Mental health diagnoses can sound neat on paper. Real people rarely are.
Zara Roth is a therapist whose work focuses on trauma, borderline personality disorder, depression, multicultural issues, and other complex mental-health concerns.
In this episode of Maxwell’s Kitchen, Zara explains borderline personality disorder, dialectical behavior therapy, trauma, emotional regulation, impulsivity, fear of abandonment, and why understanding a diagnosis is very different from simply attaching a label to somebody.
We also talk about anxiety, social media, isolation after COVID, childhood trauma, support systems, climate anxiety, psychedelic therapy, and how different people can need very different approaches to treatment.
In This Episode
Borderline personality disorder
Dialectical behavior therapy, or DBT
Cluster B personality disorders
Fear of abandonment
Emotional regulation
Impulsivity and anger
Black-and-white thinking
Trauma and childhood experiences
The importance of family and support systems
Social media addiction
Doomscrolling and anxiety
Isolation after COVID
Social skills and relationships
Climate anxiety and collective trauma
Individualized approaches to therapy
Psychedelic experiences and mental health
Psilocybin-assisted therapy
Finding purpose and meaning
Guest
Zara Roth
Zara is a therapist whose clinical work has included trauma, borderline personality disorder, depression, multicultural concerns, addiction recovery, and other mental-health issues.
Her path into therapy was unusual.
Before becoming a clinician, Zara studied electrical engineering and physics and worked in biomedical engineering. She eventually decided that career was not for her and moved through several completely different jobs before going to graduate school to become a therapist.
That background becomes part of an interesting conversation about figuring out what you actually want to do rather than simply following the career path that looks safest on paper.
Borderline Personality Disorder and DBT
A major part of the conversation focuses on borderline personality disorder, or BPD.
Zara explains that much of her experience with BPD came through working at a dialectical behavior therapy clinic.
DBT was developed specifically to help people manage patterns involving intense emotions, rigid thinking, impulsivity, difficult relationships, and other behaviors often associated with borderline personality disorder.
The approach includes several major areas, including mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
One of the recurring ideas is learning how to move away from extreme black-and-white thinking.
Instead of every situation becoming completely good or completely bad, DBT gives people tools for tolerating uncertainty and responding to difficult emotions without immediately acting on them.
Fear of Abandonment and Impulsivity
Fear of abandonment is another major part of BPD.
Zara explains how that fear can drive behaviors that may seem irrational from the outside.
Someone might repeatedly call or message another person, show up unexpectedly, react intensely to perceived rejection, or take extreme measures to keep someone from leaving.
The behavior can then create exactly the outcome the person fears.
Relationships become difficult, the other person pulls away, and the experience reinforces the original fear of abandonment.
That does not mean every person with BPD behaves the same way.
One of the most important points throughout the episode is that diagnoses describe patterns. They do not reduce an individual person to a checklist.
Trauma and Support
The conversation repeatedly comes back to trauma.
Zara talks about how childhood experiences can affect emotional regulation, relationships, social anxiety, isolation, and the way people respond to stress later in life.
But experiencing something traumatic does not automatically mean someone will develop the same long-term problems as another person who went through something similar.
Support matters.
Zara discusses research suggesting that people who experience trauma but have strong validation, stability, and support around them may cope very differently from people who experience similar events without anyone they feel they can rely on.
Sometimes the event itself is only part of the story.
What happens afterward can matter just as much.
Social Media, Isolation, and Anxiety
We also spend a significant part of the conversation talking about technology.
Social media gives people almost unlimited access to information, other people’s lives, political arguments, disasters, wars, climate news, and whatever else they decide to keep scrolling through.
That can become overwhelming quickly.
Zara talks about doomscrolling, anxiety, isolation, and how difficult it can be to simply tell someone to use their phone less when the technology has been designed to keep them engaged.
COVID added another layer.
People became accustomed to communicating through screens, working remotely, staying home, and avoiding face-to-face interaction.
For some people, that isolation became comfortable.
Zara describes isolation almost like a habit. The more somebody withdraws, the easier it can become to continue withdrawing.
We do not yet know all of the long-term effects of that change, particularly for younger people who spent important developmental years learning, socializing, and communicating through screens.
Climate Anxiety and Collective Stress
Zara also introduces the idea of climate anxiety.
People have always lived through frightening events, but modern technology allows us to be continuously exposed to problems occurring everywhere in the world.
You can read about climate change, wars, political instability, economic problems, natural disasters, and hundreds of other things without ever putting your phone down.
Information can be useful.
Constant exposure can also become psychologically exhausting.
That does not mean the problems are not real. It means people have to figure out how to remain informed without allowing an endless stream of negative information to dominate their mental state.
Therapy Is Not One Size Fits All
One of Zara’s strongest points is that therapy cannot simply be reduced to choosing a technique.
DBT may work well for one person.
Someone else may respond better to cognitive behavioral therapy, another therapeutic approach, humor, mindfulness, stronger relationships, changes to their environment, or some combination of different strategies.
Zara gives the example of a client whose anxiety was sometimes best interrupted through laughter.
The larger point is that treatment has to fit the person.
A diagnosis can help identify patterns, but the individual still matters more than the label.
Psychedelic Therapy
Toward the end of the conversation, we get into psychedelics.
Zara was researching ecotherapy in combination with psilocybin and was interested in the possibility of psychedelic-assisted therapy becoming another tool for treating certain mental-health problems.
Her interest was also personal.
Zara talks openly about having psychedelic experiences herself, including one difficult experience that forced her to think seriously about her direction in life.
She describes going through an extremely uncomfortable period during the experience but coming out of it with a much clearer sense of purpose.
That became part of what eventually pushed her toward becoming a therapist.
The conversation is not an argument that psychedelics are a cure for mental illness.
It is a discussion about why researchers and therapists were becoming increasingly interested in what these substances might reveal when used intentionally and in an appropriate therapeutic setting.
Useful Links
Zara Roth
https://care.headway.co/providers/zara-roth
Oregon Psilocybin Services
https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/Pages/oregon-psilocybin-services.aspx
More Interviews
Borderline Personality Disorder, Narcissism & Psychotherapy with Dr. Adam Rodriguez
https://maxwellskitchenpodcast.com/maxwells-kitchen-podcast/2022/09/20-episode-90-dr-adam-rodriguez
A deeper conversation about borderline personality disorder, narcissism, splitting, identity, trauma, relationships, diagnosis, and how psychotherapy works.
