking at the beautiful forest. And I don't even see the tree, right? So UCs, we make terrible editors. Do not ever have a UC as an editor. So you can see like that detail focus versus that global focus. We need both, right? And one of the things I sometimes would do in a group or something, if I didn't yet know. or people didn't know. which way they leaned, I'd go to a whiteboard and just put a random slash on the board and sit back down and then just watch people. And what do you think I would see?

 

I'm imagining if I did that with my group. Well, some people would be like, “What did you do that for? What's that about? Do I need to put that in my notebook?” And other people would just ignore it. They'd be like, “Who cares?”

 

Yeah, or erase it. “Why did you put that up there? Get that off the board.” I've heard, “Ellen, if you don't erase that, I'm going to erase it.”  I mean, like really discomfort, whereas someone who's under-controlled doesn't even notice it. Certainly doesn't bother them, right? And so just by doing that, I can immediately get a little scan around the room of which way people might lean because of that detail-focus versus the global-focus processing. By the way, my mother is over-controlled. And so, what do you think it was like for her when she would come to my house? Oof.

 

Yeah.

 

She's noticing the laundry on the floor, the dishes in the sink, she wants things put away.

 

You got it. She would come into my house and tell me this laundry list of everything that is out of place, broken, not right, needing attention. And I hadn't noticed any of them. And so my mom and I had to have a real heart-to-heart. By the way, she did not like it when I told her she was over-controlled. So, because we processed differently, we made an agreement. She could come to my house and tell me the top three things. Five, if it was a really bad day. And I would promise not to take that as her telling me I'm a horrible human being whose life is out of control. Right. Because our brains just work differently. And it's not good or bad. That was so helpful. Oh wow. So helpful. Yeah.

 

That was so helpful. Oh wow. So helpful. Yeah. I have a reflection, but I want to make sure. Are those the two main spectrums, or is there any other ones?

 

Well, again, it's over- control to under- control on a bell curve. So, it's not a black and white thing. Yes. But you do lean one way or the other.

 

Sure.

 

For the for the reward versus threat security and then the global versus detailed. Were there any other ones like that that you wanted to cover?

 

Yeah. Sp there's reward sensitivity, threat sensitivity, detail versus global focus processing, novelty seeking. So, who do you think likes new experiences and likes to do speed? Spontaneity and all of that.  Right. And then this one is extremely important for treatment--- inhibitory control. Who do you think is there versus the other one –having high inhibitory control or very low inhibitory control.

 

Yeah, okay, yeah, yeah. Yeah.

 

Your UC folks are going to be low inhibitory. They're going to be more impulsive. Sure. Exactly. And here's the deal. And this is why it's so important to treatment. Over-controlled people, dare I say, have superior inhibitory control. Meaning, if I don't believe I should act on an urge, I won't. Right. Which is very different than the way most treatments handle urges. Yes. Well, exactly. Because what would we typically do? We'd throw skills at them to fight an urge that they don't need to fight because they don't believe they should. And that is a very different conversation. And that's, for example, one of the things about non-suicidal self-injury in the over-controlled person versus the under-controlled. And both types, you know, people on both sides have that. But for the over-controlled person, non-suicidal self-injury is typically due to the belief that the good get rewarded and the bad get punished. And I've been bad, so I need to be punished. Over-controlled self-injury is very often hidden. Upper thighs, stomach, breasts. The over-controlled self-injury is planned. It is sometimes ritualized. The under-controlled self-injury is:  I am feeling so much emotion that when I physically injure myself, that pulls my attention to the physical pain and I get emotional relief. And so, it's a way of managing my emotions. And that is an urge that I struggle to fight, right? And that is very often visible because under-controlled people are much more likely to say, I want to show my pain, even though a couple of days later they might not want to.

 

Yeah.

 

Make sense?

 

Well, and I think I'm what I'm what I'm kind of struggling with as you're talking about this is I have always identified as over-controlled. Like I’m definitely over-controlled. Yes, I know. But then I think that I would fit much more of the UC stuff. I'm much more global. I'm not detail-oriented. I typo, I am a typo queen.  I definitely am more of the risk one. I'm not a threat. I don't worry about threat too much. Anyways, I was thinking about this and just wondering about the development of this. Obviously, there's like a biological genetic, or kind of like we're born with it, but like, can it also be influenced in relation to the stuff that happens to us, right?

 

Well, it's a biosocial theory, yes, right? Yeah. So you have the biological piece, which is the biotemperament, and then you have messages from family, from environment, friends, culture. And culture, by the way, really plays a role, which I can also talk about. And that leads to the over-controlled coping, which is what we're addressing, right? So, for example, you have a little boy named Johnny. Johnny is about six years old, biotemperament of an over-controlled child. High threat, low reward. Johnny gets invited to a party. Does he want to go? No. No, he doesn't, right? High threat, low reward. This is not going to be fun. But Johnny's parents love Johnny. They really want Johnny to make friends. They know how important that is. And they say, “Let's go, honey. I'll take you. I'll fade into the background. No one will even know I'm there. But if you need me, I'll be there.” So off they go to the party. Now, typically I'll say, like, what do you think happened at the party? But for sake of time, I'll just tell you. No, you know, when I ask, what do you think happened at the party? Typically, people say he surprised himself and had fun, or he stuck by his caregiver's side. Not so important as what do you think his friends thought about Johnny having his mother at the party? Johnny's a baby. Johnny needs his mommy. “Why don't you go suck your thumb, Johnny, you big baby?” And what does Johnny learn? Johnny learns, and so sometimes when I ask that, people will say that he shouldn't have gone to the party. No, Johnny knew that. Threat sensitive, right? What Johnny learned was: I can't show my mother my fear. Johnny learns to mask. Because even though his mother did nothing wrong, Johnny basically learned I can't be anxious. And so, Johnny learns to mask. So that's how Johnny's over-controlled coping starts to develop. Make sense?

 

Absolutely. It makes sense.

 

Maybe the last place we can, because I found myself thinking there's so many things I would ask for follow-ups right now.

 

And by the way, you can have ADHD and be over-controlled. I just wanted to address that because someone who's over-controlled and has attention deficit disorder looks like they're not detail focused, looks like they don't have inhibitory control, but they freaking hate that about themselves.

 

Yeah.

 

Where someone is under-controlled with ADHD, it bothers them way less. Also, one last thing-- trauma can make an over-controlled person look under-controlled. Trauma can make an under-controlled person look over-controlled. But once the trauma is processed, the person goes back to their biotemperamental selves.

 

Yeah, I just want to hear more. You’re getting into it, but I want to hear more about the process of treatment. Yeah. You know, given the concept. I know we're running out of time, but just give us a snippet of how do you approach these things? Yeah, I'm grabbing control here, you can tell.

 

No, but that's exactly where I was. What are some of the basic differences of what it looks like working with someone who's OC versus UC?

 

Yeah.

 

I mean, the basic difference is that it's dramatic. So, you know, it again, yeah, everything pretty much, other than the structure of treatment. So, like DBT, Radically Open DBT, you are also using a diary card, you are doing skills training, but what the skills are teaching you is different. So, for example, when people are in treatment for eating disorders and higher levels of care, they typically go in and out multiple times. Why? In this theory, it's because we don't teach people how to connect outside of treatment. And so once they go back to their lonely, isolated lives, they tank. And then they go back inpatient, they connect because you have to be vulnerable, you have to do the work. They feel better, they get nourished, they go back home and they tank.

 

Assumably, a lot of people with ED are OC. That's my guess.

 

Well, with anorexia for sure, but even the others, yes, absolutely. And you'll find actually people think substance abuse is mostly under-controlled. Absolutely not. I mean, think about a person who's so over-controlled, but they have a drink, and all of a sudden, they go, oh, right. I mean, you're in big trouble then. High-powered executives are very often over-controlled till the hilt and don't even know it, that they are struggling from emotional loneliness, perfectionism, right? That all contributes to depression and anxiety. And this treatment was really developed for people with depression that did not respond to any other treatment.

 

Yeah.

 

Because what those treatments weren't helping them with was connection. Because one of the things we talk about in Radically Open DBT is social signaling. And I mean, it's like the main part of treatment. So very often when people are over-controlled, they socially signal unintentionally in ways that push people away and they're alone and they don't understand it. So, for example, everybody's been part of a group project. Have you ever been part of a group project where one person takes control and they get the A for everybody?

 

Yeah, always right.

 

Well, they get the A for everybody and then everybody goes out to celebrate. Do they always invite the person who got them the A? The answer is no. And likely, if they don't, why? Well, first, how does that person feel? What the heck? I worked my butt off, I got them all A's, they're so ungrateful. I hate people, by the way. Anyone who says I hate people is very likely over-controlled. So I hate people, right? And so, okay, why didn't they get invited? Well, when someone says to you, just give me what you have, I'll fix it, I'll make it better, I'll get us the A. What are they signaling? Leave me alone. I don't want to work with you. Even more. I'll make it better, I'll get us the A. You're stupid. I don't trust you.

 

Yeah, it's a bit insulting.

 

Yeah.

 

And patronizing.

 

So typically, you're in, by the way, you just got all of them. You're incompetent, right? How much do we like people who think we're incompetent? Not much.

 

No, not much.

 

Not much. And then they say, you know, “ I know you've worked hard, and you know, but I I'll do the editing, I'll pull it together. “ What are they saying? “I'm better than you.”

 

Yeah.

 

Yes.

 

Right.

 

“I'm better. I'm superior.”  How much do we like people who think they're better than us? Not much. Not much. And then they say, “I know you said you'd work on it over the weekend, but you know, I know you get really busy. Just give it to me and I'll take care of it.” They're signaling “I don't trust you.” So then you put it all together. How much do we like people who think they're better than us, think we're incompetent, and they don't trust us? We don't like them.

 

Well, how can you like them? Right.

 

And every time I've told that story to a room full of people, I get a bunch who all of a sudden go, Oh my God. I what's the literary thing? I was like, I feel seen. I feel a little called out. Because no one means to signal that.

 

Yeah.

 

And so, getting back to your question, what does RODBT do to help these people? We actually track social signaling. We help them recognize, and we're considered like social ambassadors. We help these highly over-controlled people, again, on the tail end of the bell curve, learn how they might be social signaling, what's behind that, maybe take a look at themselves, what they might need to learn about themselves in order to grow. You know, it's kind of like, have you ever met someone who corrects you on everything, corrects the way you load the dishwasher, corrects the way that you speak, correct? And that person correcting you thinks they're doing you a favor, but you probably don't like them very much. Right. And so we in a very, I actually love RODBT. I love doing it because we get to tease our clients. We get to be playful because guess what? They need help doing that. Yes. They need help learning how to tease and take a tease. Because teases are a crucial social way that we give loved ones feedback. Yes.

 

Yeah.

 

And again, to a perfectionist, feedback feels critical and insulting. From an RODBT perspective, feedback is a gift because feedback helps us learn and grow. So, it means the person, at least at some level, cares about you. Absolutely.

 

Yeah, we don't we don't give the teasing feedback moments to the people where I don't care about this relationship.

 

It can be left.

 

Yeah. Yeah, absolutely. I have to say, I feel like we could keep going on forever because I have so many follow-up thoughts. But I will say I find this to be very orienting and structuring. And I  imagine that's so often what patients feel when they hear this. It just gives them some structure to be like, this is why I maybe lean one way or the other. Yes, and help orient to what we need. So, I just I find that really helpful. Yeah.

 

And I enjoy the way you can always do part two if you want. Sure. And I enjoy the way you approach it. I think we're getting a sense of what your style is as well.

 

I was going to say, I don't think we've had anybody.

 

Yeah, exactly. Right, right. I needed more coffee this morning.

 

But gosh, thank you so much for sharing with us. And ultimately, again, I think in a very clear way, helping kind of non-judgmentally see that we lean a certain way. And so we need to think about that for ourselves and for our patients -- what we need in response to that. So, thank you. And it's not a bad thing, right?

 

It's not a bad thing. It's just who we are. So, let's learn how to live within and in a way that we can have the most fulfilling lives.

 

That wellness, like you mentioned, mental wellness.

 

That's a great last word.

 

Yeah. So, we've been listening to Dr. Ellen Astrachan-Fletcher talk to us about RODBT, biotemperament, and under-and over-controlled coping styles. And again, thank you so much for coming .

 

Thank you so much for having me.

 

And I'm your host, I'm Bob Boland.

 

And I'm Kerry Horrell. And thanks for diving in. The Mind Dive Podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.

 

For more episodes like this, visit www.menningerclinic.org.