Family Estrangement Therapy: When Therapists Fuel the Cutoff

Dr. Lisa Marie Bobby: As therapists, we're here to help our clients build better lives, healthier relationships. But what if sometimes, despite our best intentions, what we're doing in the therapy room can unintentionally contribute to more isolation? The reality is that individually trained therapists who are appropriately seeking to empathize with their clients, validate their experience, and asking questions about boundaries, consent, how relationships feel, these are all good things. However, sometimes we can foment these ideas with our clients that normal relationship distress is actually dysfunction.

Dr. David Rosmarin: In those cases, the therapist's job is to listen empathically, be reflective, be supportive. But in the meantime, you don't have that other person's perspective. You don't realize that the gaslighting parent is actually potentially responding to your client who's sitting in front of you, who's got their own interpersonal patterns which need to be addressed.

Dr. Lisa Marie Bobby: So how do we deal with this? How do we validate our client's perspective without reinforcing a narrative that makes it more difficult for them to repair their relationships? Well, that's where we're going today on this episode of Love, Happiness, and Success for Therapists. If this is your first time tuning in, I'm so glad you're here with me today. I'm Dr. Lisa Marie Bobby. Like you, I'm a therapist. I'm duly licensed as a psychologist and an MFT. I'm also a very proud board-certified coach, and I'm also an AAMFT approved clinical supervisor. And part of my job professionally is to help clinicians develop, as people and as happy, healthy professionals, but also as effective practitioners, which includes this visibility into ourselves, how we are showing up in the therapy room, and things that we need to be aware of so that we can manage it in our professional relationships. And that's what today's episode is all about. Lots more like this on the website growingself.com/therapists if you wanna access all of it. Sign up for my newsletter while you're there so we can stay in touch, and also keep in touch with me on LinkedIn, Lisa Marie Bobby. I'm posting stuff there every week. I would love to hear from you. All right, so let's get into today's topic. You guys are in for a treat. I am here with none other than Dr. David Rosmarin. He is a psychologist, a researcher, a professor at Harvard Medical School who specializes in anxiety. He's actually the founder of the Center for Anxiety, where he and his team see over 1,000 patients a year. He is the author of a book, Thriving with Anxiety, and his work shows up everywhere, TED Talks, you name it. But the reason why we are here with him today is because of this beautiful, powerful, and I think very timely article that he wrote in Time Magazine that I have not been able to stop thinking about. It is called Therapy Has a Relationship Problem. I'm linking to it in the post for this article. I posted it on LinkedIn if you wanna check it out. And he argues that our entire profession has gotten very good at helping people identify what's wrong with their relationships, and maybe we're not nearly as good at helping them identify pathways to repair when repair is possible. So, Dr. David, thank you so much for joining us today and unpacking all of this. It's a lot.

Dr. Lisa Marie Bobby: What if, in our desire to support our clients' ability to feel empowered, self-directed, and to have a more successful life with themselves and others, we therapists can sometimes erroneously support their isolation, even to the point of contributing to cutoffs or the decline of relationship satisfaction, even in situations where relationships maybe can be repaired? This is something that we all need to be aware of: how our work with clients in therapy can potentially make their relationships worse instead of better. And with me today to discuss this is Dr. David Rosmarin. He is a psychologist, researcher, and professor at Harvard Medical School who specializes in anxiety and the intersection of psychological well-being and human relationships. He's the author of the recent Time article Therapy Has a Relationship Problem, and the author of a relatively new book on anxiety, from what I understand.

Dr. David Rosmarin: Yeah, so they say.

Dr. Lisa Marie Bobby: Well, we'll talk about that too. Dr. Rosmarin, thank you so much for joining me today.

Dr. David Rosmarin: It's really a pleasure. Thanks for having me on the show.

Dr. Lisa Marie Bobby: So I have to tell you, I was just kind of scrolling through the news, minding my own business, and I saw your article in Time, Therapy Has a Relationship Problem, and I was like, yes, it does. [unclear] Because of my background, like you, I'm a psychologist, but I'm also a marriage and family therapist. MFT is a smaller crowd, but it's fairly well known that many times, people who are involved in clinical work can experience a decline in their relationship satisfaction when they're working with an individually minded clinical mental health professional. And I was like, oh my goodness, somebody is talking about this. So can you take us into your premise, and where this even came from? Where were you inspired to go here?

Dr. David Rosmarin: Sure. These thoughts have been kicking around my head for a little while. The sort of immediate proximal factor which prompted me to write about it was seeing something on the pages of The Wall Street Journal, by Elizabeth Bernstein a couple months ago. A really fantastic writer. And she wrote an article, I actually have it up here, Are Therapists to Blame for the Rise of Adults Cutting Off Their Parents? And in it she cited some pretty stark and scary metrics, specifically around 25% of the US population being estranged from their parents.

Dr. Lisa Marie Bobby: I did not know that.

Dr. David Rosmarin: Yes. And sorry, with any relative and 10% from their parents. That's still an incredible number of people. And in a recent survey of parents who were estranged parents who were surveyed in a research setting, a third of them believed that the child's therapist had a direct influence on this. Now, I've seen this before. This wasn't news to me, but it was such a stark point that I said, you know what? This has to be an amplified message, and I think it has to... We have to look at mental health systems as being so focused on individuals and not nearly enough on our relationships. And that was the beginning of writing this piece for Time.

Dr. Lisa Marie Bobby: Absolutely. Well, I'm so glad that you did, just to, like, bring this out into the open for people who might be in therapy, but also for therapists, which is why I'm so thrilled to have you on this show, you know, for a professional audience. And so, so for our therapist friends who are here with us today, I mean, let's unpack this. Based on what you've learned over the course of researching for this article, what is your best understanding of why this is? What is happening with therapists that can...

Dr. David Rosmarin: To me, it's very simple. You know, I've been in this field 25-ish years. Certainly more than two decades. And in the anxiety world, I've trained with among the best. I mean, the former Canadian Psychological Association president, Martin Antony, was a direct supervisor of mine. And being at McLean Hospital, I've had incredible exposure to be able to deal with not just anxiety and depression, personality disorders, psychotic disorders. I know people who wrote the books literally on these subjects. And if you look at the DSM, and if you look at the training that most therapists And myself too, I can't think of anything significant involving human relationships or connection to actually, from a therapeutic model, that I learned until I did my own CE training many years later. It was only five years ago that I picked up Sue Johnson's book on Hold Me Tight, and started to look at emotionally focused therapy started to get trained in this. And, and it just, it blew my mind on the lack of knowledge. The depth of understanding individual human suffering without understanding the social context was striking to me. I've been unpacking it for the last five years, honestly.

Dr. Lisa Marie Bobby: Amazing. I could not agree more. I mean, as an MFT, these systemic therapies are so powerful and important and profound. And also very effective, by the way, as treatment modalities for things like PTSD, depression, mood disorders. And I think that many people in our field don't understand really how different that systemic and relational perspective is without that training. I tell people all the time, so I did two programs. You know, a master's degree, and then also a PhD. And if I had only come into this as a psychologist, I wouldn't have nearly the perspective, because it's simply not part of the conversation. And I think what I also see, so I'm a clinical supervisor of marriage and family therapists, but that many individually trained clinicians, including psychologists, believe that they are qualified to support people around relational work without really having exposure to systemic modalities, and it can create a lot of problems.

Dr. David Rosmarin: You know, it could be because of a lack of exposure. It also could be a matter of philosophy.

Dr. Lisa Marie Bobby: You think?

Dr. David Rosmarin: Yeah. When you're treating an individual, let's take one of your examples, mood disorders, and I think it's an excellent one, because we know from the work on interpersonal psychotherapy that people's relationships can actually be used as a therapeutic process to help individuals with their depression. Like, that's very clear in the data. Yet when it comes to cognitive behavior therapy for depression, whether it's behavioral activation, or whether it's cognitive therapy, or whether, you know, you know, thought reconstructing people's thoughts, more Beckian style. The individual is the individual, and that is the only patient, the only client who you see. The aspects of interpersonal are really ancillary, if even mentioned at all. And I think that there's a philosophy to dealing with psychopathology among individual therapists that the social context is really not directly that relevant. It's a different lens. It's just a different way of thinking about human beings and what we need.

Dr. Lisa Marie Bobby: Such a good point. Well, and, and I think, you know, just what you're saying, that perspective, that framing for an individual clinician who really knows mental health treatment from that, like say, a CBT lens, back, forth, and sideways. Say they have an individual client sitting in the therapy room who is talking about these negative experiences that they're having with their husband or their parent. And so we are listening through that filter and... Well, you take us into that. I mean, where does that go?

Dr. David Rosmarin: In those cases, the therapist's job is to listen empathically, be reflective, be supportive. But in the meantime, you don't have that other person's perspective. You don't realize that the gaslighting parent is actually potentially responding to your client who's sitting in front of you, who's got their own interpersonal patterns which need to be addressed. Now, who's more guilty? Okay, I don't know, but we have no data. It's only one person's information. And if the entirety of that therapy is, "That's really hard. Have you considered putting up boundaries?" Then we're not treating the actual issue at hand, which is an interpersonal problem. That person's not there. We don't know who they are. We have one piece of information or one source of data, rather, and that can create major issues.

Dr. Lisa Marie Bobby: It absolutely can. There's this empathetic joining with our clients or our patients, and they are having experiences where they sincerely believe they are being victimized by this other person.

Dr. David Rosmarin: And they do believe that, and that's valid.

Dr. Lisa Marie Bobby: Totally valid.

Dr. David Rosmarin: But in interpersonal therapy, there's another side to the story. And, you know, that's... So, at least in individual therapy, one technique that I've done. Like, let's say I can't... Firstly, I've kinda shifted over, and at this point, 80% of the clinical work I do, which isn't a huge amount each week, but 80% of that clinical work involves families. I've basically defected over.

Dr. Lisa Marie Bobby: Oh, you're one of us. Come join.

Dr. David Rosmarin: Without a lot of formal training, granted, but I see the importance of it and I bring a lot of my individual training over many years into that paradigm and into that type of work. And I do think it's more effective for the patients. But let's say somebody can't or let's say you're not ready. So one thing that therapists need to do is encourage the client in front of you to speak directly to that person. Have them share their feelings in some way. Okay, in certain cases, maybe. But in most situations, there's some way of expressing a little vulnerability, maybe a lot of vulnerability, some of the pain, some of the burden, some of the hurt, and scaffolding that process, whether that's sending an email, sitting down with them for a conversation, and being able to support your client, not just in how they feel with you, but to actually reconnect and clear out some of the pain with that situation that they are dealing with. So that's one thing that I think individual therapists need to learn more.

Dr. Lisa Marie Bobby: Well, and I know that there are other ideas, but I'm hearing that this might also connect with this other dimension of your work around anxiety and emotional distress tolerance. Because a big part of this is, is that relationships can be frustrating, and they can be anxiety provoking and hurtful and all the things. And that is not necessarily a symptom that something is terribly wrong. That is, in fact, part of what it is like to be in a relationship with an actual human instead of an AI chatbot. And also such a fantastic opportunity to develop ourselves.

Dr. David Rosmarin: Okay, so let's talk about the AI chatbot. Oh, I'm so glad you brought that up. These days, I don't know about you, when I give a talk, 500 people in the audience, I ask, "How many of you have had a personal conversation with a chatbot," right? Everyone starts to blush, and the hands go up.

Dr. Lisa Marie Bobby: They do, a little bit.

Dr. David Rosmarin: And the hands go up. And the reason is 24/7 they're available. They're always supportive. If they push back, you can push back more, and then they stop. They're responsive. They're empathetic. They're always there.

Dr. Lisa Marie Bobby: Affirming.

Dr. David Rosmarin: And that is not your friend. Friendships are messy. All friendships are messy. All connection is messy. All relationships are messy. And I think that getting back to the paradigm about like individual therapists have, you know... the individual therapist approach of reducing all distress, seeing all a person's pain as a problem, if that's imputed into a relationship framework, you've basically destroyed all human connection.

Dr. Lisa Marie Bobby: When you say it that way, right, right.

Dr. David Rosmarin: True. There's no perfect relationship.

Dr. Lisa Marie Bobby: Yeah.

Dr. David Rosmarin: Human beings are messy.

Dr. Lisa Marie Bobby: And that's like being in a relationship requires, you know, you to be also a good and understanding partner for this other person who is different than you, who might have different thoughts and feelings and needs and rights and perspectives and, and that there is always a little bit of that friction. And then to be able to negotiate and navigate and come out the other side with increased understanding and compassion and tolerance, like that is so wonderful, and it builds so much, I think resilience, distress tolerance, when we help our clients do this. But I think exactly what you're saying when we are hearing people talk about these painful life experiences, and then as therapists being, that sounds like...

Dr. David Rosmarin: Too much. It's too much. It's abusive. There's something wrong, right? It's, it's impossible. And it might be, and there are situations, but I can count on one, in fact, there's one case ever in my career where I told somebody to like cut another human being out of their life, a close person out of their life. I wrote about it in the article in Time. And it was a pretty extreme case. Now, does that mean all relationships are fun and that they're all always gonna be great and that you can't, you know, that you don't have to accept people for who they are and find the good? Like, no. Like, of course. Like, I'm not minimizing or invalidating the challenge. But, and I think a lot of therapists did not like this about the piece, which is that, you know, are we infantilizing our clients to not have human connection, to not have any level of distress, to not be able to weather the actual vicissitudes that real life is going to place on us if we want to have a meaningful existence? I think often the answer to those questions unfortunately is yes.

Dr. Lisa Marie Bobby: That's hard. It really is. And I think especially, you know, so many therapists, and I think good, responsible, ethical therapists are also not saying, "I think you need to cut this person off," or, "I think you need to, you know, limit your contact." I think therapists are oftentimes creating space for clients to just sort of be with their own feelings, but also not putting up a different perspective. And so if a client sincerely believes that they're being mistreated, and that is supported by the algorithm and social media with all these, you know, influencers talking about gaslighting and narcissists and all of that, right? Boundaries and trauma.

Dr. David Rosmarin: Oh my God. And narcissism and gaslighting and the works.

Dr. Lisa Marie Bobby: Yeah. And so to connect with a therapist like yourself who's like, "Actually, let's... What can we learn from this situation? What, how are you showing up in this relationship?"

Dr. Lisa Marie Bobby: That requires confrontation.

Dr. David Rosmarin: Lisa, I'll get personal. I'll tell you. Let's do it. I had a conversation with a family member today. I love this person. They're amazing. They basically said to me like this. They, I said, "You know, sometimes you tend to get a little angry." And they said, "The reason I get angry is because other people disappoint me." So I said, "Okay. Well, is that taking any responsibility for your anger?" And they're like, "But that's the truth." And I realized it was a dead end. And is that gaslighting? Kinda, but it's not pathological. It's just a normal interaction with someone who's a little bit difficult sometimes, and also has a lot of wonderful redeeming qualities. And I'm not giving up on that conversation. I'm gonna be persistent. I'm gonna follow up at the right time. And hopefully see some light. And if not, that's okay. That doesn't mean cutting ties. That doesn't mean not going over. That doesn't mean not sending a gift on their birthday. That doesn't mean not having phone calls about other matters. That's the reality of my interactions with this other human being who is in my life.

Dr. Lisa Marie Bobby: Amazing. No, I have human beings in my life that fit that profile, and I think there's so much value there. Thought it was just me. Oh my gosh. But no, it's fine though, because then it turns into gaslighting or somebody having a different perspective than you. Tomato, tomato, right? Like, in a normal context, of course. Right. Gaslighting, in its real form, is in a power and control dynamic that is intentional and it is designed to, you know, create separation between you and reality. But the other piece of this is, like, maybe we can be in a relationship with another person who gets angry sometimes, and we're all all right.

Dr. David Rosmarin: It's okay. The original gaslighting was a, I believe, a murderer who was hiding dead bodies upstairs and had this really odd behavior, and then was convincing his wife that really everything's fine and you're the crazy one for hearing these sounds. That's extreme. So when we use the term gaslighting, let's be clear what we're talking about. Right. If you wanna use the cultural reference accurately, it's murder, covering things up, a relationship with zero truth to it. Not somebody who has a character flaw and then doesn't have the capacity right now to own it and to, you know, to let other people have their place.

Dr. Lisa Marie Bobby: Yeah. Fine. Right. Like, they can be them, and it's okay. Like, it doesn't, we don't need other people necessarily to be a certain way in order to be okay. That, you know, going back to that message of resilience. David, this is brilliant.

Dr. Lisa Marie Bobby: Okay. So then let's dig into this a little bit more deeply. You know, our friends here with us, other professional therapists who are out there every day, by the way, being heroes, showing up for other people with so much grace and empathy and compassion and, you know, going into very hard, dark places. And so we love therapists. We are therapists, all as well. And the things that we as professionals need to have visibility into so that we don't unknowingly contribute to the problem, right? Our own biases, our own blind spots. I'm thinking right now of a very powerful conversation. I should send you the link. Please. You would really appreciate it if you haven't heard him speak on this topic before. Are you... Do you know the work of Bill Doherty? Bill. Oh, fantastic. Okay. So a lot of work around, for those of our friends who haven't heard it, he is a thought leader in the field of marriage and family therapy, discernment counseling for couples on the brink. More recently, he is moving his work into the Braver Angels movement, where he's helping people on the red and blue sides of the political divide come together and have conversations where we are seeking to understand. So applying these principles to a broad societal use case, which I think is fantastic. But part of what he is talking about is this unconscious bias that therapists can often bring into the therapy room that influences the way we interpret what clients are telling us about their exchanges with difficult family members or with their partners. I'm curious if your exploration has gone into some of the self of therapist factors that can help us have more visibility into managing our own history, experiences, so that we don't impose our choices on other people.

Dr. David Rosmarin: I'll tell you, as you're speaking, here's what I'm thinking. This is what's coming to mind. You know, therapists have a superpower of empathy. And this, it's amazing. The ability to understand, to deeply feel, and to express that sense of what another human being is going through and the pain and the depth of that pain. And that empathy creates a connection in the moment. And we don't want our patients, our clients, to suffer more than they already are. They're coming in a vulnerable moment. They're opening up their heart. They're opening up their soul. They're speaking about their pain. And if that pain is interpersonal, we want to protect them. We want to help them. We want them to never feel that way again. Many therapists have also been to the depths at various levels of, you know, resistance along the way, and what we bring is a visceral sense of how hard it is to suffer. Protecting our patients from it, protecting our clients from it is great. And when it comes to interpersonal relationships, I think we need to recognize that it's never perfect, especially today. In this day and age, I think the best marriages, couples, friendships, parent-child relationships are going to have moments of tension and struggle and pain and misattunements. These are natural patterns that human beings get into when you are interpersonally yoked to another human being's emotional states. And that's not pathological, though. That's actually a sign of thriving. It's a sign of the fact that things are going well.

Dr. Lisa Marie Bobby: No, that's such a good perspective. And, you know, the way you're talking about this, too, in our role as helpers, there's this deeply empathetic, I mean, feeling somebody else's pain, but that it mobilizes this caretaking impulse. And I'm also thinking of a corollary, like, I don't know if you have children. I have two. But sometimes it is like this, you know, wanting to solve the problem for them and fix it versus helping them grow in their ability to handle hard things and be more resilient.

Dr. David Rosmarin: You know, I was introduced to behavior therapy for anxiety and, right away I saw the amazing power of exposure therapy. And simultaneously I was terrified.

Dr. Lisa Marie Bobby: Scary, like, on purpose.

Dr. David Rosmarin: It's sadistic.

Dr. Lisa Marie Bobby: A little bit.

Dr. David Rosmarin: A little, right? You have to be, like, a little bit sadistic to help your... 'Cause I, in fact, you're identifying, like, a good behavior therapist identifies exactly where your client will struggle, and helps them to build resilience and habituation and learning, and whatever model you're gonna use, through facing that fear in the hardest possible way that they can tolerate. As long as they can tolerate it, you go there. And the more that they face it, the better your outcomes will be. So it does require an amount of putting aside that sort of, "I want to protect," and really having belief and faith in your clients that they have the capacity and they can do this, and you're the coach, and you're gonna get them there. And even though it's hard, that will crystallize and help them. That'll be the catalyst to their growth.

Dr. Lisa Marie Bobby: Yeah. What this is really saying though is, is a totally different mindset on what I like to call dark emotions. I do not refer to them as bad feelings. I won't.

Dr. David Rosmarin: Okay. Dark emotions.

Dr. Lisa Marie Bobby: Are positive, they're good. It is reframing their function. Sure. Like, I would imagine, you know, somebody who's that hardcore behaviorist who's like, "No, hold the spider. Hold the jar with the spider in it."

Dr. David Rosmarin: Oh, yeah. "Let it crawl on your arm."

Dr. Lisa Marie Bobby: Like, all the things. I don't know, maybe people with a sadistic streak go into that.

Dr. David Rosmarin: I've had people in my office with a snake, with a spider, 100%. We've done it all.

Dr. Lisa Marie Bobby: Like, a boa constrictor around their neck. Well, but, you know, 'cause there's, I think, one thing to take...

Dr. David Rosmarin: Not a boa, but a garden snake for sure.

Dr. Lisa Marie Bobby: Garden snake. You're like, "It was a little one. It was fine." But to have that, like, enjoyment of other people's pain versus a totally different understanding of the benefit of having that fear response in a controlled way that that's actually helpful, it's curative, right? And that I think that many of our emotions can be seen in that way. It's a good thing when people are feeling sad or upset. There's a lot of wisdom and power in those moments if we can help them lean into it as opposed to try to get away from them. And I know that that has been part of your work as well.

Dr. David Rosmarin: Absolutely. And I think in dialectical behavior therapy, the DBT world, radical acceptance and the leaning into and opposite action in some ways, I guess. There are several aspects of it philosophically that the distress isn't there to make your life harder. It actually helps to crystallize whatever it is that you're trying to do. But obviously, I was joking. I was saying in jest before about being sadistic. You know, I really think it's a matter... I really think of myself when I do this type of work, as being like an Olympic coach. And the coach knows it's gonna hurt. Like, getting around the track with that fraction of a second faster than last time, it's gonna hurt. Like, you're not... There's no easy way to that gold or silver or bronze or even to just be able to make it to the Olympic team. It's not going to be pretty, but that is where dreams are made, and that is how we help people. And I think especially interpersonally, we have lost that. Society, we've lost it. And certainly, outside of the marriage and family therapy world and people who do this type of work, I think it's something that we just aren't aware of.

Dr. Lisa Marie Bobby: Well, I mean, it makes sense though. You know what I mean? As psychologists, we're there to diagnose and treat clinical health conditions, and it is the symptom reduction which is oftentimes quantified as negative affect, a negative feeling of some kind. And so have we as a culture, as helping professionals, become so hyper-focused on negative affect as being negative and something to be solved or made better or reduced or go away? 'Cause what you're talking about is something that's very different from that. And I think it's a bit of a, it's a different paradigm for sure.

Dr. David Rosmarin: Sure. The insurance system is built around that. I mean, we diagnose using diagnostic codes, which is a certain level of distress. We use CPT codes for specific procedures, which by the way is always for individuals, not for couples, not for families, by the way, parenthetically. And we treat said patients, clients with those procedures, and when they have a reduction in symptoms, that's considered a success, just like we would in the medical model. And I think that there are a lot of assumptions that go into that process, usually to the benefit of insurance companies, in order to, you know, think about mental health in this mechanistic, medical way as opposed to looking at what humans need to thrive and to flourish and to connect and to live meaningful existence on this earth.

Dr. Lisa Marie Bobby: Do you think from what you've seen, and also in your teaching role, that that can lead therapists and psychologists to pathologize normal experiences, disappointment and guilt or emotional pain, or...?

Dr. David Rosmarin: Yeah, so this is where I think the anxiety epidemic has taken off: our tendency to over-diagnose anxiety, all anxiety as a disorder, and not to view it as part of the human condition to a point, and to look at the functioning, the, the functional impairment rather. Like, when people are impaired by their anxiety, that's a problem, and then we can talk about that. But if people have high anxiety and they're functioning well, that sounds like a hero to me. That sounds like resilience, and that sounds like, you know, potentially they're going through a difficult time, but they're actually doing what they need to do in this world. You know, to me, that might be optimal functioning that we're actually now pathologizing in our model. That was the reason I wrote my book, Thriving with Anxiety, and the importance of thinking very differently about anxiety, along these lines.

Dr. Lisa Marie Bobby: Well, tell us more about that. I mean, I feel like we've done a good job of talking about factors that can lead therapists to, you know, sometimes unintentionally interfere with our clients' connections with other people when we are over-emphasizing the negative aspects, not maybe pushing back or not supporting clients in taking difficult steps towards relationship repair and connection. So we did that.

Dr. Lisa Marie Bobby: So with your work around anxiety, though, I think there's so much more, and I'd love to hear the ideas from your book, and also I understand you've developed some solutions that clinicians could potentially even use with their clients.

Dr. David Rosmarin: Absolutely. Okay. So since... Actually, and we don't have to get fully away from the interpersonal dimension, 'cause one of the aspects that I'm gonna speak about is interpersonal. So the book that I wrote was Thriving with Anxiety: Nine Tools to Make Your Anxiety Work for You, and it was out with HarperCollins in 2023. And since that time, I've been trying to distill it a little bit more, firstly to add more of an interpersonal dimension although there is one in the book, but also to really make it super clear, plug and play, easy for any human being, including therapists, and I came up with four steps. And if you'd like, I can go ahead. All right.

Dr. Lisa Marie Bobby: Bring it on, babe.

Dr. David Rosmarin: So the four steps are as follows, and these four steps, I will tell you, is basically everything I've learned about anxiety over the last 20 years in 10 minutes.

Dr. Lisa Marie Bobby: Oh my gosh.

Dr. David Rosmarin: Let's give it a shot. Step one is to identify. Step two is to share. Step three is to embrace, and step four is to let go. You wanna say them over to me? Identify.

Dr. Lisa Marie Bobby: Okay. Identify.

Dr. David Rosmarin: Identify.

Dr. Lisa Marie Bobby: Share. Embrace. And let go.

Dr. David Rosmarin: Let go. Okay, so we're gonna go through them. Yeah. Identify is when you feel anxious, or when your kids feel anxious, or when your friend feels anxious, or when your patient feels anxious, to identify what's the root of their anxiety. What's the root of your anxiety? Why are you feeling anxious? Most of the time when we feel anxious, we want to... Most of the time when we feel anxious, our first instinct is get rid of it, distract ourselves, pick up our phone, do anything we can to not feel that way. And same thing, when kids come in, they feel anxious. You said it before, "Is everything okay?" Like, try to calm them down. No. Ask. Find out. Identify what are you anxious about. Take a minute, 10 minutes, and figure it out. What actually is driving the train? Step one. Ready for two?

Dr. Lisa Marie Bobby: I'm ready for two.

Dr. David Rosmarin: Share it with someone else. If you're nervous about something, if you're worried, talk to someone else about it. Therapists are great at this. This is exactly what we do with our clients, get them to open up. Often therapists, though, themselves could use a little work. Yeah, we don't talk about our problems. No. We're not anxious. It's for other people. We're civilians. We're not uncomfortable. No. We don't have problems. You know, years ago, what spawned Thriving with Anxiety was my own experience of anxiety during the pandemic, and I spoke about it on the TEDx stage. I was terrified to get up there, and then, like, Harvard, you know, psychologist speaking about his own anxiety. Like, I did it, and it was great. It was amazing. I felt like I was more able to connect with my clients, with my colleagues. People came over to me. It just dropped my guard and you know, when we speak about our anxiety with other people, it connects us to them. It makes us softer. It makes us more humble. It makes us more human. And that's a skill. So, share with anyone.

Dr. Lisa Marie Bobby: Relatable, right? Yeah. That too. that connection too.

Dr. David Rosmarin: And connection. Three, embrace. This is exposure therapy. When you're nervous about something, face it. Do it. Embrace it. Whatever you're nervous... You're nervous about snakes, huh?

Dr. Lisa Marie Bobby: Not particularly, no. Okay. I, I mean, I, I'm not gonna volunteer to hang out with a snake, but I will not run away from a snake. No, I'm okay.

Dr. David Rosmarin: You're good. Yeah. Okay, fine. So I was not picking up on anxiety before, when we spoke last.

Dr. Lisa Marie Bobby: I used to have a fear of flying, though. I used to.

Dr. David Rosmarin: You overcame it by flying?

Dr. Lisa Marie Bobby: By flying.

Dr. David Rosmarin: There you go. Yeah. Let me ask you a question. Did that make you more resilient in general as a human being?

Dr. Lisa Marie Bobby: Let me... You know what? I actually think it probably did, because the idea... Well, wait, I'm not special? How dare you. No, I'm just kidding. But, you know, no really, because the idea that really helped me there, so my dad, I'll tell you the story. My dad, he was a pilot back in the day.

Dr. David Rosmarin: Oh my God.

Dr. Lisa Marie Bobby: And I was sitting next to him on a plane and like, you know, hyperventilating. And it was really scary for me when the plane would tilt, and it went like shaking and, and he was like, "Lisa, it was designed for that. That is literally the way they turn." Because prior to that I had interpreted it as we are falling out of the sky right now, like that was what would happen. Or like the turbulence, and he's like, "No, no, no, these things are built... You could shake this thing up and down so hard it would..." He's like, "Unless you hear an explosion or a really loud bang, you're okay." And I was like, "Oh." And you know what? That's helpful to know. And I was like, "Nothing has exploded. I'm fine." And so I... But I think that idea has really helped me in other parts of my life because then there's like a way of understanding, is this really a problem or is it like turbulence, like normal stuff? And I applied that idea.

Dr. David Rosmarin: You don't let anxiety get in your way. You built your grit.

Dr. Lisa Marie Bobby: Yeah, and nothing has exploded.

Dr. David Rosmarin: There you go.

Dr. Lisa Marie Bobby: I'm all right. That's it.

Dr. David Rosmarin: So that's three, embrace. Face it, whatever it is. And four, let go. We're all control freaks, let's, let's be honest.

Dr. Lisa Marie Bobby: I mean, a little.

Dr. David Rosmarin: Oh, come on. With these devices it's impossible not to be. It's like we just have so much data coming our way. We have so much control or perceived control over the universe, and anxiety always happens when that perception of control gets disturbed. And we have a choice at that point. Do we double down and try to get more, or do we like, "Okay, I'm not in control," and actually embrace that, really accept it for a minute.

Dr. Lisa Marie Bobby: Which is in itself scary.

Dr. David Rosmarin: It's terrifying.

Dr. Lisa Marie Bobby: And liberating.

Dr. David Rosmarin: And liberating. Now you're thriving with anxiety. So those are the four steps. Identify, share, embrace, and let go. And the share is about the interpersonal connection. And it's not fun. It's messy, and it's scary, and talking about your feelings with other people, and, ugh, it's like, what if they... And sometimes they don't respond the way you need, and that's hard. It's a real risk. It's not always fun, but that's part of the learning process.

Dr. Lisa Marie Bobby: Okay. So I have a couple questions for you. Bring it. So what do you do with clients, I mean, given that you have defected, you're on the MFT side now. You're one of us.

Dr. David Rosmarin: Yeah, I basically come over to the light side.

Dr. Lisa Marie Bobby: So when you have a client who is attempting to manage their anxiety by controlling other people and other people's reactions, how would you handle that differently?

Dr. David Rosmarin: I can't think of an anxious client who doesn't try to control the reactions of other people. So all of them, talk about your anxiety. Share it. Don't get angry or snippy or controlling or annoyed or irritated.

Dr. Lisa Marie Bobby: Well, it's an ownership. My anxiety, right there. I feel anxious. Not like I'm feeling this way because you, it's my anxiety is what we're talking about.

Dr. David Rosmarin: Yeah. I mean, it might be triggered by what you're doing, but that doesn't mean that it's not my feeling anxious. What I'm having is an anxious experience and it makes me feel a little jittery. Describe it, like it makes me feel a little flutter in my chest. I'm feeling nervous. Vulnerable. Yeah. Like own it.

Dr. Lisa Marie Bobby: That's good. Okay. So just, you know, helping people who are in that space, you know, observe, like this is an anxiety management tool that's happening right now, and so coming back and talking about it and following the steps. But the other thing that I'm, I'm really curious about, and just as a practitioner, I, I talk with so many therapists who are feeling like they are in such a bind because of operating in a medical model. You know, they're in a private practice where their referrals come from health insurance companies, and the expectation is that the insurance companies will be paying for the treatment, which means that we need to make sure that we are treating a disorder. And I think that what therapists are oftentimes experiencing is that either we need to frame what is going on with our clients in a, a pathological way, you know, in order to like justify the treatment, but that there can be this discomfort with, as you say, like coaching people through normal life experiences. And, and just, just to share very transparently, so this, this is one of the reasons why I incorporated in a very overt way coaching psychology into my practice. So certainly can still do psychotherapy. But you know, especially as an MFT, so many people are coming in and like, "Help us get on the same page about finances," or, "We, we need to communi-" There was not a treatment goal at all. And I felt uncomfortable with framing it any other way, so I moved into coaching psychology as a way of supporting those outcomes. That's how I solved that problem, but how do you do it in your practice? Or, I mean, do you have a... When someone is coming in asking for your help with something and you're listening, it's like you're not dealing with a psychiatric condition, and how do, like you help them understand that and kind of thread that needle in your own practice?

Dr. David Rosmarin: Great question. So, in my current position there's really two adjacent organizations. One does insurance-based and then one does more private. In the insurance-based practice, you're right, I mean, we're stuck. We can go with an adjustment disorder and we can use certain processes to help them through. One of the ideas also is, like within a session there should be certain therapeutic components, and then there can be certain pieces which are additional, which can be used to help people along in more, in more of a coaching or more of a supportive, more of a flourishing kind of domain. So there are ways to work within insurance, but you are limited. In the private practice world, where it's, it's private pay, it's a lot more flexible. Also in terms of length of sessions, in terms of point of contact between sessions and continuity of care and access to medical records, and I could go on. And I think that we are all operating in an imperfect system, and, you know, therein lies a challenge at this point in history, hopefully one that there'll be solutions to in the coming years.

Dr. Lisa Marie Bobby: No, I get that. Well, no, just finding a way to separate the two things as opposed to feeling like you have to run everything through a medical model where it doesn't always fit.

Dr. David Rosmarin: Correct.

Dr. Lisa Marie Bobby: This was so good though, and I really appreciate it. I feel like we've come full circle, you know, talking about how so many times our clients come in as individuals, they're talking about their experiences of distress and anxiety in the context of relationships, and then how our job as providers is first, you know, to assess is there a clinically significant issue going on, or safety issues. But, you know, outside of that, be approaching this with curiosity and helping our clients be able to name what's going on, talk about their feelings, embrace it, right, stay in it, connect to others. But, but maybe, like, using the stage of the relationship as a way to do that for their benefit, but also for their connections.

Dr. David Rosmarin: Very much so.

Dr. Lisa Marie Bobby: Yeah. That's wonderful. Well, is there anything else you'd like to add about your work or your solutions?

Dr. David Rosmarin: Well, I mean, for people who wanna learn more about the four steps, you know, the other... A couple months ago, I picked up Claude and I started programming, and I'm not a coder, but, you know, I started working with myself and a team. And next thing you know, we actually have a four steps app which is up and running and available on my website and totally free. it's, I want this to be available to everyone. These four steps, they're so simple. It's the kinda thing where people do not have to have clinical anxiety. In fact, it's designed for people with subclinical anxiety. There is a feature in that app to test your brain, so to speak, to see what's your level of anxiety. But yeah, totally free app on my website, D-H-R-O-S-M-A-R-I-N.com, dhrosmarin.com. Check it out, share it with your clients. Let me know what they think. People can contact me through the website. People do it all the time. And, yeah, that's a fun resource which I'm making available now.

Dr. Lisa Marie Bobby: Amazing. And your links to your book and your TED Talk are available on the same website?

Dr. David Rosmarin: Yeah. Everything's there. I mean, enough.

Dr. Lisa Marie Bobby: Well, and I would strongly encourage anyone, and I'm gonna share this on LinkedIn as well, the Time article authored by Dr. David Rosmarin, Therapy Has a Relationship Problem, which was wonderful. Yay.

Dr. David Rosmarin: Appreciate it.

Dr. Lisa Marie Bobby: Thank you so much for your time today. This was a wonderful conversation.

Dr. Lisa Marie Bobby: Guys, that was such a good conversation. I loved that. I think, I don't know about you, but it's so helpful for me to have support in reflecting on my own process from another professional who has expertise but also insight, and a different perspective. I think it's so fantastic. And that's one of, honestly, my motivations for doing this podcast. Like, I'm so aware that our profession, in many ways, is inherently isolating. You know, we can talk to people all day long, and it's not about us. We're not part of the conversation, right? At least we shouldn't be. But the reality is we need to be reflective, and we need somebody to be shining a light on our own blind spot sometimes. It's part of ethical practice. And I will also share that because I am on a mission to help helpers like us, I've been thinking a lot about this, you know, and how during our clinical supervision years, we get a lot of that, right? We meet with our supervisors regularly. Hopefully, it's an emotionally safe relationship where we're able to talk about, you know, our own feelings that are coming up, and allow them to help us be curious and see if we wanna make any changes there. And, you know, oftentimes we have a lot of support systems around us, especially when we're in school. But something I've been so aware of and have honestly been, like, trying to correct for a long time through my practice, Growing Self, is the fact that once we get licensed, all of that kind of goes away, right? That we don't have people around us asking us how we're doing, and how was the session, and being invited to, like, talk about your clients and things. Like, we're disconnected from those systems, and I think that part of our responsibility as professionals for our clients, but also for ourselves, quite frankly, is that we need to be plugged back into some kind of support system where we have people that we feel comfortable enough to be open and authentic and vulnerable with. So ideally, you're part of a consultation group, or maybe you're engaged in some type of peer consultation, or maybe you're in a formal mentoring relationship with somebody who is there to support you with your side of the equation. In Growing Self, through Growing Self Institute, I have also developed a pathway to make it easier to get plugged into that if it's something that you would like to do. Maybe you live in a smaller town or, you know, like where are my consultation partners and need support in creating that. I call it the Growth Collective. It's the Therapist's Growth Collective, and through it, we offer access to consultation groups, so you can meet regularly once a month with a group of peers facilitated by a supervisor, to have these types of productive conversations. We are also doing private practice success coaching with me once a month as well as drop-in case consultation once a month and a monthly CEU awarding training that we develop just for our members. So there's a lot going on. There is a different activity or group to participate in every single week on Thursdays as a matter of fact. And so if you've been feeling isolated, like you need to find your people or get support for yourself, your practice, your continued professional development, come check it out. You can go to growingself.com/therapists and look for the link to learn more about the Growth Collective. If you're wondering like, "Sounds great. How much does this cost?" You should know that this is a mission of love. This is not a profit center. I believe it's currently priced at something like $49 a month for access to the support that I'm describing. So come on over, check it out, growingself.com/therapists, and if it feels like it might be the right fit for you, you'll see a pathway to join the group and get connected. All right. But in the meantime, thanks for connecting with me today. I appreciate you listening. I hope you get in touch with me on LinkedIn, and I'll be back in touch very soon. All right, take care.