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International Life Services' Advanced Training Institute | Greg Lester, PhD

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[Music] um

i'm virtually certain some of you know

him already

uh he is dr greg lester he's a

licensed clinical and consulting psychologist

psychologist

he's held membership on the graduate

faculty of the university of st

thomas is on the continuing education

faculty of cross country

education and his senior research director

director

with the improvement research group um

greg's talk our presentation today

is entitled the difficult client talking

to those

who can't listen so with that i turn it

over to you dr lester

all right thanks very much dude i

appreciate edge

all right hello everyone welcome it's

nice to be with you i've missed being

with you guys

uh since we didn't have the aha last

year and i've tried to come

in uh in previous years so i've had to

cancel a couple times my travel schedule

got a little crazy i was

traveling about 40 weeks a year and

started to come back

so first thing i want to note

is i am not one of you um i do not rent

a crisis

pregnant a crisis pregnancy center etc i

am a psychologist

but my specialty is one that is a little odd

odd

there are only about six people in the

world who uh teach this

and it is one that cuts across

all areas of both mental health and

believe it or not

ministry there was a study done

by the university of hawaii in

conjunction with loyola

in chicago that found that

ministers see more people with

diagnosable mental health conditions

than all mental health clinicians combined

combined

and i consider you guys to be a

combination of ministry and clinical

so you see a lot

of what i'm going to describe today in

fact the data show

that the thing we call a personal

disorder is the most common mental

health condition

also the least understood even by most

mental health clinicians

the data show we've done studies all

over the world north and south america

australia new zealand scandinavia

southern europe western europe romania

japan china south korea taiwan zambia and

and

all of those studies show that somewhere

between 15 and 19

of people have lives that are harmed in

the way i'll be describing

and in clinical population people like

you see in crisis

somewhere between 39 and 100 of your

clientele will present

with these conditions now the reason you

should care about that and the reason

i'm here

i always think it's first thing speakers

today is why you should bother listening

is these people don't listen like you

and i do these people do not have the

psychological equipment

to be able to have the kind of

conversations that you and i have with

each other

that make an impact and what we've found

over we now have 60 years of research on

this population

is that there are specific ways you can

think about them

and specific methods you can add to how

you talk to them

to double your impact increase about

like 100 100

you know 60 years ago we couldn't say

that 60 years ago the lore was forget

you can't help these people there's

nothing we can do to make a difference

these conditions are permanent well

fortunately we have so much data now

that that is not true anymore one of our

gurus in the field was a psychiatrist

unfortunately passed away a few years

ago at harvard named john gunderson

and he was one of the engineers of

getting personnel disorders listed in

the diagnostic manual

back in 1980 and one of his final books

he says

we know so much about helping this

population that we can now ethically say

to these clients yes

i can help you so let me tell you what

we're going to do today

because i work a lot with

crisis pregnancy groups i've worked with

you guys um

i i spoke a catholic i was the keynote

speaker catholic charities

annual conference one year i'll be doing

two days

in october for the texas crisis

pregnancy network etc

so i am familiar with the clientele uc

with what you have to uh

what you're up against and what you do

so what i'm going to do today is

focus what we have found in the

personality disorder

area works for you to apply

in your context in your

situation with your clientele now to do that

that

i'm gonna have to do a couple of things

and i want you to know this is a crash course

course

my most basic course on personal

disorders is six hours long

and my fundamental course is 18 hours long

long

i now have about 45 minutes with you so

let me tell you what we're going to do

first i'm going to tell you how we came

to see this so you know what the

terminology means

then i will show you what a personal

disorder is there's a graphic

that describes it so you can see why

this population people come to you in a

crisis pregnancy situation who have a pre

pre

pre-existing personality disorder are

coming to you

missing important psychological pieces

and if you try to have a normal

conversation with them it's not going to happen

happen

so i'll show you what it looks like it's

not complicated

you'll be able to get it then i'm going

to give you half a dozen techniques

drawn from our literature that we have

found are kind of the most

powerful in making an impact

i'm not going to ask you to change

everything you do

i'm going to give you some things to add

on and some methods to adjust

what you do to have an impact now those

aren't going to hurt anybody so you don't

don't

if if someone isn't personal disorder

and you do the things i'm going to tell

you to do you're not going to hurt it's

going to be fine

it just isn't going to make that much

difference but it makes a difference

with this population

so you know you and i overlap

and we're in the same business of saving lives

lives

you know you say them one way i save

them another way because the personal

disorder diagnosis

increases suicide risk by 700 percent

borderline disordered people have a

suicide rate 400 times the general

population and 800 800

times the population of women

childbearing years

so we're in the same business in that

sense so having an

impact for you and for me is paramount

so let me tell you how we came to see

this you guys real quick

you gotta understand that mental health

is a new science you know

i am not a minister i'm a scientist i am

i'm gonna call myself a mechanic of the mind

mind

and our science started only about a

hundred years ago when the first

condition identified as psychiatric

and what i'm going to use occasionally

you guys is a white board i'm going to

write on it so forgive the crude nature

of my

graphics but we found the powerpoints

kind of uh frees people's brains

so the first condition you've heard this

term that was ever

uh coined for a mental health condition

in the early 1900s

now that term literally means

misperception of consensual reality what

it means is

the reason someone's life doesn't work

is there see

they see and hear things that's all it

means it doesn't tell you why

it's called descriptive pathology

so the first condition ever

identified as a mental health condition

that damaged people's lives and kept

them from living good lives with the

thing called psychotic that term was

coined by a neurologist named emil creplin

creplin

and you know people who hear voices who

have hallucinations

have delusions very severe psychiatric

symptoms so we identified that early on

as a thing as a condition it's

considered consistent across the world

it's as consistent as pneumonia or

anything else

we didn't know what in the world to do

with it so the answer was they couldn't

function in society

we put them into asylums we warehouse

them and

and it was a sad era you guys um they

were not good places the first

asylum in in england was in a town called

called

bedlam that's why this the phrase became

something total bedlam

because it was lousy along came

another neurologist in the 20s who

noticed there were other people whose

lives that didn't work well

but they weren't quote crazy they didn't

see and hear

things but they had emotional reactions they

they

to the situation they were depressed and

nothing was wrong

they were a panicky and nothing was

dangerous they were anxious

and nothing was threatening to them so

they didn't misperceive reality but they

had emotional reactions that were

inappropriate to the situation you know

if you have upset

feelings that are appropriate that's in

normal limits

like uh regrettably about uh 10 days ago

pam and i lost our

little kitty cat of 13 years mango you know

know

i cried over him for three straight days

and you know what that was appropriate

loved him

he slept with us every night he was a

wonderful pet

so you know i boo-hooed but you know

what if someone's crying

all day every day in normal life that's

inappropriate that's something wrong

so he gave a name to people who have

emotional reactions that didn't fit the

situation to contrast it to

psychotic he called it being neurotic

and you've heard that term right all

neurotic means is

it means that your emotional state

is inappropriate to the situation

now this the neurologist who came up

with this term you might have heard of

his name was

sigmund freud and he said

i actually think we can fix these people

and so his conclusion is that the reason

people are having inappropriate

emotional reactions

is that they had an emotional reaction

that was appropriate

a long time ago to something they were

abused and so of course they were upset

they were abandoned so of course they

were upset and what happened was

that upset from that event never went away

away

so he developed a way to go back in time

to find out where it started in order to

resolve it

and he developed a model that you've

and the job of psychoanalysis is to

review back to your life to find out

where did this bad feeling start

what was it that happened that made you

feel this way

and then the an analytic process is a

psychological process designed to

disconnect you from that

to get that not to run you and then that

fades and you have emotional reactions

appropriate to the current era

pretty intelligent actually

psychoanalysis gets a lot of contentious

humor thank you woody allen

but it's a pretty good model for doing

that but here was the problem

we had two conditions we had

psychotic people who we were locking up

because they couldn't function in society

society

and neurotic people who were doing

psychoanalysis with

to unhook them from old bad feelings

well here was the problem

come along 1950 we found that there were

people who didn't fit either one of

these things

they weren't quote crazy and doing bizarre

bizarre

and sometimes bad things so we didn't

lock them up

but psychoanalysis failed with them and

all this going back in their life to

their childhood

went nowhere in fact some of them it

actually made

them worse so what happened was we realized

realized

that there were some people who had

lives that were in trouble

who are behaving badly who are

experiencing distress

causing trouble for themselves and

others even like psychotic people do

but they didn't fit psychosis and they

didn't fit neurosis psychoanalysis

didn't work and we shouldn't lock them up

and we didn't know what to do so in the

1970s the american psychiatric

association said hey

we have to redo our science so we have a

way to think about these people we're

not helping or we don't

understand so they put a very famous

committee together called the dsm-3

committee and the committee sat down

with the science

and looked at it and said it just

doesn't work we're going to start over

so they through the previous manuals one

was published in 1952 and one in 1968 in

the trash

and said we're going to redo mental

health in a way that encompasses

all the people that we're trying to help

and don't and they said

here's how we're going to do it we're

going to do it by what things look like

and some people psychologically

malfunction in a way that looks like

is the is the psychological version of a

it resembles an illness only in our

mental health

and the reason it resembles an illness

things like depression things like anxiety

anxiety

things like attention deficits things

like addiction

and those symptoms work very similarly

to how physical

illnesses work because they run a

predictable and reliable course

you know covert runs a course um

a head cold runs a course the flu runs

the course well so does depression

so do panic attacks so do psychotic episodes

episodes

so so do manic episodes and so when you

look at people who have trouble

psychologically in some ways some of

them look like they have the mental health

health

version of the thing we think of as an illness

illness

so they said we're going to call stuff

like that psychiatric illnesses

because they look like illnesses

and we're going to put them in a

diagnostic category we call it axis

one and we're going to give them names

that they're up for the symptoms depression

depression

major depressive episode bipolar dysthymia

dysthymia

anxiety generalized anxiety phobia panic

social we're going to keep the term

psychotic because that is

symptom and we're going to put in other

names like attention deficit

addiction all symptomatic conditions

just like we have symptomatic physical

conditions and they said but here's

where we missed the boat

not everybody who functions badly in life

life

works like that other people malfunction

in a way that looks like the thing

in medicine we call a disorder

now the way an illness differs from a

disorder is that an

illness is acquired and this is

something you get something you have

you catch covet i caught covet

i caught it before anyone knew what it

was i consider myself patient zero for colorado

colorado

because i came back from a trip on the coast

coast

last year in late january with a quote

weird flu

and those of you have heard me talk

before i'm a fitness fanatic

you know i just had my physical last

week and i scored the highest level and

the 99 of fitness for people my age

and when i walked up a set of stairs

with this flu i couldn't breathe

i would be gasping for air and thinking

have i let myself go

and then of course i gave it to everyone

i know my wife

my best friend his wife my martial arts

school so i

kind of patient zero but it ran a course

okay and we all recovered and we're all

fine and we're all vaccinated so thank

you god you know what's interesting to me

pam's symptoms are a little different

from mine you know tom hanks and rita

uh wilson actors they caught it in

australia and i had exactly the same

course of symptoms he had and pam had

exactly the same course of symptoms she had

had

so we know the illness has run a course

the difference is a disorder isn't

caught it isn't acquired it's indigenous

to the system

it is a system gone haywire so notice

when you

have the flu we don't say have a flu disorder

disorder

i notice when you have diabetes we don't

say you caught diabetes you see who

developed a metabolic disorder so

disorders are developed

and illnesses are acquired and disorders

don't have

symptoms disorders have what are called characteristics

characteristics

see these were first called character disorders

disorders

because they're characteristic not symptomatic

symptomatic

we dropped that because we were afraid

it sounded more realistic and we're not

trying to be moralistic

trying to be scientific the difference

between a symptom and a characteristic

is a symptom cause is trouble just by

being there

i couldn't catch my breath when i had

covered that was a problem

a characteristic isn't a problem of

being there because it feels like you

it's that it makes trouble for you so

when you develop high blood pressure

that's not going to bother you what's

going to bother you is it causes a

stroke or a heart attack

and characteristics and a disorder don't

run a course

they're what are called pervasive and enduring

enduring

in other words they stick around and

they're all over the place so the

committee said what we

figured out is that

some people have psychological condition

causing trouble that looks like an

illness because it has symptoms that run

a course where

other people seem to have a characteristic

characteristic

pervasive and enduring pattern that

doesn't bother them but causes trouble

for themselves and

others like a disorder and they said

this looks so different

than any other thing we ever thought of

that we're going to separate it into a

separate category and they called it

axis 2.

and they said you know what this looks

like a disorder of you know looks like

it's out of whack over here what it

looks like is out of whack over here is

the psychological system

called the person see this over here on

the left

looks like what someone gets or has this

on the right

looks like the way a person is so we're

going to call it a disorder of the

system of the person

now the name we use for how we

experience the system of the person

another per a person now the

system of the person another human being

is we call it their personality

so we're going to call this a disorder

the system the person or a

and they said now we know why we failed

these people because

up until we we did the science

everything we did was designed for symptoms

symptoms

all the medications the antidepressants

the anxiety the antipsychotics

they're all for symptoms all of our

psychotherapy psychoanalysis

object relations behavior cognitive

therapy for

symptoms and guess what symptomatic

treatment doesn't work for

characteristic problems

you can't treat diabetes with an antibiotic

antibiotic

so these people on the right are the

people we didn't know how to think about

and we couldn't help and this

is the distinction we were missing

because freud didn't make the

distinction neither did crepelin

and they said well doggone it now we understand

understand

why everything we developed in mental

health for the last 80 years has

failed with these people on the right because

because

they have something wrong with how they are

are

not that they've forgotten a symptom

so they said cool now let's come up with

names for the different versions

and it took us about 10 years

and we have pretty well established

there are ten different types of

personality disorders

and we have names for them they're

called things like

paranoid schizoids schizotypal borderline

borderline

anti-social histrionic narcissistic

avoidant dependent

obsessive compulsive so we have criteria

for diagnosing

they are consistent across planet earth

we've studied other ones passive

aggressive self-defeating sadistic

they haven't held up well and so over

the last three diagnostic

manuals the dsm-3 in 1980 the dsm-4

1994 and the dsm-5 in 2013 and i was on

the committee

that revised the personnel sort of

section for dsm-5

i ran one of the research sites we have

established over 50 years that this is a

valid important condition

but the difficulty for you guys is it

isn't going to show up as quite

psychiatric because they're

symptomatic they're not going to look

superficially like someone with a mental

health condition

now what we've found you guys

is that the personal disorders are so

different from

psychiatric symptomatic conditions that

we had to

change everything and a whole

almost cult-like group of us have gone

into personality sort of work

and we have our own journals on experts

and your garden variety

mental health clinician does not

understand this stuff

so what we have found is this what we

call a psychiatric

condition is a malfunction of the

psychology or neurology of a person

for example we know that depression is caused

caused

by a malfunction in the limbic system in

the brain

there are things called 5-ht receptors that

that

have to do with a neurotransmitter we've

heard of called serotonin they don't

work right

and so we develop drugs that enhance

serotonin to treat depression

it's a malfunctional limbic system we

know that that post-traumatic stress

disorder we call it disorder synonymous is

caused by the amygdala in the

hippocampus forming a loop

francine shapiro and a thing called emdr

figured this out

and we have to unhook that loop in their brain

brain

we know that a tension deficit is a

screw up of the executive functions

right here in the prefrontal orbital

lobes the russell barkley has developed

ways to moderate with the stimulant

medications and the non-stimulants etc

so we know that all of those are a

crossed wire and a short circuit

a personality disorder completely different

different

let me draw it for you

here's a personality now normal personality

personality

is your toolkit for living life and in

it your tools are called

traits so i'm going to draw a bunch of

traits here's a trait

here's a trait here's a trait you have

those are your hammer saws and nails and what

what

your normal personality gives you is the

flexibility to handle life's curves

there's a trait called introversion it

allows you to

enjoy solitude and recovery there's a

trait called extroversion

it allows you to attach to people connect

connect

there's a trait called conscientiousness

that allows you to be detailed

and to be refined when you need to fill

out your tax return and not get audited

by the evil irs

and a normal personality has enough

traits in it

to where you can be the different ways

you need to be at different times

there's a place in munich called the max

blank institute for human developments

the largest research program in human

development in the world

and they call personality your adaptive tool

tool

kit now you don't have to be perfectly

flexible or adaptive you have to be

adaptive enough

so when i'm doing psychotherapy with a

patient i'm in therapist mode

i'm making interpretations drawing connections

connections

looking at history when i'm at home with

my wife pam i'm in husband mode

i don't treat her like a patient trust

me that would not go

well when i'm on a roller coaster i'm in

roller coaster mode screaming and yelling

yelling

when i'm at a funeral i'm in funeral

mode and i'm somber

and reverent you know so you have all

these different ways of being now here's

what we've discovered you guys

in some human beings as they're developing

developing

that system fails and they end up with only

only

one way to be in their toolkit

and that's all they have and they don't

have another way to be

so it's not that they have a symptom

what's wrong with them

is they're missing alternative ways to

be they're not flexible they're not

adaptive the way they are

isn't inappropriate when they're in a

situation where it's appropriate

but it's inappropriate at other times so

we don't call these people sick we call

them inappropriate

paranoid personality disorder means you

have only one way to be you're

you're suspicious all the time of everyone

everyone

a therapist says you can trust me

someone with paranoid personality goes

why would they be

saying that to me because they're always suspicious

suspicious

someone with dependent personal disorder

is always submissive

they can't think for themselves so you

say think for yourself and they go

we have to tell me how to do that i had

a patient literally say to me

but what are the rules for making up my

own rules pardon me

narcissistic personality disorder people

are self-confident but they have no

right to be self-confident

if you know what you're doing

self-confidence makes sense but if you

don't you should be a beginner

but a nurse is always grandiose and self-righteous

self-righteous

they're like oh i know it i know

everything i know all about that

i had dinner with one and i just was

feeling evil

and something came up that said oh this

thing happened i go oh i know about that

and i knew they didn't

so i said okay tell me what i was just

being sadistic

they're like oh well uh well uh i mean

they didn't have a way to say

i don't know so what we found is that

people with personal disorders are

missing psychological pieces you take

for granted

you know people can must be missing a

foot we know what narcissists are missing

missing

empathy they don't know what it is they

don't have it

you know how people convincing a kidney

people with antisocial are missing

honor and remorse

you know how you can be missing an eye

well some people are missing independence

independence

and so we were shocked to find out that

what this condition is is these are incomplete

incomplete

people you know we have that phrase

people we say they're not all there you know

know

it's true so what we found was no wonder

we weren't helping them

because we were trying to repair things

that cause symptoms

where these people they're missing

pieces that you and i take for

granted in the movie uh collateral jamie foxx

foxx

plays an avoidant personality sort of

cab driver who realizes

he's driving around a psychopath play

but tom cruise is a hitman

on his heads and he finally gets mad and

he looks in the rearview mirror and he

says to tom cruise

what happened to you you are missing

pieces that are automatic for a human being

being

and that's a little action movie now we

found out after we started working

successfully with these clients

that there's something else missing too you

you

have a have an ability and we have a

name for that ability we call it the

ability to self-correct

now that you take for granted because

it's automatic but it's a high level

cognitive function it requires a meta

observational position

self-objectification self awareness

self-control and self-regulation

our name for that in personal disorder

work is your observing

ego so we draw it like an eyeball

you are watching yourself and when you

mess up you do better next time

we found that whatever disables the

growth of diverse trades i'm not going

to bore you with that

also disables observing ego so to make

the point it doesn't work i'm gonna draw

a circle around it

and put one of the european slashy

things through it to show it doesn't work

work

here's the key for you guys to pay

attention you

are accustomed to talking to people who

have an observing ego

you and their observing ego talk you

give them information

and you expect them to be able to take

the information

and apply it to themselves these people

can't do it the whole reason you fail

with them

is they don't have the

self-observational function

to take the brochures you give them the

videos you show them

the the advice you present and apply it

to make good decisions not because

they're missing the information

it's that they're missing the function

to make use of the information

see this is where you guys run into a

brick wall

you want to give them the pamphlet you

want to show them the video you want to

tell them the data well guess what

it's all correct and it doesn't make any difference

difference

because they're missing the function

you're expecting to take the information

go oh

i get it i need to you know have this

child and make the world

better and they don't get it it's not

if there's no they in there to do the getting

getting

okay and what we found you guys is this

dual deficiency of trait

diversity and observing equal capacity

changes their functioning to where they

do screwy things

over and over john leslie who was

one of the people who ran the committee

arizona for dsm-5 says it this way

a personality disorder is a human being

who persists in a behavior

in the face of clear evidence it's inappropriate

inappropriate

and ongoing bad consequences so you can tell

tell

that right now i am having a

conversation with your observing ego

you are taking in the data the

information i'm giving you

and you think going to think of how to

apply it to your work

that's because you're not personality disorder

disorder

okay but 39 to 100 of your clientele

are now here's what that means you don't

have to stop giving them

information but you have to talk to them

in a way

that bypasses the non-work and observing ego

ego

in order to have an impact on what

they're going to do okay so this is the

thing we found in mental health

we had to change everything even that we

were doing

the work with symptomatic patients

because it didn't work here and so we developed

developed

models that are really good they have

weird names

dialectical behavior therapy

mentalization based treatment

transference focused psychotherapy

developmental object relations blah blah

blah blah

forget it i'm going to teach you

techniques from those

designed to help you have the point you're

you're

trying to make make a difference to them

okay now i've just taken you through

80 years of research you guys it took us

forever to understand this stuff okay

so let me get on let me get my my

page up here hang on a second my little

thing isn't working

i've got some notes i want to make sure

i get you everything

on my little uh there we go i went to

sleep that's why i have a little pad

electronic pad here

the point is this none of what you're doing

doing

will have an impact with this population

unless you take into account that

they're missing psychological structures

you take for granted

now let me go through the techniques

that we have found

are really helpful here let me get a new

page out

okay if you remember nothing else from this

this

hour i want you to remember this so if

you've been snoozing if i put you to

sleep if the dog's been bargaining to

feed the cat come back

i have a technique that is magic

it's going to sound really stupid really

basic and when i read it in a book in

1988 one of the first books written

and personal source i thought that's the

dumbest darn thing i ever read

i started using it this puppy has magic

freaking powers remember this

when you're talking with someone who

isn't getting it

if you begin to phrase what you tell

them in a particular way

it's like a stealth bomber that flies through

through

and hits them and the technique is

e t the search for

extraterrestrials i'm kidding i'm

married to a sci-fi junkie so i make

sci-fi jokes

what this stands for is you do a three-part

three-part

sentence or three it can be three sentences

sentences

the first thing you say is a positive

statement about

support

you say something supportive okay

here's the problem if all you do is

support you're not going to make any difference

difference

but so the first thing you have to do is

support because if all you do is

confront you won't make any difference either

either

then you make a positive statement about

okay this is connecting with them that

opens the terrain to where you can

hit them over the head with a hammer

s e t and if you phrase

everything you say to them with an sct

you will be

astonished at how it works

here's an sct i want you guys

to learn this technique is so powerful

you're really going to feel satisfied

doing it and this is what it sounds like

see you didn't even hear it did you

it goes right by you i'm really glad you

came to the center

i i'm proud of you for facing this and listen

listen

i totally get how hard this decision is

for you

and what you're feeling but you know

you want life to exist like i do

you see what that does it kind of

creates a territory that gives an

opening for you to say the data say the truth

truth

and to bypass the yes buts

and the defenses they're going to use

i had a man come to see me who was a

very good man he was a veterinarian of

all things and

he was dating and we were talking about

some life history things he wanted to do

and he started dating a woman i like it

because i was picking a personality disorder

disorder

and i told him he shouldn't get serious

with her so it was kind of

laid down the gauntlet while he quit you

know he couldn't keep her and me

so yeah i got killed off eight years

later he called me up

and he said he came he looked terrible

he said my life's a disaster

you're the only one who this is trouble

you gotta get me out of this you know

that's one of those no good deed goes

and punish things

how do i get out of this and i said i

trust we'll try to say this to her no i

ha i said if you told you want a divorce

no she'll try to kill i mean he said that

that

so so i ended up describing sct and he

said yes

i get it that'll work so for three

months all i did was teach him

everything he said to his sct

this was a relationship with darn

nervous because of her

i tell you guys i couldn't believe it

smoothest divorce

i've ever helped happen and she was

seriously disorder i mean catastrophically

catastrophically

dangerously disordered no property

rights they had three kids

no custody battle they had a lot of

money she was a physician he's a veterinarian

veterinarian

and he came and he said i can't believe

it's gone this smoothly

why does sct work with her i said well i

can give you the theories he goes no i

don't care forget it

i'm just glad it does i wish i'd known

it eight years ago thank you save my life

life

which i didn't but sct did and i want to

tell you i got an email from a little

while back

that said dear greg i wanted to write

you and tell you how i am

my second wife he met a woman he brought

her in because he wanted me to evaluate

her she was wonderful he said we're

married with seven kids they're grown

you got me start on this new life it's

now an old life and i want you know it's

a wonderful life

and i want you guys to know that i

hadn't spoken him for 17 years

sct it was created by a psychologist

named jerry

kreisman out of the university of missouri

missouri

i have used it with hundreds

of personality assorted patients and it

works i have never seen it fail actually

now i'm sure it has so don't you know

take my word for that

but if all you remember is a statement

of support

your well-meaning a statement of empathy

their well-meaning

the truth the truth can be pretty rough

but it'll work and there's a lot of

room for uh how do i say

uh flexibility or you can do a whole

bunch of support

whole bunch empathy brief truth you can

do a quick support

quick empathy hard truth use uses it

according to how

you work i'm reasonably confronted

personally sorted

special disorder specialist we're pretty rough

rough

so i try to emphasize the sport and the

empathy because i'm pretty good at the

hard truth

see how what you think but if you

remember nothing else sct

is freaking genius magic created by god

designed for humans i'm telling you i i

don't believe it when i read it and i

want to tell what book it's

the book stinks number two

people make bad decisions because of

now what i mean by lack of sorting is

this population

cannot tell st something very

fundamental things about life that come

naturally for you and here's the most important

important

they can't tell the difference between a thought

a feeling

and it's when you mix these three up

that people make bad decisions so a

very very powerful foy for you to talk

that will

open the door for you to have an impact

is to make sure that when they say

something you identify

what they're referring to is thought or

feeling or behavior because a client

will say this well i felt like i should

have an abortion

that's not a feeling that's a thought so

you say is so you had the thought

i should have an abortion now see what

that does is it constrains

that to the thought area and it opens up the

the

other areas of life to be uncontaminated

by it

or they say well you know

i i i thought i had been bad

no bad is a feeling and so you say oh

you felt bad so you identified as a

feeling and it puts it in its box

and opens the rest of life

or you know well they were just

enraged with me no they

may have felt rage but what did they

actually do

well they yelled at me oh so they yelled

at you

and i thought that was bad no you felt

bad so they yelled at you and you

felt bad yeah and i felt like i couldn't

take it

then you had that thought so they yelled

at you you felt bad and you had the thought

thought

i can't take this do you see that

how that cleans up thinking feeling behaving

behaving

now that i have it sorted and i have

each of those

in their realm i can begin to talk about

other things but as long as that model process

process

where they think feelings are thoughts

and they experience thoughts as

behaviors and they experience

behaviors as feelings you're not going

to get anywhere because it's going to go

into kind of a whirlpool and this

population lives in a whirlpool we have

a name for it we call it drama

and we even have diagrams how it works

and to get out of that whirlpool you

have to get out of that whirlpool to

talk in a way that makes a difference

so by sorting that's a g it doesn't look

like one

make sure when you're talking you say oh

so you had the thought such and such oh

so you felt

such and such okay oh so

they did such and such you did such and such

such

i told them off well now that's a

thought tying someone off what did you

actually say

so notice you guys i'm not telling you

what to say here in terms of giving them data

data

i'm telling you a method to add on to

the way you talk

to give you opening to have an impact

because listen you've got to move

heaven and earth to have an impact with

this population

the data show it takes in formal psychotherapy

psychotherapy

six sessions with them to reach the same

outcome of one session with a patient

with symptoms

so this is a big deal so two

techniques i've gone over with you so

far the genius magic

divinely inspired technique called sct

support empathy and truth

and then the fundamental technique

called sorting to make sure

that everything's in its place so that

you're talking outside of the whirlpool

called the

drama okay so there's two

number three

don't give advice don't give information

don't say i'd like to give you this brochure

brochure

you'll bump right up against no

observing ego say

so i want to ask if it's okay with you

or if i give you a brochure about this

say well listen i have some advice would

you like to hear it

uh my analysts will say to me greg you

want to know when through went through

my head while you said that

i had a patient who was borderline

personality disorder at a therapy group

and she got mad at the group and said

when i bring up a problem you guys give

me solutions i don't need solutions i

come up with solutions

what i need from you is support and

empathy and understanding she was really mad

mad

so she brought up a problem a couple of

sessions later

and their silence and one of the group

members said you know i just put myself

in your position

and i know however i have heart by the

time with that and she goes now see

that's helping me that's what i need so say

say

can i give you some advice about that

now does it guarantee they'll take it

of course not does it mean that it'll

it'll it'll solve everything of course

not what it means is you won't

bump up against the missing observing ego

ego

with the yes but the justification the

rationalization and if they say no i

don't want advice

don't give it because it wouldn't have

worked anyway let's say a patient you

want to know what i think they go not

really fine

okay well what else do you want to tell me

okay all right uh we got a couple of

last things then we're going to do some

questions if you've got some in the last

five minutes it's it's uh 12 52

so we've got eight minutes left i

promise not to run over it's hard to

shut me

up so i promised i would shut up okay next

this population is on high defensive

alert freud

identified defense mechanisms as a way of

staying right and when people are afraid

they're wrong they get defensive this

population has always spread the wrong

so they have all these experiences for

things to work so one of the things you

need to do with this population

they don't feel right and they're coming

to you in crisis which makes it worse anyway

anyway

so find some some ways to compliment you

know i'll say to a new client

you know i'm really glad you came in

what you're struggling with

you're struggling with this by yourself

that's hard and you know it took guts

to come sit in this office people don't

want to it's people are embarrassed

people feel bad and you know that tells

me you know what that tells me

you got guts you know what that tells me

you can deal with this we can work on

this because that's what that tells me

about you

you can say to a client you know i like

the way you said that you said that very well

well

or good thought that's a way to think

that i like that that fits

find some ways to throw that in because

if all you're doing is telling them you

should make the the decision i'm telling

you to make and not the decision you're

thinking about but

right up against the lack of observing

ego so find some ways to compliment and

tell them they're right

make sure it's genuine don't lie

find some ways i don't care if you have

to say

those are really attractive shoes you

know i really like those

i don't care what it is say something

good okay let me give you one last

thing then we'll see if there's some

questions if not i've got you know

another six hours i can give you

this one's helpful too this one's pretty

powerful so

people experience and language

things in either as visual

can't spell let me redo that i'm sorry

or physical listen to how they talk and

use the same language

some people are visual they say i don't

see that i don't see it happening that way

way

no i can't picture that well say that

back to them well i'll tell you how i

see it would you like how i see it

some people are auditory they say that

doesn't sound right

no i don't i i can't hear it that way or

say well let me tell you it this way

some people are physical i i don't feel

like that's true

i i i don't i don't feel like it's that way

way

say well you know you might feel like

it's so

listen to what sensory channel

they speak in and it will tell you what

sensory channel to speak

back to them in so listen do they say i

hear that

i see that i feel that what do they emphasize

emphasize

okay all right so let me review real

quick and then we will

see what questions you may have so the

things that are really applicable to you

that i can teach you in this length of time

time

to add on to what you do are phrasing

things in an sct

sort identifying thought feelings and behaviors

behaviors

are specific to put them in their realm

so you have

opening for to make an impact make sure

you ask permission so because they're on

high defensive alert

and ask permission before you give them something

something

because they don't have the observing

ego to automatically take it in

and find ways to make them right and

listen for the predicates they use of which

which

system they tend to operate most in and

be consistent with

them you know when i i saw professional

athletes watching the olympics

and he's and i said well let's find a

way that won't sideline you from this

that that feels like you're you're

out front you know i'm using these these

metaphors for how

how they how they experience okay all

right good you guys let me get rid of my

white board here

and any anything you'd like to ask got

like three minutes left because of

course i've run over

uh anything if not i can re-emphasize things

things

uh dr lester someone asked if you could um

repeat uh s-e-t the sec example

a little bit slower oh yeah i do speak

fast don't i sure you bet

so let me get sct up here and i'll do a

couple slower

let me get back to my scg hang on okay

i'm really glad you're here today

i think it shows you have courage

and i think that means you know

i really like the way you said that

because it says to me you have good

clear thinking

you've got a head on your shoulders and

you're going to be able to

look at the things i'd tell you at the

brochure i give you

and know it's the truth and tell you

it works like that see the reason it's

difficult to get

is that it is so kind of in a good way slick

slick

that it goes right by you that's the whole

whole

method is it slides right

in so i understand your

i understand your desire to have examples

examples

it means you want to use this well to

have an impact with your clients

do you see i just did it you don't even

see it do you

and it just goes right by it so yeah i'm

sorry i go so fast i appreciate

your your uh request for me to do it in

a more

measured measure tone or

speed all right we got a minute anything

else i can do for you in a minute you guys

guys

okay so let me finish with this listen

thank you for the work you're doing you

guys i hope that that small piece i can

add for you from what i do can i

interrupt we have one more question and

i'm sure of course

wayne has it go ahead thank you so much um

so my question is we saw during covid

the type of client we were serving was

drastically different than we had served before

before

so instead of seeing clients that were

abortion minded but they were much more

open to making a life decision we saw

the clients it was a dead heart stop

i want an abortion why are you not an

abortion provider why am i here

does this thing technique work on them or

are we talking about a heart matter now

no no no no no

that's such a good question for this reason

reason

this population when they're threatened

get more

rigid because they only have one way to

be they cling to it

let's face it the covet pandemic put

everybody in crisis mode

so what you're seeing is an amplified

version of the personality disorder

where they're just stuck on this

and you can tell they don't have

flexibility they have adaptability they

don't have objective voice in their head

the answer to your question is

absolutely these techniques help

absolutely they are what will make chip

away at that

no guarantees with any human being of

course but your best

shot with somebody that rigid is this because

because

when they're listen when a married

couple comes in in a crisis

they're as rigid about this kind of

stuff as someone is about having an abortion

abortion

so we have designed our personal disorder

disorder

work to work with the very thing you're

talking about the

escalated rigid dramatic absolutist

not willing to consider no observing ego

no openness and you can tell

the techniques i'm teaching you are to

try to provide openings

with some people you don't need that

they're open you give them information

right you know them they're the ones you like

but you are right this population has

been terribly threatened

with just the covet going on and it puts

them into

an excessively rigid and deficient state

so yes try these with them

try this with them it helps can you give

us like one really good example like

like a sample statement of someone who

in that type of rigidity is like

no i'm going to kill my baby where do i go

okay so your thought is

i'm gonna go kill my baby i get it

how does that feel so notice what i did

i just put the thought into oh that's

the thought

now i'm gonna go to another realm that

isn't addressed because they're

describing that as their feeling and it isn't

isn't

so i'm gonna say well how's that feel

and they're gonna say see

you don't know what they're going to say

that's what you want

what you want is for them to not know

what to say

because now you've got an opening where

they're not

certain so by sorting that i'm going to

kill my baby

into okay so your thought is i'm going

to have an abortion i get it

i get that that i get that that thought

i get that now

what's that feel like now

and then you're going to go elsewhere

because you're going to put that in its cage

cage

and you're going to over or you can say

use an sct

i'm glad you're thinking about what to

do with this pregnancy

i can see this is really hard for you

but i think that may be a premature conclusion

see what that does softens up the territory

territory

it's kind of like i'm going to use a

terrible analogy it's calling in an air strike

strike

to clean out some of the defenses before

you send in your soldiers in the war

remember you guys remember something

a clinical conversation is not an advocate

advocate

advocacy conversation if you advocate

with this clientele

you might as well not bother talking to

them because they're oppositional

they're defiant they're rigid they're unreasonable

unreasonable

so you do not add clinical conversation

i have the same purpose as

advocacy but it doesn't have the same

method as advocacy

and what you're trying to do here is

make an opening so yeah

try these with that population excellent question

question

i appreciate that i already feel

decompressed by it

okay i mean you know isn't it

interesting just in our little example

how it feels when i do it just an

example what you can feel what it does

in your head

can't you isn't it something and it only

took us 80 years to figure this stuff out

out

doctor i'm gonna let you guys one quick

one this one's very quick

i'm gonna do a quick one it came in

on a chat function do you have a recommendation

recommendation

um for where there's a marriage uh

with a narcissist uh for a therapist in

la that might be able to deal with that

okay so uh personal disorder is a pretty

distinct uh subset so i have

uh no i don't know anyone personally so

i'll tell you to find someone

uh call up ucla in their psychiatry

department at the hospital

and ask for someone else good with

personality disorders

um medical schools usually have a

department that has somebody

that's good at it uh the other thing the

second thing you can do

is the mecca a kind of vatican for

personal disorders is called the meniger

institute it's in houston as part of

baylor medical school

call them up and say who do you know in

l.a who's good with personality

disorders because they wrote the book on

personnel sources they

did the first study in 1966. so go to

ucla and say who you got

or call up men and girl and say who you

got because you don't want a garden

variety clinician for this you guys

they want it will fail okay good question

question

all right so you guys i'm going to check

out and let dan here finish with you

thank you for having me

it's always a delight and a joy but i

hope it's been helpful

we'll see you again next time i'll let

you go bye-bye bye-bye

all right so uh dr lester is signed off but

but

nevertheless i thank him it was i

thought a very useful and

very informative presentation

i'm going to offer before we close a

short closing prayer

in the name of the father and of the son

and the holy spirit amen

having heard um dr lester's presentation

we renew the prayer that we made at the outset

outset

grant that it assists us in furthering our efforts to defend

our efforts to defend and protect your creation lord

and protect your creation lord and to defend all that is good

and to defend all that is good and in accord with your plan for your

and in accord with your plan for your creation

creation grant in particular that it um that it

grant in particular that it um that it assists us in

assists us in understanding loving and helping persons

understanding loving and helping persons with personality disorder

with personality disorder we ask this through christ our lord amen

[Music] okay so before we leave uh

okay so before we leave uh let me announce our next presentation uh

let me announce our next presentation uh we have dr

we have dr tom glesner of nifla the national

tom glesner of nifla the national institute of

institute of family and life advocates i think most

family and life advocates i think most are

are probably all of you are familiar with

probably all of you are familiar with nifla um

nifla um nipla was the plaintiff in a previous

nipla was the plaintiff in a previous supreme court case concerning the

supreme court case concerning the posting of um

posting of um abortion advocacy outside pro-life

abortion advocacy outside pro-life counseling centers the visera case which

counseling centers the visera case which was successful in the supreme court

was successful in the supreme court tom will present on september 1st the

tom will present on september 1st the first wednesday

first wednesday of next month on the topic

of next month on the topic of the new of the supreme court case

of the new of the supreme court case that is up

that is up uh up uh now in the supreme court

uh up uh now in the supreme court uh dobbs the dobbs case which

uh dobbs the dobbs case which in which the state of mississippi is

in which the state of mississippi is challenging roe v

challenging roe v wade and tom's presentation will be

wade and tom's presentation will be the mississippi case and the inevitable

the mississippi case and the inevitable demise of roe versus wade

demise of roe versus wade so that of course is of gargantuan

so that of course is of gargantuan interest to everyone

interest to everyone um and i i hope you can join us you'll

um and i i hope you can join us you'll receive

receive you and other others who

you and other others who have previously participated in our

have previously participated in our programs will receive an email

programs will receive an email invitation

invitation and um i i hope that you can join us

and um i i hope that you can join us then so again uh thank you everyone

then so again uh thank you everyone for participating and i hope to see you

for participating and i hope to see you again

again next month on wednesday the first for

next month on wednesday the first for tom blessner's presentation

tom blessner's presentation thank you very much thank you dan thank

thank you very much thank you dan thank you jacob

you jacob and thank you rosie

and thank you rosie thank you everyone for joining

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YouTube Transcript:International Life Services' Advanced Training Institute | Greg Lester, PhD

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International Life Services' Advanced Training Institute | Greg Lester, PhD