Psychodynamic Technique and Therapeutic Intervention: Mirroring, Clarification, Confrontation, Interpretation

[MUSIC] Morning, Dr. Matt. Good morning. How you going? [MUSIC] I suppose I feel a little bit more of a buzzer today. Level in it. [MUSIC] Oh yeah. Is this in reference to the levels? [MUSIC] That's right. It's the promised levels. I don't know if it's going to really take up all that much time. [MUSIC] But here we go. [MUSIC] We should have, I feel like last time I mentioned it, Kramer in Seinfeld wanted to make his house levels. So it makes a bet with Jerry on if he can do the levels, then he doesn't do the levels and he goes, I could have done it if I wanted to. So even if we didn't actually release this episode. [MUSIC] I don't know if there's any. >> Yeah, we could have done it for a while. Levels, Jerry. Levels. It's a pretty good episode. So we talked about how, and then that's in the first episode. There's the level zero. It's extremely important. Remember, picture the levels in a descending impairment, reverse pyramid. The one that you do the most, this is the top part of your food groups. Okay, this is level zero. That's the supportive elements, the alliance, and technical containment. Refer to the other episode for that. What is the next most common intervention you do in an interview or a therapy session that is called empathic mirroring, level one, empathic mirroring? >> Yeah, I'm excited to hear you talk about this. Because I'm curious to hear how you distinguish empathic mirroring from sake containment. But give us some. >> Yeah, start off. Spoiler alert, they probably aren't all that different. But we can draw a distinction. So the problem with empathic mirroring is what does that mean? I don't think it's a very clear term. In this context, I'm going to define it as getting the patient to talk more, to continue their narrative without changing the trajectory or content of the narrative. Okay, so it's any intervention you do that basically gets people talking more. Along the lines that they're already doing. Classical terms that would be encouraging free association. Now there's a lot of different ways you can do that. It can be very, very simple. It can be simply, tell me more. Tell me more. It can simply be looking interested. You can do this nonverbaly. Or it can be reacting, emoting with your face to what the patient is telling you in a way that demonstrates care, interest, and that you are feeling what the patient is feeling. Another important area that I would recommend developing, if you haven't already, is I think it's important for psychiatrists, clinicians, psychologists, therapists to have a wide variety of "hums" and "hums" in their back pocket to try out. "Hums" and "hums" nonverbal acknowledgement sounds very important. You're not offering up any new content. You're not redirecting in a specific way. You can do this nonverbaly and it prompts people and encourages them to continue speaking. Interesting. Because you're defining empathic mirroring as kind of getting the person to continue to talk. I think that in terms of biodecapsulate in one sentence, it's reflecting that the patient's subjective experience in a tuned way. I'm going to build off a little bit of theory, but it might be relevant here. Containment comes from beyond. To me, the main focus on there is building the capacity to think and regulate emotions. You do that by digesting and metabolizing what the person says and reflecting, giving it back to them in a form that they can think about. Whereas mirroring comes from co-hut, which has to do with the development of a self, in that essentially a child has their experiences and they need another adult to reflect it back to them so that they can see themselves in other people in some sense. The focus when someone's doing mirroring is to say, "I see your experience and the need to be recognized." I'm relatively similar, but I think of containment as more of processing and putting thoughts into a container and metabolizing thoughts in a way that they can hear back and mirroring as a way to show that this person has an individual self that can be seen and is important and recognized. I've actually categorized those things under the same umbrella. I think the co-hutian idea is pretty much a beyond-s idea. If you're doing one, you're doing the other in my opinion. This is where we're going to trouble. Why do I put those in level zero and this one level one? It's simply terminology. This is again an issue where when different authors, different people use different—sorry, the same terminology to refer to different things that get super confusing. So cast aside everything you've learned or thought about when it comes to empathic mirroring, don't even use that terminology if you don't want to. Just call it level one interventions. Anything you do that gets somebody to continue talking. Yes, it can be a level zero intervention that causes them to continue talking without redirecting them. You can simply talk about what you've noticed in the patient's emotional process like I can feel how sad you are touching on these memories again right now. Just by saying that, you may cause the patient to continue speaking and you have not asked some question or brought up some subject or used some new words to redirect them in some fashion, even inadvertently. So it's a clarify? Level zero is about support and containment. Level one doesn't matter what we call it, but it's about getting the person to continue talking without changing their trajectory. That's right. Yeah, or free associating. An important tool for this, in my opinion, is called punctuation. This is via Bruce Finck of the Lacanians. You basically punctuate by basically emphasizing some particular word or turn of phrase that someone has just said to you. Okay, you're not introducing new content, but you're just sort of highlighting something that they've said. I like, I don't know if anyone listening, no audience I've spoken to has ever known this reference, but ever play Metal Gear Solid or heard of that video game series. I remember reading it in Nintendo Power as a kid, but I never played it. Right. So there's somebody who's made like some video online of the main character of that series, because in their cutscenes in the dialogue, the guy who writes these games, Kojima, he likes to have the main character just repeat like one word of what the person who's just said to them in a questioning tone. Okay, they might be talking about like, oh, you know, well, the government has done X, Y, Z. And Saul Sniff will say the government. Right. You can do the same thing as a psychiatrist therapist clinician. Okay. When patients say something, you can simply repeat back a keyword that they said and the patient will continue to discuss it. That is a form of level one and path of memory. One example, they might just say, you know, my friendships, my life, you know, they're all just messed up right now, you know, after everything. You might just say messed up. You might just say after everything or your life and your relationships, your friendships. Simply repeating back, very powerful tool. Don't discount this. Give it a try. Give it a try. You're probably already doing it once in a while. But that or your hands and hands, great ways to just continue getting patients to talk. Because why do we need this? One people will think, I've already explained all there is to explain about something. But you may find that you get a richer narrative or more information that you would not have gotten if you prompt people to continue talking on one line of thought, one line of narrative. Rather than asking specific questions about specific material that you, the clinician, want to learn about getting and encouraging narrative in this fashion. Very, very powerful for getting information. This applies to therapy, this is a plastic diagnostic interviewing, this applies to forensic psychiatry. Like the Hums and the Hums, if I could do a whole episode on your grunts and how they were. But yeah, I guess it's essentially like the, you're bolding what you would bold if you were to take a sentence and if you were to control be something, you're, you're control being some aspect of what the person said. Yeah, maybe at the end of this episode, you can edit in some of those clips from that solid slink video. A soldier that was thrown in prison along with me. Prison. She said that she had just joined up with a new recruit. A new recruit. I was in contact with her by Kodak. Kodak. Okay. So what's level two? So again, we're going in decreasing amount of data. of intervention, how much you do this in the session, you do tons of zero all the time, you're doing zero all the time, you do one, empathic marrying sometimes, not sometimes, a lot, but less so. And what's less frequent than that? Clarification. Level two. What is clarification? This is probably what diagnostic interviews are the most familiar with. Okay. Basically asking any kinds of questions or doing anything that gets the patient to go into more depth or detail about what they're talking about, but it, even if it redirects the narrative, it doesn't challenge the narrative and it doesn't highlight any inconsistencies or patterns just yet. You're just getting more information. And I like to think about it in two different ways. If the patient's narrative is the surface of a river, okay, imagine the surface of a river flowing. Clarifications can either increase the level of detail and attention on the surface of that river or it can increase the level of depth information that you get. So there are some types of clarification. The small plug to leave a review if you can leave a review will help other questions find our show and we'll let us keep making it. If you're on Apple podcasts, open the show page, scroll to ratings and review. If you like this, tap five stars. If you're not sure what to put for the review, just say hi, Dr. Foo. And if you're on Reddit or YouTube, leave a comment, Dr. Foo reads absolutely every single one. Let's get back to the show. Can you explain this river analogy a little bit more when you say going deep and more surface? Can you give us a little bit more of a picture of what you're thinking? It's basically just a way to think of what a patient is saying to you. If it's an evenly flowing river and then suddenly they stop talking or suddenly they change to subject, right? You might think of the river damning up or the river changing direction. And you notice that that probably tells you that something happened inside the person, usually what the analysts will call a defense that changed the flow of that narrative. And sometimes it's just a matter of getting that river flowing again. That's the level one interventions and pathoc marrying. And sometimes that part of the river is important and you want to get either more depth or more surface level details. So what do I mean by surface level details? Well let's say they talk about, well you know I had a fight with my friend last week and you know it was terrible. Okay, well that's important. That's some information there but we want more details. Surface level details would be surrounding events in sequence and context, right? Concrete stuff. Where were you with your friend? How did you get into that discussion? What was the discussion actually about? What happened after the discussion? All these things are concrete surface level, usually consciously accessible facts. That's river surface level clarifications when you ask for more details. Depth on the other hand is another important subtype of clarifying questions. When you get clarifications with depth, I like to think of it as fantasies, wishes, imaginations, emotions. Okay, when you got into that, what were you feeling? What kind of emotions were you having there? Did you wish that it was going in a different way? Whether you think about what were you imagining your friend feeling about you when they start bringing that up? Does this remind you of anything in your life? Has this ever happened to you before? How do you usually tackle this? Still all on the same subject? Not challenging the narrative, not highlighting contradictions, inconsistencies or patterns, but just getting more information. You can get it surface or depth. We talked about class episode that the overarching goal of therapy is to have the patient expand on their emotional life and shine light on their emotional life. Here, we're not inputting any hypotheses as to what's going on. We're not trying to, like you said, confront or point out contradictions. We're just trying to, in our mind, get a better visual per the patient of what happened and better understand the situation that they're experiencing. Don't assume that information is readily conscious for anybody. We go through a lot and we aren't fully aware of what we're going through. I like thinking about clarifications with Carl Roder's description of it in that it's just the process that's helping somebody see more clearly, figure out the meaning of things and really just what happened. Because someone went through something, doesn't mean that they can see it clearly. Try to put it into words, get those surface and depth clarifications. Awesome. Some examples, you can simply paraphrase something. You can confirm your understanding and you could say, "Hey, that sounds a lot like containment." Maybe. Let me make sure I understood that correctly. The reason why you got into this conflict with your friend was that first you were kind of having a dispute about debt, but it spun into something a little bigger, is that right? You could say, "Hey, just now you mentioned briefly that that was actually the end of your friendship." How exactly did that happen? How did it get from the debt to that? Popular clarifying question that I like to try out comes from, I forget his name, I'm sorry, a trainer I had for interpersonal psychotherapy, was what was that like for you? Very vague, but a great way to prompt people to clarify their experiences. What was that like for you? That's a great way to make them go deeper, a subtle way of asking them to go a little bit deeper. I like, like you said, even repeating things back can be clarifying. In my own individual therapy, once upon a time, a therapist would repeat back almost exactly what I would say and then I would disagree with it. It helped me and I was like, "Oh no, what I'm describing isn't perfectly capturing what I'm experiencing, when I hear someone reflect it back." Then I can hear the discrepancies in terms of the things I want to add. It can be very helpful for people. Yeah. Making those highlights in those discrepancies will be the next stage, the little next level of intervention. Before that, an important concept to highlight for clarification interventions and the process of clarification level two is the concept of exploring either imagination, fantasy, or actual memories in a hallucinatory level of detail. This is super, super important, not just for therapy, but also in forensic psychiatry and other kinds of diagnostic interview. This is actually what you will do. It's not the only thing you rely your opinion on far from it, but this is what you do for not guilty by reason of insanity evaluations. What you do in the therapy, too, let's take that example again of the guy having a fight with a friend. Have the patient describe the events step by step moment to moment in a hallucinatory level of detail. Obviously, you're not going to have time for this in men management, but in the therapy and the friends that contribute, you might go into really a lot of sensory details to you say, "Where exactly were you standing in the room? Where was he standing?" What time of the day was the quality of the light in that room? What was the color of the walls there? What was it? Any smells, just a hallucinatory level of detail with all the senses and walking moment to moment, you are essentially trying to induce the patient into a vivid memory of the event. Now, keep in mind, the nature of memory means that it's going to be edited. It's not going to be fully accurate. We don't do this stuff to take everything that someone remembers as absolutely true. We do it as a way to explore and to compare it to everything else we know in the case. You actually used that expression, hallucinatory level of detail in the past. I actually didn't quite understand what you meant. I think you put in a little more detail here, but just in case anyone else was confused. What you're just saying is that you can close your eyes and visualize exactly what happened. For some reason, I think I got caught up in my hallucination. All you're saying is you can close your eyes and feel and act. It feels like you were there when that whole detail. It's to a level of detail that you can even hallucinate it basically, just kind of the idea that you're getting behind it. You could experience, re-experience, hallucinate is just confusing. It's like, I don't know. I think it's a block. I didn't come up with the terms. This is just how I was trained. It's the literature. Analysts were so floury in the past. I felt like that. I really feel like they had just competitions and who could be more vague or complicated to actually in their writing, yeah, to use in the sense. We can talk about these things in an easier way, but unfortunately, I'm held prisoner by my training in the terminology. Let's move on to level three. Okay. So level three. is by the way, probably the, well traditionally you could say that this was the intervention that set apart psychodynamic psychotherapies from other psychotherapies, especially behavioral or cognitive therapies. Okay. But I think that's really an artifact of when we really only had like maybe two different kinds of therapies that were considered bonafide therapies that academics really care about. You know, today we have this vast field of different therapies including integrated ones and eclectic ones. So probably what I would say is that the presence of the confrontation level of intervention is what sets apart a depth therapy from another type of therapy. So it's an important one to understand. What is confrontation? It's not shaking your fist at the patient. It's not shaking the patient and saying, look at this, pay attention to this. No, confrontation. It's about yeah, it's about holding up one thing and then comparing it to another and saying, do you notice that? Do you know that? I like to hold my hands up like I'm holding up a platter. I like to say it's showing the patient their own mind or their own patterns. Right. That's confrontations. Confrontation is any intervention that points out a pattern, a discrepancy, an inconsistency or some kind of a change in the narrative or between different parts of the patient or between the values of the patient and the behaviors, anything that is odd, a pattern or contradictory. If you pointed out explicitly, bring attention to it, hold it up for the patient to notice. That's confrontation. Yeah, and I think how this plays out is going to differ a lot. I think it's important for us not to focus on confrontation as therapists. I think you need a good therapeutic alliance to be able to do it for the patient to receive it. We talked that sometimes there will be confrontations even on intakes, but then I think you should be a lot more gentle in terms of pointing out confrontations in the sense of the goal isn't necessarily to have the patient learn something new and have a different experience. The goal is probably just information gathering. But when you're doing it in a sense that you're trying to get the patient to kind of acknowledge some sort of inconsistency in their psyche or have a few things, you need a really good therapeutic rapport. It needs to be something that you have enough understanding that the patient will be able to receive it. Yeah, depending on the level of the confrontation, absolutely true, that's why these are in descending order of frequency of use, right? Zero all the time, one extremely frequently, two very frequent and three less frequent. It is entirely possible for you to go 20 years with a patient and never do a confrontation, which is a problem because fundamentally confrontations are how we actually get people from going ego-sintonic to ego-distonic, which is what we're trying to do. Because if someone sees or feels a pattern, a set of behaviors, set of values or any part of them, as part of them, they will never let that go. No matter how much it hurts them, no matter how much it hurts other people. If you can convince somebody through repetitive confrontation that there is something that they are doing or that's a part of them, which is causing them or other people problems and that it could be changed or it should be changed, that's how we actually get fundamental personality change. Confrontation, very important. In a formal therapy, I would say you should be doing these by session three at the latest. You should always do them gently and add a quick groundwork, but you should be doing them. In diagnostic interviewing, I don't think you should hesitate from doing these if you know how to do it gently and in a way that does not give off the impression that you're being punitive, overly critical, or anything like that. You can do confrontations, you should do confrontations, but you don't do them aggressively. You might just simply say, "I know this that, well, I'm already picking a hot button version of this." You've mentioned that being having poor concentration is a big problem for you, and that's the main reason why you're coming in. You've also told me that you smoke six-plants a day of weed. What do you make of that? Is that something that's related or what do you suppose is going on there? It might be worth bringing up immediately in the first session. You have to use your clinical judgment, and there's a difference between simply pointing it out, pointing it out repeatedly over time, and pointing out the pattern or the behavior and linking it to both how it helps the patient, how it's adaptive, and how it hurts the patient, how it's maladaptive. That's where you're really trying to build to eventually in terms of a long-term process of confrontation, but again, these can be used in the short-term in order to gather more information or to bring the patient closer to the inside. Can you give us a more specific example of a confrontation? Yeah, because it's a level of intervention all of them are that cover such a broad variety of things that you can be doing. I think we can only give some very limited examples, but it's worth talking about. One example might be simply making some kind of a connection between, let's say, somatic symptoms and stress. It seems like every time something that's stressful happens to you or that makes you feel like you're a bad person, you often get to get feeling very sick, have a headache, and then you lie in bed for the rest of the day and you kind of avoid people. Why do you suppose that happens? Do you agree that that happens and why do you think there's some connection? A confrontation presents something to the patient as important, potentially linked and you want to then ask if they can come up with some hypothesis about it. That's one example. It might also just be, have you noticed that every time we start talking about your best friend, your ex-best friend, you change the subject pretty soon afterwards. These are both more therapy-oriented confrontations, but they're salient nonetheless. Let's think of a more maybe medication management version of a confrontation. I gave a couple of interviewing versions of it, but I suppose it can even be a confrontation about observation of affect versus statement. You're coming in here and we're talking about medications and it seems like you want to get better. At the same time, I can't help but notice that when we discuss the side effects of medications, you seem quite anxious about it. Have you really feel about taking medications? Is that something that you really feel comfortable with or do some doubts? That was a confrontation that was followed by a clarification. There's no problem with mixing and matching these interventions. It's simply finding any kind of pattern, inconsistency, or something that doesn't make sense in a patient's narrative or presentation and highlighting, showing it to the patient and having them reflect on it. I have a quick example from medication management. Patient has actually also doing therapy with all the changes and details. Essentially whenever they were mad at me, this is an interpretation, but whenever they were mad at me, they wanted to taper off all their medications. There was multiple sessions that they would be in acute distress and would be essentially decompensated. They would say they want to taper off all their medications. I would have to hold up the conflict that put me in and saying, "It's hard because I feel like whenever you're mad at me, you want to taper off the medications." I also see that you're doing much worse. In terms of how, in medication management, it doesn't make sense. I don't typically start thinking about tapering off medications when someone's in an acute crisis. I would hold up that to them and try to help them to think through it. I think that's a perfect example of a confrontation. Again, that's just really holding up anything that involves the patient's own mind, behaviors, their decisions, and showing it to them to look at together with you and to reflect upon it. Anything beyond that, we are probably going into an intervention outside of the second dynamic framework such as a directive, a skill, or instruction, or we're going to interpretation. Before we get to level four interpretation, for confrontation, there is a important concept. I'm going to refer to a legal concept. It's the ordinary, reasonable person standard. When it comes to negligence, there is this legal fiction of having an ordinary, reasonable person standard. As a finder, a fact, do you remember? You are supposed to think, "What would most reasonable people do in this situation?" someone who's was sufficiently far apart from that and their actual behaviors, then they may be negligent. That's a short version of that legal concept. But you got to have an ordinary person standard when you work as a clinician. I know we are not necessarily working with people who can be held to an ordinary person standard that wouldn't be fair, but nonetheless it helps us understand whether or not a behavior is of clinical importance or not. Or if a pattern is of clinical importance or not. So in a mental health treatment realm, I want everybody to consider and know to some extent. And this may require some research. We're not ordinary people. We're not always just interacting with ordinary people. You have to know population norms got to ask what would most ordinary people, what do the majority of the population, what would they think do or feel in the same situation and is the patient different from that? Or even if the patient is not different from that, okay? Are there any other things that other ordinary people would have done or felt in the same situation? This is a path to suggesting alternative behaviors or happens. Even if psychotherapeutic therapies are non-directive, simply asking why a patient didn't do an alternative behavior or didn't feel something in an alternative opens up that possibility. In the behavioral therapy, you would actually actively suggest it. You would go like, what about this thing? Would you like to try that? When you try and tell me how you think or feel about it? But having the ordinary person standard allows you to notice things that are clinically important and allows you to prevent, to some extent, collusion with the patient's habits, defenses, patterns. Yeah, it's funny. I really like the way you put it. I feel like the thing I often enforce with trainees and supervisors is a big part of our job is common sense. And using your common sense for when a patient reports like, oh, I had a breakup a week ago and I'm doing spectacular, use common sense. And as you said, it's really helpful for not colluding with patients or not colluding with patient defenses. Common sense tells me that that's a pretty a typical reaction. And listen, maybe there is something that helps explain why that patient's having that experience, but it still needs to be talked about. Yeah, I think it's super important also because when you care about a patient and you empathize with them and you want them to get better, you're going to miss stuff because you're kind of living in the world of that patient and it's going to feel emotionally correct and all makes sense. But if you don't draw back and observe it in this way, you're going to miss stuff. A similar concept is the shared cultural scotoma. Scotoma being like a blind spot in the eye, individual field. This is something that's been written about in the psychoanalysis where two people, a therapist and the patient of the same culture may both mutually ignore some glaring aspect of the clinical situation because for both of them, it's a cultural norm. But even if it's a cultural norm, it may be something that's of clinical interest. So just be aware of this possible. I wish we. There's a lot of year in regards to the current political climate that's relevant, but we're not going to talk about it. Let's go to level four. Well, I think that's a different episode where we gripe about today's American shared cultural scotomos. Perhaps people can comment that's something that they want for another day. Level four. We're getting close to end of time. So let's just do the last level. This is the least important one, I think, unless you're object relations analyst where they start dropping these in day one interpretation. Interpretation. Okay. Now, keep in mind, again, same terminology, different concepts. I think different people in psychoanalysis even when they talk about when interpretation is, they're actually talking about very, very different things. Okay. So for this context, when I say interpretation as a level four, rare intervention, it's basically anything that explicitly makes a link between a pattern or a defense towards some kind of an unconscious process for the patient, wishes, desires, conflicts, ways of relating unconscious. Okay. How do you get to these? You have to have the evidence. You've got to have receipts. Do not give an interpretation until you have countless or at least numerous examples that you have already confronted with the patient of the defense pattern or unconscious process happening. Okay. You know, this can be a superficial interpretation. It can be a depth interpretation, but just like confrontations, you go from surface to depth. Okay. You start out maybe just saying, you know, it kind of seems like that, you know, you love your mother and you want to be close to her, but every time you spend time with her, you spend teasing her, criticizing her. Could this be something related to having two feelings about your mother, a part of you that wants to be close and loving another part that resents her and feels aggressive towards her? Right. That may be a little bit more surface level. And then as you go deeper and deeper intervention, you're going to start getting to a historical narrative. You're going to talk about why, where does this come from, right? Well, you know, it seems that this tendency to feel both angry and loving towards your mother sort of comes from a little bit of the inconsistent experience you had with whether or not she was happy with you when you were younger. And that you maybe had some feelings of competition between the rest of your family for her affections because she would just be away for so many times when you're younger. That might be why it doesn't seem to be easily accessible to you consciously that you're not always aware of the parts of you that are angry at her alongside the parts of you that love her. Again, again, I want to re-emphasize as you said, this is the thing that should be done the least. And especially in medication management, this is not something that you should be pulling out these deep emotional wounds and interpreting them for the patient. Yeah. And I actually think that has no place in a medication management treatment. Yeah. And I, you do see people play acting psychoanalysts in once every three months therapy and every once every three months medication management. And I think that does more harm than good. Yeah. Because this is my training and this is what I advocate. An interpretation should only be made when the patient is almost on the cusp or able to make it themselves. Okay. You should have so much database of information from clarifications and repeated confrontations showing the patient their own patterns and minds that by bringing it up the patient will say, hey, you know what? That's obvious to me. You know, you're right. This has happened so much. And those things did happen to me. And I think they are related. Right. That should be the time when you do an interpretation when the patient is almost able to explain to themselves. And in the same way, I advocate for a similar thing, though, it's much easier to reach for diagnosis. You should not make a diagnosis ideally until you have demonstrated to the patient that you have collected the history, made the observations, pointing them out to the patient, got a mutual agreement and say, hey, you know what? You know, so far we've been talking about multiple episodes throughout your life starting from around the age of 20, where for three, four days in a row, you've had decreased need for sleep, increased activity and all these other things. And you spend too much and you get into fights, you know, that's basically a definition of hypomania. And I think that means that you have a bipolar to this where they should be almost ready to make a diagnosis themselves based on what you've covered in the history of picking. It's the same principle. Yeah. And I feel like there's almost like a caricature of how people think about psychoanalysis and that like you get this like mind blowing interpretation. And then it's almost like a piece of advice that now that I can see the world differently. And that's not how it plays out. And it's not a feel good happy thing where it's like you nail the interpretation. Then it's like, oh my god. Now I everything's kind of cleaned out and I understand everything. It doesn't it doesn't look like that. As you mentioned, all the legwork is done on levels zero through three and that the interpretation is just a small skip. It's not this gigantic jump of some undetected emotion that is finally elucidated by some grand therapist. Yeah. I do believe in a Rogerian way that if you're just doing zero one two, your work is done. The patient will heal on their own. But you know, if you want to do some threes and fours too, and this is a long-term therapy, so much better, right? But just don't neglect. The first levels in order to do the rest. Yeah. All right, I think we're wrapping up. See you next time. Thanks for listening. If you want to support the show, check out my very practical anti-depressing course. If you want to check that out, go to psycho.arm.f-a-r-m. If you prefer to read, you can go to amazon.com. You can search my name, Gregory, GRE, G-O-R-Y, Malsberg, M-L-D-E-G-R-G. And the book is PsychoFarm's Guide to Treating Depression. It's a nice, easy, readable, practical guide to medication for depression.