Post-Consult Debriefs w/ Dr. Jacob + Tiffany

Added: 2026-06-02

[00:00:05]So when I'm sitting, one of the first things is I just want to hear how somebody um the narrative somebody has of themsself, >> you know, what they choose to talk about, how they choose to talk about it.

[00:00:19]Um is it, you know, linear? Am I >> redirecting or trying can I follow the story?

[00:00:27]>> Interesting. you know, their story is their life history. It's a really important narrative. Um, so what somebody chooses to focus on, their education, romantic relationships, successes, failures, um, moves, family, you know, the million things like any one of us could focus on has relevance. So what somebody chooses to share when they when I say like like tell me about you, how did you get to this place? And then the how somebody shares it.

[00:00:58]You know, does it make them happy, sad, anxious, frustrated, or maybe just feels like a story? Like we could be talking about The Color of the Sky, >> right, without a lot of emotion. Whether that's accurate to how they feel or not, I don't know. I'm sitting down for the first time meeting Tiffany. Um, it's something I would be really interested in if I was to see Tiffany long term. I would be very curious about how she might pick other parts of her life story and how she feels about those things >> or if there's a lack of affect, you know, what that's about. The other thing I I'm sort of listening for are some either contradictions or some based on my own um knowledge of psychology and of personality disorders of how somebody thinks about different key areas. And for BPD, one big thing is interpersonal relationships and one's sense of self.

[00:01:55]>> Mhm.

[00:01:56]>> So she went, you know, just by natural way of thinking about herself. She talked about her history, her friendships, her family, um her romantic relationships. She sort of just put it all on the table. Now, is that salient to her because I'm a BPD person and we're talking about BPD or that's the most important thing to her would be worth better understanding, but that's what we have to go on for right now. And this sort of real challenge of I really want friends and I really want a community and she said something along the lines of like that has made me fe you know contributed to my suicidality.

[00:02:35]Mhm.

[00:02:36]>> So, it's obviously a really important area for her, but why that is becomes a point of better understanding. So, she's somebody who says, "I've had a hard time making friends and I'm really trying people please." What generally happens for people? And that may align with her experience and something that you would sort of pursue over time in therapy is um are you so busy worrying about the other person and how they see you or feel about you that you lose you in that?

[00:03:07]>> And when you lose you in that, none of us could feel really loved and known for who we are because we're not we're not genuinely showing up as us >> to begin with. People aren't always aware of that, especially when you've learned how to navigate and function in life by Rebby, I want to be your friend.

[00:03:27]Oh, you like yoga. Maybe I sort of like yoga, but I'll talk to you about yoga and beef it up and then not talk about the fact that like I hate sweating [laughter] >> or something like that.

[00:03:38]>> Right. Right. Right.

[00:03:39]>> Because I just want to connect with you about something. But what gets missed is a whole part of me that makes me me that I sort of either devalue, dismiss or leave out of the relationship. And when you sort of do that over time and that's your way of navigating, big parts of you get let gets left out of >> relationships.

[00:03:56]So that's just I just sort of was touching on pieces to better understand why she's feeling at times so deeply sad which when you sit with her you wouldn't necessarily know because she talks about it >> with such um comprehension you know like this is how I see it and there's there's not a ton of affect it doesn't mean she doesn't have it I mean we're sitting here with lots of cameras it's not exactly a time where you feel like you can let your guard down but it may that might have been the case if I was just sitting with her in a room with just her.

[00:04:30]>> Yeah.

[00:04:31]>> That that a effect may not be as present and that might preserve her in some ways, but also may send the message to other people that like I kind of got this.

[00:04:40]>> Yeah.

[00:04:41]>> Um now the thing about folks who struggle with BPD BP BPD tendencies is sometimes they feel like they have to show people how much pain they're in for people to understand their pain.

[00:04:54]>> Right? That's the other side of this.

[00:04:56]you know this well right >> um and I'm not saying that like show everyone so you know >> but I don't know what you're feeling you know where is that emotion and how to get in touch with that emotion and then be able to be okay with those vulnerable parts of oneself that may not be so appealing to oneself or to other people or you're you assume is not appealing to other people >> I might argue differently >> right I mean, I did wonder because Tiffany um I do wonder if you know she she talks so much about her feelings and I had a thought at a certain point that that ended up like covering up the affect or doing something I don't know what but something >> with the a effect I'm not sure. So, you know, >> or how speech how how talking does that stops you from >> feeling >> from feeling and and so people can be really aware cognitively and be able to talk a lot about their understanding, >> but how they feel about it is a whole different layer that sometimes people don't necessarily even realize they're not in touch with how they feel because they're so busy understanding.

[00:06:11]>> It's kind of like, well, let's slow it down for a second. How's that making you feel? She's had some serious things happen in her life that I imagine for anybody would have an impact to what degree and in what way I would want to understand her experience. But the way she talked about it was just sort of like this was my history. Granted, I did ask her that question.

[00:06:31]>> Yeah. Yeah.

[00:06:32]>> And um I have a sense that she has far more feelings about it >> than I was um I got to know at least.

[00:06:41]>> Yeah.

[00:06:42]in an instance where um affect is getting blunted potentially maybe I know this is like asking for a holy grail kind of answer but >> but I'm going to ask but [laughter] why not um um but what are what are some of the ways a person can begin to reconnect affect to the events or the story and what's the benefit of doing Not >> that is like a million-dollar question.

[00:07:15]Um >> I have a million dollars. No, [laughter] just kidding.

[00:07:18]>> Thanks, Ravie.

[00:07:19]>> Sure.

[00:07:20]>> Um yeah, so there are a lot of different ways. Um the the one way that what regardless of whether you're a psychonamic therapist, whether you're doing using some MBT strategies, you know, whatever it is you're doing, slowing somebody down.

[00:07:35]>> Yeah.

[00:07:36]>> Just slow it down.

[00:07:38]Whether it's slowing it down, literally saying like, "Well, hold on, let's slow things down for a second >> and starting to shine a light on a lot of cognitive understanding, >> but how do you feel?"

[00:07:50]>> It's like coming back to that what's going on for you inside.

[00:07:55]>> Let's pay attention to it. Um, that allows somebody at least to gain some window in their tendency to gloss over emotions rather than be present to them.

[00:08:08]I remember when I first met you um and one of the first things we talked about was doing some just a basic self assessment.

[00:08:18]>> You know, because your your feelings matter.

[00:08:20]>> Yeah.

[00:08:20]>> And they matter a lot. But sometimes people, even the most skilled therapists, I'm sure I've done this in my history too, >> of not paying enough attention to what's going on in the moment, >> either by helping somebody slow down, asking somebody to, hey, why don't you use this self assessment tool throughout the week and just start paying attention to yourself?

[00:08:43]>> Um, or by continually coming back to, well, like how do you feel? Another thing that can happen is just paying attention to what's going on like in the room. Somebody may say, "Oh, I'm fine."

[00:08:54]But they're tearing up.

[00:08:55]>> Yeah.

[00:08:56]>> Right. So, there's some disconnect there. Well, you're saying you're fine and you're tearing up. Let's pay attention to that >> because the emotional piece can easily get overlooked when somebody is so good at talking about them, you know, their problems.

[00:09:08]>> Sure. Sure. Yeah. I think that can be both like asset and challenge to the prog to progress simultaneously. So, what I think Tiffany's really kind of good at talking about some of these things as well as she understands them.

[00:09:22]>> Yeah.

[00:09:23]>> Um, but I think there's a whole lot of feelings that are also happening um that would be worth looking into further.

[00:09:31]>> How did you find the conversation with Karen?

[00:09:33]>> It was good. Um it it was good just because um her voice really is soothing and she really is very kind and you can just feel that and um yeah I I I really enjoyed having that session.

[00:09:50]>> Um what did you sort of take from it?

[00:09:53]>> I don't like I I I didn't I didn't want to analyze my thoughts be too much and I just wanted to like be able to speak to you freely. But I do, the one thing that did kind of slip in my mind is I wonder if a little bit of my anxiety was also just um being afraid that she would be like, "This person doesn't have BPD." You and I don't I don't I don't know truly if that's like 100% a fear. I think it was like a culmination of things. I do think it was the fact that y'all are so close and um you know uh I just wanted to do a good job. Um like I I don't think that she would say that to my face. So it's like one of those things where like intellectually it didn't make sense.

[00:10:44]>> But what made you think that that would occur to her? Like what makes you think that that's a thought that could >> cuz I feel like I always have to kind of prove it to people sort of thing just because of like my high functioningness.

[00:10:56]This is probably a terrible analogy, but I sort of equate it to sexual identity.

[00:11:01]Like, how can you possibly tell somebody that they're not queer? How can you possibly tell somebody that they're not bisexual or asexual or just whatever, >> you know? And so, that's kind of what I feel like a personality disorder is like to a certain degree. Like, yes, you can look at functioning. You can look at ability to have relationships and all of those things, but it's not like a psychotic disorder to where you can see a person like actively talking to like voices or like displaying really bizarre behavior. So, it's like to me, you're absolutely right. It's a part of my identity. So, for I think that that's why it hurts so much because >> that's why what hurts so much >> when people like feel the need to like be like that's not you. And it's like, but you would never. I mean, maybe I know some people would, but I feel like a large part of society would be like, that's insane to tell somebody that they're that they are gay or straight or whatever. And so that's that's why I think it's so just like hard for me to understand why people think it's so important that they tell me who I am >> or how I understand.

[00:12:00]>> Yeah. Is it because you have struggled for a long time to hold on to an identity which actually by the way I don't entirely know what that means because I [clears throat] for for myself I don't know if I could uh say yeah this is my identity like I'm not so clear on that fuzzy miasma myself. Apparently other people are, I guess.

[00:12:25]But is finding the BPD diagnosis a way for you to have an identity?

[00:12:34]>> That's a really good question. And um no, because and the reason why I say no is because when I watched your video, I was like that's me. So it wasn't a matter of like maybe that will make me fit in or maybe I'm like that. It's like like once again it's like analogous to like when a kid is like you know developing their sexuality and then you just know who you are. Like if that makes sense. You know who you are.

[00:13:02]That's the only way that I can describe it is that when whenever I watch the videos, whenever I talk with my therapist, when I, you know, talk with other people who have the disorder, I've never felt more understood. So, it's like that to me is another reason like I said why I get so enraged or like infuriated when people want to like and like right now I'm being calm but like when we interviewed yesterday and I was being more like animated and I said that I felt like I was getting angry like I get angry because like I said it's like just so preposterous but I think that we're at this really pivotal point in history where people are really starting to open their minds to mental illness, but it's to a point where it's becoming a fashion statement.

[00:13:48]And it's like to me, this is not a fashion statement.

[00:13:51]>> So that's another reason why I'm like it's not a way for me to find an identity. This is my identity.

[00:13:58]>> You're saying what's your identity? What is your identity? My identity is a person who struggles with self-worth, maintaining interpersonal relationships, disregulated emotions, chronic suicidal thoughts, not understanding, you know, how to um not just automatically think that I'm the problem. Not automatically think that I'm a piece of [ __ ] I'm worthless.

[00:14:28]like I you know so for some people it can be one of the most liberating experiences to realize that you're not a villain like you do have an altered like neurochemical state and you do have you know and but and and not like it's just I don't know like it just >> but what's interesting in your experience of identifying with the with with like the BPD characteristics traits, >> right?

[00:15:06]>> Is that it sounds like on the liberation has come from the fact that that's where you feel most understood.

[00:15:12]>> Yes.

[00:15:13]>> Yes.

[00:15:14]>> Which is amazing by the way that you have found a sympatico with that.

[00:15:18]>> Yes.

[00:15:19]>> And then simultaneously it must not be very liberating to also Yeah. be consistently questioned, right?

[00:15:27]>> Yes.

[00:15:27]>> I'm I'm just curious. That's a part of my anger that that's what kind of that's what continues to perpetuate my resentment and anger and like in some ways isolation because that was the point that I wish that I would have kind of explained more to Karen is that I used to be like more so like just like [sighs] I would I felt like in order to have real deep friendships, you tell people the deepest his darkest secrets wide away and that's how you connect with people. But I didn't understand that people can't handle all of that information, all of that emotion, all of that. And so because of the loss, the because of the judgment, because of the shame, because of all of these things, I don't open up. So, for some people, they may look at me and be like, "Wow, this person's on the internet talking about these really vulnerable, intimate things, and they think that I'm giving it all, but like there's like in some ways I wish we would have met sooner so that like I said once again, people would believe me more, but on other ways, not to be like annoying, but maybe this h like this was the right timing because maybe a part of like my ultimate goal is to just reinforce force um dstigmatization and be like you need like the you being the public needs to stop thinking that they can just be armchair psychiatrist like I went to school for 14 years like not to say that I'm like hot [ __ ] but it's like and even me going to school for that long I missed something that was in core to my own identity and self. So it's like just take a step back, listen to a person's story, understand that mental illness and you know is like you know and just the internal struggle is a lot more complex than you seeing a 20-minute v video on YouTube and having like the whole entirety of me as a human.

[00:17:36]>> Yeah. Do you feel okay? How do you feel right now? Are you okay?

[00:17:38]>> I feel good. I feel >> because we pushed a little in this conversation. So I'm just checking with you. I'm glad that you did because the only way to achieve my goal is the only what is like the expression but like the only way to like grow or prog progress is through challenge you know cuz if I'm just like let's make this as easy as possible and like let's just you know then like that's not going to make me reflect that's not going to make me cuz that's also a part of this process was I was hoping to like possibly educate but I also wanted to learn >> so the only way to learn is to challenge your preconceived notions.