BOLD Blog, San Diego, Therapists in San Diego

00:00 [Music]
00:05 welcome to MedCircle i'm Kyle Kittleson
00:07 joined today
00:08 by Dr Lamb Dr Lamb thank you for being
00:11 here this is your first time on med
00:13 circle i'm sorry we couldn't do this in
00:14 person but i'm glad we could do it
00:15 virtually
00:16 why don't we start off with an
00:17 introduction on who you are and
00:19 what your role is providing mental
00:22 health care
00:22 in your community fantastic yeah thanks
00:25 for having me i
00:26 am Dr Kristy Lamb i am a psychiatrist
00:29 i'm also trained and board certified in
00:30 family medicine as well
00:33 i am the co-founder and ceo of bold
00:36 health
00:37 we are a mental health clinic here in
00:39 encinitas california
00:40 and we treat primary mental health as
00:43 well as substance abuse
00:45 and um have been up and running since
00:48 2017.
00:49 i trained at georgetown in um
00:53 general medicine that's where i went to
00:54 medical school and then came to ucsd
00:56 here in san diego for
00:58 a combined residency in family medicine
00:59 and psychiatry
01:01 and have been practicing dual practicing
01:03 ever since
01:05 i want to start off from the top saying
01:07 thank you for
01:08 providing your time giving your
01:11 information and insight it's always
01:13 valuable
01:13 but especially during these very
01:16 uncertain times so thank you
01:18 from me and thank you from our med
01:20 circle members uh in this
01:22 session we're going to talk about the
01:24 triangle of conflict what is this
01:26 yeah so the triangle of conflict um is a
01:30 theory a psychoanalytic theory that was
01:33 first really formulated concretely
01:37 by david malin but is based actually off
01:40 of
01:40 a lot of the freudian um original
01:43 concepts
01:44 of the unconscious processes that really
01:46 drive anxiety
01:48 and our symptomatology in regard to
01:50 mental health
01:51 so it's a very basic concept that
01:55 um basically states that our deep core
01:57 feelings
01:59 five to six different philosophers will
02:01 uh
02:03 posit different kind of core feelings
02:05 but deep core feelings at some point in
02:07 our lives
02:08 most of us were told are not okay
02:11 we shouldn't have them those feelings
02:13 get pushed down and this is the bottom
02:15 of the triangle feelings
02:16 and anxiety goes up so anxiety is one
02:19 other kind of part of this triangle
02:22 um so any of us who may have experienced
02:24 trying to hold back tears maybe in a
02:26 movie
02:27 or you know not trying to keep feelings
02:29 in
02:30 you'll notice that your throat might get
02:31 a little bit tight
02:33 uh you may start to get a little shifty
02:35 right a little bit
02:36 um avoidant right anxiety goes up
02:40 and then anxiety feels really
02:42 uncomfortable basically by definition
02:44 and so then we do things what we would
02:46 call defenses
02:47 to avoid feeling that anxiety to
02:50 regulate that anxiety
02:52 but really at the core defenses keep us
02:54 from feeling those deep core feelings
02:56 that we
02:56 in our childhood learned are forbidden
02:59 that we
03:00 shouldn't or can't feel these feelings
03:01 there'll be a problem in relationship
03:03 so we push them down we get anxious and
03:05 then we defend through now defenses can
03:07 be
03:08 anywhere from um you know
03:11 going for a run right so if i'm angry i
03:14 push it down i might get a little
03:15 anxious in my body and i might go for a
03:17 run that might be a really healthy
03:18 discharge
03:19 it doesn't actually have me going back
03:21 and actually dealing with the core
03:23 feeling that i'm having
03:24 but it's it's a healthy release but the
03:28 defenses can also become
03:29 more destructive or more pathological
03:32 things that can this is where our
03:34 symptomatology for mental health can
03:36 come in so this is where
03:38 we can dump into depression self-attack
03:40 isolation
03:41 avoidance uh drinking or drugging
03:44 um and so this triangle of conflict has
03:47 become
03:47 really the foundation of the therapy
03:49 that i do in conjunction with medication
03:51 management's with with patients
03:53 so that we can really understand the
03:56 core processes that are going on that
03:58 mental health um is really
04:01 you know there's twofold there's the
04:02 biological piece
04:04 of neurotransmitters and um kind of
04:07 inborn temperament
04:08 brain structure electrical activity but
04:11 there's also a huge component that is
04:14 actually more malleable which is
04:16 our psychodynamic uh relationship to
04:18 ourselves and to others and this is the
04:20 place where therapy really plays a big
04:22 role
04:22 so this is the place where we can
04:24 understand why we're dumping into
04:26 depression or
04:28 our cravings for substances go up or ocd
04:30 symptoms are higher
04:32 because of things that have been going
04:33 on in our lives we can feel a sense of
04:34 control that we can intervene in a
04:36 different way
04:37 okay so this triangle of conflict then
04:39 has three
04:40 main points the the first point if i'm
04:43 understanding correctly
04:44 are the the cognitive distortions or
04:48 or misperceptions we have that likely
04:51 came from how we were raised and these
04:53 can be
04:53 limiting beliefs or the thought of i'm
04:56 not good enough
04:57 but whatever the however those manifest
04:59 for an individual
05:00 those types of feelings of course lead
05:02 to anxiety which is the second
05:05 part of the triangle and then we try to
05:08 cope whether we're doing so
05:09 consciously or subconsciously to curb
05:12 that anxiety
05:13 in the best case scenario we might go
05:15 for a run but we're still not dealing
05:17 with the core
05:18 issues and a worst case scenario we
05:20 might turn to drugs and alcohol
05:22 and then we're definitely not dealing
05:23 with any of the issues correctly
05:25 absolutely yeah and so if you think of
05:27 an example of this right i could get
05:29 angry at my husband for something he's
05:31 really done like really be
05:33 pissed at him right i also love him so
05:35 this the anxiety often comes up in the
05:37 midst of
05:38 mixed feelings so anger towards someone
05:40 that i also love can be really hard to
05:42 hold
05:43 um most of us have been told it's not
05:45 okay to be angry
05:46 um i'll give you something to be angry
05:48 about we learned that anger's not okay
05:50 so we push it away but anytime we push
05:53 away a feeling
05:54 we get anxious so then i may beat myself
05:57 up and say gosh if i hadn't you know if
06:00 i'm angry at my husband
06:01 for um you know uh
06:04 coming home late well if i had let him
06:07 know
06:08 or if i had helped him so that he could
06:11 have gotten off the door
06:12 earlier then this wouldn't be a problem
06:14 right i'm turning it back on myself
06:15 in some way so defensively
06:19 rather than feel my anger directly
06:21 towards him i get anxious
06:22 and i turn it back on myself i may feel
06:25 anger get anxious
06:26 and say screw him i'm gonna go have a
06:29 drink
06:30 i could say i'm gonna go for a run lots
06:32 of different things that i could do
06:35 healthy or unhealthy it's keeping me
06:38 from actually getting
06:39 in connection with this deep core
06:40 feeling of anger which is really
06:42 important
06:43 the feeling of anger is letting me know
06:45 i'm not okay with my husband's behavior
06:47 right
06:48 now right i want to address this right
06:50 so anger
06:51 moves us if we allow ourselves to really
06:53 feel it to set a boundary to say hey hon
06:56 i love you
06:57 love and what you did made me angry
07:00 yeah i'm wondering if we could talk
07:02 about this right so when we can tolerate
07:04 the feeling we can actually then engage
07:06 in a healthy way okay so that sounds
07:10 really nice on paper but when i'm angry
07:13 at somebody especially in a long-term
07:15 romantic relationship
07:17 it is so hard for me to feel angry
07:21 and then use that feeling to very calmly
07:24 say
07:25 hi i love you but i would love to talk
07:28 about this thing
07:29 i'm going why did you do that why do you
07:31 think that would be okay
07:32 so how do i i understand what you're
07:35 saying
07:35 but how do i actually put that into
07:37 practice because that's difficult
07:39 absolutely and so this is where i see
07:43 many of my patients this is the primary
07:45 work that we're doing together
07:46 is to help them really feel deeply their
07:49 feelings even the painful ones even the
07:51 hard ones
07:52 so that they can feel regulated in it
07:54 without feeling anxious
07:56 because if i'm feeling anxious over my
07:58 anger and i haven't completely repressed
08:00 it
08:01 i might say i'm so angry right
08:04 and that's where anger plus anxiety can
08:07 lead to discharge can need to be
08:09 being me saying oh i'm so pissed why did
08:12 you do this you're the worst right
08:13 that's
08:13 discharging out my anger because
08:16 really a feeling is nothing more than a
08:19 physiological response in the body so if
08:21 my husband does something that pisses me
08:23 off
08:24 my chest expands i feel heat in my body
08:27 and i don't know if you notice but your
08:28 hands went like this right i've
08:30 clenched fists or hands like this right
08:32 that's what anger is it's just a
08:33 physiological sensation in the body
08:36 so if i can tolerate that and not get
08:38 anxious over it
08:39 and i can notice my jaw clench and i can
08:42 take a deep breath
08:44 i can say that makes me really angry
08:48 that's powerful but only when i'm
08:49 grounded right
08:51 when i'm not getting anxious over these
08:54 feelings
08:54 so if i get anxious over my anger i feel
08:57 out of control
08:59 i often will do things i wish i didn't
09:02 or say things i wish i didn't say
09:04 but if i can take a deep breath regulate
09:06 my anxiety over my anger
09:09 i can be very clear and i feel like this
09:11 is kind of my life's purpose
09:13 is to um free anger from the
09:16 stigmatization that this is a horrible
09:18 thing
09:19 it's actually this beautiful emotion
09:21 that lets us more deeply connect with
09:23 other people
09:24 that if i can really tell you hey what
09:26 you're doing is actually pushing me away
09:29 is making me angry and we can work
09:31 through that that actually
09:32 deepens our relationship so i can be the
09:35 most
09:36 rational the most grounded when i let
09:38 myself fully feel all of these feelings
09:42 now if if you're able to do that that's
09:45 wonderful
09:46 what if your spouse is unable to meet
09:49 you there and you approach them and say
09:52 hey look i love you so much and this
09:55 thing that happened i felt myself get
09:57 really angry
09:58 and instead of me you know boiling over
10:01 this i just wanted to bring it to you
10:02 and see if we could
10:03 at least talk about it or maybe even
10:05 find a solution which sounds beautiful
10:07 but then they respond with
10:08 well what do you mean you're angry
10:10 you're so sensitive you know and then
10:12 they
10:13 they meet you with that type of emotion
10:15 how should we respond to that
10:16 such an important point yeah and so it's
10:18 actually something that i often you know
10:20 in couples therapy often you know
10:22 sometimes people say oh we need to work
10:24 on gratitude or we need to work on being
10:26 more loving i'll actually say you
10:27 actually need to work on being angry
10:28 with each other
10:29 and we need to cultivate the space to
10:31 say not only
10:33 do i want to know let you know that i'm
10:37 angry i also want to work on being able
10:39 to accept your anger
10:40 without immediately getting defensive
10:42 yeah i get defensive we can't have a
10:44 conversation and then you're going to
10:45 meet me here
10:46 so it's such an important point so a
10:48 technique that i
10:49 have coined the term leaning into the
10:51 defenses right and so if somebody says
10:53 you're so sensitive and i you just say
10:55 yes
10:56 because i yeah i'm having feelings to
10:58 this so
10:59 you're exactly right i i i
11:02 i am being maybe a little overly
11:04 sensitive to this because if we lean in
11:07 you can't fight somebody who's agreeing
11:08 with you oh absolutely
11:11 that shut the whole thing down when you
11:12 said that i just started nodding because
11:14 that shuts the whole thing down yeah
11:16 you're right you know what and in the
11:17 past
11:18 i've gotten really aggressive and i and
11:20 i know that sometimes these
11:21 conversations when we talk about things
11:23 where i'm upset
11:24 i've been kind of i can be kind of awful
11:27 i don't want to do that i'm wondering if
11:29 we could come back and we could talk
11:31 about this in a different way
11:32 this time so lean into the defense and
11:35 then ask for what you want
11:36 right yeah but you always do that i i do
11:40 don't i
11:41 i do yeah and so i would love for this
11:43 to go differently because i noticed this
11:45 anger coming up and i don't want to pull
11:46 away from you i actually want to connect
11:48 with you
11:49 right and this is a really important
11:50 point is that anger is actually
11:53 connecting when you can actually be
11:55 received
11:56 for your anger it's the it makes us feel
11:59 incredibly safe because then i can be
12:01 angry and you can still love me
12:05 we can still be connected absolutely
12:08 this is this is really great
12:09 and i appreciate you letting me play
12:10 devil's advocate here absolutely
12:12 yeah so what happens though
12:16 when somebody perhaps has
12:20 uh missed i don't even hate going here
12:23 kind of but like misplaced sensitivity
12:26 meaning if i uh forgot to take the
12:30 garbage out
12:31 yeah right i just forgot i was busy and
12:34 my spouse comes in and says
12:36 that really upset me that you forgot to
12:38 take that and we need to have a
12:40 i would go we need to have a
12:40 conversation about the fact that i
12:42 forgot to take the garbage up i would be
12:44 annoyed
12:45 that this little my new thing that i'm
12:48 viewing it as
12:49 uh is causing us to have a full-blown
12:51 conversation
12:52 so i guess i'm asking where is the line
12:55 between
12:56 all right let's get in touch with our
12:57 anger and be communicative to
12:59 are you kidding me we need to you need
13:02 to have a little more resilience
13:04 well it sounds like then you're angry
13:06 towards the partner
13:08 yeah and then we need to have a
13:09 conversation about that you're right
13:11 right all right and and the idea with
13:14 you know with the couples that we talk
13:15 that i talk with it's
13:17 when the person tells you they're angry
13:19 what we can do is say
13:21 i really i'm never working to make you
13:24 angry
13:25 so can we maybe understand this a little
13:27 bit better um you know i had
13:29 so much on my plate and i really do i
13:32 hope you know i really do try to
13:34 do my load and i usually take out the
13:37 trash
13:38 but i know you know that we had all of
13:40 these things going on and there was some
13:42 and so
13:43 i forgot and so i'm sorry that i forgot
13:45 um
13:46 and i hope that makes sense um and
13:49 you know the other however the other
13:52 caveat to that is
13:54 sometimes we are just trying to piss our
13:55 partners off right and can we
13:57 like can we own it like you know um this
14:00 past weekend
14:02 you know i was kind of being a jerk to
14:04 my husband he's like what i was like
14:06 i don't even know why i'm angry i am
14:08 being a jerk like and then i could own
14:10 it right and then we could talk through
14:12 that right and so
14:13 the idea that if i'm being overly
14:15 sensitive
14:16 if i'm being under sensitive all of it
14:19 is okay if we can talk about it i may
14:22 not even know why i'm angry
14:24 i may not know why i'm being overly
14:26 sensitive right that partner could say
14:28 gosh
14:28 i know you always take the trash i don't
14:30 know what's going on there's probably
14:32 something else underneath because it's
14:33 usually not about the trash
14:35 right you know it's about something else
14:38 right and so just starting the
14:40 conversation i have a
14:42 a mentor who talks about this idea that
14:44 the feelings are the light bulb
14:46 so if we let the feeling through it may
14:48 not make sense
14:49 we may not completely understand it but
14:51 if we let the light
14:53 of feeling illuminate the room we'll see
14:57 all we saw was the trash but as we feel
15:00 the anger we can look and see oh it
15:01 wasn't the trash can
15:03 it was the fact that we haven't felt i
15:04 haven't felt connected to you
15:06 and so i'm being pissy about this thing
15:08 that has nothing to do with the trash
15:10 but
15:10 i miss you and i want to connect right
15:13 so if we can allow the feeling to just
15:15 again
15:16 illuminate what's really going on we
15:18 usually do the flip
15:20 it's like i can't feel unless it's
15:21 justified i can't feel unless i know
15:23 that it's accurate
15:25 but um you know if we put you in an fmri
15:29 and um show you uh your partner not
15:33 taking out the trash
15:34 your amygdala is gonna fire 200
15:36 milliseconds before your brain goes
15:38 that's really annoying right so the
15:40 feeling comes
15:41 first and comes from the stimulus
15:45 and then we can think about it and
15:47 understand it try and negate it and act
15:49 like we're not angry but we are
15:51 and it may not make sense it's like it's
15:53 just the trash can why am i so upset
15:55 but i am yes and and it's in it like you
15:58 said it's not
15:59 it's not about the trash exactly that's
16:02 the vehicle in which this is coming to
16:03 surface
16:04 that uh that's good Dr Lamb
16:08 pretty good you're setting the bar
16:09 pretty high here this is the first one
16:11 we're recording a lot of videos today
16:12 this is our first one
16:14 so um okay now we've talked about the
16:16 relationships
16:18 part of the of this triangle how could
16:21 this apply and i'll let you choose an
16:23 example
16:24 of a workplace issue and how we can be
16:27 aware of our thoughts to navigate that
16:29 more effectively
16:31 yeah so i find this comes out a lot and
16:33 um
16:34 you know i think that as we're talking
16:35 about this whole triangle we're thinking
16:37 about this idea that
16:38 when we push down feelings anxiety goes
16:40 up and the higher our anxiety is
16:43 the more we're going to probably go to
16:45 less helpful
16:46 defenses so higher anxiety often worse
16:50 defenses so if i'm a little bit anxious
16:54 or stressed during the week and my
16:55 husband pisses me off
16:57 right i might be a little bit sniffy or
16:59 something but if i'm
17:00 really stressed i might you know snap
17:03 back in it you know i might really kind
17:05 of take it over the edge
17:06 and so just modulating and noticing our
17:10 baseline level of anxiety can be really
17:12 helpful and in the workplace you know
17:14 we've seen this recently with a lot of
17:16 stress going on in in work environments
17:19 um
17:19 that people who might otherwise be able
17:21 to navigate a conflict in a healthy way
17:24 that they may be more likely to be
17:26 potentially some people get really
17:28 demanding
17:29 some people go passive when they're
17:31 feeling really anxious
17:33 some people get really controlling and
17:35 so
17:36 i've even seen in our own office here
17:38 right that um
17:39 some of that going head-to-head where a
17:41 small thing going on people having a
17:43 difference
17:44 of opinion about how a policy policy
17:47 should roll out or how we should do
17:48 things right
17:49 feelings get pushed down there's some
17:51 sense that there's some frustration but
17:53 we're not really allowing the feelings
17:55 to be anxiety goes up
17:57 and then somebody gets really
17:58 controlling or
18:00 sends out 17 emails because their way of
18:04 discharging anxiety is through
18:06 um spreadsheeting and emailing right
18:09 i've met that person yeah i am that
18:12 person
18:15 not to point any fingers right but um so
18:18 if we can notice right and i i mean if
18:20 i'm up at three in the morning sending
18:22 an email
18:22 like i need to check myself i need to
18:25 notice
18:26 wow these this is my defensive pattern
18:29 i need to re excuse me really check in
18:32 and say
18:33 okay what's going on right now where is
18:35 this anxiety and what's coming up
18:36 underneath this
18:37 i'm feeling like i have to detail
18:40 everything
18:41 what feelings am i noticing as we're
18:43 trying to
18:44 shift to more things to virtual or
18:46 whatever we're kind of navigating
18:49 wow i'm anxious because i got a lot of
18:50 feelings about this i'm frustrated
18:53 um there's some grief about losing some
18:55 of the
18:56 in-person groups as we go to virtual so
18:58 there's all these feelings that come up
19:00 and if i'm not navigating them or
19:02 noticing them and sharing them and
19:04 creating space to
19:05 kind of process all of this my anxiety
19:08 can go up and i can take it out um
19:11 on the computer i think that
19:14 we live in a world more than ever where
19:17 people
19:17 are doing everything possible to avoid
19:20 feeling even remotely bad
19:23 and i've noticed i will do that with um
19:26 my phone as soon as i feel
19:29 uh irritated annoyed frustrated tired
19:32 whatever i go well let me get on
19:34 instagram
19:35 and now my mind's thinking about this
19:38 person i don't know on instagram and
19:40 blah blah blah
19:40 and i'm constantly avoiding my feelings
19:42 and then at the end of the day when i
19:44 try to go to sleep and i put my phone
19:46 down for the first time my brain
19:48 goes excuse me Kyle all those feelings
19:50 you suppressed
19:51 we have to address right now yeah and
19:53 then of course i'm like well i'm going
19:54 to take a melatonin and try to avoid
19:55 them even further
19:57 and you do that for months and years and
19:58 all of a sudden this
20:00 problem absolutely and this you know
20:04 kind of i have a different way of
20:06 conceptualizing a lot of mental health
20:08 in that i you know i prescribe
20:10 medications i am
20:12 board certified psychiatrist i use the
20:14 dsm
20:15 in order to speak to other providers but
20:18 really
20:18 um that's the diagnostic and statistic
20:20 manual that kind of gives criteria
20:22 for um specific um
20:26 mental health disorders but based on
20:29 this triangle of conflict i
20:30 really psychodynamically can
20:33 conceptualize mental health
20:35 symptoms as just that as symptoms
20:38 right that there's this unresolved issue
20:41 that's dumping into something whether it
20:43 be substances or ocd symptoms or
20:46 binging and purging or um cutting right
20:49 i'm gonna i'm not gonna feel anger
20:51 towards you i'm gonna get anxious and
20:52 i'm gonna cut myself
20:54 right and it can really dump into
20:56 depression as well so this can be a huge
20:58 place where we can
20:59 isolate avoid and numb i had a patient
21:03 who had
21:03 ocd tics severe depression
21:07 um had just come out of the hospital and
21:10 um
21:10 we noticed that as soon as she had any
21:13 conflict in her life with
21:14 anyone in her life she would dump
21:18 massively into depression isolate
21:20 couldn't get out of bed
21:21 and the more that we could give her
21:22 access to just letting it be okay that
21:24 she had these mixed feelings
21:26 her depression resolved and now she
21:27 comes in smiling
21:29 and you know saying um you know i
21:33 you know i have no depressive symptoms
21:35 last week um i was really pissed at my
21:37 mom
21:37 it's like great right we've all been
21:40 there yeah
21:41 right i could notice i was angry she
21:43 didn't even have to it wasn't anything
21:44 that you know her mom wasn't doing
21:46 anything egregious
21:47 right but she could just notice that
21:48 even these little small things that she
21:50 kept pushing down
21:51 we're building and building a building
21:53 and just dumping into depression and so
21:55 the more that we can allow ourselves
21:57 to be free to feel exactly what we feel
22:00 the less all of these symptoms come in
22:03 and i see that again and again and again
22:04 clinically
22:05 excellent i hope people are taking notes
22:07 of this this is
22:08 simple stuff but impactful stuff once
22:10 you can realize it Dr Lamb thanks for
22:12 sharing
22:13 uh some of your time with us today we'll
22:15 have more from Dr Lamb so make sure you
22:17 check
22:17 the links below this video i'm Kyle
22:19 Kittleson remember whatever you're going
22:21 through
22:21 you got this
22:26 [Music]