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Are you the person everyone leans on, appearing to have it all together—successful, reliable, always in control—yet quietly wrestling with loneliness and hidden pain beneath the surface?

The struggle of perfectionism and emotional hiding can create a silent barrier, making true intimacy in relationships feel just out of reach. It's a paradox: the more polished our outer lives become, the more isolated we may feel on the inside.

In this episode, listeners will explore how the pressure to be perfect and the tendency to conceal emotional pain can undermine connection and authenticity within intimate relationships. The conversation unpacks why these patterns develop, how they often go undetected—even by those closest to us—and, most importantly, what practical steps can help foster openness, vulnerability, and real emotional closeness.

Whether you’re personally carrying hidden burdens or longing to better understand and support a loved one, this discussion offers guidance for building genuine bridges toward being truly known.

Margaret Robinson Rutherford, PhD, is a clinical psychologist in private practice with more than thirty years of experience treating individuals and couples for depression, anxiety, and relationship issues. Her 2023 TEDx Talk on “How to Recognize Perfectly Hidden Depression,” where she challenges the mental health profession to recognize this overlooked and misunderstood presentation of depression, has received more than two million views.

Episode Highlights

06:56 Hidden struggles of everyday people.

10:08 Understanding relationship dynamics.

11:47 Addressing Partner's Emotional Withdrawal

16:32 Creating the term for hidden depression.

19:06 Understanding suicide and connection.

23:26 Communication issues in relationships.

26:55 Reflections on parenting and perfectionism.

30:19 Discussing vulnerability in relationships.

31:42 Expressing personal struggles.

34:22 Identifying and expressing emotions.

38:19 Term ‘Perfectly Hidden Depression' Impact.

44:08 Balancing family and personal growth

Your Checklist of Actions to Take

• Notice and Name Patterns: Observe your partner’s tendencies to avoid discussing emotional pain or vulnerability, and gently point out specific instances you’ve noticed.
• Inquire with Curiosity: Invite your partner to share by asking open-ended, compassionate questions about significant events rather than commenting on their level of busyness.
• Share Your Own Feelings: Model vulnerability by expressing your own emotions and desire for connection, such as stating your wish to know your partner’s inner world better.
• Offer Written Resources: Send your partner articles or information about perfectly hidden depression as a low-pressure opening for discussion.
• Create Safe Pauses: Support opportunities for your partner to slow down and reflect by encouraging downtime rather than filling every moment with activity.
• Celebrate Small Risks: Acknowledge and reinforce even tiny steps your partner makes toward vulnerability, understanding that each disclosure is significant.
• Check Your Own Role: Reflect on whether your own behaviors contribute to maintaining distance or perfectionism in your relationship and address them collaboratively.
• Exercise Patience: Recognize that changing entrenched emotional patterns takes time and sustained support; commit to ongoing encouragement and understanding.

Mentioned

Perfectly Hidden Depression (*Amazon Affiliate link) (book)

Perfectly Hidden Depression Workbook (*Amazon Affiliate link) (book)

How to recognize perfectly hidden depression | Margaret Rutherford | TEDxBoca Raton (*YouTube link)

I Don’t Want to Talk About It (*Amazon Affiliate link) (book)

Brene Brown

Relational Health Assessment 

Connect with Dr. Margaret Rutherford

Website: drmargaretrutherford.com

Facebook: facebook.com/DrMargaretRutherford 

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LinkedIn: linkedin.com/in/drmargaretrutherford/ 

Pinterest: pinterest.com/doctormargaret/ 

Instagram: instagram.com/drmargaretrutherford

Connect with Dr. Jessica Higgins

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Email: [email protected]

If you have a topic you would like to be discussed, please contact us by clicking on the “Ask Dr. Jessica Higgins” button here. 

Thank you so much for your interest in improving your relationship. 

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Thank you!  

*With Amazon Affiliate Links, I may earn a few cents from Amazon if you purchase the book from this link.

Episode Transcript

Doctor Margaret Rutherford, it's so lovely to have you on the show again. You were a guest many years ago, and I am so grateful to have you back. 

Thank you, Jessica. I really appreciate you having me back on. It has been six or seven years. 

Has it? 

Yeah, I know that seems. Well, we all lived through a pandemic. 

Yeah, right. And you're a clinical psychologist. 

I am. 

You're widely known for your TEDx talk and your books around Perfectly Hidden Depression. And we're going to be looking at this in the context of intimate relationships. And you've been serving people for 30-plus years. 

I've been a psychologist now for 33 years, and I didn't get. It was my second career, so I was in my late 30s when I started working as a psychologist. 

Yeah, I'm not far behind you, but I've got my definite years in the field. 

People keep asking me, ” Are you getting tired of it or whatever? And I don't know about you, Jessica, but I feel so much of the time that what we do can be life-altering for people, and it's just such an honor to be involved with someone in that intimate a way. Not intimate like most of us think about that term. 

No, I use intimate as in like vulnerable and close, not when I say sexual intimacy, but it is extremely. We're in the inner workings of people's lives and relationships, and to be let into those inner worlds, it is deeply vulnerable and also has such a profound impact when people are experiencing and feeling the transformation. It is life-altering. I agree. 

I'm sure eventually I will step away from it, but for right now, it's just as soon as I think, well, no, think about my age, I think, not yet. 

Yes. Your voice matters, and you're making a big impact. 

Yeah. 

“So, for people who don't know much about it. Just pivoting to our topic here, don't know much about the Perfectly Hidden Depression as you define it. Can you help people understand what that is and how it might differ from what they might think? Depression in general, of course.” 

“Of course. I mentioned in my TED Talk- in fact, it's one of the major points of the talk- that it won't be long if it's not already occurring, that all of us know someone or we know of someone who has taken their own life, and yet that life looked great; nothing there didn't seem to be anything wrong. And so perfectly hidden.” 

And it's not going to fit the criteria for clinical depression. There's not going to be a lack of energy; there's not going to be a depressed mood that you can see or a change in their mood. 

They're just hardworking, usually very achievement-oriented, very successful, very busy people who adopted that way of being at a very young age, typically because they were being reared in a culture or a family where either they were being hurt, or there was very little safety for them, or maybe there was just no safety in emotional conversations; you weren't allowed to be transparent. I grew up: if I was angry, go to your room until you can be sweet.

Yeah. 

So it is these people that are walking around and sometimes are our best friend or someone who coaches our child's soccer team or could be the pastor at your church or anything, but 

That was a long-winded answer to your question. 

Well, it's really important in the constellation of it. It's important to kind of look at what it looks like in descriptors because you're saying it perfectly relates to perhaps perfectionism, that things can look really great, everything on paper is dialed in, and who would question that there's pain, and yet you're saying it's very well hidden, very contained, and not very visible. And so it is a juxtaposition to what the outer presentation is, or what's visible when they enter. 

Exactly. And a lot of the comments, or some of the comments on the TEDx, have said This scares me because you mean somebody I really care about, even my child, could have these feelings and be more than reticent to talk about it because there is such a wall built around it. 

Yep. 

So it is something that people might sense occasionally if you get really close to someone, or you'll notice things about them: they rarely talk about themselves, or at least in any deeper way. And when you're in a relationship, they are very invested in you not seeing their inner pain. They're just very invested in that. It's hard for them even to open. 

Up in therapy, yes. And that's important to name, even with themselves. Right? Like. 

Yeah, and I don't know how many mental health professionals listen to your program. Probably a lot. But it's also a blind spot in our treatment because we go to the DSM symptom checklist. And if you don't have four or five of those, five or six, then you don't qualify. You're not depressed, and yet you are. 

It just looks very different and masterfully hidden. 

Wonderful word. Yes, very masterfully. 

“Okay, so in an intimate relationship, do you find that a partner will see signs, or do you talk to us a little bit about what this could look like?” 

“They can see signs. It sort of depends on what the basis for the relationship is in the first place. Frequently, when you really stop and think about it, what kind of people do people who overfunction attract? People who underfunction or people who are also overfunctioning? Where there's an avoidance of conflict, there's avoidance of deeper kinds of conversations; there's a fear of that. And so there's an attachment style that's more avoidant, or however you want to put it. And so they kind of, unfortunately they can build this great-looking life. And they're out in the community, raising money from nonprofits, and they're both attorneys, and their dockets are full or silent. The agreement between the two of them is We just don't go there.” 

Okay, so in response to the question of whether or not there are signs, you're saying there are, in the EFT language, we might call it the couple's dance or their dynamic. But you're also saying how they organize. I imagine even stages of life when one is building a business or has a prominent career. And then you have children in the mix, maybe multiple children. Like, there's good reason to be focused on these very important aspects, and very demanding at times, that need attention, but also can be major distractors. 

Right, and I think I remember an email I got several years ago from someone, and I get this frequently: if I imagine that my partner is keeping his or her pain secret, what do I do? And I think that one of the things is not necessarily to try to approach or challenge their level of activity. It's just noticing. That's why I said they can notice it. They don't necessarily notice it, given whatever their particular Functioning level is. But they can notice it. And then you say things like, Sally was your best friend, and she moved away; she's across the world, and you've never said anything to me about it. I just noticed you seem to be keeping a lot of things to yourself that, for a lot of us, would be hard things. So you notice, you talk about what you notice, not necessarily preaching at them that they're too busy. 

Yeah. And tell me if I'm hearing, I'm kind of hearing a wondering that as we notice, we can inquire that gives the person a chance to perhaps give somebody an email. 

Who said to me, he said to me, I finally, what I want to do is look at my wife and say, I don't know you any better than I did the day we married, and we've been married 12 years, so I don't know you any better than I did then, and I want to know you. And so you come from a place of talking about yourself. And that's when the person who might identify with 

but sees their partner really stuck. 

Okay, great. I love this. So as you speak to the possible dynamics, the one that perhaps isn't as overfunctioning, I mean, look, they could have their own retracting for other reasons, or they could be a little bit more available and present and have a longing. Right. They may feel this yearning to know their partner's inner world, or what is that like for you? Or having that emotional intimacy and connection. And then for the two people that are a bit more overfunctioning, they're both a little distracted. So maybe they both don't feel as emotionally bonded, but they're kind of running a similar program. So maybe there's not as much conflict. Is that right? 

Right. And also, someone who identifies with percolating depression likes a lot of control. I worked with a woman who was discovering this in herself very painfully, and she did some great work. It was actually while I was writing the first book; even a couple of times I asked her, Could I use her words? Because her words were, I named one chapter “Breaking Your Silence” because it felt like that's exactly what she was doing. And she said, I recognize how controlling I have been in my relationship; I just expected him to go along with the decisions I made, and he allowed me to do that. But we're both stuck in that I'm lonely; he's lonely. 

And she said, I allowed myself to tell him that I was sad about something or that I was angry about something for the first time in our relationship. And he looked at me and said, I'm so glad you're doing this. But that would not always be the response, right? That would not always be the response. 

Right. Okay. So we're talking about signs. We're talking about the way a couple organizes and their dynamic. 

Yeah. 

We're also mentioning tension, or a little tension, like what that friction can look like where one is yearning or reaching and the other one isn't, or perhaps they're both not reaching. And so we're also talking about. 

That's a typical approach, avoidance kind of dynamic in this. 

Yes. And also the impact on emotional intimacy and knowing. That closeness. Can you speak about perhaps other ways that the emotional connection, the closeness in a romantic bond would be impacted? I know you use the acronym PhD. 

PhD. 

Perfectly hidden depression. 

Yeah. That's kind of an interesting irony, isn't it? Yeah. I think 

I used that word lonely before. When I wrote the first book, I actually, I was trying to figure out what this was. I wrote a post back in 2014 and just picked a term out of the air, The Perfectly Hidden Depressed person. Are you one? And I was trying to describe it to myself. And so I was writing about it because that particular post went viral, and I got lots hundreds of emails about, How do you know about this? 

So as I was writing and trying to firm up my own ideas about what the telltale signs of this were,

 ‘what actually was showing that, if you could see that in someone, like over-responsibility, like discounting hurt, discounting any kind of either present discomfort or pain or past pain. And I was asking people to get in touch with me if they identified with any of this.’ 

And probably in a three-month period of time, I got around 90 people who said, I'd like to be interviewed. I culled that down to about 60 over a year and a half. I had, like, an hour and a half, two-hour meetings with all of them. And I asked them, why in the world a brain surgeon? I remember some of these people so well. 

And a huge advertising exec in your state of California, a motivational speaker, a graduate student. I mean people from all walks of life, all ethnicities. And I said, why in the world would this post by a therapist in Fayetteville, Arkansas, get your attention so much that you would risk talking to her, talking to me. And what they all told me, I would swear 90% of them use this word. It's one I just used. I don't want anyone else to be as lonely as I have been because there is such a lack of real connection that these people go through all of their lives and they have friends. Maybe they have one friend that sort of. They let in on some of what's going on. Often that friend is out of town, so there's not too much contact. 

“But one guy said, I've been married three times, and the reason why those marriages didn't work is I didn't let my spouse know what was going on with me. No one knows.” And so I think, Jessica, that the part of this that's so poignant and makes the suicide risk for these people so much more, so much stronger is that, I don't know what you learned in graduate school, but I learned in graduate school that the number.

And these people would say no. Even maybe their spouses; they don't feel all that connected to. Not really in a gut-level way. So it is. 

In fact, I've been writing a little bit. I'm a Food Network junkie because I love to cook. And Anne Burrell killed herself last year; she was a very well-known Food Network personality. I mean, talk about upbeat. Sometimes when I watch was like, is she a little manic? So, and of course I don't know her. And I'm making it; it was all conjecture on my part. I just wanted some thoughts about Anne Burrell. Could this be a part of her makeup? And I won't know the answer to that question, but I've had a couple of people who did know her message me and said, yeah, I think, you know, this could be what she was struggling with. Brené Brown talked a lot about perfectionism. Terrence Real has a really good book called I Don't Want to Talk about It, about COVID depression. Wonderful book. 

But neither one of them really mixed perfectionism with suicide risk. So, again,

Yes. Thank you for just speaking to how significant and severe the pain and the disconnection can feel, and that suicide is an option of relief. That they're just. 

In fact, the reason why I got asked to interview for an audition for TEDx was that one of their co-organizers went to the funeral of one of her very good friends who had died by suicide, and the husband walked up to her and said. And they were- I mean, she looked completely fine. Her husband came up with a book in his hand and said, “Do you know anything about this?” And it was my book. And actually, on her. Well, and then she contacted me and said Who are you, and “What is Perfectly Hidden Depression. And so she asked me to interview for the TEDx in Florida. I don't want to scare anybody, but I've been contacted by people who've buried their children, who had perfect-looking lives, who've buried their best friend, who've, you know, it can happen. 

Yes. And to be looking at how to create some openings or bridges, I don't know what you would say, but it's giving an alternative. As you talk about the perfectionism or performance, it's almost as though, as you said, it's a protective strategy. 

Very protective. 

And perhaps the other alternatives or other strategies don't feel accessible or don't feel too terrifying. And so if we can have loved ones who inquire with compassion and interest and explore and maybe give room, is this what these bridges can look like? 

Wonderful bridges. I love the word openings. Again, you don't want to go, you're just doing too much; that's the worst thing you can say to someone. –No, I'm not; I'm fine. You know, I just like being busy.-

Well, and just to bring the voice for a couple of partners who feel so triggered or even activated when their partner doesn't open up or seems to be concealing, isolating, or hiding, it's very easy to interpret that or perceive that incorrectly that, oh, they don't care, they don't love me, they're not invested, they don't really want, you know, they're not. You fill in the blank. Right.

Yup, great point. 

And so it can be really painful to not have your partner turn towards you and to not know why and to be knocking at the door. Knocking at the door. Like, it makes sense that at some point you want to bust through the door. Right. 

Sure. 

I'm not saying like that's the best strategy or that you're going to get the result that you want. But I can appreciate the impulse to want to scream and holler to try to get a reaction or try to get your partner to, like, shake them or wake them up or somehow access more of what's on the inside. And yet, as we said, this is so well grooved. 

It is. And the other thing that I like to talk to people about, who might now I will say I'm trying to think- have I ever had someone like, yes, a few people. But 

And then eventually they might bring in their partner. But one thing a partner has to ask themselves is, do I have a role in maintaining this behavior? You know, do I count on her to always be the one who's driving the boat? I mean, do I count on her or him or them to be a certain way so that my life is better? 

And that is kind of a hard question to ask yourself sometimes, but it's an important one because you may be part of that interaction that's keeping them from sticking their head out and going, “Are you really there? Can I count on you? 

Yes. And I can appreciate how confusing this might be if this is quite hidden to even recognize. Oh, there is something here to explore that I'm participating in. 

Right. 

So if there's a lot of curiosity and wonder and interest in what would help perhaps you to express or take a risk and share something more vulnerable. How do we create more of a safe environment? How can I participate in giving you more, maybe even more room and space to just feel right? Like if someone's built up their schedule so much that they don't even have moments of pause to even have self-reflection, like, oh well, that's important, right? Like, it's hard; it's easy to get microscopic thinking or myopic in our thinking. And so it sounds like if we can look at the dance or the system and how we can support each other. Is that right? 

Yeah, of course. And as you were talking, I was thinking about some other concerns that people have written to me about. Well, yes, I realize I'm perfectionistic, and maybe I even have some of these traits of Perfectly Hidden Depression. Am I passing that on to my children? And one woman who's 17 years old killed herself. She, after several years- that was quite a few years ago now, seven or eight years ago. And she has confided in me that she realized that she was very much a perfectionist and unintentionally may have given him the message that this isn't a safe place to talk about it. And she's just heartbroken because of that, but there's not a cause effect. I mean, it was not the reason why she killed herself. But certainly she realized that her family has really changed now. 

And they are very open about any kind of pain they may feel or anger they may feel, whatever. And so 

Yeah, I mean, this is really important that you're mentioning the home environment and if the family is fortunate to have two parents in the home. Right. How they're relating to one another and then the environment that's created for the children. “And likely I'm assuming you could speak to this, but I'm imagining the protective strategy of Perfectly Hidden Depression often does come from a lot of learning, whether or not it's in early life in the family home. I think our culture and Western culture very much emphasize achievements, and we love achievement.” 

“We watch award shows. Yeah, the NBA's in New York's having a ticker tape parade today because of achievement. I mean, we worship celebrities, and you get the raise if you're perfectionistic. You know, you get the attention. So there's a built-in system. I wanted a PhD after my name, because that fit my perfectionistic self. So there are things that we believe in or that we support, certainly as a culture. And minority people have reached out to me. People of color have said, Margaret, if I wasn't perfect and even more perfect than anybody else, I wouldn't have gotten the opportunity.” 

Right. 

I wouldn't have gotten the job; I wouldn't have gotten the raise. I wouldn't have gotten my culture said, ” You go out there and be the first person to graduate from college. 

Yeah. I'm thinking about immigrant families too, where there's an enormous amount of pressure to succeed. And we came here to give you opportunity and all of these. Okay, so we could talk a ton about how the influences really can create enormous pressure and grave consequences. You're talking about just the extent of this pain and the choices that people will make even in that state of pain, and taking their lives. And also, can we pivot- I know we don't have a ton of time- with you talking a bit about. So what we started to talk about is there an opportunity to start to create more vulnerability or culture in the family home or in the couple system? Even if it's Incremental. 

“Like, I don't know if you would agree with this, but I would think that the risk-taking of revealing, showing the inside parts or the underbelly or vulnerability can be baby steps. Like, it doesn't have to be like, “Oh, I'm gonna just be like, cut wide open. Like, it can be, “Oh, no.” 

“That you'll scare yourself so much.” 

“Yeah.” 

“Or the person that's not. They're not ready for you to do that necessarily. Someone sits down on my couch and says, “Well, I took a small step. I said, “There are no small steps toward this kind of thing. And actually, one of 

I find it really hard to talk honestly about myself. Bam! That's it. You don't have to say anything else. That's a huge step. And the other person goes, “Well, I really appreciate you telling me that. I've sort of sensed that about you, or I've noticed that. I just know you don't go there, kind of thing.” 

And then maybe you sit with that for two, three weeks or months, or, I mean, you can go. And then maybe you tell that person, well, this. I want to talk about my struggle with being bullied, or I had dyslexia, or my dad was an alcoholic. Whatever you start with, even just getting those words out is a huge step because you are. I liken it to the game of Jenga, where the strategy involved is to pull out the piece that will not cause the whole structure to crumble and then put it on top, and it gets harder and harder, but you have to do it with a lot of care. And so it's adopting another way of being that's more open and more transparent. 

‘But again, you don't rip everything apart and throw it all on the floor and say, “This is who I am, or you'll probably have a not-good response to that. You'll shut back up like a clam.’ 

Yes. So go slow. Be really attuned and attentive. Right. Sensitive and aware. Okay. And so this is for the person that recognizes what. Maybe I could start to show more of my inside or be in conversation or let people in a question before my question. Do you find that I commented earlier about sometimes people may not even give themselves space? Do you often find people don't even know how they feel because they're not accustomed to giving themselves time? Yes. You're nodding. 

I'm nodding big time. I literally have. I remember a guy who- he so didn't want anyone in his town to know that he was there, but he drove an hour and 15 minutes to see me from another town. He'd become suicidal. And he was a referral from a hospital in Houston. And when he sat down, he said, I don't know why people talk to their spouses about anything difficult. He said, I never talked to my spouse about anything. Why would I want to talk to her about my emotions? 

“Yeah, I don't want to be a burden. I don't want to create heaviness for her or him.” 

“Exactly. It's a downer. It's that I've got to solve my own problems and all that stuff. Well, we literally- but what I figured out quickly, and actually this is a sign of. Probably the most prominent sign is when that person.” 

You add in the perfectionism and the shame and the counting your blessings and all that stuff. So we literally started working with a wheel of emotion, where you literally have the most basic ones at the core. And then I would say, what feeling do you think is most associated with this story in your life or this event that happened? Well, I guess it disappointed me. Okay, well, can you see how disappointment is a mild form of grief? 

Yeah, I guess I can. And we began working in that way so he would literally have words for his emotions. But one time he said to me, because I was asking him something about his feelings, and he said, Margaret, you keep asking me about my feelings. I stay in my head all the time because I make choices; I make decisions. I jump over the emotions part. Well, gradually, we worked together for about a year and a half, and he began to open up and realized that the reason he'd been suicidal was that he just kept having serial affairs. And he was having serial affairs because he was so perfect in other ways that he felt like he needed to be bad. He needed to do something out of the box. But he was miserable doing it. 

And he was miserable in his job. He was incredibly successful. And so we began looking at all these things, and sure enough, he learned how to talk about his pain. He learned. He changed jobs; he changed careers totally. He was much happier. 

Started talking to his wife. 

Started talking to his wife. 

Okay, good. 

Who had hung with him over three affairs. 

Oh, yeah. 

But I remember he conveyed a story to me that was very eye-opening for him because his family had known he was at Menninger in Houston, and it was the Christmas holiday after he had been discharged, and he'd been discharged maybe about six or seven months; his family came over for Christmas. They didn't know anything about his work with me or anything, but they were leaving, and his father leaned over to him, and kind of slapped him on the back and said, “That depression thing is gone. Right. That was it, and he looked at me, and he said, “That's where it comes from. And I can see it now. And I can see that there was just no admitting mistakes, there was no questioning, there was no depth, very little vocabulary. 

Right. And likely the lineage of just having underdeveloped skill in this area. 

Right. 

And value for it. Right. But I can appreciate what you're describing. 

Yeah. 

So coming back to the couple dynamic. 

Yes. 

For the partner that is noticing this might be a difficulty, or they might even see the distress or pain and have made attempts to invite or be soft about getting curious, but it just hasn't worked very well, or they struggle with how to help. Can you give some more input for people listening who are negotiating intimate relationships around how to help?

This may sound like a self-serving answer. I'm sure it will sound like a self-serving answer. But people have told me there's something about the term Perfectly Hidden Depression if that person who had tried said, “Would you be willing to read an article if I send it to you? And I have lots of articles on my website about Perfectly Hidden Depression. And you just begin to tease. The feedback I got was that the word that gets people, quote-unquote, gets people to kind of go, “She's talking about me, is the word perfectly. Because they have really invested so much. But there's both a little fear there; Oh my God, you know, does he see what I'm doing? 

But there is also a sense of, Oh my God, someone is seeing that, about how hard I'm working to be Superwoman, Superman, whatever, and what it's costing me. And that can feel like a connection, a very beginning connection. So they might hand the article back to them or send it to them and go, I don't know why in the hell you sent this to me. You know, how dare you? But I kind of doubt it. And they might just ignore it. That might be more what would happen. But they also might say, What do you see in me that you think is going on?

Or, “There's something here that resonated.” 

Right. 

How that person chooses to follow that breadcrumb, so to speak. 

Right. 

Okay. Do you ever find instances that the partner who wants to explore if this is happening for their partner has to reach? Not has to, but reaches a point where they feel a boundary is now emerging, that they are also needing to take care of themselves. Right. If they're in a role of being understanding and supportive and have made efforts to be kind and compassionate, but their partner's not responding, it limits the relationship, as we've talked about. There's a lack of capacity or difficulty engaging in intimate connection. Have you found that sometimes a spouse or a partner will have to draw a line and say, I don't know how to continue in this relationship? 

That certainly could be the case. 

But you haven't found it a lot. 

The people who have come to me to talk about this now- one person did. She was engaged to be married to someone who was gonna be the perfect union, but she was actually being abused in the relationship. She broke off that engagement. And then there was the woman I told you about who began part of their healing. 

now how the partner is going to handle that. It may be that they now say, I'm ready to be more real. And the other partner says, well, I'm not. I won't support that. I don't want to go there with you. And that would be a very painful kind of thing to recognize, I think, so. 

That you would more than likely say, well, I've changed, and I recognize this is important now, and it might end the relationship. 

Okay, thank you. Are there any other tips or recommendations or suggestions you have for people in a relationship negotiating this together? 

I think it takes patience. Again, you used the word several minutes ago. Strategy. It is a way of being that has really entrenched itself. And what I find with some people is that they can be aware. They can raise their awareness of that. Oh, I tend to walk around with a lot of shame that I never talk about, but it's like a thumb in my back all the time, and I'm aware of that. And I can even see it in different parts of my life changing. It is really hard and scary. 

Yes, well, it seems important to acknowledge that people can also get support. And one of the things you've developed not only in your TED Talk and your book, but you have a new workbook. Do you want to tell people about that? 

Well, it sort of addresses what we're just talking about, in that some of the feedback I got from the original book, Perfectly Hidden Depression: How to Break Free from the Perfectionism That Masks Your Depression, was that it was a hard journey to make by yourself and to work through the book. People said it took me a year and a half or two years to work through the book because the exercises were. Had me go pretty deep. And so I heard that feedback, and I thought, all right, let me see how I can make this more approachable. So instead of kind of going back into the past and looking more into what made this part of your strategy or part of your structure, your self-structure, let's just look at the telltale signs. 

And let's take it, instead of from the bottom to the top, let's take it from the top and see how, looking at how you're always volunteering your time or you can't say no, or you don't allow yourself to complain or just see the dark side of something, that's also a blessing. You know, you have four children, and that's great. You've always wanted a big family. That's wonderful. Be grateful, but that's four lunches and four soccer meets and four nap times or whatever it happens to be. So you want to have and kind of existence. I can feel this, and I can feel that. So basically we take the 10 traits and work from the other way and say, how do what might be stopping you from challenging this? What are you scared of? What do you anticipate might happen? 

And let's work through those defenses and then get to the meat of it. You keep what is worth keeping about that perfectionism. You keep what's worth keeping. But then you decide, this is really. This does not enhance my life. This hurts my life. And so you don't throw out the baby with the bathwater, as they say, but you take, you assess what's keeping me hidden versus what's really helping me achieve. 

Yes. And that perhaps we can be high performers and also have an openness and very connected relationships and be connected to self. 

Yes. And so, it's called the Perfectly Hidden Depression Workbook: A Step-by-Step Guide to Challenge the Ten Traits of Perfectionism That Mask Your Depression, and it's been out for a couple of months. And so, it's a workbook like many other workbooks, but I hope it's helpful to these kinds of folks. drmargaretrutherford.com, my website.

Wonderful. I'll make sure to put the link to your workbook, your book, your TED Talk, and your website in today's show notes a lot. And you've mentioned there are lots of free articles and ways to contact you and be more supported in what you have to share. 

Right? 

Wonderful. Well, thank you so much for all that you've shared here today. 

Thank you for once again having me on your podcast.