Valentine's Day Episode: Relationships, trauma and psychotherapy with Dr. Erica Krakovitz

A lot of clients, they're in abusive relationships or relationships where their partner is. Is cheating, and they have all of the internal cues, but they're choosing to ignore them or not trust themselves. I sit with them, and I'm like, okay, what are. What is the meaning we can make of this? What are the lessons we can learn? And it's like, trust yourself. Right? You were feeling like hindsight's 20 20. What did you know? You know, looking back, what were the red flags? And. And clients were able to say, oh, yeah, like a part of me Knew.

Hello, I'm Dr. Farah Wythe.

And I'm Dr. Grant Brenner.

We're psychiatrists and therapists in private practice in New York. We started this podcast in 2019 to draw attention to a phenomenon called the Doorknob Comment. Doorknob comments are important things we all say from time to time, just as we're leaving the office, sometimes literally, hand on the doorknob.

Doorknob comments happen not only during therapy, but also in everyday life. The point is that sometimes we aren't sure how to express the deeply meaningful things we're feeling, thinking, and experiencing. Maybe we're afraid to bring certain things out into the open or are on the fence about wanting to discuss them. Sometimes we know we've got something we're unsure about sharing and are keeping it to ourselves. And sometimes we surprise ourselves by what comes out. Well, Erica, welcome to the Doorknob Comments podcast. It's a pleasure to have you. Today, we'll be talking about relationships and stuff, whatever else comes up. It would be amazing if you could introduce yourself for our listeners.

Absolutely. I'm a clinical psychologist and a marriage and family therapist. I've been working in the field in some capacity for around 10 years, maybe 10 to 12 years. I specialize in relational work, obviously marriage and family therapy, relational work, and attachment work with individuals. I also do some trauma work. I kind of integrate and blend psychodynamics, cbt, act somatic therapy, emdr, you name it. I like to learn new things. I'm now most recently studying ifs. I like to just draw from different things and just custom my approaches to treat each client individually. I started in advertising, television advertising. So I took a very hard pivot. I've done pr, marketing, advertising, worked in resorts, ski resorts. So I've done a lot of things before becoming a psychologist, but this is by far my favorite career.

And what sort of inspired you? What was the turning point for you to.

Yeah, one of the reasons I. I'm interested in Trauma and relationships is I had a lot of traumas in a short period of time in my life and two of them were to do with relationships. One was with a long term partner who I was on and off with for 10 years and one was with my parents getting divorced in a very volatile way that left me kind of in the middle as an adult, living at home at the time, trying to figure out my life. So those were two of the things. And then also losing a friend in a car accident that I was a passenger in. So that was another relational attachment trauma and just trauma in general. So those are the three things that kind of kicked me into this career. I just obviously went to my own therapy because I was struggling with PTSD from the accident and just felt like I want to do this work for other people too.

That's really inspiring.

Yeah, I can relate. I can relate. Sorry. You went through all that.

Yeah.

You know when you talk about like the different modalities that you have been exploring, what's the latest thing to sort of. I don't know if you want to talk specifically about ifs or about certain aspects of relationships, but I'm curious, what are your favorite or types of cases to work with and why are you pursuing that training right now? Because I think it is kind of trendy and I don't know that much about it.

Well, let's let folks know what ifs is first a little bit. So IFS stands for internal family systems. It was a form of therapy started by Richard Schwartz. Correct. 20 or 30 years ago. And it's based on the idea that people have different parts to their personality that kind of dissociate form in relation to trauma. The manager, like the.

The firefighter and a jire. The manager of the exile core self.

The exile is like the sort of the wounded child or the inner child. And the core self is I think presented as sort of like the self that is, well, is sort of the healing force. So it has spiritual overtones. There's a strong following among some people. For the founder, I'll just say for me, I studied treatment of trauma and dissociation from a more general model using the theory of structural dissociation and work with patients with dissociative identity disorder where people can have lots of different parts you. But it's more their own way of understanding what they call their system. So I'm really curious how you're taking in ifs and Ferris question, like why ifs beyond. It is becoming much more recognized now.

Yeah, I found that I'VE always, historically, even when I was an MFT doing CBT and psychodynamic work, clients always come in and they're like a part of me feels this, a part of me that, a part of me. So we've been talking parts work since like the very beginning. So I feel like part of it is just kind of a natural way to put labels to things we've already been doing and to normalize the internal chaos that a lot of clients come to session with. And yeah, the other piece is it is trendy. And so I got curious about it. Why is it so trendy? Like something must be amazing about it. And so I found an IFS therapist to just try it on the other side of the couch. And I have been doing some, some light trainings in it just to kind of get from. I read his book. So I, I haven't yet taken the leap and done the, the intensive 5000$. You have to win the lottery to be in the training, but.

Oh really?

Yeah.

There's an online sort of three day course where Schwartz demonstrates IFS with two very traumatized patients that I found helpful just to see how it works. Particularly because I'm already trained in treating from that point of view. I wonder why it's trendy. I mean I think from my point of view, I think and this may come up in terms of relationships with external parts with other people, that nowadays there's much more pluralism, there's much more multiplicity. Personally, I think that this idea that we are sort of singular and if you don't have all this internal consistency, if there's, if there's any self contradiction, you're a hypocrite. We have to kind of flip the script on what identity is and start that we have multiplicity, that we are plural and maybe some people are more plural than others. But certainly if there were difficulties growing up with the relationships in the family or peers, then one's own sense of self is probably more likely to have not only different parts, but I'd say that those different parts, right, they don't, they don't work well together, they don't talk to each other. For me in a certain way it comes down to teamwork, internal teamwork. It take, you know, teamwork, dreamwork.

Absolutely, I agree with that. Yeah, I think, I think really ifs, I mean most modalities really kind of go hand in hand. They, they kind of are collaborative as opposed to contradictory in that. Like one of the key things I think about IFS is you're Distancing yourself from these parts of yourself that you're ashamed of. So, you know, in act there's. You're kind of putting things at arm's length, like diffusion, right. And you're looking at it and trying to just take distance so that you aren't so identified with it and you can kind of take a more objective stance. I think that's something that ifs does that's really powerful in different therapeutic modalities where you're just kind of like, okay, this is that exile part that this inner child part that I'm so afraid of and ashamed of. And if I just put it over here, maybe I can deal with it better. And if I separate my core self from it, I'm less identified and less fused. So I like that aspect about it and I think it just goes nicely with other modalities I've learned over the years.

Yeah, well, it sets the stage also to have a dialogue. You know, you talked about disconnecting. I thought of a study that I saw on self compassion and they found that people with trauma, they had them do a self compassion, you know, exercise, you know, arm of the study and then they had them do like a detached awareness arm of the study. And then they had a control group. They actually found that the people in the self compassion group did better than the people in the detachment group. However, what I think is there's a rhythmicity. It's that back and forth between getting distance and then having dialogue and making connection, developing the good relationship with yourself and that feeling of internal kind of compassion based mutual respect is. All therapies kind of go through this back and forth. Right. And as you said, the therapies themselves are, I guess you're implying that there's competition among them, which there often is. But interestingly, the American Psychiatric Association's guidelines on the treatment of borderline personality disorder just came out and there were no top recommendations, meaning there were no Class 1A, like high evidence based recommendations. The best recommendation was like a 1B recommendation, which is that all structured therapies are generally recommended for borderline personality disorder, which shares some features with complex trauma.

It is. And I sometimes, I don't know, Erica, how you see this, but a lot of times what I say is that people somehow, if they're in the right hands, they will find their way to the treatment that sort of aligns most closely with what they can participate in fully. And so I do wonder if there is a sort of foot in the door with you. So sort how you approach the Problems that people come in with, particularly with relationships, because that seems to be an area of expertise.

Yeah, I think I. And I tell clients this on the phone before I even start with them. I'm going to start psychodynamically because that's my foundation. That's what I've been doing for the longest, and that's how I conceptualize them, basically. So I spend the first two sessions just digging into their. Their past, getting their whole life story, significant relationships, significant life events, traumas, positive life events. I'm also kind of getting their narrative, kind of like the story they tell about their life. And I just find that to be useful just for gaining insight and awareness, both for me and for them. And I'll make interpretations and point out, like, you know, connections that I see. And then at that point, we kind of pivot into whatever they're wanting or needing. Like, I. You know, some clients love somatic work. They love just trying to learn how to be in their body and develop a greater sense of agency over their nervous system. So some clients just want to stay cerebral and do all the talk therapy. And so we're doing more psychodynamic, more cbt. And I. And I really. I mean, I use the client kind of as, what. What are you looking for? You know, what. What's your previous experience in therapy? What was helpful, what wasn't. So it's not so much maybe a little bit coming in. I mean, with trauma, I think somatic and emdr like those modalities, because Bodi keeps the score. Right. Are more effective in general. So to supplement. But in general, I let the client kind of come in and say, this is. This is what I want to do, and I'll work with them on it.

I find that's often helpful, though. I also find people with trauma and dissociative disorders, they may have certain problems in their sense of self or their agency, where I've had a handful of patients need much more direction as to where they should focus. In dermatology in med school, we learned the saying for rashes, which, if it's wet, make it make it dry. If it's dry, make it wet. And sometimes I wonder if someone's very cerebral. You may want to look toward the embodied stuff. Right. And if they're in their bodies all the time, you know, you want to look into the intellect and look for those linkages. But I had a specific question. So when you're listening to a person tell their story, is there anything in particular you're paying attention to? Not necessarily for what they're sharing, but how they discuss themselves.

Yeah, I mean, that's, that's a good question. I think, I think I am very content focused, kind of looking for what are the themes and patterns, what are the self narratives, what are kind of like the self conceptualizations they've developed over time, what are just the patterns in thinking and behavior. But certainly I have many clients, I think this is really common in general that come in and they're talking about terrible things that happen to them and they're just laughing and smiling and so, you know, you know, that's obviously a manager part. They're guarded, it's a protective part. It allows them to still connect with people despite their traumas. And so like I'll notice that things like that for sure it is harder because nowadays I do most of my work virtually, so I'm not able to attend to kind of the energy I feel in the room or body language so much, you know, below the shoulders. So I think that's been more challenging since switching to virtual. But even so, sometimes you can pick. I mean, you can still pick up on energy in a different way virtually. So I'm paying attention to that. What's my somatic sense when I'm sitting in the room in the therapeutic space with this client, Am I feeling anxious? Am I feeling kind of like a void? And so attending to that, I, I do a little bit as well.

And how was it for you, you know, throughout these modalities, do you think there are things that carry over a little bit more easily? Obviously the EMDR and the somatic stuff is probably limited by, you know, the virtual platform. But are there things that you think really tend to shine in this new way of working?

Yeah, I mean, honestly, I think you can do most modalities, even emdr, which people tend to think you can't do that virtually. You know, we, I do tapping with clients like this and it's, it's just as effective according to research. And I've had breakthroughs with clients using emdr. So I haven't found any modality that I've done with clients to not be necessarily as effective. Granted, when I was in person, pre Covid, fully in person, I was doing mostly psychodynamic and CBT oriented work. So I didn't even get to try some of these other modalities that now. But, but yeah, I, I feel like it's, it's more case by case and I have breakthroughs with all different modalities with clients.

There's An EMDR specific electronic health records and virtual platform as well.

Yeah.

FYI, which, which does some. It has some of the technology kind of baked into the interface. Like, sometimes there's lights that move back and forth and stuff.

Oh, really? I don't know that.

Yeah, there is, but I don't. I don't remember the name of it.

But I'm sure buzzers, like people can hold buzzers. You can. They can order a pair and just like hold the buzzer as well. You know, set it at the speed that they want. So, yeah, there's different ways to do it. I mean, now people are doing ketamine all virtually, which I can't even imagine, but it's. It's there.

So my malpractice attorney doesn't recommend getting into that.

I can imagine.

But there is a certain kind of intuition that is hard, you know, not to digress, but I think in principle, right. People could show more of themselves on the screen. You don't have to be just tightly focused in, you know, from here up.

Yeah. I mean, sometimes people are so close to the screen, I'm just like, wow, I'm like sitting like an inch. If we were in a therapy room, I'd be like 2 inches from their face. And this is like very intimate. So, yeah, sometimes I feel like it is. And. And you're seeing their space. You're see their living conditions. You're seeing. You know, it was, it was. I mean, when I. When I switched during COVID to all virtual, I found this is kind of more superficial, but I found, which was interesting, some of my lower fee clients were living in these big palaces and. And some of the higher fee clients were living in more modest means. So just learning about a client and what their narratives are around. Around money, you know, and things like that, I mean, was really eye opening for me when I went.

And I also think there's something that's really neutral about both. People are kind of logging in from their own spaces as opposed to like the patient coming to your space.

Right.

Which I. So I have found that some people actually tend to do better and then the work is less likely to get interrupted, which I think is huge.

Yeah, yeah, absolutely.

Are there things, let's say that you have noticed, like, patterns that you've noticed in terms of, let's say, what people are struggling with in relationships lately or things that you want people to know as they are, say, moving in and out of relationships?

Yeah, I think a common theme. I mean, boundaries are huge with any relational work. We're talking boundaries also, I think intuition and learning self trust. A lot of clients, you know, they're in, in abusive relationships or relationships where their partner is, is cheating and they have all of the internal cues, but they're choosing to ignore them or not trust themselves. And, and so, you know, when it all blows up, I sit with them and I'm like, okay, what are, what is the meaning we can make of this? What are the lessons we can learn? And it's like, trust yourself. Right. You were feeling like hindsight's 20 20. What did you know? You know, looking back, what were the red flags? And, and clients were able to say, oh, yeah, like a part of me knew. You know, we go back to parts. Like a part of me knew. And then there was this other part that was like, no, you know, I love this person and, and I need to, you know, get married by 25 and have my 2.5 children. So like the manager part shows up. Right?

So, yeah, I find one of the single biggest problems that people in this situation where there's betrayal and difficulty with trust of oneself, which, you know, goes back often to their, their childhoods, is that they get stuck on the other person's intention. He didn't mean it or did he mean it? Was it on purpose or not? And a lot of times what I try to refocus people on is, is it meeting your needs, whether it's intentional or not, whether it's immoral or not? How do you find that? Comes up.

Yeah, so they're stuck on the intention, but not. Not on the.

Not on. Like that. It doesn't work for them. Right. Like this isn't working for me. They're, you know, they're essentially rationalizing it. Well, he didn't mean it. And a lot of times that's what sort of the perpetrator will say, well, you know, it was a mistake. I really, you know, the truth is this, not that. Because there's multiple truths. Right.

Yeah, I think, are your needs being met? What do you. How does this person make you feel? Are key themes? There's so many people pleasers that that's when they go into, oh, this person didn't mean it. I have to cater to them. My needs don't matter as much. So, yeah, absolutely. I think bringing the emphasis back to what are your needs and how are they being met or not being met, as opposed to, you know, and, and forget about what you think their intentions are, what are they saying, and are the actions aligned with what they're saying?

So, yeah, I think that is, is such a good point. And sometimes I feel like my patients, who tend to be really psychologically minded, compassionate, gentle people, I think are prone to maybe making more excuses for others. And then I, I do find myself a little bit pulled into the role of, well, this, this might be a pattern where you give people the benefit of the doubt too much. And kind of looking at that and wondering really, I think one of the things that has come up a lot is really when to cut things off. And this feeling of, I don't know whether it has to do with the mindset, this feeling that while there's been so much invested and, you know, but I stayed with him too long or I didn't see it through. So that is, I think, such an interesting place to be.

The relationship research shows that the gambler's fallacy or sunk cost fallacy, the amount of investment people make is one of the determinants for sure. Giving people the benefit of the doubt rather than the the doubt of the benefit is a critical fail sometimes. So how do you get people to kind of listen to their truth or, you know, trust themselves and especially if they doubt themselves?

Yeah, I mean, I'm working on building the self trust, but also I don't feel like it's my job to, to nudge them too soon if they're not ready. If they're still ambivalent and they're in the contemplation phase, I'll let them stay there for a little bit because my, my fear is that they jump out too soon and then they're like, well, what if? And then they're regretting. So sometimes it does take things, you know, we talk with addicts about they have to hit their rock bottom. Sometimes it takes hitting a rock bottom in a relationship, unfortunately, for a client to really be like, okay, there's no way. And so I do let clients kind of, you know, I'm of course, trying to highlight things that I'm seeing, but I'm certainly, I don't think my push them before they're ready. I just have to meet them where they're at. So. But, but that is a good point. Farrah is like, because, because certainly sometimes a client stays in way longer than I would have imagined wanting them to call it.

Right.

Yeah, Experience is the best teacher. And people often sort of won't listen to their therapist or their friends anyway. Right. You hear that all the time. Like, my friend said he was no good for me. Or, you know, those love chemicals are super powerful too.

Oh, yeah.

Yeah, there's also this.

Yeah, yeah.

Like the oxytocin and the dopamine and the, you know, there's this old psychoanalytic concept of moral masochism. And sometimes people talk about self sabotage or self defeating behaviors. I'm wondering how, how you talk about that.

Yeah.

Oh, yeah. I mean, that all goes hand in hand with self worth. And if someone's belief in themselves is, is, you know, like, I'm just not worthy, I'm not good enough, they're going to seek that out and they're going to, or they're going to find something great and sabotage it because that's what's in line. That's what they know, that's what's in line with their identity and their narrative. So certainly I'm working. I feel like I do a lot of self worth, identity and self worth work with clients and relational work. For sure.

I do think that sometimes I feel like I learn a lot about, let's say, people who I've, I've known for a long time and I feel that I understand them. And then seeing how they navigate relationships because they can say, oh, this is what I know I deserve, or they can seem like they have a sort of deflated sense of self and make demands or accept things. And so I do think that that's when we really see that there may be some different sides that are not fully integrated.

Yep, absolutely. Yep.

And I think that's something that can come out through psychodynamic therapy. Right. Like, oh, well, do you think, you know, that does this demand seem reasonable or not, you know, and have people reflect on that a little bit?

Yeah, yeah. Another psychodynamic piece I see a lot, as historic and outdated as it may be, is people do date versions of their parents because that was their first imprint of what love looks like. And if it's chaotic or if it's, you know, abusive, then that's sometimes, oftentimes I see that's what they're seeking out. They don't have a different framework or model. So I'm always asking questions, how familiar is this? What does this remind you of? You know, who does this person remind you of?

Yeah, there's, I think there's actually some relatively recent research that supports that. That is actually often the case. It's obviously not the only factor, but people like to reject that idea. It's kind of like if you were raised, you know, in the woods and you did a lot of off road, like driving and the car that you drive is like a Dune buggy. Then when, you know, then when you drive around like you're driving in a dune buggy. So you meet other people who like to drive in a dune buggy. Yeah, it's not that surprising in a way. How about healthy sense of self and healthy relationships? What, what is that? What is the head? Is that, is that, is that real? Oh, not a positive note.

Yeah, no, definitely. I, I mean, I, One of the most rewarding things about relational work for me is watching a client progress from, like an abusive relationship to something that's a lot more rewarding and meaningful, where their needs are being met, where there's mutual respect, where they're enjoying, you know, their partner's company, where their partner builds them up instead of breaks them down. And I think that's a product of the, the self work that they do and learning better communication skills and learning about their emotions and how to understand what, what are, what are my needs? How does my partner impact me? What do I want to feel in this relationship? Right. Like mirror, like magical questions. What's the ideal? And kind of working towards that. So I, yeah, I, I kind of, I, I, I witness it a lot. I think it's, it's pretty cool to watch clients progress into those types of relationships. And even if they are already in those types of relationships, obviously conflict is a natural part of relationships, and so helping them navigate that better, even in a healthy dynamic, is, is fun for me.

So, yeah, we have a tool in our, in our irrelationship dysfunctional book series called the 4020 40, which is like a form of nonviolent communication, so two parties or more. But for a couple, you know, they take 40% for each of them, and then 20% of the conversation is devoted to the relationship itself, almost like the relationship is the offspring of the two people. And then there's kind of rules that you speak compassionately, you listen to, understand not to, not to formulate your next argument in, in the litigation process.

Right. Yeah. I'm always using with my couples, like, we're on the same team. What are you doing? Like, you know, we're, we're working towards the same common goals. Unless, of course, a couple comes in and one partner is one foot out the door, then we're doing that work. But, but for the most part, with couples that are both in it and wanting to do the work, I am reminding them we're on the same team. How do we collaborate on this? And I think that's really helpful to see you and your partner as more like a A unit working towards the same common goals.

Now, are some people just better off single? I mean, I'm not, not joking.

That'S a good question. I, I do find that my clients that kind of avoid, they're avoiding for a reason. But certainly, I mean, asexuality or people that are like, just prefer to a more independent lifestyle. Like, I don't, I, I certainly don't discourage that. If a client is functioning and they're happy, you know, when they feel content, like, I'm not going to push them to go dating, but I, I will always be curious about what led them to this. Yeah.

And I, I do think that, I don't know that I would say people are better off single or partnered. I think it depends on the individual and it depends on the moment in their life, probably. But to see that there are good things about being partnered and there are good things about being single too. Right. And so that can be really challenging to say. Well, listen, right now the dating thing is just not happening, but you have all this freedom, so what do you want to do with it? Because maybe this is my own stuff, but I'm like, a few years from now, you may not be this carefree. Right. And there will be compromises that need to be made and conflicts that need to be resolved. And that takes a lot of energy, I think, away from, let's say, other goals that people may have.

Yeah. And I like Esther Perel's kind of how she talks about, we're never going to find someone that checks every box. And so we need more than one person to fulfill our needs. We need our partner for certain needs. We need our friendships, our family. And so if, if someone's single, they're fulfilling needs through their friendships, through their family relationships, through maybe more casual dynamics, intimate dynamics. So certainly I'm kind of like seeing it through that lens too. How are your needs being met as a, as a single person?

Yeah, we're not, we're not pathologizing being single, but some people really embrace singlehood for a lot of good reasons. But as you said, you can expl explore whether they're, they actually have a need for attachment that they're denying or whether it's really a good choice. And, and yeah, sometimes it's good to be sober from dating. I have found for patients to have time to sort out their own stuff, and dating just kind of makes it really hard to work through stuff. Sometimes that's true. And then we've got that whole AI companion thing, which unfortunately we won't have time to get into today.

You can part two. What's it maybe in part two? We'll delve into that one.

Well, where can we find you? Where do you find you?

Online website. Drkrakovitz.com where else? I'm on Psychology Today. I have an Instagram.

What's your Instagram handle? Do you know?

Good question. I think it's Dr. Krakowitz, but I have to double check because I'm not as active as I should be on my Instagram account. But it's Rikaka Krakowitz, so yeah.

Well, thank you so much for joining us and sharing your experience and your training and I think it's going to be super helpful for people to tune in.

Thank you, Dr. Kraknitz. Yep.

So nice meeting you, Farah. I'll talk to you soon.

Remember, the Doorknob comments podcast is not medical advice. If you may be in need of professional assistance, please seek consultation without delay.