Hello, friends! I hope you are all doing well. Special shout out to the moms out there this week! In this episode, I two awesome listener questions.

Our first question comes from a listener who has been enjoying the podcast and requests an episode focused on “daddy issues.” They express curiosity about the causes and potential solutions surrounding this concept. In response to this inquiry, we will delve into the complexities of “daddy issues,” examining various contributing factors and discussing potential strategies for healing and personal development.

Moving on to our second question, a long-time listener writes in for the first time, sharing their ongoing struggle with severe social anxiety. They describe how their anxiety often leads to dissociation during conversations, causing them to make impulsive decisions to end interactions prematurely. Despite trying conventional treatments such as CBT, exposure therapy, medication, and group therapy, the listener feels disheartened by the lack of progress and wonders if there are other options available. We’ll explore alternative approaches and offer insights on how to navigate social anxiety in a more empowering way.

As always, you can send me questions to duffthepsych@gmail.com and find the show notes for this episode at http://duffthepsych.com/episode350

Today’s episode is brought to you by Mindbloom, the leader in at-home ketamine therapy for depression and anxiety. You can get $100 off your first treatment at http://mindbloom.com/duff with the code “duff”.

Transcript

Question 1:

Hello Doctor,

I hope you’re doing well. Your podcast has been very helpful, and I was wondering if you could talk about daddy issues (causes, solutions) in your next episodes.

Thank you very much!

Answer 1:

Thank you for your question. The term “daddy issues” is commonly used in a playful manner, but let’s delve into its actual meaning and explore the potential causes and solutions for individuals who identify with this concept.

It’s important to note that “daddy issues” is not a clinical diagnosis found in the DSM, and its definition may vary among individuals. In general, it refers to the negative impact of a person’s relationship with their father during childhood or the absence of a father figure in their life, which can manifest in various ways in adulthood.

When discussing “daddy issues,” it’s essential to recognize that it is not exclusively a gendered term and can be applied to individuals with different family structures. Additionally, cultural and societal influences shape our understanding of fatherhood and its impact on emotional development.

One potential cause of daddy issues is having an emotionally unavailable, detached, inconsistent, or abusive father. Some fathers may struggle to express emotions due to societal expectations of male stoicism. Consequently, they may have difficulty providing emotional support and modeling healthy emotional expression to their children. This lack of emotional attunement can lead to insecure attachment styles and challenges in forming secure relationships later in life.

There are three types of insecure attachment styles: anxious-preoccupied, fearful-avoidant, and dismissive-avoidant. Individuals with daddy issues may struggle with trust, intimacy, vulnerability, and maintaining healthy boundaries in their relationships due to their attachment experiences.

Another theory suggests that individuals unconsciously seek out relationships that mirror dynamics from their past as a way to gain control over or resolve unresolved issues. Familiarity can provide a sense of comfort, even if the experience is negative or unhealthy.

Research supports the notion that individuals with absent or poor relationships with their fathers may experience difficulties forming healthy relationships in adulthood, as well as higher rates of mental health issues and low self-esteem.

It’s important to approach this topic with self-awareness. Recognizing patterns in your preferences and relationships that may be influenced by your upbringing and relationship with your father is powerful. Engage in self-reflection, seek educational materials on attachment, and seek feedback from trusted individuals to deepen your understanding.

Mourning the loss of the idealized father figure you may have yearned for is also an essential part of healing. It’s necessary to acknowledge that the past cannot be changed and focus on your own growth and self-care.

Stereotypes associated with individuals who have daddy issues, such as being attracted to older partners or needing constant reassurance, should be approached with caution. While some behaviors may emerge as a result of these experiences, generalizations can perpetuate harmful stereotypes.

Therapy can be a valuable resource in navigating daddy issues. Working with a therapist can help you explore your upbringing, identify patterns, develop self-regulation and communication skills, and engage in corrective emotional experiences to heal past wounds.

In conclusion, daddy issues encompass a range of experiences, and there are general themes and strategies to address them. Remember to approach this journey of self-discovery and growth with compassion and patience. Take care of yourself, and seek support from trusted professionals and loved ones along the way.

Question 2:

Hi Mr. Duff,

I’ve been listening to your podcast for years and it’s a great help (thank you!), though it’s my first time writing in.

I’ve been struggling with *really* bad social anxiety for many years. It has reached the point where I just feel like I start to dissociate whenever people talk to me.

I’ve come to terms with my social circle being as limited as possible, but the dissociation keeps causing me to make really bad decisions in all sorts of unavoidable situations – I just react automatically in any conversation, and this automatic reaction is of trying to end the conversation and get away at any price. It gets me into so much trouble in daily interactions and I don’t know how to stop it from happening.

I’ve been through the conventional treatment for social anxiety – years of CBT and exposure therapy, many SSRI medications, and group therapy. None of those were any help and it’s all that people talk about.

Is there anything else to be done about it or will this be my life forever?

Answer 2:

Thank you for writing in. This sounds like a frustrating situation. I think that it is important to note a few things off the top here. First off, it’s true that the most commonly talked about approaches such as CBT aren’t going to be effective for everybody in every situation. However, I also think we need to consider the fact that the provider matters a whole lot. In fact, there is some research that demonstrates that the match between the patient and therapist and the level of the therapist’s skill may matter a whole lot more than the specific techniques that are used.

I often make the analogy to food. If you tried Thai food once and didn’t have a good experience, you wouldn’t necessarily write off Thai food, right? There are other dishes and other chefs out there that you might totally vibe with. That is to say, I would ask you not to write off CBT, exposure work, etc. entirely. Nothing is a panacea, but there may be elements that are very helpful to you in the future. BUT, it’s totally valid to be looking in other directions.

One type of treatment you may look into is psychodynamic treatment or psychoanalytic treatment. A lot of CBT work can be focused heavily on the here and now. What happened, how did you feel about it, and why? It can be very action-oriented and solution-focused. One area of weakness for straight CBT work is the lack of focus on history. I wonder if the issue here is that you need to dive deeper. Not to challenge your assumptions about what other people think about you, but ask where the origins of these insecurities lie.

For example, I have worked with multiple people that have had issues with frequent dissociation or social anxiety that was at least partially the result of not living authentically. In some cases, this is related to gender or sexuality. In others, this was just about living a life that they hated and trying to pretend like they were satisfied. These realizations are likely only possible when you find someone that you can come to really trust and when you are encouraged to dive deeper than just the surface-level issues.

I also wonder if you have ever looked into whether the social anxiety might stem from another issue, such as autism. I know there are a lot of people on the spectrum that are misdiagnosed because their particular issues look like OCD or social anxiety. It may take some advocating for yourself and local research, but if you think this could be a factor, I would highly encourage you to get an evaluation.

Another therapeutic strategy that you may find some success with is Acceptance and Commitment Therapy, or ACT. ACT focuses on helping you develop psychological flexibility, which is the ability to experience and accept your thoughts and emotions while also moving toward your goals and values. You’ve likely already done some of this work with exposure and mindfulness techniques, but one of the differences is in the spirit of the approach, which would have you connect more with your values and goals. It’s not just about symptom mitigation; it’s about approaching a life that you want to live.

Physical health is another area to consider. For example, thyroid issues or blood pressure issues can cause you to have extreme bodily reactions in social situations, which might prompt the dissociation and discomfort. In terms of interactions with people, there is nothing wrong with having a small circle of friends, but if it is bugging you because you want to be able to interact with people more fully, that is totally valid. One strategy you might try is radical honesty. Simply telling new people that you meet that if you go blank, you don’t hate them – you just dissociate a lot could actually go a long way toward making you more comfortable, even if it seems counterintuitive. Just like panic, sometimes dissociation and social anxiety are secondary reactions. It’s more that we are worried about the potential of having social anxiety or disconnecting than it is the actual threat of the social situation that causes us problems. If we can find a way to reduce the intensity enough for you to ride out the initial rush of dissociation or anxiety, we might be able to see some progress in sticking with social activities rather than avoiding.

You mentioned that you have tried exposure work, but this is also another area where I would advise you to be careful about generalizing. A lot of people that say they do exposure work actually suck at it. Finding someone that is specialized and knows what the hell they are doing could help you break through some barriers.

So, hopefully, these ideas are helpful to you. I appreciate that you are still trying to find ways to make progress despite having limited success in the past. You got this! Remember that therapy is a journey, and sometimes it takes time to find the right approach or therapist for your specific needs. Don’t give up and keep seeking support. Take care!