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 014 - Concluding the Prototype Series

🎙️ Episode Link

Overview:
In the final episode of their personality disorder prototype series, hosts Eliza and Ken step back from case-by-case analysis to reflect on the bigger picture: what they've learned, where they remain ambivalent, and how prototypes function differently from diagnostic labels in actual clinical practice. Using a real case example (given the pseudonym "Sylvia") pulled from the IRT archives, they walk through what happens when a person's interpersonal pattern statistically overlaps two personality disorder categories — and why the more useful question often isn't "which label fits?" but "what story explains this?"

The conversation ranges from the neuroscience of how each host mentally represents the SASB model, to the risks of diagnostic stigma, to the increasingly common experience of patients arriving in session having already self-diagnosed from social media. Throughout, Eliza and Ken return to a central thread: interpersonal prototypes don't just describe a person's suffering — they point directly toward what to do about it.

Who This Episode Is For

Primarily clinicians, especially those doing case formulation with patients who present with overlapping or ambiguous personality disorder features, or those looking for a framework that bridges categorical DSM diagnosis with a more dimensional, narrative-based understanding. It will also resonate with clinicians who feel unsettled by the way personality disorder labels get used (or misused) in and outside the field.

It's also relevant for general audiences — particularly listeners who have encountered personality disorder or mental health terminology through social media and are trying to make sense of how much weight to put on a label versus their own lived story.

🧩 Major Themes and Discussion Points:

1. Ambivalence About Diagnostic Labels Eliza and Ken openly discuss their shared ambivalence about the concept of "personality disorder" as a category — not as a critique of Lorna Smith Benjamin's work, but of the broader exercise of translating rich interpersonal experience into a fixed diagnostic label. They point to their prior work (building on the Panizo et al. paper) showing that while a solid bridge exists between interpersonal theory and DSM-defined personality disorders, that bridge doesn't always need to be crossed.

2. SASB as a Middle Ground Both hosts describe SASB (Structural Analysis of Social Behavior) as occupying a useful middle level of abstraction — more organized than the raw flood of a client's phenomenology, but far less reductive than a single diagnostic label. Because SASB is a navigable, coordinate-based system, it helps clinicians locate a patient's patterns relative to other possible patterns without collapsing all that nuance into one word.

3. The Sylvia Case — When Diagnoses Overlap Ken introduces "Sylvia," a case from the IRT archives whose interpersonal prototype statistically overlaps both obsessive-compulsive and passive-aggressive personality patterns. Rather than forcing a differential diagnosis, Ken shows how returning to Sylvia's actual story — a "good kid" pushed past her limits, resentful of failed caregiving — resolves the apparent diagnostic ambiguity into a single, coherent, human narrative.

4. Self-Diagnosis, TikTok, and Over-Identification Eliza raises a pattern she sees increasingly in practice: patients arriving with self-diagnoses sourced from TikTok or non-clinical books, and sometimes over-identifying with a label ("that's because I'm borderline") in a way that forecloses on agency. She and Ken discuss how prototypes — because they map onto a story rather than an identity — are harder to over-identify with, and instead open up a patient's sense of choice in how they respond to their patterns.

5. Treatment Is Built Into the Story Unlike a diagnostic label, which often requires a separate step of matching to an evidence-based protocol, an interpersonal case formulation tends to make the treatment direction visible within the formulation itself. If a patient's self-hatred is understood as something learned from a rejecting caregiving relationship, the therapeutic task — relearning self-regard, reworking that relational narrative — is already implied.

6. Alliance Ruptures and Enactments in the Room Ken and Eliza close by discussing why therapeutic alliance is especially difficult — and especially important — when working with personality pathology. Because these patterns are fundamentally interpersonal, they tend to show up directly in the therapy relationship itself, not just in a patient's outside life. Understanding a patient's prototype helps clinicians recognize enactments and countertransference pulls as expected features of the work rather than personal affronts.

📚 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.

Curious how interpersonal prototypes could reshape your case formulation? Listen to the full episode of Loving Differently, and catch up on the rest of the personality disorder prototype series if you missed earlier installments. Interested in formal training? Learn more at www.irtinstitute.com/trainings

Episode 013 - Interpersonal Harmonics Mini Series Ep 5 - Cluster A’s unpacked

🎙️ Episode Overview:
In this episode, hosts Eliza and Ken wrap up their prototype series on the personality disorders by tackling the final and arguably most challenging cluster: paranoid, schizoid, and schizotypal personality disorders. Using Lorna Smith Benjamin's Interpersonal Reconstructive Therapy (IRT) framework and SASB (Structural Analysis of Social Behavior) coding, they trace each pattern back to its developmental origins — showing how a child's early relational world gets encoded into adult expectations, fears, and coping strategies that can look, from the outside, like simple "standoffishness" or "odd" thinking.

Along the way, the conversation raises some genuinely provocative questions: Is schizoid personality actually a disorder, or just a mismatch with social norms? Where's the line between schizotypal thinking and psychosis? And what does it mean for a therapist to be a "rhetor" — a persuader — when a client's entire belief system was shaped by people who taught them not to trust reality?

Who This Episode Is For

This episode is written primarily for clinicians, trainees, and supervisors — particularly those working in outpatient, inpatient, or crisis settings who encounter guarded, withdrawn, or eccentric presentations and want a deeper formulation-level understanding of what's driving them. It will also appeal to psychology students and general listeners with a strong interest in personality theory, attachment, and the psychology of trust and reality-testing.

🧩 Major Themes and Discussion Points:

The Paranoid Bind: Safety Through Distance and Control
Paranoid personality is rooted in a baseline expectation that others intend harm. Eliza and Ken unpack how sadistic, cold, controlling parenting — often paired with scapegoating and messages that the child was "bad" — teaches a child that safety comes only from walling off and tightly controlling the self. The episode explores why this makes the therapeutic relationship itself an uphill climb: why would someone who expects betrayal ever trust a therapist enough to begin treatment?

1. Is Schizoid Personality Actually a Disorder?
   One of the episode's most interesting threads questions whether schizoid personality — characterized by minimal interest in relationships and a rich inner fantasy life — represents pathology at all, or simply a temperament that diverges from social norms. The hosts discuss cultural variation, the "lone cowboy" archetype, and how modern niches (remote work, solo hobbies, digital life) may fit this personality style far better than traditional social expectations do.

2. Schizotypal Personality and the Double-Bind of Reality
   The developmental history behind schizotypal personality is described as uniquely "crazy-making": a parent who is both physically distant and demanding, punishing the child for autonomy while being simultaneously dependent on them for caretaking. This contradictory messaging erodes the child's trust in their own perceptions, setting the stage for magical thinking, ideas of reference, and a belief in influence at a distance as a way of managing fear and aggression from afar.

3. A Real Clinical Case: Fear of Harming Others With One's Mind
   Ken shares a case example of a young client who feared that his thoughts and feelings could physically harm his mother — a belief traced directly back to a caregiver who described his behavior in bodily, life-or-death terms. The case illustrates how schizotypal beliefs, while clinically striking, make coherent sense once mapped onto a client's attachment history.

4. The Therapist as "Rhetor": Persuasion, Collaboration, and Shared Reality
   The hosts explore the idea of the therapist as a rhetor — a persuader — and what it means to ask a client to reconsider a belief system taught to them by the people they were most loyal to. This raises broader questions about the boundary between maladaptive belief and religion, mysticism, or culturally normative belief systems, and how clinicians can build a case formulation compelling enough to shift entrenched, reality-distorting patterns.

5. Where Schizotypal Meets the Psychosis Spectrum
   The episode closes with a discussion of where schizotypal personality sits relative to schizophrenia-spectrum conditions — and the long-standing, still-unresolved debate about how much of this presentation is biologically driven versus shaped by developmental and relational input.

📚 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.

Curious how attachment history shapes even the most guarded and unusual personality presentations? Listen to the full episode of Loving Differently to hear the complete breakdown — and don't forget to subscribe and leave a review to help more clinicians find the show.

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.

‌If you haven’t already, please like, subscribe, and rate this podcast on whatever platform you listen!

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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