Welcome back to the Psychiatry and Psychotherapy podcast. I'm your host, Dr. David Peter. Today I am thrilled to be joined by an outstanding cohort, my Tuesday cohort, the 2025 to 2026 group of talented clinicians who spend a full year with me deepening their psychodynamic skills and reflective function. In our last episode, we explored primitive defenses. Today we're moving into neurotic and mature defenses. Kicking us off is the compassionately discerning and quietly authoritative doctor Jason Mallow. He is an outpatient psychiatrist and director of an outpatient psychiatric clinic at Maine Health, Maine Medical Center in Portland. He is deeply passionate about psychotherapy and will be kicking us off talking about regression and then later turning against the self. Next, we will have the nuanced integrator and psychologically astute doctor Olga Kuznet Sova. She is a psychiatrist working in two academic hospitals in Boston, originally trained in internal medicine in Russia. Olga now excels as an emergency and consultative liaison psychiatrist while also seeing patients for therapy and psychopharmacology.

She's a dedicated CrossFit athlete and will be covering compartmentalization and later repression. Next up, we have the gracefully observant and finally attuned Dr. Chinette Hôtelling. She is a psychiatric mental health nurse practitioner in Montana, who lives right by Glacier National Park. After years of medical surgical RN work, she has had a powerful journey into mental health. An avid hiker skier, backcountry adventure, she'll be talking about isolation of affect. Then we'll have the genuinely inquisitive and equanimous presence Jason Kent, a licensed professional counselor who I would recommend in Charlottesville, Virginia. After 15 years of advertising for major brands, he transitioned into practicing psychotherapy and now worked extensively with addiction and failure to launch cases. He will be presenting on intellectualization and displacement. Next, we have the subtly illuminating and warm Dr. Dina Golden. She is a nationally certified family and psychiatric mental health nurse practitioner and clinical professor at the Florida International University in Miami. She is the author of Fast Facts for Psychopharmacology for nurse practitioners, which I have a copy. Deena will be covering rationalization. Then we will hear from the courageous and compassionately discerning Dr. Katia Renee. She's a psychiatrist with a deeply psychotherapy-based practice in Washington state. Katia grew up speaking three languages and has lived in multiple countries. She's an avid skier, hiker, swimmer, dancer. She will be discussing moralization. And in the second half, we have the segacious and clinically luminous doctor Natalie Dreyfus. She is a psychiatric nurse practitioner, founder of Docside Psychiatry Clinic in Seattle. She works with adolescents and adults and also psychotherapyotherapy and has a special interest in psychoncology. She brings a strong psychodynamic foundation along with somatic and holistic approaches she would be presenting on undoing. Then we will have Chris Diedana, who is a heart-centered and authentically attuned licensed mental health counselor working in Orlando, Florida. He is deeply passionate about real-life transformations he witnesses every day in therapy. He will cover reaction formation. Then, Dr. Amanda Sekhi Jima, the finally attuned and developmentally-precipient child and adolescent psychiatry fellow at the University of Louisville, brings a rich background in movement, language, and cross-cultural experiences. She is presenting on identification and will close the episode with reversal. Finally, Dr. Lethal Meldnick, a viscerally resident and psychologically astute psychiatrist

who works in an adolescent day treatment program in New York

while maintaining a private practice

and teaching fellows at Columbia

will bring us a memorable Batman example

when she presents sublimation.

I hope you enjoy the episode.

If you leave a comment on YouTube,

I will be happy to share it with the people that are presenting today and let's start the episode. Jason Mallow, take us off with the regression. Yeah, last night, I was watching this documentary and I just had to show this example because it really stood out to me. So it's a documentary and Mel Brooks. And yeah, he once played this love doctor on a dating show. And the interviewer asked him something, like when can a heterosexual woman know when it's an appropriate time to get married? And his response was something like, oh, when their boyfriend puts down their rattle. Okay. I don't know. That was fitting. But regression is, so it's a defense mechanism where people seem to return to an earlier stage of development. It's definitely like a backtracking to an earlier way of coping with stress. That can be psychological and or environmental. And our psychology does develop in stages. We've heard of Freud's oral anal phallic. And for the parents out there, we definitely know kids don't progress in a straight line. There's an ebb and flow to development, but there is a progression. And it typically with aging, this gets less dramatic. The progression I mean. Yeah, I've seen it with kids when they get sick, they'll regress to earlier stages, you know, all of a a sudden the lose abilities that they had before. Yeah, so it's normal with kids to regress. How do adults do that? How do adults regress sometimes? Yeah, it totally happens with kids. I know firsthand about sleep regressions, but yeah, it happens with adults too, of course. And it could be natural and adaptive for adults. It's not always pathological and you can think of romantic relationships where you'll hear partners talk with each other and like, baby, like voices. You know, like, snuchi, wuchi, cutie pie, that sort of stuff. Everyone else cringes, right? That's not a part of that regression. No, and yet, like we do it as human beings, and you are like capable, well-functioning adults. I mean, you can all probably imagine someone going back to their home they grew up in, and then just like infantilized by a parent or a little kid feeling like criticism is to getting into civil and rivalry, that sort of stuff. But then it can be male adaptive too. I'm thinking of patients throwing full-blown tantrums in the office, stomping their feet, getting that fetal position on the floor. And I know Nancy McWilliams has pointed out that like, somatization can be a form of regression. And it reminds me of how Freud wrote about like the ego first being like a body ego.. And so the ultimate regression may be a somatic experience in the body some more. Yeah, that's good. Or like a, like finally common pathway to dissociation, right? And just kind of, but in that, sometimes the regression, it feels like they're regressing too an earlier developmental time, right? And that's, and so we may notice that as providers, we may be curious about it. What do you do, what do you tend to do, Jason, if someone regresses in your office? Well, you know, it can be, it can come in the form too of like, you know, patients who have made strides with becoming more autonomous or just like having healthier behaviors, self-agency, and yet like backsliding, right? And then someone's like drinking again or getting into problematic relationships again. I think the good news is is that with this defense mechanism is that people typically don't lose what they've achieved. It's just like where they're at right now. It's just overshadowing temporarily. And I think helping patients recognize that and become more cognizant of it can, and normalizing it too, can help support them actually having some greater control over time. That's good. Yeah, it's like that maybe their coping mechanism self-gotten or advanced, but then in the regression they go back to old habits. And so so kind of I love your positive view on that that you have gained the ability to jump out of that faster maybe. Yeah, I like that. Yeah, and it might be just like you have to temporarily be some of that kind of holds on to their past successes until they can get to a point of recognizing it, but like you'll hold on to it for them and help them with like grounding and stuff like that to get out of it. That's good. Thank you. Jason, let's talk about compartmentalization. Olga. Okay. So I got confused, you know, about compartmentalization at first because there's one that is commonly known, right? And we use it sort of like in everyday life, and it almost feels like it's a good thing to compartmentalize. And so it's just kind of like a definition is an act of mentally separating different parts of your life, thoughts or identities, so they don't conflict with each other. So for example, we all do it like a doctor who focuses, or even a therapist, who has some personal problems at home, but he can focus on sort of like problems of their patient, you know, and not be sort of like emotionally disturbed, you know, maybe during the session, right? Another example that I had is therapists who would leave work stress at the office and is fully present with family at home but we all kind of know that's not realistic. We all come home and kind of we feel like we need some time to ourselves. So I'm sorry, challenging. We can, we can regress to earlier stages once we get home, right? Because it's a safe place. Yeah, and I think it's normal, right? Yeah, and so as a defense mechanism, it's more like the ability to keep conflicting beliefs, emotions or behaviors separated so that they don't sort of like interact with each other and now person is not sort of like feeling anxiety about it. It's kind of similar to hypocharchy, which was new to me when I read, you know, in Nancy

McWilliams about it.

So for example, a person who chits in business, right? But at the same time, you know, sees himself as a very moral and kind person, right? But at the same time, kind of like do something, yeah. Oh, bad. And or a person who acts lovingly towards family, but abuses others and thinks it's okay, you know. So there are the things that I wanted to point out that it's similar to splitting too, right? And so there's this tension between, you know, those two sort of like different beliefs and it's not integrated. And I think in therapy, I don't know, I was thinking about how I would approach it. I'm sure it naturally came up during my therapy, maybe just kind of wonder, you know, gently why person sort of like acts a certain way. I don't know, maybe somebody has other suggestions on how to manage this kind of defense in therapy as well. I see it as largely adaptive, right? I mean, there was this guy who came on my podcast talking about ordinary men. And a lot of the times he was very cognitive. And Katya, I know this is one of your favorite books. Yes. And he was very cognitive and very emotionally distant. And then there was this one part where he was talking about

this early discovery, he was in Germany,

and he found these files, and he understood what he found.

And he made this connection, and he starts getting very emotional.

And it's like he couldn't hold that compartmentalization anymore, right?

Where it was probably very adaptive to be very intellectual and separate the emotionality when he was really trying to just find the facts and the details. We have this horrendous thing, right? So it would be totally overwhelming to like fully grapple what that was like for the Jewish people to be murdered as they were by the German military officers. So yeah, compartmentalization can be very adaptive. And so if it's happening, it's happening for good reason. I think about compartmentalization tool. I like how you separated it with like this. We're gonna, the tool that we use, and I remember working as a nurse on the floor during COVID. And, you know, walking into a patient's room who I distinctly remember, you know, this older gentleman. And both were, there were two patients on my panel and both of them were COVID positive. One of them was not doing well, not at all, thinking. And it was when visitors also couldn't be in the hospital. And so holding that space for this patient in the distress and then walking outside the room and I'm putting, gathering myself together.

And then I go into the next room

where this other patient is also COVID positive,

not showing any symptoms, pretty happy, go lucky,

he's able to talk to his family.

And I think it was, when I was reading about this,

...