The ULTRA-WEALTH Empathy Gap: The Hidden Cost of Fame, Power, and Privilege

Dr. Sarah Boss, Clinical Director at The Balance RehabClinic, offers a profound look into the hidden challenges that come with wealth and privilege. Behind the surface of success lies a complex struggle—constant pressure, easy access to substances, and the risk of losing balance in a world flooded with extremes. She explains how true healing goes beyond quick fixes and requires deep understanding of the nervous system and early life experiences.

Structure and healthy boundaries become essential tools, especially when freedom can easily lead to chaos. Dr. Sarah also highlights the importance of honest relationships—people who say no and hold others accountable—in a culture where yes-saying often dominates. Healing, she reminds us, is not about thinking our way out of pain, but about creating safety, connection, and resilience. This episode invites us to rethink what it means to live authentically and find lasting balance amid life’s pressures.

🔗 Watch now for a revealing conversation that challenges the myths of wealth, uncovers the unseen struggles behind success, and explores the path to genuine balance and recovery.

About Dr. Sarah Boss: With extensive training in psychiatry, psychotherapy, neuromodulation, and functional medicine, Dr. Boss combines cutting-edge science with a holistic approach to treat clients comprehensively.

For further mental health information and support, visit The Balance RehabClinic website: https://balancerehabclinic.com/

Follow Dr Sarah Boss:

https://www.linkedin.com/in/dr-med-univ-sarah-boss-881761105/

Follow Abdullah Boulad:

https://www.linkedin.com/in/abdullahboulad/

https://www.instagram.com/abdullahboulad/

You can order Abdullah’s book, ‘Living A Life In Balance’, here:

https://www.amazon.com/stores/author/B0BC9S5TCF

Follow The Balance RehabClinic:

https://www.linkedin.com/company/thebalancerehabclinic/

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Chapters

• 0:00 Introduction
• 0:00 Introduction
• 2:06 Dr Boss’s Experience: Psychiatry for Homeless Shelters to Royalty
• 3:53 Do the Rich Struggle More?
• 5:07 Money Doesn’t Guarantee Happiness
• 6:03 Wealth as a Mental Health Risk Factor
• 8:40 How Much Money is Too Much?
• 10:16 Public Perception, Jealousy & Social Media
• 12:08 No Structure, No Stability
• 15:41 Success and Social Isolation
• 18:46 Work-Life Imbalance and Burnout
• 28:39 Planning Major Life Transitions
• 30:47 Replacing Work with Extremes
• 32:10 Do the Wealthy Have a Right to Care?
• 34:17 Barriers to Getting Help When You’re Rich
• 40:39 Loneliness, Identity & Fame
• 48:39 How Children of the Wealthy Suffer
• 1:00:20 Boundaries Raise Resilience
• 1:10:44 Preventing Entitlement in Children
• 1:17:02 Substance Abuse in the Ultra-Rich
• 1:20:14 The Problem with Celebrity “Yes Sayers”
• 1:22:17 Addiction & Reward System Breakdown
• 1:27:53 What Real Recovery Looks Like
• 1:34:09 Therapy Must Be Empathic & Real
• 1:39:07 You Deserve Help

Transcript

Dr. Sarah Boss 00:00:00  Many of them think I'm not supposed to feel bad. I have everything, I don't have the right to struggle.

Abdullah Boulad 00:00:07  There is a lack of empathy. Yes, definitely. For for this demographic. A very successful man in in his early 60s. He told me, look, I feel empty. I, I cannot enjoy life.

Dr. Sarah Boss 00:00:21  We know and we understand that money doesn't buy health nor happiness. To have everything, to not have to work and get up in the morning to make money and keep everything going is a high risk factor. What we need most is love and care. Structure means safety and means without limits. We're lost.

Abdullah Boulad 00:00:45  Welcome to the Living, Alive and Balance podcast. My name is Abdullah Bullard. I'm the founder and CEO of the Balanced Rehab Clinic. My guest today is Doctor Sarah Barres, clinical director at The Balance and the leading expert in mental health care. In this episode, we explore the hidden mental health struggles of famous and ultra high networks a group often misunderstood, rarely discussed, and almost never studied.

Abdullah Boulad 00:01:12  With over a decade of experience supporting clients from royalty to celebrities. Doctor Boss opens up about the unique psychological burdens that come with extreme wealth and public exposure. We talk about empathy gap surrounding this demographic, the shame and mistrust that prevent many from seeking help, and the complex relationship between money, identity and emotional well-being. Doctor boss shares insights from her clinical experience, including how early attachment, trauma, substance use and loneliness manifest in this population and what true healing looks like behind closed doors. I hope you will enjoy Sarah For how long have you been working now with the high net worth demographic, and how did you get into it?

Dr. Sarah Boss 00:02:06  I got into it. initially it started in Vienna when I worked in a very big or the Europe's biggest addiction treatment center, and we had a public healthcare system, covered. Really great program and really successful program. and, and then when we, when it was clear that it was so successful, then of course, there were many people interested also not usually using the public healthcare system.

Dr. Sarah Boss 00:02:37  So we started having, one part of the clinic then for for patients that would privately pay directly pay us and and offer them like a bit more, a bit more tailored to their needs. What was missing, especially in that area of Europe. And that's that's how I started a bit to work with, with different, demographics, so to say. And then I went afterwards I went to Zurich and worked in, just private facility. The main target group was, yeah, this demographic we're talking about today. And so I went from experience from working, also with, with homeless people on the streets of Vienna, for example, to about everybody that comes into the public healthcare system to then many years working with, also famous people, royals, with people that have that come from all over the world, very, very international demographic. And yeah, very, very specific needs also that we'll speak about today.

Abdullah Boulad 00:03:53  Is there a big difference. You have seen, let's say, from treating and, homeless to, to someone let's say more wealthier side of the spectrum.

Dr. Sarah Boss 00:04:08  Yes of course. I mean on one hand side of course, the obvious that these, these kind of clients are usually very educated, very international, very very open minded. You know, having traveled a lot. Being very international, of course. But then also on the other hand side, seeing that it's, it's, it's surprisingly for some people, harder for them to, to enter good treatment or, treatment that really meets their, their needs. And it seems what I learned over the years, it seems even harder for, for these kind of patients To to find the right support. Then for somebody that just enters the public health care system on the predesigned way to so to say, because there is no other option and that's what there is.

Abdullah Boulad 00:05:07  So there is a misunderstanding of this client group. You would say.

Dr. Sarah Boss 00:05:11  Yes. Yes. I think there are a lot of, or maybe false assumptions around this kind of group that, I think there is a tendency that a lot of people think that they as they have more money or more resources and everything, to, to their own like available that they, that they have everything they need, including, for example, health care or including good therapy.

Dr. Sarah Boss 00:05:40  But this is just not always true. In, in my, in our experience.

Abdullah Boulad 00:05:46  So they are kind of misunderstood. And you mentioned money. but someone would, would, would say money could buy anything. And why could someone would with Welles and fame and money, can struggle. Do they struggle?

Dr. Sarah Boss 00:06:03  Yes, absolutely. They struggle and struggle a lot. I personally think that having too much money is even a risk factor then with some studies, but really years ago, about, wealth. Like we know that of course being poor is is a is another risk factor. No question about it. But there is also a lot of data on that. We have a lot of research on these kind of situation. And we know of course, that that's that that brings a lot of struggles with, with it. But then it's also a risk factor to have, more than a certain amount available because that also increases a lot of stress, a lot of struggling and many dynamics we will go into that, that you wouldn't imagine from the outside.

Dr. Sarah Boss 00:06:56  And I think there is a huge misconception in the whole, in the, in general, that we believe that the more somebody has the better. And, but we don't see what what what's the cost on that. Well, like, what kind of what kind of dynamic is caused by having this kind of, wealth and also what it takes to maintain it, and also not just regarding from the outside, what people would think about these kind of patients, but also the patients themselves, because many of them think I'm not supposed to feel bad. I have everything, I don't have the right to struggle. I I'm, you know, I have everything at hand. Or, for example, I don't have the right to, to gain weight because I have a personal trainer every day and I'm surprised. I have a gym at home and I'm supposed to to just be fit and perfect, but that's just not human. To ask or ask ourselves that nobody should ask to be in such a situation. So that's for sure.

Dr. Sarah Boss 00:08:04  A big misconception that, and already data on it, that a certain wealth doesn't mean we're more happy. Generally, statistically, the in between is the best. You know that we don't have to worry too much, but that we do have this also natural motivation and, this, this more human drive to achieve things and also not this pressure that comes with having a lot then or much more than we would need in our lifetime.

Abdullah Boulad 00:08:40  So you mentioned the middle is is the ideal phase, but is there is there a specific amount of wells which, describes, like an ideal, ideal middle or is it does it differentiate also between, region, country culture, etc.?

Dr. Sarah Boss 00:09:01  Yeah, there was there was one big published study. I don't remember exactly the amount, but it was surprisingly, in the middle. It wasn't a lot, I think after like after having what? It depends on the country, of course, after having what you need for each month, plus being safe about, you know, having your savings, not having to worry for you and your family, that's the limit, not more.

Abdullah Boulad 00:09:27  How does how does the comparison with others around us affect. because I understand you can. There was one study where where they compared, Wells and what you have on your salary, on your payroll. If you they ask people if you got 50,000 a year as a salary, and everyone else would get 100,000. no. Sorry. 30,000. Would you be happy they said yes. If then they asked if you would make 100,000 and everyone else would make 200,000. Around you. Would you be then happy? No, but the absolute amount is even though it's higher. We compare ourselves a lot also with, with with our surrounding.

Dr. Sarah Boss 00:10:16  Absolutely. And there, there, there is always the perception. And more and more now with the social media and with everything public that a lot of people feel like. It's just not fair that some have so much and and some and most of the people don't. And I think there is a lot of jealousy, of course, and a lot of comparison, like you said.

Dr. Sarah Boss 00:10:42  And that causes a lot of, kind of rejection also towards these kind of clients. We see a lot because the people, of course, don't see what what was the work behind that, you know, to get there or what was the achievement or what that means. Like from seeing from the outside, it seems like somebody is rich or that's what's on the new newspaper or in social media and has everything and doesn't have to do anything, and that's what's perceived. But it's it's just mostly not like this. And even if it is like this, that's a risk factor. That doesn't mean that that's happiness or healthy life. I think it's even the opposite. I think it's very challenging because to have everything to not have to work and get up in the morning to make money and keep everything going is a high risk factor because you need an immense, An immense organization of your own self to be able to be so structured, to get up in the morning, even even though you don't have to, to do your things, to have a rhythm, to have a schedule to, to still do your or your workout or or your sports, take care of everything you want to and have, have a balanced life.

Dr. Sarah Boss 00:12:08  That's that sounds easier as it is. If you have everything at hand and don't have that, like, naturally, you know, pre-designed from society, that's not necessarily easy. A lot of people experience that, for example, when they lose their job or when their, for example, when when they when out of health reasons, they have to stay home longer or they're in rehab or long term vacation or whatever, they they're surprised that even though they always thought it would be so great to have as much time as possible, even paid, but it's not as easy always as it sounds. You have to have a lot of resources to be able to stick to, a balanced life.

Abdullah Boulad 00:12:53  Yeah. It's, it's it's it's a big irony. You know, we, we run in our life to, to gain more wealth and independency. But then when we get there, when we get there, in the sense, let's say I build a company, I sold the company, and I have a lot of money, a lot of wealth.

Abdullah Boulad 00:13:15  Then I start struggle with with my routine. And this is what we're talking about. As long as we have like a structured, routine in place, everything is kind of going, going fine. When we start to lose it, we start to struggle with self-control. and and it was interesting. Last week I had a conversation with one of a potential client who contacted us. And it's, it's an it's a, a very successful, man in, in his early 60s. He told me, look, I started so many businesses now and everything was successful. I sold it. my aim was to to create wealth. I'm now wealthy. This is the the box I was able to take, but I, I feel empty, I, I, I cannot enjoy life. I'm not enjoying life. And he mentioned that to me, when he looks around himself and see friends and, and people around him, those who struggled in their life or had like some bad experiences, they were able to, to enjoy life better.

Dr. Sarah Boss 00:14:36  Yes, definitely. We hear that a lot. And there are several points important around that. One is for sure that if you imagine somebody has worked and worked and worked so many years and built so much that first, it's a huge difference to go from 100% work and functioning to all of a sudden having time. Like we mentioned before, they they didn't have a healthy routine yet. Maybe they was just focused on work and all of a sudden they have all day to themselves again and and don't really know what, what to do anymore. So also what happens to a lot of people when they're on vacation. That even though it sounds great to be on vacation, but that the first days are really challenging or people even get sick, then because the immune system finally, you know, the stress hormones go down and all of a sudden they notice how exhausted they are. So that's, I think one thing that they're that they're not not even used to it anymore. And also that they sacrifice so much on the way.

Dr. Sarah Boss 00:15:41  Like they, they usually give a lot of people give up their friends, their normal social life, their, their yeah, their, their normal routines or on the weekend or hobbies. And then all of a sudden all this is gone. Even though that was never the plan. You know, the the plan usually is like for everybody else, I, I, I work, I achieve something and then I will enjoy it. But then when the and then I would finally, be there that that just doesn't happen sometimes. And there is this emptiness or this void almost like, it's it's almost like, like falling after achieving so much because it's, it's it's such an extreme also, it's such a difference and, and it's sometimes very lonely.

Abdullah Boulad 00:16:31  Yeah, I see this. I see this with, with many entrepreneurs, Particularly who find, their joy and identification with their work. They do, but they definitely don't, include social life, too much in into her daily life, their daily life and, but how how comes that that we manage in one part of our lives so successfully? But fail, let's say fail in the standard way.

Abdullah Boulad 00:17:05  in another part.

Dr. Sarah Boss 00:17:06  I think, because we're not aware sometimes how important it is, it seems it seems not important, but it is immensely important. And, we we need we always need a a balance in everything. And also the, the what happens sometimes is that if the natural drive is gone, the motivation to do something, to achieve something, that they create such a void, like such an emptiness or So this this feeling a lot. Describe it. Like. And what now? What am I supposed to do now? I climbed the highest mountains. What should I do now? What's left? And if we're not prepared for the little things anymore, like for the, for the, for example, the, the, the barbecue on the weekend or the going to the beach with the family. If we can't enjoy that yet, we we have to learn it again. Like people really have to learn again to, to enjoy also the little things because it's also like an an upregulation of our reward system like we see in addiction, if we do anything to the extreme, also work.

Dr. Sarah Boss 00:18:14  the other things get lost. We, we sometimes lose the capability to, to enjoy little things everyday things to also see the beauty around us. And we do need all these kind of things, even though they seem small and not important, but they are actually the most important we have, because they what we have long term hopefully. And what we need also when we're not working anymore and when we're not in that in that mindset, so to say.

Abdullah Boulad 00:18:46  Would you, would you say that, people who mainly focus on work and they may have satisfaction in that part of their life, they tend more to get into burnout at some point because they have lack of, differentiation and regulation with other.

Dr. Sarah Boss 00:19:06  Exactly. Definitely, definitely. Because usually the cost to being so successful is that you don't have working hours. And we know that it's just so essential to be able to turn off your phone after 4 or 5 or whenever the the shift or the work stops and just disconnect and be you. But these, these kind of of people that work all the time.

Dr. Sarah Boss 00:19:32  They're always available. They always have to make decisions. They usually work in different time zones in the afternoon. They work in in another continent, and they don't disconnect and they get used to it. And it gets more and more and more, and then there is no private life anymore all of a sudden, and all of a sudden, all the people around them, all the contacts are somehow related to work, and it's like invading their life more and more and more. And there is no, no disconnection anymore.

Abdullah Boulad 00:20:04  I see sometimes in on social media entrepreneurs, they just claim there is only work and this is your creating. If you're if you're doing and this is the passion you are following in your in your life, this gives you your satisfaction. And this is balance enough. and and there is also for particularly for entrepreneurs and high achievers. They look at, let's say, employees who who seek more like work life balance or give answers in in questionnaires or onboarding assessments that they are they have been seen as, not not hard workers.

Abdullah Boulad 00:20:49  So I know we're talking about the high net worth, but the entrepreneur view on on work life balance. is there a lack of understanding of it, and is there something like work life balance?

Dr. Sarah Boss 00:21:01  Yeah, I think it's very individual. There are, of course, people that can work a lot, really enjoy it. Like maybe made made their hobby to work. For example. I know some architects, they really love the work. They live at the office, but but because they love it and they, they don't, they don't feel stressed by it always. It's just also something creative. But so we have to really differentiate I think. And then there are people that really have this immense, pressure to it all the time and they notice it. So I think it's always the question, how do you feel like, how do you sleep, for example? Can you are you able to disconnect when you choose to, or do you feel like you're not in control anymore because you have to do so much? You work took over your your life, and then it's of course a problem already.

Dr. Sarah Boss 00:21:56  And to your question, that's I think that that happens a lot. But that also depends so much. There are people that are extremely effective in their work, in what they're doing, and they have great results in their working hours. And when they disconnect, they disconnect. And then they're ready again and creative again to come the next day. And just because they do don't do more hours than they're supposed to or that they're, that they're hired for, does that mean they're lazy or anything, or not committed to work because they do show the results they're expected to show and they are actually doing what they're supposed to, which is, restore your everything, relax. b be able to disconnect, to come back to work the next morning and be the best, the best of yourself. And and that we we need. Because it doesn't make sense also for somebody, for example, to stay 12 days, a 12 hours every day and, not listen to your own needs and not, rest and not, recover and, and then not do not do a great job, for example, because you, you start making mistakes or you start, not, you know, being creative or being problem solving anymore.

Dr. Sarah Boss 00:23:19  That's why, for example, in many jobs, for example, like, medicine Doctors. We that has had to be regulated because the there was so much overtime and it could be seen that you everybody makes mistakes after a certain amount of time working. So it it needs to be it makes sense to not work too many hours. It really depends on how you work. I think.

Abdullah Boulad 00:23:45  Yeah, but if you if you are the entrepreneur, if you are that figure and I hear this also from like friend entrepreneurs, they they feel like okay cognitively I want to work less. But then they, they the pendulum goes from to little and then they get bored to too much. So there is a difficulty to find that that balance.

Dr. Sarah Boss 00:24:12  Absolutely. And like everything it needs practice and maybe some support in the beginning because we really need to find things again for them that they can connect to and not feel like they're bored. All of a sudden, they can't just put an hour in their schedule and meet time, and then they don't.

Dr. Sarah Boss 00:24:31  They don't have anything prepared and they don't know what to do. That won't work. Then they feel like it's a bad experience. I don't know what to do with myself. or it's boring for me to be at the beach or to go for a walk. It has to be always realistic. We always have to find something that's like, that really works for each person. and then and then and then really cultivated practice it, find something or several things if possible, that really give them something. Because in the end, that's what it's all about. We need to, meet our needs somehow. But and we have many needs, not just social connection and safety and relaxation and restoring of our energy and everything. We have many needs. We also need to feel creative and playful, which as adults. That's, that's a different, way to deal with it. But those are human needs we are all born with. And, we need to somehow find ways to.

Abdullah Boulad 00:25:34  To cover when I see, let's say, entrepreneurs or people selling their businesses or suddenly stop working because they turn 65 and some countries, and that's a danger.

Abdullah Boulad 00:25:48  Yes. That's absolutely that's a big, big danger moment in their life. They need to be planned for it, not just to plan the exit of a job or an exit, often of a business, you are selling off and making a lot of money. You need to plan. Also. What's next? What's the next step in your life?

Dr. Sarah Boss 00:26:07  Absolutely. That's very important. Like in many movies, it's shown that for all of a sudden they retire and and they're supposed to go fishing. And they didn't try that once or golf. They tried that once and it doesn't work.

Abdullah Boulad 00:26:21  And why does it not work? I mean, is our brain differently wired until that stage and it cannot shut off or our nervous system? Is there any any biological clinical effect?

Dr. Sarah Boss 00:26:35  It's this. I mean, it's like like with addiction, like I said earlier, but I think comparable because if we are, if we are so used to the extreme, for example, you know, this this is we know that there is positive stress and negative stress, but a lot of these people are really successful and do enjoy their work like there are others as well.

Dr. Sarah Boss 00:26:56  They they feel stressed, but it's kind of mostly positive stress sometimes. Then it's negative, but they feel that drive like they're continuously under some more stress hormones than others because that comes with their work and they work well on that. Like they say that that's, that's the, the, the range of activation that I work best and that I'm most effective and most successful. And then if that falls away from one day to the other, it just can't work. Because then then it's like as if we would take its cocaine, for example, and we have an immense neurotransmitter explosion in our brain. And then the next day, there is nothing like we can't live in these extremes. And we we have to gradually that will be the best thing, gradually reduce something, for example, work and then cross over to something else to do in our life and and practice that and prepare it. Like you said, that's essential because we see there's a lot of data on that. That's a high risk factor. A lot of people develop symptoms when there is big change in their life, for example, retirement.

Dr. Sarah Boss 00:28:07  That's a big, big, a big, moment in life that it was such a huge change that if not prepared. There is a lot of people struggling or, entering university, these kind of things like moving out of, of, of your home, as a young adult, these kind of transition moments are very, very important to keep in mind, to protect ourselves a bit before we do them, to just prepare best.

Abdullah Boulad 00:28:39  What can someone do to protect, or to be better prepared for this significant, life changing moment?

Dr. Sarah Boss 00:28:46  Prepare already month ahead, or the best would be all our lives to not even live such an extreme, to already have more contacts again, find things we like to do. Maybe if possible, in group or with, with friends, with people we like. to to have also, some things we like to do by ourselves. Find, find joy, find relaxation in whatever it can, eat whatever it is and really prepare for that. And then maybe also some people shouldn't maybe retire all the way.

Dr. Sarah Boss 00:29:23  You know, we should if we if we have our brain and if we're really good at something, it also somehow doesn't make any sense to work until a certain age that, the government defines in each country and then just stop. You know, a lot of people say, for example, also me in my profession, I can theoretically work until I, I die until the moment I die. And that that's beautiful. But I can, just reduce the hours. But why should we completely stop? If we like to do something, maybe we can still find another way of doing it. For example, supporting other companies, being a consultant, or writing a book or, or giving interviews, whatever it is, it's it's also sometimes good to to still find something, you know, that again fulfills that need we have. Because a lot of people said, I want to use my I want to keep on using my skills. You know, that I was working with so many years. Why should I just pretend they're not there anymore? From one day to the other, it feels like I'm I'm I'm useless.

Dr. Sarah Boss 00:30:34  And that's that's also something that can easily be avoided.

Abdullah Boulad 00:30:38  Also, what you're saying is like be a service to some something else or someone else. Other companies be on the board.

Dr. Sarah Boss 00:30:46  For example.

Abdullah Boulad 00:30:47  Be helpful for and and useful to to to keep that sense of purpose. but at many, in many cases I've seen, these entrepreneurs or people, they turn into extreme sport, for example, they try to find their joy with sport and or excessive healthy living. Yes. then they have to train and prepare for the next marathon and jump from one to the other, and next the next. Yes, that's also very on the other extreme. So they, they, they want to fill their void. They have emotionally with, with another addiction.

Dr. Sarah Boss 00:31:28  Exactly, absolutely. And the time because they, they, they're not prepared to have so much time. So that's what they jump into. What also happens a lot after addiction of substances. It's again comparable every extreme. If we live an extreme then it's we are at risk to jump into the next extreme.

Dr. Sarah Boss 00:31:51  Once it's it's it's gone. What we were just driven by. So to say.

Abdullah Boulad 00:31:58  You've been working now for quite some time with, with this demographic. have you been ever criticized of, of, focusing on this demographic?

Dr. Sarah Boss 00:32:10  Yes. The other day there was an interview of a German newspaper and, surprisingly, that the interview started with the with the journalist asking me how I, how I see that as a medical doctor, which is my main profession. Profession, that there is such a lack of psychiatrists at the moment in the German speaking countries, but all over Europe, or I think almost all over the world, and people have to wait many months to get an appointment and there is a big need. And how I see that, that I somebody as skilled as I am, that could work with so many people, like I see so many patients, and one day that I just focus now mainly on these kind of clients. And whilst in this at the same time, I could attend so many others in the public system, for example.

Dr. Sarah Boss 00:33:05  But then this question made me think a lot about that. it was a good question. And it was it was not hard at all to answer it, because for me, it's clear that everybody has the same right for for health care and for good treatment. And it should it should make no difference how wealthy somebody is or where somebody comes from or what kind of insurance he has. And I do work with everybody also still in my private practice or in my surrounding. I work with people, sometimes for free if they need to, and then I work with extremely wealthy people. But what they all have in common, that they they're all human beings, and I see them as they are, as a human being, as a person that I want to help and that I want to understand. And the these questions made me realize again how, how hard it is for these kind of, demographic patient group to find help and for all the the stereotypes they have to face, as if they as if they didn't have the right for the best possible care.

Dr. Sarah Boss 00:34:17  And it seems like it is harder for them. I really think if somebody is in in need, for example, for mental health, that it's harder for the really wealthy people to, to get help as it is for somebody that already, knows where to go, goes into a, you know, a hospital or wherever and everything is taken care of. So it's not that easy for somebody that can choose and that wants to avoid the public hospital, maybe because he shouldn't be seen there, or maybe because, he doesn't even, stay at one country all the time. Because traveling a lot, many, many, many reasons of, you know, keep it, keep him from from actually accessing something. So what I see a lot is that there also a lot of time gets lost and the time is much longer until they find the right help. And when they find help, it's not always transparent and and trustworthy, which is a terrible thing to say, but it's like that, unfortunately, that people take advantage of sometimes of patients that have a lot of resources and feel like they can charge them more, or they can.

Dr. Sarah Boss 00:35:33  They were even cases, that would would charge for referrals of, of, of these kind of, of clients, which is terrible. It should never happen because everybody should, you know, find the right treatment that just, fits to, to the needs and nothing else. So there is so much misunderstanding and misconception around this kind of client group. And also on the other hand side, there is so little offer because there are very few centers and specialists, Internationally that have experienced within with the needs of these kind of client groups, and not just when it comes to confidentiality and, adjusting, you know, to their, time and, and traveling schedule, but also to their needs and to their background and to what they have to face. So there is so much to it.

Abdullah Boulad 00:36:27  So there is a lack of empathy. Yes, definitely. For, for this demographic or client group.

Dr. Sarah Boss 00:36:34  Yes, absolutely.

Abdullah Boulad 00:36:36  How does it manifest in in your experience.

Dr. Sarah Boss 00:36:39  Just like this? That was a good example.

Dr. Sarah Boss 00:36:42  These questions because, it shows that a lot of people think from the outside. Yeah, they have everything. So they're not supposed to struggle. You know, they can they they can buy everything, but not everybody. You know, if we think about it, just five minutes, we know and we understand that money doesn't buy health nor happiness Nor support. not at all. And also, what's really important, what I see almost in every patient, is that it's also the lack of, empathy or like self self-compassion because they sometimes say, yeah, I have everything. I'm not supposed to struggle. I'm supposed to, be fine. You know, I don't have the right to struggle. I have everything at home. I have everything at hand. I don't have to worry financially. Why am I struggling? So that's why they wait longer or wait. That's why sometimes they try to solve it by themselves with substance abuse or, some kind of dysfunctional other coping strategies. But, that's a pity, of course.

Dr. Sarah Boss 00:37:49  And that's what we always start with, the that everybody should feel like, you know, I have the right to struggle because it's like everything in life, it's like having diabetes. I always make that example because Everybody can have diabetes. That's understood. And nobody would ever say, come on, you, you know about you shouldn't eat that cake, you know, now you you did. And your blood sugar goes up and and now you need more insulin or whatever medication. And, you know, nobody would ever blame anybody. Not not yourself and not anybody else. But it's exactly the same thing. Nobody should ever be blamed or blame themselves for struggling, mentally, because that's something we all can have any time. And, and it's one of the most common things we humans have to face. And like I said earlier in, in, in, in very wealthy patients, we see that it's even a risk factor to have too much, too many resources and less structure, like we said before.

Dr. Sarah Boss 00:38:52  So it's it's just to be expected and completely understandable to struggle. And we should it should never be questioned or it should never be needed to justify in any case.

Abdullah Boulad 00:39:03  Yes. I mean, they could. They could just walk into the next hospital. Why? Why is that a problem for them?

Dr. Sarah Boss 00:39:10  Because a lot of people need the confidentiality. For example, I'd say people that are more in public, eyes or more famous or royals, they can't. They can't just walk into a hospital and it could cost them. It could cost them their career. Unfortunately, now with social media everywhere, people with phones, everything is right away recorded. everybody judges and then later on would, comment on how they looked or what they did or suspect. And, so that's already one thing why it doesn't work. And then they need specific, really tailored specific care because also they're sometimes traveling a lot or living between countries like I mentioned before. It it doesn't work then to to walk into a public hospital and to tell you okay, Come back in three weeks.

Dr. Sarah Boss 00:40:00  They might not be there anymore in three weeks. And, And, yeah, many more reasons for why it just doesn't work. And they don't even have the, the, the opportunity to do so.

Abdullah Boulad 00:40:13  You have to meet them where they are exactly in their life and their circumstance. everything around that. Yeah. It still, let's say we're talking about lack of empathy from others, lack of empathy or self compassion to, to themselves. why why is, privacy and trust, more critical with this demographic?

Dr. Sarah Boss 00:40:39  It's always a big difference to, between between people that achieve their wealth working by all, by themselves. And, they usually don't struggle that much because they, they, they started in a more normal More setting and achieved. But then. And then there is this other group that maybe, you know, already was born into a wealthy family or, got some companies or whatever from the parents then, to, to keep on going. And so that's a really different story. But what always happens is that most people say not everybody, of course, never want to generalize, but a lot of people say that if they if they start being wealthy and in the beginning it's easy and they they invite everybody and they have a lot of people around.

Dr. Sarah Boss 00:41:35  But then there comes a moment when they feel like, there's so many people around me, but who who is really my friend, who really cares and who who is actually not on my payroll and who is really a friend. And a lot of people saw that in the pandemic now of Covid. A lot of people said. When, when? When we were at home. When I was alone, at home, all of a sudden I noticed nobody calls me, you know, there were no parties anymore. There were no I, no big events I took people to or I had. I didn't do any recordings anymore or company meetings or whatever, where all my so-called friends were always taken, were always part of. And then all of a sudden they noticed nobody cared for me, nobody called me, nobody worried. Nobody asked how I was. And then they noticed these kind, these people are actually not really my friends and they don't really care. Or when they struggle, they see that sometimes that they can't really trust.

Dr. Sarah Boss 00:42:39  And a lot of people are circling around them, but they they take advantage of them. They live off them, maybe of their money, but also of their fame maybe, or being part of it or want to be part of it. There's still so many people that they want to be around. Successful people or famous people, or seek out for a partner that is providing. Which is also a very sad topic because if you have to ask yourself, is my partner really with me? Because of me? Because he really cares for me, or is it because of my status, or my financial situation, or my fame or whatever? these are really, really deep and sad questions because that leads often to a lot of mistrust, because if you make that experience over and over again that I, I can't trust, people just took advantage of me. And they were not real friends or not real partners. Then, of course, that's completely normal. We develop a deep sense of mistrust. also, it can be anybody lawyers, healthcare providers, whoever, you know, they make a lot of bad experiences and being taken advantage of.

Dr. Sarah Boss 00:43:56  So they do develop a lot more mistrust than others. And also when it comes to what can I tell somebody? And that's not then later being filtered to the press or, or who knows, you know, all these kinds of kind of information. We can't imagine how it is to always be having to be careful about what you say, about how you look when you walk outside. There might be somebody taking a picture of you, and then they might be commenting on it. Oh, she looked tired this morning. Maybe she's sick, or maybe she took whatever or all these kind of things we can imagine. And to not be able to fully trust, like naturally anymore, to have to extra to be extra careful all the time about everything we do. Because in the end it depends on that. And it used to be much easier before social media. Now that made it a lot harder, of course, with everything being uploaded in a millisecond and commented on.

Abdullah Boulad 00:44:58  And most likely also with the mistrust comes this who I'm really feeling and who I am and who I am for the public.

Abdullah Boulad 00:45:09  So it's like I'm two personalities.

Dr. Sarah Boss 00:45:11  Exactly.

Abdullah Boulad 00:45:12  And I can imagine that this would also lead to more isolation. Absolutely. feeling lonely, not knowing who is close to me, who is real, who is genuine, and who is just on a payroll.

Dr. Sarah Boss 00:45:26  Absolutely. 100%. And, then also that also happens then to the partners often. So we just see that dynamic, for example. I, I also speak to a lot of partners. and they say that. Yeah, in the beginning, it was still like I still had my normal life that I used to have on the side. But then with time, I, I somehow lost it because there was no way I could meet my old friends anymore. They had, first of all, such a different life. And then second of all, it. There was no privacy anymore, and I was in a public light all of a sudden, and I couldn't, naturally move around anymore. So I started isolating myself with my new partner. And I choose that because I love the partner.

Dr. Sarah Boss 00:46:14  But it's a big topic, because it's like losing something. It's like losing a natural part of life. All of a sudden, if you're not really careful, and if you're not starting to build, to start creating a safe space around you, which is more and more difficult now with even drones flying around and, and even on on properties and everything, you know the topic privacy is a really big topic. And what you mentioned before also very important topic that the question who am I really? And who? Who am I allowed to be? Because imagine that some people. But these are like more people in, in, in, in a, in a, in maybe, you know, in a, in a situation like artists or, or, actors that are like, or musicians that are always like in the public eye, but then sometimes you have, advices that tell them now you're supposed to be more like this, or you're supposed to be more like that. You know, it's not like they always choose to do something.

Dr. Sarah Boss 00:47:20  It's also sometimes part of their creative personality, artistic personality. But people from the outside might confuse that and think, okay, that's what this person is and who he is. And they start criticizing that. And that always hurts. Because we're not robots. We can't distinguish between okay, they criticize now my my artistic personality, but that's not who I am. So how are we supposed to just be completely disconnected from that criticism, for example? It does affect, of course, it's normal and it's a very complex psychological situation to deal with that. Usually most people don't have to deal with, and it's much easier to never have to face those kind of dynamics.

Abdullah Boulad 00:48:09  Yeah, I mean, it's it's a general problem, like lack of space for imperfection. Every human would have that, but it's amplified. Yes, it's amplified in this demographic and client group. So they, every little step, every little connection interaction with the new person, with the new, friend, business partner, every travel, with, with coming with, with the mistrust.

Abdullah Boulad 00:48:39  what about children of of, famous and rich and, wealthy people. Well, how do they struggle from their parents, situation?

Dr. Sarah Boss 00:48:57  I was just thinking about that as well. because that's another big, big topic that adds on to it. Like when it comes to privacy, for example, that, you know, these small moments, like taking the kids to school in the morning. You know, if that if that doesn't can't happen anymore because there are people waiting there taking pictures, how you look. And, everybody wants to protect the children. So they usually stop doing that. And they usually have somebody to take them to school or protect them somehow to keep them out of the, the public eye. And that that already causes such a pressure that we're not supposed to have, especially not children. Because children at all, at all, at all Our moments should feel that everything is stable and safe and calm in the in the end around them if possible. Not always, but most of the time.

Dr. Sarah Boss 00:49:54  And if their everyday life is is like this, that's a big, big challenge. And they start already to not have the same, childhood situation as they as, as their friends have. So they're different from the beginning, which we call them in, in, in, in schema language to feel isolation. Some are isolated different even though from the outside it's a good different like they have more than others or they have famous parents, but that can easily turn into a negative. Different. Because different is always a challenge. We shouldn't feel different from the outside, like from some setup from the outside that causes isolation and causes, confusion in a lot of children. And then these natural things like these natural joys. Like being with the parents. Like doing an everyday thing, going to eat an ice cream or just going out doing whatever that that's just missing. Then sometimes. And that's, that's actually really sad if you think about it. Of course, on the other hand side, they can do great things.

Dr. Sarah Boss 00:51:00  And and they tried to do that and they, they, they of course do. And not everybody struggles with it. But it is a topic that, that they need to be really aware of and that they usually need to create a different set up for. So they need, you know, a lot of safe spaces around them, maybe go somewhere else on vacation where nobody would see them or recognize them. You know, it's like, extra effort. Sometimes they have to put in, to have their privacy and their private life. But then, of course, that there is for these children, there is a big, big, Other topic that a lot of times parents then choose to, you know, to to hire nannies or other people because they can't be there because they're really busy or, or or they can't, like I just said, can't go outside themselves all the time for because of the cameras and, and the, the everything that is out there for them. So then they're often raised or surrounded by by people that are not actually their, their family, or they're then sent to boarding school, to private boarding schools, meaning, well, giving them the best possible education in many languages, but they feel very disconnected there often.

Dr. Sarah Boss 00:52:25  And there is a big, problem about then feeling abandoned of, feeling, you know, like causing attachment trauma in a way, and, and feeling isolated again. In.

Abdullah Boulad 00:52:39  So you mentioned educating children or raising children in boarding schools or by nannies. Is something negative or something bad? What would be the effects? To do so?

Dr. Sarah Boss 00:52:52  Well, I wouldn't say in general, of course. You know, it doesn't have to mean that it's something negative. But in, in in some cases at least or in, in many of the, the patients we see or I see that they come from wealthy families and lived in boarding schools, we see that that was a negative factor and we know more and more, unfortunately, finally, about what what we need as human beings, all of us, and part of a secure attachment, what we all need is that that the parents or somebody, the primary caregiver, is present and is attuned to us and to our needs and can can meet them. And if that doesn't happen, because that usually doesn't happen in a boarding school, because that's a boarding school is usually about, education and, discipline.

Dr. Sarah Boss 00:53:49  And of course, a big, a big place with many people. And there is not one person that can really, you know, be there for your needs. So if that doesn't happen, we we can easily develop, attachment trauma in, in, in as a, as a strong word now, but also just a sense as something has the feeling that something has been missing. But maybe, you know, that's not, we're not aware of it because it wasn't there. If there's somebody wasn't there if something wasn't there and we can't name it, we usually don't know that it was missing and we don't know what's going on with us, and we might notice it. Then later when we when how we relate to other people, or when we enter a relationship, or how we feel with ourselves when we're alone, or the need to soothe ourselves, or that there's something missing or something is just not right, and that can that can be related to that. And we know now from trauma research more and more, for example, that neglect has also an incredible impact on on our on our well-being and neglect means that something didn't happen.

Dr. Sarah Boss 00:55:06  So somebody maybe wasn't there or wasn't there enough or couldn't give a child what the child in that specific case would have needed. And that's what we call now, trauma from neglect. And that's also something very important in this patient group, because then, for example, that is also a high risk factor then to develop, problems later on, problems of you know, personality, Problems or interaction problems, anxiety, depression or a lot. Also substance abuse then, which is also something understandable. If we if we look at the big picture, then these kind of people try to, you know, give themselves what they would have actually needed. And that's what we call them dysfunctional coping strategies. But they tried to cope. They tried to make something go away or feel something they don't feel. That's what usually, almost everybody knows more or less when we have a bad day, what people do to, to soothe or to to cope with something.

Abdullah Boulad 00:56:20  So emotional neglect could be at home. but it could be if, if your child, is being, taken care of by, by by the nanny or by by going to a boarding school.

Abdullah Boulad 00:56:35  So there is a lack of, emotional bandwidth with the parents particularly. but what if there is a this dysfunctional family environment, where especially with famous and wealthy families, or if the parents are busy working, never there and, or there is the pressure also for, for for these children to perform. And they have difficulties to create their own identity. Would, would then in that case, let's say a boarding school, be helpful for them? you know, is it you get my point. Is it always a negative thing, or is it good also to get out of your system which is affecting you?

Dr. Sarah Boss 00:57:29  Yeah, it's I think, again, we can't generalize it. It really, really depends on on each child and each personality, each family dynamic and also of each boarding school. Because there are, for example, some boarding school, actually quite a lot of them where, where, where the drug abuse started inside of the school, not from the school obviously, but around the around the during the school years, even though they weren't protected environment.

Dr. Sarah Boss 00:57:58  But that's what how they got in touch through other students. But in general I would say that of course the the best thing would be to work on the family dynamic to make that better first and but some for some personalities, it could be a good thing to to go into a more structured setting without question, because what happens sometimes is that, because there is everything. First of all, people, some parents might feel guilty. Maybe everybody can relate to that if they're working too much or not there, or busy, or maybe also struggling themselves, with withdrawing from from life because of all all this we all we mentioned already or whatever out of whatever reason. So if all that happens, sometimes people would instead of giving the child the time because maybe they don't have it, they would buy them something, a gift or or or more and more or or, I don't know, a great ski trip to wherever or a helicopter ride or whatever it is. And, and in the beginning, that's great for the child.

Dr. Sarah Boss 00:59:13  But with time they they learn that, okay, my parents are not actually there. They, they just give me something or send me someone to take me somewhere, but that doesn't, of course it's not a substitute for quality time with them. And then what's also sometimes happening, but in general with everybody, it can happen in any kind of demographic group that there's a lack of boundaries, because what we need most is love and care and boundaries, because without limits we're lost. And children need limits and boundaries because as the world is overwhelming, and if we don't learn that as children, it's really hard later on, and we have a higher risk for again, for addiction, for having problems and issues in life in general, because we need to feel like we understand how the world works, and that works through limits and boundaries, because else nothing is predictable. And we, we, we don't feel secure somehow and safe in our world. So that's another big topic. I would say.

Abdullah Boulad 01:00:20  Boundaries is, is a it's a big topic.

Abdullah Boulad 01:00:25  What is healthy boundaries when growing up children or raising children.

Dr. Sarah Boss 01:00:30  It's setting limits. Saying no. But of course in a in a caring, loving way. There are great books are about that now. For for example, from Daniel Siegel, all these books are great going into exactly this. Recommendable for every parent. But in the end it's about giving them the structure, saying no. Because if we don't say no, and if we don't say no to a behavior they're doing but in a caring way, they can't learn it from us. And if they can't learn it from us, we leave them somehow unprepared for the life out there. And and the problem, especially in very wealthy families, is that they can go along with it more than somebody else because they, they have more, opportunities to do so. They're more they can they can do more things. More is forgiven or more is taken care of. If they get into trouble, somebody would take care of it. and, and and that's a risk factor because if we don't have the social correction then from the outside also for adults later, if we don't, for example, have a boundary limit there.

Dr. Sarah Boss 01:01:45  We it's really hard because then we have to set the boundary, for example. I think sometimes it's even helpful. We see that a lot with our clients. If they're about to lose their job because of a behavior or their marriage or their friendships, then they really have the motivation to change. But if they if all this is is no is no issue because they can do almost everything, then then they can go so much further and time goes by and the more time we, we repeat it. For example, dysfunctional behavior or an addiction, the harder it gets, of course, to get out of it. And that's also a high risk factor. So going back into the limits and boundaries they're just essential absolutely essential. And and that but that takes time and that takes that. So we need to be there for it. And we can teach our children in difficult moments. That's the that's when we have the opportunity to teach them. But we need to be there for them in that moment. And we need to be regulated ourselves.

Dr. Sarah Boss 01:02:50  And if we are under so much stress because we are public figures or highly achieving, business people, then we're not really there. We're not really present, or we might not be really regulated ourselves because we have under so much pressure. And then these things easily get lost. But in general, now speaking for every parent in every background.

Abdullah Boulad 01:03:14  Would you would you see, let's say we can we can learn how to self-regulate better if we face certain boundaries in life and during childhood.

Dr. Sarah Boss 01:03:25  Absolutely. Absolutely. That's really essential. And we can cope better with everything that's out there. Also with or especially with, with everything when it comes to relationships, with friendships, with boundaries, with partners. Because as there are a lot of misunderstandings happening and all these, what we, what are called personality traits or personality disorders, in the end that what, what they have in common is that the problems the in relationships it they show in relationships that there is something they're struggling with and a pattern keeps repeating and repeating itself.

Dr. Sarah Boss 01:04:08  And the pattern usually has to do with lack of boundaries and lack of secure attachment.

Abdullah Boulad 01:04:15  Yes. And and emotional self-regulation, which which affects in our relationships. Exactly. Then when? When we when we look at families with our. Fame is present, and wealth is, is available. How? How should we protect our children? Or how should they protect their children? Growing up in such an environment.

Dr. Sarah Boss 01:04:43  That's very important. issue a topic because, it's it's really challenging. They have to kind of create a safe space for them. which means the more normality, the better, even though it doesn't seem like it at first. But they they should learn, of course, to appreciate little things because else, as we spoke about earlier. being rich doesn't won't make them happy. It's sometimes even the opposite effect. So they have to learn how to be grateful also, and how to be, How to be able to enjoy the everyday life. And for that, they need normality. Also, normal surroundings.

Dr. Sarah Boss 01:05:29  So, going, you know, going into nature, maybe away from all the cameras and hype and every public light and being more in touch with, you know, the normal surroundings, can be on a mountain in the forest, can be with other families, with friends that are not connected to this part of their life or to their their job or their public figure, and spending as much quality time together, quiet time together, and, in a safe space, in a safe environment and as much as possible, and making giving them the opportunity to develop their self, which also means to to to explore later on what they who they are and what they're good at and what they're interested in. Because what sometimes happens Is that meaning? Well, we parents want to give them one to pass on to them everything we achieved. Or maybe that they don't struggle as much as the parent had to struggle and and and give them everything so that they have it easy and they don't have to go through the same.

Dr. Sarah Boss 01:06:37  But that usually doesn't work like that, because that causes an immense pressure on the children that first of all, they can't compete with what the parents achieved because they already achieved it. They can't do it again, and they might not be as good at what they do. What they were doing is they are, and they shouldn't be in that position to have to compete or be, you know, compared to the parents. And sometimes they don't even want to step into their, into, into their footprint, so to say, because they might not even be interested in it, but they feel forced into it and they want to do their best, but then they struggle immensely because and deep inside feel like they're a failure. I'm not as good as my father was, or I don't like to do it, but I don't dare to tell him. I'm not even interested in a family business or a lot of people, and which is also completely normal. We learn bye bye like role model. We we learn from our parents.

Dr. Sarah Boss 01:07:39  So if we see that all they do is work, or all they do is, you know, enjoy parties and be famous and be on, on, on movie sets. These children don't learn what else? What what should I do actually, when I'm not at work? And what what's important in life? Because what is important in life, important in life is, as we said, the balance is, is being being able to enjoy everything. Being able to enjoy being alone, being in nature, being, having good relationships with other people, finding them maybe a partner that we really like. Maybe have a family or not. But these things are important for everybody. And if we don't show them, you know, how to regulate ourselves, to be able to have all that and how to have moments of stillness and how to disconnect and relax if we don't do that ever. Then where should they learn it from? Until they entered the treatment and the treatment center or therapy. And then they can of course, learn it also.

Dr. Sarah Boss 01:08:47  That's what we call parenting then. But in the end, as good parents. But speaking for everybody again, we should be always role models. And we should never forget that what we live in front of them is what they learn and what they will always, relate to and what will have a deep impact on them.

Abdullah Boulad 01:09:06  I absolutely agree. You know, a role, a role model said is is key here. But if I look at, let's say, a famous celebrity, and then you're always. And you will be always the son of or the daughter of this celebrity. And it's a much more difficult to to develop your own personality, your own passion, your own, whatever in life, because you will always be compared with with that person. Absolutely. Where I find people with wealth, they could disconnect from their wealth as parents and be normal. But it's also maybe unnatural. You know, they have they have worked all their life. They have, maybe suffered maybe because of the suffering they have been successful.

Abdullah Boulad 01:09:56  And, and and I hate this very often also from, from wealthy parents who have achieved a lot like how can I how can I raise my child not to be spoiled, not to be attached with the money? But I still want to live a life where I can enjoy what I've created. Like if they want to travel to. To an expensive vacation. Or if they want to buy a house. And. But the the children. This is like the dilemma I feel between. Between. Fame rich and and raising children. Is there is there a one size fits all how to raise children in these environments?

Dr. Sarah Boss 01:10:44  Yes, we we we all faced that, of course, more or less. But it's extremely important to not lose touch with the real life and the real life struggles. And there are ways around it. Just a little bit. At least not not 24 hours, of course. No question about that. That's not realistic. But people can can find a place for their children, for example, to do community work to, to learn.

Dr. Sarah Boss 01:11:11  You know, for example, here, where we live. It can be anything to, to pick up, trash on the beach to help people in need to do something positive, something social, where they learn, okay, not everybody can go on a, Paradise island on vacation, and not everybody lives like I do. We need to see that. We need to experience that. But as an as us and not as then the son of of a famous artist. And what we see, what a lot of patients do, is that they they if needed, they can change the name of the, of the, of the, of the children, you know, if it ever comes to that. For example, I saw patients that they also became, actresses from a famous actor father, but they didn't want to be compared all the time to him so that they changed their last name back to the mother's name, and they could have a completely or more normal life because nobody related them as an example.

Dr. Sarah Boss 01:12:14  And a lot of people do that. They try to protect their children as much as possible, keep them out of the photos you don't see ever how they look like. Try to have as much a normalized life as possible and try to connect as much. But we should all do that because all of us live incredibly wealthy compared to other countries still. And I think also traveling can do that. Travel to other countries where maybe nobody knows us or knows these people can also be a very important, experience. And it doesn't always have to be a boarding school. You know, they're beautiful, great social projects where young adults can go, to which I always recommend at least a couple of weeks or months working in, in an NGO or with, you know, children in need or wherever it is. They're beautiful programs all over the world to experience, to see. you know what? What's what? What are the what are other ways of living and what is out there in the world to not only see our bubble, I think that's essential and that's a like a necessity to to get the, you know, really a sense for, for what's life, what is out there and then also being able to be grateful because we need that feeling grateful is so incredibly important because then we can enjoy what we have and when we have it, and not always aim for more, because that's a horrible, vicious cycle to want more and more and more.

Dr. Sarah Boss 01:13:49  And we never get to the point where we actually feel like, okay, now I get the gratification. And and that's a big problem. It's like, it's like you're up regulating the reward system. If we get more and more and more and more and we never feel satisfied Side and and we have to go the other way. We know that the satisfaction lies in the in the everyday things and in the small things, and that's what we need to connect to. And that's where also the gratefulness comes in. And that is lost in the world in general and through a lot of, changes in society. But so that's important, I think, for parenting, also.

Abdullah Boulad 01:14:31  For children growing up in a wealthy family or and with fame, they have a big high risk of, having a struggle in their life, compared to growing up off, of the public eye or, or not excessive. Wells, would, let's say, preventive therapy help be helpful here, work on, on on self-development and, yeah.

Abdullah Boulad 01:15:03  And therapeutic support growing up?

Dr. Sarah Boss 01:15:06  Absolutely. That would be that would be the best thing. I think in general to have already something as is prevention in place. Also when we when we're facing risk factors. And that is definitely a high risk factor. And if we see somebody growing up in that situation you know in school we it's used to be it used to be called counseling. You know we don't have to call it therapy right away but to give some guidance. You know, a lot of young people get that usually before they choose a job. Like they get some guidance, counselling. What kind of, education should I start or what kind of job training? So in for for these wealthy people like these normal steps, they just fall away again. Like, it's it's not the same way to be treated. But why should they fall away? They have just the same needs. They're also developing brains. Also young adults also feeling lost, sometimes completely normal struggles. They don't have a different brain, so they need just as much or even more supporting.

Dr. Sarah Boss 01:16:16  You know, defining who what they really want to do with their life and how to cope with all that they have to face. That is not as their friends might have had it. And then what they usually do is relate more to people that live in, in, in similar situations, which is not always what what would be the natural way. Maybe they they like to have other kind of friends, but then they end up surrounded, which is also very a natural thing to do. We surround ourselves by people that might be more understanding or might be in a similar situation, but that is not always the the best way to go either. So yes, definitely would be a good thing to get some more support in that face.

Abdullah Boulad 01:17:02  These children if they grow up without being fully regulated or with the proper support. Therapy. Their traumas they bring with them. Many, many end up with like some substance abuse patterns. How how is your experience around this demographic with substance abuse and what types of substances are are they attracted to and why?

Dr. Sarah Boss 01:17:28  Yeah, there's really a high, high risk for substance abuse.

Dr. Sarah Boss 01:17:33  I think on one hand side it's because it's so available for them. First of all, they can they can obviously afford it. They it's all around them. You know, it's really hard to avoid because they might go, you know, to parties or the people around like from other wealthy families. And it's, it's always a part almost always around them. And they, they're, they kind of grow live into that. Also as a way to stimulate first to party, then stimulate, but then maybe also feel the avoid or try to regulate themselves or try to push them higher because there is some pressure on them and they are supposed to perform or are supposed to give a good, image towards the outside world or whatever they, they're facing. So they, they start like it's also kind of self doping. Sometimes when we speak about stimulants, about, amphetamines, about, cocaine, these kind of substances, ketamine, they're very commonly abused. But then also, a lot of alcohol, of course.

Dr. Sarah Boss 01:18:45  And, yeah. Or drug combination and, so yeah, I think it's one on one hand side. It's, it's, it's more available for them. And then also it's, it's, it's easier forgiven. Like we said before, which is a risk factor because they can. They can just allow themselves to to mess up easier. For example, once I will never forget that I, I saw a client that there was his family paid for somebody that would always clean up behind him like that, no matter what trouble he got into. And that was extreme situations that he he made it go away and he dealt with it and that. And that's a big problem. It's like maintaining his struggle because in a normal situation, what would happen is that if I mess up, then I have to I have to deal with the consequences, and the consequences are good because that means, okay, I have to change something about me, about my behavior. Exactly. Now, I got into that car accident or I lost my job.

Dr. Sarah Boss 01:19:53  Now I have to do something. I have to enter treatment because I don't want. I don't want to lose everything, and I want to obviously change something about my life. But imagine that that falls apart a way and there is no accountability. You can do almost everything and everybody. Somebody takes care of it. Then afterwards that's a big problem.

Abdullah Boulad 01:20:14  This comes also, you know, whenever you are at the top, let's say in a company or as a celebrity, as a famous wealthy person, you have the people around. You are all yes sayers.

Dr. Sarah Boss 01:20:27  Yes, absolutely.

Abdullah Boulad 01:20:27  Absolutely. Who who is out there who says no or set the boundaries when you're in in this situation, that's rare. Yes. And how can you make yourself accountable for something if you don't see it anymore? And I've seen many, many people, in our clinic, and they don't see it anymore.

Dr. Sarah Boss 01:20:54  Yes, absolutely. They see. They say that a lot that everybody says says yes to everything they say because everybody's somehow scared of them.

Dr. Sarah Boss 01:21:04  And that's again when we come to who is my real friend? Because real friends would tell me, you're not. That's not good what you're doing. You know, that's, you know, you're just not going the right way or you son, I'm worried about him, but nobody dares to say anything anymore. Even I even heard from practitioners. Like even even, you know, like specialists around them, not telling them what they want or prescribing the medication they want. Like it's really difficult. And that again, when that's again when it comes to the, the right, I mean, everybody should have the right for honesty and transparency and, and to, to be treated, you know, the way they should be treated. It's a big problem. Absolutely. And also when it comes to again, the the topic of.

Abdullah Boulad 01:21:49  It has a lot to do with, with dependency, you know, codependency in a relationship or of a famous person, or if you surround yourself just by people who are on your payroll.

Abdullah Boulad 01:22:03  So. So basically, if I think about it, you should you should sort of surround yourself with people who have nothing to do with your with your business or with your fame and, dependent.

Dr. Sarah Boss 01:22:17  Exactly. The best way possible. Shouldn't even know more about it. But that's of course hard. Also in the, in the, in the everyday life. And I think what also plays a role is that that they, they live such an extreme in a sense that, you know, for, for, for most people, they, they have celebrations and like there's something special is happening, a birthday or promotion or whatever. But imagine if every day is like living a celebration. There's also a big pressure in the business world, for example, like a lot of business meetings now. High end business meetings they like. There's so many drugs involved and prostitutes and whatever. Incredible restaurant. Two star chef with. You know, everything is like high end and it's not good. Our brain is not built that way.

Dr. Sarah Boss 01:23:14  We not we cannot possibly enjoy the extremes all the time and then expect to be able to enjoy normal things again. It's like it doesn't work like that because evolutionary we build to, you know, look for food. many hours a day. And then if we found berries, we were incredibly happy. And our reward system would fire and, and flood us with, beautiful, feelings. But then they were they were out of season again. And then we had to look for other things. But our brain is still the same even after many more years. But we're we're not. We're not prepared for that. That's really new now that we would flood ourselves with so much reward theoretically. But then most our patients say, you know, I get all this, but I can't enjoy it anymore. I have the best chef at home, or I go to the best restaurant in the world at the moment, but the food doesn't taste good to me anymore. When I think back into my childhood and my grandmother used to prepare me my favorite dish, or that was such a difference.

Dr. Sarah Boss 01:24:21  And that's exactly it. So and that's normal. And that's also part of our treatment to understand again that that's normal. It's like a a dysregulation of our reward system. And we can work on that. Again we can normalize it again. But it is a high risk factor to live like that or to have to to have party every day in champagne every day and whatever kind of lifestyle.

Abdullah Boulad 01:24:47  So you gave me right now an excuse to go to a fast food restaurant from time to time.

Dr. Sarah Boss 01:24:52  If you can enjoy it. Yeah, everything you can enjoy is good.

Abdullah Boulad 01:24:57  Is. Yeah. Okay, so when we when, when this, client group, get into a substance abuse. I understand they want to feel whether a void, emotionally or they want to increase, like, their performance. what else? Is there anything else? they're.

Dr. Sarah Boss 01:25:19  I think also coping, like regulating, for example, a lot of people would take something. I mean, in everywhere, in every. I think everybody knows that to an extent when when they're very stressed and they don't have time or feel like they don't have time to regulate in a healthy, natural way.

Dr. Sarah Boss 01:25:38  they start abusing substances to a downer, you know, to feel more relaxed or like a, a machine, like, turn a button and, And then I'm supposed to be relaxed. So I think a lot of people do it to regulate either down or up, like being again, being productive in the morning, maybe after not sleeping many hours because they had to go to some kind of film festival or whatever, but then in the morning they have to be on the set again. And how, how they, how are they supposed to do that? So they would start taking a sleep medication at night whenever they get home, and that an upper like a stimulant in the morning, and then maybe more substances to be more, more, productive. Or a lot of people also say, actually, deep inside, I don't feel good at all anymore because they're supposed to actually rest or disconnect from all that, or they might even feel depressed and or maybe don't feel secure anymore, like self secure. You know, a lot of people, they seem that they're really secure in what they're doing, but deep inside they feel different actually.

Dr. Sarah Boss 01:26:45  And they they have to cope with that every single day, and then they might abuse substances to be able to deal with that, or to speak in front of many people, or to to play in front of many people. That's really, really difficult. in the end, you know, it seems easy or it seems natural when they're doing it, but there's a high cost to it sometimes. So I think regulation of any kind of emotion or also maybe disappointment or feeling lonely and not feeling, then I think to to to simplify that, I think a lot of substance abuse is either to not feel something, something we, we can hardly cope with or to feel something we don't, and to fill that void and to, to to up tune ourselves somehow.

Abdullah Boulad 01:27:32  What can they do? Because at some point, we have seen we sometimes you see in the media overdosing, suicide, like these are the extremes or someone has gone into a rehab or in treatment or has gone on to rehab and rehab and rehab, ongoing.

Abdullah Boulad 01:27:53  What what could an ideal recovery process for, for these people be?

Dr. Sarah Boss 01:28:00  Yeah. As we see, what is very effective is, is a combination first to give them a safe space, which usually means getting away from their surrounding somewhere where they really feel safe, a beautiful environment and, and really can feel that they're trustworthy relationships to, to the therapist, to many therapists. And then after a detox, then really getting into touch again with themselves, like with the people, with the person behind, or that maybe the person they used to be, if they can, you know, if they if if they can relate to that or maybe in the, in the, the other, the other The group that we mentioned maybe relate first time in their life to who am I really? What do I really need? What do I, really want to do in my life? And for that, they need time, and they need the right professionals to guide them through the process. And then we we need what's what we do here.

Dr. Sarah Boss 01:29:04  I think there should be a lot offered to, to explore, to, to discover many things they can do because it's not one fits all. Everybody needs to find, activities or therapies that we can really benefit from and that we can really keep on doing because it needs to be sustainable. That's the key. That needs to be a change of lifestyle and a change of patterns and something more balanced, like for ongoing, sustainable, success. And that needs to be practiced and, and prepared also. That's what we usually do. Then towards the end of this day that we want to prepare, we want to help implement a healthier routine, a healthier schedule, finding already the right, things to do back home, like really making a difference to not, fall back into old patterns. Because of course, life is is usually about repetition for all of us. And it's really hard to to break patterns and dysfunctional behavior, but it's doable. And with the right setting for sure.

Abdullah Boulad 01:30:20  You mentioned like feeling safe.

Abdullah Boulad 01:30:24  Yeah. This is where it starts to be able to open up to engage with, with the treatment. how, how how do do we achieve the sense of safety for someone who has been mistrusting maybe all his life.

Dr. Sarah Boss 01:30:44  Well, I think that what we know from from a nervous system perspective, we know that actually safety, we feel here safety is actually a gut feeling how we say in English. But safety is actually something we detect. We notice that sometimes that without without knowing or maybe even being aware of it or questioning it, we might feel, like we should not be close to some kind of person, or we might feel a sense of, danger is is what the nervous system would detect. But we might feel like, okay, I better leave now. Or we see that in dogs. Dogs, sometimes they bark to some people and then sometimes they don't. It's because they detect dysregulation in in another being or they don't. And so in the end we need to feel safe with somebody.

Dr. Sarah Boss 01:31:39  That means that that in the best case, the therapists in in a treatment setting should be really regulated and should be, of course, honest. So if they notice, if they can experience that, okay, this person understands me and is honest and transparent. Meaning we explain what we're doing, we explain why we're doing something and and we give them the feeling that they can really trust us and that we can understand them. Then they can finally relax and finally experience that, first of all, not alone with their struggle. And second of all, that they can trust somebody. And then we can, you know, with time that that itself, that therapeutic relationship is already a very effective tool because it allows so-called parenting. It allows us to experience something we might have not had as children because there were there was the caregiver wasn't there or something didn't happen, or maybe something happened that shouldn't have happened. So we can later on in life learn many things or meet our needs and first of all, through the therapies.

Dr. Sarah Boss 01:32:52  But then later on, we learned to do that ourselves and we learn to connect again to our needs. And if we can understand again, if we can feel again, what do I need? What would I have needed as a child? What do I need now? Then we can. We can find the right people that could fulfill our needs, and we can find ways to fulfill them ourselves, by ourselves, or doing certain activities or doing certain, you know, coping, vagus stimulation techniques, however, we want to call them find healthy. Healthy methods can be yoga, qigong, anything. And these things are very, very important. And these things can can happen in a safe, secure environment. And they usually do. And that's actually the the key effect of a good therapy.

Abdullah Boulad 01:33:47  Yeah. So this is also the feeling I have when it comes to our treatment program, the way we create this kind of safety is by being regulated ourselves and co regulate this, this, this feeling and the trust we create.

Abdullah Boulad 01:34:09  then we are now we are back also on on the empathy. Once the the clients feel okay it's authentic. It's genuine. And they really care about about me as a person, not as a figure, not as whatever I have in my bank account.

Dr. Sarah Boss 01:34:30  Exactly, absolutely. And that's the beauty of our work. We see that a lot. I just thought about it the other day. I, for example, I don't I usually don't even know what our patients are really doing. exactly. I know it, of course, overall, because it helps me to to understand their struggles. But usually we don't talk about details or every numbers. They tell me what. And that's the beauty of my work. They tell me what they think I should understand, to help them best. And they give me all the information that they think could be valuable, important to understand. But we don't ask and we don't care, and we don't look up anything. And that's that's sometimes such a new experience, sadly, for our clients, because they're not used to that kind of actually should be normal treatment, that they're just seen as a human being and that we are here for them.

Dr. Sarah Boss 01:35:28  And, and that's usually a very positive experience. And they usually feel like the first time in a long time they can relax and just finally, finally really focus on themselves, even though it seems like their life is to make them feel better or everybody around them. But usually it's not. It's not that easy.

Abdullah Boulad 01:35:51  Yes, and maybe also to experience healthy boundaries. Absolutely nothing.

Dr. Sarah Boss 01:35:56  I absolutely, like you said that the saying no. They really appreciate that because we for example, my position I'm a I'm a psychiatrist, I'm a psychotherapist and other things. But my I'm that's part of my job also to give healthy feedback like to to always be truthful and not to to say what, what a client might like to hear. Of course not. It's not always about that. It's really about carefully like, but carefully. I insist in, in a, in a positive in a, in a caring way again, like a parent should do it. We do it always caring. No parent likes to set boundaries.

Dr. Sarah Boss 01:36:38  I personally think that's the the hardest thing about being a mother is that setting boundaries. I really don't like it, but I know how important it is and I try to do it in the best way possible. And that's exactly the same with the clients that if we set if if we give them that those settings, the settings they would have needed maybe already a long time ago. They appreciate it because then they notice that it comes from a good place, it comes from a caring place. And and that they can, you know, they can experience again structure through that. And again, like I said earlier, structure means safety and means, that the world is more understandable in their own behavior is more understandable because usually they come into treatment because they want to explore. They don't understand what's going on. Why can't I cope with that? And I always insist that our clients are usually extremely intelligent. If they. If they could. If if you could solve it with thinking about it, they wouldn't come because they're extremely intelligent.

Dr. Sarah Boss 01:37:42  They would have solved it already the first day. But it's not through thinking, and it's not about what you have at hand. It's really about what's going on inside of your nervous system and what might have happened or not happened in your childhood. That might still affect you in the here and now. And that's where we are there to guide them and to give them that and to to help them then give it to themselves. And that's a beautiful thing because that empowers them, that gives them then the feeling, okay, now I can cope with it with everything. I can do it, I experience it now. I they showed me and now I can do it myself. I don't need destructive or dysfunctional coping mechanisms anymore, or I don't feel I don't need to isolate myself anymore from all this world around me, or I don't need to be so mistrusting anymore. Because all these, in the end, are defense mechanisms. They learned through time out of bad experiences. And that's a beautiful thing. They can open up again to the world more, and they can be more flexible again and not rigid around behavior.

Abdullah Boulad 01:38:50  Beautiful. Thank you. What would you if you could speak now to to someone who is struggling or to a family member of someone who's struggling in that demographic, what would you tell them?

Dr. Sarah Boss 01:39:07  That there is very, very human and normal to struggle and that, there is support out there and that they should not not hesitate to seek out support because that's that's the key to not, not have to to not have to, let too much time pass and struggle and and then in the end, it all comes to, you know, developing more self self-compassion. Again, like I mentioned before, which is so important to never feel like I'm supposed to not struggle because that's just not human. To say that we wouldn't say that to our friends or to our family either. You're not supposed to struggle. It's just it happens. And, there is help out there and there is support out there. And the sooner the better, because, you know, no need to struggle more than necessary.

Abdullah Boulad 01:40:06  Well said. Thank you very much.

Abdullah Boulad 01:40:09  Thank you for all the work you've been doing and achieving. Also had the balance. I appreciate your your engagement, your support and your your compassion. to the team and of course, to all our clients. Thank you very much, Sarah.

Dr. Sarah Boss 01:40:25  Thank you.