Episode 015 - Therapists Need Their Own Case Formulation

🎙️ Episode Linked Here

Overview:
After a long run of episodes on personality disorder prototypes, Ken and I found ourselves in an hour-long conversation we wished we'd recorded, so we hit record. This episode picks up mid-conversation and turns the lens around: if everyone has a case formulation, so does the therapist. We talk about blind spots and why we need others to reflect us back to ourselves, the irony of helping patients change while being unable to change our own families, and why knowing your own formulation builds patience for how slowly deep change really happens.

We also revisit the distinction between diagnosis and formulation, explore why attachment figures stay with us even after estrangement, and reflect on what it means to love differently rather than stop loving. Along the way, we share some of our own origin stories as clinicians and name a pattern many therapists will recognize: the helper or fixer whose sense of worth gets tied to whether patients change.

Who This Episode Is For

This episode is primarily for clinicians: therapists, psychologists, counselors, trainees, and supervisors who want to understand how their own history shows up in the room. It will be especially useful for anyone thinking about countertransference, supervision, or their own reasons for entering the field. Listeners outside the profession who are curious about how therapists think about themselves, or who are working through complicated relationships with family, will also find a lot here.

🧩 Major Themes and Discussion Points:

1. Blind spots need mirrors. It's far easier to map someone else's formulation than our own. Much of what we don't see in ourselves is protective. That's why therapists benefit from their own therapy, from training that includes knowing their own formulation, and from trusted colleagues who can reflect them back to themselves. Patients get the same gift in good therapy: a kind reflection that elaborates a part of themselves they couldn't see alone.

2. You can't be your family's therapist. Many of us came to this work because of what we learned in our own families. A common heartbreak is believing that becoming a therapist will let us go home and heroically change the system that shaped us. Inside a family, we have a different role, less clarity, and far less leverage. What happens there is not a measure of our clinical skill. Without that awareness, it's easy to slip into countertransference: watching a patient's process and wishing for something in our own life, or finding resonance with a patient instead of helping them take the next step.

3. Real change takes time, for patients and for us. IRT isn't a ten-session model, and it isn't about changing a single thought. It works with the organizing structure of how someone sees themselves and others. When you've had to let go of some of your own Red and build Green, you develop much more empathy and patience for what you're asking of your patients. Like grief, this work is iterative: new life events can activate old patterns, in patients and in therapists, whose caseloads can ping their formulation in ways they never anticipated.

4. Diagnosis tells you how someone is like others; formulation tells you how they're unique. Echoing a conversation between Allen Frances and Marvin Goldfried on the Talking Therapy podcast, we discuss why both matter. Diagnosis supports communication and research; formulation drives treatment. Everyone has a formulation, with or without a diagnosis, because everyone has attachment history. From a formulation lens, comorbidity isn't a problem to untangle; it's added nuance in one coherent story of how this person makes sense.

5. Loving differently, not loving less. From an IRT perspective, our attachment figures live in our minds, which is why estrangement rarely resolves what we're reacting to. The goal isn't to turn off love. It's to transform it: to move from living in spite of, because of, or in yearning for someone, toward a relationship that is mutual, adult, and authentic. That often means seeing caregivers as human, with their own histories and copy processes, without excusing harm and without swinging between idol and demon. Grief is part of nearly every one of these stories.

6. The fixer trap and choosing with awareness. A familiar therapist origin story is the child who was rewarded for being helpful. If your worth is tied to whether patients change, that's an essential piece of your formulation to know. Ken shares a centering lesson from Lorna Smith Benjamin: our job is not to make anyone change, but to ensure that even if someone chooses Red, they choose it with full awareness. For a therapist with a fixer history, letting patients make their own choices may itself be part of loving differently.

📚 References Mentioned in Episode:

Mentioned in this episode (for verification and linking):

• Talking Therapy podcast, Allen Frances and Marvin Goldfried — episode on diagnosis and formulation https://open.spotify.com/show/6OpdUxppI3QsZxz2dTaDKA?si=ae84780aa6784f3e

• Lorna Smith Benjamin — Interpersonal Reconstructive Therapy (IRT) and Structural Analysis of Social Behavior (SASB)

• Previous Loving Differently episodes: personality disorder prototype series

If you've ever wondered how your own history shows up in your clinical work, this episode is for you. Listen to Episode 15 of Loving Differently on Spotify or wherever you get your podcasts, and subscribe so you don't miss what's next.

Coming up, we're considering listener-requested topics including anger and staying connected, being a good partner, and parenting through an IRT and SASB lens.

Have a question or topic you'd like us to take on? Email us at podcast@irtinstitute.com.

Episode 012 - Interpersonal Harmonics Mini Series Ep 4 - Narcissistic and Antisocial Personality

🎙️ Episode Overview:
In this episode of Loving Differently, Dr. Kenneth Critchfield and Dr. Eliza Stucker-Rozovsky continue their Personality Harmonics series by exploring narcissistic and antisocial personality disorders through the lens of Interpersonal Reconstructive Therapy (IRT). Rather than asking, 'What's wrong with this person?', the conversation asks a different question: 'How did these interpersonal patterns develop?' Drawing on attachment theory, developmental trauma, and interpersonal learning, the episode examines the stories that can lie beneath some of the most misunderstood diagnoses in psychology.

Who This Episode Is For

• Clinicians working with personality disorders, trauma, and attachment injuries
• Graduate students and trainees learning case formulation
• Individuals trying to understand difficult relationship patterns
• Family members and loved ones seeking greater understanding
• Anyone interested in how developmental experiences shape personality

🧩 Major Themes and Discussion Points:

What lies beneath grandiosity?

When most people think of narcissism, they think of arrogance, entitlement, or a need for attention. But what if those behaviors are only the surface of a much deeper story? Ken and Eliza explore how vulnerability, shame, and fears of rejection can coexist with grandiosity—and why understanding those origins doesn't erase the harm narcissistic behaviors can cause.

When control becomes a survival strategy

Antisocial personality disorder is often reduced to stereotypes about manipulation or criminality, but this episode asks a different question: What does a child learn about relationships when trust is dangerous? The discussion explores how environments marked by neglect, violence, or exploitation can teach someone that vulnerability is unsafe and that control becomes a means of survival.

Can we understand behavior without excusing it?

Ken and Eliza discuss the challenge of holding two truths at once: harmful behaviors have real consequences, and those behaviors emerge from understandable developmental histories.

Why are personality disorders so difficult to treat?

The episode examines why narcissistic and antisocial patterns can create unique challenges in treatment and how therapists can inadvertently reinforce the very patterns they hope to change.

The human stories behind diagnostic labels

Throughout the conversation, the hosts return to a central idea: personality disorders are not simply diagnostic categories—they are interpersonal stories shaped by love, loss, attachment, and the human need for connection.

📚 References Mentioned in Episode:

Benjamin, L.S. (2003). Interpersonal diagnosis and treatment of personality disorders. Guilford Press.

Critchfield, K. L., & Benjamin, L. S. (2024). Structural analysis of social behavior: A primer for clinical use. APA.

The goal of this series is not simply to identify personality disorders—it is to understand the human stories beneath them. Listen to Episode 12 and consider: how does your understanding of narcissistic and antisocial patterns change when you view them through the lens of developmental history and interpersonal learning?

Episode 011 - Interpersonal Harmonics Mini Series Ep 3 - Histrionic and Borderline Personality Disorders

🎙️ Episode Overview:
In Episode 011 of the Loving Differently Podcast, Dr. Ken Critchfield and Dr. Eliza Stucker-Rozovsky continue their personality prototype series by exploring histrionic personality disorder (HPD) and its relationship to borderline personality disorder (BPD) through the lens of Interpersonal Reconstructive Therapy (IRT). Rather than reducing personality disorders to symptom checklists, this conversation focuses on the underlying interpersonal patterns, developmental histories, and emotional learning that shape these prototypic presentations.

Ken and Eliza discuss how attachment disruptions and developmental trauma contribute to relational strategies commonly seen in both histrionic and borderline dynamics. They also explore important distinctions between the two patterns, including differences in dependency, emotional expression, identity organization, and interpersonal control.

Throughout the episode, the discussion emphasizes the importance of case formulation over rigid diagnostic labeling. Using concepts from IRT and the SASB model, they examine how clinicians can better understand what behaviors are attempting to accomplish interpersonally — and how therapists can avoid unintentionally reinforcing maladaptive cycles in treatment.

The episode also addresses the cultural and gendered assumptions that often surround personality disorder diagnoses, encouraging clinicians to approach these patterns with nuance, compassion, and curiosity rather than stigma.

🧩 Major Themes and Discussion Points:

• Understanding histrionic personality disorder through an IRT framework

• Similarities and differences between histrionic and borderline personality prototypes

• Developmental trauma and attachment disruptions in personality organization

• Dependency, emotional expression, and relational control in HPD vs BPD

• Why personality disorders are often misunderstood in clinical settings

• How therapists can avoid reenacting maladaptive interpersonal cycles

• Gender and cultural biases in diagnosing personality disorders

• Using compassion and curiosity to improve treatment outcomes

📚 References Mentioned in Episode:

Benjamin, L.S. (2003). Interpersonal diagnosis and treatment of personality disorders. Guilford Press.

Critchfield, K. L., & Benjamin, L. S. (2024). Structural analysis of social behavior: A primer for clinical use. APA.

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Episode 010 - Interpersonal Harmonics Mini Series Ep 2 - Borderline and Passive Aggressive Personality Disorders

🎙️ Episode Overview:
In this episode of the Loving Differently Podcast, we continue our personality prototype series by exploring borderline personality patterns and passive-aggressive dynamics through the lens of Interpersonal Reconstructive Therapy (IRT).

Rather than focusing on symptom checklists alone, we look at the interpersonal learning that shapes these patterns—and why they can feel so persistent in therapy.

We also discuss complex SASB codes as one similarity between these two disorders, transference/countertransference, gift of love, and clinical implications of IRT therapy for both these prototypes.

🧩 Major Themes and Discussion Points:

- BPD involves complex interpersonal patterns rooted in developmental trauma 
- Mixed messages (love/fear, control/neglect) drive instability 
- Self-sabotage often follows success due to internalized dynamics 
- Therapy requires consistency and resistance to reenactment 
- Passive-aggressive patterns center on fear of control and indirect resistance 

📚 References Mentioned in Episode:

Benjamin, L.S. (2003). Interpersonal diagnosis and treatment of personality disorders. Guilford Press.

Critchfield, K. L., & Benjamin, L. S. (2024). Structural analysis of social behavior: A primer for clinical use. APA.

Eliza’s dissertation

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Episode 009 - Interpersonal Harmonics Mini Series Ep 1 - Avoidant, Dependent, and Obsessive Compulsive Personality Disorders

🎙️ Episode Overview:
Episode 009 of the Loving Differently Podcast begins our Interpersonal Harmonics miniseries with a deep dive into Cluster C personality disorders through the lens of Interpersonal Reconstructive Therapy (IRT).

We explore avoidant, dependent, and obsessive-compulsive personality patterns, focusing on how these presentations emerge from developmental trauma, attachment relationships, and interpersonal learning histories.

Rather than relying solely on DSM-5 diagnostic criteria, this episode highlights how interpersonal patterns provide a more meaningful, humanizing framework for understanding personality disorders.

Avoidant patterns reflect a fear of rejection paired with a desire for connection. Dependent patterns develop from extended nurturance and control, resulting in learned incompetence. Obsessive-compulsive personality patterns center on perfectionism and fear of imperfection.

Using IRT concepts like copy process, SASB, and the gift of love, we outline how these patterns are formed and how they show up in therapy.

We also discuss clinical implications, including how to build alliance, avoid reinforcing shame or criticism, and tailor interventions based on case formulation.

This episode is designed for clinicians seeking a deeper understanding of personality disorders beyond symptom checklists, offering a compassionate and practical framework for treatment.

(00:00) – Launching the Interpersonal Harmonics miniseries

(02:00) – Why Cluster C personality patterns first

(04:30) – Avoidant personality: beyond anxiety

(06:30) – Fear of rejection, humiliation, and longing for connection

(09:00) – Developmental origins and criticism

(17:30) – Therapy stance with avoidant patients

(43:30) – Transition to dependent personality

(45:00) – Developmental pathways to dependency

(52:00) – DSM vs interpersonal patterns in dependency

(01:01:00) – Transition to obsessive-compulsive personality

(01:03:00) – Perfectionism and fear of imperfection

(01:08:00) – Living in the courtroom

(01:14:00) – Therapy stance for OCPD

(01:24:00) – Experiencing life beyond perfectionism

(01:28:30) – Summary of Cluster C

🧩 Major Themes and Discussion Points:

- Personality disorders are adaptive interpersonal patterns shaped by developmental trauma

- Avoidant patterns involve fear of rejection and defensive withdrawal

- Dependent patterns reflect learned incompetence and reliance on others

- OCPD is driven by perfectionism and fear of imperfection

- Case formulation is essential for effective treatment

- Therapy requires avoiding criticism and working within attachment systems

📚 References:

Benjamin, L.S. (2003). Interpersonal diagnosis and treatment of personality disorders. Guilford Press.

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Episode 008 - Personality Disorder through an Interpersonal Lens – Validating Lorna Benjamin’s Approach

🎙️ Episode Overview:
In this episode of the Loving Differently Podcast, we (Dr. Ken Critchfield and Dr. Eliza Stucker-Rozovsky) dive into a newly accepted paper examining the interpersonal diagnosis of personality disorders through the lens of Interpersonal Reconstructive Therapy (IRT). Using the SASB model, we explore how longstanding debates in the DSM-5—categorical versus dimensional models of personality disorder—can be reframed through interpersonal patterns and developmental histories.

We discuss how personality disorders are best understood not as fixed traits, but as learned relational strategies that once served adaptive purposes in difficult environments. Drawing on empirical findings from Panizo et al. (2025), we examine interpersonal hostility, comorbidity, and how overlapping personality disorder features emerge naturally when viewed dimensionally. We also explore how interpersonal case formulation offers clinicians greater empathy, specificity, and hope for change.

Throughout the episode, we connect theory to clinical practice—highlighting how IRT helps clinicians move beyond symptom management toward helping patients reconstruct deeply ingrained relational patterns rooted in developmental trauma. We also preview an upcoming series focused on specific personality disorder prototypes and their interpersonal harmonics.

• (00:00) – Introduction and context for the Panizo et al. paper

• (02:30) – Why personality disorders remain a central clinical challenge

• (05:00) – Categorical vs dimensional models in the DSM-5

• (08:30) – How SASB conceptualizes interpersonal patterns

• (12:00) – Developmental trauma and adaptive origins of personality patterns

• (16:00) – Interpersonal hostility as a core feature of personality disorders

• (20:00) – Understanding comorbidity through interpersonal overlap

• (25:00) – Five interpersonal clusters identified in the research

• (32:00) – Clinical implications of interpersonal diagnosis

• (40:00) – Hope, change, and reconstruction in IRT

• (48:00) – Bridging DSM language with interpersonal case formulation

• (55:00) – Preview of upcoming personality disorder series

• (63:00) – Final reflections on empathy and clinical relevance

🧩 Major Themes and Discussion Points:

• Categorical versus dimensional models of personality disorder

• Interpersonal patterns as the core of personality pathology

• Developmental trauma and adaptive origins of symptoms

• Comorbidity explained through interpersonal overlap

• Empathy and hope in personality disorder treatment

• Clinical relevance of IRT and SASB

• Reconstruction and long-term change in therapy

📚 References (click for the file):

Panizo, M. T., Harrison, E. G., & Critchfield, K. L. (in press, 2026). Interpersonal Diagnosis of Personality Disorders: Explaining Comorbidity and Enhancing Clinical Relevance. Journal of Psychotherapy Integration.

Episode 007 - What is the “R” in IRT? Reconstruction, Red & Green, and the Gift of Love

🎙️ Episode Overview:
In this episode of Loving Differently, Dr. Ken Critchfield and Dr. Eliza Stucker-Rozovsky explore the “R” in Interpersonal Reconstructive Therapy (IRT): what reconstruction actually means in the context of personality, identity, and therapeutic change. Drawing from core IRT concepts—including Red and Green patterns, the Gift of Love, copy processes, and attachment-based learning—they examine how early relational experiences shape personality and why entrenched interpersonal patterns persist even when they cause suffering.

The hosts discuss how reconstruction is not about becoming a different person, but about altering entrenched ways of relating to oneself and others. They dive into questions many clients ask: Will I lose who I am? What changes, the self or the patterns? What does it mean to return to the “birthright” or Green self? Through clinical examples, they illustrate how the Gift of Love keeps maladaptive patterns alive and how understanding their function creates motivation for change.

Ken and Eliza also explore how various therapies approach similar problems, why IRT emphasizes underlying attachment motivations, and how clinicians help clients shift from Red to Green using awareness, case formulation, and repeated practice. The episode concludes with a reflection on courage, identity, and the profound emotional work involved in personality change.

🧩 Major Themes and Discussion Points:

• What “Reconstruction” Means in IRT
  Understanding how personality patterns can be changed without losing one’s core identity. Exploring clients’ fears about “losing themselves” when shifting from Red to Green; differentiating self from learned relational templates.

• Red and Green Patterns as Modes of Being
  Red = regressive loyalist patterns rooted in attachment;
  Green = chosen, flexible, reality-aligned ways of responding.

• The Gift of Love as the Emotional Engine Behind Psychopathology
  Patterns persist because they express loyalty to important early caregivers and internalized relationships (“family in the head”). Without addressing the motivational attachment roots, therapies like CBT or EFT struggle to break entrenched patterns.

• Clinical Example: OCP-related Patterns
  Perfectionism, self-neglect, and control as survival-based relational strategies rather than “traits.”

• Existential and Emotional Dimensions of Change
  Reconstruction involves grief, letting go of unattainable attachment wishes, and accepting uncertainty.

• The Courage Required for Personality Change
  Clients confront mistrust, fear, and emotional risk; therapists honor and support their bravery throughout the process.

📚 Key Takeaways:

- Reconstruction in IRT means altering entrenched interpersonal patterns, not replacing one’s core identity.

- Red patterns are sustained by attachment-based motivations (the Gift of Love), making them emotionally compelling and hard to block.

- Understanding why a pattern persists is essential for creating motivation and capacity for change.

- Green patterns represent chosen, reality-based, value-aligned ways of being and require repeated rehearsal.

- True change involves both behavioral practice and existential shifts—including grief, letting go, and reclaiming the birthright self.

- Clients with personality-related patterns show remarkable courage in pursuing transformation.