Fragile Rounds june 2026 edit

0:00 Okay, great. So, great. So, uh Wesley had a question. Uh yeah, the last uh meeting when you were talking about the severely fragile patient and fragmentation uh molds and fragmentation u someone here asked you if that is a punitive super ego. >> Yes. >> And you said no, it's a development issue. It's a fragmented system, >> right? >> But then in the book you say that the splitting is the torture due to unconscious guilt. >> Yeah. So the Yeah.

0:45 >> But is it development or is it conflict? >> It's it's well it ends up being both. Like every defense ends up having a punitive function because it deprivives the self or others. And uh but it's not the thing I was trying to highlight was that uh when one part is attacking another part, it's not the same as a punitive super ego attacking the whole person. Like a voice saying you don't deserve to feel happy. You don't deserve good life and punishment. You deserve punishment. A voice inside like the punitive super goal working that way as an operator to punish. um the process of a split where one part is going after another part. One part saying they're supposed to be say thin, one part saying

1:31 they're supposed to not worry about being thin. Like they're kind of fragmented aspects that oppose each other itself is not punitive super ego but the overall system of split up system functionally is uh so damaging. Uh so it's it's it makes the guilt it makes the guilt happy. It makes the anxiety go down. uh and ultimately see keeping split prevents anxiety. It prevents cognitive disruption and nausea and eventual tension. So it has a function to reduce anxiety. So um but so does everything in the punitive system does that you know it all it all uh reduces the anxiety because it's a punishment itself.

2:19 Does that make sense? So it's it's it's really it's it's a >> um >> like self attack is part of a a self-punishment system uh of anger going inward in a neurotic person. That's not the same thing as one part and another part opposing each other in some sort of dialogue and you know even attacking one part attacking another part. Like in the case we had before uh the patient was going unconscious and putting a bag over her own head. One part was trying to kill another part and um and in a disorganized dissociated way. So there's like a separated off aspect of self, another victim aspect of self and it uh a split system but ultimately it's it

3:07 does the same job almost as a self-punishment you know in a way it works but more subtle splitting it also is damaging and destructive and um so um so it does reduce the anxiety. So subtle devaluation, subtle idealization do the same thing. They reduce the anxiety. They reduce reduce the complexity of the feelings. They reduce the anxiety and they have a defense function. So so like look at political discourse and there's a splits and such. It keeps the anxiety low and that's what keeps it going in part is that there's psychological reduction of anxiety for each group. And look at look at uh groups being marginalized and devalued. That drops

3:54 the anxiety down for people who have guilt in their system. Whether they even believe that that group should be punished or not, it still because it's human suffering. It drops the anxiety down. It may make them consciously worried and nervous but unconscious anxiety goes down. So people don't do anything about it. Do you know what I mean? people become paralyzed in their comfort and they don't say anything and do anything. Right? So these have broad broader implications but it works within like families and groups and and within the self in a way too system level. Okay. Um so the layers of the unconscious here you know you have your this zone of the violent murderous primitive primitive murderous rage is

4:40 going to make repressive symptoms uh torturous rage and guilt is going to make cognitive disruption and and primitive defenses. So layers down here need to be experienced in order to take away the ability or the need to have significant primitive defenses and cognitive disruption. So to get rid of that needs to be proc that needs to be processed for the person not to be able to keep going back to that when those feelings are mobilized by life. So what ends up happening is there's the person gets more capacity and they can they can isolate a effect they can tense up they can observe processes they can feel little bits of the feelings they're relatively it gets

5:25 harder and harder in life for these things to come up we take certain events and it's the same concept with the highly resistant patient who uh have this primitive zone at the deeper zone of the unconscious so this primitive murderous this primitive rage here can down in a high resistant patient at the very early phase of life, but they also have layers of other levels of complexity above it. So they tend to operate more with the strided muscle and maybe smooth muscle on a bad day. But in the right event and circumstance, all of a sudden the person can't think straight in a in a severe stress situation or during therapy when you get into these deeper zones of early early trauma. And then people have seen my high resistant case in the book. He had a moment like

6:12 that where this severe early trauma pocket moved in and he got cloudyheaded for a minute. So that's can happen with a highly resistant patient. But it's also it's the baseline norm with with the fragility because they're they almost don't have like structures above it. And remember that concept that um this blasting concept that everything blasts up when there's mobilization until you work to build the filter and make the process of feelings coming up tolerable and not too intense so they can actually face and feel those feelings u and and incre on an increasing level. And you're seeing some of that work here. Uh and with the objective that this whole box eventually

6:58 can get to be more green so they can tolerate more levels of feeling without falling into projection splitting and and major cognitive disruption. So more green less on the other ones. So is that okay Lydia? Yes, it's okay. Again, I'm still thinking about u how this is the state uh fragility or how it is the description of the brain function as a permanent. >> Okay. Yeah. No, I don't I don't think it's a permanent brain function. It gets replaced by forward operating structures

7:46 on a brain level. Prefrontal systems, forward systems who can observe emotional processes rather than fall into these these situations of repression, shunting into confusion and primitive defenses where they can't see their process like the lights go off. They can't hold the conscious. They can't keep the observing system working. So you're making that observing system have capacity. >> All right. So this is >> Yeah. And I mean I think you may have seen at some point I I have um later sessions with her um uh that I can show one of maybe at the end of the end of December in this course to give you an idea what she

8:31 looks like with later later on with more capacity. And she looks quite neurotic. not quite neurotic but like tension and isolating affect and those things but we'll see how she gets to in this 20 sessions. >> All right. So like working with character defenses is necessary with the patient. >> No, we don't want to build character defenses here. We're not building character defenses. We're not building a neurosis. So we don't want to build that structure. What we replacing these with is muscle tension and isolation of a effect. observing in a self-caring healthy way. We're not building character defense defiance compliance, helpless passive. No, we're not building those. We're um making observing in a self-caring way, making

9:18 muscle tension when there's anxiety. That's what we're building. >> All right. Okay. Thank you. >> Okay, Louie. >> Yes. >> Hello. Good evening, Alan. Um I have a question. yesterday um what I think is a severely fragile patient came in with all of those split modes acting very very very intensely. Uh it was the first time I was meeting him and I was wondering how you try to find well what what it is that you do when someone comes in split mode and you don't even have kind of a a you know some level of agreement on what it is that you're supposed to do together.

10:03 >> Right? So when they come in and they're in this sort of a chaotic situation of projective processes, fragmentation, self attack, high distress, these kind of things. Is that what you mean? >> Yes. Correct. Yes. Yes. >> Yeah. That's a real challenging situation. Um what I would do is um is um adopt a a neutral engaged uh stance of reflection where you connect one thing to another and just observe and ask about the phenomenology. Ask about what sort of thought processes come, how does that impact on them? Just ask and underline a few things. So it's quick links. Just connect a few things and let the person move around. Connect a few things, let the person move around. If they get solid into one

10:49 place, say they get a lot of nausea, then I'll do regulating anxiety. If they get cloudy and they stay cloudy, I'll try to regulate anxiety. But in other words, if they're rotating way up in this, you know, box up here, uh, you know, I'm going to be doing this split modes. I'm just going to be trying to, you know, help them observe projection, help them regulate anxiety. if they can get into the yellow, I'm going to be doing uh you know exploring, ask about the difficulties and uh try to get a sense on on what they're what they what they're needing at that time, which is probably the ability to reflect and um and if they if they're up here, I'm going to I'm ask about their emotion responses. I'll ask about how much guilt

11:36 it makes when they feel anger. I'll ask about with those things if I can get here with some UTA working. Sometimes it's such a mess you can't see the UTA. You can't see it working at all. It is working a bit, but you can't really see it because there's too much chaos in the office at first and and it's hard to pick that up. So, you might just have to just get through that session and and then bring them back and have a handful of sessions. Like, I mean, I have other cases that start off like that. It's just chaotic. And that's why I call it stabilization >> phase because you really need some stabilization >> because right now just the mere asking like what it is you think the problem is or >> oh yeah not >> what what kind of help do you think you you want to to have here

12:22 >> um is so disorganizing in a way um I mean I think that if we if we treat this as kind of barrier to engagement or finding common ground kind of thing. This is just going up to be more misaligned than anything else. >> Oh yeah. I mean this there's no question uh that you can't uh you know um you're in shoes already. So it's more becomes a dominant process of working with them with the modes they come in with. So um where's my process on stabilization stuff? It's really like they can't tolerate being held for recap. They can't tolerate sitting down and deciding what the problem is and making consent with you. If they're that

13:10 disturbed, right? Just connect some stuff together to gradually build something. Show that you're not a threat. Show that you want to understand what connects to what and think about building some connectors, which is basic raft raft building. You got a drowning patient. You're going to put sticks together. Round throw them sticks. This connects to this. This connects to this. Because of the past, you worry you're going to get judged again. Because of judgment, that can bring frustration. Frustration sounds like it makes you upset when it comes make your body upset. >> When you get anxious, sounds like it gets you cloudy. Just connect, connect, connect connect >> and you want to get to hear it. It might take you some sessions. >> It might take you some sessions. I've got a case like that. Like, >> okay. >> Okay. Thank you. >> Okay, great. Is there any other uh

13:55 thoughts before we get going, Ken? I had a quick question, Alan, about >> uh when sometimes when patients have really intense emotional experiences in therapy, they kind of can get afraid of doing emotional work and they want to back away from that and they want to go easy and I'm curious how you handle that. >> Um, okay. So if they get too anxious, it's usually if they back off and it happens, it means it can mean more more than one thing, but it may mean that the process is too long, too much over threshold for that session. So they were too anxious to the point they got scared of their process. They get scared of going to the office and things like that. So they might take a break and come back. That happens.

14:43 Um in my in my early years I you know there's patients that just disappear from treatment. I didn't know why they disappear from treatment. Some it was that looking back on it. It was just too anxious and I wasn't regulating the process adequately or projection was sticking and I wasn't dealing with it. So and then there's some people that are going to do that almost no matter what you do. They're going to be in and out. But what we can do to minimize is try to get a reflective stance. Regulate when they can tolerate recap, recap. Keep the concept of guilt on the front. The goodness of the person and the guilt. Keep that in the review at at all times in the recap in the thinking. These things make it more of a safe process. Helps a person settle and then they can get down below threshold at the

15:30 end of sessions. Even if they're up here, you can get them settled somewhat down here. So these are ways to try to prevent that. >> Okay. >> Thanks. >> Great. So let's see where we were here. Um just going to covered some of the bits of the metsychology here already. Um but um you know we're always thinking where are we at on these you know where are we at as far as activity level uh and um what kind of processes on the front and how are we working with that process on the front and what kind of interventions are required

16:15 uh you know is it that we're in the raft building business and basic bringing back structure so the person is not drowning with the high anxiety. Is it mode work where we're connecting things in and out and building this overall accepting, seeing, and knowing mode? Is that the job? Or is the job starting to break through some feelings and start portraying and some guilt dipping uh different levels of feelings? Is there some UTA there working connecting the past and present? Are they able to explore some of the past even if it's mostly cognitive to process some of the emotions and understand the transference into the T into the C? So um are you in graded regular graded format like over here where you can move with some breakthroughs? I mean these are all the questions you're having is which box are

17:00 you in and what can you do? Uh Julie I think you had a comment or question. >> Yeah. Um, I was listening to you recently and hearing sort of an estimate of how much time to devote in an appointment for recapping and realized, oo, I think I underestimate just when to even start that transition into recapping. So, could you give us your thoughts about recapping and and uh uh safeguarding time in the appointment? uh like what point in an hour appointment or 50-minute appointment are you thinking yeah we got to start >> trying to to do that here >> so it's early early on here um I mean

17:48 depending on where you are in the treatment course and the capacity of the patient if you're but you can also just think by spectrum here >> here um the whole mild and moderate when you're doing graded work and it go same goes with repression patients with graded work you want to leave leave a third of your session for the main recapping at the end and and work back into the guilt about anger that was already talked about. Like dip back in. You're going to see you see that with some of these sessions here, which is kind of where she's operating in the recent sessions we've looked at down here. The end of the session often is bumpy because termination of the session brings the death and trauma and they get anxious and distressed at ter at the end of the sessions often. But

18:35 you got to just wrap up the session and ask them to bring that content for the next session. Don't ext you don't want to extend the session. Just wrap it and go >> and recognize there's going to be reactions on the end of sessions in this work here. It is what it is. It's as what the process is and it just tells you that they the reflective system is not great yet and they're still stuck in and out of projections and confusion and such. Okay. Um, >> thank you. That that's really helpful because I think I've experienced that recapping with the mild and moderate actually brings up the content again and I've been holding off recapping because I'm thinking, you know, I don't want to open things up. But so you saying that is really really helpful because the

19:20 solution is actually starting earlier. >> Well, one well one thing will help too is make sure when you're in a recap mode, you're in recap mode and when you're in the last recap mode. Now last recap mode is you're starting to talk about what you did the whole session. You're starting to talk about what's coming. You're talking about what just happened. You're summarizing the process. You might go back to the dip on the guilt. kind of clean up leftover guilt bits that are still making nausea or cloudy. Go back there per second, recap again, and you're now booking your next appointment. So, in other words, I have a different kind of stance and everything when it's like last recap. >> Okay. >> Okay. Little recap in between. >> It's little like a segue. It's like

20:05 >> so this takes this, this takes this, where does that come from? Ready for the next thing. It's a different It's a different stance. you're one is, you know, you're bringing an end to the into this end to the session and patients get to know, oh, this is last recap because I'll tell you a lot of the time the patients completely lose track of time because they're cloudy in and out they're in and out of cloudy head. So, they they can't track the time. I mean, they get it after a while, but sometimes they're just amazed that a whole hour is gone. Like, you know, it's they weren't even there. So, um, that's where we have an orienting stance. Uh, our stance will help orient the patient. Eventually, you get that rhythm back and forth, you know, and they'll start the last recap after a while because they know it's,

20:51 you know, 45 minutes like we're wrapping up >> and uh, but it takes a little bit. And these are some of the details things of getting the rhythm together with the patient on on on the process like the team team processes, you know, how you're collaborating, you know, how you're working together. >> Great. Just a very quick follow- on question. Do your do you have does your office have a clock that clients can see or not? >> Yeah, it does there. And I mean on Zoom I think most of the time I think people can see their I don't know if they notice it but you know what I mean but >> Yeah. But it's uh >> Okay. >> Yeah, I have a clock that's sort of a side uh we can both see it. Yeah. >> Okay. Okay. Great. Thanks. >> Okay. I agree. I think it's mid-rise. I

21:37 think it's mid-rise without and mid, but mid-rise is below threshold. So, that's putting her over mild moderate for sure. Uh we don't yet have negations and such, but she's green below. She's below threshold with mid-rise. That means we're not over here anymore. We're not here. We're over here. And based on that, I'm going to start to think about what interventions are going to think about. See, green means green intervention. So, what are you thinking? Right? What would you do when you see solid? Press into solid. Press or brace. You're thinking grading. You're thinking pressing. You're thinking ready if you need to recap. You're thinking guilt

22:22 immersion. You're thinking portraying. Thinking regulating. You're thinking maybe breakthrough. Okay. So, you have solid. You press into solid. If she gets mushy, you got to recap on the mush. Regulate anxiety on the mush. If she gets mushy, like nausea, cloudy, projective process. Okay. which you're going to handle. You know, like when a person actually has fear, uh they tell you and they c they sometimes counterreact with anx with fear with uh anger. You can how to regulate how to handle it. You can ask the where the thoughts on it. You can ask just reflect on it. Ask where it comes from. You can regulate anxiety. You can behave different than the projection. And you can just observe the process move. like give it a minute, it

23:07 settles into cognitive disruption. If it's hardcore projection, then you're going to handle it differently than if it's an obsessive worry. And remember that these things like the same idea down here, an idea you're going to judge, you're going to judge me. Tension and defense comes on that. That is solid neurotic obsessive worrying here. They're scared of you. You're a threat. And they have no anxiety, no tension cuz you are, you see, the threat. There's no mixed feelings up here. So you have this kind of continuum in a way between projection as a hardcore

23:54 projection, a big P projection if you like, and down here an obsessive projection idea of your judgment down here. You make the decision based on the anxiety channels and um and uh response to intervention. Now, one intervention I do called it a worry. I said the worry, right? And I'm working with it like it's down here. If she can't deal with it like it's down here and can't see it as an anxiety mixed feelings piece, I'm working with it up here. I'm going to have to deal with it. Um, so counterreacting with anger. So some patients if they perceive you as say um angry at them, they get angry at

24:40 you. They they're mad, start yelling and stuff. I mean uh you know this is stuff that you see in the emergency departments where there projections there and the people are they'll hit someone uh throw something get yelling aggressive because the perception is that you're an angry threat at them. So it's uh in other words, some people will go to fear and some people go to go to, you know, aggression when they're under threat, right? Depends on their own their own background and wiring and how they work. Okay, you get the general concept here. And so here's the thing. I have to just test it and see. And then I'm going to respond always to her response. The whole name of the game here is responding to her response. So then the

25:27 real challenge for us is knowing what the response she has is. What is it she's doing to know what kind of interventions that was helpful? And that comes to the boxes like what box are you in? And um you know like is it we're here I think we may be here. Anxiety maybe projective process a little fuzz a little nausea. We're up here. We're in yellow to red here. But let's see. This is classic graded format here. I pressed I pressed up. I pressed on the feelings with me. She fought off the projective tendency. You see, when she fought off the tendency to project, what anxiety channel did she get?

26:14 Did you see it? How did the anxiety go? when she fought the projective process, she got cognitively disrupted. Okay, we're definitely up here. We have CPD coming up here to block the the the rise in the UTA and projected process going to CPD. And so now we're she's fuzzyheaded and she she declared it. So what did I do? recaped. And that's a classic little recap I just did there. Okay. And she her response was to have a sigh. Great. So we decide here

26:59 means we've gone back below threshold or on threshold. We went from above threshold to below threshold or on threshold. Great. Now that we got some tension coming back, what are you going to be doing once you solid? Remember what you do? what you do with solid, right? You press into solid and you recap on the mush. Okay, that's what you're this graded work becomes press or brace recap. Press or brace recap. And just so you know that this is really the classic graded format is really only over here. Remember over here there's not really any room to do recapping. They can't tolerate it. Uh here she's great. She really she thrives on the recap. gets nice and toned. Uh

27:47 it's you have luxurious space to work here because they have a base and that base takes a hell of a lot of work for patients to get if they're over here to start with. They got to build those muscles to reflect and hold and observe, right? And she demonstrated the beginning of the session. She can do that up to a certain level. Then she gets into some trouble. What's the next thing you can do with the heat, right? You can portray the rage, right? This is actually the stack we're on here. Positive feeling she had. Remember, grief for a millisecond, then the rage and guilt went over threshold into some stomach into bladder. CPD little projection. Okay. And here this box we can do it's nice

28:33 time to do portraying as a cognitive exercise and to see if any kind of guilt can tie into the heat and whether the alliance gets stronger and the system can unlock itself. Yeah, go ahead. I'm not sure who >> it was. Sorry. Um, I was wondering, um, when you said that she can't reflect on her feelings, it means she can't she's she's doing all her work to hold on to it. Um, I just didn't understand cuz I thought that people should know what they're feeling in order to >> she knows what she's feeling. She knows the heat is rage, but she's at she's saying, "I can't connect it to anything else. I can't do anything else intellectually. I'm at my max. I can observe the heat." And I say, 'Great,

29:19 let's observe it a little more. What does it want to do? Like that's kind of the natural to me. >> And I did. >> Go ahead. >> Doesn't reflecting usually reduce anxiety and make it easier to hold a feeling? >> Um, it depends. It depends. It might. And it might make it more drop all the feelings away if you start reflecting too much. >> Portraying portraying is going to keep it going up >> because I'm pressing into the portrait. You see, you're bracing into the portrait. You're keeping mobilization up. If she gets cloudy again, I'll recap again. If she gets nauseous, I'll recap again. She gets projection, I'll deal with it. >> So, it's okay to brace up even if she's not got everything like all the all the understanding intellectually of her emotions at that moment. >> Well, she understands she feels rage

30:04 right now. You don't need anything else. >> You know who towards who and what. >> Doesn't m doesn't matter. It doesn't matter. No, you don't need that one. That's what she's saying. If you're going to ask me where this connects to childhood, I'm going to go fuzzy. Okay. You say, "Let's just sit here and keep doing our exercise here." >> Okay. Thank you. >> And Matt, you're right. I did a subtle little challenge. I said, "Can you hold the anxiety aside, let it melt away, and let the feelings rise?" So, really, this is up here. Challenge the repression, challenge the dissociation, and portray. This is kind of where we are. What does it mobilize? Remember, it mobilizes the UTA, mobilizes the unconscious therapeutic alliance. And the unconscious therapeutic alliance now opens the unconscious and sees all of her close people burning up in a

30:53 fiery hell. Now, where does the anxiety go then? Right? It can make her dizzy, can make her nauseous. So you get CPD and repression trying to fight the UTA. See UTA trying to move. CPD and repression fighting the UTA. Okay. So what do you want to do now? And this is the way these early breakthroughs go. They look like this. They're like they're like first breakthroughs that try to seal up really quick because they get so anxious. You know, it's like a little some feelings were felt, you know, more cognitive. The resistance drops, the

31:39 alliance shows the opening system, and then the then it's heavy in there. It's the gates of hell flip flipped open. So, you can try guilt immersion again. You could try recap. Um, yeah. So, I'm probably going to regulate anxiety. That's my my expectation because she's feeling guilt on a decent level and she's able to hold off the repression and hold off the cognitive disruption, hold off the projection, hold off the self attacks and feel some guilt in her body. And remember this whole concept of guilt immersion is based off of this that when she can do that, let me ask you, what does the patient need to know in order for them to be comfortable to open their unconscious? What do they need to know?

32:29 That they love people that they don't want to murder and torture everybody. They need to know that they are a good person doesn't want to murder everyone or they will not open their unconscious to get there. They have to see all the feelings together. You help them by bringing in the guilt with instead of it being split up and repressed, you bring it in alongside the rage. Bring the love in there alongside the rage. And look at her go into the strided. She feels her body get toned because you see toned. And toned is great because that's a solid foundation off which the next set of feelings can come. You can open the gates of hell from a solid foundation. You don't want to be standing on mushy quicksand try to open the gates of hell. It's going to be brutal. You're going to

33:16 sink into it, you know. So this is building that capacity base with striated ability to observe in a self-caring way at a higher level. This is capacity building. It's also has a therapeutic effect. It's a it's a it's a partial kind of walking. Uh we didn't talk about this much and I didn't I don't have a slide on it but it's about um uh working with the little ones uh in these situations. Um, I mean a lot of it just make me sound intuitive. Like imagine if the patient is a parent of the little one. What would she naturally do? You see, it's just intuitive that she would comfort and protect and all those things. But it helps to have the self-mpathy in those moments. It helps her to experience that. You see? So, um,

34:03 it's comforting and, uh, that she can do it as a strong adult person. She can do that for the little one. You see that she's not stuck in the little body anymore. She's got adult reflective capacity and strength to be able to comfort the little one. And this is what she didn't have before treatment. You understand? She had blastings and projection processes and fragments. And you've helped build that capacity to have a caring adult take care of the little one and walk her through the gates of hell because that's what's coming. The little one has the hellish feelings, has the hell hounds, the torture chambers that's in the little one. So, a little one needs a whole lot of help uh to process that. And so, so this is

34:49 just something else to make a slide on this sometime maybe because it's it's a whole section about when do you ask about this stuff? Uh the little one, but it's also just I hope this makes common sense like if a little one was there, what would you do? I mean, what would you do? So I think of it like that. What would I do? You know, if a little one was there, the resistance structure would be she becomes defiant, compliant, helpless, passive, uh, you know, distancing, controlling. You don't want her have any of that. You're just building a it's like a portal. You know what I mean? Like a portal to the unconscious. The portal is holding tone and reflecting and then the portal can open. You see what I mean? and you get transported to the to the unconscious content.

35:35 >> Yeah. >> So, >> let me ask you, can you understand now why it would be a complete disaster if the therapist tries to have a warm attachment relationship from the beginning with this kind of patient? How disorganizing that would be, destabilizing self-injuring uh disaster uh for the patient. self harm goes up, hospitalization, overdose, you know, because the positive feeling coming from the therapist blows up the system. The patient has no capacity. And also, if the therapist is trying just to generate positive, it shows that the patient's got no hope of ever getting to their unconscious. So, they're infuriated with a therapist who wants to be Suzie Sunshine. That's a quote from a patient,

36:20 you know, a patient who wants to just have a positive experience. it's um we're having a positive experience but it's hellish work to get there but you know what I mean so in other words a split system and it's the same concept as a therapist who doing too much just just challenge challenge challenge with a patient like this and um where you basically the therapist becomes a negative force for the patient and it's split negative that's also going to be problematic because there's there isn't room for guilt and you know so these things. It's all um it's the requirement of being of doing mirroring of what is in the patient. Really, that's largely what the early part is. It's mirroring of what is what's going on sequences

37:06 studying it and then getting to do grave