 We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show, behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to the next episode of The Therapy Show, behind closed doors with me Jackie Jones and the wonderful Bob Cook. And we're going to follow on from what we did in the last podcast and look at The Paranoid Client. Correct, often called, well in the personality adaptations book by Van Joins called The Brilliant Skeptic. I'm very well aware of this one, Bob. Good. Yes, why? Okay, so with all these, well, I'm guessing, you want me to guess why? That's because you have some affinity with the paranoid traits or personality. Yes. Okay. Oh, you'll like this then. I do. I love it. The more information I can get about this. When you know this yourself, so you'll be a very good person to speak on this podcast. But with all these different styles of personalities that we're dealing with. I'd like just to talk about a way of thinking about this in general. And that's around a continuum of health. In other words, on one side you've got what some people might call mild symptoms and something might be called in the world of the neurotic well, or you might want just to call it traits if you wanted to. If you go up to more intense traits, working all the way up to the other end of the continuum, which is personality disorders, where the world is more black and white and fixed, and there's less flexibility or spontaneity. If you go to the other side, where you've got the neurotic well or the worried well, which is often called on that side of it, there's more flexibility than there may be traits of the style. We're going to talk about paranoia. So on the worried well, or the neurotic side, we're talking about traits. And on the other side, we're talking about much more fixed personality disorders, where there's far less flexibility, there's lacking of spontaneity, and it's very black and white. And then in the middle of that, you've got more intense traits if you like. It's like a continuum from left to right, from mild to the other end, a more of a personality disorder, or even psychosis. So whatever style we're talking about, think about and continue with health, because when you said you identified with the paranoid personality if you like, I think you're talking about traits, or what I would call in the area on the left-hand side of the continuum, which is more like the worried well, or the neurotic well, there's different names for it, but it's more in the arena of traits, rather than the other end, which is very black and white, fixed personality, lack of spontaneity. I think you're talking about that you've got quite a reasonable adult, but you have certain traits that you identify perhaps with this particular style of character. Yeah. That's right. 100% yes, I'm not diagnosed as anything. Luckily for me, yeah, I'm sure there are some people who will disagree with that. But no, it's the traits and what you're talking about. I often talk with clients about you being like a sliding scale. You know, people talk about narcissism an awful lot lately. I don't know whether the pandemic's bringing a lot of narcissism. People like Trump around, haven't you? That's it, yeah. They're puking around where they're real narcissists, I think on the right-hand side of the scale. Yeah. But I kind of associate that with the traits around the antisocial behavior types. You know, I often say that those are the people that I would see in private practice. I don't think a narcissist, you know, somebody that's diagnosed with a disorder would come to see me in private practice. Well, certainly not with the narcissistic side. I know this isn't a podcast on narcissism. But on the narcissistic style, if it was really a personality disorder, they wouldn't even think of coming to see you. Yeah, that's generally what I say to people. You know, I wouldn't see them, yeah. No, and you're quite right with most of the personality disorders. They're so fixed. They're often being, maybe in sections that have been in the psychiatric system, and they're not likely really to reach out for therapy unless they're sometimes sent by the police where part of a court order is that they get therapy. Or maybe by a spouse, or maybe when people maybe even friends of theirs said we'd better go and get therapy. So they might go, but people with personality disorders don't usually reach out for therapy. No. But the traits, you know, I like the traits. I'm quite attached to my personality traits. I've got them very well. That's right. So it's very important that when we're talking about these styles, we're really talking more about traits or adaptations rather than a real disorder. Because once we go on to the disorder level, one, they don't usually come to therapy and be there if they do, they're very fixed. They often have bizarre delusions, might even have fluid psychosis in front of you. Yeah. So when I'm talking about these styles or adaptations, they're more in the worried well section or what we could call traits if you like for the case of the podcast. So if we're going to think of paranoid people or people who come from that paranoid style, one thing I always think about they are very much come from the place they have to control the world. In other words, control is a really important part of their personality. So when they come to see a therapist, they will really attempt to control the therapist. Now, that's from a surviving place because they see the world as out to get them. They see the world as threatening to them. So they need to control the world before they get swallowed up by the world. So when it comes to your therapist, control is a really important process and they will attempt to control consciously if you're not sorry unconsciously even not consciously. They will attempt to call the therapist. So that's a really important one to look out for. Yeah. And I think it, you know what you were saying, I think it's a really valid point that it's all about protection and safety and security. That's, that's where the control comes from. That's right. And in the in, I'm going to talk about a book here. I'll say I'm not particularly into labels, but the book I'm going to talk about is an important book because if you're a psychotherapist, you might turn to this book because it talks about traits, but it also talks about clusters. And it also talks about personality disorders. And that's the diagnostic statistical manual, which actually is a manual for psychiatrists and American psychiatrists in the Britain you've got in Britain or the UK, you've got what's called ICD nine. This is very similar, but you would, or you might turn to this book to just have a some thinking about what clusters or what behaviors or what thinkings might actually make up people who've got traits or even personality disorders. And one of them I was looking at, I've just got a few here, I'm just going to read one of them out to you around this is what I'm talking about. And it says suspects without sufficient bias that other people are exploiting, harming or deceiving him or her. Yeah, so they really are it's important for them to control the therapy room. And also with that, they will not trust the therapist. And they will not trust people easily. So on the traits level. They're not going to trust people very easily. The nicest language will have a don't think message, sorry, don't trust message. And when we talk about tests and other podcasts, this is where this is, this is really quite true for this style of character. They will test the therapist, mainly because they don't trust them. And they come from a place that they could be attacked or harmed quite easily by the other. I see it. Yeah, I know you spoke in previous podcasts that when you were talking about the mayor cat, I kind of see that as kind of paranoid where they're constantly looking the, you know, the on high alert a lot of the time to see if, if there's been caught out by something. Yeah, see the skit so it character or the withdrawn character we talking about when I gave that mayor cat analogy. Yeah. I understand where you go with that as a bit of difference because what you're talking about is hyper vigilance. Yeah. Now, with the skit so it's a it's hyper vigilance about exposure. So in other words, they have a real fear of exposure. And they may pop and pop down very quickly. Because they don't stay exposed to the world with a paranoid person. They're hyper vision just like you said, because they're afraid of attack or afraid of being harmed or afraid of the world in that that way. So they're very hyper vigilance. And on the straight side, you'll see that exactly the way you just started to talk about they'll start to look around they'll be agitated. They'll probably ask questions around, you know, straightforward questions about, you know, you know, why is that cushion there? Why is that seat there? How come you're sitting there? So many different types of questions. Now, I remember I think of a paranoid person that I was working with recently before I stopped working clinically. And he rang the buzzer so I went to the front door, and he was he was a young lad and he had to put you over him. And he said, I've come for the appointment with Bob Cook. And then he said, and by the way, don't look don't look over there because those two people by the bus stop have been following me all the way. Don't look over there. No, no, no. And he just strode straight past me, because, you know, that's quite an acute sense of power now. There weren't people following by the way, but he had that sense of hyper vigilance because he was afraid that the world was out to get Tim was to going to attack him and that it was unpredictable. And he needed to control the world. Yeah, yeah. It's it's that, you know, needing to know everything what you were saying early on about asking lots of questions and why is that cushion there? Why do you sit there? Why do I sit here? Why all those sort of things that's that kind of is what I see a lot of. The first few sessions is just literally answering lots of questions. They do set tests for the therapist to pass, hopefully, or not. And that's all around trust. Now, usually what of course is when you set a test, there's nearly always a failure part to it. So therapists can't really pass the tests. Yeah, they can at least perhaps account for them. But paranoid really, really have a don't trust process. They also don't trust anyone in terms of being loyal to them. You know, they don't expect people to really be there for them or have their back. Yeah, they expect people to let them down. So therefore they're very suspicious people. They're very suspicious of the therapist. So that's interesting when you for their business, set contracts and have boundaries and have stuff with things we're talking about. Because I don't know if you do this, but some therapists may have contracts where they expect the client to sign that certain things, even a treatment contract level. Well, a paranoid client would think, probably it's a trick and why is a person asking me to sign anything. Now, according to their level of disturbance will be how they handle that. So only the person out of disorder wouldn't even sign it. I don't think people at the level of perhaps the worried well or the trait level will ask lots of questions properly before they sign anything. Yes, yeah. What does it mean if I sign it? Am I contracted to being in therapy for the next five years or what am I signing? What does that mean for me? Yeah. Be very specific. And also, they don't expect the therapist to be on their side. They expect the therapist to let them down. They expect the therapist to disappoint them. They expect the therapist to actually trick them in some way. Because that's the way that's that's really been how their world was. And they've got coping mechanisms linked around survival. Because there's, you know, it's like there's no one else but themselves in the world. Yeah, they can't rely on anybody else. Friendships and people will let them down. Yeah. I the therapist will. Now, the bit is how does the therapist get around that? So you said a moment ago, you work with paranoid clients. How do you, you know, when you're thinking about this, the third the paranoid client is going to, yeah, it's going to have a don't trust message is going to set traps for you is going to be suspicious of you. It's going to expect you to let them down. What do you, how do you see the work with the client? That type of client very, you know, very early on, what do you see as the major emphasis? For me, probably consistency. You know, a few things. I think it's quite important that I remember a lot of the information that they've given me. Right, yeah. I can clarify names of people and places and things like that so that I'm being consistent as in I'm listening to what you're saying I'm taking it in and I'm remembering those things about you. But consistency appointment times turning up on time doing what I say I'm going to do. If I say one week we're going to work on this and then the next week I don't do it. That's, that's going to just fuel the fire for I don't do what I say I'm going to do. Yeah, and you would expect the paranoid client to ask quite a lot of questions. Lots of structure. I've got my whiteboard here. Do you know what I mean? I might draw diagrams and talk through the theory of things. I'm not just pulling it out. I rub it out with a hat sort of thing. There's a point to it the structure to it. Yeah, so you're providing probably a structured boundary consistent reliable framework which the paranoid client probably has never had, or it's been an environment which has let him down. And I'm prepared to let them down to a certain extent because I get a sense sometimes that they will just up the ante to try and prove that the paranoia is there for a reason. Yeah, so you're prepared to sort of go along with that. Yeah, and be prepared to make mistakes. And, you know, then bring that back into the therapy room. Yeah, another sort of, you know, taught by characteristics and features of the paranoid is suspicious and they're very suspicious and very jealous, usually usually without any justification. Now, that's really important when you think about in terms of how many clients clinicians have. So, you know, say the average professional therapist has 20 clients, just say an average. The paranoid client will be very, probably if they know that would be very jealous, very suspicious. Wouldn't want to wouldn't want you to have a relation with therapist to shares you with them with other clients and very suspicious about people that any particular justification at all. That's a shame. I was just thinking, you know, we have a waiting room with our institute and, you know, clients sitting there and a paranoid client particularly will be very suspicious of. They often want to sit in the waiting room by the way, but if they did sit in the waiting room, they'd often be very suspicious about the client. So if they were sitting there and say the therapist door that they're going to see is next to that waiting room client comes out the paranoid client to be very suspicious and jealous without any justification of what, you know, of the relationship with the previous client. Because they're in their background. They've been let down, they've been hurt. Life's been unpredictable. They haven't been able to control events. Yeah, it's a it's a it's a very unpredictable, powerless. History they've usually had. Inconsistent parenting is one of the things I think that a lot of people talk about in sessions with me when it's that never knowing 100% that mom or dad is going to be there emotionally available to them or turn up to pick them up from school or you know for whatever reason. That's right. That's correct. And so the coping mechanism is to take control to not believe anything anyone says to not trust people to be suspicious to be jealous, all in order to put to make the world predictable and to attack people before they attack them. To attack without justification before their thoughts are anyway is they get attacked by the other. They will blame others before they get blame themselves. Yeah, which is quite difficult for the the the paranoid client to to be intimate with somebody else to be vulnerable to to be in relationships 100% if they've got that lack of trust and feeling like they're always going to be let down and suspicious and all those sort of things. It's it's a challenge for a lot of clients. Oh, and that's right so it's hard to have relationships with people who are highly paranoid. It's difficult from that framework. And the other thing is of course they're hyper vigilance all the time. So they're cuttles are very high levels and they're very, they're just always on guard. So it's hard to have a relationship with somebody who's actively paranoid. And for them it's also exhausting to be hyper vigilant all the time like you say you're kind of on that upper echelons of anxiety and stress all the time because you need to be on high alert. That's right. So in the transaction analysis world, which we both are. There's a diagram in the ta world called the okay corral and open and he took his ideas from Freud and actually but you can also link into attachment models. And in the okay corral he took four existential positions that people come from throughout their life and the paranoid person will come from a place of I'm okay. Yeah. So from the beginning the therapist is in the paranoid eyes, which reflects this history from a coping place of course. Yeah. So how do you prove that as a therapist. Like we said being consistent showing up. Do you think you ever gain 100% trust from somebody that has paranoid traits. Well, I was, well, let's say trades rather than personality disorders or tends to continue because I'm not sure if you do right up there. Yeah. But if we're talking about trains I think we can get to a place where we can offer them a different type of world if they want to step into it. Now, the question is how you do it. Personally, patients, you have to be very, very patient. You have to have to create a world what you were talking about early on I think in terms of consistent boundaries structure reliability all the things you were just talking about so they have a different type of experience. They're not going to easily buy into that because they will in their child think is a trick. Yeah. Now, where you're heading towards the parent paranoid client of course is the scared frightened child underneath all the layers of defense. Now they're laser defenses to attack to blame and to take control before you do. Yeah, in there. They're thinking. It's not straightforward work methodologically, but if you hold in your head that you are attempting to reach that vulnerable scared frightened child. I think you've got more of a chance. The problem is, if the therapist takes it all personally. Yeah. If they attack the blame, the lack of trusting the suspicion or personally, then things will go very wrong. Yeah, and I can see how that works because if you're in a situation where you're feeling like you're not trusted and you know that you are a very trustworthy person. I'm going to kind of buy into that constantly trying to prove that you are trustworthy and yeah. Yeah, it's the same if you it's the same for all these things, all these processes in a way harder for I think people are borderline if you're working borderlines or paranoid clients or or my antisocial clients or people that attack. You know, not just attack, but attack without any justification. If the therapist takes any of these processes personally, they're lost. They can go the best thing is that go to their own therapy and go to their supervisor to talk about all their issues they have with these types of clients. So what type of client needs is environment you talked about earlier on and a client who will stay with them and inquire underneath the attacks. Yeah, and inquire gently about what's, what's underneath the process of over control process of suspicion, the process of jealousy, and if it actually helps them in their life. Yeah, I think as a parent and ex foster care and the way that I relate that is, you know, there's always something behind the behavior. Often we focus on the behavior and take that personally, whereas it's a form of communication with a lot of children. You know, I work a lot with kids and it's kind of looking behind the behavior. It's easier to not take it personally if we do that. And like you were saying looking at the skirt child, the child that's trying to protect itself. If we can keep that in our mind's eye, then the distrust and the behavior that's in front of us, it's easier to take it less personal. I think it's another philosophical point, absolutely Jackie, absolutely. And there's another philosophical principle to bear in mind here, that however bizarre the behavior, or the power nor in this case, that if you trace back to the childhood will make perfect sense in that context. It doesn't make sense in the context of the psychotherapy route necessarily in the present day, but if you traced it back this behavior, these thought process to the early childhood, where the client comes from. That bizarre behavior will make a sense. Yeah, 100% sense. Yeah. So it's how you get back there. Yeah. Number one, you don't take it personally. Number two, that you can see the scared child, hopefully. And number three, I think, a lot of search for, you know, or inquiry, if you like, about the coping mechanisms which were set up all those years ago to protect them from what. Now, as we know, it's probably to protect it will be protect to protect them for from trauma, from unpredictable life, from abuse from a place where they've been let down or they've been not understood or they've been misattuned or they've been met. It'll be all those things where the child has felt so scared that the only way they can protect themselves or the only way they can see themselves protect themselves is to attempt to blame to attack to take control to be suspicious to be jealous, etc, etc. And then that way they create a whole barrier or series of barriers around themselves. And hopefully from their perspective will never be hurt. Number one is what you said earlier on, how do they then reach out to the world in an authentic way where they can ever be in a relationship, which is healing or trusting. Yeah. And like you said earlier on patients, it's, it's, it takes a lot of patience. Yeah. But if you can reach beneath those coping mechanism to the different levels of scare within beneath the paranoia and inquire what was happening in their world at that time. You have much more chance of helping heal that scare. Yeah. And again, I'm not sure how you feel about this but with clients that show personality traits such as paranoia, I do my utmost to not get in a tug of war with them. Of trying to prove certain things. I kind of let go of the rope at some points. And, you know, if there's a lot of resistance to what I'm saying, I won't push it. I will just let them stay in that place for a while without encouraging them out with their comfort zone. Let's put it that way. Yeah, because they're already putting up another barrier. They're already distrusting whatever it is. Well, I mean what you're saying is really important that you can leave your own ego outside the room because they're, they're major, major actual defense mechanism is to control. Yeah, and to attack. Yeah, you move into any think which can be perceived as a controlling battle. The only person to lose will be you. Because they're used to that. Yeah, that's the way they survived and that's what they expect the world to be like. And if you move into that, then there's only one way or only one process. You know, you'll end up in a battle and it goes nowhere. In fact, what will happen will be a repeat of history. Yeah, yeah. For the client. Yeah. That's a major point. I told you so. That's the major game. Yeah. Yeah. Major game. I told you so. And in transactional terms, now I've got you son of a bitch. Yeah. Very common game in TA, but very common game for paranoid. Yeah. And at some point we need to do the game playing because I find that fascinating. Yeah. So the other side of things I think, you know, touching on it just before we wrap up the paranoid personality trait is that there's there's a lot of strategy and a lot of thinking they're very much in the head. There's not a lot of feeling and emotion stuff goes on with this. It's it's very logical. It's very cognitive. It's all. Well, yes, that's, as you go down the layers, you do need to get to feel this. Of course, but a good way to get to feelings. So that's what they think about what they're feeling. Yeah. You know, sometimes stops and then in the tracks. Yeah, that frame of reference. Yeah. And I think with all the stars we're talking about, you need to go with their frame of reference, whatever that is. Yeah. Whether it's whether it's about withdrawing. So maybe you need to think about initiation, whether it's about in the world of cognition, then for what you've just said there, meeting the thinking level. If you talk about history, hysteronics meeting with the feeling level, we have to meet them where they come in. Yeah. And then we need to go beneath that whole world. And with the paranoia is to gently ask them what they think about what they're feeling or finding a way to go down beneath the cognition is vitally important to reach the, what I believe is vitally critical, which is a huge scare of the world. These are people are very, very, very scared and afraid of living, because they always believe they're going to be attacked, they're going to be hurt, they're going to be swallowed up. They will cross the road, you know, without any justification that the other person on the road is going to hurt them. But because they see the person frown, or so they see the person, I don't know, put their hands in the pockets. They think they think the person is going to attack them or hurt them. They may continue down the road but often might cross the road because they fear conflict. Now, of course, if it's a personality disorder, another story, but they live in a perpetual world of fear. Again, you know, if you're aware of that and see that scare, then being compassionate towards the behavior and understanding in that, that's the way to do it is to see it is all coming from a place of fear and scare. That's right. And, you know, the therapist, I agree with you again, and also to be aware that they may see any attempts of compassion or TA language, nurturing strokes as a trick. It's really not really important not to go and overwhelm them with loads and loads of positive strokes or positive nurturing or positive compassion or whatever you want. So it might be much more compassionate to find a way to think about the timing of positive strokes and compassion rather than just give them a full meal because these people are people have grown up without a full meal. Yeah, yeah. And it can be seen as quite condescending. You know, if they're trying to control their environment and suddenly you're being quite, you know, over the top invalidating and affirming everything that they're doing, they might see that as quite condescending. Again, because they're in that cognitive place, the feelings, the emotions don't mean anything. They don't mean that you might be able to trip them. Yeah. So, so you might I think it's a good point about but you are in the end need to get to their feelings and need the cognition. Yeah. So, to summarise, it's kind of like being in a minefield sometimes being in a therapy room with somebody that has a paranoid personality traits. They want to be in control. Yeah, they have the map. They know where all the mines are and where the traps are and where the tricks are, but it's usually without any justification. So if you can get underneath that, you know, that whole those whole coping mechanisms to get to the scared child who imagines where these maps and traps are and everything else that goes with it. So the perceptions are a very good way to get there, but you need to, I think with timings, everything gets psyched about. Yeah. But we're not rushing it, are we Bob? We're not doing it. No, slow patient work. So that's fantastic. Thank you so much. And the next one, we're going to be looking at passive aggressive. Yes. So, another traits of yours, is it? That one's not one of mine. Is that one of yours, Bob? If you talk about traits, it's really interesting. If we're going to passive aggressive, let's switch to passive aggressive then. Okay. Wait a minute. Let's finish this one and we'll do that in the next episode. Are you going to finish this one? Finish this one first. Draw this one to an end. Oh, let's, let's do this. I want to, I like to say something positive about the power, people have paranoid traits. So, you know, the nickname that was given by Paul Wehr and Van George in a book called personality adaptations. I think it was 2002. They called the paranoid client brilliant skeptic. And they have wonderfully brilliant minds. They work very well. They're very, very good thinkers. And they're very engaging people from that frame of reference. And I think if you can meet them at that level, of that level of thinking, you're going to go a long way. Yeah. And in a lot of work environments, they're really good because they're very detailed focused. Very specific and detailed. And I'll also ask questions. Which in certain jobs is a must. Certainly is go a long way. The devil's in the detail. That's the one. That's the one. Right. See you in the next episode, Bob, where we'll be talking about passive aggressive. Yeah. Yeah. See you soon. Goodbye. Bye. 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