Dysfunctional patterns in relationships with Dr. Christine B.L. Adams

Wednesday, January 29, 2020

In this, the 100th episode of Psychcast, Nick Andrews talks with Lorenzo Norris, MD, MDedge Psychiatry editor in chief, about the January front-page article in Clinical Psychiatry News that featured Matthew E. Seaman, MD, an emergency physician with depression who took his own life. The article describes the Dr. Seaman faced.

Later, Christine B.L. Adams, MD, a psychiatrist who practices in Louisville, Ky., discusses her book, “Living on Automatic: How Emotional Conditioning Shapes Our Lives and Relationships” (Santa Barbara: Praeger, 2018), with Dr. Norris.

Take-home points from Dr. Adams

  • Children learn emotional patterns in families. These behaviors get reinforced. As children form dating relationships, for example, those patterns continue to be reinforced.
  • People may go on autopilot and have knee-jerk reactions in response to people, which allows them to react emotionally without thinking about what’s necessary for each person.
  • Long-term dynamic psychotherapy can help patients observe what they are doing in relationships and what others are doing.
  • Ultimately, patients can be taught to look at and uncover their automatic responses.
  • Once these patterns are uncovered and moved from the emotional realm to the intellectual realm, they can be interrupted.

Genesis and development of the book’s principles

  • Homer B. Martin, MD, a Louisville, Ky.–based adult psychiatrist who worked with Dr. Adams for 30 years, developed the original premise of the book. When he died, his wife asked Dr. Adams, who was his protégé, to finish it.
  • The book is based on the observations made by Dr. Martin during his 40 years of conducting psychotherapy with patients. It is designed to be accessible both to psychiatric trainees as well as to general readers.
    • Dr. Adams started teaching the concepts in the book during a 6-week university class to determine whether the ideas were digestible and useful.
    • Mainstream movies were used to help people learn to observe and identify roles that were emotionally conditioned and to determine how a character’s change in behavior would change the other person.


Yazici E et al. Use of movies for group therapy of psychiatric inpatients: Theory and practice. Int J Group Psychother. 2014 Apr;64(2):254-70.

Ross J. You and me: Investigating the role of self-evaluative emotion in preschool prosociality. J Exp Child Psychol. 2017 Mar;155:67-83.

Werner AM et al. The clinical trait self-criticism and its relation to psychopathology: A systematic review – Update. J Affect Disord. 2019 Mar;246:530-47.

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Podcast Participants

Lorenzo Norris, MD
Lorenzo Norris, MD, is host of the MDedge Psychcast, editor in chief of MDedge Psychiatry, and assistant professor of psychiatry and behavioral sciences at George Washington University, Washington. He also serves as assistant dean of student affairs at the university, and medical director of psychiatric and behavioral sciences at GWU Hospital.
Renee Kohanski, MD
Renee Kohanski, MD, is a board-certified psychiatrist with additional training in forensic psychiatry. She has been a board examiner for the American Board of Psychiatry and Neurology, and she has practiced within community mental health and departments of corrections. Currently, she is the sole proprietor of RK Psychiatry Associates. She can be seen and heard as a national commentator on general issues as they may relate to psychiatry.