"Overcoming Toxic Shame"

Join Dr. Jill Levitt and me 

at our fabulous new workshop

Sunday, February 5th, 2023

8:30am - 4:30pm PST - 7 CE units

Click here for information and registration

In today's podcast, David and Jill describe their new workshop on Overcoming Toxic Shame. This workshop will feature video snippets from a fantastic session with a beloved colleague named Melanie who struggled with intense feelings of anxiety and shame for more than 8 years. You will see her transformation from utter despair to joy in a single therapy session lasting roughly two hours, and you will get the chance to learn and practice the techniques that were so transformative for her.

Most mental health professionals also struggle with feelings of shame because of their belief that they aren't "good enough" and from fears of being found out. You will have the chance to heal yourself while you master cool new techniques to transform the lives of your patients!

In today's podcast, David and Jill do a live demonstration of a couple of the many techniques they will illustrate on February, which will include the Paradoxical Double Standardl Technique, Externalization of Voices, and the Feared Fantasy. You will not only witness a remarkable change in Melanie, as well as a sudden, severe and unexpected relapse half way through the session. David ang Jill will ask, "If you were the therapist, what would you do right now?" What follows is AMAZING!

Jill practices and serves as the Director of Training at the Feeling Good Institute in Mountain View California. She is also co-leader of my Tuesday evening weekly training group at Stanford (now entirely virtual). This group is totally free and is available to mental health professional in the Bay Area and around the world.

You can reach Dr. Burns at david@feelinggood.com.

Live Therapy with Cody, Part 2 of 2

Last week we presented the first of our session with Cody, a young man wanting help with his fairly severe social anxiety since childhood. My co-therapist for this session was Dr. Rhonda Barovsky, the Feeling Good Podcast co-host, and Director, Feeling Great Therapy Center.

Today, you will hear the exciting conclusion of his session, and the follow-up as well!

Part 2

M = Methods

We focused on cognitive work and interpersonal exposure techniques as well. I will leave it to you to listen to the podcast, as I became so engrossed in what we were doing that I stopped taking notes. However, we used a number of tools within the group, including:

• Identify the Distortions in his thoughts

• Examine the Evidence

• Externalization of Voices

• Self-Disclosure

• Rejection Practice

• The Experimental Technique

• The Feared Fantasy

And more.

Cody received an abundant outpouring of love, respect, and encouragement from those in attendance (LINK).

We also gave Cody two “homework” assignments to complete following the group.

1. Do at least three Rejection Practices in the mall and notify the training group members via email within 24 hours that he had completed this assignment.

2. Complete the Positive Thoughts column of your Daily Mood Log.

If you'd like to see Cody's complet4ed Daily Mood Log, you can check this LINK.

If you'd like to see Cody's intimal and final Brief Mood Survey plus Evaluation of Therapy session, check this LINK. As you can see, there were dramatic changes in all of his negative feelings. However, he wanted to retain some anger toward his childhood friends who made fun of him.

Here’s the email we received from Cody about his homework assignment.

Hello groupers, I can proudly say mission accomplished! Although it took me around 7 hours to do it, I did it.

A lot of emotions came up as I kept trying and chickening out. I really feel like something has changed in me, by the last person I felt almost no anxiety and now I keep asking myself why I was ever afraid of this (I hope it sticks. I know I'll need to keep up this momentum I'm sure).

Having to do this email and being held accountable to you all was what drove me to the finish line. Thanks again, see you all next week!

Thanks to you, Cody. You were incredibly inspiring in group and after and the work you did will touch the hearts of many people, just as you have already touched the hearts of all the people in our group!

And thank you all for listening!

Cody, Rhonda, and David

Featured pic of Cody in one of the small group practice sessions in David's virtual Tuesday training group.

Live Therapy with Cody, Part 1 of 2

I recently treated Cody, a young man wanting help with his fairly severe social anxiety since childhood, during one of our Tuesday evening Stanford training groups. My co-therapist for this session was Rhonda Barovsky, PsyD, the Feeling Good podcast co-host.

The full session will be broadcasted in two parts, starting today and finishing next week.

Part 1

T = Testing

At the start of the session, Cody’s depression score was only 6 out of 20, indicating minimal to mild depression, but his score on the loss of self-esteem was “a lot.”

His anxiety score was 11 out of 20, indicating moderate anxiety, and his anger score was only 2, minimal. However his score on the Happiness test was only 11 out of 20, which is only moderately happy, indicating a lot of room for improvement. If you like, you can review his Brief Mood Survey at this LINK. We’ll of course ask him to take this test at the end of today’s session so we can see what, if impact, we made on his feelings.

E = Empathy

Cody described his shyness like this:

“I’ve been shy for as long as I can remember and feel introverted. It started in middle school. I felt like I never fit in or connected with people very deeply. In middle school, you really want to fit in.

“I wanted my friends to like me, and one day they all started to torment me. Our seats in school were assigned, so I couldn’t get away from them. I cried at recess every day for months. Then, one day, they suddenly went back to being my friends again, and I never understood why.

“When they were tormenting me was the most painful moment of my life. I felt like they were judging me.

“I’ve worked on my own and I’ve gotten over 90% of my social anxiety. At first, I was afraid of answering the phone or even ordering a pizza, so I got a job where I was required to answer the phone and got over it.

“Now I’d like to date, but this has been a problem for me. Also, when I’m treating someone, and this topic of social anxiety comes up, I get uncomfortable. I think if I could overcome the rest of my shyness, it would boost my confidence.

“The podcast you and Rhonda did with Cai on Rejection Practice (LINK) inspired me tremendously, and I managed to do one Rejection Practice. By now I’m chickening out again. I go to the mall determined to do it, but I just keep putting it off. Asking women to reject me seems incredibly frightening, and I’m afraid people will judge me or see me as a predator. I love in a small town, and most people know each other.

“When I was thinking about the session all day today, I felt nervous and my stomach tightened up.

Cody brought a partially completed Daily Mood Log to the session, which you can review at this LINK. As you can see, the Upsetting Event was thoughts of approaching someone at the mall for Rejection Practice.

His negative feelings included the entire anxiety cluster, shame, the entire inadequacy cluster, unwanted, humiliated, embarrassed, the entire hopelessness cluster, frustrated, annoyed, and anger with himself. These feelings ranged from a low of 35% for shame to a high of 100% for foolish and humiliated and 90% for the hopelessness cluster.

And as you can see, many of his negative thoughts focused on the theme of being judged by others who might see him and think he was strange, or a disrespectful jerk, and so on. He was also convinced that women would be annoyed by him, and that the word would spread so that he’d lose the respect of people he cared about.

A = Assessment of Resistance

Cody’s goal for the session was to feel motivated to do the Rejection Practice he’d been avoiding, and to get rid of the negative thoughts that were holding him back.

He said he’d be reluctant, though, to press the Magic Button and make all of his negative thoughts and feelings disappear, so we listed what his fears might actually say about him and his core values that was positive and awesome. Here’s the list we came up with:

Positives

My anxiety

1. My anxiety shows that I care about peoples’ comfort.

2. My anxiety protects me from rejection or doing something foolish.

3. My fears of being seen as a predator show that I want to fit in with the social norms and not be weird or threatening to women.

4. My fears show that I want to be respectful towards women.

5. My fears of being judged show that I care about friends and family.

6. My anxiety shows that I care about my reputation.

7. My feelings of inadequacy show that I’m aware that I have things I want to work on.

8. Those feelings also show that I’m humble.

9. My feelings show that I really care about connecting with others, which is one of the most important things in life!

10. My negative thoughts and feelings motivate me to work hard on changing.

11. They also show that I have high standards.

12. My hopelessness shows that I’ve tried to do Rejection Practice six times and have always chickened out. So I’m being realistic.

13. My hopelessness also protects me from getting my hopes up and then being disappointed.

14. My unhappiness gives me greater compassion for my clients.

15. My anger energizes me and motivates to do something new.

Tune in next week for the exciting conclusion of the live work with Cody!

David and Rhonda

Curing YOUR Social Anxiety—

The Ridiculously Cheap and Awesome

Shame-Attacking Marathon

Jacob Towery, MD

Michael Luo

Today, we are joined by Dr. Jacob Towery and Michael Luo to promote their  upcoming, two-day Social Anxiety Marathon.

Jacob Towery, MD is an adolescent and adult psychiatrist and therapist in private practice in Palo Alto, California.  Michael Luo is a fourth year medical student at the Chicago Medical School.

More on them at the end of the show notes, but here’s the scoop. Jacob and Michael will be offering a mind-blowing, two-day marathon for anyone who struggles with social anxiety, which includes shyness, public speaking anxiety, and performance anxiety. They will both be present, along with more than ten experts in TEAM-CBT, coaching participants in the latest tools for quickly overcoming all social anxiety.

And here’s the amazing thing. You can come and attend, and transform your life, for only a $20 donation to one of their four listed amazing charities.

For information / registration, click here

How cool is that? Don’t pass this up. It will be an in-person, hands-on training experience designed to free you from the fears that narrow your life. You will learn and participate in cognitive therapy exercises, identifying and smashing the distorted thoughts that trigger social anxiety, as well as the Self-Defeating Beliefs that trigger social anxiety like the Spotlight and Brushfire Fallacies, the Approval Addiction, and more.

They will also illustrate and lead you in a wide variety of Interpersonal Exposure Techniques, including Smile and Hello Practice, Self-Disclosure (which Michael demonstrates in real time on today’s show), Rejection Practice, Flirting Training, Shame Attacking Exercises, and more.

David claims that Jacob is likely the world’s top expert in Shame Attacking Exercises, and we illustrate several on the podcast. Rhonda described a Shame Attacking Exercise that I challenged her with. It was incredibly terrifying, but turned out really well!

David also described the impact of self-disclosure on a wealthy and powerful businessman he treated who was so insecure that he was even terrified to be around his wife and children.

People who are socially anxious nearly always try hard to hide their negative feelings out of a sense of shame, so others, even friends and family and colleagues, typically aren’t aware of how they feel inside. Michael courageously discloses his own negative thoughts that triggered feelings of social anxiety at being around Jacob, his mentor.

1. Maybe I’ll make a mistake.

2. I might be wasting Jacob’s time.

3. Then he might not want to mentor me.

These thoughts caused feelings of loneliness and shame. I felt much closer to Michael when he disclose these feelings. Jacob added that he was totally unaware that Michael had been struggling with these thoughts and feelings.

The treatment of social anxiety is profoundly serious, because we are involved in changing the lives of people who are suffering and lonely and inhibited, but the treatment can also be fun, hilarious and of course, enlightening.

Michael wraps up the show by describing the transformation this training has had on his own life.

If you wish to attend, act rapidly because space is limited and will be given out on a first-come, first-serve basis. I hope you can attend, and make sure you let Rhonda and David know about your experiences!

Thanks for listening today!

Rhonda, Jacob, Michael, and David

Secrets of Overcoming Romantic Rejection

Part 2 of 2

In last week's podcast we interviewed Dr. Kyle Jones on the topic of how to overcome romantic rejection, and answered five of your questions. Today we publish Part 2 of that interview. Rhonda, Kyle and David will tell you how to stop obsessing about someone who has rejected you, and whether you can "heal completely,"and how you can get your confidence back, and more!

6. Do you have any tips for moving on and realizing that maybe your ex isn’t as great as you think they are?

David

20 qualities I’m looking for in an ideal mate.

Rhonda

Time, patience, space away from each other. Make lists of qualities you liked about your ex and qualities you wish were different.  Fill out the form: “20 Qualities in An Ideal Mate” and review how many of these qualities your ex had.

7. Since cheating is something that happens so often in relationships, what would you recommend (techniques wise) for someone who’s been cheated on in trying to get their confidence back?

David

YOU CAN USE THE DAILY MOOD LOG, DOUBLE STANDARD, ETC. OVERCOME FEAR OF BEING ALONE. ETC. Examine the Evidence; Worst, Best, Average.

Kyle

Cheating can be really devastating if you and your significant other were in a monogamous relationship. What are the negative thoughts you have about yourself after you’ve been cheated on? Practice talking back to those.

8. How can we boost our confidence back up after a breakup in general even if we haven’t been cheated on?

David

SAME ANSWER.

Rhonda

Do things you love to do with people who love you:  go dancing, go to the beach, go hear music, read, etc.

Daily Mood Log on the thoughts that lead to your lack of confidence.

9. Do you guys believe in the notion that you are capable of “healing completely from your ex (aka completely being over them and all the pain the breakup brought you)” or do you believe that it’s not possible.

David

I MEASURE THINGS. YOU CAN DO WAY BETTER AS YOU GROW. IS THERE A CLAIM THAT THERE IS NOW AN INVISIBLE BARRIER ON YOUR SCORE ON THE BMS. THIS IS SUCH, EXCUSE MY CRUDITY, HOGWASH! HOPEFULLY, YOU’LL NEVER AGAIN FIND SOMEONE JUST LIKE THE PERSON WHO REJECTED YOU!

Rhonda

You may never be exactly the same, why would you want to be?  Every experience in life gives you the opportunity to grow (as cliche and kind of yucky as that sounds).

Maybe you need to acknowledge and examine your role in the breakup, come to a place of humility or maybe even compassion, but definitely understanding. Interpersonal Downward Arrow to look at the Roles and Rules in your past relationships.  Relationship Journal to see how you have contributed to the relationship problems.  Maybe do Reattribution to see what you contributed to the relationship problems and what they did.

10. What are some realistic expectations to have coming out of a breakup, recovery wise, and what are some unrealistic expectations?

David

I DON’T IMPOSE MY STANDARDS AND AGENDAS ON OTHERS! THAT’S LIKE MISSIONARY WORK, TRYING TO GET SOMEONE TO ADOPT YOUR STANDARDS. I TRY TO LISTEN (EMPATHY) AND THEN SET THE AGENDA WITH THE PATIENT, AND THE NEGOTIATION STEP IS SOMETIMES IMPORTANT. I ALSO USE STORY TELLING TO ILLUSTRATE A RADICALLY DIFFERENT REALITY FROM WHAT THE PATIENT “SEES.”

Rhonda

I can’t add anything to that, except, after examining your role in the relationship, you may see the expectations you want to eliminate and the ones you want to maintain.

11. Do you guys feel that you shouldn’t date for a while after getting your heart broken?

David

THIS CAN BE A GREAT IDEA. I ALWAYS INSIST, AS PART OF NEGOTIATION PHASE OF AGENDA SETTING, THAT THE PERSON OVERCOME THE FEAR OF BEING ALONE BEFORE DATING, WHETHER OR NOT A REJECTION HAPPENED.

Rhonda

This is a very personal decision.  Have you had time to heal before getting into a new relationship?  Have you had time to examine your role so you can make changes if you choose, so you won’t repeat the same mistakes in the next relationship?

12. Do you have to move on from your ex to go back out into the dating world again and to possibly be in a relationship again? Do you guys feel that “jumping” from relationship to relationship can be a bad thing? Why or why not?

David

THESE THINGS ARE ALWAYS ON AN INDIVIDUAL BASIS. I THINK IT CAN BE HEALTHY TO DATE A VARIETY OF PEOPLE AND NOT GLOM ONTO THE FIRST PERSON WHO EXPRESSES AN INTEREST IN YOU. THAT WAY, YOU CAN COMPARE A VARIETY OF RELATIONSHIPS AND IN ADDITION, YOUR DATING SKILLS WILL IMPROVE. THE “20 THINGS I’M LOOKING FOR IN AN IDEAL MATE” CAN BE VALUABLE.

Rhonda

“Jumping from relationship to relationship” sounds so judgmental.  Are you finding yourself in relationships where you have similar complaints from your last relationship, repeating patterns that you dislike?  Then I would pause and take time to heal and learn before starting another one.

Kyle

What does be “moved on” really mean here? Would you have to never have a thought about your ex again before dating? That might be impossible! I don’t think there’s anything wrong with dating multiple people or starting and stopping relationships with some frequency – especially if you’re looking for a good fit and it’s not working out with someone.

13. How do you overcome your trust issues when getting into another relationship after your heartbreak?

David

PATIENT WOULD HAVE TO GIVE ME A SPECIFIC EXAMPLE, AND NOT DEAL WITH THIS OR ANYTHING “ABSTRACTLY.”

Rhonda

Daily Mood Log work, starting with a specific event that led to the lack of trust.

Let us know if you would like a third podcast on how to deal with romantic rejection at some point, since we have a number of remaining questions. Thanks!

My book, Intimate Connections, will help you with dating and rejection issues!

You can contact Dr. Kyle Jones at

kyle@feelinggoodinstitute.com

End of Part 2

Secrets of Overcoming Romantic Rejection

Part 1 of 2

In today’s podcast we are proud to interview Dr. Kyle Jones from the Feeling Good Institute in Mountain View, California.

Kyle Jones, PhD is a clinical psychology postdoctoral fellow affiliated with Feeling Good Institute in Mountain View, California where he provides individual psychotherapy in a private practice. He co-leads a monthly consultation group with Maggie Holtam, PhD where therapists can get help with exposure methods for anxiety. He has recently become an Adjunct Professor of Psychology at Palo Alto University - teaching Clinical Interviewing in the clinical psychology PhD program.

Kyle wrote: “Here are some questions from patients of mine for our podcast today - we don't have to go through all of these bust just some talking points!"

We will publish part of the questions in today's podcast, and several more next week. There are even more questions, so let us know if you would want a Part 3 on this topic at some time in the future.

Below you will find the list of questions with some responses by David and Rhonda BEFORE the podcast. To get the true scoop, listen to the podcast, as most of the comments below were simply ideas that popped into our heads prior to the podcast.

Although we focus on romantic rejection in these two podcasts, the idea really pertain to rejection in all segments of our lives.

1. Why do you think it’s so hard for us humans to handle rejection/why do you think we are so afraid of it?

David

THE LOVE ADDICTION SDB. LOOKING TO EXTERNAL SOURCES FOR FEELINGS OF SELF-WORTH AND HAPPINESS. THE CBA IS CRUCIAL, SINCE PEOPLE MAY NOT WANT TO STOP LINKING SELF WORTH WITH LOVE.

Rhonda

Plus, it hurts.  And our brain is wired to experience pain when rejected.  We are wired that way.

Evolutionary psychologists believe it all started when we were hunter gatherers who lived in clans. Since we could not survive alone, being ostracized from our clan was basically a death sentence. As a result, we developed an early warning system to alert us when we were at risk of being rejected by our tribemates. People who experienced rejection as more painful were more likely to change their behavior, remain in the clan, and pass along their genes.

Kyle

Getting dumped sucks! We aren’t really taught how to handle rejection very well in our culture.

2. Are we capable of overcoming the fear of rejection and how do we accomplish that? 

David

You can face your fear with REJECTION PRACTICE. The FIRST SECTION OF INTIMATE CONNECTIONS IS ON OVERCOMING THE FEAR OF BEING ALONE.

Rhonda

Is part of the fear of rejection also a fear of being alone?  You can use the “What If” technique to uncover more about those fears.  Then put the thoughts in a Daily Mood Log, and challenge them with a variety of techniques you can select for a Recovery Circle. You can also face your fears with Rejection Practice and/or Exposure.

3. When it comes to getting dumped do you guys believe there is a good way to approach it communicating wise?

David

YOU CAN USE FIVE SECRETS TO FIND OUT WHY THE OTHER PERSON IS REJECTING YOU. OR, PERHAPS BETTER, YOU CAN TURN THE TABLES ON THE REJECTOR, SINCE IT IS PART OF A CHASE GAME.

Rhonda

If you want to know more about why you were “dumped,” will you trust the other person to be honest with you?  Will you believe them when they respond?  You might want to do a Cost Benefit Analysis to decide whether or not you even want to ask them to explain why you were “dumped.”

Kyle

It depends on the situation. If you have gone through a divorce and have children, you may still need to talk with you ex-partner. Generally, I don’t think it’s a good idea to stay in touch and keep chatting with an ex who dumped you!

4. If we are caught off guard with the breakup and don’t see it coming and all of a sudden one day our partner decides to end the relationship, how do we not let our emotions get the best of us in that moment in that very moment?

David

WHEN YOU SAY, “GET THE BEST OF US” IT SOUNDS LIKE YOU’RE NOT ACCEPTING YOUR FEELINGS. IS IT OKAY TO FEEL FEELINGS? THIS QUESTION SOUNDS LIKE EMOTOPHOBIA.

Rhonda

It’s perfectly reasonable to be sad, to cry, to be shocked and angry.  Why not have those feelings?  You also don’t have to expect to respond with a “perfect 5-Secrets.”  Maybe you need to take a break from each other, breathe, walk, calm down, and then meet again to talk talk, if that is what you want to do.

Kyle

If you get blindsided by a breakup it can really be shocking and overwhelming. It’s okay to feel how you feel in that moment I would think.

5. When it comes to recovery after being broken up with, how do you fight the urge to go back to your ex?

David

THIS URGE IS DUE TO THE BURNS RULE: WE ONLY WHAT WE CAN’T GET, AND NEVER WANT WHAT WE CAN GET. ALSO, CAN DO A CBA ON CHASING.

Rhonda

Also, look at the thoughts that are leading you to want to get back together.  What do they say about you that is awesome?  Then examine them for Cognitive Distortions, and talk back to them with Dbl Standard or Ext of Voices.

Do a “Time Projection,” see yourself in 5 years, in 10 years, in 20 years.  Have a conversation with your future selves to talk about what you want, what kind of person you want to be with, how you want to be treated in the future.

Practice “Distraction,” when you start thinking about your “ex” distract yourself by concentrating intensely on something else, music, work, friends, cooking, another hobby.

Kyle

Come back to reality and remember all the crummy ways an ex may have been treating you, instead of letting your mind ruminate on how great things were during the first few weeks of dating. Come up with all the good reasons to continue wishing/hoping you and your ex will get back together and talk back to those.

My book, Intimate Connections, will help you with dating and rejection issues!

Stay tuned for Part 2 next week.

How Skillful is your Shrink! Now you can find out!

The Exciting Recovery Coefficient--

and the FEAR the grips the hearts of the therapists who are afraid to use it!

People often wonder how skillful or effective their therapist is, but until now, there was no very valid or precise way to know. But now there is, and it has fantastic implications for psychotherapy.

Today, we feature an interview with Kevin Cornelius, a therapist at the Feeling Good Institute in Mountain View, California.  Kevin Cornelius is a Licensed Marriage and Family Therapist in private practice at Feeling Good Institute, with in-person counseling for teens .Kevin is a Certified Level 4 Advanced TEAM-CBT Therapist and Trainer.

I asked Kevin to write a brief description of his evolution from a career in acting to his career as a shrink. Here’s what he wrote:

After many years of working as an actor I was ready for a change. After some painful personal events, I saw a therapist who was quite helpful to me. She helped me see that changing to a career as a therapist could be a great thing for me.

I went to school and got my Master's in Marriage and Family Therapy. Just before I began applying for internships to complete licensure, I learned that the children's theatre group I had grown up in was looking for a new supervisor to lead the group following the death of its beloved founder and leader. This was a wonderful opportunity for me to use my theatre skills and my desire to help young people in their growth and development.

I was very fortunate to be hired and worked as the director of the children's theatre group for 19 years. Towards the end of my years with the children's theatre, I was ready for a change and thought it might be time for me to finish getting my therapy license.

It had been 15 years since I had worked with a patient in a therapy session, so I had a lot to learn! I was so lucky to discover David Burns and his amazing TEAM-CBT. The testing element of TEAM enabled me to see right away where I needed to improve so I could focus my efforts on improving specific skills.

Being able to study with David in his Tuesday group at Stanford was a golden opportunity. Here was a framework designed to make therapy as effective as possible being taught (for free!) by one of the world's greatest therapists.

I'm so happy I followed David's advice to get involved at Feeling Good Institute while I was still pre-licensed. Learning TEAM while I was completing the process to earn my license as a therapist enabled me to start my career in private practice with confidence and a stable foundation. Now, I get to continue learning from mentors at Feeling Good Institute, from the wonderful Feeling Good Podcast, and the valuable lessons I get from my patients.

I'll sum up my good fortune with a theatre reference and quote the Gershwins: "Who could ask for anything more?"

Kevin recently made the courageous decision to find out exactly how he was doing as a therapist. And the results surprised him tremendously.

Background Information for today’s podcast

Outcome studies with competing schools of psychotherapy in the treatment of depression have been disappointing. They all seem to come out about the same, slightly better than placebos, but not much. For example, in the British CoBalT study of 469 depressed patients treated with antidepressants vs antidepressants plus CBT, only 44% of the patients treated with antidepressants plus CBT experienced a 50% improvement in depression after six months of treatment, and the multi-year follow-up results weren’t any better. This was better than the patients treated with antidepressants alone, (only 22% experienced a 50% improvement), but still—to my way of thinking—very poor. We see more improvement than that in just one day in patients using the Feeling Good App.

Here are just two of many online references to that landmark study:

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00495-2/fulltext

https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(15)00495-2.pdf

Because of the disappointing results of research on the so-called "schools" of psychotherapy, the focus is switching, to some extent, to the effects of individual therapists, since even within a school of therapy, there can be huge differences in therapists’ effectiveness. Some therapists seem to have the proverbial “green thumb,” with many patients improving rapidly, while others seem much less effective.

Is there a way to measure this? Now there is!

And do patients have a right to know how effective their shrinks are? That’s what I’m proposing!

For at least twenty years or more, I’ve been trying to sell therapists on my Brief Mood Survey with every patient at every session. That’s because you can see exactly and immediately how depressed, anxious, or angry, etc. your patient was at the start and end of today’s session.

This allows therapists to see, for the first time, exactly how much the patient improved in various dimensions within the session, as well as how much the patient relapsed or continued to improve between sessions.

Here’s a simple example. To make things really clear, let’s imagine that your depression test goes from 0 (not at all depressed) to 100 (the worst depression imaginable, and your patient has an 80 at the start of today’s session. That would indicate a horrendously severe depression, similar to patients hospitalized with depression.

And yet, your patient might be functioning effectively, and might appear reasonably happy. So, bonus #1, you can see exactly how your patient was feeling at the start of the session. You might think of the BMS as an “emotional X-ray machine.”

Now, let’s assume you have an excellent session, and feel like you’re clicking with the patient, and the patient scores 40 on the end-of-session BMS. That would be a phenomenal 50% improvement. Of course, a score of 40 means that the patient is still moderately depressed, and has a way to go, still the goal is a score of 0 on the depression test and a huge boost in the patient’s score on the happiness test on the BMS.

Keep in mind that in the dozens of psychotherapy outcome studies that have been published worldwide, the very highest levels of improvement in months and months of therapy are  never higher than this.

So, I call this the Recovery Coefficient (RC), and it is a very precise measure of any therapist’s effectiveness in treating anything you can measure accurately.

In an informal study of de-identified data of more than 10,000 therapy sessions at a local treatment center about two years ago. I discovered that the RC the first time therapists met with their patients predicted the improvement over the entire course of therapy. In addition, different therapists had vastly different initial RC scores, which can range from -100% in a single session (meaning a complete elimination of symptoms)  to +100% in a single session (meaning severe worsening.)

Sadly, because all patient or therapist identifying information was removed to protect identities, I had no way of letting the therapists know their skill levels!

But today, we are joined by a therapist who had the guts to calculate his RC in ten patients to see how he was doing.

He was initial incredibly demoralize with his percent reductions (RC) of 45% for depression and 47% for anxiety in 50 minute sessions,  He reasoned that a 44% in a class would be a failing grade, but I pointed out that this isn’t the right comparison. After all, if you had a contract to build the Brooklyn Bridge, and could complete nearly half of it in 50 minutes, you’d be doing something incredibly amazing.

Kevin's Depression and Anxiety Recovery Coefficient Calculations

And indeed, Kevin’s scores actually showed he was outperforming all the published outcome studies on depression by a factor of several hundred. Which was, I think, a well-deserved pleasant shock to his system! I’ve always had tremendous admiration and respect for Keven because of his obvious great skill and intelligence combined with world-class compassion and humility.

In addition, patients complete the Evaluation of Therapy Session (ETS) immediately after the session, and rate the therapist on Empathy, Helpfulness, and other crucially important dimensions. Kevin’s Empathy score was 19.6 (96.5%), indicating near perfect empathy ratings from his patients. This is extremely impressive, since most therapists get failing Empathy scores from nearly all of their patients when they start using the ETS scales.

However, what was really cool is that Kevin brought the Daily Mood Log he prepared prior to the podcast. As you can see if you check the link, recording his intense negative feelings and self-critical thoughts when he initially completed his calculations. This helps to explain the fear that so many therapists—nearly all—feel when it comes to being accountable for the first time in the history of psychotherapy.

Here's what he was telling himself:

1. I’m not doing well enough.

2. I’m fooling myself.

3. I’m letting my patients down.

4. I’m a fraud.

5. I should be better.

6. I should charge less.

7. I suck!

During the podcast, we used some TEAM-CBT to deal with these concerns live, in real time, using Positive Reframing, Identify the Distortions, Examine the Evidence, and Externalization of Voices to smash these thoughts.

If you’d like to see the Positive Reframing Table he brought to the session, you can check here.

In Kevin’s case, the RC calculations, which are simple and only take a minute, gave him a huge gift—the confirmation of his immense technical therapeutic skills as well as his empathy.

But what if you’re not like Kevin, and you discover that your RCs are not so great, and that your Empathy ratings are in the failing range. Isn’t that kind of terrible?

Well, it depends on how big your ego is, and how motivated you are to improve. I’ve gotten plenty of horrible ratings on the ETS, and have had lots of sessions with poor outcomes, including sessions when I wrongly believed I was doing a great job. It DOES hurt.

But over the years, my patients have dramatically shaped my therapy approach, and have become my greatest teachers by far. I now enjoy pretty tremendous outcomes with the vast majority of the people I treat, but could never have improved without the constant feedback.

Psychotherapy skills are a lot like athletic workouts, and they say, “no pain, no gain.” This is definitely just as true for shrinks.

Are you a shrink? Do you have the courage to check out your skills?

Here are a couple more random comments. Over the years I’ve seen the scores of many therapists in training, and many established shrinks in the community. And sometimes I’ve been surprised that some of the big name, flashy people were actually very unskilled in real therapy situations.

And I’ve also seen that some of the giants of our field, were humble, kindly individuals, like Kevin, who were quietly working miracles, but not even realizing it.

And I also had this brainstorm. If you’re a patient, and your shrink refuses to use the BMS and ETS, for whatever reason, you could take the test prior to and after each session, and calculate your therapist’s Empathy Scores and Recovery Coefficient scores.

Mmm. I am thinking there might be a business model in here somewhere! Like a website where you could take the tests and get all the calculations automatically. And maybe that type of information could be published...

After all, wouldn’t patients LOVE to have this information BEFORE going to a new shrink for treatment. And isn’t that EXACTLY where our field should be moving? Accountability and transparency?

I hope you enjoyed meeting the incredible Kevin Cornelius today. Thank you for listening and supporting our Feeling Good Podcasts!

Warmly, david

Yikes! Do I REALLY have to share my feelings? 

Last week, we featured Part 1 of a live therapy session with Keren Shemesh, PhD,  a licensed clinical psychologist who began having intense panic attacks when her mother and father visited from Israel.  Today, we feature the exciting conclusion of that session, with follow-up.

If you are interested, you can listen to the follow-up with Keren and Jill who joined us st the end of today's podcast. They comment on the session as well as the details of what happened following the session. I (David) raised the question of why so many of us have trouble being honest and open with our feelings, especially anger. Jill suggested that it might be due to the false dichotomy people see, contrasting aggression with love. But you can be honest and loving at the same time, including when you express feelings of anger. Of course, we make the Five Secrets of Effective Communication sound easy, but these powerful tools actually require an enormous level of skill as well as commitment.

Part 2 of the Keren session: M = Methods

We began the Methods part of the session with a bit more Paradoxical Agenda Setting, and listed some really GOOD reasons NOT to open up more to her mother.

1. I want to protect her because it may be hard and upsetting to her.

2. I’m not used to being vulnerable with my parents.

3. I don’t want to rock the boat or change the status quo.

4. I’m not sure I want a closer relationship with my mother. NOTE: David and Jill were thinking that we often resist intimacy because we have negative pictures in our mind of what real closeness is. For example, if you think it means something yucky and upsetting, you obviously won’t want to get “close.” Jill tried to finesse around this by suggesting Keren might aim for a more “honest” relationship instead of a “closer” relationship.

5. There are things about me that they’ve rejected, like the fact that I don’t really want children. And I’m not so sure I want to make myself vulnerable and get rejected again!

6. I’m afraid I’ll get swallowed up and enmeshed.

We asked Keren what kinds of feelings she was hiding from her mother.

1. My feelings of nervousness and intense anxiety, and the intense somatic symptoms, like the knot in my stomach.

2. I am scared for her future, since she is not in good health and she’s not taking care of herself.

3. I have feelings of anger and resentment about the fact that I’m not the kind of daughter they wanted.

4. I’m sad about her health and seeing her struggle.

5. I feel hurt when I think how I have failed them and let them down.

6. I sometimes feel like I don’t really belong.

At this point, I became so absorbed in the session that I stopped taking notes, so you will have to listen carefully to the recording of the session which was fascinating.

I do recall, however, that we began working on communication, using the Five Secrets of Effective Communication (LINK), as well as tips on how to proceed, taking it one step at a time and not trying to do it all at once, and role playing practice.

Then we did some Externalization of Voices with the thoughts on Keren’s Daily Mood Log, using several strategies: Self-Defense, the Acceptance Paradox, and the CAT, or Counter-Attack Technique.

You can see the Daily Mood Log she completed after the session, based on the work we did in the session, at this LINK.

Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session

In addition, Keren and Jill will be with us to record the follow-up.

T = End-of-Session Testing

You can review Keren’s BMS and EOTS (Patient’s Evaluation of Therapy Session) at the end of the session at this LINK.

Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session

As you can see, her depression score fell to 1, indicating substantial improvement, while her suicidal thoughts and urges remained at 0. Her feelings of anxiety vanished, but her feelings of anger remained fairly elevated, falling from 7 to 4. We would not expect further improvement in this dimension until she’s had the chance to share more of her feelings with her mom.

Her feelings of happiness only increased from 10 to 13, again any further improvement would not be expected until she’s had the chance to do her “homework” following the session. However, her satisfaction with her relationship with her mom increased from 19 to 26 out of 30, which is substantial, while still leaving some room for improvement.

On the EOTs, you will see that our Empathy and Helpfulness scores were perfect, along with our scores on the Satisfaction with Session, Commitment to homework, unexpressed Negative Feelings, and honesty scales.

Here’s what she like “the least” about the session:

“Nothing. This has been a powerful experience.”

Here’s what she like “the best” about the session:

“This has been empowering. The hidden emotion is like a blind spot. I know it is there, but I cannot see it. I loved when David pointed to my avoidance, and I am glad we focused on the hidden emotion. Jill and David were able to see the depth in situation and I feel seen and understood.”

Follow-Up

We exchanged a number of emails following the session, and will also talk to Keren and Jill live on the podcast so you can catch up on what happened.

But here is an excerpt from one of Keren’s emails:

Here is what has happened so far:

On Friday morning, she made some comments about my gray hair and that the fridge gasket was not properly clean. I got really annoyed, but did not say anything. To be honest, I was too angry to use the 5 secrets and needed time to cool off. About after half an hour later, on our way to the acupuncturist, I told her that I love having her over and that it is special to me that we spend time together. She thanked me for everything that I am doing for her on this trip. Then I added: "this morning, when I came to check on you, you commented on my hair and then you told me to clean the fridge gasket..." I was going to follow up with 5 secrets, but before I was able to finish, she interrupted me and said "Gosh, I am so critical! I am sorry, I didn't mean it that way. I can see now why your sister gets upset with me. I can't believe myself." I told her that I love her honesty and while her criticism comes from a caring loving place the how and when she says things sets tone.

This was a breakthrough because even though I did not finish using the 5 secrets I got through to her and felt heard. It was encouraging for me to feel that I could be understood and accepted by her.  I have clients who say that they love the 5 secrets, but like to call it the 3 secrets because they find it effective enough to use only 3. (I still encouraged them to use all 5). I can see now what they mean, I did not finish my 5 secrets spiel and got some good results.

I believe that my conservation with my mother will further trickle during her stay. Perhaps because there is a lot to cover, or perhaps it's the way we communicate.

In either case, I feel good about having the talks that I previously dreaded.

I have not had any panic attacks since, but I don't think they have completely gone. I believe they will be there to remind me to address certain emotions that need addressing.. . .

I will keep you posted and may even send this to the group. Just need to think about it a bit longer.

Responses from the Tuesday Group
who observed our work with Keren

Here are just a few of the comments from the 35 therapists who observed the session. This is part of the feedback we get on the quality of our teaching at the end of every Tuesday training group.

Please describe what you specifically disliked about the training/

Nothing. The live work was fascinating to watch. David and Jill were masterful as always!

This was a truly moving and inspiring and helpful session. I can't think of anything I didn't like about it.

Nothing I disliked. I think I would have liked to see Keren do more deliberate practice with the 5 secrets with grading and more roleplaying. Conceptualization was a bit hard to follow.

Please describe what you specifically liked about the training.

Thank you for such an authentic, moving, beautiful session. And tour-de-force demonstration of TEAM therapy.

Observing David and Jill as co therapists in service of Keren was an amazing learning opportunity! The power between them was exponential and felt like they successfully addressed every angle. . .  I had not considered using EOV and loved how effective that was in crushing Keren's thoughts. I also loved how Jill finessed gently guiding her to address Hidden Emotion, having clear conviction that this was where the "action" was.

I can understand what Keren said that she wants to be closer but does not want to be enmeshed.

I think that it helped us in our work with immigrants and those who live away from where they were born. The discussion about the desire to be a parent or not, was another aspect of the work that I really respected.

Excellent class tonight! Keren's gift to the class was priceless and David and Jill's masterful teaching was outstanding as always. Thank you!!!

I got to feel closer to her and to several group members through their sharing. David touched me with the notion that opening up to one's parents is an important gift that many of them don't get to receive.

Thanks for listening today!

Rhonda, Keren, Jill, and David

When the Hidden Emotion isn't Hidden!

Today’s podcast will feature a live therapy session on September 13, 2022 with Keren Shemesh, PhD,  a licensed clinical psychologist and certified TEAM-CBT therapist. The entire session was recorded and will be presented in two consecutive podcasts. The two co-therapists are Jill Levitt, PhD, a clinical psychologist, and Director of Clinical Training at the FeelingGoodInsititute.com.

Part 1 of the Keren session

I will summarize the work that Dr. Jill Levitt and I did with Keren according to the familiar sequence of a TEAM-CBT Session: T = Testing, E = Empathy, A = Assessment of Resistance (formerly Paradoxical Agenda Setting), and M = Methods, with a final round of T = end-of-session Testing.

In today’s podcast, we will include the T, E, and A. In Part 2, we will include M = Methods and the final T = Testing.

T = Testing

Just before the start of the session, Keren completed the Brief Mood Survey (BMS) which you can review at this link:

Keren's Pre-Session BMS

As you can see, her depression score was only 3 out of 20, indicating minimal to mild depression. There were no suicidal thoughts, and her anxiety score was 10 out of 20, indicating moderate anxiety. She was also moderately angry (7 out of 20) and her happiness score was 10 out of 20, indicating very little happiness. Her relationship satisfaction level with her mother was 19 out of 30, indicating lots of room for improvement. However, she rated “degree of affection and caring” at 6 for “very satisfied,” which is the highest rating on this important item.

We will ask her to take the BMS again at the end of the session, along with the Evaluation of Therapy Session, so we can see what the impact of the session was on her symptoms, as well as how empathic and helpful we were during the session.

These ratings will be important, because the perceptions of therapists can be way off base, but the perceptions of our patients will nearly always be spot-on.

Keren also brought a partially completed Daily Mood Log, which you can see at this link:

Keren's Daily Mood Log (DML) at the start of the session

As you can see, the upsetting event was her mother’s visit from Israel. She had moderately to severely elevated negative feelings in nine categories, along with 17 negative thoughts, along with her rather strong beliefs in all of them. Most of her thoughts were of a self-critical nature, with lots of Hidden Should Statements as well.

E = Empathy

At the start of our session, which took place in front of our Tuesday evening training group at Stanford, Keren described her struggles like this:

On Wednesday I woke up at 3 AM with panic attacks, one after another, and no way of getting back to sleep. I get somatic symptoms, I felt weak, nauseated, with no strength, almost paralyzed, and emotionally unstable.

This was four days after my mother arrived form Israel. In the last 20 years, she and my dad visited me only once, on my graduation. I always had to visit them in Israel every year and was frustrated they none came to visit me in the Bat Area.

On my last visit in May, I expressed my frustration about them not visiting me. They took it to heart and made plans to come for the Jewish high Holidays. My mom arrived first a few days ago and It’s my first time alone with her.

She’s a Jewish mom and she stresses me out. Of course, I was really excited when she first arrived, but after four days I feel overwhelmed. This is SO MUCH WORK!

I feel sad. I’m afraid I won’t be able to function. I just cannot seem to enjoy my time with her. I feel fragile, but I’m hiding it.

She’s 73, and the signs of aging are obvious now. She needs more care, and it’s tough to see her aging.

Dad has always been super athletic, and he’s in great shape, but she doesn’t exercise or take care of herself. She’s frustrated about aging and is angry with us for not accepting her as she is.

I don’t want to seem unhappy. I’m overwhelmed and just feel bad!

David and Jill empathized, and Jill emphasized how much her parents must love her, coming from such a great distance to be with her, but also acknowledged how hard it must be for them and for Keren to be living at such a great distance. Jill pointed out that one of the issues Keren may be struggling with is the belief that their time together should be fun and conflict-free, since the time is so precious.

Keren continued:

My biggest problem is that I feel I cannot be me when I’m around them . . . . They want me to be a different version of myself. . . . They want me to be a mother, and they want grandchildren. But I’m in the 5% of women who don’t have any interest in having children. I’m 46 years old now, and I guess I could see myself adopting, but having a family is a big job, and I’ve never had the passion. So, I feel like I’m a disappointment to them. But we never talk about it.

I sometimes feel invisible and unseen when I’m around them. They’d be so much prouder of me if I had children they could brag about.

Keren also shared her frustration and anger with her mom for not taking better care of her health. Since her mom has been in town, Keren has arranged all kinds of fun activities for them to do together, but Keren’s joy is dampened by the many unspoken feelings she is constantly trying to hide, for fear of conflict and upsetting her parents.

A = Assessment of Resistance

Keren gave us an A+ in Empathy, so we went on to the Assessment of Resistance phase of the session, where we set the Agenda. Keren’s goal was to get over her panic attacks, and we discussed three possible treatment strategies with Keren:

1. The Hidden Emotion Technique: This technique would be based on our hunch that Keren’s panic attacks are the direct result of the many feelings she is consciously, and subconscious trying to hide and sweep under the rug.

2. Dealing with the self-critical thoughts on the Daily Mood Log she provided at the start of the session. LINK

3. Using Forced Empathy to help her see the world through her mother’s eyes, as we did in a fairly recent podcast with Zeina, another member of our Tuesday training group who was in conflict with her mother.

Keren expressed considerable enthusiasm for options 2 and 3. I (David) pointed out that she appeared to be ignoring / avoiding the first option, and raised the question of whether that meant it might be the most productive, but scariest, of the three options.

Keren conceded that this rang true, and wanted to start out with learning to express her feelings more openly and directly, but in a respectful and loving way.

In next week’s podcast, you’ll find out what happened!

Part 2 of the Keren session: M = Methods

We began the Methods part of the session with a bit more Paradoxical Agenda Setting, and listed some really GOOD reasons NOT to open up more to her mother.

1. I want to protect her because it may be hard and upsetting to her.

2. I’m not used to being vulnerable with my parents.

3. I don’t want to rock the boat or change the status quo.

4. I’m not sure I want a closer relationship with my mother. NOTE: David and Jill were thinking that we often resist intimacy because we have negative pictures in our mind of what real closeness is. For example, if you think it means something yucky and upsetting, you obviously won’t want to get “close.” Jill tried to finesse around this by suggesting Keren might aim for a more “honest” relationship instead of a “closer” relationship.

5. There are things about me that they’ve rejected, like the fact that I don’t really want children. And I’m not so sure I want to make myself vulnerable and get rejected again!

6. I’m afraid I’ll get swallowed up and enmeshed.

We asked Keren what kinds of feelings she was hiding from her mother.

1. My feelings of nervousness and intense anxiety, and the intense somatic symptoms, like the knot in my stomach.

2. I am scared for her future, since she is not in good health and she’s not taking care of herself.

3. I have feelings of anger and resentment about the fact that I’m not the kind of daughter they wanted.

4. I’m sad about her health and seeing her struggle.

5. I feel hurt when I think how I have failed them and let them down.

6. I sometimes feel like I don’t really belong.

At this point, I became so absorbed in the session that I stopped taking notes, so you will have to listen carefully to the recording of the session which was fascinating.

I do recall, however, that we began working on communication, using the Five Secrets of Effective Communication (LINK), as well as tips on how to proceed, taking it one step at a time and not trying to do it all at once, and role playing practice.

Then we did some Externalization of Voices with the thoughts on Keren’s Daily Mood Log, using several strategies: Self-Defense, the Acceptance Paradox, and the CAT, or Counter-Attack Technique.

You can see the Daily Mood Log she completed after the session, based on the work we did in the session, at this LINK.

Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session

In addition, Keren and Jill will be with us to record the follow-up.

T = End-of-Session Testing

You can review Keren’s BMS and EOTS (Patient’s Evaluation of Therapy Session) at the end of the session at this LINK.

Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session

As you can see, her depression score fell to 1, indicating substantial improvement, while her suicidal thoughts and urges remained at 0. Her feelings of anxiety vanished, but her feelings of anger remained fairly elevated, falling from 7 to 4. We would not expect further improvement in this dimension until she’s had the chance to share more of her feelings with her mom.

Her feelings of happiness only increased from 10 to 13, again any further improvement would not be expected until she’s had the chance to do her “homework” following the session. However, her satisfaction with her relationship with her mom increased from 19 to 26 out of 30, which is substantial, while still leaving some room for improvement.

On the EOTs, you will see that our Empathy and Helpfulness scores were perfect, along with our scores on the Satisfaction with Session, Commitment to homework, unexpressed Negative Feelings, and honesty scales.

Here’s what she like “the least” about the session:

“Nothing. This has been a powerful experience.”

Here’s what she like “the best” about the session:

“This has been empowering. The hidden emotion is like a blind spot. I know it is there, but I cannot see it. I loved when David pointed to my avoidance, and I am glad we focused on the hidden emotion. Jill and David were able to see the depth in situation and I feel seen and understood.”

Follow-Up

We exchanged a number of emails following the session, and will also talk to Keren and Jill live on the podcast so you can catch up on what happened.

But here is an excerpt from one of Keren’s emails:

Here is what has happened so far:

On Friday morning, she made some comments about my gray hair and that the fridge gasket was not properly clean. I got really annoyed, but did not say anything. To be honest, I was too angry to use the 5 secrets and needed time to cool off. About after half an hour later, on our way to the acupuncturist, I told her that I love having her over and that it is special to me that we spend time together. She thanked me for everything that I am doing for her on this trip. Then I added: "this morning, when I came to check on you, you commented on my hair and then you told me to clean the fridge gasket..." I was going to follow up with 5 secrets, but before I was able to finish, she interrupted me and said "Gosh, I am so critical! I am sorry, I didn't mean it that way. I can see now why your sister gets upset with me. I can't believe myself." I told her that I love her honesty and while her criticism comes from a caring loving place the how and when she says things sets tone.

This was a breakthrough because even though I did not finish using the 5 secrets I got through to her and felt heard. It was encouraging for me to feel that I could be understood and accepted by her.  I have clients who say that they love the 5 secrets, but like to call it the 3 secrets because they find it effective enough to use only 3. (I still encouraged them to use all 5). I can see now what they mean, I did not finish my 5 secrets spiel and got some good results.

I believe that my conservation with my mother will further trickle during her stay. Perhaps because there is a lot to cover, or perhaps it's the way we communicate.

In either case, I feel good about having the talks that I previously dreaded.

I have not had any panic attacks since, but I don't think they have completely gone. I believe they will be there to remind me to address certain emotions that need addressing.. . .

I will keep you posted and may even send this to the group. Just need to think about it a bit longer.

Responses from the Tuesday Group
who observed our work with Keren

Here are just a few of the comments from the 35 therapists who observed the session. This is part of the feedback we get on the quality of our teaching at the end of every Tuesday training group.

Please describe what you specifically disliked about the training/

Nothing. The live work was fascinating to watch. David and Jill were masterful as always!

This was a truly moving and inspiring and helpful session. I can't think of anything I didn't like about it.

Nothing I disliked. I think I would have liked to see Keren do more deliberate practice with the 5 secrets with grading and more roleplaying. Conceptualization was a bit hard to follow.

Please describe what you specifically liked about the training.

Thank you for such an authentic, moving, beautiful session. And tour-de-force demonstration of TEAM therapy.

Observing David and Jill as co therapists in service of Keren was an amazing learning opportunity! The power between them was exponential and felt like they successfully addressed every angle. . .  I had not considered using EOV and loved how effective that was in crushing Keren's thoughts. I also loved how Jill finessed gently guiding her to address Hidden Emotion, having clear conviction that this was where the "action" was.

I can understand what Keren said that she wants to be closer but does not want to be enmeshed.

I think that it helped us in our work with immigrants and those who live away from where they were born. The discussion about the desire to be a parent or not, was another aspect of the work that I really respected.

Excellent class tonight! Keren's gift to the class was priceless and David and Jill's masterful teaching was outstanding as always. Thank you!!!

I got to feel closer to her and to several group members through their sharing. David touched me with the notion that opening up to one's parents is an important gift that many of them don't get to receive.

Thanks for listening today!

Rhonda, Keren, Jill, and David

Ask David: Featuring Matt May, MD

Can hypnosis be used for evil?
Can you fall out of love?
Why does cheerleading fail?

In today’s podcast, we discuss three intriguing questions from listeners like you:

1. Can hypnosis be used for evil? Matt says no, David mainly agrees, but isn’t entirely convinced.

2. Is it possible to fall out of love? This can and will happen. What can we do about it?

3. Empathy vs. Cheerleading: What’s the difference between cheerleading and genuine empathy with someone who’s upset?

Can hypnosis be used for evil?

David and Matt describe their experiences, both as kids and later as shrinks, with hypnosis. David and Matt both used hypnosis early in their careers, especially in David’s one-session treatment for smoking cessation, which Matt also used. But as their TEAM-CBT skills have grown, both of them use it much less frequently.

It can be used for many purposes. In a recent podcast # (link) with Dr. Jeffrey Lazarus, we learned that it can be used for warts as well as a wide range of psychosomatic problems, like Irritable Bowel Syndrome and tics, as well as bedwetting, school phobia, performance anxiety, and more. Matt strongly believes that agenda setting (also called Assessment of Resistance) is just as important in hypnosis as in TEAM-CBT. You have to first bring the patient’s subconscious resistance to conscious awareness and melt it away using paradoxical techniques in order to optimize the chances of success with hypnosis.

Matt pointed out that hypnotic states can be quite powerful, and can even be used for surgery, but emphasizes that people will never td what they genuinely don’t want to do when hypnotized. He says that hypnosis is really a form of willful collaboration between the hypnotist and the hypnotic subject. Although stage hypnotists seem to have some kind of “Svengali” power over the volunteers who come up to the stage to be hypnotized, these people are actually subconsciously volunteering to act silly and have fun in front of the audience. This doesn’t mean they are faking it, but it does put these shows into a slightly different perspective.

David described many goofy things he did as a teenager after he purchased a book called “25 Ways to Hypnotize Your Friends” at a magic store in Phoenix for 25 cents, and found that the techniques actually worked with many of his friends. He sometimes had a lot of fun giving post-hypnotic suggestions, and that he and his friends found hypnosis to be incredibly exciting and fascinating.

Once he hypnotized a friend named Jerry and told Jerry that after he woke up, every time he heard the word, “TV,” he would shout out “Boing” in a loud voice without realizing it. In addition, his subconscious mind would keep track of how many “TVs” he heard, and then he’d should Boing that exact number of times.

David explains:

Then we went to the local Dairy Queen a few blocks away all ordered at the window, one by one. When it was Jerry’s turn to order, and the lady asked him what he wanted, we all started saying “TV, TV, TV” as fast as we could, and Jerry would shout out “boing, boing, boing” in a loud, confident voice!

She said, “I didn’t quite get what you want to order,” and when Jerry tried to order, we did it again.

It seemed incredibly funny, and fun, but in retrospect I WAS using hypnosis to kind of take advantage of someone, so you might say it CAN be used for evil, perhaps. However, Jerry didn’t seem to mind, and we all thought it was a pretty exciting adventure.

When I was a senior in high school, one of my teachers said that hypnosis was dangerous and told me to stop hypnotizing my friends, so I got scared and gave it up until I became a psychiatrist years later.

Like anything, hypnosis is just a tool, and it can be helpful for suggestible individuals, but we have more than 100 techniques in TEAM-CBT, because no one tool has the answer for everybody and every problem.

David and Matt both agree with anxiety, depression, and anger are very much like self-induced trances, since you are giving yourself and believing messages (hypnotic suggestions) that aren’t actually true. For example:

• The depression trance: “I’m no good. I’ll be depressed forever.”

• The anxiety trance: “Something awful is about to happen. I’m in incredible danger.”

• The anger trance: “You’re no good!”

Psychotherapy can be seen as an attempt to get each patient to “wake up” from the trance that has trapped them.

In David’s opinion, politicians sometimes put their followers in trance-like states, getting them to believe repeated suggestions that are blatantly untrue. We saw this in WWII, where Hitler essentially “hypnotized” an entire nation to believe some horrific lies and to spur them to unspeakably horrific actions.

Of course, as Matt has pointed out, you have to WANT to be hypnotized, so possibly the German people wanted to see themselves as superior human beings who had been victimized unfairly by evil forces that needed to be eradicated. So, killing and the abuse of him beings became the focus and purpose of the nation.

Is this possibly also happening today? And is that why narcissistic leaders want to control the media, so they can control the “hypnotic messages” that people get, and why they lash out in such a hostile way at anyone who dares to challenge or contradict them?

Is it possible to fall out of love?

A podcast listener says she often falls out of love with her husband, but after they talk things over, and resolve their differences, she falls in love again. She wants more on this topic, so Matt, Rhonda and David discuss the pitfalls of pursuing perfect, romantic love. David reminds us that some of the most successful marriages are in India, where the parents decide who you will marry. David said that when he was in private practice in Philadelphia, 60% of the patients he saw did not have a loving partner, and most were trying to find someone to love. That’s why this is one of his favorite topics.

Then Matt, Rhonda and David contrast healthy vs unhealthy love, and Matt created the following table that contrasts them.

Perfect Love

By Matt with a little editing from David

Cheerleading vs. Empathy

Rhonda describes a recent traumatic experience which was profoundly disturbing to her. However, when she tried to tell a friend how upset she was, her friend did “cheerleading,” telling her that she shouldn’t be so upset, that she’d feel better again soon, and so forth. Rhonda said it was very annoying to be on the receiving end, and her friends efforts to cheer her up actually made her feel worse.

Then, when two friends simply used the Five Secrets of Effective Communication to “listen,” it was a great relief.

David recounted a similar experience when his beloved cat, Obie, disappeared in the middle of the night, and was likely killed by a predator animal in the woods behind his house.

When David told his Tuesday group what had happened, one member of the group similarly tried to cheer him up, which triggered an angry rebuke from David, who told her NOT to try to take his grief away. He said,

“My grief is my loving connection to Obie, who was my best friend in the whole world. I will grieve his loss for the rest of my life. And to this very day, I talk to Obie, as well as my good friend Marilyn Coffy who passed away recently, every time I go out slogging. This is not a problem that I need help with, but a gift of love.”

We’ve touched on the codependent urge to cheerlead that so many people, including shrinks, have. For example, our podcast on “How to help, and how NOT to help,” covers this topic pretty thoroughly. However, we decided to focus on cheerleading again today, since it is such an important topic, and is a bit of an addiction that many people have.

The following is a chart we discussed during the podcast, and you might find it helpful.

Cheerleading vs. Empathy
by David , Rhonda, and Matt

When you empathize, you give the other person zero, and zero in, instead, on how they’re thinking and feeling. That’s why I (David) call Empathy the “zero technique.” But, paradoxically, when you give them “nothing” you are giving them “everything.”

In case you’re interested in honing your own empathy skills, you can take a look at the Five Secrets of Effective Communication (link). To develop these skills, you might want to read Feeling Good Together (link), but make sure you do the written exercises while reading. Otherwise, you’ll only get intellectual understanding of them, whereas skill is what you actually need, and that can only be developed with practice!

Sadly, most people, including therapists, believe that their empathy skills are already excellent, but that is rarely valid! In fact, there’s a ton of room for improvement in ALL of us!

We thank you for joining us today. Please keep your excellent questions and warm comments coming in. Rhonda and David want to thank Matt for his frequent, brilliant, and heart-warming appearances on the Feeling Good Podcast.

Remember that we’re still trying to grow our show, and recent hit 6 million downloads. We are currently getting around 160,000 downloads per month, which is terrific. It would help us a lot if you give a five star review for our show wherever you get your podcasts, as that might boost our ratings. We love our fans and thank you for listening!

Horrific World Events: Can TEAM-CBT Help Us?

Featuring Live work with Meina

Last week, we presented Part 1 of the session with Meina, a young woman struggling enormously because of her feelings about the new Iranian revolution. Today, we present the exciting and unexpected conclusion and follow up of the incredible session with Meina.

Part 2: The Conclusion

When Meina returned, her mood scores were very similar to what they’d been at the start of the previous session. This indicated that empathy alone was not sufficient to trigger any meaningful changes in how she felt. She said that she’d had some fears about what listeners might think, since, as we mentioned, Meina rarely, if ever, opens up about how she’s feeling inside, so talking openly on the podcast definitely means facing her fears and venturing into some radically new territory.

The ineffectiveness of Empathy alone is important, because she graded our Empathy as an A+. Many therapists wrongly believe that empathy is the most healing tool we have in therapy. This is idealistic, but wrong. Empathy is definitely important, but without the A and the M of TEAM-CBT, very little, if anything, will change.

And, in most instances, patients appreciate good listening, that’s for sure, but they want more. They want tangible changes in how the feel and interact with others.

Today, Meina showed more emotion. She mentioned that she’d been a Michael Jackson fan, and liked his song about how our (inner) voices don’t get out. She was feeling tearful, and angry, and said that in her work, her voice was not coming out, and this was a matter of great distress.

She also mentioned that after she cried and expressed her rage about the young woman who was murdered by the morality police, an annoying “eye twitch” that she’d had for six months suddenly disappeared. Meina has also had many experiences in the past of experiencing health anxiety symptoms whenever she’s upset about something and hides or suppresses her negative feelings, like anger.

She had participated in many of David’s Sunday hikes before the pandemic, and sometimes had weird somatic sensations, fearing she had some neurologic disorder, only to have her symptoms instantly vanish when she finally expressed her anger. Many of you will recognize this as David’s “Hidden Emotion Technique.”

She also said she’s afraid she’ll be seen and stereotyped as an “angry woman” if she shows her anger, and said she may even have an Anger Phobia, thinking that anger shows that you’re a “violent person.”

She said that she’s always been quick to get angry, and wanted to focus the session on anger. Her goal for the session had shifted in the two days since we did Part 1, and she now wanted to learn how to express her anger more effectively.

M = Methods

In the rest of the session, we used the TEAM interpersonal model to deal with an intense conflict Meina had recently when she was trying to get her colleagues to issue a statement on behalf of her institution supporting the women in Iran who were protesting, and had partially complete the Relationship Journal in preparation for today’s session.

As you may recall, when you use the RJ, you will discover—and this can be quite shocking—that you are actually causing the very relationship problems that you are complaining about. And this came as a huge surprise to Meina.

The remainder of the session was incredibly inspiring, and Mina did some magical work. I’ll let you listen to the rest of the session to see how the work unfolded. If you’d like to review Meina’s RJ, you can click this LINK.

End of Session T = Testing

If you’d like to see Meina’s end-of-session mood ratings, along with her Evaluation of Therapy Session, you can check this LINK.

If you’d like to refresh yourself on the Five Secrets of Effective Communication, you can click this LINK.

I was incredibly proud of the brilliant and inspiring work that Meina did during this session. She experienced the “Great Death” of her “self,” along with the “Great Rebirth,” or the “waking up” of the “non-self.”

At the start of this podcast, we asked the question of whether TEAM-CBT could be of help when people are struggling because of events that are both real and horrific. Now perhaps you see my answer: a resounding and unexpected YES. However, there are a couple of disclaimers.

First, the person has to be asking for help, and Meina definitely was. Having an agenda that makes sense to the patient is always, in fact, one of the most important keys to successful therapy.

Second, the therapy will usually be totally unexpected, and the work we do with each person will be highly individual. We’re not in the business of creating simple formulas to deal with this or that problem. Instead, TEAM emphasizes a step-by-step process which will be unique and totally different for every person you work with.

And finally, we have to thank our old friend, Epictetus, for once again reminding us that our feelings do not result from what’s happening, but rather from our thoughts about it. And the goal is NOT to blame you for the way you feel, but rather to give you the key to unlock the door and free yourself from the suffering you’ve endured.

Meina, Rhonda, and I hope the incredible and brave work that Meina did in this session will be helpful for you, too!

Horrific World Events: Can TEAM-CBT Help Us?

Featuring Live work with Meina

Today, we see lots of horrific events, and violence and hatred seem to be on the upswing. There are the repeated and horrible mass shootings in the US, the horrific war in the Ukraine, and the extensive protests that are rocking Iran. Those problems are real, and terrible in reality.

So, maybe the TEAM-CBT model, with its emphasis on our interpretations of reality, and our relationships with others, might seem like irrelevant and useless tools.

Or are they? Let’s check it out. Sometimes, as you’ll see, things can a take sudden and unexpected change in direction in TEAM-CBT if you follow the energy. There is no “formula” for treating anything. We treat humans, not diagnoses or problems. But we do go through the T, E, A, M model in a systematic way so we can find out what, if anything, each patient wants help with, and then design an individualized plan to make that happen, if possible.

Part 1

T = Testing

Today’s guest, whom we’ll call Meina for protection, migrated to the United States from her mother country, Iran, as a young woman, and she’s definitely upset. In fact, her mood scores are among the most severe that I’ve seen recently. Her depression score of 15 out of 20 indicates severe depression, and her anxiety and anger scores of 19 and 20 out of 20 indicates extreme anxiety and anger.

You can see Meina’s Daily Mood Log at the start of the session as well, with nine categories—depression, anxiety, guilt, loneliness, humiliation, hopelessness, frustration and hatred all estimated between 90 and 100 out of 100, again confirming the most extreme upset a human being can experience.

As you might expect, her happiness score was 0 out of 20, indicating no happiness at all, and her Relationship Satisfaction Scale score, thinking of her husband, was only 19 out of 30, indicating considerable marital distress.

What’s causing those feelings? Well, let’s take a look at her negative thoughts and how strongly she believes them:

1. I’ll always suffer because of being born in Iran: 90%

2. My heart will stop from feeling so much hatred. 80%

3. There’s nothing I can do to help (the women who are protesting.) 100%

4. It is pathetic that I can’t stop feeling so angry. 90%

5. I’m going to get sick because of these feelings. 90%

6. Many young women will be tortured and killed. 100%

7. I’m going to lose all my friends because I’m so angry. 70%

8. My marriage will also be negatively impacted. 100%

E = Empathy

In the empathy phase of the session, Rhonda and David simply listened, as Meina described terrifying memories of the being a child during the Iran Iraq war, and being left alone to care for her younger sister when her parents were away every day, and bombs were coming down all over the city. She said that on many occasions she was so scared that she wanted to commit suicide by jumping out of the window of their apartment in Iran.

And now, all those terrifying memories have come flooding her mind again, triggered by the events in Iran, as well as her fears and run-ins with the “morality police” when she was a young woman. She expressed profound connection with the young women who are now fighting the intense suppression of human rights in Iran, all in the name of religion!

Once their car was stopped, and a policeman put a gun to her mother’s head because she had not covered her hair properly. She also described the attempts always to separate the girls and the boys to prevent any type of dating or romantic behavior, and the constant fear of being imprisoned if you did the wrong thing. Meina tells us:

I saw friends who were beaten up, and was humiliated for eating an apple. I was arrested for wanting to go to parties to listen to music. I lived in constant fear of being tortured and had panic attacks by night and by day. . . I left Iran when I was 22 and have never gone back, for fear of ending up in prison. . .

Then, when I finally escaped to the United States, I never fit in. The young people were interested in the latest music, and did not seem interested in my story, in my experiences. I never felt like I fit in. I think I’ve felt lonely my entire life.

Now I feel embarrassed, being from Iran, because it’s such a violent country. . . And I have panic attacks every night. I cope by imagining that I’m in Iran, visiting and counseling girls who have been imprisoned, and giving them tips on how to use the Five Secrets of Effective Communication so they won’t be tortured, raped, and murdered.

Meina said she still feels alone, since few people, including her husband, are really interested in her story, including her horrific memories of growing up in Iran, or how she feels now. She said she also feels intensely guilty, since she still has friends and one relative in Iran who are facing desperate circumstances, while she enjoys comfort and safety here in California.

She rated us as an A+ on empathy, so that brought us to A = Assessment of Resistance.

She added that she always hides her emotions, something she learned to do for survival in Iran, and that she’s afraid to let them out, and continues to hold and hide them. As a result, she struggles with constant tension and anxiety of constantly hiding her anger.

David commented on the paradox that she looks chipper and in control, and can be funny at times. But she feels incredible loneliness because other people rarely know or care about how she actually feels. She added:

What if I’m just being selfish. Maybe I shouldn’t complain so much!

A = Assessment of Resistance

Meina said this about her goals for the session:

I know I’m not in a position to change what’s happening in Iran, but what I do want help with is the fact that I’m so overwhelmed with negative feelings that I’m losing my effectiveness at work and I also don’t seem to be able to connect with my friends and colleagues.

I don’t want to have such hatred and anger for the morality police. And I don’t want all those painful memories to keep coming back and ruining my life, like my uncle and grandmother who suffered from dementia and almost constant terror towards the ends of their lives.

At this point, we ran out of time, and had to schedule the remainder of the session two days later.

End of Part 1

Tune in next week for the fantastic and unexpected conclusion of the work with Meina!

Audrey Kodye

Sunny Choi

Diversity: Trauma and Training

featuring Sunny Choi and Audrey Kodye

Rhonda and I are proud to feature Audrey Kodye, a psychologist with a private practice in Canada, and Sunny Choi, LCSW, who specializes in the treatment of underserved populations in the San Francisco Bay Area. In today’s podcast, these beloved TEAM-CBT therapists bring us an important discussion on the impact of racial, gender, religious and sexual bias, including tips on how to incorporate relevant questions into our initial evaluations of all new patients, as well as illuminating ideas on how to maximize treatment effectiveness with TEAM-CBT.

Both Audrey, who was born in Mauritius, and Sunny, who was born in Hong Kong, describe their experiences with bias and violence, both when growing up, and as adults, and how these experiences shaped core feelings of not being “good enough.”

Sunny explained that how he incorporated the negative messages that were triggered by his traumatic experiences:

I grew up in a privileged family in Hong Kong, and was favored as a male child. When we came to the United States, I was 12 years old and undocumented. I got beaten up because I had slanted eyes, and I was hated because I was gay. I worked super hard, getting a degree in engineering from UCLA and a master's in management from Stanford, and became successful, but got more and more depressed due to my belief that I “wasn’t good enough.”

Now I work with marginalized populations, the poor, people of color, LGBTQ, immigrants, and abused women.

Audrey said:

I’ve also felt like I wasn’t good enough. . . . I’m a light-skinned black woman from Africa, from a lower-class family in Mauritius. . . . My ancestors had to be very resilient due to prejudice, and I’m very proud of them. I’ve also struggled with social anxiety and depression due to the racial trauma I’ve experienced.

Sunny and Audrey have both been helped by TEAM-CBT, and feel it has a great dealt to offer and have appreciated that diversity is celebrated in the personal work so many people do in David and Jill’s Tuesday training group. They say that “TEAM has helped us and our patients as well!.”

They gave some valuable tips on how to incorporate diversity awareness in to treatment with TEAM, but the same tips would be helpful to anyone interacting with a friend or colleague who may have been the victim of abuse.

Sunny added:

“I got scared and anxious when thinking about this topic prior to today’s podcast. What I’ve been through has definitely shaped my behavior, my thinking, and my feelings, and the hatred is still happening today.”

He tearfully described the experience of his cousin who has a Chinese restaurant in Oakland, and someone threw a rock through the window to act out on their hatred for Asian Americans.

Audre said:

"I also felt sad and anxious while preparing for the podcast. It’s not easy to talk about racism and discrimination, and I felt a lot of self-doubt about my own experiences with racism and discrimination before the podcast, because they have so often been invalidated. People get defensive and are often incredulous. They don’t believe it. So you run into conflict and opposition and defensiveness when you try to speak out."

David agreed and emphasized how sensitive and defensive people can be when our “blind spots” are confronted, especially when we’ve been in a state of denial, thinking of ourselves as totally innocent when we’re not!

They discussed three keys in thinking about racism and discrimination:

1. Systemic racism: the Five Secrets of Effective Communication can be helpful. For example, it is important to acknowledge the anger your patients may feel because of the injustices they experience.

2. Micro-aggression: These are subtle put-downs that may sound like compliments, and might even be intended as such, but are really hurtful. For example, when learning that Sunny is gay, someone may say, “Well, Sunny, you certainly don’t act gay!” This statement, which might sound innocent, actually implies that you’re “less than” or “less of a man” if you’re gay!

3. Internalized oppression: This is when the person who is being targeted turns against himself or herself, and internalizes the message that “I’m not good enough,” or “I’m defective.”

David points out that this is similar to Freud’s model of depression, which he thought of as “anger turned inwards.” Although Aaron Beck railed against this construct, I have to admit that the negative thoughts of people who are depressed nearly always do have a hostile, bullying tone.

David also compares racial discrimination and hatred to the three components of “Abuse Contract” he often explains in his work with abuse victims. There are three parts to the contract:

1. I get to abuse you, physically, psychologically, sexually, or financially for my please.

2. We have to keep it secret. If you ever tell on me, or even imply that I’m doing something wrong, I’ll REALLY hurt you.

3. It’s all your fault. You’re the dirty bad one, and you deserve what I’m doing to you. I’m a god who is superior and without fault.

And in spite of the absurdity and cruelty of this “contract,” human beings seem to have the capacity to buy into it, and this includes children and adults as well.

Sunny also emphasized that Asians especially are told NOT to be angry, and that’s why it can be so helpful to use the Five Secrets with trauma patients as well as Positive Reframing to encourage acceptance of anger and seeing that it can be entirely healthy and justified.

Sunny and Audrey provided additional tips on working with marginalized groups. The most important thing is to ask about trauma and encourage the person to talk about it, as opposed to keeping these experiences hidden, even in therapy. He They said that many patients will open up immediately, and will often use the entire therapy hour just venting. The experience of being heard and supported can be deeply appreciated, and can also provide important clues to the origins of the patient’s feelings of depression, shame, and anxiety.

Simple, obvious questions are all that are needed, such as: “Have you ever experienced racism, rape or sexual trauma, or homophobia. Have you ever been bullied or beaten?

Sunny gave many additional examples of subtle racism when he was working in Silicon Valley as a manager. But colleagues he didn’t know often thought a person he was supervising was the manager, and he was the person being supervised.

Audrey described similar experiences when people told her she was super smart, and that was probably because she was “mixed”--that is, not purely of African descent--or because she’d worked “really hard,” implying others who belong to her ethnic group do not. Again, an apparent compliment which is really a subtle put-down.

Sunny tearfully described how he took years and years of voice training, trying to change his accent to sound “less Chinese.” Now he says, “I finally feel okay with who I am!”

Although, I think Rhonda and David might say, Audrey and Sunny, we love you, and you’re way more than “okay” in our eyes. You’re our teachers and you’re showing us the way, and making us aware of our own many errors and biases, in a kindly and loving way. Thank you!”

Thanks for listening today!

Rhonda, Sunny, Audrey, and David

TEAM-CBT with children and teens,
featuring Jeffrey Lazarus, MD

Tics, Irritable Bowel Syndrome, Chronic Pain,
Bedwetting, Fears, Phobias, Performance Anxiety, and more

In TEAM, we usually conceptualize four categories of problems: depression, anxiety disorders, relationship problems, and habits and addictions. Although there are similarities in the treatment of each of these targets, there are also important differences.

Today’s guest, Jeffrey Lazarus, MD, is a pediatrician who specializes in a fifth category, somatic complaints, which can include physical symptoms like chronic pain, dizziness and fatigue without any known medical cause. This category also includes as irritable bowel syndrome, headaches, tics with and without Tourette syndrome, bed wetting, and a wide range of other problems which are common in kids and sometimes in adults as well. Dr. Lazarus also works with anxiety disorders, such as test anxiety, sports performance anxiety, public speaking anxiety, school phobia and more.

Although Dr. Lazarus worked as a general pediatrician for the first 27 years of his career, he switched to hypnotherapy when the painful plantar warts on his feet were unexpectedly cured following a single hypnotherapy session from a colleague. Dr. Lazarus was so impressed that he began studying hypnosis and incorporating it into his work with children, teens, and adults. He now works from a TEAM perspective, incorporating Testing, Empathy, Paradoxical Agenda Setting (also called Assessment of Resistance), and a variety of cognitive methods, along with hypnosis.

He began today’s podcast with a case of a young man he was treating for persistent bed wetting, and was surprised when his patient slammed him in the written feedback on the Evaluation of Therapy Session form following the session, labeling Dr. Lazarus as a bit “narcissistic.” At the start of the next session, Dr. Lazarus responded non-defensively with the Five Secrets of Effective Communication. This won the boy over, leading to a successful outcome. Jeff said that the Evaluation of Therapy Session form and the Five Secrets have “saved him” on several occasions with disgruntled patients.

Jeff then presented several fascinating cases where motivational factors and resistance played a major role in the treatment, and emphasized that treatment failure would probably have been inevitable if these factors had not been brought to conscious awareness. For example, a teenager who frequently had to go home from school because of somatic symptoms listed, at Dr. Lazarus’ suggested, the many advantages of his symptoms, such as “I don’t have to go to school,” “I get extra attention this way,” and more.

After this intervention, the boy decided that it just wasn’t worth it, because there were lots of fun things he was missing out on at school, and his symptoms rapidly subsided.

In another case of bed-wetting, Jeff discovered that a 10-year old knew that he wouldn’t be permitted to go on sleep overs at his cousin’s house until he outgrew his bed-wetting problem. But when he “listened” and encouraged the boy to talk about his distress, the boy explained that his cousin had a “creepy dog” that frightened him, so he actually didn’t want to go on sleepovers.

Jeff encouraged the boy to tell his parents what was really going on, and when his mother said he wouldn’t have to go on any sleepovers unless he wanted to, his bed-wetting suddenly disappeared.

He described many additional cases where motivational factors dominated his patient’s problems, including a promising teenage tennis star who suddenly developed a fear of flying which made it impossible to go with her parents to important weekend tournaments. But with Dr. Lazarus’ support, she confessed that her life was dominated by school, study, and going to tennis tournaments, with no free time to be a “normal teenager.” She finally confided that she was just “tennissed out” and wanted to have more fun in life, to have dates, and so forth.

By subconsciously developed a flying phobia, she was subtly going on strike, and saying “I don’t want to do this anymore.” But by developing a symptom, she could continue to be nice and say “I can’t do this,” rather than saying “I don’t want to do this anymore.”

These subconscious maneuvers are not manipulative, but automatic. When brought to conscious awareness, the patient finds himself or herself in control, and can decide to go in a different direction.

This patient mustered up the courage to tell her parents and her coach, who were understanding, and her fear of flying suddenly disappeared as mysteriously as it had first appeared.

Dr. Lazarus emphasized that the child’s complaints are real—they’re not making up the symptoms, and they need empathy and support, and the chance to tell their story. Parents are nearly always focused on “pushing” and “helping,” efforts that just make the problem worse because the child pushes back.

Although parents do this out of love, their misguided efforts to “help” can actually be a barrier to successful treatment. Jeff said he often does what he respectfully and affectionately calls a “parentectomy,” which means encouraging the parents to stay out of the picture regarding the individual patient problem and homework he assigns.

I have called this tendency of symptoms to be hiding the patient’s actual motives the “Hidden Emotion Phenomenon,” and it’s equally common and powerful with adults with anxiety disorders as well. Essentially, anxiety prone individuals, including children, teens and adults, tend to be exceptionally “nice,” and are often people pleasers. So, they may not always listen to their feelings, which then turn out indirectly, as this or that type of anxiety or somatic complaint.

Essentially, the symptoms are saying what the patient’s mouth cannot say!

Instead of trying to solve the problem, you can view the symptoms as a subconscious solution to a problem that’s being suppressed and not verbalized. Bringing the problem to conscious awareness can make it possible for adult and young patients to express their needs and feelings directly, which typically leads to a rapid disappearance of the initial complaint.

If you’d like to learn more about Jeff’s fascinating clinical work, and perhaps learn more about this ‘Hidden Emotion” phenomenon, and how he integrates hypnosis with TEAM-CBT, you can view a number of resources, including video clips from actual therapy sessions, at his website, JeffLazarausMD.com

And, if you’d like, you can contact him directly at JeffLazarusMD@gmail.com.

Thanks for listening today!

Rhonda, Jeff, and David

Ask David: Featuring Matt May, MD

1. Roy asks: How can I challenge my core belief that there is something wrong with me?

2. Lynn asks: Do you have any recommendations for someone with health anxiety?

Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways.

1. Roy asks: How can I challenge my core belief
that there is something wrong with me?

Hello Dr .Burns,

Regarding podcast 294, I had a few quick questions/suggestions on acceptance. Is it possible to do a podcast with you and Matt and Rhonda on one specific core belief?

The belief: There is Something Wrong With Me

Let me explain. I have dated and had relationships with some very physically attractive women in the past. In the last year I have not been able to duplicate these past successes and I suspect it's because I am at least 10 years or more older than these women ( 23-28). Let's say I NEVER EVER date or have a relationship with my specific type EVER again? This has caused a ton of frustration and some depression ( low) but has been a bit to my self image and self esteem

Thoughts? Thanks Dr. Burns

Roy

David: At my request, Roy provides more information on his Core Belief: There is something wrong with me.

Why believe it?

1. My parent said "What's wrong with you?" whenever I got in trouble in school ( infers there IS something wrong with me)

2. It feels like there is something wrong with me

3. I make mistakes and am not perfect so there MUST be something wrong with me

I believe this Core Belief to be 100 % True

David: I asked Roy to provide a Daily Mood Log.

DML

Activating Event: 3 specific events

A) My ex girlfriend dumped me and ended our relationship

B) A woman I suspect is a super model said No to my request to go out on a date

C) I have recently struck out with the last 5 women I REALLY want to date. They ALL rejected me

Feelings:

Depressed/Down/Unhappy (70%)

Worthless/Inadequate/Defective (80%)

Unloved/Rejected (95%)

Hopeless/Discouraged (99%)

Frustrated/Defeated (99%)

Resentful/Irritated/Upset (99%)

Negative Thoughts

1.There is something wrong with me (100%)

2. I must get this specific woman's love and approval to feel good about myself (80%)

3. If I am a sexy charming guy then this woman would find me attractive. I must not be very attractive (100%)

4. If I played in the NBA or NFL then this woman would be attracted to me (100%)

5. The sex would be amazing if I were to be intimate with this woman (100%)

6. I would be so much happier if I was to have a relationship with this woman (100%)

7. Women like her with incredibly sexy attractive bodies only go for high status millionaires. I am not a millionaire. It's awful I am not a millionaire (100%)

8. I am 10 years older than these women and therefore my age turns them off (100%)

David wrote back, suggesting that Roy list the benefits of his belief that “there’s something wrong with me.”

Positives of believing There is Something Wrong With Me

• Very easy explanation why these specific types of women reject me

• I don't have to make any changes about myself ( clothes) or behaviors ( more charming)

• Familiar feeling and comfort in familiarity

• I can feel sorry for myself and have a pity party

• Gives me something to complain about with my friends lol

• My fantasy ( sexual and relationship) of these specific women remains unchallenged and is a great distraction when bored

• Shows I accept I am not perfect and defective

• I accept responsibility for my failings

• Don't have to get angry or upset about my mother's poor parenting skills

• Incredibly easy cop out whenever I fail to achieve any type of goal

• Can quit working towards a goal when face adversity

Next, Roy identified some distortions in this belief.

Distortions in believing There is Something Wrong with Me

-emotional reasoning

-self blame

-overgeneralization

Why? Feels like there is something wrong with me. I am assuming 100% blame. I am not focused on any positive things done in my life

I am stuck because my mother said what's wrong with you when I was a kid. I concluded there must be something wrong with me. Whenever I get rejected this core belief surfaces.

Is this what you had in mind?

All the Best and THANKS

Roy

David’s response

Hi Roy,

Thanks for the email.

Everything about you and me could be improved. Is that all you mean when you say “there’s something wrong with me?”

Or are you saying you have a “self” that is somehow damaged.? If so, was your “self” always damaged, from the time of birth? Or did it “become damaged” at some point?

If the answer is yes, at what point did your “self” become “damaged?”

To me, conversations about “selves” have no meaning. Conversations about specific flaws or problems do have meaning.

You are kind of kicking your dating problem up into the clouds of abstraction, to my way of thinking, when you obsess about a “damaged self.”

Lots of colleagues who used to come to my Sunday hikes had dating problems, in your age range, and most eventually solved them. But talk about “damaged selves” was never part of the dialogue that I can recall.

I wrote a book on dating, Intimate Connections.

Just my thinking!

d

More from David after an email exchange

I don’t think you answered, or attempted to answer, my question. One problem is that you would like to date and have sex with more younger women who are in great shape. That is something specific and clear. I understand it, anybody can make sense of what you are saying.

When you say, “In addition, I believe I have a ‘self’ that is defective (or whatever), I don’t “get” what you are talking about. Can you explain this at the fourth-grade level?

Do you mean that you get upset when you get rejected? Is that all you mean?

Or do you mean that you get frustrated and disappointed when you cannot get a date with X, Y, or Z woman?

Nearly all men have these reactions at times. Does this mean there is “something wrong” with their “selves?” There are lots of reasons why woman A might not be attracted to man B. Do you agree?

Which reason makes the man’s “self” not good enough.

She may not be attracted to him because he is chasing her, for example. This means that his dating style needs some fine tuning, and perhaps that he needs to learn to be happy when he is alone, and that he does not “need” love or her love, etc. Those are specific things, easily changed.

But I don’t get the “self” bit!

We all having varying qualities and ratings. Take math. Everyone has a certain skill in math. 50% of people are above average, and 50% are below average, in math.

Do you agree? Is there some skill level that means that there is something “wrong” with your “self?”

Thanks!

D

On today’s podcast, Rhonda, Matt and David discuss effective and ineffective approaches to dating, including a mind-set that may be a huge turn-off to women. They also illustrate how to challenge some of Roy’s distorted thoughts using three strategies:

• Self-Defense

• The Acceptance Paradox

• The CAT, or Counter-Attack Technique

Matt and Rhonda speculate that Roy may be harboring some anger toward his mother, and toward women in general. David is less convinced, but more focused on change in the here-and-now, regardless of causes, which can sometimes be difficult to prove. At any rate, if Roy’s goal is to develop more loving and rewarding relationships., there are many available tools.

2. Lynn asks: Do you have any recommendations for someone with health anxiety?

I am a long time fan of your work, and I have a long history of health anxiety. My therapist tells me that this is really death anxiety. I'm not sure I agree...but do you have any recommendations for someone with health anxiety? ( imaginal exposure therapy has not been helpful) I'd be eternally grateful for any insight.

David’s reply

Thanks for the kind words, Paul. I will try to include this in an upcoming Ask David segment!

Matt’s reply:

Using uncovering techniques, like the ‘What if’ technique, Hidden Emotion, Downward Arrow and Interpersonal Downward Arrow could help answer this question.  If you had a problem with your health, what would you worry about, most?  If you were having a problem with your health, what would you worry about, in terms of how other people would treat you?  What would it mean, about you, if you had a problem with your health.  Identify the specific negative thoughts behind your suffering will help your therapist identify methods that could help you.  As far as Death Anxiety, you could consider a chapter in Feeling Good, where David breaks this fear down into more specific parts.  Are you afraid of the process of dying?  The moment of Death?  What comes after?  If so, what are you afraid of, specifically?  Most people don’t fear Death, it doesn’t really exist, like a shadow, just the contrast to something real, Life.

In the podcast, Matt, Rhonda, and David emphasize the role of the Hidden Emotional Model in the treatment of Health Anxiety, and describe two dramatic cases involving rapid recovery, one of them personal—David’s belief he had a lymphoma in his armpit shortly after completing his psychiatric training. The other involved a college student with a long history of health anxiety who David and Matt hypnotized. While in the trance, she suddenly “remembered” what she was actually upset about, and burst into tears.

This was a life-changing moment!

Thanks for listening today!

Matt, Rhonda, and David

313: People who “yes-butt” you.

People who resist exposure.

Does God exist? Does the “self” exist?

How to you justify Ellis? 

"Should" we care about Putin's war on Ukraine?

"

1. Rhonda asks: How can you respond to someone who yes-butts you?

2. Thomas asks: Do we have a self? Does God exist?

3. Thomas also asks: Ellis said we should upset ourselves over someone else’s problems, but how about Putin, and Russia?

Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways.

1. Rhonda asks: How can you respond
to someone who yes-butts you?

David’s Reply

Thanks, Rhonda. We can demonstrate this with Matt on the podcast recording later today!

Matt’s Reply:

The answer is to fall back to Empathy and try to see how we are creating the problem.  For example, when we are giving advice, we may have fallen into a trap, in which we are getting ahead of their resistance and would want to get behind it.

As often happens, the question, and its answer, went in an unexpected direction. Rhonda, like many therapists, noticed that one of her social anxiety patients was subtly resisting exposure—facing her fears. Matt and Rhonda model how to respond to patients who keep putting off the exposure.

This answer illustrates how therapists and the general public alike can improve your use of the Five Secrets of Effective Communication (LINK) with the use of “Deliberate Practice,” with role reversals and immediate feedback on your technique.

Rhonda starts with a low grade, and then rapidly achieves an A grade!

Click here for the Five Secrets of Effective Communication

2. Thomas asks: Do we have a self? Does God exist?

Thank you for giving me your time and attention. I appreciate it, even if we don't agree. I have talked about whether or not God and the self exist. David Hume made the argument about not having a self, only perception. Of course, questions arise if we don’t have a “self.”

Thomas

Thomas also comments on Nathaniel Brandon:

Why do we use the words who? Him? Her? He she they.?? I certainly don't believe Nathaniel Brandon’s horseshit. He talks about a teenage self, a father self, and a child self

And all that is just horseshit.

But do we have any self?

David’s response:

Hi Thomas, Thanks for your question! You ask, “But do we have any self?” You ask about God, too.

People have been asking for my chapter on the “Death of the Self,” and my efforts to debunk the idea of a “self.” I have not had the time and motivation to bring that chapter back to life, since it is so hard for people to “get” what I’ve been trying to say, which is exactly what Wittgenstein and the Buddha were trying to say. But I will try to share one idea with you, in the hopes that it might make sense.

As I have previously suggested, these questions about some “self” or “God” have no meaning. For example, how about this question: ‘What would it look like if someone had no ‘self?’ What, exactly, are we talking about?

I know what this question means: “So you think Henry is too high on himself.” This means that we think some person named Henry is arrogant or narcissistic, something like that, and we want to know if someone agrees with us. I understand this question, it makes sense. There is a distinct difference between people who are quite humble and folks who are overly impressed with themselves. So, we are talking and using words in a way that has meaning and makes sense.

However, I cannot answer the following question because it does not make any sense to me: “Does Henry have a ‘self’?” So, this question, to me, is language that is out of gear, like a car in neutral gear. No matter how hard you press on the accelerator, it will not move forward or backward.

If you cannot “see” or “grasp” the difference between my examples of a meaningful question and a nonsensical non-question, that’s okay. In my experience, few people can grasp or “get” this. But to me, the difference is quite obvious.

Is it okay if I use your email as a somewhat edited “Ask David?” I can change your name if you prefer. I don’t think people will “get” my answer, but hope springs eternal!

David

Matt’s Response

Many brilliant minds have addressed this question in more eloquent and thorough ways than I could, including the Stanford-trained neurologist and philosopher, Sam Harris, in his book, ‘Free Will’ and Jay Garfield in his book, ‘Losing Ourselves’ There’s very little I can say, about this topic, that hasn’t been said more eloquently by individuals like these and many others.

Meanwhile, I’m glad that this question has arisen on the podcast because I see clinical utility in the implications of this question, including in the treatment of depression, anxiety, anger, narcissistic pride and relationship problems.

For example, I might be thinking, ‘I’m so mad at my (bad) self for eating all those cookies’.  Or, I’m so proud of myself for making a million dollars’.  I might start to think I deserve more, because of my special self and feel superior and angry, ‘that persons (bad self) shouldn’t have cut me off in traffic!’.

When we take the ‘self’ out of the equation, we realize that these thoughts don’t make sense.  If our brains are just following the laws of physics, without any self, jumping in there to influence the process, then we couldn’t have done differently, with the brains we had, and neither could anyone else.

Hence, the idea that people have ‘selves’, which can be good or bad, make decisions and the like, is a setup for suffering.  In the cookie example, I would have to train my brain, through practice with therapy methods, to develop a different set of habits, rewiring of my brain, to reach for a salad rather than a cookie.  I can’t simply insist that my ‘self’ rewire my brain for me.  I’d have to practice and do my TEAM therapy homework!

Anger and Narcissism are some of the hardest-to-defeat problems.  However, realizing other people are simply doing what their brains are programmed to do, takes away the anger and blame.  Just like we wouldn’t hold a grudge for years against a wild animal that bit us, we could also forgive and accept a person who bit us.   and we can’t feel unnecessarily superior or proud of our ‘self’ if we accomplish something wonderful, because we don’t’ have a ‘self’ that did those things, just a brain and the right environment, neither of which we can take credit for.

This approach is called ‘reattribution’ in TEAM, which is useful for defeating ‘self-blame’ and ‘other (self) blame’.

Here are some other methods to leverage the no-self concept and free your mind of this hazardous way of thinking:

1. Experimental Technique:  Try to define what a ‘self’ is.  Then conduct an experiment to see whether the self is capable of doing the things you think it can do.  For example, can your ‘self’ stop understanding the words you are seeing on this page?  Or does your brain helplessly decipher the shapes of these letters into meaningful sounds and language?  Can your self exert its free will to decide to focus exclusively on one thing for one minute, like your breath or a point on the wall?    It can’t.  If your self can’t do such simple tasks, what can it do?  One can see meditation as a kind of ‘experiment’ to see whether our ‘self’ is calling the shots, using its free will, or if our brains are just doing what brains do.

2. Socratic Questioning: You can ask questions that can’t be answered to show that the ‘self’ is more like a ‘unicorn’ than a cat.  For example, how big is the ‘self’?  What’s it made of? Where is it located?  Can you see it on a MRI?  No radiologist has ever visualized a ‘self’ and you probably realize you can’t answer these questions, any more than you can, ‘what do Unicorns like to eat?’, bringing us closer to understanding that it’s probably a made up thing.

3. Examine the Evidence: What evidence is there that there’s a Self?  What evidence is there that there is no self? On the latter side, Consider Occam’s Razor, which suggests that the better hypothesis is the simpler one which still explains the observations.  One hypothesis is we have a brain generating consciousness.  Another hypothesis is that we have a brain that generates consciousness and a self that is having those experiences, operating the brain.  Based on Occam’s Razor, the better hypothesis is the former, that we have a brain creating consciousness.

4. Outcome Resistance: People get scared off by the idea that there’s no self or free will, that their brain is making decisions, without a self intervening.  In Christian Tradition, for example, Thomas Aquinas essentially invented the concept of ‘free will’ so that God’s punishment of Adam and Eve could be explained, morally.

Otherwise, God would seem rather cruel, to create a system where he knew that would happen.  This is an example of how ‘free will’ and the ‘self’ are linked to blame and anger.

Even if you don’t believe in God, you might be concerned that the idea that there is no free will would mean that the criminal justice system would fall apart.  Criminals could say, ‘I had no choice’.  Talking back to these elements of ‘resistance’ could help free one’s mind.

For example, without free will, it’s true that blaming other people and retaliatory justice wouldn’t make sense.  However, one could still enforce laws, only in a compassionate way, for the sake of protecting others making the same mistake.  A murderer, if they realized this, could mind meaning in fulfilling their sentence, realizing they were doing a service to humanity, rather than being punished for their bad self.  Instead of seeing other people as having ‘bad’ selves, we can have a sense of sadness, connection and concern, even with a murderer, when carrying out justice, understanding that, ‘there but for the grace of God, go I’.

David mentions, in passing, a mild red flag with the concept of "free will." He points out that this is another concept, like "God" or the "self," that has no meaning, if you really grasp what Ludwig Wittgenstein was trying to say in his classic book, Philosophical Investigations. One way to "see" this, although it is admittedly almost impossible to "see:" because it is so simple and obvious, would be to ask yourself, "What would it look like if we "had" something called "free will?" And what would it look like if we "didn't?"

The question is NOT "do we have free will," but rather, "Does this concept have any meaning? Once you suddenly "see" that the answer is no, you will be liberated from many philosophical dilemmas. But as they say, enlightenment can be a lonely road!

the Buddha, as well as Wittgenstein, ran into this problem that people could not "grasp" the simple and obvious things they were trying so hard to say! As humans, we get spellbound by the words we using, thinking that nouns, like "self," must refer to some "thing" that either exists or doesn't exist! To my way of thinking the question is NOT "Does god exist" or "do human have free will," but rather, do these questions make sense? Do they mean anything?

The answer, to my way of thinking (DB), is no.

However, . . . you might not "get" this!

3. Thomas also asks about Dr. Albert Ellis

Hi David,

Do you agree with Ellis that one is better off without making oneself upset over other people's problems?

What about Putin and Russia and all the violence, another mass shooting, and trump running for president again?

Ellis didn't think one should be disturbed about these things. Or at least upset. What do you think?

David’s reply

Hi Thomas:

Here’s my take. Healthy and appropriate negative feelings exist! One SHOULD be upset by horrific war crimes. I suspect that if Beck and Ellis, were they still alive, they would both strongly agree, but of course, I cannot speak for them!

Thanks for listening today!

Matt, Rhonda, and David!

How to Master the Five Secrets: If You Dare!

In our recent podcast surveys, one of the highest rated show topics was learning therapy techniques, both for therapists and for the general public. That’s why today we’re going to take a deeper dive on some of the fine points of the Five Secrets of Effective Communication. We’ll show you how to use them with individuals who are angry and hostile, including some patients with Borderline Personality Disorder as well as kids who may be ticked off at a parent. These topics were specifically requested by people who completed the podcast survey.

Link to Five Secrets

The Five Secrets are like a fantastic musical instrument, capable of working magic for troubled relationships. You can’t just sit down at a fine grand piano and pound on the keys and expect great music to emerge. You’ll just get cacophony.

To learn the Five Secrets, you need:

• Great determination and desire

• The willingness to endure the “Great Death” of the “self,” or pride.

• Tons of ongoing practice with immediate feedback and deliberate practice involving role reversals until you get it “right,” or receive an “A.”

To get started, Rhonda and David made a list of a few of the most challenging criticisms a therapist might hear from a patient, or a parent might hear from a teenager.

Criticisms from patients included:

• You don’t care about me!

• I’m not getting better. You’re not helping me!

• You charge too much!

• All you care about is your darn techniques.

• That’s not my child’s name! You’re not listening to me!

And this one, from a first time patient referred by the courts:

• I got anxious last night and masturbated to your image, which I found on the internet, and it really helped!

These are some criticisms from kids:

• Stop nagging me!

• Stop giving me advice. I don’t want any advice!

We demonstrated the “Intimacy Exercise” I have created for our training programs. You can use this exercise to work on conflicts with patients and conflicts with loved ones. It works exactly the same way in both situations. You’ll need someone to practice with.

Step 1. One of you agrees to play the critic and the other plays the role of the person being attacked (therapist or parent, for example.)

Step 2. The person playing the role of the critic verbalizes the hostile comment.

Step 3. The person playing the role of the therapist / parent responds as effectively as you can, using the Five Secrets of Effective Communication.

Now you must STOP. The exchange is done. No further interaction in the role playing format is permitted.

Step 4. The person who played the role of the therapist / parent gives himself / herself a grade between A and F. Ask yourself, “How well did I do just now?”

Step 5. The person who played the role of the critic gives the therapist / parent a letter grade, and then provides the following specific kinds of feedback using Five Secrets language.

Positive Feedback: Here’s what you said that worked pretty well. Your Thought Empathy was great, and your Disarming Technique was fairly good. Your Stroking was excellent, especially when you said X, Y, or Z.

Negative Feedback: Here’s what you said that needs a little fine tuning: Your Feeling Empathy was completely missing—you did not acknowledge how the other person was feeling. Your “I Feel” statements were also missing, and there was no Inquiry at the end.

Then you can suggest ways to include the Five Secrets elements that were missing or “off,” and demonstrate how you might improve the response to the criticism with a role reversal, followed by another round of grading and positive and negative feedback.

Continue using role-reversals until both parties can get an A on the exercise, always using the same harsh criticism that you’re trying to learn how to master. Don’t try something new until you’ve mastered the thing you’re working on.

The practice is powerful but hard, and requires the philosophy of “joyous failure.” This means welcoming the chance to get immediate feedback about your skills, or lack of skill, instead of getting blown away, defensive, or “yes-butting” the person who’s trying to correct your technique.

You will hear some pretty dramatic examples of this on today’s podcast!

The Five Secrets can be life-changing, but the price of learning is fairly stiff. If you want the rewards, the exercise we demonstrate in today’s podcast can be incredibly helpful—but scary!

Also, you can read my book, Feeling Good Together, and do the written exercises while reading if you’re a therapist or a general citizen. This helps a lot. Dr. Jill Levitt said she kept Feeling Good Together on her nightstand for more than a year when she first joined by training group at Stanford. Her dedication and hard work have clearly paid off for her.

If you’re a therapist, you can also read the chapters on E = Empathy in my Tools, Not Schools, of Therapy book, and make sure you do the written exercises while reading!

Thanks so much! And good luck if you’re brave enough to try our “Intimacy Exercise!”

David and Rhonda

Check it Out! 

The September, 2022 Podcast Survey 

Dear Podcast fans. Thank you for your responses to our podcast survey yesterday, asking about your likes and dislikes, as well as your suggestions for the future of our podcast.

The following report is based on 355 responses we received the first day of the survey. A link to the survey report will be included in spots so you can examine it for more information!

LINK TO SURVEY RESULTS

Thanks So much!

Rhonda and David

PS Rhonda is now our official Host and Producer!

Demographics

Gender: 58 / 42 = female / male

Age: 21 to >70. None under 21.

Education

• Grad school: 64%

• College: 29%

• High school, grammar school, other: the rest

Comment: high average education level is likely due to high number of therapists

Therapist

• No 56%

• Yes 33%

TEAM certified therapist

• Yes 15%

• No 85%

Podcast Interests

Listen to improve your therapy skills?

• Yes 47%

• No 53%

Listen for personal healing?

• Yes 90%

• No 10%

How many episodes have you listened to?

• All 26%

• A lot 37%

• About half 16%

• Just a few 21%

What elements do you value the most?

• Teaching Therapy Techniques 86%

• Live Work 72%

• Story Telling 58%

• Critical Thinking 57%

• Inspiration 54%

• Warmth 46%

• Laughter 42%

• Guest Interviews (36%)

• Under 30%: Tears (23%), Banter (29%), Controversy (17%),

What types of podcasts appeal to you the most?

• Therapy Methods 194

• Live work 184

• Anxiety Help  168

• Ask David 163

• Self-Help  158

• Depression Help 156

• Relationship Problems 154

• TEAM Training 126

• Habits and Addictions 107

• Procrastination  94

• Guest Experts 88

• Weight Loss 51

Other

What do you think about paid ads?

• Hate it 28%

• Love it 20%

• Unsure 52%

Would you recommend the podcast to a friend?

• Yes 96%

• No 4%

What grade would you give the podcast?

• A 77%

• B 20%

• C 3%

• D 0%

• F 0%

Written Responses

Elements you like the best (selections 356 responses)

• Learning about techniques to help patients from experts in the field! Realistic and humorous portrayals and disclosure

• Always pick up a new concept

• Brilliant teaching and great techniques

• The idea that long- lasting change can happen quickly

• The use of Paradox

• There is done sort of therapy by proxy that seems to happen during live therapy work. Even when situations are different, amazingly meaningful.

• I enjoy the Q&A podcasts where you cover 4 to 5 great questions. Having Rhonda and Matt (and, of course, Dr. Burns!) give their viewpoints on topics that can be helpful to everyone is very useful.

• Learning how to retool my brain.

• I love the feeling of comfort I get from hearing your stories, both personal and from guests. I was particularly touched by Rhonda’s openness when she first joined the podcast and worked through her feelings of inadequacy. I think about those episodes a lot because I relate to them.

• Feel less alone

• The live therapy sessions. Hearing Dr. Burns, Jill, Rhonda and others do externalization of voices, positive reframing, and other techniques is SO incredibly powerful.

• Hundreds more! (link)

Elements you like the least (selections 356 responses)

• The long intros sometimes before the topic gets started

• Boasting, rambling on and on.

• Sometimes the attitude towards other practices and theories is condescending and fails to appreciate the contributions different approaches make to understand and alleviate suffering.

• endorsement emails

• Something I've noticed in live coaching is that there seems to be a strong focus on externalization of voices as a method. In Feeling Great, I love your 50 methods - but I wonder why it feels like 80% of the time you focus on externalization of voices vs other methods.

• Honestly, that's super nit-picky. But I felt like I had to include something in the "liked least" section. Otherwise, I think the Feeling Good podcast is A+++

• Not a fan of the hokey -- the weird Hello Rhondas, etc. Ditto for the four letter words. IMO these detract from the content, dumb down/lessen the credibility of the presenters and content. Distracting and make me cringe. I won't quit listening... just unprofessional and low class.

• Hard to complain about something this good

• Hundreds more (link)

What other topics might interest you?

• Trauma work. Meaning - I find that MANY people are talking about "Childhood Trauma" as if it's a separate thing. "Trauma-Informed Therapy" seems to be a new hot topic. Wondering what you feel about trauma and this seeming growth in trauma-focus.

• Use 5 secrets in relationship with someone with borderline personality disorder

• 5 secrets training

• How to make friends

• How TEAM principles can help you raise happy/healthy kids!

• Discussion of how to manage anxiety when it’s hard to pinpoint the direct cause, making it hard to challenge our thoughts. Also topics on panic attacks.

• integrating the buddha dharma with cbt

• Definitely PTSD (I have PTSD from finding my partner dead after a suicide), body image, more about dating and relationships.

• How to treat low self esteem.

• How to increase happiness. How to make touch decisions about careers or other things that have pros and cons. For example, doing the decision making form and having the scores be around 0 or both negative scores.

• How to heal after a break up and how to manage rejection while dating (e.g., someone rejects you after a few dates)

• I would love to see more episodes on habits and addictions and also a life episode on shame attacking exercises!

• Hundreds more (link)

Comment: Some of these excellent suggestions have been covered already, and you can find them on my website by using the search function and / or the list of podcasts with links. For example, we’ve already had a five part series on boosting happiness (link) as well as boosting self-esteem (link) and how to use each of the 5 secrets (link), and much more. Take a look! (link to list of podcasts)

What other topics might interest you the least?

• Anything related to organized religion. (Disorganized religion, I'm okay with!) lol) ;)

• Weight loss/eating disorders

• promoting other therapists

• "worried well" privileged patients.

• Anxiety and phobias

• Can’t think of any

• Why TEAM CBT is superior to all other forms of therapies.

• Nothing it is all helpful to make me realize I am not alone and we all have our own internal struggles

• I love it all

• Therapist workshop announcements

• Hundreds more (link)

Suggestions for improving the podcast (194 responses)

• Keep doing listener questions and answers and case examples.. the Buddhist perspective of not having a self and bigger picture etc

• Hidden emotion technique examples ongoing as I think that helps to know what common pressures people have experienced in Davids practice that we might also see etc.

• Maybe fewer judgy comments, including more guest speakers, more inclusivity. Always love the live work

• Keep bringing in therapist from around the country in the world to talk about what they do with team

• No, just please keep making it.

• DON'T CHANGE A THING!

• I mention above but I think getting David out to more of the enormous self-help podcasts would really help spread the word and open a lot of people’s eyes. A big one that I think would be a great fit is the Tim Ferriss podcast

Comment: Thanks. I’d love to be on any podcasts with large audiences. Please contact them and tell them to invite me! I’m not comfortable and don’t have the time to do this or the resources to hire a PR / marketing person, but they might respond to suggestions from listeners.

• It seems like a majority of the live therapy patients are TEAM CBT therapists so sometimes that can make me wonder if the techniques are as helpful to someone who doesn't already believe in the efficacy of the treatment. I'd like to see more treatment with people who are unfamiliar with TEAM CBT, although I realize that may not be possible.

Comment: I do not generally work with the general public because that would be tantamount to entering into a therapeutic relationship and would expose me to liability issues. Since I work for free, I cannot and will not take this chance, and liability insurance is costly. When I work with therapists, it is personal work in the context of their training, and is not construed as the start of a therapeutic relationship.

• I have done extensive research with large numbers of people, comparing the ease and nature of treating shrinks vs the general public, and there is absolutely no difference in the types of problems they have, the intensity, or the speed of recovery.

• If anyone would like to volunteer to indemnify me, which would be immensely costly for you, I’ll happily work with anyone!

• Hundreds more (link)

Why would you or wouldn’t you recommend it to a friend?

• I already have multiple times. Because the advice is different to what I hear elsewhere, it’s compassionate, blunt, and takes an inward look with a huge dose of kindness.

• It can change the way you live life

• Rhonda and David are so genuine together, smart, funny and informative

• It would help them, especially friends with depression or anxiety

• It is the highest quality methodology delivered by the highest quality therapists!!

• It helped and encouraged me

• too much advertising and plugging

• Because it offers real practical information that could be useful to anyone

• It helped me get out of a black hole

• It’s entertaining and informative.

• Life skills everyone should learn!

• Read both Feeling Good and Feeling Great. Dr. Burns’ content has saved my life! The five secrets has rewired my brain and helped me save my relationship, too! And Dr. Burns’ personality and sense of humor is just the icing on the cake.

• Hundreds more (link)

Thank you to all who responded!  We appreciate you!

David and Rhonda

Smashing Shyness--

Shame-Attacking and Beyond

Come to our Full-Day Workshop on Sunday, October 2, 2022

For therapists and lay people alike

Click here for registration and more information

Today we interview our beloved Jill Levitt, PhD who will be joining me in teaching the upcoming social anxiety workshop on October 2^nd. Jill is the co-leader of my weekly psychotherapy training group at Stanford, and is the co-founder and Director of Training at the Feeling Good Institute in Mountain View, California.

Social anxiety was one of the most frequent problems that patients sought help for when I was in private practice in Philadelphia. Because of my own severe and persistent social anxiety since childhood, it’s my favorite problem, too. Whatever you’ve had, I can tell you that I’ve had the exact same thing, too, and know how sucky it can be. I can show you the path to freedom from that affliction, and what a joy that will be!

According to the DSM5, there are at least five types of social anxiety:

1. Shyness

2. Public Speaking Anxiety

3. Performance Anxiety. This a broad category that can include athletic or musical performance, or any time you have to demonstrate your skills in front of people who might judge you. For example, I had a severe camera phobia since I was a child, and only got over it a couple years ago!

4. Test Anxiety

5. Shy Bladder / Bowel Syndrome

In addition, other negative feelings typically go hand-in-hand with social anxiety, such as shame and loneliness, as well as depression and feelings of inferiority and even hopelessness.

This workshop will focus on therapists looking for training. However, the general public are also included, since you will get the chance to practice and work on your own fears during the workshop. I (David) have noticed that feelings of social anxiety, especially performance anxiety, are almost universal among therapists, at least judging from those who attend our weekly TEAM-CBT training group at Stanford.

So, come to heal yourself AND to learn how to heal your patients and loved ones.

We will be covering not one, but four treatment models for social anxiety in the workshop:

1. The motivational model: Nearly all anxious individuals resist exposure, which is a crucial part of the treatment.

Most therapists also resist exposure for a variety of reasons, thinking the patient is too fragile, or the technique will be too dangerous or upsetting for their patients. This is unfortunate, since this pretty much dooms the treatment to failure, especially if you are aiming for a “cure” rather than endless talk and hand-holding.

2. The Cognitive Model. Although usually not completely curative, the Daily Mood Log is essential to treatment, so you can find out exactly what patient are thinking and feeling at one specific moment when they were feeling anxious. I present the case of Jason, a young man feeling shy and anxious while standing in line to check his groceries one Saturday morning at the local grocery store.

Many cognitive techniques are incredibly important and useful in the treatment of social anxiety, including Explain the Distortions, the three types of Downward Arrow (uncovering) Techniques, the Double Standard Technique, Externalization of Voices, the Feared Fantasy, and more. Although these methods are helpful and illuminating, they will rarely or never be quite enough for a complete cure. For that you will need:

3. The Exposure Model. In the workshop, we will be teaching:

• Smile and Hello Practice: In today’s podcast Jill discussed the purpose of this technique, how to introduce this technique to your patients, and how to implement it. This is an example of the many techniques we will teach on October 2. David provided a dramatic example of how this humble technique changed the life of a young man from India.

• Flirting Training

• Talk Show Host

• Rejection Practice

• Feared Fantasy: We role-played how I used this humor-based technique in my work with Jason

• Self-Disclosure

• Survey Technique

• Shame-Attacking Exercises.

We will also explain how to use several techniques crucial to the reduction of the patient’s resistance:

• Dangling the Carrot

• Gentle Ultimatum

• Sitting with Open Hands

• Fallback Position

However, many therapists have intense resistance to making patient accountable with these techniques that are absolutely central to TEAM-CBT, thinking they are cruel or crude or narcissistic, or some such thing. In the podcast, Jill illustrates a beautiful and gentle but firm way of introducing these techniques to patients, and emphasizes that they are actually ethical, therapeutic, and necessary for a good outcome.

She also emphasizes, and I totally agree, the importance of going with the patient into the real world to do the Exposure Techniques. I have used extreme exposure techniques on hundreds of occasions when treating anxious colleagues on Sunday hikes for example, urging them to stop hikers we meet and disclose their own shyness, for example.

The advantages of doing this type of thing in the real world include the ability to coach the “patient” with the best examples of how to use whatever technique you’re advocating, and to be there to support the patient during and after the experience.

4. The Hidden Emotion Model. This technique is often extremely helpful in the treatment of any form of anxiety, but is perhaps less often used in the treatment of social anxiety. I can think of one example when it was extremely helpful. This was a woman whose boss kept pressuring her to give presentations about their company locally and to groups in other locations as well.

She opted out because of her social anxiety. But lurking behind her symptoms were her feelings of resentment about being asked to do too much. Once she brought these feelings to conscious awareness, she decided to discuss his expectations, her feelings, and her compensation with her boss. This worked well, and her public speaking anxiety magically disappeared.

Although this pattern is not common, it is always worth consideration in your treatment plan, because family and friends often pressure people with social anxiety to confront their fears, and this typically does trigger feelings of resentment and resistance.

We also discussed two Self-Defeating Beliefs that are nearly universal in individuals with social anxiety: the Spotlight and Brushfire Fallacies.

In the podcast, I give examples of several techniques that were life-changing for patients. Jill emphasizes that one of the underlying treatment themes is how to “wake up” from your trance so you can learn not to take yourself so seriously and begin to have fun and enjoy yourself and others way more. Improvement is not the goal of treatment.

The goal of treatment is word that many mental health professionals fear and resent: CURE! In the podcast, I describe the difference between a 100% cure for any form of anxiety, and a 200% cure.

Do you know the difference? I give an example of my own fear of heights when I was in high school. Of course, that’s a phobia, and not a form of social anxiety, but you can also have a 200% cure for social anxiety, too!

In a 100% cure your fears go to zero. You are no longer particularly anxious about talking to strangers, or public speaking, for example. In a 200% cure, you come to LOVE the very thing that terrified you in the past.

Rhonda, Jill and I think this will be a powerful one day experience. We will focus on a common problem that is usually treatable fairly quickly, and often with fabulous and life-changing results. We hope you can join us!

For registration information, please go to:

CBTforSocialAnxiety.com

Thanks!

Jill, Rhonda, and David

Professor Mark Noble Shares his Thinking on the Uptick in Loneliness.

Rhonda starts today’s podcast with a beautiful podcast endorsement from Eduardo, a fan who loved our recent podcast 303, featuring the dramatic, humble, and inspiring Jason Meno, a data scientist and software engineer who is making superb contributions to the Feeling Good App. Eduardo was especially interested in how to bring non-verbal, difficult-to-access negative thoughts to conscious awareness with the Stick Figure Technique.

Today we interview Professor Mark Noble on the topic of loneliness. Mark is best known for his pioneering research on stem cells, but he has become an active and beloved member of the TEAM-CBT community since joining one of my Sunday hikes back in (date?)

Mark is currently an active member and small group leader in Rhonda’s Wednesday TEAM training group. He generously wrote brilliant chapter for my most recent book, Feeling Great, and has also written the Brain Users Guide to TEAM CBT which you can download for free from https://www.feelinggreattherapycenter.com/resources

Mark begins by dedicating today’s podcast to listeners who may be struggling with feelings of loneliness, and explains that loneliness appears to be on the increase, along with virtually all types of negative feelings, especially since the onset of the pandemic.

He emphasizes that there are many roads to loneliness, including:

• Loss of a loved one, including friends, family, colleagues, or even a beloved pet

• Betrayal by someone you trusted

• Being trapped in an abusive relationship

• Being abandoned or neglected as a child

• Not being accepted by your family due to sexual orientation, religious preference, choice of life partner, or other factors

• Feelings of isolation due to COVID

• A dead marriage

• Infidelity

• And more.

Of course, Social anxiety is one of the most common causes of loneliness, and last week we interviewed two individual, Cai Chen, MD, and Chan Mary Soeur, RN, BSN, who have fallen in love. Both were lonely and struggled for years with social anxiety. Their work with TEAM-CBT has not only helped them greatly with their anxiety and loneliness, but has brought them intense romantic love!

Not bad!

People struggling with loneliness often think there’s something “wrong” with them. For example, you may feel unlovable, and fear that you’ll be alone forever. In addition, the belief that we “need” love to feel happy and fulfilled often leaves the lonely individual feeling like they’re doomed to endless unhappiness and a lack of fulfillment if they’re alone. Mark explains that the scientific definition of loneliness is the distress you feel when you think that your ”needs” for connection and relationships differ from what you have.

In addition, he believes that loneliness is not abnormal, but is rather an indication of healthy brain function that has been important to the survival of the human race. For example, feelings of loneliness motivate us to connect with others. In fact, feelings of loneliness prompt babies to cry for their mothers when they feel hungry, hurt, or alone, and this process begins within seconds of being born.

We raised the question of whether the cure for loneliness is internal or external. The internal solution involves changing the way you think, and your relationship with yourself. The external solution involves trying to find a loving partner or becoming more involved in activities with others. Although this is the solution most people pursue, it often falls short.

David emphasizes the important of the internal solution, and discovering that you can feel completely happy and fulfilled when you’re alone. In fact, this is the first step in overcoming loneliness that he emphasizes in his book, Intimate Connections.

Mark, Rhonda and David also discuss some of the paradoxes of TEAM-CBT, and how the “need” for love often drives others away, since you are asking people to give you something you can only give yourself. In contrast, when you feel happy within, and no longer “need” the love of others, love will often pursue you.

We hope you enjoyed today’s podcast, and want to thank our buddy, Professor Noble, who has made so many in our TEAM-CBT community feel less lonely and more connected!

Warmly,

Mark, Rhonda, and David

Swimming in the River of Love

Rhonda starts today’s podcast with a beautiful podcast endorsement from a fan named Vicky, from Australia, who was thrilled with the two recent live therapy podcasts with Nazli (podcasts 301 and 302). She wrote that she felt so lucky to hear someone with the exact same negative thoughts, and same feelings of depression and anxiety, that she’s had since she was 10 years old. I have often said that when therapists have the courage to do their personal work in public, you not only heal yourself and learn cool techniques first-hand and experientially, but you also heal many others who are touched and inspired by you.

Thanks to all of our fans for your frequent loving comments and cool questions for future Ask David podcasts.

We then give a little promotion for several upcoming group events, involving:

• May 2, 2022. Dr. Jill Levitt and I will be teaching an exciting, full-day workshop on “Smashing Social Anxiety: Shame-Attacking and Beyond.” It will be open to shrinks and the general public alike. The focus will be on learning to treat social anxiety, including your own! For registration and more information, please go to CBTforSocialAnxiety.com.

• September 13, 2022: Drs. Brandon Vance and Heather Clague start two new Feeling Great Book Clubs. For registration and more information, please go to www.feelinggreattherapycenter.com/book-club.

• September 14, 2022. Drs. Heather Clague and Brandon Vance will start their weekly “Deep Practice” group for training in the Five Secrets of Effective Communication. This type of practice is absolutely needed if you want to use these fantastic techniques to greatly boost your clinical effectiveness or enhance your relationships with the people you care about. For registration and more information, please go to www.feelinggreattherapycenter.com/5-Secrets.

• Date (to be announced). Zeina Halim soon begins the first-ever book club for When Panic Attacks. This terrific group could be helpful if you’ve ever struggled with phobias, social anxiety, chronic worrying, panic attacks, OCD, PTSD, and more. For registration and more information, please go to https://feelinggood.com/2022/08/08/anxiety-book-club/

• Date (to be announced). Zeina Halim will collaborate with our Feeling Good App development team in an experiment to test a month’s use of the Feeling Good app with or without a weekly practice group to supplement your work with the app. This exciting project is currently in the planning stage, but if you think you might be interested, please contact Zeina at Zeina Halim so she can contact you once we’re ready to start.

As an aside, the app will be free since we’re still involved in beta tests, but the weekly practice groups will involve an additional charge.

Today we feature a love story involving Dr. Cai Chen, a young psychiatrist who did his residency training in Texas and now has moved to California to be with his love, Chan Mary Soeur, RN, BSN. Both have been members of my TEAM-CBT training group at Stanford. Cai practices at the Feeling Good Institute in Mt. View, California, and Chan Mary who is pursuing a master’s degree as a Psychiatric Nurse Practitioner.

Cai explains that he’d felt socially anxious and lonely for used, and used the tools in my book, Intimate Connections, when he got tired of dating sites. One crucial thing he learned is that you have to stop “chasing” if you want to find love. Then he met Chan Mary in one of the breakout groups in our weekly training group.

Chan Mary said,

“I also used to struggle with social anxiety. Even now, on this podcast I have thoughts that I won’t be as impressive as Cai. Cai is much better at expressing himself and being vulnerable in front of others.

“I’ve been on a personal journey to get over my intense social anxiety. I’ve always held back in groups, and have never been the first one to reach out.

“After listening to the Feeling Good Podcast’s episode on how to overcome social anxiety, I decided to challenge my fears and reach out to Cai. I contacted him and told him I really admired the courage he was showing in his transparency about his feelings, and in his courage to challenge his fears with the many Interpersonal Exposure Techniques we were learning about in our training.

“I also decided to try another technique, Flirting Training. I told him that I thought everything he was doing was inspirational, and that I felt close to him.”

Rhonda asked about the importance of taking risks if you struggle with social anxiety. Chan Mary explained it like this:

“I was extremely anxious about reaching out to someone I didn’t know. For me, a simple thank you email and introducing myself was anxiety provoking because I had never done that before. I was also worried about asking too many questions because I didn’t want to come off as intrusive or even bothersome.”

Chan Mary continues:

“After conquering my initial fears of reaching out, I went even further, I invited him to join me for a week in Hawaii as our first date in 2021 for my vacation. I usually went on a medical mission to Cambodia, but couldn’t because of the pandemic. So I did the boldest thing ever—I met him in person in Hawaii!”

Cai describes the fears he had:

“I was scared. I thought, ;what if we get too close and our relationship falls apart.’ In fact, after accepting the invite, I called and told her that I’d changed my mind. She got angry, and I realized I had mixed feelings, so I turned to David’s Decision-Making Tool.

(You can get it for free at the free chapter link on the bottom of the home page of David’s website.)

“This tool helped me see why I was stuck, so I called Chan Marie back and asked for her forgiveness. I’d been hiding my feelings, so I told her I really liked her and had been afraid of ruining a great relationship.”

Chan Mary said: “I was scared, too. But I told myself to trust myself, and that it felt safe to trust him, too.”

The rest, as they say, is history. The date was terrific, and after some initial hesitation, Cai decided to move from Texas to California to be with “the love of my life!”

Was it all roses from then on?

All relationships, I’m pretty sure, have difficulties, and Cai and Chan Mary explained that they both have trouble expressing negative feelings. Cai explained it like this:

“I always try to be nice, so I push my negative feelings down, and automatically sweep them under the rug. Chan Mary helps me with this. She pushes me to tell her what I’m upset about. And although it’s frightening at first, once we express our negative feelings they kid of fizzle out. Chan Mary has become an expert in David’s five Secrets of Effective Communication, and that has helped tremendously.”

Chan Mary explained her difficulties with negative feelings like this:

“The Hidden Emotion Technique has been helpful for me when I start to feel anxious or upset. I have to reflect and ask myself, ‘What’s the deeper issue here?’ Often, I don’t even know what I’m upset about!”

Chan Mary added:

“Thank you to David and Rhonda and everyone who made the Feeling Good Podcast possible. I’m just like many of your listeners, and this podcast has been life-changing. The techniques, you shared on the podcast have transformed my life! If I did not take the steps to conquer my social anxiety, Cai and I probably would not be here today.“

Cai and Chan Mary are delightful, and their obvious love is an inspiration in this time of increasing violence in the world and such intense political divide and hatred here at home.

I asked where their relationship is heading and Chan Mary hinted that Rhonda and David might be getting invitations to a wedding one day soon!

Cai and Chan Mary are two of my favorite people in the whole world. It’s a privilege and a blessing to know them and share a little of their lives.

This is Rhonda….

"I love Cai and Chan Mary, too. I was in the Tuesday Stanford TEAM Training group for years with Chan Mary, and feel really close to her for lots of shared experiences. I am lucky enough to see Cai every Wednesday in our International TEAM Therapy Training Group, and I always look forward to reading the wise comments he writes on the TEAM certified listserve.

Next week, we’ll look at the other side of the coin, as Professor Mark Noble leads a discussion on the recent rise in loneliness, which is often associated with social anxiety.

Warmly,

Cai, Chan Mary, Rhonda, and David

TEAM-CBT Celebrates Diversity

Today's featured image is Sean Williams, co-founder of the BAD Group

Rhonda starts today’s podcast with a terrific endorsement from Steve, from England. He really liked Feeling Great, and said he benefited from the personal work with Dr. Mark Taslimi that we published as the first live therapy on the Feeling Good Podcasts (see podcasts 29-25 and 141.)

Steve wrote that the live work, and the teaching points that Dr. Jill Levitt and I made during the podcasts to explain our strategies, is the best learning by far. Rhonda and I strongly agree, and I feel fortunate to have been able to publish many additional live TEAM-CBT sessions since that time. It is my hope that some day these live therapy podcasts will be used in teaching graduate psychology classes so that future practitioners can pick up where we left off and benefit from the rapid treatment techniques we’ve developed.

Today we interview Amber Warner, LCSW, Sean Williams, LCSW and Chelsea Dorcich, MFT. Amber is a Level 3 certified TEAM therapist, living and working in Lake County, where she provides mental health care in a rural community. She has a private practice that includes a virtual practice for anyone in the State of California. Amber has been a member of our Tuesday TEAM-CBT group for the past year.

Chelsea is also a Level 3 Certified TEAM therapist with a private practice for anyone in the State of California. Both Chelsea and Amber work at the Feeling Good Institute in Mountain View, California.

Sean is a Licensed Clinical Social Worker and also Level 3 TEAM-CBT therapist and co-founder of the TEAM CBT Clinicians of BAD, for Black African Descendants, along with Amber and Chelsea. He is a long-time and beloved member of the Tuesday training group at Stanford. He currently resides in Colorado and works for the Ohio State University where he works with active duty and retired soldiers regarding their PTSD suicidal ideation and trauma. He treats patients and also supports the Ohio State University’s research. He also has a part-time private practice for people who live in Indiana.

Amber got our podcast going by saying:

“My introduction to TEAM-CBT was in 2017, while at a Sunday workshop about 1 1/2 years ago. I’d been struggling with grief after accidently finding out my employer had hired others at a higher salary, so I started a Daily Mood Log and did a downward arrow (this is an uncovering technique) using one of my negative thought. I discovered that my Self-Defeating Belief (SDB) was not included in David’s list of 23 common SDBs.

“I felt like all the weight of the world was on my shoulders because my employer had hired white people with less experience at higher salaries. I asked myself what I was going to do.

“Do I care to stand up for myself? It felt like a heavy dilemma. I decided to face my fear and talk it over with my employer. It took some time, but things eventually turned out in my favor.”

Way to go, Amber!

Amber mentioned that Philip Lolonis, LCSW, a member of our TEAM-CBT community, urged us to create and teach an introductory TEAM-CBT course for African-American clinicians in 2021. Amber reached out to Sean and Chelsea and asked if they'd be interested in creating a “Clinicians of Color” group on Facebook. And that got the ball rolling.

Rhonda asked, “What kinds of challenges have you faced?”

Sean said that one barrier was the whole process of getting licensed. It requires a lot of time and money, nearly always meaning large loans and years of training. One goal of their group is to assist interested people through from initial training through the licensing clinicians, as well as introduce TEAM therapy to the larger therapeutic community.

There are very few Black mental health professionals within the TEAM community. Amber explained that one of their goals is to provide support and encouragement to young Black men and women who might want to enter the counseling profession by attending medical school, or a doctoral or graduate school in counseling or psychology, or obtaining a certified coaching diploma.

Amber also stated that TEAM-CBT has made a powerful impact on her, Chelsea and Sean, so they formed an affinity group, TEAM CBT Clinicians of B.A.D. Their primary goal is to support and encourage clinicians of color to learn and practice TEAM-CBT and explore culturally responsive methods to enhance the therapeutic alliance and improve treatment outcomes.

Sean explained that he was introduced to TEAM and David’s work around the year 2000. He was looking at books in the self-help section of a Barnes and Nobles bookstore, but most of them were too expensive. He said,

“Most of them were too expensive, but then I saw Feeling Good lying on a table, and it was only $8.95, so I purchased it and read about the list of cognitive distortions that David had created. That book changed my world view and changed me as a clinician. I realized that I really wanted to disseminate this information to clinicians of color.”

Sean explains why he resonated with Feeling Good:

“Many of the cognitive theoretical principles were extremely empowering to me. In “Feeling Good” there was a diagram of a man where it demonstrated how human beings process their experiences through thoughts, beliefs and assumptions.

The whole idea of my thoughts impacting my emotions and behaviors was mind blowing to me and still is. It made me recollect on all my past struggles such as relationship break ups, job losses, public speaking anxiety, and so forth, and my reactions towards those situations unbeknownst to me at the time were primarily based on my thoughts about those events.

I believe that it’s important that all people have access to these powerful therapeutic interventions regardless of race, ethnicity or culture. The reason why it’s important to disseminate these powerful tools to people of color is because people of color are reporting high rates of psychological distress but are less likely to get treated for it.

“According to webmd.com ‘…African Americans are more likely to report feelings of sadness, hopelessness, and worthlessness than are adult whites. Still, in 2018, 18.6% of white Americans received mental health services, compared to less than 9% of African Americans.’

“I think TEAM-CBT can even help alleviate suffering related to racial stress. Although racism is a non-distorted reality the concepts in “Feeling Good” and the whole TEAM framework can orient a person to adopt the healthiest possible perspective when moving through those realities.”

Chelsea said she learned about TEAM-CBT when she moved to the Bay Area in 2017. She says, "I also found that TEAM was a roadmap and a blessing. I could really connect. This is an amazing framework for everybody!”

We also discussed one pitfall that some clinicians fall into. The idea that our thoughts, and not events, create all of our feelings can be liberating. But it can also be used to invalidate genuine, healthy anger. Racial bias and cruelty are real.

"They are NOT cognitive distortions," she says. "Racial bias is very real. But TEAM-CBT can free us from the inner prison of depression and anxiety and self-doubt that results from distorted perceptions. Of course, sometimes perceptions are totally valid, and sometimes it’s time to fight and stand up for what’s right."

David added that

"We had to do a lot of fighting and protesting in the 1970s, when the Viet Nam war was waging, and the forces of darkness were powerful and destructive. Now, it seems, we have many more battles to fight, and we are lucky to have crusaders like Chelsea, Amber, and Sean.

"Thank you for what you are doing!"

Thank you all for listening today.

Chelsea, Amber, Sean, Rhonda, and David

Following the show, Sean kindly emailed me with some information addressing some of my questions about black people and the mental health system in the United States. He wrote:

Although I was super anxious, I really enjoyed doing the podcast with you two. I used the “Dare to be Average” principles in Feeling Good to help me relax and it worked! Here’s a few additional notes about black people and our mental health system. I hope it helps!

Insights into Diversity

By Sean Williams, LCSW

Why is it important to disseminate TEAM-CBT to people of color?

Data from the American Psychiatric Association (APA) shows that only 2 percent of the estimated 41,000 psychiatrists in the U.S. are Black, and just 4 percent of psychologists are Black. On college campuses, close to 61 percent of counseling center staff are White, and 13 percent are Black, according to a 2020 Association for University and College Counseling Center Directors survey.

he shortage of psychiatrists and counselors of color has severe implications for all Black individuals needing treatment. A 2019 survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) found nearly 5 million, or 16 percent, of Black Americans reported having a mental illness. However, only one in three Black adults who needs mental health care receives it.

Because of the scarcity of mental health professionals of color, it can be difficult for Black Americans to find a practitioner with whom they feel comfortable enough to share any race-related trauma. One 2016 study in the Journal of Black Psychology found that African American therapists and their patients often had relationships marked by a “distinct sense of solidarity … as evidenced by having a better understanding of the context of Black clients’ lives.

For more information, see https://www.insightintodiversity.com/addressing-the-lack-of-black-mental-health-professionals/

306: Ask David: Featuring Matt May, MD

1. Kevin asks: Hi David, Is it possible to have a healthy relationship with someone who can be classed as “Borderline Personality Disorder”?

2. Brittany asks: How do you deal with the injustice of people who rip you off without giving you credit?

3. Paul asks: Is there a way to know if I have done the Hidden Emotion Technique correctly?

Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways.

1. Kevin asks: Hi David, Is it possible to have a healthy relationship with someone who can be classed as “Borderline Personality Disorder”?

Hi David,

Is it possible to have a healthy relationship with someone who can be classed as “Borderline”? What are keys to being in a relationship with someone that exhibits some of these characteristics? Is it a lost cause? Is borderline personality disorder bullshit and simply a result of assumptions such as “I need love to be worthwhile” as indicated in your books?

Best,

Kevin

David’s reply

Great question, here are a couple brief responses off the top of my head:

"Healthy" exists on a continuum. In my experience, the therapeutic relationship with a patient diagnosed with BPD exists on a continuum, it is not all-or=nothing, and you can have excellent interactions, but this often requires great diligence and skill in the use of the five Secrets of Effective Communication.

I have not observed any unique relationship between the Love Addiction and BPD. That's because the "need" for love is pervasive in our culture, and is, in fact, one of the most common Self-Defeating Beliefs. I do believe that Other-Blame (along with Self-Blame) is a common feature of BPD, along with the unwillingness to be accountable and to have tow work hard and consistently for recovery. I have had a number of patients with BPD threaten suicide if I asked them to do psychotherapy homework, for example.

At my clinical in Philadelphia, we diagnosed the ten personality disorders prospectively, at the intake evaluation, and depressed patient with and without BPD improved at almost the same rate during the first 12 weeks when treated by the forerunner of TEAM-CBT, when controlling for severity of initial depression. I published this surprising finding in the top journal for clinical psychology research, the JCCP, but it got little attention for some reason, and some of the reviewers of the article were critical of this finding which they found difficult to believe or accept.

DBT has been the "go-to" method for BPD, and BPD therapists may think that CBT / TEAM-CBT would or could not be helpful. Still, I am grateful for DBT welcoming such patients and helping them, when so many therapists avoid these patients! At my clinic in Philadelphia, something in the range of 28% of our patients were diagnosed with BPD at intake.

david

Matt’s Reply: I’m really just guessing, but perhaps Kevin is feeling quite sad, worried and hopeless, about his relationship. Perhaps he’s been treated badly and is also angry and scared that this will continue to happen in his current relationship. If so, he might be having thoughts like, ‘This relationship will always be terrible’ or ‘They will continue to hurt me and disrespect me and treat me badly’ of maybe, ‘This is their fault, they have Borderline Personality!’.

This is only a guess, but if it were the case, I would imagine Kevin could use a great deal of empathy and listening, right about now. It is possible he has been treated terribly or even abused. His partner may indeed meet the criteria for BPD, in which case they would be tremendously sensitive and frequently reactive and prone to unhealthy expressions of anger. Perhaps Kevin has displayed tremendous patience and tried very hard in the relationship, which would be admirable, but only amplify his disappointment when the same hurtful patterns continue. Kevin may even feel worthless, if he believes that the way he is being treated by others is an indicator of his worth as a person.

I feel for you, Kevin, and hope you’re getting the Empathy you need. I think there is a lot we could offer someone in this situation, in addition to Empathy, as well.

We certainly have the technology, in TEAM, to alleviate the worthless feelings, the anxiety and worry, the feelings of anger and hopelessness, etc. and to replace these with a sense of confidence, joy and optimism. We could also offer skills that that one could use to substantially improve the quality of their relationship. Meanwhile, there are many reasons why someone would prefer to maintain very high levels of hopelessness, anger and worry and low self-esteem in this context.

For example, as a protection against getting hurt again. Or they might not want to like and admire themselves if their partner is dissatisfied with them. We’ve also discussed, on the podcast, how tempting and seductive Blame can be. When we tell ourselves, ‘It’s their fault, they have Borderline Personality Disorder’, this type of thought can give us pleasant feelings of superiority. Kevin may not have any of these thoughts or feelings. My point is that, before trying to ‘help’ someone in Kevin’s shoes, I’d certainly want to explore all the good reasons he would want to continue to feel extremely upset and all the good things this says about his sensibilities and values.

In addition to Empathy and an exploration of Resistance, one tool that is sometimes helpful in this situation is the Decision Making Form. This is a simple but powerful tool, available online, thanks to David’s generosity, which one can use to compare and consider, with great care, the three options they have in a relationship: continue the status quo, end the relationship or take personal responsibility for improving the relationship. There would be pro’s and con’s to each of these options. Meanwhile, you will notice that there’s one option that is NOT on that list, which is to change the other person. Trying to change the other person, blaming them, is the cause of relationship problems and another version of the ‘status quo’.

For the sake of argument, let’s imagine Kevin, or someone like him, is convincingly talking back to the resistance. Maybe he also does the ‘Relationship Journal’ and he experiences the death of the blaming self, witnesses how his behavior is causing the problem, etc., this would be a tremendous achievement, but, I would still have some questions:

Would they want to feel better, now, or would they want to wait until after they have a better relationship? Would they want to embrace and accept and love their partner, now, flaws-and-all … or would they prefer to keep their guard up, until things improve? Are they still needing the other person to change, in some subtle way?

The reason I’d have to ask these questions is because of my own limitation: I can only help someone feel better in this moment, the way things are, right now. Similarly, I can only help someone improve their relationship, in this moment, while their partner is still treating them badly. When people are open to these terms, their lives and relationships can transform in beautiful ways. They can come to appreciate and love themselves and others, just as they are. David, you’ve said that’s the paradoxical first step towards improvement, I think.

2. Brittany asks: How do you deal with the injustice of people who rip you off without giving you credit?

Hi Dr. Burns!

I hear you say often how it upsets you that people use your work and don’t give you acknowledgment or credit for it. I wondered how you deal with your thoughts like the unfairness or injustice of it.

Or maybe you don’t want to deal with those thoughts because the anger helps you in some way? Like it motivates you to create more content & host more trainings etc. so people know the ideas come from you. I was just curious.

I deal with similar issues at work where I work really hard for an outcome and then once it happens other employees will take credit for it or just plain ignore the fact that I played any role.

I think hearing how you deal with not getting acknowledged would help me too.

Thank you,

Brittany

David’s reply

Thanks, Brittany, and good to hear from you again! Maybe we can make this an Ask David. I've been ripped off so much that I try to ignore it, since it would consume a great deal of energy. We may take legal steps once we raise money for our Feeling Good App. For the most part, I always have so much to do, and try to keep moving the ball forward.

But yes, I DO get ticked off at people. Plagiarism was considered a severe violation when I grew up, and I still view it that way. Of course, all around the world we can see a tremendous amount of horror and evil being perpetuated by humans. I once asked Dr. Albert Elis a similar question, since Wayne Dwyer ripped him off. His answer was: "I just tell myself that Wayne Dwyer was an asshole, so he was just doing what he SHOULD do, since that's what assholes do!

David D. Burns, MD

Matt’s Reply: This question is for David, not me. However, I would like to express my deepest and most sincere gratitude to David. David has dedicated his life in the service of improving the lives of others. He has published over a hundred scientific articles and revolutionized the practice of psychotherapy in the form of the TEAM model, as well as publishing at least 12 books, including Feeling Good, the most-prescribed book for depression. He has traveled the globe to offer training seminars to therapists, as well as offering free training to countless students, trainees, residents, PsyD’s and psychologists in his groups, including his ongoing Tuesday training group.

It is disturbing and upsetting that someone like David, who has offered so much, would be a target for plagiarism and theft and I admire him for continuing his work, despite all of that.

3. Paul asks: Is there a way to know if I have done the Hidden Emotion Technique correctly?

Hi Dr. Burns,

It blows my mind how simple yet logical TEAM CBT is. And I am really excited about potential of the app, and I sincerely hope that this will be a revolution in field of psychology and psychotherapy. I really enjoy reading Feeling Great, but some techniques I find complicated.

I would like to ask, is there a way to know if I did Hidden Emotion Technique correctly ?

Also, I would like to ask if fear of mental illness does count as hypochondriasis as well.

At the end I would like to say, that I really appreciate your work Dr. Burns, and I hope that your work will spread around the world and get recognition it deserves, so even more people can be healed.

Paul

David’s reply

Thanks for the kind words, Paul. I will try to include this in an upcoming Ask David segment!

Matt’s reply

You asked if you did the Hidden Emotion technique correctly. They say that the proof is in the pudding. Do you feel better? Are you experiencing relief? Keep in mind that the Hidden Emotion technique is one of many and may not be the correct method for some individuals. Also, for it to ‘work’ will require not only revealing the hidden emotion, but discovering how to address that emotion. Will you use cognitive techniques to untwist the thinking that is causing this emotion? Will you use the 5-Secrets to respectfully communicate that emotion in a productive way? Will you make a decision about your future that will correct the problem? There are lots of options, but the outcome, if the Hidden Emotion is successful, will be relief.

You also asked if worrying about having a mental illness counts as hypochondriasis. The nice thing about this model is that I get to admire you for having all kinds of hypochondriacal worries about your mental health and point out how it’s a ‘solution’ rather than a ‘problem’ and how such worrying speaks highly of you, how responsible you are, how much you care and how much you value your mental health. I’d need you to convince me that it’s a problem!

Ask David: Featuring Matt May, MD

1. Nick asks: “What if you want a positive relationship with someone who does not want the same thing?”

2. Debbie asks: Hi David, I can't stop ruminating and obsessing about weird states of minds or when I was afraid of harming someone or remembering. Everyone says to let go but why do I hang on. Where in your book can you help me?

3. Dean asks: I’m having trouble sleeping. What should I do?

4. Kathy asks a question about social anxiety / panic and the hidden emotion technique.

Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways.

1. Nick asks many general relationship problems that all need specific examples.

Dear David,

Thank you for all the amazing work you do. Your books and podcasts have helped me to understand and start to transform a lot of negative and unwanted frames that I carry around. I'm also working with a Level 3 therapist who I found through the Feeling Good Institute.

One area I'm working on is building my empathy skills using the Five Secrets model. I see how powerful it is in situations where both people are open to a positive relationship. But I struggle with the idea that each of us creates our own interpersonal reality, and can always create a positive outcome regardless of the other person. Can you help me understand how to apply the technique to some challenging situations?

- What happens if you want a positive relationship with the other person, but they fundamentally do not? I find that this situation leads the other person to react to the Five Secrets with anger or indifference.

Or they view you as weak for exposing your emotions and vulnerability, and try to exploit them for advantage over you. Is it even worth trying to have a positive relationship with such a person?

David’s reply

I try not to impose on people who do not want a positive relationship with me. You could also provide a specific example, as I always insist on having! These vague questions to my ear are kind of useless.

Matt’s reply

David, you’ve said that the cause of all relationship problems is Blame.  I agree with this and sense that Nick’s question is driving at that point, as well.  If someone doesn’t want to participate in our definition of a ‘positive’ relationship, the approach that is most in line with the 5-Secrets and Empathy is to let go and stop demanding the other person change.  That’s the cause of the problem:  trying to force people to do things, our way, regardless of what they want.  This will cause them to resist and will damage the relationship.

David, you have also talked about the opposite mindset of blame, where we can wield 5-Secrets honestly and effectively, the concept of ‘Open Hands’.  When we have the attitude of ‘Open Hands’, we can welcome other people and receive them or gracefully let go. This mental state avoids conflict and the ‘blame game’ in a healthy, non-avoidant way.

For example, if someone says, “I don’t want to have a relationship with you”.  We might reply, using the 5-Secrets, ‘You’re right, I’ve been disrespectful and inappropriately pushing you too hard in the direction of having a relationship with me.  I appreciate your letting me know, clearly, that this isn’t something you want.  While I can imagine you might be angry with me, I’m sure you don’t want to talk about that, but prefer, instead, to end the relationship as quickly as possible.  I’m feeling awkward and would like to get out of your hair as soon as possible, too.  What can I do to facilitate ending this relationship in a way you would be satisfied with?”

To put it another way, while you can maximize your chances of having a positive interpersonal experience with someone, using these communication skills, the 5-Secrets, they are not ‘mind control’ and trying to use them that way will only make matters worse, hence the importance of the internal mindset of ‘open hands’, accepting others’ preferences and being willing to let go, perhaps grieve, refocus our attention elsewhere, if that’s not what they want.  Otherwise, we are in the ‘chasing’ and ‘blaming’ role, which is doomed to fail, as has been discussed on previous podcasts.

It may also be useful to consider whether it’s actually possible to ‘not have a relationship’ with someone.  My sense is that there is, in fact, a relationship, even between total strangers and between people who have decided, mutually, to end their relationship.  We could point out how those two types of relationships might differ, say, if you were to bump into each other in a grocery store.  In the latter example, you might be expected to try a bit harder to avoid contact, with an agreed-upon, ‘ex’ than you would, with a stranger.  There are rules and expectations and ways in which both people think about the other person and define their ‘relationship’, even if you are saying that it has ‘ended’.  The conflict comes when we don’t have the same agenda and don’t agree on the terms and rules of the relationship.

There are many other related topics, including the ‘gentle ultimatum’, ‘interpersonal decision making’ and ‘blame CBA’ which could be useful for Nick.

Nick continues

- What if you believe the other person does have a fundamental desire for a good relationship, but they are so attached to their anger, fear or depression that their only reaction is hostility and defense? Perhaps such a person can't or won't admit to their emotions, and rejects the empathy. Should you keep trying, and at what point if any should you give up?

David’s reply

Need a specific example! I may have mentioned that!

Matt’s reply: 

A specific example sure would help!  The problem seems related to the ‘blame game’ which we just talked about.  We are demanding the other person change, and stop being so hostile and defensive.  Instead, consider using Interpersonal Decision Making and look at the three options that are available, in any relationship.  If you decide to take responsibility for the relationship, try the Relationship Journal, so you can see through the blame that is causing the problem.  You could also use positive reframing to admire their hostility, defensiveness, anger, fear and depression.

Nick continues:

Perhaps there are mistaken or lying about the facts, and unwilling to admit it. Or you disbelieve what they say because it doesn't match their actions or is calculated to deflect blame. For example, you may have a conflict over who cleans the house. The objective fact is that you do this 80% of the time and have done it the last 5 times in a row, while the other person has consistently left garbage lying around. Yet the other person says

"I feel like you never do housework and I am always the one cleaning, and I'm sick of it". How can you find truth in such a statement?

David’s reply

Work this out on a Relationship Journals. Write down what you said next, and follow th steps clearly spelled out in Feeling Good Together. Or, I could send you one.

Matt’s Reply

Disarming is really challenging because it requires us to let go of our version of the ‘truth’, at least temporarily, in order to see the other person’s truth.  People often don’t want to do that, even for a moment!  Furthermore, if the other person is angry, they are likely to distort the truth in their statements, for effect, to be more persuasive.  The problem with this, is that it will call our attention to the lies they are telling, tempting us away from seeing their truth.  Without knowing more about the situation, I could only guess at what their ‘truth’ is.  Here are some possibilities, though:  Is it possible that they have some reasonable expectation for us to do more of the cleanup than them?  Are they offering something else in the relationship that offsets their lack of cleaning?  Do they do the majority of the cooking?  Do they do the shopping?  Do they pay more of the bills?  Also, were they the last one to do the cleaning?  When they clean, do they spend more time on it or do a more thorough job?  When they clean, do they clean up their things as well as yours?  Do you do that?  You stated that they leave their ’garbage lying around’.  Is that how they see it?  Is it possible that they put their things precisely where they wanted them to be and didn’t want you ‘tidying up’?

The point is that disarming requires seeing the bigger picture, not just the one data point that best supports your blaming them.  Try to see past this and, if you can’t, considering Interpersonal Decision making and the Blame CBA, where you would write down the good reasons to blame the other person and insist that your version of the truth is complete and correct and that theirs is wrong and bad.

Nick carries on

- What should you do in situations where you both have attachments to other incompatible goals? In Lee's case on episodes 96-98 of your podcast and Chapter 27 of Feeling Great, both Less and his wife had the same fundamental values with regard to raising their daughter. So once he applied the Five Secrets, they were able to move past their ego defenses and share the same perspective. But what if there is a zero-sum situation where both of you have different core values? For example, choosing a grade school for your child. One parent sincerely believes in their core values that their child will benefit from attending a rigorous school where they will be challenged and grow. The other parent sincerely believes in their core values that children should be in a relaxed environment where they can play as much as possible. Can the Five Secrets help with this type of conflict?

David’s reply

Read the chapter in Feeling Good Together on the idea that the attempt to solve the problem IS the problem, and the refusal to solve it is the solution.

I think you’ve got some work to do! Now we’ll see if you do it!

Matt’s Response

In this case, you could agree to disagree and let a professional decide what would be best for your child.  Studies conducted longitudinally by Chess and Thomas showed that no one parenting style was ‘best’ overall, but rather that outcomes for human being were determined primarily by how well the parenting style suited the child.

2. Debbie asks: Hi David, I can't stop ruminating and obsessing about weird states of minds or when I was afraid of harming someone or remembering. Everyone says to let go but why do I hang on? Where in your book can you help me?

David’s reply

You can read my book, When Panic Attacks. You can use search function on website for many illuminating podcasts on anxiety and OCD. You can sign up for the free anxiety class. Go for it. Then ask specific questions about something you're working on based on these resources.

Matt’s reply

Well, you’re not alone!  Nobody can ‘stop ruminating’.  Try a mental experiment, where you try to ‘stop ruminating about a blue-eyed tiger’.  Tell yourself, ‘I must stop ruminating about a blue eyed tiger!  I must stop ruminating about a blue eyed tiger!’.  You will come to realize that it’s Impossible and the harder you try, the more you obsess.  One possible solution is to find something else, something better, to become the focus of your attention.  Imagine a ‘Miracle Cure’ were possible.  What would you most wish to see happen in your life?

You could then use the Decision Making Form, to weigh different options, comparing the miracle cure to the status quo, for example.  There are, after all, real advantages to ruminating and obsessing.  You might have a sense that you’re being responsible, protecting others, preventing yourself from going into weird states of mind and harming people.  This is part of your moral nature, doing no harm, being considerate and thoughtful, sacrificing your needs for others.  That’s a good thing!  Also, you might be afraid of committing to pursuing your dreams, for good reason.  There are real disadvantages of doing that.  The risk of failure, humiliation, conflict, disappointment and defeat, for example.  Until you are convinced that you would want some other version of your life, despite the many advantages of rumination and the disadvantages of change, other methods are unlikely to be effective.  If you firmly decide and are committed to change, meaning that you have convinced yourself that this is what you want, on the Decision Making Form, then there are lots of methods that could be helpful.

For example, you could use the Get Specific method and an assessment of Process Resistance.  When do I want to be cured?  What would I be willing to do, to have my dreams come true?  What are some small steps I  could take to get there (Anti-Procrastination / Little Steps for Big Feats).  What time will I do these tasks?  Sit down and schedule time in your day to pursue your dreams (Activity Scheduling).  If intrusive thoughts come in, try ‘Self Monitoring and Response Prevention’.  If temptation is especially tenacious, try the Devil’s Advocate Technique.  I’d recommend looking into things like the ‘Hidden Emotion’.  Is ruminating a form of ‘niceness’, an avoidance of a conflict?  For example, who are you angry with?  Have you told them?  If you go live your best life, who would object?  You can also give yourself a certain amount of time, per day, to obsess, wholeheartedly (worry breaks).  How much time would you like to spend ruminating?  Schedule this time and if you’re ruminating outside that time, remind yourself that you have plenty of time to ruminate later.  Again, there are a lot of methods that could help and finding the right ones will be a bit of trial and error!

3. Dean asks: I’m having trouble sleeping. What should I do?

Hi Dr. Burns, I picked up a copy of 'Feeling Great' and am excited to start reading it.

I have been battling anxiety, depression, and severe chronic insomnia for the past year. Do I start with TEAM-CBT for anxiety/depression and deal with that first, or do I supplement with CBTi-for Insomnia and do both at the same time?

I met with the Mayo Clinic last fall and they said the root cause of the Insomnia is some depression. I have been to a lot of doctors, specialists, and therapists and so far no one has been able to help. Thank you!

David’s reply

I am not familiar with the insomnia app but it can likely give you some of the basics of sleep hygiene in case you do not already know them. TEAM can be helpful, to say the least, for the mood or relationship issues that may be triggering the troubles sleeping. Often, we may have trouble sleeping because we are upset about something. Sleep difficulties are a non-specific manifestation of being upset about something.

There is no special relationship with depression, however. It could be anxiety, anger, anything. Let me know what evolves for you!

And, of course, sleep difficulties do not always result from emotional disturbance, but this is often the case. For humans, problems don't usually just come from out of the blue, but from your life!

David

Matt’s reply

The best response to the question, ‘How do I get to sleep at night’, that I’ve heard is, ‘try to stay awake’.

Meanwhile, I have a couple of thoughts on diagnosis and treatment planning.

Having a diagnosis of ‘anxiety’ or ‘depression’ is like having a ‘diagnosis’ of ‘cough’ or ‘fever’.  Our feelings are symptoms, not the source.  g.  if someone has symptoms of a cough and fever, that could be the result of any number of different underlying causes:  bacteria, viruses, fungi, allergic reactions, autoimmune disease, toxin exposures, etc., etc.  To make more accurate guesses about an appropriate treatment regimen, we need greater specificity.  In the treatment of symptoms like depression, anxiety and insomnia, we would need to know much more about a specific moment in time when you were having these symptoms, what you were doing, what you were thinking and details about the feeling state you were in before deciding how to prioritize the methods that would be part of a treatment plan, which we call a ‘recovery circle’ in TEAM.

In medical school, they train physicians to ‘cast a very wide net’, when considering all the possible causes of the symptoms a patient is experiencing. This list of possible causes is referred to as a ‘differential diagnosis’ by physicians.  The idea is to organize this list according to what is statistically most likely given all the information we have on hand and to conduct various tests to narrow down these options, in order to prioritize a treatment strategy that is most likely to be effective.  Meanwhile, we want to keep open in our minds that our diagnosis could be wrong and that we will need to monitor the outcome carefully, with frequent testing, rather than assume we know the ‘root’ problem with 100% certainty, so we can modify the treatment strategy based on results.

While it’s tempting to try to try to optimize treatment results by matching the diagnosis with a ‘school’ of therapy, (ERP for OCD, EMDR for trauma, DBT for BPD, etc.), there are several problems with this ‘schools’ vs. ‘tools’ approach to therapy. For one, the reality is that people are quite complex beings and diagnostic labels are quite imprecise and limited.  Even when we have an accurate diagnosis, we can’t predict precisely which specific set of methods will be required to help someone recover.  Furthermore, even if someone has the exact same set of upsetting negative thoughts related to their anxiety, depression and insomnia, perhaps their thoughts circle from ‘I must get some sleep, I’ll never get to sleep, I’ll feel terrible tomorrow, Everything will go wrong, I’m a hopeless case, I’m a loser…I must get some sleep (repeat)’, even if the thoughts are the same in multiple different people, we can only make informed guesses, rather than predict, perfectly, what method(s) will suit that individual best.  Will it be the double standard technique, or cognitive flooding, sleep restriction, the hidden emotion, the Socratic technique or memory rescripting, self-monitoring or response prevention, something else?

The solution to this uncertainty is the Recovery Circle. The ‘recovery circle’ is a customized list of at least twenty methods, that are selected based on the specific feelings, thoughts or behaviors someone would like to see change.  Each of these methods will have some reasonable chance to help an individual, with their particular thoughts and feelings and behaviors.  The idea is then to ‘fail our way to success’, using trial-and-error, with measurement in between, to discover, scientifically, what is the best method for that individual.  Once we do, we focus on practicing that method regularly to gain skill with it, until our patients are not only cured, but able to recover from relapses on their own, because they know the methods that are most helpful to them.

Another consideration is that, in general, folks benefit from an approach that is kind, empathic, respectful, grounded in science and measurement, and attentive to resistance and motivational barriers to change. One reason I would recommend TEAM to a family member or friend is that it contains each of these necessary elements of therapy and also has the greatest diversity of tools to help someone, as well as a customized approach to treatment.  I think that’s why TEAM has been shown to be much more effective than other forms of therapy.

All that said, it’s important to realize that TEAM itself is incomplete and we would want to continue to expand up the model and, when you’re in treatment, know that it’s fine to get a second, third or fourth opinion on what methods and approaches are most likely to benefit you.

4. Kathy asks about social anxiety, panic and the hidden emotion technique.

Hi Dr. Burns,

Thank you so much for all the great information you put out there! I had a question about hidden emotion. If I experienced dizziness in a social setting ten years ago and now I panic whenever I am in a similar situation anticipating the dizziness. Is there still a connection to the original emotion that is still hidden or is it a habit at this point? Thank you so much

David’s reply

Were you upset with somebody or something in that situation?

Matt’s reply:

You could use uncovering techniques, like the ‘What If’ Technique and the ‘Interpersonal Downward Arrow’, among others, to figure that out.

For example, ‘what if you got dizzy?  What’s the worst that could happen?

You can write down your answer, and continue to ask yourself, ‘what if that happened, what would I be anxious about?’.  Then, as yourself, if that happened, what would other people think about me?  How would they treat me?  What kind of people are these people, I’m imagining?  How do I feel about people like that?

304: TEAM-CBT, Spirituality, and Beyond: Featuring Angela Poch

Rhonda begins today’s podcast, as usual, by reading two touching emails from podcasts fans, including Coach Teddy, who said that Podcasts 295 and 296 featuring live work with Zeina were incredible, and Carol who was equally enthusiastic about Podcast 297 (on “Homework—Yuck!).

Carol also strongly recommends David’s book, Ten Days to Self-Esteem which is a simplified version of Cognitive Behavioral Therapy that can be used as a manual for therapy or self-help groups.

https://www.amazon.com/Days-Self-Esteem-David-Burns-M-D/dp/0688094554

Today, we interview Angel Poch, a certified life coach, registered professional counselor, and certified Level 4 TEAM therapist and trainer. She lives two hours north of Glacier National Park in British Columbia, but teaches therapists and treats people virtually from around the world. Her new booklet, “The Truth Shall Set You Free,” integrates TEAM-CBT with a Christian perspective and is available for free on her website. https://www.angelapoch.com/.

She is a regular in David’s weekly virtual psychotherapy training group at Stanford and assists in the teaching. She has also worked tirelessly and selflessly behind the scenes making David’s work way more accessible to lay people as well as mental health professionals wanting to learn more about TEAM-CBT.

For example, she adds links to every new Feeling Good Podcast on David’s website, so you can easily find and link to more than 300 podcasts. Check it out!

She has also transformed a massive amount of David’s work into electronic tools for shrinks, accessible in David’s online shop:

Recently, she has created two amazing new documents you can link to.

One is a spreadsheet that lists 138 of David’s TEAM-CBT tools and techniques, like the “Anti-Procrastination Sheet” and many others, with page links to the descriptions of how to use each tool in David’s books, like Feeling Good, Feeling Great, David’s TEAM-CBT therapist eBook, and many others. Check it out!

This data base will be invaluable to interested lay people, therapists, and teachers who want clear instructions on how to use the Daily Mood Log, Relationship Journal, and numerous additional tools and techniques.

Derek Gurney and Angela are working on an equally awesome database for the Feeling Good Podcasts: Check it out as well!

Angela begins her personal statement in today’s podcast by describing her struggles with depression and irritability, including some very dark days in 2006. Her doctor recommended an SSRI antidepressant, and she went to integrative health program, “Depression: the Way Out” that required participants to read Feeling Good

https://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/0380810336

Although she didn’t love the book, she resonated with the idea that all of our feelings, positive and negative, result from our thoughts, or perceptions, and her depression cleared up. She liked that when she read Feeling Good, she got many new tools she could use to change her negative thoughts and feelings. She also appreciated the ideas in the book didn’t go against her belief system, which many fear about psychology. David pointed out his own father, a Lutheran minister, worried about this, and was very suspicious of psychiatrists. Angela’s thinking, which resonates with David’s, is that the core ideas of religion and psychotherapy are actually high compatible, and even synergistic.

Angela explains that when she was a young child, she didn’t fit in socially or even in her own skin. “I felt like I was a boy in a woman’s body. I felt like I was in the wrong body, and prayed for help.”

She started to see in a very limited, childlike way, her thoughts were distorted, that a body was just a body and she could trust God wouldn’t give her more than she could bear. These new realistic, counter thoughts relieved the negative body dysmorphia she’d been struggling with. She reports, “I decided it was okay to be flawed and not fit in.” The rest of her young childhood was mostly joyful.

In middle school she was the target of mean-spirited bullying because she was a tomboy. She developed intense social anxiety and was relieved when her mom took her out of school. She was homeschooled for a few years and studied Karate to exercise and develop some confidence.

High school brought new challenges. She describes responding with her version of the Five Secrets of Effective Communication to an aggressive bully who threatened her with brass knuckles and challenged her to fight her. However, the girl backed off and started telling people that Angela was her friend!

After a bad relationship, Angela started to struggle with depression and described her suicide attempt when she was 18 because “I wanted the pain to stop.”

She explains that:

I met my husband, moved home, and started reading the Bible. I was impressed by the passage, “the truth shall set you free.” I realized I had to control my own thoughts rather than look for the approval of others, but she still didn’t totally recovery from my anxiety.

The cognitive piece in Feeling Good helped Angela a lot. She states, “I pursued a lot of careers, never holding down a job for more than 6 months, and one day someone asked if I’d considered a career in counseling. . .” She went on to take one of David’s four-day live intensives in Whistler BC where she learned TEAM-CBT and hasn’t looked back since! After learning and applying TEAM, Angela was able to crush her social and other anxieties.

Angela has a deep love for her Creator and has done a great deal of thought about the integration of her Christian faith with TEAM-CBT.

David also has a strong interest in the overlap between TEAM-CBT and virtually all religions and spiritual paths. He described an unusual and overpowerful spiritual experience he had as a medical student crossing the Nevada desert that made a strong impact on him.

Angela would like to mention,

“I have a profound gratitude for David’s work. He makes things so clear and relatable. His approach is applicable to all faiths or no faith if one is truly ready to give up their negative thoughts and feelings. As we aim for the truth, and let go of the so called “self,” we find peace and joy. I will forever be indebted to him because I would not be able to help people without TEAM and that brings me joy every day!”

I, David, would like to thank Angela for her intense and tireless devotion to helping spread the “gospel” of TEAM-CBT in so many ways!

Thanks for listening today!

Angela, Rhonda, and David

I

The Dramatic Journey of Jason Meno

In today’s podcast, we interview the amazing but humble Jason Meno, who has been doing incredible programming for the Feeling Good App for the past year. Like everyone on our app development team, Jason was driven to TEAM-CBT and the Feeling Good App by his own personal struggles, and also by his training in Buddhism and his commitment to doing something to help relieve the enormous suffering endured by so many people in the United States and around the world who are struggling with depression and anxiety.

The podcast notes will focus first on how he recently came to join our app team, and then on Jason’s amazing early years in his search for meaning and a solution to his personal suffering and tragedies.

Jason’s journey to the Feeling Good App

Jason began the podcast by describing how he became familiar with David’s work. Then he described his own personal journey and search for enlightenment. I’ll summarize some of both in these show notes.

He said:

I was struggling with severe depression in 2020. I felt like my body was falling apart because I’ve been afflicted with type 1 diabetes since I was five years old. I didn’t have the resources to work with a therapist and felt hopeless, so I searched the internet, looking for a way of overcoming depression on my own. I first turned to apps for help, but my experience was not great.

I eventually found David’s book, Feeling Good: The New Mood Therapy. Through that book, I discovered that depression and anxiety are cons and that I was tricking myself. However, I didn’t use the tools or do the written exercises in the book.

I started listening to the Feeling Good Podcasts and waited for the new book, Feeling Great. Often, when listening to the podcasts I would start crying. I am not a crier, and this often happened in public, so it was pretty embarrassing!

I was also practicing meditation every day, but that didn’t provide much help. It does have its benefits and was a solace for me when I had nothing else, but after years of practicing, it still didn’t give me the tools to combat the thoughts that trigger depression and suicidal urges.

But then I had an “ah-ha” moment when David talked about resistance and the power of positive reframing. It was a tremendous relief to see that it was reasonable to feel the way I was feeling. I devoured the Feeling Great book but still wanted to die since I was still not doing the written exercises that David repeatedly urges the reader to do.

Then, on one of the podcasts, someone said, “you can’t challenge your negative thoughts in your head.”

I resisted that message and told myself that I had no negative thoughts. Many of my negative thoughts are quiet since you learn to empty your mind when you meditate. But then I realized that negative thoughts are just the top layer of your consciousness and that the concept of “cognitions” not only includes thoughts like “I’m a loser,” but also your daydreams, beliefs, and perceptions.

Then, once I sat down and wrote down my negative thoughts, identified their distortions, and challenged them with more realistic thoughts, I began to feel a lot better within five minutes!

If you, the podcast listener, are feeling down, there’s a step-by-step guide in Feeling Great that could be enormously helpful to you. I started following this guide, and then I really started to feel great. After using it a few times, I had the thought, “Wow, this could be a pretty amazing app!”

One of the first questions you ask yourself, “do I really want to feel better?” had a massive impact on me and, of course, is one of the unique elements of TEAM-CBT. And although I made mistakes while using the tools on my own, they still helped more than anything else I’ve tried.

Eventually, I saw a non-TEAM therapist who provided me with some great empathy and valuable perspectives while I used the TEAM-CBT process and daily mood log on my own.

Then I suddenly realized that I had no more suicidal thoughts. TEAM-CBT is a way for you to rapidly train your mind and develop a new mindset that reduces suffering. This is an important ethical issue to me, given all the suffering that remains throughout the world, and it reminded me of my Buddhist vow to help others.

So, I signed up to be a beta tester for David’s Feeling Good App. However, I was disappointed in the early version I tested and created a 12-page document listing my complaints. Then I reached out to Jeremy Karmel, the CEO of the Feeling Good App, and he invited me to join the development team.

I was so excited that I left my job as a data scientist working on an automated insulin device and joined the app development team. And although I was not familiar with the computer language Jeremy was using, I learned it quickly, and now I’m programming all kinds of cool things for the app!

Jason’s early years

You may or may not be familiar with Herman Hesse’s famous 1922 novel, “Siddhartha,” which traced the journey of the young Buddha as he was searching for personal enlightenment and unlocking the key to human suffering. (https://en.wikipedia.org/wiki/Siddhartha_(novel)) I have not read many books, because I am a slow reader, but that one is short and has always been one of my favorites. Jason’s intense and dramatic journey reminds me of Siddhartha’s path.

Jason’s road to TEAM-CBT, his current passion, was not a direct one at all. Like myself (David), he was raised in a strict Christian home but found himself attracted to exciting and controversial topics when he was in high school, like astral traveling and “lucid dreaming,” which means becoming aware when you are dreaming so you can take charge of your dreams and do things in your dream world that you may not be permitted to do in real life.

For example, Jason has been treated for type 1 diabetes since the age of 5 and has to monitor his blood glucose levels 24 hours a day. Things like fresh orange juice are dangerous because they cause a spike in blood sugar, but in a lucid dream you can drink all the orange juice you want! I can identify with Jason’s yearning for fresh squeezed orange juice, because I grew up in Phoenix, Arizona, and we had many orange trees in our yard, so the orange juice was plentiful and incredibly delicious!

When Jason was a teenager, there was a magic / occult shop near his high school that he would joyfully and curiously explore after school, but his parents were dead set against it. They told him that he was exploring ideas promoted by the devil and threatened to kick him out of the house!

I also identified with these memories, as I also used to hang out in magic stores in Phoenix when I was in high school. But these were more the kinds of shops that sold tricks of various kinds that magicians could use.

Although Jason studied biomedical engineering in college, he continued to be fascinated by his more exciting “alternative” occult pursuits, and dropped out of college to join a cult in Sedona, Arizona. The cult members insisted that he could cure his diabetes simply by believing he could, so he obediently stopped taking his insulin and monitoring his blood sugar for one day and nearly died.

Jason described that his mother struggled with emotional issues. After running away with him twice when he was 10, she lost custody and disappeared to Santiago, Chile. Jason had not heard from her since. But one day, out of the blue, his brother called him and said that their mom had suddenly returned home, and there was some talk of starting a family bakery.

Jason was thrilled and purchased a plane ticket to fly from Indiana to Hanford, California, to surprise his mom after not seeing her for 10 years and offer to help with the bakery.

But then right before leaving, his sister called and asked if he had heard the news. At first, he thought she was talking about the family bakery, but his sister said, “No, mom just committed suicide.” Jason was devastated and sadly flew home out for the funeral. Although his mother’s body was not present at the funeral, he looked and suddenly thought he saw her standing in the church during the service.

This jolted him, understandably, until it dawned on him that it was his mother’s twin sister. His aunt offered him a new life, a car, and a beautiful home in Carmel-by-the-Sea, California, but he was still obsessed with the cult, so he returned to the cult in Arizona.

He spent all his savings of $3,000 for special training to become a cult leader and ended up living as a homeless person in Boulder, Colorado. However. he started running out of his diabetes medications and having panic attacks. He eventually found work in a Buddhist retreat center in the mountains of Colorado and started studying Buddhism, making friends with the monks, and began doing traditional mediation.

He said that mediating intensified his negative feelings, and he became suicidal, and even tried a special “suicide meditation” that he’d learned from the cult in Arizona. They claimed that if you did this meditation, you would disappear and end up in a kind of different universe, but after trying it several times, he realized it was all bunk and gave it up, along with the other crazy cult things he’d been taught.

However, he did make a sound connection with traditional Buddhism, and lived at the retreat center for about a year. He described a special meditation where you ask yourself, “what doesn’t need to change?”

The goal is to discover that the answer is “nothing” since everything is in constant flux, and this meditation is intended to lead to a kind of acceptance. But, he says, “at first I resisted.”

He said he did experience feelings of pleasure and euphoria during some of his mediations, but that this was not a permanent cure for his depression. That’s because the meditation was a distraction or escape from his negative thoughts, a kind of temporary trance-like state, but when you finish meditating, you are back to your normal life, so your negative thoughts and feelings return.

Jason has become an enthusiastic advocate of TEAM-CBT, and described two ways of challenging negative thoughts based on David’s Externalization of Voices Technique. One approach is highly rational, and it reduces your negative feelings but does not flood you with feelings of joy or enlightenment. The other approach reduces your negative feelings AND energizes you with feelings of joy. The second involves using David’s Externalization of Voices Technique along with the three strategies for crushing negative thoughts:

• Acceptance

• Self-Defense

• The CAT, or Counter-Attack Technique.

David asked Jason to discuss one of the traditional Buddhist definitions of enlightenment. You are “enlightened” if you are free of greed, ignorance, and delusions. However, he sent this delightful email following the podcast recording:

Hi David and Rhonda,

Thank you so much again for having me on the podcast! It was a blast!

I wanted to clarify an important mistake I made:

A commonly accepted Buddhist definition of enlightenment is to be completely free of the three root poisons of greed, hatred, and delusion. These are considered to be the source of suffering / negative thoughts / mind states (Buddhists refer to these as Kleshas). I can't remember exactly what I said in the podcast, but I think I may have incorrectly listed the three poisons as greed, delusion, and ignorance. Delusion and Ignorance are considered to be in the same category, so I think I forgot Hatred. Oops! Looks like I'll have to brush up on my studies again! Hopefully, we can help make this clear in the show notes as well.

If you or anyone you know is at all interested in learning more about Buddhism, its philosophies, and history, I highly recommend the YouTube channel Doug's Dharma.

Candidly,

Jason

I am very grateful for the creative and life-changing contributions that Jason is making in our Feeling Good App, and I feel tremendously lucky to know Jason on a personal and professional level. His quite humility speaks loudly and boldly about the kind of loving and genuine person he is, and if you decide to beta-test our app, you will have the chance to benefit from his personal journey and his professional genius!

If you’re interested, you can sign up to beta test the app at www.feelinggood.com/app. If you would like to contact Jason, you can reach him at asonmeno@feelinggoodapp.com.

After reviewing the draft of the show notes, I got this link from Jason:

Also, if you are interested in reading a little more of the story, I wrote this article a few years ago about some scary health challenges I had and how I ended up leaving the Buddhist retreat center and returning to school: Buddhist Enlightenment or Just Life with Diabetes?
Thanks for listening today!

Thanks!

Rhonda, Jason, and David

Today, you will hear the the second half of the live therapy session that Dr. Jill Levitt and I did with Nazli, a young woman from Turkey, at our recent “David Burns Live” workshop on May 22, 2022. Nazli has been struggling with intense performance anxiety and generalized anxiety, and generously who volunteered to be a “patient.” Jill and I are very grateful for Nazli’s courage in sharing herself so courageously with all of you, and hope you enjoy the session and learn from it.

Last week, we played the first half of the therapy session, including the initial T =Testing and E = Empathy. Today, you will hear the exciting conclusion, including A = Assessment of Resistance and M = Methods, and final T = Testing.

As a reminder, you can review the Daily Mood Log and Brief Mood Survey (BMS) that Nazli filled out at the start of the session.

Part 2 of the Nazli Session: A = Assessment of Resistance and M =  Methods

After a period of empathizing, Nazli gave Jill and David an A in Empathy, so we moved on to the Assessment of Resistance portion of the session. This often involves the following steps:

• Invitation Step

• Miracle Cure Question

• Magic Button

• Positive Reframing

• Pivot Question

• Magic Dial

Jill issued a Straightforward Invitation, asking Nazli if she was ready to get down to work, or if she needed more time to vent. She said she was ready to go to work, so Jill asked what changes she was hoping for during the session. This is the so-called “Miracle Cure Question.” This helps to focus the session on something specific.

Nazli said that her hope was to reduce or eliminate the negative thoughts and feelings that were making her clinical work so stressful. And like nearly everyone, she said she’d eagerly press the Magic Button.

Then Jill and David pointed out that although we didn’t have a Magic Button, we did have some powerful techniques that could help, but it might not be the best idea to use them. That’s because there might be some positives hidden in her negative thoughts and feelings, and perhaps we should first take a look.

David and Jill asked Nazli these three questions:

1. Given your circumstances, why might this negative thought or feeling be totally appropriate and understandable?

2. What are some benefits, or advantages of this negative thought or feeling?

3. What does this negative thought or feeling show about you and your core values that’s positive, beautiful, or even awesome?

This technique is called Positive Reframing. The goal of Positive Reframing is to reduce the patient’s subconscious resistance to change, along with their feelings of shame about their symptoms.. Paradoxically, the moment patients see the beautiful and awesome things about their negative thoughts and feelings, their resistance to change typically disappears. Positive Reframing is one of the unique features of TEAM-CBT and it opens the door to the possibility of rapid change.

As an exercise, see if you can find some positives in five of Nazli’s feelings,

• Anxiety

• Ashamed, bad

• Inadequate

• Hopeless

• Angry

Please do this on paper, and NOT in your head, using the blank Positive Reframing Tool you’ll find at the end of the Daily Mood Log.

Getting it “right” isn’t important. What is important is trying. This will get your brain circuits firing in a new way. Then, when you see the work that we did with Nazli, you might have your own “ah-ha” moment, as well as a powerful new skill that may be helpful to you as well.

Okay. Did you do that yet, or do you plan to look at the answer without doing the exercise?

Oh! I see! You’re planning to look at the answer.

If you want to learn at a deep level, whether you’re a therapist or lay person, do the exercise first! It may be challenging at first, but it will fire up your brain circuits, so when you look at the answer, you’ll suddenly have a new and deeper understanding of Positive Reframing.

When you’re done, you can check this link to see the work that Jill and I did with Nazli.

But either way, I’m grateful that you’re listening to these podcasts and reading the show notes!

If you click on this link, you can find the Emotions table from Nazli's Daily Mood Log showing her goals for each negative feeling after we use the Magic Dial.

After we finished the Magic Dial, we went on to the M = Methods portion of the TEAM-CBT session, and helped Nazli challenge some of her negative thoughts using a variety of techniques including Explain the Distortions, the Externalization of Voices, Examine the Evidence, the Acceptance Paradox, and more.

One of the thoughts she wanted to work on first was this one:

“If I don’t fix this patient or make him/her satisfied, then she/he will judge me and think poorly about me.”

Together with Nazli, we identified a number of distortions in this thought, including a couple more that popped into my mind while doing the show notes:

• Fortune-Telling: Making a negative prediction without good evidence.

• Mind-Reading: Assuming that I know how my patients are thinking.

• Hidden Should Statement: Telling myself I should be doing better.

• Mental Filtering: Selectively noticing the times sessions have not gone well.

• Discounting the Positive: Overlooking the positive feedback I typically get from patients and supervisors.

• Magnification and Minimization: Magnifying the importance or “awfulness” of negative feedback from patients, and overlooking the potential value of processing their negative and positive feedback with them at the next session.

• Emotional Reasoning: Thinking that my feelings of inadequacy and anxiety mean that I really am screwing up with patients

• Self-Blame: Beating up on myself constantly when I’m seeing patients.

Nazli’s belief in this thought went down from 80% to the range of 10% - 20%, since there was some truth in the thought. Sometimes you’ll want to smash a negative thought, so your belief in it goes all the way to zero. Sometimes, it’s okay just to reduce your belief in a thought substantially, but not all the way to zero.

We also encouraged Nazli to begin using the Brief Mood Survey (BMS) and Patient’s Evaluation of Therapy Session (EOTS) with every patient at every session so she can get immediate and accurate feedback of how she’s doing, and so she can fine-tune her therapeutic strategies based on this information.

This practice is vastly more effective than Mind-Reading, since therapists’ perceptions of how patients feel tend to be wildly inaccurate most of the time. If you are a therapist, T = Testing at start and end of every  is a vitally important key to personal and professional growth, although it takes courage because sometimes—or even often—you will have to confront some information that may threaten your feelings of pride!

You can see Nazli’s final ratings of her feelings on the Emotions table her Daily Mood Log at the end of the session. Since the changes in all of her negative feelings were dramatic, we asked Nazli two questions:

1. Are these ratings valid, or are you just trying to please David and Jill?

2. If so, what were the effective ingredients of your session. What, more than anything else, accounted for the significant and rapid changes you experienced?

You will hear how she answered these vitally important questions on the podcast, and you can see Nazli’s BMS and EOTS after her session if you click the link.

Thanks for tuning in last week and today! Once again, Rhonda, Jill and I want to thank our wonderful and courageous Nazli from the bottom of our hearts! We hope you enjoyed this session, and the chance to look behind closed doors to see how psychotherapy actually works in a real session with a real human being who, like nearly all of us, struggles at times with that ancient belief that “I’m just not good enough!”

In fact, we’re all, in many ways, “not good enough,” and will probably never be “good enough.” But that is never the cause of our problems, especially our lack of self-esteem.

Do you know what the actual cause is?

Do you know what the solution is?

Take your best shot, make a guess, and then you can click on this link.

Thanks!

Rhonda, Jill, Nazli, and David

In the next two podcasts, you will hear the live therapy session that Dr. Jill Levitt and I did with Nazli, a young woman from Turkey, at our recent “David Burns Live” workshop on May 22, 2022. Nazli has been struggling with intense performance anxiety and generalized anxiety, and generously who volunteered to be a “patient.” Jill and I are very grateful for Nazli’s courage in sharing herself so courageously with all of you, and hope you enjoy the session and learn from it.

Although the facts of your life are probably quite different from Nazli’s, you may be able to identify with the almost universal theme of feeling like you are not “good enough.” The ultimate antidote to this type of suffering is simple, but so basic that you may not “see it” at first, especially when it comes to your own negative thoughts and feelings.

Although we all have many flaws and shortcomings, our inadequacies are rarely or never the cause of our emotional distress. Our emotional distress, in terms of anxiety, depression, inferiority, loneliness, hopelessness, and anger, nearly always results from our thoughts, and not so much from what’s actually happening in our lives.

In addition, the thoughts that trigger those kinds of feelings are almost never valid. Instead, they are loaded with cognitive distortions. As you probably know very well, I have often said that depression and anxiety are the world’s oldest cons.

And here’s the really good news. The very moment you change the way you THINK, you can change the way you FEEL!

Sounds wonderful. But isn’t it just a little, or a lot, too good to be true? And can you really trigger real change at the gut level by changing the way you think?

Let’s find out!

In today’s podcast, you’ll hear the first half of Nazli’s session, including T = Testing and E = Empathy. Next week, you’ll hear the exciting conclusion of her session, including the A = Assessment of Resistance and M = Methods, followed, of course by the final of T = Testing so we can see if Nazli really changed, and if so, by how much. We’ll also see and how she rated Jill and David on Empathy, Helpfulness, and more.

If you’ve followed the Feeling Good Podcasts, you know that doing live therapy to challenge your own demons is part of therapist training in TEAM-CBT This experience greatly deepens your understanding of team and allows you to give this message to your ow patients:

“I know how you feel because I’ve been there myself. And it will give me great joy to show you how to CHANGE the way you FEEL, too!”

I think of this personal step as the transition from technician to healer. But you cannot take this step with credibility if you haven’t yet done your own “work.”

At the start of the session, Nazli explained that she’s struggled with anxiety ever since she was a child, and that’s what triggered her interest in a career as a clinical psychologist. In my experience, this is true of many if not most mental health professionals. Although the general public often have the impression that shrinks have it all together, nothing could be further from the truth. Most went into the field hoping to find a solution to their own suffering, and a great many—probably nearly all—are still searching and hoping to find a their “cure.”

After completing her master’s degree in counseling 10 years ago, Nazli got a job at a counseling center, and in spite of the fact that she received consistently good feedback, she quit after 2 and 1/2 years and took a job in administration. This was because of the intense anxiety she experienced during sessions, resulting from the constant and relentless bombardment with negative thoughts that popped into her mind when treating  patients.

However, she still yearned to do clinical work, so she decide to go back to clinical work several years ago and has been doing therapy for patients being treated for cancer. But the negative thoughts and feelings still continued to haunt her.

You can review them on the Daily Mood Log that Nazli showed us at the start of her session. As you can see, when she’s treating patients, she feels severe depression, anxiety, shame and inadequacy. She also feels humiliated, hopeless, and discouraged, along with some moderate feelings of anger and resentment.

Nazli explained that she has no fear of public speaking, but said that when she’s working with a client, she constantly criticizes herself for fear of making a mistake and tell herself:

• I’m not doing a good job.

• This job is not for me.

• Should I just quit?

• My friends are at a better place in life.

• I’m 38 years old and missing out on a lot.

• Why am I like this?

Recently, she went to visit one of her patients, a young woman struggling with lung cancer; but when Nazli entered the room, her patient said: “I don’t want to talk to you!”

Nazli said, “I was devastated and felt like crying.”

When you review Nazli’s Brief Mood Survey (BMS) at the start of the session, you’ll see that the only feeling that was elevated was anxiety, and that was minimal. However, her score on the Happiness Test was only 8 out of 20, indicating that she didn’t feel very worthwhile, happy, hopeful, motivated, or satisfied with her life. This meant that her negative thoughts and feelings when she was seeing patients were making a huge impact on her capacity for happiness and self-esteem.

Her minimal scores on the depression, anxiety, and anger scales on the BMS also reflect the fluctuating nature of anxiety and other feelings for many people. For example, you may have little or no anxiety most of the time, and when you’re having a session with your shrink you may not feel especially anxious, either. But when you encounter the situation that triggers your anxiety, the feelings suddenly spike tremendously, along with a host of other negative feelings, and then the emotional discomfort can be overwhelming.

End of Part 1 of the Nazli Session: T = Testing and E = Empathy. Next week, you will hear Part 2: A = Assessment of Resistance and M =  Methods.

Thanks!

Rhonda, Jill, Nazli, and David

Podcast #300: Celebrating Five Million Plus

 In today’s podcast, we celebrate, thanks to Rhonda and Fabrice, our 300^th podcast, featuring some of our most beloved guests since our first podcast on October 27, 2016. We began with Fabrice Nye, who describes the birth of the Feeling Good Podcast, and two of our favorite and most popular guests, Drs. Matthew May and Jill Levitt. The schedule for all of the guests appears below.

The featured guests include Fabrice Nye, Matthew May, Jill Levitt, Angela Krumm, Lorraine Wong, Kyle Jones, Brandon Vance, Heather Clague, Leigh Harrington, Sarah Hester, Brian Wright, Mark Noble, Thai-An Truong, Stirling Moorey, Rose Markotic, Mark Taslimi, Sunny Choi and Elizabeth Dandenell.

Rhonda, Fabrice and I want to thank all of our guests who have contributed so generously to our efforts, and to all of you, who have supported us!

Most of the guests today have done personal work with David, often with Jill, Matt, or Rhonda as co-therapists, and almost all had some version of “I’m not good enough” when they were upset, and all found solutions to this which expanded their humanness and deepened their skills as TEAM therapists.  Our guests who did personal work were asked how things had been for them since doing that work, and they all reported that the results have been long-lasting, even permanent!

In the following email I just received, Dr. Matthew May shared some feelings about today’s show.

Hi David,

I like the show notes and approve of their humble nature.  Brevity is the soul of wit!

If I were to edit anything, and I’m not sure that I would, it would be to list all the names of all the excellent folks who participated, in the first paragraph.

My sense is that it was their vulnerability, as well as their willingness to do challenging personal work, that led to enduring improvements in mood, relationships and lives.

I thought it was the personal endorsements and descriptions of how TEAM has improved their lives, that were the most compelling themes of the podcast.

Adding to this, it goes without saying, that none of this would have happened without you, David.  You created this model of therapy for one thing.  You also created this community of people.  As you said before the podcast started, the most meaningful and important part of all of this has been the relationships and friendships that have developed as a result of this work.  (I’m paraphrasing and not doing a very good job of it, sadly!).

In any case, I caught myself wondering if this format of therapy, one that is public and open, might be the future.  Meaning, instead of hiding our flaws and insecurities behind closed doors, if we might continue to attack the shame and stigma of “mental illness” by exposing it to the light of day, realizing that there was nothing to be ashamed of or afraid of, only opportunities to connect and be in the good company of other flawed, imperfect souls, just like us.

-Matt

Fabrice replied to Matt:

Early Christians were doing their confessions in public—why not? ☺

Our numbers continue to grow each month, so please continue to tell your friends about us. We do not accept commercial advertising, something Fabrice suggested early in our development, so you are our only marketing team, and we thank you for sticking with us and sending us so many beautiful emails, reporting your responses to our shows, asking questions, and suggesting new topics.

Our audience consists of lay people looking for personal healing as well as mental health professionals looking for new treatment tools as well as their own personal healing.

Warmly, Fabrice, Rhonda, Matt and David

299: Ask David: Retirement blues;
patients who refuse homework
(and the therapists who love them);
ADHD; David's new pooping story; and more! 

We regret that our beloved Matt May, MD could not join us today due to an emergency involving his website. We look forward to him joining us next time for more exciting Ask David’s that will include: Does the “self” exist? Does God exist? And MUCH more!

We open with two announcements:

1. Return of the awesome Feeling Great Book Club, with Drs. Brandon Vance and Heather Clague, will meet weekly, starting on September 13th. This will be a terrific experience, and only costs $12 per week with a sliding fee scale if you cannot afford it. You will go through the Feel Great book, learn techniques, have fun, and practice in small groups. This is a fantastic opportunity for everyone. For more information, go to:  https://www.feelinggreattherapycenter.com/book-club.

2. The TEAM-CBT World Congress, Warsaw Poland, August 18 - 21. This first of a kind event will take place live and virtually, and will be somewhat like David''s famous Intensives with teachers from around the world, many of whom have been featured on this podcast.  The CONGRESS will feature interactive sessions which participants can learn and practice the elements of the powerful TEAM system while receiving expert coaching on TEAM techniques. This event is organized by Daniel Minte, Mariusz Wirga, and Yehuda Bar Shalom. For more information, please go to:  https://teamcbt.eu

Today’s questions: Retirement depression / anxiety; patients who refuse to do exposure or psychotherapy homework; treating procrastination and ADHD; David’s new pooping story, and more!

1. Paul asks: Are you planning on doing a podcast about people who are about to retire and are very anxious about the prospect and also depressed about closing that chapter in their lives? I’m in that boat.

2. M asks: My patient refuses homework and isn’t getting better. I think I’m a victim of what you’ve referred to as “reverse hypnosis.” What should I do?

3. Heather asks: Hello David! How would you treat ADHD with TEAM-CBT?

4. A asks: Hello sir, Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper?

Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways.

In some cases, I did not have time to polish and edit my responses below. I’ve been super busy developing the Feeling Good App, which is coming along tremendously well. It has the potential to help millions around the world who are struggling with depression and anxiety, but I have to be super careful with my time these days. If interested in beta testing, you can sign up here.

1. Paul asks: Are you planning on doing a podcast about people who are about to retire and are very anxious about the prospect and also depressed about closing that chapter in their lives? I’m in that boat.

David’s reply

Have you read the introduction to Feeling Great? Or done any of the written exercises in that book, or in any of my books? Of listened to my free Ted Talk on my website?

We can provide more specific information in the live discussion on the podcast.

2. M asks: My patient refuses homework and isn’t getting better. I think I’m a victim of what you’ve referred to as “reverse hypnosis.” What should I do?

Dear Dr Burns, Many thanks for your blogs, podcasts, books and TEAM CBT. I have experienced (and I am experiencing) being hypnotized with a Panic Attack patient with Border Line PD- .

I know this after the sessions. During the sessions I feel I cannot even think well. I see this client through SKYPE, And cannot see her face to face due to distances.

I have try to follow your approach, but she’s resistant, I do include exposure exercises that she never completes. How to do a Shame Attacking Exercise when I cannot go with the patient to the places she needs to in order to do the exposure.

I have even been in the phone and she driving, but 2 years later nothing works. Any thoughts will help!

Many thanks in advance. M.

David’s reply

Thanks, great question! Some training or individual case consultation or both, or workshops, would help a lot. We have two free weekly training groups for therapists in California and therapists around the world.

For example, the last two weeks in our Tuesday group we have focused on the negative thoughts and feelings therapists have during sessions that interfere with their ability to do excellent work. So your question is very timely and relevant!

Also, the www.feelinggoodinstitute.com has free and paid training. Two of the finest teachers are Mike Christensen and Dr. Jill Levitt, and there are many others as well.

Jill has just released an introductory recorded class on TEAM-CBT that you can purchase and watch whenever you like. She is a brilliant teacher!

And yes, you HAVE been hypnotized during sessions!

David

3. Heather asks: Hello David!! How would you treat ADHD with TEAM-CBT?

Hi there! It is Heather Donnenwirth, from podcast 267. I hope you are doing well. I really enjoyed being apart of the podcast with you, Rhonda, and Kyle. Thanks again for including me in that experience.

I have another question for you about the podcast you did on ADHD. I totally agree with you about ADHD not being a diagnosis and agree that is more helpful to treat the symptoms.

Many of the clients that I work with have been diagnosed with ADHD or are convinced that they have it. Procrastination seems to be a common symptom of "ADHD" that people want help with and that can be treated easily with the TEAM model and with the anti-procrastination and motivational tools.

The symptom that people ask for help with that I am feel less confident about helping them with is difficulty with focus and distractibility, and would love your thoughts about how to treat these symptoms? I have improved my own focus with motivational techniques and with practicing bringing my attention back to what I want to focus on when my mind starts to wonder. Also, taking notes has helped me to stayed focused, but I am curious if you have any other ideas about increasing focus?

Sometimes the people I work with have distorted thoughts about focus as well, such as: "If I'm not interested in something, I can't focus on it," and "I need medication to focus," etc.

Anyway, I value your knowledge and opinion and wondered if you have any tools for increasing focus?

Also, do you treat hyperactivity and excessive talking? I have also noticed that parents some time play an enabling role with kids diagnosed with ADHD, and don't require their children to do schoolwork that they think is too hard or if they are bored and having a hard time focusing.

Sorry this is long!!! I hope you are doing well!!!

Warmly,

Heather Donnenwirth

David’s reply

I’d just ask the person to focus on one moment when they had that problem and then do a Daily Mood Log, as you’ve pointed out, and also brainstorm with them on how to solve the problem. But first, would have to do empathy and assessment of resistance, same as with anybody!

As you point out, the motivational factors can be enormous. For example, Adderall is just the same as Dexedrine, and highly addictive and euphoric street drug. If I had some right now, I’d be highly excited and write 30 pages of stuff!

In addition, I can use ADHD as an excuse for not doing stuff that’s boring. Someone who is motivated can easily find a solution.

The summary before college I was lucky to get a job in a bank in Phoenix. My job was filing checks by hand. Boy, that was boring!

I made it a bit less boring by trying to find the most unusual names while I was filing checks alphabetically. One of the many unusual (to my young and uneducated ear) names was J. Karekin Moojian!

As freshman in college, I found I had trouble concentrating and grasping what the professors were saying in lectures to large classes of a couple hundred or so students. And I had NO IDEA whatsoever what the teacher was talking about!

What helped was simply asking another student as we were walking out of the class. I’d say, “What was the professor trying say?”

Then the other student, who seemed way smarter than me, would just give a one sentence summary, and I’d suddenly “get it.” So, if you’re motivated, you can find a way!

In medical school, I had to memorize gross anatomy. I had little aptitude and no interest. I had never even take a biology class in college, and did not know what was in the “abdomen” or “thorax.”

So I made up little games, sitting for hours in the library memorizing stuff. It got me through—just barely1

David

4. A asks: Hello sir, Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper?

Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper. Thank you.

David’s reply

Interesting question! Probably okay either way. No research on this issue!

I slightly favor doing it by hand, but that is likely because I have done it that way for 40 + years! d

Thanks for listening and reading today!

Rhonda, and David

Today we feature Professor Hitendra Wadhwa PhD who has been a fan of David’s work for the past ten years. Hitendra has just published a new book, Inner Mastery, Outer Impact.

Hitendra is a Professor of Practice at Columbia Business School and Founder of the Mentora Institute, and his class on Personal Leadership & Success is one of the most popular at Columbia Business School. He believes that the secret of leadership and success in business stems from inner mastery. He also has his own fascinating and skillfully produced podcast called Intersections where he interviews accomplished individuals from different spheres of human pursuit to draw out their insights and stories about the pursuit of success and happiness.

One of Hitendra’s aims has been to integrate current psychological trends with  ancient wisdom in order to glean the most important ideas needed for happy and successful lives. He has backed this up with a daily meditation practice he began 20 years ago, seeking answers to the most basic questions about the meaning and purpose of our lives and a philosophy that leads to joy, connection, and productivity.

Hitendra gives an example of how inner mastery can lead to outer impact. A colleague named Dan used to relentlessly find shortcomings and point to improved solutions every time Hitendra presented his work when he was first working as a business consultant. He said that he carried a grudge against Dan for several weeks because he was trying to impress his colleagues and felt put down by Dan.

Of course, this type of attitude and defensiveness can easily trigger the very adversarial responses we fear. Then we tend to blame the “outer” and overlook how we might be inadvertently creating our own negative external reality. Fortunately, the opposite is equally true. When your attitude suddenly shifts, and your “inner” self changes, your outer reality will nearly always suddenly shift at the same time.

One day, one of Hitendra’ s supervisors said to him: You should be more like Dan. He’s trying to help you take your game to the next level, but you don’t take a similar interest in helping him find ways to improve his work!”

Hitendra explained the impact of his supervisor’s statement:

“This comment suddenly turned on a light bulb in my head. I realized I was viewing Dan as an enemy, so if he criticized me, I thought he was against me, so I viewed him as the “enemy.” Instead, I decided to find the truth in his criticisms and began to view him as an ally, as a teacher, as someone who wanted to help me.

“At that point, our entire relationship changed dramatically, and I felt empowered!”

Of course, podcast fans will realize this as the Disarming Techniques, one of the Five Secrets of Effective Communication that David has popularized.

Hitendra also discussed other themes in his new book, like what it means to “be true to yourself,” and how to discover the crown jewel within yourself, at your core.

He also described how to tap into the five sources of core energy within yourself: Purpose, Wisdom, Growth, Love, and Self-Realization. He said that many people are afraid of Love, fearing that it is the same as weakness and will lead them to get taken advantage of. He suggested that in reality, love is a powerful force, and gave examples of the expression of love in a variety of successful business.

He told many fun and inspiring stories, including his stuckness when trying to think of a way to honor his father’s 80^th birthday. He couldn’t think of what he’d say at the celebration, because he’d always done the opposite of what his father had recommended. But then, while meditating, he saw that he’d been inspired all long by how his father had lived his life.

He talked about the concept of transcendence as well as racism, and pointed out that we tend to label people based on some characteristic like skin color. But this can be very misleading, because two people who are Black, for example, will often have radically different backgrounds and life experiences.

As an example, he described someone from the Caribbean who had no experience of racial discrimination when growing up. He emphasized that when we label people, we get lazy and do not respond to the reality and depth of who that person really is. Essentially, we are then putting people in “boxes” instead of seeing them for the full richness of who they are.

He also said that our human identities are partly shared and partly unique. For example, Martin Luther King, Jr. learned a great deal from Mahatma Gandhi, who in turn was inspired by Leo Tolstoy—indicating a merger of three strikingly different cultures.

Using story-telling, Hitendra addressed basic questions like:

• How do we integrate our (partially hidden) inner and outer selves?

• Who am I, really?

• What’s my purpose in the universe?

He said that what many psychologists believe they “discover” is actually not new, but based on ancient wisdom, like the practice of gratitude in meditation, and shifting your mindsets, and tuning in to your capacity for compassion and kindness, and finding the best of yourself.

Rhonda and I want to thank Hitendra for his journey and wonderful new book, and all of you as well for tuning in and joining us on our journey!

Warmly,

Rhonda, Hitendra, and David

297: Yuck! Homework!

In today’s podcast, we discuss the important but dreaded topic of psychotherapy homework, and our featured guest is Alexis, whom some of you know from her fabulous work organizing beta tests for the Feeling Good App. Today, Alexis brings us a very special gift, by showing us how she "walks the walk."!

At the beginning of the podcast, we discussed the two major reasons to do psychotherapy “homework:” First, the homework gives you the chance to practice and master the techniques you’re learning, so you can keep growing and strengthening your skills. And second, because it's an expression of motivation; motivation alone can have powerful anti-depressive effects and lead to rapid recovery.

I also talked a research study I did with a friend and colleague who got depressed following the breakup of his relationship with the woman he’d been dating for several years. Each night he would partially fill out a Daily Mood Log, including a brief description of the upsetting even or moment. Then he would circle and rate his negative feelings on a scale of 0 (for not at all) to 100 (the worst), for how he was feeling at that very moment. Then he recorded his Negative Thoughts and indicated how strongly he believed them on a scale from (not at all) to 100 (completely).

He was telling himself that he’d never find anyone to love, that he’d never find work, and so forth.

Then he’d flip a coin to decide on one of two courses of action. If heads, he would jog for 30 minutes or so at a fairly fast clip and then re-rate his belief in each negative thought as well as the intensity of each type of negative feeling on the same scales of 0 to 100. If tails, he would work on his Daily Mood Log for 30 minutes and then rerate his belief in each negative though and the intensity of each type of negative feeling.

He did this for several weeks and I was thrilled to see that he recovered on his own from a pretty severe bought of depression without any psychotherapy or medications. However, I did give him a little coaching on how to challenge various kinds of distortions.

Once he recovered, we analyzed the data using Structural Equation Modeling. We discovered that the jogging had no effects whatsoever in reducing his belief in his negative thoughts. This finding was not consistent with the popular idea that exercise boosts brain endorphins and causes a “high.” I was not surprised, since jogging has never elevated my feelings, either, although some people do report this effect.

In contrast, on the nights that he worked with his Daily Mood Log, there were massive reductions in his belief in his negative thoughts as well as his negative feelings. This finding was consistent with the idea that psychotherapy homework is very important, whether or not you are receiving treatment from a human shrink. The study also confirmed the idea that distorted negative thoughts do, in fact, cause depression and other negative feelings like anxiety, shame, inadequacy, and hopelessness, and that a reduction in your belief negative thoughts triggers recovery.

Anecdotally, I would like to add that he maintained his positive mood and outlook following his recovery. His career flourished, and he got married. I showed him his negative thoughts years later, and he was shocked. He found it hard to believe that he was giving himself and believing such harsh and distorted messages at the time he was depressed.

I’ve often said that there is a kind of hypnotic aspect to depression, anxiety, and even anger. You tell yourself, and believe, things that are simply not true! Recovery is a little (or a lot) like snapping out of a hypnotic trance!

Here is another implication of the study of exercise vs the Daily Mood Log, as well as other studies that have confirmed the critical importance of psychotherapy homework in recovery from depression and anxiety. Because we know the importance of homework, if we are not asking our clients to do homework, then we may actually be impeding their progress rather than supporting them.

That’s why I let people know prior to the start of therapy that the prognosis for a full recovery is very positive, but homework will be required and is not optional. If they feel like they don’t want to do the homework, I don’t encourage them to work with me. This is called the Gentle Ultimatum and Sitting with Open Hands.

Oddly, enough, this approach seems to enhance patient motivation as well as patient compliance with homework between therapy sessions. The homework, in turn, speeds recovery and reduces patient drop-out.

When I’m doing research, I try to create mathematical models that reveal causal factors that affect all human beings, and not some finding that only applies to this or that school of therapy. Therefore, it would seem to follow, that doing “homework” is just as important if you are working on your own without a therapist. And it would seem like it should be important in our app, as well.

These hypotheses have been confirmed. Practice, and doing specific exercises that I’ve created, are just as important to the degree of recovery in beta testers who are using our Feeling Good App, as well as in people who are working on their own without a therapist. Today, we are joined by Alexis, who works on her own negative thoughts whenever (like the rest of us) she feels stressed out or upset.

Alexis described an example of her homework, starting with this upsetting event at the start of the pandemic:

Daily Mood Log

Next, Alexis recorded her negative feelings:

As you can see, she felt intensely guilty, anxious, inadequate, and lonely, and had a few additional feelings that were somewhat elevated.

Then she pinpointed two negative thoughts, along with her percent belief in each one.

1. I’m a bad daughter. 100%
2. I should move back in with my mom. 50%

Then she identified the distortions in her thoughts, and explained why each distortion will not map onto reality. This technique is called “Explain the Distortions.”

Explain the Distortions

NT: I’m a bad daughter 100%

All-or-Nothing Thinking. I’m focusing on the idea that I can be 100% good or bad , which doesn’t make sense, since nothing in this world is completely good or bad.

Overgeneralization I’m calling myself a ”bad daughter,” as though this is label described my entire being.

Mental Filtering Instead of focusing on some of the positive things that I do. I’m focusing on the idea that I’m not doing enough.

Discounting the Positive I’m not thinking about all the loving things that I do for my mom and that I enjoy doing for her and with her.

Mind-Reading I’m telling myself that my mother thinks that I am a bad daughter, but I don’t actually have any evidence for this.

Fortune-Telling I am telling myself that I’ll never be good enough.

Emotional Reasoning: I feel like a bad daughter so I think it must be true.

Magnification and Minimization: I’m magnifying how important my conduct is to my mother (big ego).

Should Statement: I’m telling myself that I should be a better daughter and that I shouldn’t have moved back to the city where I prefer to live.

LAB: I’m labeling myself as “bad daughter.”

Self-Blame: I am blaming myself for being a “bad daughter.”

Other-Blame: I might be blaming my mother for expecting so much.

NT: I should move back in with my mom. 50%

All-or-Nothing Thinking. I’m telling myself that I’m either there 100% or not there 100%, which doesn’t really make sense. Even if I don’t live with my mom, I can still visit often and stay as long as I like.

Mental Filtering I’m focusing only on my duty to a parent and not on my commitments to myself.

Fortune-Telling I’m telling myself that something bad will happen to my mother and that she will be unable to care for herself.

Magnification and Minimization: I’m magnifying my importance (ego!!!)

Emotional Reasoning: I feel like I should live with her so it must be true.

Should Statement: I am shoulding myself.

Self-Blame: I’m blaming myself for leaving and for wanting to live on my own.

Other-Blame: I am secretly blaming my mother for making me feel this way.

Straightforward Technique

You just try to challenge your negative thought with a positive thought (PT) that fulfills the Necessary and Sufficient Conditions for emotional change:

• The Necessary Condition: The PT must be 100% true, and not a rationalization.
• The Sufficient Condition: the PT must significantly or greatly reduce your belief in your Negative Thought.

Negative thought: I am a bad daughter (I should move back in with my mom.)

Write down a more positive and realistic thought:

My mom is in average health for her age and can take care of herself. She has the financial resources to maintain her lifestyle without my help.

Ask yourself:

Is this negative thought really true?

Maybe. I love my mom more than just about anyone. I do lots of things for her and with her and enjoy her company immensely.

Do I really believe it? I do.

Socratic Method

When you use this technique, you ask yourself questions to lead yourself to the illogic of your negative thought.

NT: I am a bad daughter

Questions:

Are you sometimes a good daughter? Yes

Do most adult children feel like they are a bad kid sometimes? Yes

NT: I should move back in with my mom

Questions:

Should adult children live with their parents? Not if they don't want to!

Worst, Best, Average

With this technique, you list the qualities of the opposite. Since you’re calling yourself a “bad daughter,” you can list the qualities of a “good daughter.” Then you can rate yourself in each quality, thinking of when you’re at your worst, when you’re at your best, and your average.

When you’re done, you can review your ratings. If there’s one area where you need to improve, you can put together a 3 or 4 step plan for changing. Sometimes, as in Alexis’ case, you’ll realize that you’re actually doing just fine, and no change is needed!

This technique was the icing on the cake, and Alexis decided that her thought, “I’m a bad daughter,” wasn’t actually true.

These were her feelings at the end.

As you can see, Alexis put in some time and effort to challenge the negative thoughts that were triggering her unhappiness. We are indebted to Alexis for being so open and vulnerable, and for showing this how it works.

Is it worth it? That was a lot of “homework!”

That’s a decision you’ll have to make for yourself, of course. The Dalai Lama said that happiness is the purpose of life. That’s not entirely true, but there’s a lot of truth in it, for sure!

So, the question might be, what would some greater happiness be worth to you?

If you are interested in beta testing the Feeling Good App, you can sign up at www.feelinggood.com/app.

Thank you Alexis for the very special gift of your knowledge, tremendous skill, and vulnerability!

Until next time—

Rhonda and David

Podcast 296: Forced Empathy: A Master Class--Part 2 of 2

Last week you heard part ! of our work witt Zeina, a young professional woman struggling with a conflict with her mom. Zeina feels like her mother is too critical of her, and she finds the criticisms devastating. In today's podcast, you will hear my co therapist, Dr. Jill Levitt, and I, doing Forced Empathy with Zeina, and you will hear the exciting conclusion of the session. I am including the entiere show notes from last week, in case you have not yet reviewed them.

Show notes from last week commence here.

Today Dr. Jill Levitt and I do live work with Zeina Halim who has been experiencing some intense negative feelings because of her mother’s criticisms of her. Zeina is a member of my weekly training group at Stanford and has appeared on the podcast on several previous occasions (Please provide numbers plus link to podcast page on website.)

Zeina is one of our small group leaders in our Tuesday training group.  She works with teens and adults in-person in her office in Menlo Park and also provides tele-health sessions for clients living anywhere in California.

Dr. Jill Levitt is the co-leader of my Tuesday training group at Stanford and will be my co-therapist today. We hope for some more of the “magic” that frequently appears when we do therapy together. Today’s podcast will illustrate a number of teaching points, including these:

1. Forced Empathy: We illustrate exactly how to use this powerful and sophisticated technique. When I first created this technique many years ago, I thought there would be little interest in it, so I rarely taught it in my workshops or training groups. In the past several years, an intense interest in this technique has emerged, so you will get to see exactly how it works.
2. Five Secrets Resistance: There has been great interest in the Five Secrets of Effective Communication that are featured in my book, Feeling Good Together. When used skillfully, they can have a phenomenal effect on any troubled relationship. I am even aware of a case of a woman who was kidnapped at gunpoint by a violent serial rapist who planned to kill her. Out of desperation, she used the Five Secrets I had presented at a workshop he had just attended, and he let her go and turned himself in to the police. The Five Secrets literally saved her life.

And yet, many of us stubbornly refuse to use the Five Secrets with family, friends and loved ones. Why do we fight against the very tools that would rapidly bring us peace, love and joy? And what can we do about our own internal “resistance”?

3. The “inner” and “outer” solutions: Whenever you are involved in a conflict with someone, there are two battles raging at the same time. One is the “inner battle” with your own negative thoughts, telling you that you’re no good, or that the other person is to blame, and the voice that powerfully urges you to do battle.

We approach the “inner battle” with the familiar Daily Mood Log, that helps you pinpoint the distorted messages you are giving yourself. You will see that those messages—the way you talk to yourself when you’re upset—are loaded with distortions; such as All-or-Nothing Thinking, Overgeneralizations, Mental Filtering, Discounting the Positive, Mind-Reading, Labeling, Should Statements and Hidden Should Statements, Emotional Reasoning, Other-Blame, and more.In today’s session, we do battle with Zeina’s distorted thoughts with the Externalization of Voices, arguably one of the most powerful psychotherapy tools ever created.

4. The EAR Checklist / Relationship Journal. The “outer battle” involves the words you use when you respond to the other person’s criticisms of you. Here we use the Relationship Journal, another super powerful tools that allows you to analyze your own statements with the EAR Checklist and see the shocking reality that you are creating the very conflict that you are complaining about so vigorously. This involves one of the “Great Death” of the self, which can be profoundly painful, but it also leads to liberation from your self-created misery and the chance for renewed love and connection with the person you feel so alienated from.
5. Two-hour sessions. You can do far more in a single, two-hour session than in many 50 minute sessions scheduled at weekly intervals. I have often said that this is how I always do therapy, and if you have some therapy skills, this model is vastly more effective and cost-effective as well. It puts you under pressure to accomplish something today, right now, and not in the vague or distant future.
6. Uncovering Techniques. You will see how you can use the Man from Mars Technique to uncover more of your patient’s negative thoughts and core beliefs. This is just another way of doing the classical “Individual Downward Arrow Technique” that I developed way back in the 1970s.
7. The Acceptance Paradoxes. There is a great deal of talk these days about Acceptance is being an important key in many schools of psychotherapy. But what is acceptance, and how do we teach it to our patients and colleagues? Today’s session with Zeina, who has a great interest in Buddhist philosophy and practices, illustrates one of more than 20 paths to acceptance, and this one in particular will teach you the steps in accepting others, especially when you are desperately trying to change them and you are insisting that they “shouldn’t” be the way they are!

Self-acceptance is always about grasping a gigantic paradox—and that’s why I’ve always called it the Acceptance Paradox, which states: Accepting yourself as you are, warts and all, is actually the greatest change a human being can make.

Can you see why this is a paradox? It’s because the very moment you accept yourself, everything about you and your world will appear to change. Now here’s another acceptance paradox we will explore today. The very moment when you accept another person exactly as she or he is, that person will suddenly change.

Of course, that is the exact opposite of what we usually do when we desperately keep trying to “change” them, a strategy that actually forces them to be the very monster you are trying so hard to destroy. By the way, do you know what the plural form of paradox is, when you combine Self- and Other-Acceptance? The plural form is called the Acceptance Paradise.

8. T = Testing is crucial! You cannot do truly effective therapy without the T = Testing. You will find out EXACTLY how effective—or ineffective—you are in every session with every patient. When you listen to the podcasts, you can ask yourself questions like these: How effective are Jill and David being? Will they get good empathy and helpfulness ratings from Zeina? Will we see any reductions in Zeina’s powerful negative feelings at the start of the session? Will she make a breakthrough in her relationship with her mother?

At the end of the session, you will see the answers to these questions. And if you’re a therapist, that kind of powerful and precise information will allow you to grow and learn as a therapist, especially if you approach the information with humility and respect for yourself and your patients.

There is almost no limit to the evolution of your therapist skills if you use the T = Testing model I have developed. There is almost no chance for personal growth if you do not use these or similar assessment tools.

However, the price of growth is steep. You have to be willing to see your own failures and errors at every session with every patient, and this will often be painful. But this is the pain that can lead to your own personal transformation along with the blossoming of your own superb therapy skills.

Today, in Part 1 of the Zeina session, you will hear the T = Testing and E = Empathy parts of the session. Next week, in Part 2, you will hear the very brief A = Assessment of Resistance, which really only included the “Miracle Cure Question: ”What, really, are you, Zeina, hoping for in tonight’s session?” You will also hear the amazing M = Methods portion, which will start with Forced Empathy, followed by Externalization of Voices and Five Secrets Practice, along with the final T = Testing and homework assignments for Zeina following the session.

Rhonda, Jill, Zeina and I hope you enjoy the podcasts and learn a great deal from them. And we all want to thank you, Zeina for your courageous and brilliant work, sharing your inner self so openly and generously. I believe that sessions like the one our fans will witness today and next week have the potential to provide hope and healing to people around the world, not only today, but for decades to come. At least, that is my hope!

I also want to thank you, Jill, for your extraordinary teaching and clinical skills, and for your brilliance and warmth.

Thank you for tuning in!

Rhonda, Zeina, and David

Here is a follow-up note from Zeina

Hello David, Jill, and the Tuesday group,

Boy, do I have an update for you all! So, at first, I struggled, and I was very worried to have to potentially send an update to the group that may have been disappointing.

On Saturday, I saw my mom, and I shared with her the insights that I had in our session. She was appreciative, but I didn't feel very connected to her. I had talked with her about this while she and I were on a walk, and I wondered if maybe walking while talking was taking away some of the intimacy or connection that might have happened if we had been looking at each other while talking.

I also noticed that while I was externally behaving somewhat better if my mom criticized me, internally, I still hadn't progressed very far. I would still feel very distant from her; and I still wasn't doing the five secrets.

Today, on Sunday, I saw my mom again. While she did not criticize me, we still got into a little bit of an argument.

I was a bit angry, but as I let myself cool off, I noticed myself feeling incredibly sad inside--like a sadness that had been building and building over the past few weeks. I tried to talk with my mom about it, but she resisted at first.

We had a project that we were working on together today and she thought it would be better if we talked on another day and got back to our project; I insisted, however, and asked that we please talk today. I did not realize it at the time, but I think I had some major hidden emotion stuff happening with my mom (more on this later, perhaps some hidden sadness that was masquerading as anger).

I shared with her that I had felt incredibly sad and genuinely worried about our relationship. I recently moved in order to live closer to her and see her more often, but I had noticed that almost every time she came over to visit me at my new place, we would get into an argument at least once.

I shared that these arguments had really been weighing on me and worrying me. I also told her that I noticed that we would get into arguments when we were at my place, but not as much when I visited her at her place, maybe because I am so particular about how I like things to be at my place.

She, then, said in a very gentle and loving way, "I think ‘particular’ about your space is the operative word here."

I realized that she was totally right, and I was so pleasantly surprised by how gentle and loving she was when she said it.

Feeling encouraged by how the conversation was going, I shared more and said that I had noticed that I had become more sensitive around our arguments lately and that I was feeling very disconnected from her, and I didn't know how to get reconnected with her. I also shared that I had been feeling lonely in my life in general lately and made a guess that maybe my loneliness was making me expect more from our relationship.

Additionally, I also guessed that I might be feeling more drained emotionally because I am doing more hours of therapy per week than I have ever done in my life, and maybe I had yet to find the right balance of how to recreate and regenerate my energy in my off-hours.

I shed many tears all throughout this whole conversation. I checked in with myself and noticed that I was feeling more connected to my mom, but there felt like there was still more, particularly about my loneliness.

This next paragraph might seem like a major tangent, but hang in there!--I promise it is all connected :)

Then, I switched gears a little bit to share with her a different conversation and insight I had had in the past week or so about my recent feelings of loneliness. I had been having a conversation with my very dear friend, James, about how I had been feeling lonely, but was not feeling as drawn to connecting with most of my girlfriends, but only really drawn to my guy friends.

Initially, I thought it was a male-female difference, but then I noticed that I was feeling drawn to my new friend Leigh Harrington, who is female. I realized that maybe the difference had more to do with the fact that almost all my male friends and Leigh were quite funny and playful people, whereas most of my girlfriends were more serious people.

As for myself, I tend to be a more serious person and am not as funny or playful as many people. I realized that I was relying on other people for my laughter, playfulness and fun, rather than learning how to create that myself.

Having just done some flirting training with Matthew May earlier that week, I saw that humor, like flirting, can be a learned skill and might have more to do with a willingness to take risks than an innate quality that people either have or don't have.

I was feeling excited that I could learn to be funnier and flirtier and create more laughter in my life, instead of relying on other funny people for this.

I shared all of this with my mom. She then went on to make a further connection that really blew me away. She said, "I bet if you start to be funnier and create more laughter for yourself and others, you will also start to feel less lonely." It felt so true!

The times I feel most connected to people are when I am laughing with them. THIS is the kind of relationship and connection with my mom that I had been missing lately--when I share deeply with her and, because she knows me so well, she is able to further my insight and understanding of myself and help me to grow.

I feel so connected to her now. I realize now that I think part of my resistance to using the 5 secrets with my mom was maybe a hidden emotion component--I had these deep feelings and worries about our relationship; I was confused if moving closer to her had actually helped our relationship or if it was harming it, and I was genuinely missing these kinds of deep, connecting conversations with her, which we had not had in a while.

My mom has been hanging out at my place all day today and now I notice myself being easily loving and patient with her and my being "particular" about my things and my space has vanished--at least temporarily!

There are a lot of take-aways for me from this whole thing, but one of the biggest ones is that I think I was trying to do five secrets without really fully going into my "I feel" statements as much as I needed to--I feel statements are often the secret that I neglect the most as a person and as a therapist.

So, to connect to what we are doing this week in class, I think I would make a guess that when I ignore the five secret that I need to do the most and struggle with, it can hamper my ability to do the rest of the five secrets effectively and genuinely.

I could write a lot more about all of this, but I think I will stop here for now. I hope this wasn't too confusing as I know I touched on a lot of different things. Thank you all for your time and attention. I'm open to comments or questions.

Warmly,

Zeina

Here is a reply to Zeina from one of the Stanford Tuesday group members

Gosh! Zeina, this is beautiful and so straight from the heart. Takes immense courage to do a deep dive in exploring oneself. I have been marveling at how meticulously you‘ve sifted through and worked towards addressing the different dimensions of the relationship between you and your mum. You are also an amazing raconteur, you’ve brought out the subtle nuances so beautifully!

Your mail took me on an emotional roller coaster ride. It was such a compelling read and had me as a captive co-traveler, holding my breath, and crossing my fingers!

I loved your insights on the “I feel”. Reading that was a personal breakthrough for me, where my relationship with my mum is concerned. That’s exactly what is missing in our relationship too … whoaaaaa! I just don’t share my feelings with her! I love how you were able to do that though, because I can feel this huge wave of resistance engulfing me, despite my insight. I know I’m not yet ready to take the next step! Funny, how tough it can be to be vulnerable before one’s own mom!

More power to you Zeina for ‘daring greatly’ and taking the next step after the Tuesday class. Also, for keeping us posted and for sharing with us in such a detailed manner, and in the process, helping us all learn and grow. Deep regards for your mum as well. She comes across as a tenacious mother of a tenacious daughter … if I may say so.

Warmly,

Nivedita.

Here is a second follow-up from Zeina.

Hello David, Jill and Tuesday group,

I just wanted to send another update as my relationship with my mom has continued to evolve in quite beautiful and magical ways since I sent this last email.  It seems to me that maybe she has stopped criticizing me entirely--I'm not quite sure.  Maybe I need to pay more attention.  Perhaps if she does criticize me, she does it in a gentler way or maybe I am less sensitive to it.  All I know is that she has been wonderfully supportive of me in these past few weeks and we have not gotten into a single argument.  Our relationship suddenly seems easy in a way that I have never experienced before.  I am so profoundly grateful.  I know that we will probably relapse at some point and this may not last forever, but, now I know this is possible.  Now, I know my way back here.  I have always wanted a relationship like this with my mother, and I always thought it wasn't possible because of who she was as a person. Little did I know that to have the mother I always wanted, I needed to do the changing. I knew that the 5 secrets were powerful, but I had thought that their power was more confined to a single interaction or the moment when you use them.  I don't know that I have been especially good at practicing the 5 secrets with my mom lately, yet the effect seems to keep lasting and lasting. I am truly speechless at the profound transformation that has happened.  Thank you. Thank you. Thank you.

I would love any responses!

Zeina

Here is some of the feedback from the training group in the section, “What did you like the best about today’s training session?”

• Jill’s thoughtfulness in selecting the Forced Empathy technique over the Relationship Journal. Jill looked at what had worked in the past for Zeina and saw it as a potential strategy for her current concerns and the result was tremendously positive.
• I loved the training! I loved watching forced empathy and I began to empathize with a close relative simply by watching Zeina empathize with her mom. I was crying throughout. It is hard to describe how touched I was
• Zeina's honesty and her responses to forced empathy was amazing!
• Amazing personal work. Entire session was great learning experience for me. How Forced Empathy brought the shift in Zeina’s way of thinking.
• I really enjoy witnessing the live sessions including this one with Zeina. Seeing how the totality of the model comes together in real time with the clinician's judgment and intuition guiding the specific process is really enlightening and seeing someone's beliefs shift in real time is very inspiring and moving. It was a really nice way to re-join the larger group and I'm glad to hear that went into David's thinking in scheduling it.
• I really like the Forced Empathy. Zeina had a lot of resistance at the beginning. However, She shed tears during doing the Forced Empathy. I also like the role reversal when doing the Externalization voices. I can always learn how to deal with the difficulties of life from David and Jill's wisdom.
• The whole thing was so great. I was really moved by the forced empathy.
• I always LOVE seeing forced empathy modeled to get better at this complex skill, and I am also, like many others, almost always blown away with how powerful it is. I also thought this was a great example of multiple paths (individual mood and relationship work) and multiple methods being all used in one two-hour session so skillful and masterful.
• I loved the open ended approach and the ongoing exploration until the goal was formed/explored/ discovered. For me, it was a demonstration of trust in the process. I especially liked David's "The Man From Mars" that seemed to me an amazing tool with sorting out the mess of relationship work. I also loved Forced Empathy especially here with the work on mother daughter's relationship. I am really intrigued to explore it for myself in regard to my relationship with my parents and my daughter.
• Seeing the whole encounter with Zeina and seeing how Jill and David thought through it together, it was all so organic and incredible to witness
• Very helpful to see the progression of the session.
• Zeina's session has been a gift not only to us, but also to our mothers. Forced empathy felt like a pivot point in treatment and I loved that Z was able to go deep and connect with her mother's feelings. I have plans to travel and visit my mother next month and have been feeling anxious about it. I was reminded of the unconditional love of a mother that is beautiful and spiritual. David and Jill did amazing and transformational work. This is so inspiring!
• I liked everything and how the methods and techniques were woven together very skillfully.
• Personal work is really the best and so gratifying to see. David made a comment at the end about how it would help with motivation to use the skills and work more on them after seeing them in action and I do agree with his comment even if I'm totally not paraphrasing correctly. I LOVE personal work because it bring these skills to life in a way that role plays don't. and of course, it's all the better that someone gets a personal benefit, that's all good too.
• David and Jill did an amazing job again! However, Zeina’s honesty and vulnerability was the greatest gift during this session. I could relate to her struggle as well, so I was extra impressed about her determination to work on this issue.
• It was amazing personal work for me. I feel so grateful for this experience.
• This was another example of the "magic" of TEAM, especially when the therapists are the incredibly skilled Jill and David. What a great, vulnerable and poignant example of relationship issues with a parent. I was very impressed and moved by the power of the Forced Empathy technique. By Zeina's ability to feel into the point of view of her mother, and her insights and connections, especially around how the times of criticism can be seen as opportunities for greater acceptance and love. Moving and really beautiful personal work!!!
• I was moved to tears when Zeina cried her mother's tears during the Forced Empathy exercise and said "I need her to accept me as I am." Wow--that was so powerful! And as for so many others, this experience felt super relevant and helpful to me for one of my own important relationships, and I'm feeling excited to try out Sergio's approach on my own loved one.
• Forced Empathy: I loved all of it! So helpful and informative to witness live work.
• I immediately got why the “what’s my grade?” question was skipped (since the use of the Forced empathy technique had yielded such powerful results). I am eager to try this with a particular client who is having similar issues with their mom. On a more personal level, I felt extremely close to Zeina and seeing how vulnerable and open she was willing to be. This has melted away a lot of my resistance in using the 5 secrets with my own mom. Thank you Zeina!
• I liked seeing the "visitor from Mars" used to uncover Zeina's thoughts when David was having trouble understanding what the issue was. It was great to see David feeling a little "lost" and see how he worked through that.
• Watching the Forced Empathy technique was amazing! I also appreciated when Jill offered several options for which direction to go and explained her rationale. I found it to be a helpful learning moment and also liked the warmth that came across.
• I saw my mom's critical behavior as coming from love-brought tears. Same for my Dad
• Zeina did really powerful and enlightening work! It was also a great learning experience to observe David & Jill.
• I have enjoyed listening to and learning wonderful techniques from Jill and David. I can definitely relate to parent's/child criticism conflict myself, so I have learned some methods of effective communication, empathy skills, especially the opposite empathy (where you step into the shoes of a person you have a conflict with) and learn to empathize strongly vs feeling frustrated and having blame thoughts
• I love every time we do personal work. I always learn and grow so much personally and professionally. Thank you, Zeina for this amazing gift, and thank you, David and Jill for your masterful work. I loved every moment of it!
• Amazing personal work!
• I enjoyed the entire process. I appreciated the partnership between David and Jill. I so appreciated Zeina's work and vulnerability. I like David's creative way of doing the Ind. Downward arrow using "man from Mars" perspective. I liked getting to see, again, the power of Forced Empathy, as it illuminated how we create the very behavior in the other, that we then complain about. I loved how Zeina surrendered to doing the Forced Empathy exercise with such wonderful openness.
• I loved the seamless way Dr Burns and Jill moved between the methods. And Zeina’s courage to be vulnerable. Had an aha moment myself - of course her mother will criticize her because the last thing she wants is for Zeina to have disastrous finances like her own. It shows deep love and caring
• Another Master Class! I loved watching David and Jill working with Zeina. Change the Focus is just an amazing Method. I appreciate Zeina's vulnerable disclosures. Such generosity is much appreciated. This is an amazing group, and I feel privileged to learn from such sophisticated practitioners, who are so generous with their insights and decades’ worth experiences. Some days I just can't believe my luck to be with such heartfelt, dedicated, compassionate and wise folks!
• I very specifically like seeing a long personal work session...the big picture seeing the whole session. Thank you! I learned so very much and how things smooth into each other as session progresses.
• It was great seeing Forced Empathy demonstrated as I've never seen it before and learned so much from the overall training with Zeina, David and Jill. So glad Zeina was willing to be so vulnerable; really appreciated at the end when she said she felt pressure to empathize with her mom if she was vulnerable with her and mom laid it on thick, was wondering the same exact thing in that very moment! Loved how David diffused that for her and put less pressure on how she would handle it! So grateful to be part of this awesome group where I am growing and learning every moment!
• The hi quality demonstration of Five Secrets empathy by David and Jill
• Jill’s patience. David waiting for AHA MOMENTS and pointing them out and best of all ZEINA!
• Personal work is always insightful. I really like the forced empathy technique. I also enjoyed the display of creativity and flexibility of the team model. Amy would regularly explain that it was a model to be used creatively and it's exciting to know there is so much to learn. It can be adapted to each individual. Viewing therapy as a series of skills to learn rather than a step-by-step instructional book is what makes me really love TEAM.
• Loved how Dr Burns used the individual downward arrow so seamlessly during the empathy phase. Dr Burns empathy too was spot on when he said to Zeina that "she could not lean on her Mom." This one line was really powerful for me and resonated deeply.

Loved Jill's internal solution as well as the forced empathy option along with the option of working on the good reasons not to do the 5 secrets. Jill was on a roll with her empathy ... "feels like you're walking on eggshells and don't know what will hurt her." I also liked Jill's disclosure about the times she gets critical with her boys are times when she is most concerned about them. Also liked Jill highlighting how Zeina practicing the Five Secrets was not working at a point because she was not using enough feeling empathy unlike as when doing the Forced Empathy

Podcast 295: Forced Empathy: A Master Class--Part 1 of 2

Podcasts 294 (Part 1) and 295 (Part 2)

Forced Empathy: A Master Class

Today Dr. Jill Levitt and I do live work with Zeina Halim who has been experiencing some intense negative feelings because of her mother’s criticisms of her. Zeina is a member of my weekly training group at Stanford and has appeared on the podcast on several previous occasions (Please provide numbers plus link to podcast page on website.)

Zeina is one of our small group leaders in our Tuesday training group.  She works with teens and adults in-person in her office in Menlo Park and also provides tele-health sessions for clients living anywhere in California.

Dr. Jill Levitt is the co-leader of my Tuesday training group at Stanford and will be my co-therapist today. We hope for some more of the “magic” that frequently appears when we do therapy together. Today’s podcast will illustrate a number of teaching points, including these:

1. Forced Empathy: We illustrate exactly how to use this powerful and sophisticated technique. When I first created this technique many years ago, I thought there would be little interest in it, so I rarely taught it in my workshops or training groups. In the past several years, an intense interest in this technique has emerged, so you will get to see exactly how it works.
2. Five Secrets Resistance: There has been great interest in the Five Secrets of Effective Communication that are featured in my book, Feeling Good Together. When used skillfully, they can have a phenomenal effect on any troubled relationship. I am even aware of a case of a woman who was kidnapped at gunpoint by a violent serial rapist who planned to kill her. Out of desperation, she used the Five Secrets I had presented at a workshop he had just attended, and he let her go and turned himself in to the police. The Five Secrets literally saved her life.

And yet, many of us stubbornly refuse to use the Five Secrets with family, friends and loved ones. Why do we fight against the very tools that would rapidly bring us peace, love and joy? And what can we do about our own internal “resistance”?

3. The “inner” and “outer” solutions: Whenever you are involved in a conflict with someone, there are two battles raging at the same time. One is the “inner battle” with your own negative thoughts, telling you that you’re no good, or that the other person is to blame, and the voice that powerfully urges you to do battle.

We approach the “inner battle” with the familiar Daily Mood Log, that helps you pinpoint the distorted messages you are giving yourself. You will see that those messages—the way you talk to yourself when you’re upset—are loaded with distortions; such as All-or-Nothing Thinking, Overgeneralizations, Mental Filtering, Discounting the Positive, Mind-Reading, Labeling, Should Statements and Hidden Should Statements, Emotional Reasoning, Other-Blame, and more.

In today’s session, we do battle with Zeina’s distorted thoughts with the Externalization of Voices, arguably one of the most powerful psychotherapy tools ever created.

4. The EAR Checklist / Relationship Journal. The “outer battle” involves the words you use when you respond to the other person’s criticisms of you. Here we use the Relationship Journal, another super powerful tools that allows you to analyze your own statements with the EAR Checklist and see the shocking reality that you are creating the very conflict that you are complaining about so vigorously. This involves one of the “Great Death” of the self, which can be profoundly painful, but it also leads to liberation from your self-created misery and the chance for renewed love and connection with the person you feel so alienated from.
5. Two-hour sessions. You can do far more in a single, two-hour session than in many 50 minute sessions scheduled at weekly intervals. I have often said that this is how I always do therapy, and if you have some therapy skills, this model is vastly more effective and cost-effective as well. It puts you under pressure to accomplish something today, right now, and not in the vague or distant future.
6. Uncovering Techniques. You will see how you can use the Man from Mars Technique to uncover more of your patient’s negative thoughts and core beliefs. This is just another way of doing the classical “Individual Downward Arrow Technique” that I developed way back in the 1970s.
7. The Acceptance Paradoxes. There is a great deal of talk these days about Acceptance is being an important key in many schools of psychotherapy. But what is acceptance, and how do we teach it to our patients and colleagues? Today’s session with Zeina, who has a great interest in Buddhist philosophy and practices, illustrates one of more than 20 paths to acceptance, and this one in particular will teach you the steps in accepting others, especially when you are desperately trying to change them and you are insisting that they “shouldn’t” be the way they are!

Self-acceptance is always about grasping a gigantic paradox—and that’s why I’ve always called it the Acceptance Paradox, which states: Accepting yourself as you are, warts and all, is actually the greatest change a human being can make.

Can you see why this is a paradox? It’s because the very moment you accept yourself, everything about you and your world will appear to change. Now here’s another acceptance paradox we will explore today. The very moment when you accept another person exactly as she or he is, that person will suddenly change.

Of course, that is the exact opposite of what we usually do when we desperately keep trying to “change” them, a strategy that actually forces them to be the very monster you are trying so hard to destroy. By the way, do you know what the plural form of paradox is, when you combine Self- and Other-Acceptance? The plural form is called the Acceptance Paradise.

8. T = Testing is crucial! You cannot do truly effective therapy without the T = Testing. You will find out EXACTLY how effective—or ineffective—you are in every session with every patient. When you listen to the podcasts, you can ask yourself questions like these: How effective are Jill and David being? Will they get good empathy and helpfulness ratings from Zeina? Will we see any reductions in Zeina’s powerful negative feelings at the start of the session? Will she make a breakthrough in her relationship with her mother?

At the end of the session, you will see the answers to these questions. And if you’re a therapist, that kind of powerful and precise information will allow you to grow and learn as a therapist, especially if you approach the information with humility and respect for yourself and your patients.

There is almost no limit to the evolution of your therapist skills if you use the T = Testing model I have developed. There is almost no chance for personal growth if you do not use these or similar assessment tools.

However, the price of growth is steep. You have to be willing to see your own failures and errors at every session with every patient, and this will often be painful. But this is the pain that can lead to your own personal transformation along with the blossoming of your own superb therapy skills.

Today, in Part 1 of the Zeina session, you will hear the T = Testing and E = Empathy parts of the session. Next week, in Part 2, you will hear the very brief A = Assessment of Resistance, which really only included the “Miracle Cure Question: ”What, really, are you, Zeina, hoping for in tonight’s session?” You will also hear the amazing M = Methods portion, which will start with Forced Empathy, followed by Externalization of Voices and Five Secrets Practice, along with the final T = Testing and homework assignments for Zeina following the session.

Rhonda, Jill, Zeina and I hope you enjoy the podcasts and learn a great deal from them. And we all want to thank you, Zeina for your courageous and brilliant work, sharing your inner self so openly and generously. I believe that sessions like the one our fans will witness today and next week have the potential to provide hope and healing to people around the world, not only today, but for decades to come. At least, that is my hope!

I also want to thank you, Jill, for your extraordinary teaching and clinical skills, and for your brilliance and warmth.

Thank you for tuning in!

Rhonda, Zeina, and David

Contact information for Jill and Zeina: please provide what you want to have included in the show notes.

Here is a follow-up note from Zeina

Hello David, Jill, and the Tuesday group,

Boy, do I have an update for you all! So, at first, I struggled, and I was very worried to have to potentially send an update to the group that may have been disappointing.

On Saturday, I saw my mom, and I shared with her the insights that I had in our session. She was appreciative, but I didn't feel very connected to her. I had talked with her about this while she and I were on a walk, and I wondered if maybe walking while talking was taking away some of the intimacy or connection that might have happened if we had been looking at each other while talking.

I also noticed that while I was externally behaving somewhat better if my mom criticized me, internally, I still hadn't progressed very far. I would still feel very distant from her; and I still wasn't doing the five secrets.

Today, on Sunday, I saw my mom again. While she did not criticize me, we still got into a little bit of an argument.

I was a bit angry, but as I let myself cool off, I noticed myself feeling incredibly sad inside--like a sadness that had been building and building over the past few weeks. I tried to talk with my mom about it, but she resisted at first.

We had a project that we were working on together today and she thought it would be better if we talked on another day and got back to our project; I insisted, however, and asked that we please talk today. I did not realize it at the time, but I think I had some major hidden emotion stuff happening with my mom (more on this later, perhaps some hidden sadness that was masquerading as anger).

I shared with her that I had felt incredibly sad and genuinely worried about our relationship. I recently moved in order to live closer to her and see her more often, but I had noticed that almost every time she came over to visit me at my new place, we would get into an argument at least once.

I shared that these arguments had really been weighing on me and worrying me. I also told her that I noticed that we would get into arguments when we were at my place, but not as much when I visited her at her place, maybe because I am so particular about how I like things to be at my place.

She, then, said in a very gentle and loving way, "I think ‘particular’ about your space is the operative word here."

I realized that she was totally right, and I was so pleasantly surprised by how gentle and loving she was when she said it.

Feeling encouraged by how the conversation was going, I shared more and said that I had noticed that I had become more sensitive around our arguments lately and that I was feeling very disconnected from her, and I didn't know how to get reconnected with her. I also shared that I had been feeling lonely in my life in general lately and made a guess that maybe my loneliness was making me expect more from our relationship.

Additionally, I also guessed that I might be feeling more drained emotionally because I am doing more hours of therapy per week than I have ever done in my life, and maybe I had yet to find the right balance of how to recreate and regenerate my energy in my off-hours.

I shed many tears all throughout this whole conversation. I checked in with myself and noticed that I was feeling more connected to my mom, but there felt like there was still more, particularly about my loneliness.

This next paragraph might seem like a major tangent, but hang in there!--I promise it is all connected :)

Then, I switched gears a little bit to share with her a different conversation and insight I had had in the past week or so about my recent feelings of loneliness. I had been having a conversation with my very dear friend, James, about how I had been feeling lonely, but was not feeling as drawn to connecting with most of my girlfriends, but only really drawn to my guy friends.

Initially, I thought it was a male-female difference, but then I noticed that I was feeling drawn to my new friend Leigh Harrington, who is female. I realized that maybe the difference had more to do with the fact that almost all my male friends and Leigh were quite funny and playful people, whereas most of my girlfriends were more serious people.

As for myself, I tend to be a more serious person and am not as funny or playful as many people. I realized that I was relying on other people for my laughter, playfulness and fun, rather than learning how to create that myself.

Having just done some flirting training with Matthew May earlier that week, I saw that humor, like flirting, can be a learned skill and might have more to do with a willingness to take risks than an innate quality that people either have or don't have.

I was feeling excited that I could learn to be funnier and flirtier and create more laughter in my life, instead of relying on other funny people for this.

I shared all of this with my mom. She then went on to make a further connection that really blew me away. She said, "I bet if you start to be funnier and create more laughter for yourself and others, you will also start to feel less lonely." It felt so true!

The times I feel most connected to people are when I am laughing with them. THIS is the kind of relationship and connection with my mom that I had been missing lately--when I share deeply with her and, because she knows me so well, she is able to further my insight and understanding of myself and help me to grow.

I feel so connected to her now. I realize now that I think part of my resistance to using the 5 secrets with my mom was maybe a hidden emotion component--I had these deep feelings and worries about our relationship; I was confused if moving closer to her had actually helped our relationship or if it was harming it, and I was genuinely missing these kinds of deep, connecting conversations with her, which we had not had in a while.

My mom has been hanging out at my place all day today and now I notice myself being easily loving and patient with her and my being "particular" about my things and my space has vanished--at least temporarily!

There are a lot of take-aways for me from this whole thing, but one of the biggest ones is that I think I was trying to do five secrets without really fully going into my "I feel" statements as much as I needed to--I feel statements are often the secret that I neglect the most as a person and as a therapist.

So, to connect to what we are doing this week in class, I think I would make a guess that when I ignore the five secret that I need to do the most and struggle with, it can hamper my ability to do the rest of the five secrets effectively and genuinely.

I could write a lot more about all of this, but I think I will stop here for now. I hope this wasn't too confusing as I know I touched on a lot of different things. Thank you all for your time and attention. I'm open to comments or questions.

Warmly,

Zeina

Here is a reply to Zeina from one of the Stanford Tuesday group members

Gosh! Zeina, this is beautiful and so straight from the heart. Takes immense courage to do a deep dive in exploring oneself. I have been marveling at how meticulously you‘ve sifted through and worked towards addressing the different dimensions of the relationship between you and your mum. You are also an amazing raconteur, you’ve brought out the subtle nuances so beautifully!

Your mail took me on an emotional roller coaster ride. It was such a compelling read and had me as a captive co-traveler, holding my breath, and crossing my fingers!

I loved your insights on the “I feel”. Reading that was a personal breakthrough for me, where my relationship with my mum is concerned. That’s exactly what is missing in our relationship too … whoaaaaa! I just don’t share my feelings with her! I love how you were able to do that though, because I can feel this huge wave of resistance engulfing me, despite my insight. I know I’m not yet ready to take the next step! Funny, how tough it can be to be vulnerable before one’s own mom!

More power to you Zeina for ‘daring greatly’ and taking the next step after the Tuesday class. Also, for keeping us posted and for sharing with us in such a detailed manner, and in the process, helping us all learn and grow. Deep regards for your mum as well. She comes across as a tenacious mother of a tenacious daughter … if I may say so.

Warmly,

Nivedita.

Here is a second follow-up from Zeina.

Hello David, Jill and Tuesday group,

I just wanted to send another update as my relationship with my mom has continued to evolve in quite beautiful and magical ways since I sent this last email.  It seems to me that maybe she has stopped criticizing me entirely--I'm not quite sure.  Maybe I need to pay more attention.  Perhaps if she does criticize me, she does it in a gentler way or maybe I am less sensitive to it.  All I know is that she has been wonderfully supportive of me in these past few weeks and we have not gotten into a single argument.  Our relationship suddenly seems easy in a way that I have never experienced before.  I am so profoundly grateful.  I know that we will probably relapse at some point and this may not last forever, but, now I know this is possible.  Now, I know my way back here.  I have always wanted a relationship like this with my mother, and I always thought it wasn't possible because of who she was as a person. Little did I know that to have the mother I always wanted, I needed to do the changing. I knew that the 5 secrets were powerful, but I had thought that their power was more confined to a single interaction or the moment when you use them.  I don't know that I have been especially good at practicing the 5 secrets with my mom lately, yet the effect seems to keep lasting and lasting. I am truly speechless at the profound transformation that has happened.  Thank you. Thank you. Thank you.

I would love any responses!

Zeina

Here is some of the feedback from the training group in the section, “What did you like the best about today’s training session?”

• Jill’s thoughtfulness in selecting the Forced Empathy technique over the Relationship Journal. Jill looked at what had worked in the past for Zeina and saw it as a potential strategy for her current concerns and the result was tremendously positive.
• I loved the training! I loved watching forced empathy and I began to empathize with a close relative simply by watching Zeina empathize with her mom. I was crying throughout. It is hard to describe how touched I was
• Zeina's honesty and her responses to forced empathy was amazing!
• Amazing personal work. Entire session was great learning experience for me. How Forced Empathy brought the shift in Zeina’s way of thinking.
• I really enjoy witnessing the live sessions including this one with Zeina. Seeing how the totality of the model comes together in real time with the clinician's judgment and intuition guiding the specific process is really enlightening and seeing someone's beliefs shift in real time is very inspiring and moving. It was a really nice way to re-join the larger group and I'm glad to hear that went into David's thinking in scheduling it.
• I really like the Forced Empathy. Zeina had a lot of resistance at the beginning. However, She shed tears during doing the Forced Empathy. I also like the role reversal when doing the Externalization voices. I can always learn how to deal with the difficulties of life from David and Jill's wisdom.
• The whole thing was so great. I was really moved by the forced empathy.
• I always LOVE seeing forced empathy modeled to get better at this complex skill, and I am also, like many others, almost always blown away with how powerful it is. I also thought this was a great example of multiple paths (individual mood and relationship work) and multiple methods being all used in one two-hour session so skillful and masterful.
• I loved the open ended approach and the ongoing exploration until the goal was formed/explored/ discovered. For me, it was a demonstration of trust in the process. I especially liked David's "The Man From Mars" that seemed to me an amazing tool with sorting out the mess of relationship work. I also loved Forced Empathy especially here with the work on mother daughter's relationship. I am really intrigued to explore it for myself in regard to my relationship with my parents and my daughter.
• Seeing the whole encounter with Zeina and seeing how Jill and David thought through it together, it was all so organic and incredible to witness
• Very helpful to see the progression of the session.
• Zeina's session has been a gift not only to us, but also to our mothers. Forced empathy felt like a pivot point in treatment and I loved that Z was able to go deep and connect with her mother's feelings. I have plans to travel and visit my mother next month and have been feeling anxious about it. I was reminded of the unconditional love of a mother that is beautiful and spiritual. David and Jill did amazing and transformational work. This is so inspiring!
• I liked everything and how the methods and techniques were woven together very skillfully.
• Personal work is really the best and so gratifying to see. David made a comment at the end about how it would help with motivation to use the skills and work more on them after seeing them in action and I do agree with his comment even if I'm totally not paraphrasing correctly. I LOVE personal work because it bring these skills to life in a way that role plays don't. and of course, it's all the better that someone gets a personal benefit, that's all good too.
• David and Jill did an amazing job again! However, Zeina’s honesty and vulnerability was the greatest gift during this session. I could relate to her struggle as well, so I was extra impressed about her determination to work on this issue.
• It was amazing personal work for me. I feel so grateful for this experience.
• This was another example of the "magic" of TEAM, especially when the therapists are the incredibly skilled Jill and David. What a great, vulnerable and poignant example of relationship issues with a parent. I was very impressed and moved by the power of the Forced Empathy technique. By Zeina's ability to feel into the point of view of her mother, and her insights and connections, especially around how the times of criticism can be seen as opportunities for greater acceptance and love. Moving and really beautiful personal work!!!
• I was moved to tears when Zeina cried her mother's tears during the Forced Empathy exercise and said "I need her to accept me as I am." Wow--that was so powerful! And as for so many others, this experience felt super relevant and helpful to me for one of my own important relationships, and I'm feeling excited to try out Sergio's approach on my own loved one.
• Forced Empathy: I loved all of it! So helpful and informative to witness live work.
• I immediately got why the “what’s my grade?” question was skipped (since the use of the Forced empathy technique had yielded such powerful results). I am eager to try this with a particular client who is having similar issues with their mom. On a more personal level, I felt extremely close to Zeina and seeing how vulnerable and open she was willing to be. This has melted away a lot of my resistance in using the 5 secrets with my own mom. Thank you Zeina!
• I liked seeing the "visitor from Mars" used to uncover Zeina's thoughts when David was having trouble understanding what the issue was. It was great to see David feeling a little "lost" and see how he worked through that.
• Watching the Forced Empathy technique was amazing! I also appreciated when Jill offered several options for which direction to go and explained her rationale. I found it to be a helpful learning moment and also liked the warmth that came across.
• I saw my mom's critical behavior as coming from love-brought tears. Same for my Dad
• Zeina did really powerful and enlightening work! It was also a great learning experience to observe David & Jill.
• I have enjoyed listening to and learning wonderful techniques from Jill and David. I can definitely relate to parent's/child criticism conflict myself, so I have learned some methods of effective communication, empathy skills, especially the opposite empathy (where you step into the shoes of a person you have a conflict with) and learn to empathize strongly vs feeling frustrated and having blame thoughts
• I love every time we do personal work. I always learn and grow so much personally and professionally. Thank you, Zeina for this amazing gift, and thank you, David and Jill for your masterful work. I loved every moment of it!
• Amazing personal work!
• I enjoyed the entire process. I appreciated the partnership between David and Jill. I so appreciated Zeina's work and vulnerability. I like David's creative way of doing the Ind. Downward arrow using "man from Mars" perspective. I liked getting to see, again, the power of Forced Empathy, as it illuminated how we create the very behavior in the other, that we then complain about. I loved how Zeina surrendered to doing the Forced Empathy exercise with such wonderful openness.
• I loved the seamless way Dr Burns and Jill moved between the methods. And Zeina’s courage to be vulnerable. Had an aha moment myself - of course her mother will criticize her because the last thing she wants is for Zeina to have disastrous finances like her own. It shows deep love and caring
• Another Master Class! I loved watching David and Jill working with Zeina. Change the Focus is just an amazing Method. I appreciate Zeina's vulnerable disclosures. Such generosity is much appreciated. This is an amazing group, and I feel privileged to learn from such sophisticated practitioners, who are so generous with their insights and decades’ worth experiences. Some days I just can't believe my luck to be with such heartfelt, dedicated, compassionate and wise folks!
• I very specifically like seeing a long personal work session...the big picture seeing the whole session. Thank you! I learned so very much and how things smooth into each other as session progresses.
• It was great seeing Forced Empathy demonstrated as I've never seen it before and learned so much from the overall training with Zeina, David and Jill. So glad Zeina was willing to be so vulnerable; really appreciated at the end when she said she felt pressure to empathize with her mom if she was vulnerable with her and mom laid it on thick, was wondering the same exact thing in that very moment! Loved how David diffused that for her and put less pressure on how she would handle it! So grateful to be part of this awesome group where I am growing and learning every moment!
• The high quality demonstration of Five Secrets empathy by David and Jill
• Jill’s patience. David waiting for AHA MOMENTS and pointing them out and best of all ZEINA!
• Personal work is always insightful. I really like the forced empathy technique. I also enjoyed the display of creativity and flexibility of the team model. Amy would regularly explain that it was a model to be used creatively and it's exciting to know there is so much to learn. It can be adapted to each individual. Viewing therapy as a series of skills to learn rather than a step-by-step instructional book is what makes me really love TEAM.
• Loved how Dr Burns used the individual downward arrow so seamlessly during the empathy phase. Dr Burns empathy too was spot on when he said to Zeina that "she could not lean on her Mom." This one line was really powerful for me and resonated deeply.

Loved Jill's internal solution as well as the forced empathy option along with the option of working on the good reasons not to do the 5 secrets. Jill was on a roll with her empathy ... "feels like you're walking on eggshells and don't know what will hurt her." I also liked Jill's disclosure about the times she gets critical with her boys are times when she is most concerned about them. Also liked Jill highlighting how Zeina practicing the Five Secrets was not working at a point because she was not using enough feeling empathy unlike as when doing the Forced Empathy

May 30^th, 2022

Our recent Ask David with Dr. Matthew May included a question on the Acceptance Paradox that triggered many enthusiastic email responses, and people were asking for more on this topic. Rhonda read several, including an email from Jeff who finally “got” the Acceptance Paradox and grasped the meaning of the “Great Death” of the Self. So, today, we’re dedicating the entire hour to this topic.

In addition, I’m including a link to a partial draft of a manuscript I’m working on entitled “25 Paths to Self-Acceptance.” It’s fragmentary and far from complete, but does include some potentially useful ideas and techniques, including a vignette with a quiz about a woman from South Los Angeles who experienced what I call “instantaneous enlightenment” during one of my 5-day psychotherapy intensives several years ago at the South San Francisco Conference Center near the San Francisco airport. (LINK TO MS)

First, here’s what a listener named Jeff wrote after the previous podcast.

Ah! I F-I-N-A-L-L-Y get what you're saying. I've pondered this death of "self" for quite a while after reading Feeling Great and it finally sunk in.

Saying "I want to improve myself" or "become a better person" is nonsensical. It's like there's an amorphous ghost "self" that I want to somehow "improve" or make "more worthwhile." But it's all made up. There is no actual "self." Meaning, I can improve skills I have - but my "self" won't be better. My skills might be - but there's no "self" to improve. I can improve my juggling skills but never my "self." Wow.

Even when it comes to flaws, I can see that they're also very specific. I don't have a flawed "self" or a bad "self." I may have certain flaws but there's no "I" or "self" to be flawed or worthless.

It took me a long time to see it - but now that I do, how awesome it is to stop having to IMPROVE myself. Instead, I can just let go of "my self."

Thank you for the response and the additional information. That is so helpful! !

During today's show, a number of vignettes illustrating acceptance were shared, including a man from the CIA who was intensely ashamed because he didn’t have a sense of humor, and all of the men he worked with loved to hang out during breaks at work telling jokes and laughing. He pretended to laugh, but inwardly felt ashamed and inadequate, and was telling himself that he was inferior, or defective because he didn’t have a sense of humor.

His enlightenment came during role-playing with a powerful technique called the Externalization of Voices. David played his Positive Self, and the patient, in the role of his Negative Self said this to David:

Patient, in the role of his Negative Self: You know, you’re really inferior because you don’t have a sense of humor. You’re not a real man!

David in the role of the Positive Self, responded like thi:s.Well, you know, you’re right. And in fact, I have tons of flaws. My lack of a sense of humor is just the tip of the iceberg!

This struck the patient as incredibly funny, and he began laughing uncontrollably for several minutes and almost feel out of his chair.

Then David said, “Not bad for someone with no sense of humor,” and that triggered even more laughter.

That’s why it’s called the Acceptance Paradox. The very moment when you accept yourself, exactly as you are, warts and all, everything—all your perceptions of yourself and the world—are suddenly transformed, and your freed from the prison you’d been in for many years, or possibly for your entire life.

Let me spell out what happened. For many years, my patient had been struggling with his lack of a sense of humor, and the harder he fought, the tighter the trap become. He could not change, and his life had become grim, and he felt inadequate and ashamed, thinking he wasn't a "real man," which seemed awful!

The very moment he "gave up" and accepted the fact that he had no sense of humor, he suddenly found his sense of humor, and laughed uncontrollably for several minutes.

That's what I mean when I say that acceptance is the greatest CHANGE a human being can make--and that's a gigantic paradox. Can you see that now?

One important focus of the show was debunking the many reasons people have for resisting Self-Acceptance, such as:

1. If I accept myself, I’ll just be ordinary, or below average, and I won’t be special.
2. Acceptance is a slippery slope. If I accept something bad about myself, or some awful thing I did, I might end up doing something immoral or wrong.
3. If I did something immoral or wrong, or even if I screwed up and failed to achieve my goals, I deserve to suffer.
4. If people see that I’m flawed or “less than,” they’ll judge me.
5. If I accept myself, I’ll lose my motivation to learn, to grow, and to improve myself.
6. If I accept myself, I’ll have to lower my standards. I may be unhappy, even miserable at times, but at least I have high standards!
7. When I beat up on myself, it shows that I’m honest about my flaws.
8. If I accept myself, I will end up accepting the fact that I might really be inferior!

In addition to addressing these concerns, Matt, Rhonda and David contrasted healthy vs unhealthy acceptance. For example, unhealthy acceptance is associated with feelings of depression, shame, hopelessness, paralysis, loneliness and cynicism. Healthy acceptance, in contrast, is associated with the exact opposite feelings of joy, pride, hope, creativity, intimacy, and laughter.

Matt pointed out that most, and conceivably all people who resist acceptance are not “seeing” something potentially incredible and life-changing.

David pointed out that the “Great Death” of the “self” that the Buddha described more than 2500 years ago is not really the “death” that people fear, but is really the “Great Rebirth.” When you “lose” your “self,” you actually lose nothing, because there was nothing there in the first place. But you gain the world, along with liberation from your suffering.

And that’s every bit as true today as it was at the time of the Buddha!

Thanks for joining us today.

Rhonda, Matt, and David

293: The Five Secrets with

Violent and Angry Individuals,

Featuring Heather Clague, MD

Heather Clague MD is a Level 5 TEAM therapist and trainer with a practice in Oakland, California and consult-liaison psychiatrist at Highland Hospital in Oakland. In addition to running an online consultation group for TEAM therapists, she is faculty for All Things CBT,  teaches for the Feeling Good Institute, and has taught the Five Secrets of Effective Communication to medical staff. Her writing can be found at psychotherapy.net.

With Dr. Brandon Vance, Heather co-leads the Feeling Great Book Club, a book club for everyone, everywhere who wants to learn the magic of TEAM.

In today’s podcast, Rhonda and David speak with Dr. Heather Clague who describes her working in the psychiatric emergency room at Highland Hospital in Oakland, California, and other emergency facilities including Fairmont Hospital in San Leandro, California, interacting with hostile and psychotic individuals who often have to be held against their will because they are a danger to themselves or others, or unable to care for themselves.

Although today’s podcast will be of special interest to mental health professionals, it will also be of great interest to anyone having to interact with strangers, friends or family members who are angry and abusive.

She explained that

In these types of settings, we often have to give patients the opposite of what they want. For example, if they’re involuntarily hospitalized for dangerous behavior, we have to restrain them, or keep them in the hospital, when they desperately want out. Or, if they want to stay in the hospital, we may have to discharge them. Many of these patients are psychotic and lack judgment, so they may shout and act out in anger and frustration.

The Five Secrets (LINK) have been a godsend, and when it works, the results are amazing. For example, if a patient is screaming for us to release them, the natural instinct to get defensive just agitates them more and is rarely or never effective. If in contrast, you say, “You’re right, we are holding you against your will and you have every right to be angry,” they usually feel heard and calm right down.

In one recent case, an agitated and confused homeless woman needing dialysis was near death because she was refusing treatment and refusing to take her medications. She was manic, agitated, and talking rapidly, non-stop.

I said, “I think you’re really upset because we’re keeping you against your will.”

The patient shouted “Yes!”

Then I said, “And you’re telling us that you do have a place to go to if we let you out.”

The patient said, “yes,” in a softer voice, and let the nurse come in and give her her medications, which she took.

Heather described phrases she uses to get into each of the Five Secrets in high-secrets situations when you don’t have much time to think and have to respond quickly, including these:

For the Disarming Technique: “You’re right,” followed by a statement affirming the truth in what the patient just said.

Thought Empathy: “What you’re telling me is” followed by repeating what the patient just said. This is helped greatly by writing down what the patient said.

Without writing things down, this technique tends to be impossible for mental health professionals OR the general public. In spite of this, most people refuse this advice!

Feeling Empathy: “Given what you just told me, I can imagine you might be feeling X, Y, and Z” where X, Y and Z are feeling words, like “upset,” “anxious,” or “angry,” and so forth.

Inquiry: Heather emphasizes two productive lines of Inquiry:

“Am I getting it right?”

“Can you tell me more about how you’re feeling?”

“I Feel” Statements: “I’m feeling X, Y, and Z right now,” where X, Y, and Z are feeling words like sad, concerned, awkward, and so forth. When done skillfully, this technique adds warmth and genuineness, and facilitates the human connection.

Heather cautions against saying “I feel like you . . . ” since this ends up not as a statement of your own feelings, but a criticism of the other person. “I feel that . . . “ has the same problem.

Stroking: This conveys caring, liking and respect, but cannot be done in a formulaic way. You might say things like “I care about you and I’m really concerned that you’re struggling right now,” or ‘What you are saying is very important, and I want to understand more.”

For example, you might say this to an angry patient being held against his or her will:

“You’re right, I am holding you against your will, and insisting that you stay, and I don’t like it either. But I’m very concerned that if I let you out now, you might get hurt, or do something to hurt yourself, and your life is precious. I don’t think I could forgive myself if I did that.”

Of course, all of this has to come from the heart and has to be done skillfully, or it will not work.

Heather described other inspiring stories of challenging patients she’d worked with, and we took turns modeling Five Secrets responses to ultra-challenging patients, including one who was brought into the ER by police on a gurney in leather restraints who took one look at her doctor and said, “Boy, are you ugly!”

On another occasion, she walked into the room of a male patient, introduced herself, and asked if they could talk.  He replied provocatively, “Sure, if you get into bed with me, baby.”

Rhonda and Heather reminisced about their meeting at one of my four day intensives for mental health professionals several years ago at the South San Francisco Conference Center, and became best of friends. They have traveled together to India and Mexico teaching TEAM-CBT and spreading the gospel according to Burns!

I also reflected on my two years of internship and residency training at Highland Hospital, and my profound gratitude and admiration for that hospital and the many dedicated and talented health professionals who serve there.

Thanks for tuning in today!

Heather, Rhonda, and David

David Meets the British TEAM Group, Part 2:

Burns vs. Van de Kolk, Treating somatic symptoms, chronic doubters, GAD, and more!

Last week, David answered four questions posed by the British TEAM-CBT group. Today, he answers five more questions, including one on controversies in the treatment of PTSD.

5. Peter – Positive Reframing in TEAM—How much is “enough?”

When you do Positive Reframing to reduce Outcome Resistance, how extensively do you have to do it? Do you have to include every emotion the patient has listed on their Dailly Mood Log? Do you also have to focus on most or all of their Negative Thoughts? What’s the best approach?

6. Tom – Burns vs. Van De Kolk

After reading The Body Keeps the Score, by trauma specialist and psychiatrist, Dr Bessel Van De Kolk, it would appear that people with complex trauma require a high degree of stabilizing work, like deep-breathing, meditation, or yoga, before they can engage with effective therapy. Otherwise, they might not have the words to describe their emotions, or might have repressed memories. In addition, they might not engage or might become destabilized and highly emotional or destructive towards themselves and other people.

I wonder if that’s your experience with patients you have seen with severe complex trauma in your career? Do you think the TEAM-CBT model has limitations in this area and would you refer to a trauma specialist before embarking on TEAM therapy with such a patient?

7. Sean – Treating Somatic Symptoms with TEAM

I’m curious about dealing with the somatic experiences of patients struggling with anxiety, depression, insomnia, trauma, etc. Clients can often challenge their distorted Negative Thoughts but still struggle with the somatic symptoms.

I’m curious to know David's thoughts.

8. Hassam – Treating Chronic Doubters with TEAM

I’m wondering if David has had experiences with chronic doubters - obsessive doubt in which a patient might say:

"Yeah, all these cognitive techniques seem good and all, but what if really I am useless and worthless, and all of this has just been a gimmick? What if it is all a lie? What if we have missed something which really would show how worthless I am ?"

Basically, this is closely related to the Pure O version of OCD. OCD is known as the doubting disease, and I really want to hear David's thoughts on how he operates with extremely sticky doubting thoughts.

9. Jacky – Treating Generalized Anxiety Disorder (GAD) with TEAM

I have a question about clients with Generalized Anxiety Disorder. When they present with multiple worries, do we need to cognitively restructure every worry? Clients with GAD often have multiple worries so we could be there for quite a while if we have to work on every single worry!

End of the Part 1 Questions. David will return to the British group for Part 2 in the future, since they had many additional questions.

Here is a note from Dr. Peter Spurrier to all who want more information about the UK TEAM-CBT training group:

If you are interested in learning more about our group, or want to contact members, please visit us at: https://feelinggood.uk.com/

You will find contact details for many of us on the "Our TEAM CBT Practitioners" page. If you are interested in joining our TEAM-CBT training group, or want more information, you can email me (Dr. Peter Spurrier) at Docspurr@gmail.com.

David Meets the British TEAM Group, Part 1:

Treating adolescents, Intrusive thoughts, TEAM-CBT homework,

Surprises from the beta tests, and more.

1. Greg – What were the Surprising Results of the Feeling Good Beta Test?

What were the surprising results you referred to in the beta testing the new TEAMCBT App? Were there some things that weren’t effective or didn’t work in the way you expected?

2. Rima – Is Psychotherapy “Homework” required in TEAM-CBT?

I have a question about rapid recovery with TEAM CBT. Traditional CBT usually takes quite a lot of sessions and requires homework between sessions. How does this fit with a recovery in a single (two-hour) session? Do the patients still have to do homework?

3. Paul – Treating PTSD with Intrusive Thoughts

How can TEAM help an individual who has intrusive thoughts about a traumatic event in their past?

4. Jessica – Treating Adolescents with TEAM-CBT

Do you need to vary the therapy techniques when working with adolescents, as opposed to adults? And if so, how?

5. Peter – Positive Reframing in TEAM—How much is “enough?”

When you do Positive Reframing to reduce Outcome Resistance, how extensively do you have to do it? Do you have to include every emotion the patient has listed on their Dailly Mood Log? Do you also have to focus on most or all of their Negative Thoughts? What’s the best approach?

The following questions will be answered next week in Part 2 of David's encounter with the British group.

6. Tom – Burns vs. Van De Kolk

After reading The Body Keeps the Score, by trauma specialist and psychiatrist, Dr Bessel Van De Kolk, it would appear that people with complex trauma require a high degree of stabilizing work, like deep-breathing, meditation, or yoga, before they can engage with effective therapy. Otherwise, they might not have the words to describe their emotions, or might have repressed memories. In addition, they might not engage or might become destabilized and highly emotional or destructive towards themselves and other people.

I wonder if that’s your experience with patients you have seen with severe complex trauma in your career? Do you think the TEAM-CBT model has limitations in this area and would you refer to a trauma specialist before embarking on TEAM therapy with such a patient?

7. Sean – Treating Somatic Symptoms with TEAM

I’m curious about dealing with the somatic experiences of patients struggling with anxiety, depression, insomnia, trauma, etc. Clients can often challenge their distorted Negative Thoughts but still struggle with the somatic symptoms.

I’m curious to know David's thoughts.

8. Hassam – Treating Chronic Doubters with TEAM

I’m wondering if David has had experiences with chronic doubters - obsessive doubt in which a patient might say:

"Yeah, all these cognitive techniques seem good and all, but what if really I am useless and worthless, and all of this has just been a gimmick? What if it is all a lie? What if we have missed something which really would show how worthless I am ?"

Basically, this is closely related to the Pure O version of OCD. OCD is known as the doubting disease, and I really want to hear David's thoughts on how he operates with extremely sticky doubting thoughts.

9. Jacky – Treating Generalized Anxiety Disorder (GAD) with TEAM

I have a question about clients with Generalized Anxiety Disorder. When they present with multiple worries, do we need to cognitively restructure every worry? Clients with GAD often have multiple worries so we could be there for quite a while if we have to work on every single worry!

End of the Part 1 Questions. David will return to the British group for Part 2 in the future, since they had many additional questions.

Here is a note from Dr. Peter Spurrier to all who want more information about the British TEAM-CBT training group:

If you are interested in learning more about our group, or want to contact members, please visit us at: https://feelinggood.uk.com/

You will find contact details for many of us on the "Our TEAM CBT Practitioners" page. If you are interested in joining our TEAM-CBT training group, or want more information, you can email me (Dr. Peter Spurrier) at Docspurr@gmail.com.

Podcast 290: A Case of Social Anxiety: Featuring David with Dr. Stirling Moorey (Part 2 of 2)

Last week, you heard the first part of this live therapy session with Anita, a woman struggling with severe social anxiety. David and Dr. Stirling Moorey, from London, are co-therapists. Last week included the T = Testing and E = Empathy portions of the session. Today you will hear the A = Assessment of Resistance, M = Methods, along with end of session Testing and follow-up.

A = Assessment of Resistance

David asked Anita if she was ready to roll up her sleeves and get to work, or if she needed more time to talk and be listened to and supported.

Because she was eager to get to work, David asked the “Miracle Cure Question:” He said, “What would happen in today’s session if it went really great and knocked your socks off?

She said that her negative feelings and self-critical thoughts would be greatly diminished.

David asked the Magic Button Question, and she said she’d press it for sure!

David said he had no Magic Button, but did have some powerful techniques that could be super helpful, but was reluctant to use them. Anita was puzzled, and this led to Positive Reframing. He encouraged Anita to ask the three questions about each Negative Thought and feeling on her Daily Mood Logs:

1. Why might this thought or feeling be perfectly appropriate, given your circumstances?
2. What are some advantages, or benefits, of this negative thought or feeling?
3. What does this negative thought or feeling show about your core values that’s positive, beautiful, or even awesome?

Although puzzling at first, Anita soon got into the swing of it and came up with the following list of Positives.

1. If I tell myself “I have nothing to say” in a group, I’ll listen more and learn more.
2. I won’t risk speaking and making a fool of myself. So my social anxiety is really a source of self-protection, or even a form of self-love.
3. My self-criticisms show I have high standards.
4. My high standards motivate me to work hard and do my best.
5. My self-doubt shows that I’m humble.
6. My concerns about being judged show that I care for the people in the group and want to have positive relationships with them.
7. Shows I’m not pushy, dominating, or arrogant.
8. When I tell myself that “They are all better than me,” it shows that I have room to learn from all the people who are ahead of me.
9. This shows I want to grow and do better.
10. This shows I’m honest and realistic about my limits and flaws.
11. This shows I’m accountable.
12. This gives me “vicarious joy” in the accomplishments of others, a Buddhist concept.
13. This thought shows that I can appreciate the gifts of others, which is a gift to them.
14. When I tell myself, “I wasted a year,” it shows that I value hard work, learning, and dong a good job.
15. It shows that I value what other people think, and take their criticisms seriously.
16. It shows that I want to be seen for who I am!

David pointed out that there were many positives on the list, and if we had time many more could be added, but asked Anita if the positives were:

• Real?
• Important?
• Powerful?

She gave enthusiastic “yes” answers to all three questions, and then david asked the Pivot Question: Why in the world would you want to press that Magic button, because if you do all these positives will go down the drain, right along with you negative thoughts and feelings

Anita suddenly didn’t want to press the Magic Button, but agree to use the Magic Dial and lower her goals for each negative feeling, which you can see if you click here.

This concluded this part of the session, which brought us to the M of TEAM.

M = Methods

During the Methods portion of the session, David and Stirling used a number of techniques, including:

• Identify the Distortions
• Explain the Distortions
• Straightforward Technique
• Externalization of Voices with Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique)

And more, using frequent role reversal until she got to “huge” wins, which didn’t take long. Stirling also asked gave Anita how she might test if her fears about the way others saw her were accurate, and they devised some homework to do in the Wednesday training group to find out if other group members had experienced similar doubts about their abilities as therapists. This would involve using:

• Self-Disclosure -
• Survey Technique
• “I stubbornly refused” Technique

You can see her final Daily Mood Log if you click here (LINK).

We also jumped in and tried to work with Anita’s conflict with her supervisor, but ran out of time and might pick up that thread again in a future session if she is interested.

I might add that both David and Stirling also used Self-Disclosure and Story-Telling during the session, as well as some spontaneous humor, which can also be viewed as a valuable treatment method, but one that is hard to explain or teach.

You can see Anita's final Daily Mood Log with the outcomes of all of her negative feelings. As you can see, she exceeded her goals in every category, which is not unusual, and was feeling pretty terrific!

She had the homework assignment to listen to the recording of the session and complete her DML, so you will only see a couple of the Positive Thoughts listed.

Final T = Testing

You can see Anita's final BMS here, and her  Evaluation of therapy Session here  As you can see, there were dramatic reductions in depression and anxiety, but only a modest boost in happiness. It would be interesting to see if the happiness goes up further after her "behavioral experiment" at Wednesday's tuesday group. Her scores on the Empathy and Helpfulness scales were perfect.

Follow-up

This is the email we received from Anita three days later, right after her "behavioral experiment" in Rhonda's Wednesday TEAM-CBT training group::

Hi Stirling, Rhonda, and David,

I did the survey question in Rhonda’s Wednesday training group. Here’s what I said:

“I am so nervous right now. I sometimes feel like I do not have much to say and so I stay silent in the group. I get anxious and think you all are so far ahead of me in your skills, so I miss out on sharing. I was wondering if any of you sometimes feel the same way?”

So many hands shot, so many affirmed my question and thanked me for asking because they get anxious too. I was a little overwhelmed. Loved the experience!

Rhonda I hope I did not take too much time.

 Anita

Rhonda, Stirling, Anita, and David

Podcast 289: A Case of Social Anxiety: Featuring David with Dr. Stirling Moorey (Part 1 of 2)

Today, David is joined by one of his first students, Dr. Stirling Moorey, for co-therapy with Anita, a woman struggling with social anxiety. You may remember Stirling from Podcast 280. Stirling was one of David's first cognitive therapy students, and they spend a month doing cotherapy tether in 1979 and again in 1980. David described the magic of their work together in his first book, Feeling Good, and today they are reunited as a therapy team again for the first time in  more than 40 years!

I, David, am super excited about working with Stirling again, and hope you enjoy our work with Anita. Rhonda, Stirling, and I are very grateful for Anita's courage and generosity in letting us share this very personal and real session with you!

Anita is a member of the Wednesday International TEAM Training group run by Rhonda and Richard Lam, LMFT.  She lives in Nairobi, Kenya, and has a Master’s Degree in Counseling. Here is how she introduces herself:

I am Anita Awuor from Nairobi, Kenya.  I have worked as a therapist for 20 years but only recently been introduced to the TEAM Model which has changed the way I work. I work with couples, individuals and families. And recently I worked with an NGO part time.  It’s an honor for me to be here to work with David, Rhonda and Stirling.

Dr. Stirling Moorey had the good fortune to be trained by two founders of Cognitive Behavioral Therapy, Dr. Aaron Beck, and our own, Dr. David Burns. Stirling and David worked together in 1979, when Stirling was in medical school in London and came to Pennsylvania for an elective with Dr. Beck. Once he arrived, Dr. Beck asked David if he would work with Stirling, and then, history was made as David created the 5-Secrets of Effective Communication after watching Stirling provide deep empathy to the patients they worked with together.

Stirling is currently a Consultant Psychiatrist in Cognitive Behavioral Therapy and was the Professional Head of Psychiatry for the So. London & Maudsley Trust from 2005-2013. He is currently the visiting senior lecturer at the Institute of Psychiatry, Psychology and Neuroscience in London. He is the co-author, with Steven Greer of The Oxford Guide to CBT for People with Cancer, and co-edited the book, The Therapeutic Relationship in CBT, published by Sage Publishing.

T = Testing

If you click here, you can take a look at Anita’s initial Brief Mood Survey, which was completed just prior to her session with Stirling and David. As you can see, her depression and anxiety scores were in the moderate to severe range, but her anger score was minimal, only 1 on a scale from 0 to 20. Her Happiness score was extremely low, and here marital satisfaction score was fairly good, but with some room for improvement, especially in the category of “resolving conflicts.

E = Empathy

You can take a look at the first of two Daily Mood Logs that Anita sent to us just prior to the session. It describes her anxiety while driving to a support group. As you can see, her suffering was intense. She also brought in a second Daily Mood Log which described her feelings after receiving a poor evaluation from one of her supervisors at work. The supervision did not involve her clinical work but some management work she was doing.

Stirling, with backup from David, did explored and summarized Anita’s feelings. She explained that

“Sadness has been a part of my life. I’m sad more often than I’m happy. Sometimes, the negative feelings are hard to live with. . . Problems in relationships often trigger my negative feelings, especially when others criticize me, and I’ve been down the last several days because of a poor evaluation I received from one of my supervisors at work. . . I don’t like criticisms or conflicts, and sometimes I tell myself that I’ll never be comfortable in groups.”

Stirling asked about Anita’s negative thoughts when criticized:

1. I’ll never be good enough.
2. What’s wrong with me?
3. It’s all my fault.

She described a sequence where her negative thoughts about the situation lead on to more general self critical thoughts like “I’ll never be comfortable in groups” and she then ruminates about her perceived shortcomings. She said, “when I have these kinds of thoughts, the feelings of sadness, anxiety and worthlessness get very high.”

David read her two Daily Mood Logs (LINK) and she described the criticisms she received from her supervisor, who suggested that Anita’s efforts had not been helpful. Anita felt hurt and angry, especially since this was the first time she’d received criticisms from her supervisor.

Anita added that when she goes into a negative spiral, everything becomes ‘huge,” and she also tells herself, “I’m a bad mom.”

Stirling asked what she does to cope when she’s in pain:

“I cry a lot. I beat myself up. And sometimes I share my feelings with my husband, but sometimes I just hold it all inside. Sometimes sharing with my husband helps, but sometimes it doesn’t.”

David asked Anita how she was feeling now, and she said that her anxiety had already gone down a lot.

To bring closure to the Empathy phase of the session, David asked Anita to grade us on Empathy and she gave us As, and Rhonda had the same idea, scoring us as A +.

I commented on the idea that Stirling's superb empathy skills were based, in part, on the "nothing technique." He systematically, skillfully, and compassionately summarized her words and acknowledged the pain they conveyed, without trying to make interpretations, and without trying to help or rescue. In other words, he gave her nothing but tremendous listening, which was exactly what she needed!

Although this sounds simple, and nearly all therapists will think, "Oh, I do that, too," in my experience, this skill is actually quite rare. it can be taught, and that's on eo the goals of our two free weekly training groups for therapists. But learning genuine and effective use of the Five Secrets of Effective communication requires tremendous humility, dedication, and hard work on the part of the therapists who hopes to learn.

End of Part 1. Next week, you will hear the exciting conclusion of the live therapy session with Anita!

Podcast 288: TEAM-CBT for Video Game Addiction, Featuring Adam Holman, LCSW

We are joined today by Adam Holman, who specializes in the treatment of teens and young adults with video game addictions. Adam was drawn to this field by his own 16 hour a day addiction to video games which caused him to fail his first two years of college. Following his recovery, he decided to become a therapist so he could specialize in the treatment of this problem, and the rest, as they say, is history.

He was drawn to TEAM-CBT because of the emphasis on measuring outcomes with every patient at every session, using my Brief Mood Survey and Evaluation of Therapy Session. Prior to that, he said he felt like an “imposter,” and had no evidence that he was actually helping his patients. He explained that his clinical supervisor wasn’t much help, and simply said, “Well, Adam, your clients are coming back, aren’t they?” implying that this meant they were improving and satisfied with the treatment.

Adam explains how he created his own measures first, and then found an online therapist group at Reddit, and heard about the Burns measures, which, he says, “were a gift to me and my clients.” By looking at his feedback, he learned he was “helping” too much and trying to solve problems prematurely, before really “listening” and empathizing with his patients.

He had some tips for the parents of kids with gaming habits. The first is for them to recognize that the addiction is not the problem, but rather the child’s solution to the problems in his or her life. In his own case, for example, he explained that he was struggling with enormous amounts of anxiety, but felt relief when playing video games. Nearly all the kids he’s treated are struggling with depression, anxiety, and relationship problems, and often feel considerably better just by having the chance to talk and have someone show an interest in them.

He said that most of his patients start out with a scowl, arms folded, defiant that someone is going to try to control them or tell them what to do, and they aren’t looking for “help” because, in most cases, their parents bring them to treatment. They are surprised when Adam empathizes and tries to understand their thoughts and feelings. He said most do have issues they want to work on, although it’s not usually their gaming habits. Initially, this can cause conflicts between Adam and the parents, because they think Adam is siding with their children instead of “fixing” them.

He said the paradoxical techniques in TEAM are especially helpful, helping them identify all the really GOOD reasons for their addictions using tools like the Triple Paradox, although this is enormously confusing to the kids at first. They have to list all the positive advantages and benefits of their addictions, plus all really sucky things about quitting, as well as what the addiction / habit shows about them and their core values that’s positive and awesome. They get excited and want to share their lists with their parents.

He completes the Triple Paradox with the Acid Test question: “Why in the world would you want to change, given all of the positives?”

So, Adam’s second tip for parents is to focus on your relationship with your child and not on his or her gaming addiction. Adam teaches parents the Five Secrets of Effective Communication, and they find that the problem usually disappears on its own. However, he agreed that learning to use the Five Secrets skillfully requires a lot of commitment and hard work from the parents.  Adam recommends reviewing podcast episodes 65-70 on The Five Secrets to learn more.

Rhonda mentioned that in many cases, the kids are struggling with social anxiety, and Adam mentioned that when they are playing video games with others online, they usually do not feel anxious because they don’t feel judged.  Once again, the games are a solution to a problem, fulfilling the need for socialization and connection.

Adam uses the concept of “Sitting with Open Hands” to find out what the kids want to work on, instead of imposing an agenda on them. He described one client who was socially anxious and thought people were “creeped out” by him. Adam asked if he wanted to get over that “right now” and persuaded the young man to go outside where there was a lot of foot traffic and start doing “Smile and hello” practice as well as “Self-Disclosure” to strangers. One of the first people he said this to said he was, in fact, shocked, but added, “You made my day!”

This was a huge relief. The young man began feeling less anxious in social situations. He developed an interest in tennis and felt more
comfortable playing with his peers, and his interest in computer games reduced significantly.

Adam uses the full spectrum of TEAM-CBT techniques in his treatment, including the Devil’s Advocate Technique, Stimulus Control, and more.

Here are some of the tempting thoughts a video gamer might have:

1. Common now, it’s okay, everyone plays!
2. It’s going to be really fun!
3. It’s way more fun than homework!
4. Homework is not that important anyway.
5. I can do the homework later.

Adam’s third tip is to avoid trying to convince your child to change or to provide solutions for them. He explains that this creates a dynamic where it’s the parents vs. the child and the video game; a battle where neither side wins and both sides end up angry. For more on this topic, Adam would recommend podcast episode 146: When Helping Doesn’t Help.
Related to this, he described a case of a boy with a 12-hour a day habit, and his grades were suffering. The parents had tried everything to try to fight and control his behavior, including hiding all his power cords. Feeling as though this was unfair, he stopped at a garage sale on the way home from school and bought a used Gameboy. Clearly, this type of strategy is not effective.

Then the parents got better at listening, with the help of Adam, and they found success. Instead of restricting access to the games, they worked with their son to strike a balance. Their son developed an interest in skiing and the focus on video games diminished.

Adam’s fourth tip for parents is to try to encourage balance and stand with your kids, working together as a team. For example, you can ask them, “We understand that you enjoy playing games because it’s fun and helps you to relax, and we want you to be able to have fun and relax! What do you think would be a healthy and appropriate use of video games?”

In Summary, here are Adam’s four tips for parents:

1. Recognize that the addiction to video games is not the problem, but rather the child’s solution to problems in their lives. There are many good reasons they have likely found to play games ranging from relieving anxiety, to social connection, to simply having fun instead of doing boring homework.
2. The best way to support your child is to focus on your relationship with them and not necessarily the video game addiction. The Five Secrets of Effective Communication are a great tool for this.
3. Avoid trying to convince your child to change and don’t try to provide solutions for them. While boundaries are important, this creates resistance and his often ineffective.
4. Stand alongside your child and work with them to encourage balanced use of video games. This may involve encouraging other hobbies or agreeing on a plan together with regards to how much video game use is healthy and appropriate.

If you would like to contact Adam, you can find his information at mainquestpsychotherapy.com.

Warmly, David & Rhonda

287: Ask David, Featuring Matt May, MD: Acceptance. Irritating Questions. And More!

Today, Rhonda, Matt and David answer several challenging questions submitted by fans like you.

1. William asks: How would the TEAM-CBT model look with an addiction or a habit like procrastination?
2. Robin asks: What’s the difference between a habit and an addiction?
3. Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness!
4. Matt asks: What’s the full list of questions that David finds irritating?
5. Matt also asks: How do we help patients who don’t “get” the Acceptance Paradox?
6. Phil asks: Hey David, Rhonda and Mark, Can’t thank you enough for all your hard work and effort! Where do you guys get all your energy?!

Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways.

1: William asks: “How would the T.E.A.M. model look with addiction and procrastination?”

I have a question about your recent podcast on weight loss with Dr. Angela Krumm. She is doing a great job … but did not need any help from others.

About the T = Testing part of TEAM, you could say that Angela had lost her kilo’s. But I am not recognizing the testing in the form of a depression / anxiety test or something alike.

With the E = Empathy part, it is even more strange. Where is the Empathy section?

How would the T.E.A.M. model look with addiction and procrastination? Anyway, I assume you can’t expect that addiction and procrastination issues will be solved in a single therapy session?

I realize that Dr. Burns empathized in the podcast, but then the ‘work’ already was done.

Thanks a lot,

William

David’s reply

Thanks, William, for your thoughtful questions. I will probably make this an Ask David, but here's the short answer.

Yes, empathy must always come first. As you point out, Angela was simply discussing the methods she used for weight loss. This was not a live therapy session.

And yes, in therapy sessions I always start with T = Testing, but often add the Temptations Scale as well.

And yes, procrastination can usually be cured in a single (two-hour for me) session, and sometimes addictions too, but severe addictions might need ongoing support, as with AA for example.

Rhonda and I did a free two-hour workshop on Habits and Addictions on January 26^th, 2022, sponsored by PESI. To view it, you can click on the link and download the entire video. Then you can watch it locally on your devise.

On the bottom of my homepage on www.feelinggood.com, you’ll find an offer for two free unpublished chapters on habits and addictions.

D

2: Robin asks: What’s the difference between a habit and an addiction?

No email, just the question.

David’s reply

You could check with a dictionary. I think Shakespeare said that a rose by any other name is still a rose!

Technically, an addiction is associated with physiologic dependence and withdrawal symptoms during discontinuation. But once again, if “yearning” is a withdrawal symptoms, then habits, too, could be seen as addictions of sorts. You might also think of habits and addictions as two points on a continuum, with addictions being on the more severe side of the bell-shaped normal distribution curve.

But all these definitions are, to some extent, arbitrary. Does “alcoholism” exist? Or just people who are drinking excessively?

3: Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness!

Dr. Burns, I am a huge fan of your books and podcast, and I enjoyed your talk today on Habits and Addictions as well as your “Feeling Great” bonus chapter on the same. I struggle with a habit of internet surfing (news, social media, etc.) when I’m avoiding boring or unpleasant tasks at work.

Do you feel that motivational and cognitive techniques are sufficient for addressing this habit when it often feels like my actions operate below the level of consciousness? For example, I often start surfing the internet before I even consciously realize what I’m doing! Additionally, I’ve found stimulus control to be difficult for this habit given that I work on the computer all day.

Any advice on addressing this particular habit, or similar ones, would be much appreciated. Thank you for all of your work helping people! Edwin

David’s reply

Check out the free chapter(s) offer at bottom of my homepage. Read, do then exercises, then you can ask your question.

Also, it depends on how far “below consciousness” your habit is. If it is only a couple inches below, you should be fine!

D

4: Matt asks: What is the full list of questions that David finds irritating?

David’s reply

Good question. Most of the time, I really appreciate the comments and questions from our many fans around the world, but there are, in fact, some questions that I find irritating.

This may not be the “full list,” but these are some questions that could use, perhaps, a bit of fine tuning!

Some people ask vague, “help me” questions, and like “I’ve always struggled with anxiety. What should I do?”

There are two problems with this question. First, I spent most of my life answering this question with inexpensive paperback books, free podcasts, free anxiety and depression classes on my website, and more.

So, I don’t want to have to repeat all of that for this or any person who writes to me. Perhaps you can tell me which resources you’ve already tried, and where you’re stuck, specifically.

Sometimes, I list the resources, like the “Search” function on every page of my website, www.feelinggood.com, or the list of books there, or the list of podcasts, with links, or the free classes, and more.

In addition, those of you who are familiar with my work understand that I never try to help anyone on a “general” level. I can only help you at a specific moment in time. When was it? Where you when you felt anxious, or whatever? What was going on? What were you thinking and feeling at the moment? Record it on a Daily Mood Log, and highlight the Negative Thought you can’t successfully challenge. What are the distortions in that thought?

Then I can give you all kinds of help!

Perhaps in a future Ask David I can list some more types of problematic questions.

Thanks!

But while we’re at it, here’s another. Sometimes, people will ask a question that was answered 40 years ago, and ever since, as if they’ve come up with something new. In addition, if they ask questions with a kind of “gotcha” arrogance, I sometimes feel annoyed.

Here’s an example. People sometimes say,

“Oh, I can see that my negative thought is irrational, but it still upsets me. That shows that cognitive therapy doesn’t actually work!”

Here’s what I’m thinking when I hear that:

“Aren’t you special! My goodness, no one ever thought of that before!”

In fact, you may be able to identify some of the distortions in your negative thought, but you DON’T see that it’s “irrational.” You STILL BELIEVE IT!

I’ll say it again. Let’s say you’re trying to challenge a Negative Thought on your Daily Mood Log, like, “I’m a failure” or “I’m defective,” and you believe that thought 100%. Obviously, you’ll feel pretty bad.

There are two requirements for an effective Positive thought:

1. 1. It must be 100% true.
   2. It must drastically reduce your belief in the Negative Thought, perhaps all the way to 0%.

The very moment you stop believing the Negative Thought, your feelings will instantly change.

This is not “easy,” like so many people seem to think. That’s why I’ve developed more than 100 methods for challenging distorted thoughts. You won’t need them all, and perhaps you’ll only need a few, but it’s great to have so much firepower available to relieve people of the suffering they experience from feelings of depression, panic, guilt, shame, inadequacy, loneliness, hopelessness, anger, and more.

I have wondered if it would be helpful to have a place on my website where I could give the instructions for asking really good Ask David questions. Then I could require people to read it prior to submitting questions.

5: Matt also asks: How do we help patients who don’t “get” the Acceptance Paradox?

I have a question about one moment in time, the actual moment of recovery. I'd like to better understand what's happening, in that moment, and why some folks, especially those with hopelessness and a strong desire to 'be better' get stuck at the brink, during 'externalization of resistance', for example, and respond in ways like, 'I'd love to accept myself, I just don't know how' and 'it's too hard to accept myself.' I have felt frustrated with clients when they say this and find it challenging to disarm. I feel tempted to disagree and argue that it's far 'harder' to criticize ourselves than to simply *not* do that. I will think, 'it's hard to put down the whip? It's hard to lower the bar? wouldn't it be harder to continue to carry the whip and keep the bar raised?'. I can see how disagreeing and arguing, here, risk empathy and agenda-setting errors. I suspect my resistance has to do with not wanting to collude with the patient's hopelessness/avoidance. I then wonder, perhaps getting hypnotized, whether there is some real difficulty, other than resistance, that I'm not understanding.

I am entering these conversations with a set of assumptions, which may be incorrect, regarding what is happening in the moment of recovery:

My assumptions are that the cognitive and motivational models are correct and that self-criticism, and the desire to criticize oneself (high-standards) are what result in low self-esteem and feelings of worthlessness. Hence, to make the transition from depressed to recovered, the process would start with approving of our depressed self. Putting this another way, we can't recover, before we recover ... so in the actual moment of recovery, we will be accepting our self-critical, depressed 'self', flaws-and-all, including the 'flaw' of being self-critical. Positive Reframing and successfully 'talking back' to our resistance catalyzes this change and allows us to use methods like, 'Acceptance Paradox' successfully, leading to elimination of worthless feelings, in that moment.

Anything either of you would disagree with, there?

If so, when a patient says, 'I want to accept myself, I just don't know how' or 'it's just too hard to accept myself', especially coupled with, 'I don't have resistance, I just can't do it', what is the best response?

Thanks,

Matt

David’s reply

The word “acceptance” has no set meaning, so I would want to start by asking the patient what they think “acceptance” is—what is it that they think they can’t or don’t want to do?

Also, what time of day did you want to accept yourself, and what were you doing at that moment. What were you thinking and feeling, and who were you interacting with? What did they say and what did you say next?

Interpersonal acceptance means accepting your role in a conflict, using the Relationship Journal, instead of blaming the other person.

I am thinking of making a list on the various “types” of acceptance, and what methods we can use to enable each type. Acceptance might be different for depression vs anxiety vs a relationship problem vs habits and addictions, and recovery from each is associated with one of the four Great Deaths of the “self.”

For example, emotional acceptance has to do with seeing the positives in all of your negative emotions, fairly easily accomplished via Positive Reframing.

Specific Acceptance has to do with moving from Overgeneralizations and Labels (e.g. “I’m a failure”) to the specific: what, exactly, did I fail at? Then you can accept that specific failure and make a plan for change if you want.

Then you can have Existential Acceptance, where you accept that you are a “failure” or a “worthless human being” on a general level, and this can be accomplished with Let’s Define Terms as well a sense of humor.

You can also do two CBAs on the Adv and DiSalvo of Self-Acceptance vs Self-Condemnation.

You can also use the Double Standard / Paradoxical Double Standard. What would you recommend to someone else with self-critical or self-condemning thoughts? And what does their Double Standard say about them that’s positive and awesome?

Just some rambling thoughts!

Another solution has to do with recognizing the nonsensical nature of the notion of the “self.: Fabrice says the magic mushroom therapy helps with this, as you finally “see” that the idea of the “self” is just a kind of illusion.

I’m just babbling. This can be a vexing problem for sure. The buddha had little luck on it 2500 years ago, as his followers couldn’t “get it” either.

Let’s add this to our Q and A list?

Finally, role reversal in Ext of Voices can often help, and also “seeing” someone else discover self-acceptance in a group setting can help, too.

I learned it from my cat Obie. Neither of us weas “special,” but we sure had fun hanging out! The six months I spent taking 20 hrs a week of table tennis lessons helped too. I improved but remained sucky compared to the pros, but it was tremendous fun trying!

Does any of this make sense or help?

David

6: Philoma asks: Hey David, Rhonda and Mark, Can’t thank you enough for all your hard work and effort! Where do you guys get all your energy?!

David’s reply

For me, I get excited about what I'm doing. Also, when I do my "slogging" (= slow jogging), which I hate, I have learned just to try to go about 20 feet at a time, like seeing if I can make it to that tree. This helps a lot. Also, I am very lucky to be doing mainly things I totally love and find exciting. That helps enormously. Finally, I am surrounded by people who are very positive and supportive, which makes things non-burdensome. Conflict can be fatiguing! Good relationships can be energizing. And oh, I forgot the main key to energy. One big cup of coffee in the morning! Warmly, david

Phil’s reply to David:

Words of wisdom, for sure! Happy slogging and all the best for a great 2022!

Thanks for listening and reading today!

Rhonda, Matt, and David

Helping the Poor in Heart, featuring Victoria Chicurel and Silvina Carla Bucci

One of my favorite New Testament quotations comes from the “Sermon on the Mount” by Jesus: “Blessed are the poor in heart, for they shall see God.” Matthew 5:8. I’m not 100% sure what this means, exactly, but it seems to me to suggest the values of compassion and humility, as opposed to self-aggrandizement.

I once had the chance to speak to a Catholic priest with a PhD in philosophy who had just returned from several years working with the indigenous people in Paraguay. He said that although the people were poor, and sometimes experiencing the effects of repression from the government, he said they were mostly happy and supported one another.

He also said that when he flew into Miami and walked through the airport, he was shocked to see so many overweight and visually unappealing people, after living for many years in Paraguay among the “poor.”

Who, really, is “poor,” and who, in contrast, is “wealthy?” That’s kind of the meaning I attribute to the Biblical quotation from the book of Matthew. I looked him up on Google, and apparently he worked as a tax collector in Copernicium prior to becoming a preacher in Judea.

At any rate, today’s podcast features two women who are working with the poor in Mexico and in the Pomona Valley in Southern California. Victoria Chicurel and Silvina Carla Bucci and working to promote TEAM-CBT in Mexico and Victoria is working with a group of Mexican women immigrants, some un-documented, most with limited English-language skills in the Pomona Valley teaching them a simplified version of TEAM-CBT.  Victoria calls these women, Promotoras.

In a pilot study sponsored by an organization called Common Good, Victoria has trained a group of approximately ten women in the ten cognitive distortions as well as the Five Secrets of Effective Communication and other simple cognitive therapy techniques, so they can teach these skills, called “psychological first-aid,” as coaches, to women without access to mental health care. These lay coaches trained are paid $15 per hour by Common Good, and the clients are treated for free. They were very enthusiastic about the results of their informal study. (The director of Common Good is Nancy Minte, the sister of one of our esteemed colleagues, Daniel Minte, LCSW.)

Victoria described a shame attacking contest organized by Daniel Minte, a Level 5 TEAM therapist. Shame-Attacking Exercises were developed by the late Dr. Albert Ellis from New York City, one of the founders of cognitive therapy,. Shame-Attacking Exercises are designed to help people with social anxiety get over their fears of looking foolish in front of others. You intentionally do something bizarre in public so you can discover that the world doesn’t come to an end when you make a fool of yourself. . The goal of the contest was to do the most weird and courageous Shame Attacking Exercise.

The winner was a woman who was one of the promotoras working with Victoria who suffered from severe social anxiety and who was greatly helped by a “Shame Attacking Exercise.” In one of her English classes, she stood and announced she was going to do something ridiculous to overcome her fear of making a fool of herself in public, and warned them that she had a terribly singing voice. She then burst into song, singing the national anthem of Mexico, and received enthusiastic cheers from her classmates at the end. This experience changed her life!

Prior to her experience, she had been so shy that she was afraid to express her opinions in public. After the exercise, her shyness instantly become a memory and she won first place in the competition!

Many others have been helped, too. I mentioned the experience of Sunny Choi who worked for years with Asian immigrants in the SF Bay area. He said that these patients did not expect long term treatment, and often responded in just four or five sessions, even if they were struggling with very severe problems. Victoria said they were seeing the same thing, and described a woman struggling with perfectionism who recovered in just five sessions.

The coaches in the program use my Brief Mood Survey, translated into Spanish, to track progress, and have access to the Spanish version of my first book, Feeling Good.

Silvina is working to promote TEAM-CBT in Mexico and other Spanish speaking countries like Ecuador, Peru, Spain, and Columbia. She has even created a TEAM-CBT licensing program for Spanish-speaking mental health professionals.

She says that her biggest challenge is one I have run into in my efforts to teach in the United States as well: The therapists are skeptical and have an attitude of “prove it to me.” In addition, they have difficulties learning to use the Five Secrets in their clinical work and personal lives, especially “I Feel” Statements and the Disarming Technique, as well as the paradoxical techniques of TEAM-CBT.

For me (David) personally, I welcome skepticism, but find the arrogance behind some if it to be hugely annoying! Sadly, I think that our field of mental health / psychotherapy consists, to a great extent, of competing “cults” that are not based on science, or on data-driven treatment, but rather the teachings of cult-leaders, like Freud and the hundreds of others who have started this or that “school” of therapy.

I often say that TEAM is NOT another new therapy , or “cult,” but rather a research-based structure for how all therapy works. I would love to see the gradual disappearance of schools of therapy and the continued emergence and evolution of data-driven therapy.

I applaud the efforts of Victoria and Silvina in their work with the “poor in heart.” In the mid-1980s, I developed a large scale cognitive therapy program for the residents in our inner-city neighborhood at my hospital in Philadelphia. It was a group program based on my book, Ten Days’ to Self-Esteem, and the therapists were simply people from the neighborhood who received some training in CBT and followed the Leaders Manual for The Ten Days’ to Self-Esteem groups they were directing.

The program was largely free and very successful. Many of our patients could not read or write, and some were homeless. Most had few resources, and many might be considered among those are “poor in heart.” But they were definitely not poor in spirit! Our hospital had “Feeling Good” days every six months, and they even had a Feeling Good jazz band. That program was the most successful and gratifying program I have ever been associated with.

Rhonda and I are very proud of these two fantastic women! If you would like to learn more about their work in Mexico and in the Pomona Valley, please feel free to contact them at www.TEAM-CBTMexico.

Thanks for tuning in today!

Rhonda, Victoria, Silvina, and David

Podcast 285: TEAM-CBT for Chronic Pain. Featuring Derek Reilly--

with the Exciting Findings from a New British Outcome Study

Rhonda begins the podcast with two inspiring emails about our recent podcast on “The Unexpected Results of the Latest Beta Test id the Feeling Good App, Part 1 of 2, published on2-28-2022. One is from Vivek Kishore, who used to come to all of my Sunday hikes prior to the pandemic, and Rizwan Syed, from Pakistan, who is an enthusiastic member of my Tuesday training group at Stanford as well as Rhonda’s Wednesday training group.

Here’s what Vivek wrote

Dear David and Jeremy, This is so amazing and has the potential to change the world. I am sure millions across the globe will benefit from this app. Can't wait for its launch. Thank you!

Vivek

Here’s what Rizwan wrote:

Dear David:

Reading your books changed my life completely. I am so much happy and optimistic about life compared to highly critical of myself and others and had been so much bitter.

I am sure your team therapy app would be as mind boggling and revolutionary as had been your bibliotherapy.

I am no God. Had I been one, I definitely would have chosen you as my prophet to spread my message.

Rizwan

Today, we interview Derek Reilly, a Cognitive Behavioral Psychotherapist, and Registered Mental Health Nurse with 20 years of clinical practice  specializing in the treatment in chronic pain. He is an Accredited CBT therapist with the British Association for Behavioral and Cognitive Psychotherapies in the United Kingdom, and a TEAM certified Level 3 TEAM-CBT therapist.

Derek is also a founding member of the new TEAM-CBT UK group. He has published papers on panic, OCD, and pain. He lives in Darfield, a small village in South Yorkshire, which is a mining area in England.

Derek, like a previous guest, Dr. Peter Spurrier, attended a two-day workshop I conducted on TEAM-CBT in the treatment of anxiety disorders in London in 2015. Although I felt quite discouraged during and after the workshop, thinking I’d done a poor job, and since the crowd size was modest at best, a number of those who attended apparently got the message and became excited about TEAM.

Derek said that the emphasis on T = Testing and on A = Assessment of Resistance made the biggest impact on him. He explained it like this:

David described the four forms of Outcome Resistance and the four forms of Process Resistance. I suddenly realized that resistance was huge in the population I was treating, and that my biggest error had been trying to “help,” which usually just triggered more resistance and yes-butting by my patients, who would complain that no one was helping them with their pain. Dropout rates were high, and I also felt frustrated with the lack of progress I was seeing in my patients.

Both Derek and Peter then attended my four-day intensive at the South SF Conference Center in 2017 and got hooked. Derek said:

I thought about testing, and where it could be improved, and developed my own Pain Problem Survey (PPS) of the most common kinds of negative thoughts I was seeing in my patients, as well as the negative feelings these thoughts were triggering, like frustration, anger, anxiety, and more.

I asked them to rate three emotions on a scale of 0 to 10, as well as their cognitions and behaviors, and tried to figure out what the resistance was all about. I also discovered that the simple step of T = Testing helped greatly with the E = Empathy, because my patients began to feel understood. This was different from the way I’d been trained which was to push this or that technique to “help” with their pain.

He said that the concept of “acceptance” is a popular and common buzzword these days among mental health professionals, but there’s a huge difference between intellectual “acceptance” and acceptance at the gut level. He liked the fact that TEAM offered specific tools to bring resistance to conscious awareness and to quickly reduce the resistance as well, as the paradoxical techniques that David has developed.

Some of the common Negative Thoughts he heard from his patients included:

1. I should bed doing things quicker.
2. I should be responding faster.
3. The doctor should fix me.
4. Why is this happening to me? This is unfair!

Many had been feeling demoralized that there was no medical solution, and ashamed of the fact that the could no longer work and do things that had once been automatic, like housework, or picking up and hugging the grandchildren, or going to work and earning money. Their disabilities seem to contradict their personal values, and they felt like they were letting people down.

He said:

Many of my patients had 10 or even 20 years of suffering and failed treatments, including multiple surgeries in some cases for back pain, for example, and often complained that nobody had been listening to them. That’s why the E of TEAM was so important, and I practiced using the Five Secrets of Effective Communication to respond to their complaints. I worked especially hard on Feeling Empathy. Previously, I’d been way to quick to try to “help,” that just turned my patients off.

I was helped by the empathy technique David developed called “What’s my grade?” I ask my patients, “would you give me an A, a B, or a C or lower so far?” This was crucial.

Then, when I went on to the A = Assessment of Resistance, we began to uncover, or discover, what their negative thoughts and feelings showed about them that was positive and awesome. Because I was practicing in an economically deprived area, I, and many of my colleagues, thought this would be a waste of time, and that my patients might not “get it” because it would seem too brainy or intellectual.

But it was the opposite, and by the third session, many were already beginning to see things through an entirely different set of eyes. For example, they could see the many positive in their feelings of shame, inadequacy, anxiety, hopelessness, and even anger. So they began to feel proud of their negative thoughts and feelings.

It was also helpful to take the “shoulds” out of their negative thoughts and feelings using methods like the Semantic Method and the Double Standard Technique. These approaches proved much more effective in helping people come to terms with loss/change.

Derek described his work with a man who’d been struggling with chronic back pain and depression and daily alcohol abuse, who’d had a suicide attempt and felt useless. Derek said:

He was open to examining his own role in his problems, and agreed to cut down on his alcohol intake. He found the Positive Reframing to be helpful, and saw that his negative thoughts and feelings were actually an expression of his high standards, and that his frustration was the expression of his determination not to give up.

His guilt and shame showed that he had a conscience, and a moral compass, and that he was honest with himself, and that his frustration and depression about being unable to work showed his core values.

Then we did the Magic Dial to see how much he wanted to dial down each negative feeling, like guilt, and used a variety of M = Methods to challenge and crush his negative thoughts. Once he pinpointed and challenged his Hidden Should Statements, his feelings of self-acceptance increased dramatically. Then we ended up using the Externalization of Voices to wipe out his negative thoughts.

Derek and I discussed the role of negative emotions in patients with chronic pain and other “medical” symptoms, like dizziness, and chronic fatigue. I summarized my experience as a medical student working in Stanford’s outpatient medical clinic with Dr. Allen Barbour, and how that approach was similar to the approach that Derek was taking.

I summarized my statistical modeling of three data bases that all showed identical results that the correlation between physical pain and emotional distress is not because physical pain causes emotional distress, but because emotional distress causes an amplification in the experience of pain. This is true of physical pain with a clear medical cause, such as arthritis, as well as so-called “psychogenic pain” where no physical cause can be detected.

Derek summarized his recent study of 60 chronic pain patients he treated with TEAM, which was a retrospective “clinical audit,” or chart review study. The study indicated a 57% reduction in scores on the PHQ-9 & GAD7 (commonly used depression and anxiety tests). These reductions were significant at the p < .0001 level. The changes  in the scores on the PPS were also significant.

This is the first piece of preliminary evidence in the UK to show effective TEAM-CBT can be in the treatment of chronic pain. He is writing up these finds with a colleague, Anne Garland, a Consultant Nurse Psychotherapist, and hopes to publish them soon. He also found that other negative feelings were also comparably reduced, including the “big three:” frustration, guilt, and anxiety.

Derek and his colleagues have their own Tuesday training group in England, and I will soon be joining them with Rhonda for a 90 minute Q and A session. If you’d like to learn more about Derek’s work, or if you’re interested in training, you can contact him at dwr1971@yahoo.co.uk or www.feelinggood.uk.com.

Rhonda and I greatly enjoyed the recording and share great enthusiasm for Derek’s work spreading the word about TEAM-CBT in England. We hope you enjoyed the podcast as well, and thank you for your support of our efforts!

Rhonda, Derek, and David

284: Ask David, Featuring Matt May, MD

Defeating your Self-Defeating Beliefs.

Help with fear. Dealing with people who gossip.

Today, Rhonda, Matt and David answer three challenging questions submitted by fans like you.

1. Caroline asks: I’ve done Cost Benefit Analyses (CBAs) for many of my SDBs (Self-Defeating Beliefs), and the disadvantages greatly outweigh the advantages? What’s the next step?
2. Al asks: Can you help me with fear?
3. Khoi asks: How do you deal with colleagues who gossip about your boss?

Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways.

1: Caroline asks: I’ve done Cost Benefit Analyses (CBAs) for many of my SDBs (Self-Defeating Beliefs), and the disadvantages greatly outweigh the advantages? What’s the next step?

Hi David

I finally got all the CBAs from my Self-Defeating Beliefs done. I have a ton of them. I also did a CBA on Self-acceptance and a CBA on Self-Criticism. I found out, that the disadvantages of my Self-Defeating Beliefs are massively higher than the advantages. Only with Self-Acceptance the Advantages were much higher than the Disadvantages.

Now that I have got all these CBAs done, what do I do with my findings? Do I rewrite my Self-Defeating Belief into something more realistic or lets say, into something with acceptance?

Thanks for your help!

Many greetings

Caroline

David’s reply

Great work. Yes, you can, as a first step, or next step, rewrite each belief so the disadvantages disappear, and you get to keep the advantages. This will be different for each person, and it is called the Semantic Technique, but here is an example:

SDB: Achievement Addiction: My worthwhileness depends on my productivity and achievements.

Revised version: I can enjoy working hard and being productive, but my “worthwhileness” as a human being does not depend on my successes, failures, or hard work. There are many things in life I can love and enjoy. It isn’t just all about achievement and productivity. I can learn from failures and mistakes. They make me more “human,” and not “worthless” or even “less worthwhile.” In fact, I have no desire or need to be “worthwhile.” It’s a nonsensical, meaningless concept. People don’t much care about how “worthwhile” I am. They care about how I treat them!

That’s just an example of how I deal with this particular belief. Giving up the “Achievement Addiction” actually helps me achieve more, because the pressure and the anxiety is gone. But I still enjoy working and creating stuff!

Another dimension has to do with giving up the habit of beating up on yourself.

We are talking about depression and inadequacy here. It touches also on anxiety, but anxiety can have other SDBs as well.

d

2: Al asks: Can you help me with fear?

Dr Burns, I need help with fear. Can you send me podcasts dealing with that subject? Thank you very much.

David’s reply

Tell me which of the many already published, and available via search function on my website, you have already listened to? And how much of my book, When Panic Attacks, have you read?

May make this an Ask David, since it seems lots of folks are not using the massive free resources I’ve already developed.

Have you take the free anxiety test and course on my website, feelinggood.com? The free anxiety course is, in fact, a compilation of some of the best podcasts on fear.

david

3: Khoi asks: How do you deal with people who gossip about your boss?

Hello Dr Burns,

Thanks for your time to write so many great books and creating this podcast.

I am from Vietnam and know about you and your book thanks to the publisher to translate into Vietnamese. When I read your book, it is very simple fact but very true at the same time.

I wonder how can I not know about your book earlier? Actually, I read a lot of self-help books but I find most would say about what should I become or be, but don’t really show me how to do it.

As you said, the idea I feel because I thought is not new, but I don’t know how to change my thought and beliefs after reading these books. Your books show me simple techniques but very useful and effective.

And I really like your 5 Secrets of Effective Communication, especially these podcasts, because it helps me understand more clearly. One difficult situation that I don’t know how to apply, is when somebody attacks somebody else, not me.

For example, my colleague criticizes my boss (behind his back) via email message or face to face with me. I am afraid if I agree with her, my boss might think I talked behind his back too. So, should I just keep silent for this case because she does not attack me?

Another situation is when 2 people attack each other, like 2 of my staff argue with each other, and I cannot agree with one side because it will make the others get mad with me.

Do you have any advice on this?

Thanks Dr Burns.

David’s reply

Good question, and I will include in an Ask David, if that is okay. My short answer is that in most situations, and especially in a business environment, I do not try to "help" other people who are arguing or not getting along. That is simply asking for trouble and push back. When someone is bad mouthing another person, you can possibly use Feeling Empathy and say "it sounds like you're pretty unhappy with person X, and I know that can be uncomfortable when you're not getting along with someone," or some such general comment. Then you could distract the person with some Stroking, like "I really admired your report at the company meeting," or some such thing.

We can check with Rhonda and Matt and see what they think on the live podcast. In a personal situation, you could use an "I Feel" situation, like "I actually get along with person X, but of course we all have our flaws, or some such thing. But in a work environment, I think you are right that it is important to play it safe and to be thoughtful about interactions with colleagues!

So, I commend you on your excellent questions, even though I might not yet have the best answer for you!

David

 Rhonda, Matt, and David

Podcast 283: The O of OCD:

Featuring Thai-An Truong, LPC, LADC

Overview: The "O" of OCD (obsessions) is treated differently from the "C" (compulsions.) Thai-An Truong teaches us what really works! Compulsions can be treated with Response Prevention. The techniques for treating the Obsessions include Flooding, Cognitive Techniques, Motivational Techniques for Outcome and Process Resistance, the Hidden Emotion Technique, and more.

OCD (Obsessive Compulsive Disorder) consists of frightening thoughts, or obsessions, plus rituals people do in an attempt to prevent or undo the danger. So, for example, if you go to bed and have the thought, “what if I left the burners on the stove turned on,” you might get up and check the burners. Doing this once could be considered normal. But if you do this repeatedly, you definitely have the symptoms of OCD.

Rhonda wanted me to share how I treat the obsessions in OCD (Obsessive Compulsive Disorder), also known as "pure O."

I often say I wasn’t looking to treat OCD, but OCD found me, since I do a lot of work with postpartum women struggling with feelings of depression and anxiety, they are actually about 2.5 times more likely than the general population to develop OCD. We're not sure why, but my theory is OCD attaches to the things we value the most (e.g., health, children’s well-being), and not much is valued more greatly than our baby.

“Pure O” is actually a misnomer. We think that some people with OCD only have obsessions, without the rituals, because they have lots of mental rituals that people can’t see. So therapists wrongly conclude that they just have a “pure O” variety of OCD.

We usually think of compulsions in OCD as mainly behavioral (e.g., handwashing too prevent contamination or checking the mail box repeatedly when you put your letter in to make sure it didn’t get “stuck”), but mental compulsions (rituals) are also very common. Obsessions are the thoughts or images that cause distress; compulsions, in contrast, are the behavioral or mental acts people engage in to try to decrease the distress.

Mental acts, compulsions, and rituals can include:

• Praying
• Counting
• Repeating words silently
• Recalling events in detail
• Repeating a mental list to ensure safety
• Mentally reviewing the past like a video
• Self-assurance: “I’m okay, nothing bad will happen.”
• Saying the number 4 to reduce the distress of seeing 6, associated with the devil
• Thinking of a positive image to replace the disturbing obsession/thought

Those are just common examples, but there are many more.

Dr. Edna Foa, who has done a lot of research on OCD and the effectiveness of Exposure and Response Prevention (ERP) for the treatment of OCD states that patients who have ONLY obsessions or ONLY compulsions are unlikely to have OCD.

• Over 90% of people with OCD reported having both obsessions and behavioral compulsions/rituals.
• When mental rituals were included, just 2% reported “pure O”.
  • Foa, E., et al (2012). Treatment That Works: Exposure and Response Prevention for OCD, Second Edition, p. 12

She states we need to assess patients carefully to weed out other disorders:

• Only O may be depression or GAD.
• Only C may be trichotillomania, Tourette’s syndrome, autism, schizophrenia – all can display repetitive and ritualistic actions.
• Trauma can look like OCD. For example, a woman who was raped obsessed about harm coming her way and compulsively checked the doors and windows in her apartment. She may need trauma treatment instead of OCD treatment.
• Specific Phobias: fear of animals (dogs, snakes, etc), heights, needles, storms, flying, driving, etc.
• Paraphilia: pedophilia, voyeurism, exhibitionism, etc.

Dr. Burns’ EASY Diagnostic System can be a great tool for pinpointing these and many other diagnoses.

How I’ve helped clients: A step-by-step approach:

Disclaimer: This is not meant to be a substitute for therapy. It is frequently most helpful to have a therapist work with you through this process.

1. Initial Assessment:
   1. Dr. Burns EASY Diagnostic System
   2. Y-BOCs – Yale-Brown Obsessive Compulsive Scale - not diagnosti. This tool is great for identifying types of obsessions, compulsions, and avoidance behaviors.
   3. T = Testing – Brief Mood Survey
   4. E = Empathy
   5. Psychoeducation about OCD and nature of obsessions
      1. The more we engage with them, try to suppress them/control them, the stickier they become
      2. Share with them about exposure and response prevention and TEAM-CBT approach to treatment
      3. Ultimate goal is to eliminate all compulsions – since they the OCD and are the food that feeds the OCD monster
      4. Normal for obsessions content to shift from one subtype to another
      5. Let them know I will not provide reassurance. Anything expressed/done once is educational, more than once becomes reassurance
      6. Include the family in this process
   6. A = Assessment of Resistance
      1. DML of most disturbing obsession
      2. Identify the feelings and thoughts to increase your understanding of the content and level of disturbance
      3. Can use the What-If Technique to identify the patient's root fear
      4. Do positive reframing ONLY ONCE – otherwise can become a big reassurance (e.g., you are a good person, etc.)

Here is a driving analogy for how we don’t lose our core values or safety just because anxiety has decreased. For example, think of when you first started learning how to drive. Where was your anxiety 0-100? Mine was probably about 90%. This was tied to the values of wanting to stay safe, keep other’s safe, valuing people’s lives and my own life.

Think of where your anxiety with driving is now, 0-100, after you’ve driven almost every day for months or years. Mine is mostly around 0-5%, unless I’m next to a semi, then it's maybe at 10%.

Did you find that your morals and values changed once your anxiety decreased? Did you suddenly start to drive recklessly without caring about others’ well-being?

Most likely not. This will be the same with our work with OCD. Through exposure, your anxiety around your obsessions will also be dialed way down, but your moral compass and values will still stay intact.

5. Use Burns' Triple Paradox for compulsions

1. 1. 1. 1. Goes beyond moment in time: make a list of all compulsions – want to stop all of them (response prevention).
         2. Go back to moment in time, list benefits of compulsions, values, and cost of change
         3. She described Voicing the Resistance (also known as Externalization of Resistance): The therapist might say:

“Let’s look at this list of powerful benefits of your compulsions, the important values it shows about you, and all the costs of change. Given all those powerful reasons to keep your compulsions,  why would you want to do this work to let go of them? “After all, your compulsion give you  immediate relief from your anxiety.”

"Then the therapist can review the entire list of benefits and costs of change, and ask, ”Why in the world would they want to change considering x benefit and y cost?”

4. Motivation script: I rate the patient’s motivation to get rid of compulsions (0-100) before and after the Triple Paradox, and after Voicing the Resistance. If Voicing the Resistance boosted their motivation to change, I have clients write out or record their responses when we went through Voicing the Resistance. Their homework is to read this motivation script or listen to the audio recording of it it every day and as needed, knowing that there will be moments when the temptation to engage in the compulsion is 100%.

7. M = Methods: Thai-An, do not used any traditional cognitive tools (e.g., id distortions, double standard, examine the evidence), but David does and finds them to be helpful, just not the whole ball of wax! Thai-An points out that John Hershfield, MFT,  a major author in the OCD field also talks about using identify the distortions to build awareness. Of course, David sees a missive contribution of TEAM-CBT methods that goes way beyond building "awareness."

1. 1. 1. Address self-doubt in their ability to change with TEAM structure and cognitive tools
      2. Always explore hidden emotion first (case example of OCD cured by hidden emotion)
      3. Here and now exposure as obsessions come up
      4. Fear hierarchy
      5. In Vivo Exposure (case examples) – exposures in real life
      6. Imaginal exposure – exposures in your mind
         1. Anything that can’t be done in vivo
         2. Only with the most disturbing obsession (flooding
         3. Uncover core fear with What If Technique
      7. You can use David's Devil’s Advocate for the compulsions
         1. Rate how tempting it is to engage in compulsion (0-100)
         2. E.g., OCD: You really should replay that memory one more time to make sure you didn’t molest your baby; Client: That’s OCD talking and I’m choosing to move forward with my life.
         3. Record this and then process the experience after exposure:
            1. What happened during the exposure? Did your fear come true? Were you able to tolerate the distress?
            2. How was the outcome different from what you expected? What surprised you about the outcome?
            3. What did you learn from this exercises?
            4. What could you do to vary this exposure?
      8. Relapse Prevention Training should always be done following the initial recovery..

Thanks for tuning in today!

Rhonda, Thia-An, and David

Thai-An practices in Oklahoma City, but teaches online for everyone. For more information about her clinical work, visit www.lastingchangetherapy.com. For information about r her TEAM-CBT training, visit www.teamcbttraining.com. Through her training website, you can sign up for her free TEAM-CBT webinars, which are held every other month. Her upcoming TEAM-CBT Conference in Oklahoma will be from March 30-April 1, 2022.

The Feeling Good App: Part 2 of 2--

The Surprising Basic Science Findings--

How Does Psychotherapy REALLY Work?

And Why Did Everything Change So Fast?

Feeling Good Podcast Special Edition #2: March 07, 2022

Today’s special podcast features the second part of the recording with David and Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the basic science findings most recent beta test, which included 140 participants. David uses an advanced form of statistics, called Structural Equation Modeling (SEM) to identify causal effects and to learn more about how the app actually works. This information has immense practical and theoretical implications.

Here's a portion of what we’ve discovered so far.

1. All seven negative feelings are high correlated because they all share an unknown Common Cause (CC) predicted by David in one of the top psychology research journals in the late 1990’s. Here’s the reference2

Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473.

2. The CC accounts for most of the variance in all seven negative feelings, with R-square values ranging from 66% for anger, and 98% for Anxiety. Since there has to be some error variance in the estimates of the negative feelings, there is practically no room left for any significant additional causes.

If you would like to see the standardized output of the SEM model, click here.

3. The CC also has causal effects on Happiness, but these effects are much smaller, with an R-square of only 30%. This proves that Happiness has its own causes that are completely different from the factors that trigger depression. Happiness, in other words, is NOT just the absence of depression.
4. The radical reductions in all seven negative feelings were mediated by the reduction in the user’s belief in their negative thoughts, as predicted by cognitive therapists, like Albert Ellis and Aaron Beck, as well as the Greek Stoic philosopher, Epictetus, nearly 2,000 years ago. This is the first proof of that theory!
5. At least three components of the app have been isolated which appear to have substantial causal effects in the Common Cause, which in turn triggers simultaneous changes all negative feelings as well as happiness. Those three components include:
   1. A cognitive variable: the user’s belief in his or her negative thoughts.
   2. A motivational variable: measured with extremely precise and sensitive instruments.
   3. the user’s liking of the app.

The magnitude of all three causal effects was large. However, the motivational variables and user’s liking did not have direct effects on changes in depression and other negative feelings. The changes were ALL mediated via reductions in the user’s belief in his or her negative thoughts. This finding is consistent with the hypothesis that it is impossible to reduce negative feelings without change the belief in the negative thoughts that trigger those feelings.

6. The SEM models were replicated in two independent groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. The fit of the model was outstanding in both groups, and there were few or no significant differences in the parameter estimates. This indicates that the findings are valid and do not represent capitalization on chance.
7. David has reported extremely rapid changes in all negative feelings in his single-session treatment of individuals using TEAM-CBT. Some people have suggested that this is because he often treats mental health professionals as well as individuals who are very acquainted with his work.

CLICK HERE FOR THE FULLL REPORT

However, data from the beta test indicates this is not likely to be true. Mental health professionals did not respond any differently from non-professionals. In addition, the Familiarity with David or with TEAM variables did have modest effects on the degree of liking of the app, but no direct causal effects on changes in depression or the Common Cause.

The basic research is just beginning and ongoing. David believes that the research potential of the Feeling Good App may be as significant as the healing effects documented in the outcome findings with the app in the previous podcast.

If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training module, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques for the first time to find out if the improvements last.

Research on more than 10,000 sessions by human therapists using TEAM indicates that a portion of the gains patients make during individual sessions dissipates between sessions, but the “staying power” of the gains is facilitated by the patient’s homework between sessions. As a result, patient gains tend to reach a steady state after four or five sessions.

We anticipate that something similar may be documented in longitudinal studies with the app, and are eager to see what we can learn in the next study which will extend beyond one day.

So, hopefully, the new study will be pretty cool, too! And who knows what we’ll discover, with your help! Make sure you sign up if you’re interested in being one of our beta testers!

David and Jeremy

Rhonda, Jeremy, and David

The Unexpected Results of the

Latest (and Largest) Beta Test

Feeling Good Podcast Special Edition #1: February 28, 2022

Today’s special podcast features Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the most recent beta test which included 140 participants with depression ranging from no depression at all to the most severe depression that one can possibly experience.

David explains that in the middle- to-late 1970’s he first conceptualized the possibility of creating an electronic version of himself that could treat people without any assistance from an actual shrink. He explains that

My first fantasy was a small booth you could go into, like the ones for taking photos, where you would be presented with a hologram of a shrink who would talk with you in just the same way that a human therapist does. I also imagined creating kiosks that could be placed in groceries stores or places like Epcot Center in Disney World. where people could insert 25 cents and have their emotional or marital problems analyzed, or their depression treated, and so forth. I imagined that the kiosk would be loaded with powerful statistical software that could analyze data on the fly, and create huge data bases, and do research on the causes and cures for emotional and relationship problems.

Once the internet evolved, my fantasy change slightly, and I imagined creating an electronic version of myself that would be available to anyone in the world as an app. In addition, because of some promising published research on the antidepressant effects of my first book, Feeling Good, I had a hunch that I could create an app that might be as effective, or even more effective, than human therapists.

Two years ago, Jeremy and David teamed up to see if this dream was possible. Today, they present the incredible results of the latest beta test of the Feeling Good App. They measured changes in seven negative feelings as well as happiness in 140 individuals who had access to one portion of the app—the Basic Training—for one day only. The seven negative feelings were depression, anxiety, guilt and shame, inadequacy, loneliness, hopelessness, and anger. All feelings were measured on the same scale from 0 (for not at all) to 100 (for completely). The reliabilities of the negative feelings scale were .91 at the initial evaluation and .93 at the end of the day.

David divided the participants into two groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression.

The results indicated, unexpectedly, that they may have already achieved their goal. Here’s what they found:

1. The reductions in depression in both groups, as well as the additional six negative feelings, were substantially greater than the reductions reported in large numbers of published outcome studies with cognitive therapy, other schools of therapy, and antidepressants.
2. All seven types of feelings were dramatically reduced in both groups. For example, the depression reduction was 62%and 51% in the severe and mild groups, respectively, and the anger reduction was 70% and 81%, respectively. (Click here for the complete report).
3. Individuals in both groups also reported boosts in happiness, with a 33% increase in the mild group and a mind-boggling 80% increase in the severe group. The lower (but significant) boost in happiness in the mild group was because many of these individuals were already pretty happy at the start of the app, so there wasn’t a lot of room for improvement.

CLICK HERE FOR THE FULL REPORT

One of the most exciting features of the Feeling Good App is that it does research on itself in real time and shows us which parts are the most and least effective. In fact, one part of the app in this beta test was not helpful, and actually made depression somewhat worse, on average. In spite of that, the changes in all the negative feelings were spectacular by the end of the day.

We have already modified the parts that were not effective, and anticipate the app will become more and more powerful over time. This is just the beginning, and the sky’s the limit!

The feedback we received on the app has been largely totally unexpected. Some things that we thought were blow-away were criticized, and some parts that we thought were weak were strongly celebrated. This experience has been much like using David’s feedback scales in therapy. Therapists learn that their perceptions of how their patient feel are often not off-base, and that many of your favorite techniques and strategies are not effective. This information, if processed with respect and humility, can transform your clinical practice.

And of course, similar information is rapidly and radically transforming our app! Once again, our “patients,” or more accurately “app users,” have become our best teachers.

In the next podcast a week from today, we will discuss the basic science we are doing with the help of the Feeling Good App. We are asking questions like these:

1. How does the Feeling Good App really work? What are the ingredients of therapeutic success? What are the variables that can trigger such rapid and dramatic changes in negative feelings as well as happiness?
2. What is the cause of depression? Is there any support for the theory that depression (and all other negative feelings) are caused by distorted negative thoughts?
3. Is there any support for the theory that changes in negative feelings are actually mediated by reductions in our distorted negative thoughts?
4. Is there any support for David’s prediction, first made in the Journal of Consulting and Clinical Psychology in 1998, that an unknown “Common Cause” simultaneously triggers depression and other negative feelings, like anxiety, and accounts for the strong correlations among these feelings? Here's the reference:

Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473.

5. Are some groups easier to treat and more responsive? For example, the beta group included therapists and non-therapists, as well as individuals with no or very little familiarity with David’s work, plus individuals very familiar with his work. Which groups responded better to the app? This is important because most of the world is NOT familiar with David’s work. Will they be at a disadvantage when using the app?
6. Are the causes of negative feelings, like depression, anxiety, and anger, the same as the causes of happiness? Or does happiness have its own, totally independent causes?

Stay tuned for the answers to these questions. But in the meantime, make your own predictions, and then you will find out what the data told us!

If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques. So, hopefully, the new study will be pretty cool, too!

David and Jeremy

Rhonda, Jeremy, and David

Podcast #282: Mike Christensen on Deliberate Practice: Was David Right All Along?

Rhonda and I are thrilled to welcome Mike Christiansen, head of TEAM-CBT in Canada. Mike is a fantastic clinician and teacher, and an old beloved friend. Today he talks about the impact of David’s work that is finally being felt and appreciated by innovators in the field of psychiatry and psychology.

Rhonda begins the broadcast by reading a really touching endorsement from a young man in Turkey whose life was changed by David’s work after he came close to suicide.

One of the key’s was David’s statement that we are disturbed, not by events, but by our thoughts about them.” Of course, that incredible idea goes back all the way to the Greek philosopher, Epictetus, nearly 2,000 years ago. It is so basic that most people don’t “get it,” but once you do, it can be mind-blowing. The young man ended his note to David by saying that, “Life is beautiful now. Thank you!”

Mike described a similar enlightenment experience when he was doing counseling, and first attended one of David’s intensive workshops in Canada. He knew that his training did not provide him with the tools to make much of an impact on his patients. He was excited by what he learned, and subsequently attended many of David’s workshops, and became certified in TEAM-CBT.

Mike now teaches from around the world at the Feeling Good institute in Mt. View, California. He teaches a highly acclaimed 12 week introductory course in TEAM. If you are looking for some in depth training, Rhonda and I would STRONGLY recommend this class.

Mike described a vitally important new direction in psychotherapy called “Deliberate Practice,” and is co-authoring a book on this topic with Maor Katz, MD, head of the Feeling Good Institute, and two pioneers in deliberate practice, Tony Rousmaniere & Alex Vaz.

Essentially, Deliberate Practice refers to two things. First, therapists must use rating scales, like the ones David has created, to assess patients progress in multiple dimensions, as well as their perceptions of therapist empathy and helpfulness, at every single session. This keep therapists on their toes, and gives them a crystal clear picture of their effectiveness or lack of effectiveness with every patient at every session. Although this can often be painful for the therapist, it can transform the therapist’s clinical skills and turn every patient into the finest teacher the clinician has ever had!

Second, deliberate practice refers to refined training tools for therapists to practice on an ongoing basis, not only when learning therapy for the first time, but throughout your entire career. The key is doing short, role plan exercises that focus on specific tools, like the Five Secrets of Effective Communication during the E = Empathy step of TEAAM, or the “Invitation Step” at the start of A = Assessment of Resistance, or the Externalization of Voices during M = Methods.

And here’s the most important part. After the role play, the student is given a letter grade plus specific feedback on what she or he did right and what needs improvement. Then you do repeat role reversals until the student gets an A.

David compares this to the type of training a professional athlete might receive to improve his or her skills at basketball or any sport. However, this also requires great motivation and courage on the part of those who are learning and teaching, because every error is highlighted—there’s no hiding! That’s why the philosophy of learning in the spirit of “joyous failure” is crucial to survival and success!

Rhonda, Mike, and David demonstrated this strategy several times, focusing on the Invitation Step of the Assessment of Resistance with an “easy” as well as a more “challenging patient. Sure enough, grades below an A WERE received, and errors WERE pointed out.

And, in addition, grades of A were fairly readily achieved, showing that this type of “deliberate practice” definitely DOES work.

During the podcast I took the opportunity to vent some of my frustrations with the field, and Mike and Rhonda kindly didn’t point out that I probably sounded like a half-demented loony. But I do feel strongly about this topic, and extremely proud of the amazing work that Mike is doing on so many levels.

Most therapists resist rating scales. One of my students did a survey for his PhD research, and it seemed like only a small percent (less than 5%) of the psychologists he polled who advertise in the Psychology Today website are using ratings scales to track patient progress. To me, this is both unethical, anti-scientific, and totally unacceptable.

Therapists have endless excuses for resisting, and all of the excuses are spurious. For example, they think patients won’t be honest, but the big problem is that the overwhelming majority of patients ARE honest, and therapists don’t want to hear the truth bout their errors and ineptitude.

I do not support, but rather condemn, therapists who refuse to use rating instruments. To me, this is the “unforgivable sin” in our profession. I also believe that the use of valid and highly reliable rating instruments will eventually be required for licensure, and the “science resisters” will soon be a thing of the past.

The field of psychotherapy definitely needs to move into the data-driven scientific era, and leave the current “schools of therapy,” which compete like religions, or even cults, behind, just as physics and astronomy broke away from the Catholic Church during the Copernican Revolution hundreds of years ago.

So, Mike is definitely working on the cutting edge, and he’s just awesome! If you get the chance to take one of his TEAM-CBT classes, jump on it! He will connect with you intellectually, emotionally, and, if I can use a politically incorrect word, spiritually!

Warmly, David, Rhonda & Mike

1. Sanjay asks: How can we convert our “needs” into “wants?”
2. Vanessa asks: How can we think upon the threat of a nuclear war, or the thought of America becoming a totalitarian state, or the loss of voting rights, without becoming anxious or depressed?
3. Cliff asks: I have pure obsessive OCD and get stuck on intrusive thoughts. What should I do?

Upcoming Questions in Ask David podcasts

4. William asks: How would the T.E.A.M. model look with addiction and procrastination?
5. Caroline asks: I’ve done Cost Benefit Analyses (CBAs) for many of my SDBs (Self-Defeating Beliefs), and the disadvantages greatly outweigh the advantages? What’s the next step?
6. Al asks: Can you help me with fear?
7. Khoi asks: How do you deal with colleagues who gossip about your boss?
8. Matt asks: How do we help patients who don’t “get” the Acceptance Paradox?
9. Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness!
10. Al asks: Can you help me with worrying and fear of symptoms?
11. Paul asks: Are you planning on doing a podcast about people who are about to retire and are very anxious about the prospect and also depressed about closing that chapter in their lives?  I’m in that boat

1.  Sanjay asks: How can we convert our “needs” into “wants?”

Dear Dr. Burns

I thank you for pointing out “dramatic shift” in the foot notes and it has given me immense satisfaction .

So my learning from this is that ‘Low Level Solution’ remains just a “first aid” only because it is still in the category of “NEED” has not yet moved into the category of “WANT”.

A further question comes to mind So what is the process / formula to keep the deepest desires of ours from not entering into NEEDs and remain in the WANT zone. and yet we can work with highest passion and love to achieve them . OR in other words , how do you keep your biggest desire of your APP in the WANT zone and still maintains the highest level passion to achieve it . what is he process to reach that stage?

You have already given us the answer to this and shown us the way towards Enlightenment via FOUR GREAT DEATHS of the “self.” Still if you would like to say something more that will help us to grasp the process of keeping the desires in WANT only.

warm regards

Sanjay

David’s reply

In reply to Sanjay Gulati.

You can also do two Cost-Benefit Analyses CBA. For example, the first might be a CBA on the Adv and Disadv of Needing love, achievement, or approval, for example, and the second would be a CBA on the Adv and Dis of Wanting the same.

You could also use the semantic Technique. What could you tell yourself instead of “I NEED great achievement (or love or approval or whatever) to feel happy and fulfilled.”

A third could be to do an experiment and see if it is really true that happiness always or only comes from achievement, love, approval, etc.

A fourth strategy would be to do a Feared Fantasy and have a conversation, in imagination or in role play with a therapist, with someone who has achieved tremendously. That person would have to explain that she or he looks down on most other people because they haven’t achieved as much, so s/he feels they are less worthwhile.

You might suddenly discover that such a person doesn’t actually seem especially “worthwhile,” but more of an egotistical type.

With regard to the app, I’m just having fun with it, and making all kinds of amazing discoveries. Parts of it are really effective. Other parts are ineffective and need to be changed. But it is all an adventure.

I can’t control the outcome—will it be popular? Will we develop a business model that allows us to pay our bills? Maybe yes, maybe no, maybe partially. But to be honest, I don’t really care!

And not “caring” or “needing” frees me up to care way more effectively, and more creatively, and more lovingly. And with inner peace along the way.

Here is something else. You begin to realize that there is no such thing as “failure,” only information. For example, if people don’t like some lesson, or some word I have used, I just change it and make it better. Most of the negative and positive feedback is totally unexpected and surprising, which is really fun!

I feel privileged, not pressured. These feelings are quite rewarding and addictive.

I realize, too, that most people don’t really care how “successful” I am, including you. Most people do appreciate it when I treat them well, however.

Same with our cat that we adopted at the local humane society after her owner died.

Might make this an Ask David if it is okay!

Thanks, david

By the way, you subsequently emailed me and asked me to comment on “intense wants” vs. “needs,” so here’s a little more.

When I was a young man, I used to collect antique paper money from around the world as a hobby. I can vividly recall seeing a rare uncut sheet of banknotes at a trade show that I feel in love with instantly.

It was from the US Virgin Islands from the 1850s, if I recall correctly, and it consisted of a one thousand dollar bill and three five hundred dollar bills. It was gorgeous and I was instantly hypnotized, thinking it was one of the rarest and most desirable things in the world!

But sadly, I was a poor graduate student and could not afford it, and I’m not sure the dealer, a really nice guy from New Mexico named Larry Parker, was willing to sell it. Finally, I gave up on it and stopped thinking about it.

Years later, that exact same item came up in an auction in Los Angeles, and I was starting my clinical practice in Philadelphia. So I called the auctioneer, who I knew, just an hour or so before the end of the auction, and asked how much I should bid in order to be sure that I would win that intensely coveted item. At the time, the bidding was around $2,000, and I thought I could likely get a loan from the bank to buy it.

The auctioneer told me that no matter how much I bid, there was no chance I could win it.

I asked why. He said the wealthiest man in Caribbean was bidding on it and would pay any amount of money to get it, no matter what.

I was devastated and felt my chance for true happiness and worthwhileness had just evaporated! My “intense want” was not fulfilled!

Years later, similar notes started appearing in auctions, and I was able to figure out they were all reprints, including that original uncut sheet. Although they had some modest value, they were easy to obtain, and . . . suddenly I had no desire at all to own them!

And it also dawned on me that all those years when I couldn’t have that “fabulous” (or so I thought) uncut sheet, I’d been absolutely happy.

So much for our so-called “needs!”

2. Vanessa asks: How can we think upon the threat of a nuclear war, or the thought of America becoming a totalitarian state, or the loss of voting rights, without becoming anxious or depressed?

Hi Dr. Burns,

First off thank you so much for your podcast and books. They've helped me immensely grow and I am forever appreciative!

Recently, I've been hearing statements like "American democracy may not be around in 10-15 years", "America is becoming a totalitarian state'', and "We're heading to nuclear war" from both sides of the political spectrum. All of these statements make me very anxious to hear.

I know that thoughts create feelings, so even if something is true (like the threat of nuclear war, or that voting rights are being infringed upon, etc.), is there a way we can think upon these issues without becoming anxious or depressed over them?

Thank you so much,

Vanessa B.

David’s reply

Hi Vanessa, Thanks. I’m sure many people have similar concerns. However, this is a very general question, and you have not given me any specific examples of your own negative thoughts.

So, I can only give you an equally vague and general response, which is guaranteed not to be helpful. That’s because general questions and answers tend to be little more than babbling.

All that being said, I will say that there is a healthy and an unhealthy version of every negative feeling. So, some alarm and concern is probably totally appropriate and healthy, but getting crippled with excessive anxiety and depression is perhaps not useful.

Healthy negative feelings result from valid negative thoughts; unhealthy negative feelings always result from distorted negative thoughts.

But, as I pointed out, without a single example of your negative thoughts, all of the “good stuff” will remain unseen!

Thanks.

david

PS I will make this an Ask David for an upcoming podcast.

3. I have pure obsessive OCD and get stuck on intrusive thoughts. What should I do?

Hey Doc!

Very glad I ran into your work. Started with a video and have been reading and listening to your stuff for a couple days now.

I’ve been diagnosed with OCD (PURE O). I struggle with intrusive thoughts. I have had a lot of trouble exposing myself to the thoughts in order to face them. I’ve tried a writing a narrative of my fears etc…. I just can’t seem to get the right exposure.

A couple examples: I get stuck on… I don’t believe in God, or don’t believe enough or that maybe there isn’t a God?

I get stuck on… what if I go crazy?

I wish there was a dirty sink I could go touch or something tangible I could face.

Any suggestions?

Cliff (name disguised)

David’s reply

Hi Cliff,

Sure, and sorry you've been struggling, and fortunately, the prognosis is very positive.

But I have a few questions so I’ll know what you’ve done already. First, which of my books have you read, and did you do the written exercises while reading? For example, When Panic Attacks is all about techniques for anxiety.

Second, have you done a search for OCD as well as anxiety on my website? You will find many resources.

Third, have you completed the free anxiety test and class on my website?

Fourth, sometimes a therapist with expertise in exposure can help with exposure, although that is one of a great many powerful techniques for treating anxiety. Trying to treat OCD or any form of anxiety with exposure alone is a huge mistake.

Fifth, have you used the Hidden Emotion Technique?

Let me know, and thanks.

david

Rhonda, Matt, and David

The Feeling Good App: Part 2 of 2--

The Surprising Basic Science Findings--

How Does Psychotherapy REALLY Work?

And Why Did Everything Change So Fast?

Feeling Good Podcast Special Edition #2: March 07, 2022

Today’s special podcast features the second part of the recording with David and Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the basic science findings most recent beta test, which included 140 participants. David uses an advanced form of statistics, called Structural Equation Modeling (SEM) to identify causal effects and to learn more about how the app actually works. This information has immense practical and theoretical implications.

Here's a portion of what we’ve discovered so far.

1. All seven negative feelings are high correlated because they all share an unknown Common Cause (CC) predicted by David in one of the top psychology research journals in the late 1990’s. Here’s the reference2

Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473.

2. The CC accounts for most of the variance in all seven negative feelings, with R-square values ranging from 66% for anger, and 98% for Anxiety. Since there has to be some error variance in the estimates of the negative feelings, there is practically no room left for any significant additional causes.

If you would like to see the standardized output of the SEM model, click here.

3. The CC also has causal effects on Happiness, but these effects are much smaller, with an R-square of only 30%. This proves that Happiness has its own causes that are completely different from the factors that trigger depression. Happiness, in other words, is NOT just the absence of depression.
4. The radical reductions in all seven negative feelings were mediated by the reduction in the user’s belief in their negative thoughts, as predicted by cognitive therapists, like Albert Ellis and Aaron Beck, as well as the Greek Stoic philosopher, Epictetus, nearly 2,000 years ago. This is the first proof of that theory!
5. At least three components of the app have been isolated which appear to have substantial causal effects in the Common Cause, which in turn triggers simultaneous changes all negative feelings as well as happiness. Those three components include:
   1. A cognitive variable: the user’s belief in his or her negative thoughts.
   2. A motivational variable: measured with extremely precise and sensitive instruments.
   3. the user’s liking of the app.

The magnitude of all three causal effects was large. However, the motivational variables and user’s liking did not have direct effects on changes in depression and other negative feelings. The changes were ALL mediated via reductions in the user’s belief in his or her negative thoughts. This finding is consistent with the hypothesis that it is impossible to reduce negative feelings without change the belief in the negative thoughts that trigger those feelings.

6. The SEM models were replicated in two independent groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. The fit of the model was outstanding in both groups, and there were few or no significant differences in the parameter estimates. This indicates that the findings are valid and do not represent capitalization on chance.
7. David has reported extremely rapid changes in all negative feelings in his single-session treatment of individuals using TEAM-CBT. Some people have suggested that this is because he often treats mental health professionals as well as individuals who are very acquainted with his work.

CLICK HERE FOR THE FULLL REPORT

However, data from the beta test indicates this is not likely to be true. Mental health professionals did not respond any differently from non-professionals. In addition, the Familiarity with David or with TEAM variables did have modest effects on the degree of liking of the app, but no direct causal effects on changes in depression or the Common Cause.

The basic research is just beginning and ongoing. David believes that the research potential of the Feeling Good App may be as significant as the healing effects documented in the outcome findings with the app in the previous podcast.

If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training module, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques for the first time to find out if the improvements last.

Research on more than 10,000 sessions by human therapists using TEAM indicates that a portion of the gains patients make during individual sessions dissipates between sessions, but the “staying power” of the gains is facilitated by the patient’s homework between sessions. As a result, patient gains tend to reach a steady state after four or five sessions.

We anticipate that something similar may be documented in longitudinal studies with the app, and are eager to see what we can learn in the next study which will extend beyond one day.

So, hopefully, the new study will be pretty cool, too! And who knows what we’ll discover, with your help! Make sure you sign up if you’re interested in being one of our beta testers!

David and Jeremy

Rhonda, Jeremy, and David

Podcast #280: A Beloved and Brilliant Voice from the Past: Dr. Stirling Moorey!

Rhonda and I are thrilled to welcome Dr. Stirling Moorey, from London, England, to today’s podcast. Stirling was one of my first students, and he sat in with me my on all my sessions as a co-therapist for a month for two summers in the late 1970s. I wrote about Stirling in my first book, Feeling Good: The New Mood Therapy, which was published in 1980.

One of the miracles of the internet, and zoom, is the chance to reunite with friends and colleagues from the past. Needless to say, Rhonda and I were SO EXCITED when Stirling accepted the invitation to join us!

Rhonda starts the podcast by saying that

“Dr. Stirling Moorey had the good fortune to be trained and supervised by two pioneers in the field of cognitive therapy, Drs. Aaron Beck and David Burns. In 1979, when Stirling was still in medical school in London, he did an elective with Dr. Aaron Beck at the Centre for Cognitive Therapy in Philadelphia.“

I (David) might put it a bit differently. I would say that during the early days of cognitive therapy, I had the fantastic opportunity to do co-therapy together with Stirling with many patients. I learned a tremendous amount from Stirling, even though I was, in theory, the “expert” and he, in theory, was a totally untrained and green novice. But he was phenomenal right out of the gates, and those months were among the happiest of my life.

What I learned by observing Stirling’s superb interactions with my patients eventually morphed into my Five Secrets of Effective Communication and my first book, Feeling Good Together!

Rhonda continues:

"Stirling was one of the first British therapists to study CBT when that discipline was in its infancy. David described their fantastic collaborative work with Stirling in Feeling Good, and has described Stirling’s brilliant empathy skills in dozens of workshops.

Stirling is currently a Consultant Psychiatrist in Cognitive Behaviour Therapy, and was the Professional Head of Psychotherapy for the South London and Maudsley Trust from 2005-2013. He has been a Visiting Senior Lecturer at the Institute of Psychiatry, Psychology & Neuroscience in London."

Stirling is a highly regarded therapist, trainer / supervisor / teacher and workshop leader. His main research interest is in the application of CBT to life threatening illness and adversity. He was one of the first therapists to develop CBT for people with cancer and has contributed to five randomized controlled trials in both early and late stage cancer.

Stirling is also co-author with Steven Greer of The Oxford Guide to CBT for People with Cancer, and has co-edited a book entitled The Therapeutic Relationship in Cognitive Behavioural Therapy, published by SAGE (Moorey & Lavender, eds.)

During today’s podcast, Stirling reminds us that one of the aims of cognitive therapy is encouraging patients to examine their distorted negative thoughts and self-defeating beliefs in a way that is not threatening. If patients don’t feel validated, they may feel attacked and become defensive, which, of course, can undermine the therapist’s effectiveness.

He also reminded us that the grandfather of cognitive therapy, the late Dr. Albert Ellis from New York, often attacked the beliefs of his patients in a somewhat aggressive manner, and that this can frequently trigger therapeutic resistance. In fact, an overly aggressive therapeutic style can split patients and colleagues into two camps: those who love you, and those who may stubbornly resist and oppose you.

During the podcast, we reminisced a bit on shared memories, and Stirling said that

“David took me under his wing with such willingness to share his knowledge and experience . . . and I was just an ordinary medical student. We had many great moments!”

Although Stirling was tempted to relocate to America, he decided to remain in England, and has never regretted that decision. For one thing, he met and married his beloved Magda.

My own wife, Melanie, and I were honored to take our two kids to England to attend their marriage. We all loved England and had a ball!

Magda, Stirling's wife

We discussed some of Stirling’s amazing work with the patients we saw together in Philadelphia, as well as his visit one summer when we were in California visiting with Melanie’s parents in Los Altos, where we now live. Stirling recalled that when we were out shopping one day, my wife and I tried to persuade him to purchase a large Stetson hat, but he resisted!

Stirling described the three ways in which he encourages people to change their negative thoughts using the Socratic Technique of gentle questioning: he  asks if the negative thoughts are realistic, if they are helpful, and if an alternative perspective can be taken.

The reality testing approach focuses on the important differences between healthy negative feelings, like healthy sadness or grief, which don’t usually need any treatment, and unhealthy negative feelings like depression, or a panic attack.

One key difference is that healthy negative feelings always result from valid, undistorted thoughts. For example, if a loved one dies, you may tell yourself, “I still love him with all my heart, and I’ll miss the many wonderful times we spent together.” In contrast, unhealthy negative feelings result from negative thoughts about the person who died that are distorted. For example, a young woman who’s brother committed suicide told herself,

“It’s my fault he was depressed because our parents love me more when we were growing up. I should have know that he was considering suicide the day he died, so I, too, deserve to die.”

Of course, the distorted thoughts don’t have to result from a traumatic event. For example, a chronically depressed patient may tell himself, “I’m a loser, and I’ll be depressed forever.”

A more pragmatic treatment approach focuses less on whether thoughts are distorted or not, but rather on their effects. It’s possible for a thought to be realistic but unhelpful. If a tightrope walker in the circus thinks during their act, ”If I fall I will die,” this may be realistic but not very helpful!

Stirling talked about how the third way to look at changing thoughts is based on the fact that our lives always have a narrative—a story we tell ourselves about what has happened, or what is happening right now in our lives. These stories can have a powerful impact on how we all think, feel, and behave, and may often function as self-fulfilling prophecies.

We can change these stories to make them more adaptive for us. For instance, rather than seeing the glass as half empty, we can see it as both half empty and half full; or we may choose to focus on what you can control vs. what you can’t.

What I’ve written so far are just some general ideas, summaries of things that we talked about on the podcast. But when you listen to the podcast, you will perhaps notice the warmth, richness, and depth in the way Stirling thinks and communicates. Then you will “see” and experience his true genius and his immense compassion!

We hope that we can entice Stirling to present to one of our free weekly training groups, and perhaps even see if he might agree to do another co-therapy sessions with me that we can publish on a podcast, so you can actually see and experience this master therapist in action!

Rhonda, Stirling and David

Podcast 279: Dr. Leigh Harrington on Goal Setting for Habits and Addictions or Using Habits to Feel Better

Today, we are joined by a very special member of the TEAM-CBT family, psychiatrist Leigh Harrington, MD, who will teach us how to set goals that work when battling habits and addictions.

Leigh Harrington, MD, MPH, MHSA, is a psychiatrist, TEAM-CBT Therapist and Trainer.  Originally from Michigan, where she completed medical school and graduate school, she had the good fortune to meet Dr. David Burns in 2004 during her psychiatry residency at Stanford University when she joined his original group of Tuesday night students.  She specializes is helping therapists and individuals reach their goals especially in the areas of Interpersonal Exposure, Relationships, and Habits.  She lives in Davis, California with her two beloved daughters.

Leigh begins by saying that there are many parts of the TEAM-CBT model than help when battling unwanted habits and addictions. Our habits definitely result from how we think, and the stories we tell ourselves, and treatment can sometimes be more than just treatment, but a transformational experience.

She explains that

“I gained 20 pounds following my last pregnancy, so I began to set three kinds of goals:

• Mental goals
• Physical goals
• Relationship goals”

Mental goals

She continues:

“I focused on reducing the many Should Statements I was battering myself with, like “I should have done this or that,” or “I should do this or that.” These kinds of statements sounded demanding and triggered feelings of guilt and frustration that actually made it harder to achieve my goals.

“So, I decided, instead, to notice my thoughts, and focus instead on appreciating things. This was just one of many approaches to rewiring my brain.

“For example, I realized I had been letting my brain run itself each morning. When I woke up my mind would start to tell me all the things I needed to (should) do that day. . . Sometimes I would wake up feeling “okay,” but I was definitely not in a state of bliss, gratitude or joy.

“Sometimes it seemed as if my mind would look to find reasons I might not be feeling top-of-the-world: ‘Well there is this issue… or this… and also this…’

“Which told me a story of my unhappiness, or simply a lack of joy. Of course, my mind was well-intentioned, trying to help me out, but it didn’t end in greater joy, but in the weight of ‘shoulds’ and reasons to feel crummy. It had become a habit--a thinking habit.

“I was struck by the idea that I didn’t have to let my mind think whatever it wanted and wondered if I could break this thinking habit. In habit work, we determine the new habit we want, check our motivation, plan solutions to any problems, and commit to the new habit.

“I thought I would keep my new habit simple, believable, and incorporate gratitude, as that can sometimes be helpful, too.

“My new habit was to catch myself while I was still in bed, as soon as I recognized I was having thoughts, and say to myself something I believed that, was non-controversial. When I caught myself thinking any shoulds or telling myself any unhappy stories, I said to myself, ‘I love my bed. I love my house. I love my lamp.’

“This might seem simple, trivial, or silly. But the point of the new habit was not to be profound and brilliant. The point was to change my thinking in the smallest of ways and to prove to myself I could create a new thinking habit.

“This simple thought habit has allowed me to start my day on a better note and has allowed me to prove to myself I can change my thinking habits.”

Physical goals

Leigh explains:

“Here’s how I lost the 20 pounds I had gained. Instead of focusing on one strategy – like, “I will only eat vegetables,” or “I will exercise 2 hours per day,” I focused on achieving the goal by any means. I used the experimental technique and went through a series of habit experiments.

“First I tried just thinking I’d like to lose the weight. I. This may seem crazy, but there have been times in my life when I’ve seemed to effortlessly loose weigh, so that seemed like an easy first go.

“As you might imagine, it didn’t work as well in my 40’s as it did in my 20’s. As long as I kept giving in to my urges to have a sugary treat in the afternoon as a pick-me-up, and refusing to be in deprivation, nothing at all happened with my weight.

“I also allowed myself to eat as much as I wanted to, just as I had when I was pregnant and nursing my daughter.

“Since that didn’t work,. I experimented with some green juice in place of sugary snacks. I felt healthier, but there was no change in my weight.

“Then I decided on a multi-pronged approach. I would keep drinking my fruit-smoothies in the morning, along with a protein shake mid-morning, and a normal lunch, plus a normal dinner – just one serving at lunch and dinner, and no more than one dessert per week, Whenever else I was hungry I would drink a protein drink and lots of water. I also committed to walking every day for 30-60 minutes and going to the gym at least once per week.

“And, I committed to doing this until I saw the results I was looking for. I weighed and measured myself. But in two weeks, I had lost only one pound and zero inches.

“I was discouraged.

“But I was committed to stick with it, no matter what, for as long as it took.

“Three weeks in thee was still not much change.

“But at 4 weeks I started noticing a difference and by 12 weeks the scale read 20 pounds lighter – the same as I weighed in college. Most importantly I felt great and I experienced a sense of accomplishment!

Relationship goals

Leigh continued:

“I also decided to focus on developing better personal relationships with six people, including my mother. I had always felt that she was critical of me, this thought caused me to distance myself from her. I had a better relationship with my dad. So I decided to focus, instead, on what I loved and appreciated about her. For example, she was amazing with my kids.

“This is a little funny, but I was in the middle of a difficult time in life and hired a coach specific to this situation.  I felt sad about the loss of a friend and I found her wisdom really helpful. She suggested, ‘you only need six people, your pall bearers.’

“Since I have a tendency to enjoy and like many people, it made a lot of sense to me to focus my energy on a treasured few.

“I had always prided myself on being a loyal and committed friend and didn’t’ want to give any up.  Even though the suggestion of only 6 didn’t ring true for me, it helped me drop the strongly held belief, ‘I must keep all friends forever.’ I found releasing some relationships allowed room for some really awesome new ones to grow.

“I’m loving those now. And low and behold, I started enjoying hanging out with my mom, and began to realize I had a kick ass mother!”

Leigh summarized some of the keys to successful goal-setting, including the importance of setting small, measurable, and specific goals. She described her upcoming “Boot Camp” on overcoming habits and addictions. For more information, contact Leigh at www.TeamTherapyTraining.com.

Following today’s podcast, we received this lovely note from Leigh:

Hi David and Rhonda,

I so loved being with you both today!! Thank you for being so gracious and welcoming about these ideas on how to modify habits and addictions! I love growing together.

 David, it really struck me how you were breaking things down into steps and making so clear for your listeners - it felt like your intellectual mind and your heart were going at the same time.

Rhonda, I love how you brought up ideas and framed things in such a clear way. You guys rock!!

When we finished up, I thought of a more thorough response to David’s question about slogging today. I was reminded of perfectionism and how I’m trying not to be so perfectionistic. I still remember David’s article on perfectionism from Psychology Today Magazine way back in 1980, when Feeling Good was first released. It was entitled, “The Perfectionist’s Script for Self-Defeat.”

I’ve been working on doing “B” work, and I’ve gotten so much more done and - when I don’t fall into perfectionism again - having so much more fun.

So, I like the idea of holding ourselves accountable, being committed to ourselves and our goals, and to letting ourselves do B work, instead of aiming for perfection. It seems kind of counter-intuitive, but that combo leads to getting more done and being a lot happier!

Maybe you have some insights, David or Rhonda? Much love to you both, Leigh

David wrote back:

Hi Leigh,

Thanks for the beautiful note. I have also struggled with perfectionism, especially when I was younger, and I agree with your conclusions 200%.

But perfectionism has many tentacles, and is always lurking in the shadows, waiting to jump out and grab us again!!

David

Rhonda wrote back:

Hi Leigh,

I also struggle with perfectionism, and when I am feeling overwhelmed I tell myself, “I have an abundance of time to accomplish all I want to do today, calmly, peacefully, and with unhurried grace.'”

That’s not an empty affirmation, but a positive statement created after writing out a Daily Mood Log, seeing the positives in my perfectionism, and looking at the distortions in my thoughts.

Rhonda

We hope you enjoyed this podcast, Rhonda, Leigh and David

#278: Buddhist Strategies for Financial Abundance, Featuring Zeina Halim

Jan 24, 2022

Today, we feature the work of Zeina Halim, a beloved member and small group leader in our Tuesday training group at Stanford, who specializes in the treatment of anxiety. 

This is Zeina’s third appearance on our podcast. Previously she helped us with a fabulous program on family conflicts at the start of the pandemic (Corona Cast 3, 4-06-2020) and later did live some personal work on one of the Self-Defeating Beliefs, the Achievement Addiction (Podcasts 211, 10-12-2020, and 212, 10-19-2020). 

Today Zeina brings us something radically different: Buddhist Strategies for Financial Abundance. What in the world does that mean, and why should you care? 

She starts by describing her study of Buddhist practices, and cites some books that have inspired her, including The Diamond Cutter:  The Buddha on Managing Your Business and Your Life, by Geshe Michael Roach.  

Zeina explains the quasi-mystical concept of “Karma,” which is the idea that you get what you give. In other words, the energy and spirit you convey to others, and to the universe, will come back to you. For example, when clients who are not a good fit for her practice contact her, Zeina goes out of her way to help those clients find a great fit with another therapist.  

This “Karmic practice,” she explains, has paradoxically caused many patients to suddenly seem to show up, asking for treatment. In other words, when she meets the needs of others, the universe meets her needs. 

She says that she doesn’t need to do very much at all of the kinds of traditional marketing that most other therapists do in an attempt to build their practices. This “karmic practice” has been mostly sufficient and far more effective than traditional marketing methods.

This is a theme that I (David) resonated with, since I also give away almost everything for free, and have received an abundance of positive and loving gifts from the universe in return.

Zeina cautions that this, and all Buddhist practices, must be done with balance and thoughtfulness: “When I started, I gave too much, and this can actually cause self-harm.” 

She said that some people have raised the question: “But isn’t this an inherently selfish practice, since you are hoping for abundance for yourself?” 

Her response to this is that when you receive financial abundance, you can give even more to others for free. 

She also described another book of Geshe Michael Roach’s, The Karma of Love, where you try to give to the other person and meet their needs instead of worrying about whether they’re loving you enough or meeting your needs. 

In a previous relationship, this led to inner peace and, paradoxically, she felt much more loved, although nothing observable had changed in the way her partner treated her. The change in her feeling loved all came from changes SHE made, not her partner. This aligns very closely with the TEAM-CBT approach to relationships, as well as the teachings of most religions.

We also discussed group TEAM-CBT vs. individual therapy.  I described my phenomenal experiences in Philadelphia creating a large intensive group therapy program at my hospital, which was in a rough, inner city neighborhood. Most of our patients had few resources, and many could not read or write. Some were homeless. The program was more or less free to all of them, and our patients and their families gave us so much in return. 

I was absolutely thrilled that Zeina also loves doing therapy in groups. Many patients and therapists alike think of group therapy as a kind of inferior approach, but my experience has been the opposite. If given the choice, I’d treat everyone in groups.

Zeina will be starting a TEAM-CBT anxiety group within a week of this podcast. The group will focus on all the anxiety disorders, such as chronic worrying, shyness, phobias, OCD, PTSD, and more. There will be one group for adults and one for young adults, aged 18-24.

If you’re interested, feel free to text Zeina at 1-408-412-5678, email her at ZeinaHalimTherapy@gmail.com or visit her website at ZeinaHalimTherapy.com 

As an aside, we’ll find out if Zeina’s Buddhist Karmic Marketing works. She did not ask me to promote her group. I just decided to promote it a little bit because I’m so excited about what she’s doing, and I hope her practice grows and prospers to the max! 

Thanks for joining us today! If you like what we’re doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing. This year, we’ll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen! 

Rhonda, Zeina and David

Rejection Practice: A Love Story, Featuring Dr. Cai Chen

Jan 17, 2022

Rhonda starts today’s podcast by reading two wonderful recent endorsements from listeners. A therapist from San Jose, Ca was moved and inspired by the two podcasts (Episodes 268 & 269, published 11-15-2021 and 11-22-2021) with Dr. Carly on the tragic loss of her baby via ectopic pregnancy, and another listener described TEAM-CBT as “revolutionary” due to the emphasis on reducing resistance. She compared the approach to the indirect hypnotic approach developed by the late Milton Erikson. 

Dr. Cai Chen recently completed his psychiatric residency in Texas, and then moved to California to join the TEAM-CBT community and unite with the love of his life, who happens to be a member of our Tuesday group. 

Cai attributes much of his dating success to one of the techniques he read about in my book, Intimate Connections, called “Rejection Practice,” because he practiced that technique to successfully defeat his negative thoughts about all the awful things that might happen if he tried to talk or flirt with an attractive woman. 

He would tell himself things like:

1. She’ll think I’m being too forward.
2. She’ll be offended and might call the police.
3. People who see me trying to flirt will be offended.
4. I’ll be rejected. 

He described what happened when he forced himself to get 20 rejections in a mall in order to overcome his fears. His stories about what happened are both funny and inspiring. 

Cai also describes his initial intense resistance to using this technique, giving himself messages like, “I shouldn’t have to learn to flirt because it’s beneath me!” I heard excuses like that all the time when I was in clinical practice, working with shy, lonely men! 

Rejection Practice is a powerful and potentially super-effective technique you might want to try if you’re also struggling with social anxiety or if you treat patients with this problem. 

We also illustrated the hilarious Feared Fantasy Technique on the podcast, where Cai enters an Alice-in-Wonderland Nightmare World, and meets the “woman from hell” who represents all of his worst fears, and verbalizes things like this to him:

1. You’re assaulting me and I’m going to call the police. 
2. You’re the last person I’d ever date! You’re forgettable! you
3. You’re too forward.
4. I can see that you’re very insecure!

In addition, he meets the “observer from hell” who verbalizes things like this to Cai: 

1. I’m terribly offended that you tried to talk to that woman. 
2. It’s highly inappropriate to flirt like that in broad daylight. 
3. You shouldn’t be doing that. 
4. I condemn and reject you!

Cai was surprised to discover that the monster has no teeth and experienced some enlightenment and freedom from his fears. Rhonda, Cai, and I had a lot of fun with these techniques, and hope you enjoy them, too. Again, if you’re a therapist, you might consider including these techniques if you work with shy individuals. 

We also discuss the idea of “Physician, heal thyself,” a quotation from the New Testament (Luke 4:23). We are all convinced that doing your own personal work can vastly increase your skills and depth as a clinician, because you can tell your patients, “I know what you’re going through, because I’ve been there myself. And what a joy it’s going to be to show you how to overcome your shyness and develop greater confidence, and more loving relationships with others.”

And that’s exactly what happened to Cai. He found the love of his life. You’ll hear all about it if you listen to this heart-warming podcast! 

Dr. Cai is just starting his TEAM-CBT practice at the Feeling Good Institute in Mountain View, California. However, since he is a trained physician and psychiatrist, he can also prescribe medications if patients need them in addition to the therapy.

Dr. Cai Chen is a warm and brilliant young psychiatrist. If you would like to contact him, you can contact him at Cai@FeelingGoodInstitute.com, or call him directly at 1-916-877-4749.

Thanks for joining us today! If you like what we’re doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing, since I have refused to monetize the podcasts. So our budget is meager at best. 

Still, this year, we’ll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen! 

Warmly,

Rhonda, Cai and David

Here are the questions for today’s Ask David, featuring special guest, back by popular demand, the extraordinary Dr. Matt May, and of course, our super-special hostess, Dr. Rhonda Barovsky!

1. Why is my dad the way he is? Why are people the way they are?
2. What can you do about positive distortions?
3. More Should Statements!
4. How can you talk to someone who refuses to talk to you?

Why is my dad the way he is? Why are people the way they are?

Hi Dr. Burns and Dr. Barovsky!

I love your show. Keep up the good work!

I'd deeply appreciate your time and insight.

My dad is 70, my mom is 67, and I'm 38. Throughout my life my dad has done things like he did earlier tonight.

I was at my parent's house and my mom was telling me how Thanksgiving was going to be at my parent's cabin with the whole family like we have in years past at which my point my dad firmly said "No."

My mom asked "Why?" and he just shook his head and shortly after walked out of the room to go to the bathroom, shut the door, and said "no" angrily three times in the other room to himself but loud enough for she could hear.

He'll seemingly randomly act extremely possessive by angrily forbidding family get togethers, or my mom from doing things, or family to borrow things. He'll just say "No" without further explanation.

Always, always, upon asking "Why?" to his "no."

He'll either say angrily, "Because I said so!", say nothing, or just repeat "No" further.

My mom says sometimes "Can you just gave me a reason?" and it's the same "No", silence, or "because I said so."

I don't jump into the aforementioned back and fourth communication because I know such a person can't be changed and don't want to make an argumentative mess.

He's never displayed any comfort with expressing the slightest vulnerability. He's very, very silent. All of my life he has displayed bullying type tendencies. Whenever I visit my parents he always shows tremendous eagerness to want to scowl and berate people for the tiniest mistakes (even people he doesn't know in public, like cashiers.) I think even the most skilled of five secrets practitioners might be outmatched.

My mom tonight, and all my life, has asked me why is he like this?

I've been haunted to try understand this question all my whole life too.

So, I'm putting the question to you Dr. Burns and Dr. Barovsky:

Why is someone like this?

You must've heard of similar situations and have insight?

I want to feel compassion and understanding for him. I don't want to live with baggage.

And mainly, mainly I just want to relieve myself from anger thinking should, labeling, and overgeneralizing thoughts like "He shouldn't act like this", "He shouldn't be such a bully", "He's being a jerk."

Thank you,

Mark

David’s Reply

Thanks, Mark,

I can certainly understand your sadness, frustration, and anger, as well as your love and concern for your mom.

Scientists don’t yet know why people are the way they are. My focus is on helping people at specific moments of interaction when they want help. You have not asked for help in this email.

I do make this type of statement in practically every Ask David episode, but have not had much luck in getting people to listen, because the general questions that have no answers keep rolling in.

You say that your dad cannot change. To my ear, this statement is both blaming and untrue. People change at every moment of every day.

The real question I always have is this, and it might not interest you. Do YOU want to change the way you interact with him?

You and your mom probably both do things that trigger him, like silence, or asking WHY when it is abundantly clear that this response has a 100% guarantee of triggering him.

I apologize if this is not the answer you were looking for!

David

What can you do about positive distortions?

How much information is there in the book (or a particular podcast) on how we address positive distortions most effectively?

It is mentioned briefly that these can be more difficult to overcome, because of the more positively perceived "benefits", which may also be re-enforced externally (such as "yes, he is such a nice person, nobody wants him to express any frustration or anger occasionally - not even he himself want to do this!").

It affects motivation to any change, or, at least, creates ambivalence.

Some more on this would be great, please.

Thanks, Tillerich

David’s Reply

Hi Tillerich,

Good question, and I will schedule it for an Ask David. As you point out, there usually isn’t much motivation for change when it comes to positive distortions. Positive distortions trigger habits and addictions, violence, mania, marital conflicts, and narcissism, to name just a few areas.

Each is handled differently, but dealing with motivation / resistance is key in every area.

David

More Should Statements

Johnny asks:

Can you help me disprove my negative thoughts? I manage to disprove them, but they return after a few hours.

• “A loser is someone who lives at home with his parents after he turns 18.”
• “I should be bold, confident, and secure.”
• “I should be better than I am.”

David’s Reply

Hi Johnny,

Sorry you’ve been struggling.

The first thing to do is A = Assessment of Resistance, since resistance is the key to nearly all therapeutic failure. Tools would include the Paradoxical Invitation followed by the “Miracle Cure” question: What are you hoping for? What kinds of changes are you asking for?

This is important. For example, you mentioned a problem with procrastination. If you have a procrastination problem, the strategies would be completely different.

Other tools at the “A” portion of the session would probably include

• • The Magic Button
  • Positive Reframing
  • The Magic Dial
  • The Acid Test.

If you decide that you actually DO want to change the way you think and feel, given the fact that you’re still living at home, a few of the many methods that could be used include:

• • Identify the Distortions
  • Explain the Distortions
  • Individual Downward Arrow Technique
  • Semantic Technique
  • Cost-Benefit Analysis
  • Let’s Define Terms
  • Be Specific
  • Examine the Evidence.
  • Double Standard Technique (DST): For example, would you say these things to someone else? Our son has been living with us for a while, but I don’t think of him as “a loser!” My wife and I are actually happy to provide some support while he is sorting out what he wants to do next.
  • Paradoxical DST
  • Externalization of Voices with three strategies:

1. 1. Self-Defense
   2. Acceptance Paradox
   3. CAT (Counter-Attack Technique)

There are many additional techniques that could be used. But first, the action would focus on resistance and motivation. Tackling the distorted thoughts before completing the “A” step is usually not a very good idea!

David D. Burns, MD

How can you talk to someone who refuses to talk to you?

Hi Dr. Burns,

I came across your book and podcasts during a time in which I was having a hard time communicating with my adult son. They have helped me tremendously in acknowledging my part in the problem. While I've done a lot of work on my own self-esteem, anxiety and depression, sadly it has come a little too late as my son does not want to talk to me and we are estranged. Any thoughts or advice on how to reach out to a loved one in this situation? Now that I have been practicing for the 5 secrets I want to better connect with my son and work through our issues?

Thanks,

Shelly

David’s Reply

Thanks, Shelly,

I’m so sorry that you are estranged from your son. Have you done the written exercises in my book, Feeling Good Together? That’s a good place to start, as this very topic is addressed in the chapter on how to talk to someone who refuses to talk to you. The method that can be helpful is called “Multiple Choice Empathy” or “Multiple Choice Disarming.”

We will likely illustrate it on the show.

Rhonda, Matt, and David

Hi everyone!

This special podcast features one of our favorite people, Professor Mark Noble from the University of Rochester in New York. Professor Noble is a world-renowned neuroscientist and cancer researcher, one of the pioneers in stem cell research, and all-around good guy. He contributed a brilliant chapter on how TEAM-CBT interacts with the brain for my book, Feeling Great. For the past two years he has been a very beloved member of the Wednesday TEAM-CBT Training group, adding his wisdom and clarity to the teachings.  Rhonda and my co-teachers, Leigh Harrington and Richard Lam, and all of our students feel very honored to have him in our midst.

This is our third podcast with Dr. Noble, and the first podcast to usher in the new year. We’re excited to speak with him again today. He will update us on his latest thinking on how the molecular biology of stress and learning are totally consistent with the rapid mood changes we see in TEAM-CBT. He also describes his latest writing project, tentatively entitled, The Brain User’s Guide to TEAM-CBT, and you can download it for FREE if you click here! (LINK)

In this booklet Professor Noble presents the “brainological perspective” on TEAM-CBT. He emphasizes that this booklet is written at the 9^th grade level so as not to intimidate anyone. If you’re curious, take a look, and feel free to share it with others who might be interested.

Professor Noble explains that his new booklet was inspired by patients who ask how TEAM differs from traditional (aka “normal”) talk therapy. Of course, the differences are many and profound, but one of the questions new patients and therapists ask is whether the rapid recoveries we observe during TEAM-CBT treatment are just superficial and temporary, or even fake.

Mark asserts that nothing could be further from the truth, and that the thing that makes TEAM-CBT so special is how closely it is aligned with how the human brain actually works. He explains that there are ten essential steps in TEAM, starting with Empathy. He defines Empathy as “being in a safe place, where you can share feelings without being judged.”

Empathy allows the patient to access the networks in the brain where the patient’s pain may be stored as memories. The spoken and written language exercises used in TEAM actively and rapidly modify the networks that generate the feelings of depression, anxiety, shame, inadequacy and hopelessness. Dr. Noble places a great importance on the written Daily Mood Log, which he describes as arguably the “greatest development in the history of psychology.”

He says that when you describe the horrible and traumatic things that happened to you, and you record your Negative Thoughts on paper in a systematic, step-by-step way, you can look at your thoughts, feelings, and painful memories as separate from your “self” and gain some distance from them. Then, when you pinpoint the many cognitive distortions in your negative thoughts, and substitute more realistic interpretations, you gain freedom and relief because you are actually re-wiring your brain.

He said that most of our human thinking is called Fast Thinking. This is the automatic thinking that we do 98% of the time as we go through our daily lives.

Fast thinking is great, but growth, learning and change can only result from Slow Thinking, where we reflect and analyze things. Slow thinking takes concentration and effort because you are changing actual networks in your brain when you challenge and crush your negative thoughts with powerful techniques like the Externalization of Voices.

He says that we are not just telling people to “Stop it!” or “Get over it!” Quite to the contrary, we are teaching specific, powerful techniques that give you the chance to pinpoint and modify the exact brain networks that cause your negative feelings. He explains that “language is a powerful tool for figuring out exactly how we see the world when we’re feeling down, and TEAM gives us many tools in TEAM to modify the errors in our perceptions that cause so much suffering.

Mark laments on the excessive misuse of medications for individuals, including children, who are struggling with behavioral and emotional problems. He wishes more people would simply sit down with the person who is upset and ask, “What’s going on? How are you feeling? What are you thinking and telling yourself?”

I have had the same thought when thinking about how therapists not familiar with TEAM or Cognitive Therapy use and promote dozens of presumably therapeutic approaches without simply asking patients, “What thoughts go through your mind when you are feeling depressed, anxious, ashamed, inadequate, or hopeless?” The answers to this question provide direct and immediate access to the brain networks that need re-wiring!

Mark concludes today’s podcast by saying,

“I went into medical research on cancer and other serious problems because I wanted to help people who are suffering. I’m convinced that TEAM-CBT, and the powerful Daily Mood Log that David has developed, have the potential to help millions of people around the world!”

Rhonda and I are grateful for Mark’s ongoing friendship and brilliance and want to wish all of you a happy and healthy 2022!

We are both very grateful for your support during the past year and hope you will continue to mention our podcast to friends or colleagues who might be interested in learning about TEAM-CBT.

We look forward to celebrating the five millionth download of the Feeling Good Podcast around July! Thank you!

Rhonda and David

The Sara Session—Total Blow Away!

(Part 2 of 2)

Last week, you heard the first part of the session with Sara, a woman haunted by feelings of anxiety and inferiority from the time she grew up in a village in Mexico. Because she received a great deal of mean-spirited put-downs, she same to see herself as an "outsider" who wasn't good enough. She has finally decided to challenge this crippling and disturbing mind-set, and in today's podcast you will witness her metamorphosis. She will also join us for the fascinating follow-up to her amazing treatment session.

If you click here, you can see Sara’s Brief Mood Survey at the end of the session, along with her Evaluation of Therapy Session. As you can see, the changes in her mood scores were profound, and her ratings of Jill and David on “Empathy” and “Helpfulness” were excellent.

If you click here, you can see Sara’s Daily Mood Log at the end of the session.

By the end of the session, all of Sara’s negative emotions had gone down dramatically, to zero or near zero levels. However, one negative feeling, jealousy, only went down to 30%, and this feeling was still nagging at her. She said she still felt inadequate and jealous of people who had accomplished more, since she’d been procrastinating for years at promoting and developing her private practice.

I don’t like to leave people with loose ends, if at all possible, and Sara clearly wanted to zap the feelings of jealousy if we could, since we hadn’t focused on this emotion at all during the session.

You may be fascinated by the surprise ending to the session, and the method that allowed Sara not only to blow away her feelings of jealousy, but a discovery of how she could use those feelings to connect more deeply with her childhood friends, including those who had accomplished a lot!

There were quite a few teaching points, including but not limited to these:

1. Rapid, profound, and lasting change is possible, even when people have been struggling for years or decades, or even since childhood, with feelings of depression and inadequacy.
2. The goal of therapy is not just a reduction in depression, but a total elimination of depression along with being catapulted into a state of enlightenment, joy or even ecstasy.
3. Sometimes Positive Reframing can blow away a negative thought, as you'll discover in the surprise ending to her session.
4. Sara totally threw herself, body, heart and mind into this work. That commitment is a vital ingredient of success.

Several days after the session, Sara sent this beautiful note to the Tuesday group.

Hello, Tuesday Group!

I apologize for just now sending this email. I had told David I would email the group this past weekend with an update, but I have been TOO busy dancing away (more about this in a second). 😝

Anyway, I will try to make this email short because I tend to go overboard and write too much, and I know everyone is busy. I will just share a few things that have happened since my personal work two weeks ago. I am also forwarding the email I sent David and Jill Tuesday evening after the magical evening.

First of all, THANK YOU all for your awesome support and empathy during that beautiful evening. At that time, I did not realize how much this is the story of many of us in the group (the learning disability and being bullied, humiliated and teased because of it.) I felt very connected to you and felt your love and deep compassion and understanding. Thank you!

So, I was not kidding when I wrote that I am dancing away. You see, during the last two weeks when I have been at a grocery or department store, I have been dancing away to the music playing in the store. For some reason my body just gets moving and doesn’t want to stop no matter what song is playing.

As you can imaging, this is not typical of me. As a matter of fact, I am not a music person let alone a dancer. I prefer to listen to NPR or a Feeling Good podcast when I’m in the car and don’t play any music at home.

Anyway, when I have been at a store these last few days, I have let loose. It was really funny when a lady at the end of the aisle noticed me dancing, and said to me, ‘You go girl!” We both giggled and I kept dancing even after the song was over.

I am NO longer inhibited and have allowed my body to do what it needs to do, and I really don’t care what anyone thinks or says. What a liberating feeling this is!

My husband also thought it was funny that I have made silly sounds, especially during meals, and we would just burst into laughter.

Needless to say, a lot has gone on since my personal work. I am definitely more relaxed, and therefore, less serious and more playful. Enjoying life!!!

The main shift has been my thought that has been ingrained in me my whole life: “Que van a pensar?” which translates to "What are they going to think?” I used to care and believe this !00% but now I don’t believe it (0%) and it does not matter to me what people think.

My new thought now is more powerful and I believe it 100%: "I don’t care what she (they) think. What matters is what I am telling myself!”

I have noticed myself shifting to this new thought quite a bit and it has been so liberating and empowering. I cannot express enough how freeing this feels.

In case you are wondering, the plans for the trip to Mexico will include a visit to my birthplace and gatherings with extended family members and high school classmates as well as some site seeing.

Oh, my goodness, I said, I would make this short, and here again, I went overboard. Sorry!

Once again, thank you for all the love and support!!!

With immense gratitude,

Sara Shane

I want to thank my brilliant and beloved colleague, Dr. Jill Levitt, for her brilliant work in Sara’s treatment, and I want to thank Sara for this fabulous gift she has given all of us!

When you actually SEE the magic happening, it makes all the difference in the world. And when you see the actual techniques that Jill and I were using, you will hopefully realize that you, too, can learn to use TEAM-CBT in your clinical work if you are therapist, or in your personal life if you are struggling with feelings of depression, insecurity, anxiety or low self-self-esteem.

Remember, too, that we still offer unlimited free TEAM-CBT training for California mental health professionals in our Tuesday group and for therapists from around the world in Rhonda's Wednesday group.

If you’re interested in the Tuesday group, contact Ed Walton edwalton100@gmail.com. If you’re interested in the Wednesday group, contact Dr. Rhonda Barovsky rhonda@feelinggreattherapycenter.com.

Thanks for listening!

Rhonda, Jill, Sara and David

The Sara Session—Total Blow Away!

(Part 1 of 2)

In one of my recent Tuesday psychotherapy training groups at Stanford, we reviewed the Interpersonal Downward Arrow Technique. This is a high-speed technique I created that allows you to rapidly identify the roles that you play in your relationships with others so you can pinpoint the patterns that create tension and unhappiness for yourself as well as the people you care about.

The Interpersonal Downward Arrow Technique is similar to what psychoanalysts try to do with free association on the couch, except it only takes five to ten minutes, as opposed to five to ten years. In addition, I have also developed fairly rapid ways to change and modify those dysfunctional patterns—IF this is what you want to do.

Some of the psychoanalysts call these hidden patterns “core conflicts.” The late Dr. Lester Luborsky (https://en.wikipedia.org/wiki/Lester_Luborsky), a prominent psychotherapy researcher at the University of Pennsylvania School of Medicine, has written about core conflicts extensively.

He gave as an example of a core conflict, a person who might have the belief that “my needs will never be met in my personal relationships.” Beliefs like this not only create unhappiness, but they can also function as self-fulfilling prophecies.

In addition, most people re not aware of these “core conflicts,” and do not realize they are just beliefs. Most people just believe that “this is just the way the world is,” and think they have a profound insight into the reality of human nature.

But we actually create our own interpersonal realities at every moment of every day. Since we usually cannot “see” what we’re doing, we may wrongly conclude that we’re victims of the “badness” of others. And, of course, there is always a grain of truth in that belief as well!

During the training group, we had group members identify some of their own “core conflicts,” using the Interpersonal Downward Arrow Technique, and this hit one of our members, Sara Shane, like a ton of bricks. She discovered that she sees herself as “an outsider” and has always believed she is stupid and inferior to others. And this intense belief has caused tremendous suffering for Sara for decades, including her participation in the Tuesday training group, where she is usually totally silent.

Sara traced this pattern to her childhood, growing up in a village in Mexico, where she was bullied and put down because she was short and overweight, and had the darkest skin of any of her many siblings. In addition, she struggled with a learning problem and was frequently put down and labeled as stupid.

Sara’s sudden decent into emotional hell was fueled by the fact that she was planning the wedding of her niece at a town in Mexico which was only two hours from the town where she grew up. And the thought of showing her daughter that town filled her with feelings of shame and terror, fearing she would run into the people she grew up with, including the people who cruelly put her down.

Here’s what she wrote prior to doing personal work on this problem in a subsequent Tuesday group:

Hello Jill and David,

Where to begin…all day yesterday it was very painful as I thought about emailing you...

As I’m writing this, I am in tears and I know it is going to take me a while to write everything I want to say. But first let me say that it has taken me a long time to even sit in front of the computer because this has been very difficult for me. I had earlier said I would email you yesterday morning but I know now why I could not. I procrastinating mainly because this hurts a lot, beyond what I had earlier experienced. Right now, I am not even paying any attention to proper writing because I just want to write this without worry about correctness and just express my feelings.

Let me describe what I have been feeling physically all week long since Tuesday. I have been feeling sick to my stomach especially when I was working on the DML. I felt a hole in the pit of my stomach. I felt anxiety all over my body and felt overwhelmed. At times I could not even go one. I had to push myself to complete the Cognitive Distortions on the DML. I just wanted to run away from it all. It was that painful. But I also knew this was a good thing because I was getting down to something very important that I wanted and needed to face.

So the Interpersonal Downward Arrow has been very enlightening, but also, extremely painful. And David, you are absolutely right, there is no doubt in my mind (not that there ever was), that all of our problems are encapsulated in one brief moment in time and that we create our own interpersonal reality at every minute of every day.

Let me explain what transpired on Tuesday that motivated me to be a volunteer during small group practice. After postponing it for more than a year due to COVID, my niece is having her destination wedding in Mexico in November. My husband and I along with our daughter are attending the wedding. While there, we were hoping to travel to show our daughter the town I was born in and where I completed my junior and senior year of high school. After more than 20 years in February 2020, I reconnected with one of my good friends from high school. During this conversation, we talked about making plans to get together with our classmates when I went to Mexico for the wedding. However, I have not been in touch with her since then.

In making more concrete plans on Tuesday morning for our trip, I realized we would be able to travel to my birth town. So the possibility of visiting with my high school classmates whom I have not seen for about 38 years produced a lot of anxiety for me. This was very disturbing because this is not even a set event. It is only a possibility. Thus, I started wondering way it was making me so anxious just thinking about it and knowing that I did not need to visit with anyone if I did not want to. I was quite distraught, thus, I decided to share these feelings during small group practice. I was feeling anxious, insecure, and afraid of being judged and criticized.

I’m so glad I was able to volunteer during our small group because prior to this I didn’t realize the multitude of feelings that were buried. One of the biggest revelation was how lonely I was feeling and the immense grief I was experiencing. But even more surprising was the extreme feeling of inferiority I felt although I denied it at first when Jill asked if I was feeling inferior. It was not until we were going over the “Rules” that govern the relationship that it was very clear to me how inferior I felt. And here lays all my PAIN: “I am always an outsider because I will never be good enough.” This brings me to tears!

Although I understand intellectually that my suffering results from the belief that I have a self that is not good enough and a self that others can judge, as you so beautifully wrote David in your book, Feeling Great, it is still hard for me to let go emotionally.

When doing the DML, I believed my negative thoughts 100% and found 7 to 8 distortions on each, which as I mentioned earlier, it was very painful to complete.

Negative Thoughts:

1. 1. I am always an outsider because I will never be good enough
   2. I shouldn’t get close to people so I won’t be criticized nor judged
   3. I’m not professionally successful as I should be, after all, that is why I went to school
   4. Mexican people are very judgmental

Perhaps instead of typing all the DML information on here, I should send you a copy along with a copy of the CBA. I will do this in a second email.

Self-Defeating Beliefs:

Perceived Perfectionism - My high school classmates will not accept me with all my flaws

Achievement Addiction - My worthwhileness depends on my accomplishments, professional success, and the way I look (preoccupied with my overweight)

Worthlessness - I’m basically worthless, defective, and inferior to others especially some of classmates

Brushfire Fallacy - Everyone will talk about me and look down on me (“Mexican people are very judgmental”)

Spotlight Fallacy - Talking to people feels like I have to put on an interesting mask and perform in order to impress those around me

Superwoman - I should alway be strong and never appear weak in front of others

As I worked through the DML, CBA, and S-DB these last few days so much has come up for me. I couldn’t help it but to feel lots of pain as some of my childhood memories emerged of the horrible times when I was humiliated, teased, and bullied primarily by family members (both immediate and extended family members). Sadly enough, in the Mexican culture, being dark completed, short, and chubby are frown upon and a reason to be ridiculed and humiliated. And unfortunately for me, I possessed all three characteristics beside having a learning disability which was translated as me being dumb, stupid, and slow. There were plenty of moments growing up that this was extremely painful especially moments when my own family crudely laughed in my face. I quickly learned to withdrawal and became rather introverted. As I got older, I also quickly learned to tell myself things like; “But one day I’m going to show them that I am not as stupid as they think I am” and “One day I will prove them wrong.”

I believe this also became my strength, motivation, and determination to go to college. I was always just an average student in college, and at times, I struggled, but what got me through was my determination to succeed and ultimately prove that I could do it. However, this also created strong fears of being humiliated and ridiculed by people in general. Thus, I have protected myself from being criticized or judged by pushing and staying away from people and have been very cautious and guarded regarding having close relationships. Also, for many years, I have avoided family gatherings where I know extended family members that use to tease me when I was a child are going to be in attendance. I have been rather sensitive to people’s humor and hardly ever joked myself unless I knew the person very well. I am happy to say though that I have made some growth in this area ever since I have joined TEAM. And, that is thanks to your innate humor, David. ; )

Any way, I hope this makes sense…

Thank you so much to the two of you for the opportunity to allow me to grow and learn from my painful thoughts. I know more than ever that the only way to over come this pain is by the death of my belief in the “self”.

Love,

Sara

This will be the first of two podcasts showcasing the amazing work that Sara did in a subsequent Tuesday group. Dr. Jill Levitt and I worked together as co-therapists, and we went through the TEAM model in a step-by-step manner.

In this podcast, you’ll hear the first half of the session (T = Testing and E = Empathy) and next week you’ll hear the last half of the session (A = Assessment of Resistance) and M = Methods.)

If you click here, you can see Sara’s Brief Mood Survey at the start of the session.

If you click here, you can see Sara’s Daily Mood Log at the start of the session.

If you click here, you can see the CBA that Sara completed prior to her personal work.

Thanks for listening!

Rhonda, Jill, Sara and David

272 Ask David, with Special Guest, Dr. Matthew May: Shoulds, Free Treatment, Blame, and More!

Here are the questions for today’s Ask David, featuring special guest, Dr. Matt May, and, of course, Dr. Rhonda Barovsky!

1. How can I turn off my Shoulds!?
2. Is there a downside to treating people for free?
3. What’s the difference between Feeling Great vs Feeling Good?
4. Isn’t it important to blame the other person when that person really IS to blame? 

How can I turn off my Shoulds!?

Nice podcast! (Maurice is referring to Part 2 of “I want to be a mother.”) It’s refreshing to see that we sometimes mix our needs with wants.

I also have a huge problem with regret and shame, saying to myself

• “I should be far more ahead in life.”
• “I should have dated more.”
• “I should have used my energy to create art and being productive.”

I pinpointed the moment in my daily mood log, and it occurs usually when I compare myself with people online or with people in my friend group who seem to be far more ahead in life than me in terms of career and achievements or that they used their energy of their younger years more constructive than me because they didn’t deal with depression.

I tried the semantic method to soften my thoughts regarding my should statements but telling myself “I wish I did xyz,” is carrying the same weight of regret as when I “should” myself.

These thoughts also seem very realistic to me and pinpointing the distortions in them is not helping me much because there is so much resistance and weight to the thought, plus the positive thought that I subsequently come up with does not crush the negative thought.

I often ask myself: ”Am I really a failure?”

Maurice

David’s Reply

Thanks, Maurice

You are struggling with resistance, which is the cause of virtually all therapeutic failure. You can use Search on my website to look up podcasts on Positive Reframing, Assessment of Resistance, and Paradoxical Agenda Setting.

I usually select ten to fifteen or more methods to crush any Negative Thought, but would only use them after the resistance issue has been successfully addressed.

For example, we could use “Let’s Define Terms,” as one of 15 or 20 potentially helpful techniques. It might go like this:

Is “a failure” someone who fails all the time, or someone who fails some of the time.

If you say, “some the time,” then we’re all “failures,” so we don’t need to worry about it.

If you say, “all the time,” then no one is a “failure,” so we don’t need to worry about it.

If that technique is not effective, we’d have tons more to try.

You can read one of my books, like Feeling Good or Feeling Great, to learn more about the Assessment of Resistance and the use of various techniques to crush distorted thoughts.

Might also use this on an Ask David. Can use a fake first name, too, if you like. Please advise.

david

Is there a downside to treating people for free?

Dear David and Rhonda,

I live in England, and I’m close friends with a team CBT therapist in Bristol (Andy Perrson), and I’ve been listening to your podcasts for the last year. I have found them to be stimulating, thought-provoking, often really humorous but above all enormously helpful in helping me journey with other people.

I have just embarked on counselling training and would love to steer myself down the same avenues as my friend Andy. I’d also like to use your methodology at a later date.

In the meantime, I have a question for you.

I am conscious that almost all of your work now is done on a free, pro bono basis. I think that would be my preference as well especially as I have managed to cover the economics of life from other things and it would remove any feeling of conflict, or ambiguity around my motivations in helping people.

But, I am also aware that there are so many advantages in there being a financial commitment from clients. Sadly, things that are free and that spring from generosity are not always valued by the recipient, things like commitment and timekeeping become relaxed. It can be awfully irritating for the therapist (a bit like making someone a cup of tea and them not drinking it), and probably a waste of time for the client. A bit like the example you often give around the outcomes for clients who don’t do homework.

I would be very interested in your view on this and on balance whether it is better to charge or not charge for treatment, in the scenario where a therapist does not have a desire to charge.

David comment: I think the word “therapist” in the line above was supposed to be “patient.”

I hope that makes sense.

Thank you again to you and Rhonda for all your hard work.

Kind regards

Brad Askew

(Bristol, England)

David’s Reply

We can reply live on the podcast. The thrust might be that you can make patients accountable even if you treat them for free.

What’s the difference between Feeling Great vs Feeling Good?

Dear Dr Burns,

First of all, thanks for the great work that you do and also all the podcasts you did,

I am planning to order a copy of Feeling Great, your latest book. I have a quick question below.

I have been searching the answer on the web but still can't find the answer. Does Feeling Great cover ALL the key concepts that were discussed in your previous book, Feeling Good? Or does one need to read BOTH books to get a fuller picture?

I already own a copy of Feeling Good. However, if Feeling Great already covers all the concepts discussed in Feeling Good and also comes with updates, i may just order Feeling Great and start with that instead.

Thanks.

Best,

Calvin

David’s Reply

It really depends on the intensity of your interest. There is some overlap, but also significant differences. Even though Feeling Great is way newer, there are still tons of gems in Feeling Good.

David

Isn’t it important to blame the other person when that person really IS to blame?

Hi David,

I’ve been listening to the show for awhile. Thank you for everything you do.

I just listened to episode 254, and I’m not quite sure what to think about it in the context of my situation. I think it makes sense that people are afraid to look at their own faults and what brings them to a relationship and what they contribute to a situation. And that they tend to want to blame the other person to avoid working on themselves.

But what about situations of more extreme abuse? How do you not blame the other person?

I recently got out of a relationship where I was raped. While in the relationship, there was a lot of coercive sex where he ignored my signals to stop and then afterwards told me that things happened because I had wanted them to. Eventually his behavior escalated to the point where he drugged and raped me while I was unconscious.

It’s only been 2 months since I figured out that the relationship was too unhealthy for me and left it. I’ve been in counseling 2-3 sessions per week since then. So at least I am working on myself. And I have no contact with him.

Does that mean there is not a point in using the 5 secrets? Is that only for use on other people? But the things you said about blame rang true to me. I think I avoided working on my own issues for a long time, but this situation was like a giant neon arrow saying “work here!”

I think I blame myself and him both. But I also worry about blaming myself too much—I think me blaming myself is one of the reasons I felt trapped and unable to leave the relationship in the first place. Because I felt at fault and ashamed of that, I didn’t tell anyone for a long time and that normalized his behavior and allowed the relationship to continue and escalate to its extreme.

By not placing enough blame on him, I also didn’t consider that he might be acting selfishly, lying, or not have my best interests at heart. Which also led to the relationship continuing longer. So I am wary about where and how to place blame.

Anyway, I don’t know what else to say about this except that it has all been very emotionally difficult and I never want it to happen again, so I am diligently working on myself and looking for help in all the places.

Thanks,

Rachel

David’s Reply

The thrust of the response could focus on the idea that Self-Blame and Other-Blame are both dysfunctional. I prefer the concept of accountability, and talk about this in Feeling Good Together, which might be helpful.

I think Rachel is doing well to get help for herself and her own tendencies toward Self-Blame, and think that a lot of practice with the Five Secrets could also be tremendously helpful, especially for future relationships.

David

Rhonda, Matt, and David

Today’s podcast features Dr. Peter Spurrier, a British physician who has founded TEAM-UK. Peter describes how he spent most of his career as a physician in general practice, but was forced to see patients for only ten minutes due to the British health system. He didn’t like the “quick fix” approach to patients with emotional struggles, and at the age of 55, five years before he retired from General Practice, he decided that he wanted to do something more meaningful, so he began to get training in CBT which “helped me listen better.”

However, CBT seemed stilted, and the outcomes weren’t very good, either. Then he attended a two-day “Scared Stiff” workshop I presented in London several years ago. The workshop was sponsored by my friend and colleague, Jack Hirose, from Vancouver, Canada.

I was not aware that Peter was in the audience, but was really happy to hear that he like the workshop. I had been pretty disappointed in it, since the attendance was light and I ran into quite a bit of resistance from the audience. This was a huge surprise, since I thought they’d be eager to hear about all the improvements we’d made in traditional “Beckian” CBT.

At the workshop, Peter purchased my Therapist’s Toolkit, but said “it just laid on my shelf for two or three years. Then, he began using it and decided to focus on TEAM-CBT full time.

He began listening to the Feeling Good Podcasts, starting from #1 and eventually caught up. He says that “along the way, I learned by practicing the techniques I was hearing about.”

He says he has always been a critical thinker, and initially was dubious about the T = Testing part of the TEAM treatment model. As a GP, he was required to use questionnaires for patients with anxiety and depression, but for some time he thought it wasn’t very accurate data. When he started using the Brief Mood Survey, he was shocked as he began to realize that this WAS good data, and that his reading of how his patients felt was frequently off-base. This, of course, is the foundation of the TEAM-CBT model, which is entirely and intensely data-driven.

Then he attended one of my four-day summer intensives at the South San Francisco Conference Center, and loved the warm and encouraging atmosphere, commenting on the friendliness and encouragement of Rhonda, whom he met, and Dr. Angela Krumm, from the Feeling Good Institute in Mountain View, California. They both reached out to him. He said it was actually great to get the chance to work with people, and he was delighted by a demonstration I did on public speaking anxiety and social anxiety, which captivated the audience.

After the intensive, Peter returned to London and founded TEAM-UK. He also looked up Dr. Stirling Moorey, who I’d mentioned in my first book, Feeling Good. I have also mentioned Stirling in numerous workshops, especially when teaching therapeutic empathy.

Although Stirling was my student, I learned a great deal from him, especially in the area of empathy. Peter described an outstanding chapter on empathy, written by Stirling in a book he has co-edited with Anna Lavender entitled The Therapeutic Relationship in Cognitive Behavior Therapy.

I got excited to hear this and hope we can feature Stirling on a podcast one day soon! I would love to hear about his journey since we first worked together more than forty years ago, when he was just a medical student. His particular interest has been the application of CBT to life threatening illness and adversity. He was one of the first therapists to develop CBT for people with cancer and is co-author, with Steven Greer, of The Oxford Guide to CBT for People with Cancer.

I got excited to hear this and hope we can feature Stirling on a podcast one day soon! I would love to hear about his journey since we first worked together more than forty years ago, when he was just a medical student.

Peter wrote an article on TEAM-CBT for the newsletter of the British CBT group entitled “CBT Today.” He got zero response for several months, and then heard from Derek Reilly who uses TEAM-CBT in the treatment of pain patients. And, slowly, others began to join Peter’s TEAM.CBT.UK group, and now there are 25 to 30 members. Click here if you'd like to see the current edition of the Feeling Good UK newsletter!

Peter also talked about the visit that Rhonda recently paid to the UK and TEAM UK’s first in-person meeting, at Oxford University. “It was such a great pleasure to meet and spend time with Rhonda. She formed strong connections with the group, which we hope will endure for years to come”.

Rhonda on her visit to the UK TEAM group at Oxford University.

We discussed the resistance to change that we sometimes run into among mental health practitioners. Peter said, “It’s often quite hard to get people to change their ways, and organizations are not always that flexible, either.” One of the things that drew Peter to TEAM-CBT was the fact that it offered a way to embrace the best from various approaches to CBT.

This is a phenomenon I have encountered and wrestled with throughout my career as well, and is one of the reasons I would personally like to see an end to all of the schools of psychotherapy, with a switch to science-based data driven therapy. TEAM-CBT is NOT another new “school” of therapy, but rather a structure for how psychotherapy actually works.

Although all the hundreds of schools of therapy that have cropped up over the decades have provided some insights into human nature, and some useful treatment techniques, I believe that on balance, they hold the field back and actually function a bit like cults, all claiming to have the best answers and most effective techniques—but the outcome studies simply do not support this notion. In the treatment of depression, all of the current schools of therapy come out about the same in controlled outcome studies, and none are very impressive. In fact, only slightly more than half of the patients even experience a 50% reduction in depression symptoms, which is not very good!

The British Association for Behavioral and Cognitive Therapies is the over-arching organization and accrediting group that Peter’s TEAM-UK has joined. He explains that “we are a special interest group, within their membership of roughly 15,000 CBT practitioners.” Many of the members of TEAM-UK attend Rhonda’s Wednesday training group, and there are also two practice groups, weekly, in England. If you’d like more information about their activities, please visit their excellent and appealing website, FeelingGood.UK.com.

If you are a British mental health professional, or in Europe, and you would like to learn more about TEAM-CBT, I would STRONGLY encourage you to contact Peter and join one of the ongoing practice groups. You can reach Peter Spurrier  by emailing him at:  docspurr@gmail.com

Peter says that if there is one piece of advice he would like to give to his younger self as a doctor and for life in general, it would be to learn, absorb and practice the “Five Secrets of Effective Communication.”

Rhonda and I are huge Peter Spurrier fans and hope you enjoyed today’s interview!

From Rhonda:  Meeting everyone in the TEAM-UK group was an extreme pleasure for me.  It was a wonderful experience to meet people in person that I have only met on-line, and to get acquainted with TEAM therapists I had not met before.  Everyone is a dedicated, talented and enthusiastic TEAM therapist, and excited about building community.  Plus, everyone was fun and enchanting to hang out with.  It was definitely one of the highlights of my trip to meet everyone, and to have the opportunity to engage in discussion, to learn about about their hopes, dreams, visions and plans for the future for TEAM-UK!

Rhonda and I will offer a free, two-hour workshop on habits and addictions on January 26, 2022 from 11:00 AM to 1:00 PM Central Standard Time, sponsored by PESI, so watch for the links on this or their website.  If you register, you will have access to a video following the event, in case you can't attend at that specific time. if you can attend, you’ll have the chance to try some mind-blowing techniques that will help you with overeating, drinking, drug use, nail biting, excessive shopping, or whatever you secret habit / addiction happens to be. Remember this presentation will be--

for Patients, Therapists, and the General Public

It's Totally FREE

Rhonda and David

Today’s podcast features an esteemed colleague and beloved friend, Dr. Angela Krumm, who will describe her personal victory over a recent weight gain. We will illuminate the TEAM-CBT techniques she used so that you can use them yourself if you’d like to lose some weight.

But I have to warn you that you have to do these techniques using paper and pencil. If you try to learn and use them just from listening, they will not be effective.

As an aside, if you go to my website, www.feelinggood.com, you’ll find a free chapter offer at the very bottom of my home page. If you click on it, you’ll receive two unpublished chapters from my most recent book, Feeling Great, with crystal clear instructions on the methods you’ll learn about in today’s podcast.

Angela’s biosketch goes next, including how she joined David’s Tuesday training group when she was a post-doctoral fellow in clinical psychology and how she ultimately developed the TEAM-CBT certification program at the FeelingGoodInstitute.com. Hopefully Angela can help with this paragraph!

As the podcast begins, Angela explains how she’s always viewed herself as a very fit, health-conscious woman who actually completed some marathons in the past. But during 2021, her life has been complicated by a number of tragedies and traumas, including:

1. Angela’s father was sadly diagnosed with terminal cancer and died within four months.
2. Angela had many personal injuries that impacted her capacity to exercise, including a laceration of her retina and a fractured toe. In addition, she fell backwards over a ledge in her backyard and plunged eight feet. She sustained a concussion and experienced many lingering symptoms for 6 to 8 weeks including dizziness, brain fog, and sensitivity to light.

She described what happened next like this:

All this time my weight kept creeping up. I stopped caring about exercise, and during the COVID crisis, food become a joy and an escape. Then, I had a wake-up call, an ah-ha moment when everything suddenly changed.

Angela described attending a wedding, and her husband was the photographer. When she saw herself in the photos, she was shocked that she no longer recognized herself because of the weight she’d gained.

She also noticed that the day of the wedding, she’d eaten six huge but delicious chocolate chip cookies that her niece had baked. She says,

It hit me, and I didn’t have to think twice. There’s a history of diabetes in my family, and I didn’t want to keep gaining weight and struggle with all the medical complications of type 2 diabetes. I want to be healthy and fit so I can live to an old age and enjoy my children and grandchildren!

She used behavioral and TEAM-CBT skills to tackle the problem, starting with setting specific goals for herself. She said that lots of her patients who are overweight have vague goals, like “I want to lose some weight” or “I want to get in shape,” but general goals won’t be effective. In TEAM, you always focus on something specific.

Angela explained the critical difference between Outcome Goals and Process Goals. An example of an Outcome Goal would be telling yourself that you want to lose ten pounds or whatever your goal might be.

There’s a big problem with Outcome Goals. You might go on an extreme, like fasting or eating very little, so you can lose weight fairly quickly. Then you will feel happy and tell yourself that you’re done when you’ve achieved your goal.

The big problem is that you haven’t modified your eating habits, and that’s exactly why you will quickly gain back all that weight you temporarily lost.

Process Goals are different. Instead, you focus on the number of calories you can eat each day in order to lose weight, and then you make wise food choices within your calorie limit. In addition, you start out with a gentle but consistent exercise regimen, and then you slowly build up to more exercise. Angela started with two workouts per week and built up to four weekly workouts over time.

She also set modest and realistic goals for weight loss, setting a calorie limit that would allow her two lose weight slowly, at the rate of just ½ pound per week. This plan has allowed her to lose 21 pounds, and she was looking terrific today!

She has been using a free app called Lose It which provides her with all the information she needs for tracking calories bd weight, along with her BMI (Body Mass Index). She’s now on a maintenance diet of 1800 calories per day and she’s really pleased with it.

We also illustrated several powerful motivational TEAM-CBT techniques, including:

The Triple Paradox. You divide a piece of paper into three vertical columns where you list

1. Advantages of your habit / addiction: First, you list all the GOOD reasons to continue with the status quo of unlimited eating and little or no exercise.
2. Disadvantages off change: Next, you list all the negatives and hassles associated with dieting and exercise.
3. Core values: Finally, you list what your overeating and slacking on exercise shows about you and your core values that’s positive and awesome.

As you can see, instead of pushing yourself, or your patient, to change, you go in the opposite direction. You take the role of the subconscious resistance to change, and list all the really powerful reasons to continue with your habit or addiction. In other words, you try to convince yourself NOT to change!

Oddly, this usually triggers tremendous motivation to CHANGE. This paradox is one of the key features in all of TEAM-CBT.

You can see Angela’s Triple Paradox workshop if you click here.

The Habit / Addiction Log. Here you record your tempting thoughts, such as:

1. One more treat today won’t hurt.
2. I deserve it/ I’ve had a tough day!
3. That brownie looks SO GOOD!
4. I’m an active person so I deserve to eat whatever I want.

The Devil’s Advocate Technique. This is a powerful role-playing technique where you challenge and crush the tempting thoughts. We illustrate this technique with role-playing on today’s podcast. Angela plays the role of her Self-Control thoughts and Rhonda and I play the role of the Devil, tempting Angela to give in to her tempting thoughts.

The Problem / Solution list. You divide a piece of paper into two columns by drawing a line down the middle. In the left column (Problems), you list all the things that will sabotage your efforts to diet. In the right column (Solutions), you list solutions for all of those problems.

You can see Angela’s Problem / Solution list if you click here.

We also discussed the issue of therapist resistance to these rather unconventional techniques. The problem is that therapists and counselors are trained to help. This paradoxically triggers patient resistance.

TEAM-CBT requires one of the four “Great Deaths” of the therapist’s ego—the death of the co-dependent self that feels the compulsion to save, rescue or help the patient.

David gave a personal example of the extremely adverse effects of “helping” when he was the patient in an interaction with a health professional at Kaiser Permanente in California. The physician’s zeal for helping actually had the opposite effect of driving David away, and he did not go to the doctor for the next ten years.

So now you have a feel for the TEAM-CBT approach to habits and addictions. These methods can be surprisingly powerful but remember. You’ll have to do them on paper, as Angela did, if you want success.

Rhonda and I will probably offer a free, two-hour workshop on habits and addictions in late January, and if you attend, you’ll have the chance to try some of these techniques on for size. We hope you can join us!

Thanks for listening! And thank you, Angela, for sharing your personal example and for your awesome teaching.

Rhonda, Angela, and David

PS, I thought you might enjoy this "selfie," showing the amazing results that are possible after just a few weeks with TEAM-CBT!. Keep in mind that I'm 79. Just imagine what a few weeks of TEAM could do for you!

The featured photo shows Dr. Carly Zankman
at the Big Sur with her 8 month old nephew, Micah

October was Pregnancy & Infant Loss Awareness Month. We are dedicating this and last week's podcast to

all the mothers and fathers who have lost infants or struggled with pregnancy complications and tragedies.

This will be the second of two podcasts featuring a live therapy session with Dr. Carly Zankman, a courageous young psychologist. Dr. Zankman has been struggling with the aftermath of a traumatic ectopic pregnancy and some intense fears that she may never get the chance to be a mother. In addition, she is 100% convinced that she can never feel happy or fulfilled in life unless she becomes a mother.

Last week, we featured the first half of her session with Dr. Jill Levitt and me at one of our Tuesday Stanford training groups. If you have not yet heard part one, you can link to it (podcast #268) at the list of Feeling Good Podcasts on my website. In this podcast, you will hear the conclusion of our work with Carly. We are also delighted that Carly could join us in person today to tell us what has transpired since the end of her session some months ago.

You can see Carly’s Daily Mood Log (DML) and Brief Mood Survey (BMS) at the start of the session as well as her Brief Mood Survey and Evaluation of Therapy Session at the end of her session.

You can also review her completed Daily Mood Log so you can see her final mood ratings along with how she challenged each Negative Thought.

There were a number of teaching points in Carly’s session:

1. Depression nearly always results from telling yourself, and believing, that you have lost, or don’t have, something you believe you “need” in order to feel happy and fulfilled. It could be something internal, like greater intelligence or talent, or something external, like a baby, or a family, or greater wealth or status.
2. There is a difference between a high-level and a low-level solution to most depression. In a low-level solution, you find happiness by getting what you want. For example, you learn that you are pregnant, or that you got an important promotion at work, or that someone you’re attracted to has accepted a date with you. In a high level solution, you discover that you can feel happy and fulfilled without the thing you were so certain that you “needed.”
3. Although therapeutic empathy alone has limited healing powers, it can be absolutely precious and essential. Sometimes, people have a desperate need to be heard and given the space to express their feelings and to be accepted. In addition, people who have experienced a traumatic event or series of events often need the time to describe their experiences in detail. This can function like exposure, allowing the anxiety to diminish.
4. Therapy without a meaningful agenda is highly likely to fail. And sometimes, a therapist has to “sit with open hands,” even when the patient’s agenda may be a bit different, or even radically different, from you own. Our task is not to force the patient to conform to our standards and expectations, but to help the patient find happiness on their own terms, pursuing their own goals.
5. The Downward Arrow Technique was helpful and revealing during the Empathy phase of the session. This technique allowed us to pinpoint Carly’s core belief, which was also a Negative Thought on her DML: “I’m never going to feel fulfilled in life without children.”
6. It is okay for therapists to struggle with, and discuss, moments of confusion or uncertainty during a session. This type of dialogue can involve the patient and can often help you find your path forward.
7. There were some additional steps that could have been taken but we were limited by time. For example, we could have explored the interpersonal dimension of how to enhance the communication of feelings between Carly and her husband, as well as between Carly and other family members. She sometimes feels ignored and hurt. This problem is exceptionally common and can be addressed with tools like the Relationship Journal, the Interpersonal Downward Arrow, and the Five Secrets of Effective Communication. However, this can take some time, and also requires an agenda for the patient to be willing to examine his / her role in the problem and practice some new communication skills.
8. Our negative feelings always result from our thoughts and beliefs, and not from the actual events in our lives. However, sometimes patients can be extremely fixated on certain beliefs that trigger their pain and may even put up a powerful wall to protect those beliefs. This is human nature, and part of what makes the job of therapy incredibly challenging, fascinating, and rewarding.

We are all extremely grateful to Carly for her courage in sharing this intensely personal part of her life with us. She received, as you might imagine, incredibly support from all the members of the training group during and after her session, as others had struggled with similar fears as well. You can find her Brief Mood Survey at the end of her session here, along with her Evaluation of Therapy Session.

You can also review her completed Daily Mood Log so you can see her final mood ratings along with how she challenged each Negative Thought.

For more on this topic, you might want to give a listen to one of Carly’s favorite podcasts, #79: “What’s the Secret of a Meaningful Life: Life Therapy with Daisy.” (https://feelinggood.com/2018/03/12/000-live-team-therapy-with-daisy/)

After the group, Carly received this email from one of the Tuesday group members:

Good afternoon Carly,

I want to let you know what I enjoyed the work you did yesterday. Despite the challenging and emotionally charged topics you spoke with great clarity and poise. I suspect some of the points were uncomfortable to talk about at times. You went into great detail and I never felt disconnected or lost. It all seemed very fluid and I found myself following along closely to the story. That was quite impressive. I suspect this talent is very helpful for your clients.

I was curious if I could get your viewpoint about the exchange you had with Jill that brought up an emotional response on your part. Burns seemed to describe it as more self-defense while I think you described it as more acceptance. Perhaps my memory is off here so feel free to correct me.

To me it sounded like you didn't want to give up the idea of having a baby and tying that to fulfillment so, with Jill's lead, you stated that one way or another you will be a mother. That is important to you and you will make that happen. Perhaps this was the "self-defense" part.

I am thinking that maybe the Acceptance part was the acceptance of the emotion of the strong desire to be a mother and how important this is for you. Acceptance that you have this strong desire and that is ok to feel that way. Maybe the tears you felt were the tears of liberation in realizing that it was ok to have this desire because you believe in it strongly while many people may have been pushing you to let go of that. So you may not have accepted the idea of not having kids and being ok with that but you have accepted the strong emotion that is driving you to have kids. I suppose this is also captured to some degree in the positive reframe and the dial of that emotion and NT. Am I reading the situation right? Does this make any sense or am I totally off?

Thank you for any thoughts you may have. This was a great experience for me.

Warm regards,

Jason

This was Carly’s response:

Hi Jason,

Thanks for reaching out with your kind words. I’m CC’ing the Tuesday group because I think your question is great and imagine others might wonder, too. I don’t know whether it was self-defense or acceptance, but let me try to explain what happened in that moment.

During the Externalization of Voices, Jill took a turn at arguing against the thought, “I will never be fulfilled without children,” but instead of arguing against it, she accepted it and then proceeded to list all these ways that I could make having children possible.

I don’t remember exactly what she said now (I wish someone had written it down), but hearing her say what she said led to an “a-ha” moment for me where I realized that she was right; no matter what, I will make it happen because that’s what I do and that’s who I am. She tied it back to my values that were brought out during the positive reframe, and I accepted that I don’t want to change that thought because it’s motivating for me.

Hope that helps clarify!

Warmly,

Carly

The featured photo shows Dr. Carly Zankman
at the Big Sur with her 8 month old nephew, Micah

Podcast #268 : An Ectopic Pregnancy (Part 1 of 2)

October was Pregnancy & Infant Loss Awareness Month. We are dedicating this and next week's podcast to all the mothers and fathers who have lost infants or struggled with pregnancy complications and tragedies.

This will be the first of two podcasts featuring a live therapy session with Dr. Carly Zankman. Dr. Zankman, a 27 year-old clinical psychologist in our Tuesday training group at Stanford, is facing a serious crisis involving motherhood. She is struggling with the aftermath of a traumatic ectopic pregnancy and some intense fears that she may never get the chance to be a mother. In addition, she is 100% convinced that she can never feel happy or fulfilled in life unless she becomes a mother.

The featured photo for this podcast is Dr. Zankman at the Big Sur with her 8 month old nephew, Micah. You can see the love and joy in her face, and her intense desire to become a mother herself.

The session took place at my Tuesday training group at Stanford, and my co-therapist was Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, California.

You can see Carly’s Daily Mood Log (DML) and Brief Mood Survey (BMS) at the start of the session  The DML reflected her feelings several weeks before, when she felt that her chances for pregnancy were greatly diminished, and the BMS reflects how she was feeling at the beginning of our session. As you can see, she was still moderately depressed and anxious, and her happiness and marital satisfaction scores were quite low, indicating that she was unhappy and somewhat dissatisfied with her relationship with her husband.

Carly was also anxious about being on the podcast, due to these additional negative thoughts:

1. I’m not going to be able to describe what I’ve been through. She believed this 70%.
2. There’s a potential to be judged by people. She believed this 100%.

In today’s podcast, you will hear the T = Testing and E = Empathy portions of the session, and in next week’s podcast you will hear the A = Assessment of Resistance and M = Methods portion of the session, and hopefully Carly will be able to join us for a follow-up to see how she’s been doing since the session.

The show notes for next week's podcast will include eight teaching points.

Rhonda Jill and I are all extremely grateful to Carly for her courage in sharing this intensely personal part of her life with us. She received, as you might imagine, incredibly support from all the members of the training group during and after her session, as others had struggled with similar fears as well.

Thank you for listening, David, Rhonda, Jill & Carly

Hi everyone!

This podcast offers specific help to LGBTQ individuals who are under attack from loved ones who might judge them and criticize their sexual orientation or gender identity. Plus, we all get slammed at times by people who judge us for all sorts of reasons, which can be immensely painful, so most of today’s discussion will apply to people more broadly.

I recently received a great email from Heather Donnenwirth, a therapist in Ohio who works with LGBTQ individuals. She mentioned that some of her patients struggle with how to respond to critical or judgmental statements from loved ones, including parents, and provided several examples:

• "Being Gay is wrong/a sin"
• "If someone doesn't know if they are a man or woman, then something is messed up in their head."
• "We are worried that you are going to go to Hell for your lifestyle."
• "We don't want your partner at our house, and we don't want to see any displays of affection."

Heather wanted to know how one might use the Five Secrets of Effective Communication to respond to these kinds of criticisms.

I invited her to join us in the podcast, and she wrote:

I was excited about this topic. Thanks so much for including me. David's work has improved my life in so many ways and Rhonda's Wednesday TEAM training group has been a wonderful way to practice my TEAM skills and improve the kind of care I can offer patients. I appreciate and admire you both so much!! Also, I can't wait to meet Kyle!!

I also invited the brilliant and wonderful Kyle Jones to join us. Kyle is a TEAM therapist who joined my training group in 2016 before ever seeing a patient! He is completing his PhD in clinical psychology at Palo Alto University and his dissertation research focuses on psychologists who provide mental health treatment to LGBTQ people. Kyle joined us in 2018 for a FB Live TV program on dating and flirting strategies (https://feelinggood.com/2018/06/17/dating-strategies-today-on-fb-live-sunday-june-17-2018-at-3-pm-pst/) and in 2019 for Podcast 151 on treating LBBTQ individuals with TEAM (https://feelinggood.com/2019/07/29/151-working-with-lgbtq-patients-whats-the-team-cbt-approach/).

During today’s podcast, we used the excellent statements that Heather provided in role-playing exercises with the Five Secrets of Effective Communication. We used the Intimacy Drill that I developed, which is by far the best way to master the Five Secrets.

We also discussed the issue of the inner dialogue that always accompanies the outer dialogue with the person you’re in conflict with. If you get anxious, depressed, and angry when criticized, it will be much more difficult to use the Five Secrets skillfully, because you may feel defensive and resentful and inadequate. So some work with the Daily Mood Log may also be invaluable before trying to use the Five Secrets.

Finally, we discussed the question of “Outcome Resistance.” This means asking yourself if you WANT to develop a more loving relationship with a loved one who is being highly critical of you because of your sexual orientation, or for any other reason. We decided it is perfectly acceptable to decide NOT to try to develop a more loving relationship, if that feels better to you. It may even be in your best interest or help keep you safe from harm if you’re an LGBTQ person facing discrimination and persecution because of your sexual orientation or gender identity.

I explained my own anger toward my father who was a successful Lutheran minister. However, when he retired from his ministry at the Shepherd of the Valley Lutheran Church in Phoenix, Arizona, he began working with gay individuals at the Arizona State University, trying to convert them to a heterosexual orientation. This was profoundly disturbing to me, I felt a great deal of shame and anger, and it ultimately led to a sad rupture of our relationship.

Rhonda, Heather, Kyle and David

266: Ask Matt, Rhonda, and David: Can we solve the pain in the world?

How can we deal with someone who might weaponize our vulnerability?

What can I do about my emotional eating? And more!

Today's podcast features awesome questions from viewers like you, with answers from Rhonda, David, and our brilliant guest expert, Dr. Matthew May. Here's the list of questions, followed by partial answers (prepared prior to the podcast) from David.

• Ezgi Asks: Is there any way to solve pain in the world? Some people are committing suicide because they don't wanna suffer anymore. Is there any way to "finish" the suffering while we are still living in this world?
• Megan asks: Hi David, I was wondering what your thoughts are about using the five secrets when in communication with someone who may not be coming from a place of love or respect, or someone who might weaponize your vulnerability, such as someone with narcissistic tendencies?
• Telia asks: Could you please do another episode on compulsive emotional eating? I have suffered with this my whole life.
• Daniele asks: What “upsetting event” should I put at the top of my Daily Mood Log? Does it have to be the event that triggered your depression?
• Anca asks: Should I work on a different upsetting event every day and do a Daily Mood Log? What about the days when I don’t have any distorted negative thoughts?
• Oliver asks: Dear Dr. Burns, How much time do you require your patients to spend on their daily psychotherapy homework (Daily Mood Journal)?  What is overkill when doing Positive Reframing?
• Sarah asks: Hi Doctor Burns! Your podcasts have been so helpful! I want to know what you would have said to the husband, in this episode, if he were the one that came to you, first, about the marriage.(By way of explanation, Sarah is referring to an episode on the Five Secrets where the wife was blaming her husband for saying, “You never listen” for 25 years, and was shocked to discover that she was causing the very problem she was complaining about.)

* * *

Ezgi Asks: Is there any way to solve pain in the world? Some people are committing suicide because they don't wanna suffer anymore. Is there any way to "finish" the suffering while we are still living in this world?

Thanks, Ezgi,

I will read and answer this on an upcoming Ask David. I have committed my life to helping people who ask for help with
depression, anxiety, and other problems.

I do not evangelize or reach out, trying to convert people to some new way of thinking and feeling. Also, I only work with people one to one, (or in groups), and I think healing must begin with yourself.

There are tons of free resources on my website, plus my books, like
Feeling Good, and others, can be invaluable, including on the topic of
suicide.

You can get used copies inexpensively on Amazon, too!

All the best, david

* * *

After Hearing Podcast 14 on the Five Secrets

Megan asks: Hi David, I was wondering what your thoughts are about using the five secrets when in communication with someone who may not be coming from a place of love or respect, or someone who might weaponize your vulnerability, such as someone with narcissistic tendencies?

Thank you, I appreciate you and all you do to make the world a kinder and gentler place.

David’s Response

Hi Megan,

Please provide a specific example. What did the other person say, and what, exactly, did you say next. One exchange is enough. Then we can do something amazing, and not just BS on an abstract level that will be useless. You see yourself, based on your note, as the sweet innocent victim of the other person's "badness." Once we have a specific example of an interaction that did not go well, and you focus on your own role, things will suddenly fall into a shockingly different perspective. david Will include this in an Ask David.

* * *

Telia asks: Hi David, Thank you so much for your free information and podcast #155 on emotional eating. Could you please do another episode on compulsive emotional eating?

I have suffered with this my whole life. I listened to episode 155 but I need more help like actual questions to ask myself or tools to use in the moment.

I have suffered with this my entire life, and I know with your help I can be free from it.

Thank you

Telia from Australia

David’s Response

Hi Telia,

Check out the free chapter(s) offer on bottom of my website home page. Full instructions are right there.

Feel free to contact me if any questions after following the guidelines there, and doing the exercises on paper.

d

* * *

Daniele asks: What “upsetting event” should I put at the top of my Daily Mood Log? Does it have to be the event that triggered your depression?

Hello Dr. Burns,

i am reading your second book, Feeling Great. The first one, the new mood couldn’t help me or i couldn’t get it done right. And now i am trying Feeling Great. I like the book and your thoughts.

I have struggled with anxiety and depression since 2014 - on and off. Lately more on....

My biggest problem with the exercise is that you have to put an event that make you depressed. I don’t know exactly why it started and i so it’s difficult to find an event.

What can I do? I feel depressed and don’t know why. These days the fact that i couldn’t get rid of the depression for so long is the main reason why i am depressed.

Thanks for your help,

Daniele from Italy

David’s Response

Hi Daniele,

You just have to focus on one specific moment when you were upset and want help. It can even be the moment when you are working with the Daily Mood Log.

d

Thank you, Dr. Burns!

Daniele

* * *

Anca asks: Do I have to complete a Daily Mood Log every day?

Hello Dr Burns,

Thank you so much for the podcast and all the wonderful resources you are gifting to the world!

I've been listening for the last 3 months, and I can say that your discussions with your colleagues and patients have improved my mindset and my perspective on life. They helped me to identify feelings of self-blame and other-blame that I didn't even know I had. I also didn't realize how toxic they were.

I've bought the Feeling Great Book and completed 2 Daily Mood Journals. I am still in the beginning and try to improve my skills for challenging the negative thoughts. I am just wondering if I am approaching this correctly - sorry if I missed this from the book - Do I need to complete the Daily Mood Log every day?

I am asking this because on the days I do feel down and do have a negative event and thoughts, it takes me a lot of time to complete the log, around 2 hours. On other days I feel ok, and don't have upsetting distorted thoughts. Should I record one negative event every day, with all the negative emotions and thoughts that come with it, or work on the same upsetting event every day, taking on one or 2 thoughts at a time?

Thank you for your support and your generosity.

With Gratitude,

Anca

David’s Response

Hi Anca,

Will make this an Ask David. The short question is that you can work on the DML a little bit every day. I would aim for 15 to 20 minutes a day, like meditation. On some days, you will want to put in more time, which is fine, but you get 100% credit after 15 – 20 minutes. You can work on a DML over several days.

This is just one idea, and ultimately you are in charge! Congrats on the fantastic work you are doing! david

David

* * *

Oliver asks: Dear Dr. Burns,

How much time do you require your patients to spend on their daily psychotherapy homework (Daily Mood Journal)?  And how much time did they actually spend on a mood journal?

From my experience, I seldom complete them in 2 hours, the time you set up for one session. A daily mood journal with 5 negative thoughts would often cost me 4 to 6 hours. I am wondering how much time your patients usually spend on one daily mood journal? Besides, when I was filling out one daily mood log, more upsetting events would float in my head. To avoid being distracted, I recorded the second upsetting event on another Daily Mood Journal. But I found I never had the chance to work on it because I seldom completed the first event.

I am now unemployed, so I have enough time to work on an upsetting event, even if it cost me far more than 2 hours. However, I doubt if full-time employed people have enough time to do this homework, without sacrificing the time to be spent on families, sleeping, sports, and other activities. That is somewhat upsetting.

Do you require your patients to finish a Daily Mood Journal in one day?

I believe the guidance on this topic is not only important for me, but also for all of your readers and patients.

And another question that confuses me is that what is overkill when doing Positive Reframing? And when to decide it will be overkill or not?

Thanks.

Oliver Smith

David’s Response

Thanks, Oliver. You can do a DML over several days, no need to complete it all at once. 15 to 30 minutes per day would be excellent.

ON Positive Reframing, I wait until we “get a feel for it,” and we generally have listed a dozen or even 20 or so positives.

I have an app I’m working on that will help with these questions. Will read your question on an Ask David, perhaps. Thanks!

* * *

Sarah asks: Hi Doctor Burns!

Your podcasts have been so helpful! I want to know what you would have said to the husband, in this episode, if he were the one that came to you, first, about the marriage.

If we all cause the very relationship problems that we are complaining about, what is it that the husband is doing to cause Sarah not to listen to him and explode in anger? I see that Sarah is not able to listen and empathize, however, It seems like the husband is able to listen and empathize. What would his next step be?

Thanks!

Sara

David’s Response

Thanks, Sara. This is an interesting but abstract question, and I never find that answering them is productive, as 100% of the learning is in the specific example.

If he were asking for help, I would ask him to write down one thing that his wife said, as well as what, exactly, he said next, thinking of an exchange that didn't go well, and an example he wanted help with. Then we’d use the EAR technique to analyze his communication errors and show how he’s causing the exact problem he’s complaining about, followed by a revised response using the Five Secrets.

You could do that for yourself, and we'll see what YOU might be able to learn! For example, what is something someone said to you, and what, exactly did you say next?

Or, you could make up an example for me to comment on.

* * *

That's it for today!

Rhonda, Matt, and David

Podcast 265: An Extreme Leech Phobia: Once Bitten, Twice Shy!

Today’s podcast features the treatment of an extreme leech phobia in real time, using live leeches. Dr. Danielle Kamis, a clinical psychiatrist practicing in Los Altos, California, is our courageous patient, and Dr. Matthew May, a frequent guest on the Feeling Good Podcast, conducts the treatment, while David and Rhonda observe and comment.

If you ever saw the famous Humphrey Bogart movie, “African Queen,” you know how terrifying leeches can be. But why in the world would anyone working in downtown Los Altos, California, need or want treatment for a leech phobia?

Danielle is an extremely brave and adventuresome young professional woman who loves traveling to remote places around the world (Danielle is an extremely brave and adventuresome young professional woman who loves traveling to remote places around the world.  She has had a keen interest in global health work and has spent a significant amount of time doing research with indigenous population in the pre-Andes mountains of Argentina. She has also spent time living with tribes deep in the Amazon forest as well as the jungles of Sumatra. These experiences have transported her back in time to better understand the core components of humans in our most natural state.

She described a terrifying experience while exploring in a jungle in Sumatra, where the leeches not only invade the water, but can also drop onto you from trees. After hiking through the beautiful, lush landscape for some time, Danielle began screaming and sobbing in terror when she noticed that her foot was bleeding because of a leech that had just detached itself. This was understandably embarrassing, and she realized that she needed to overcome this fear before going on another jungle adventure.

In today’s therapy session live leeches will be placed on Danielle’s skin, and she will be encouraged to surrender to the anxiety and make it as intense as possible, rather than running away or trying to control or avoid it. This is an extreme form of exposure called “flooding.” It  can be incredibly effective, and often works quickly, but requires great courage on the part of the patient and therapist, as well as a high degree of therapist skill.

To prepare for today’s exposure session, Danielle obtained four live leeches, which she kept at her apartment. She said that even looking at the leeches slithering around in the water and thinking about them biting her made her fear instantly jump to 9.5 on a scale from 0 (not at all) to 10 (the most intense anxiety).

She asked Matt if he’d be willing to do the leech exposure first. Matt agreed, since we never ask our patients to do anything that we wouldn’t do, ourselves. This modeling by a trusted friend or therapist can be a useful tool in the treatment of anxiety.

Danielle carefully removed one of the leeches with a spoon and placed it on Matt’s forearm. After crawling around for a minute or so, the leech attached itself and begin to engorge itself on Matt’s blood.

Danielle watched in fascination and fear, and then it was her turn. She bravely placed a second leech on her forearm. She was afraid it was going to be extremely painful, but was surprised when it was just a mild feeling of sandpaper on her skin. Over a period of about ten or fifteen minutes, with episodes of nausea and profuse sweating, Danielle’s anxiety gradually dropped from 9.5 at the start all the way to 1, and she felt triumphant.

You can see some photos and videos of the session here, including our lunch prior to the session at the Phoa Cabin in downtown Los Altos. It is a favorite local spot that features tremendously tasty Vietnamese food.  (LINK)

Teaching points in today's TEAM-CBT session include the following:

1. Avoidance is one of the major causes of all forms of anxiety. When you avoid or try to escape from your fears, they will always intensify.
2. Exposure is a powerful treatment tool for anxiety, but is not a treatment per se, and there are many additional tools with powerful anti-anxiety effects. I (David) use at least 40 tools in the treatment of anxiety, but exposure must always be included in the mix. It is probably impossible to cure any form of anxiety without exposure.
3. All patients and most therapists resist and fear exposure. Patients fear exposure because of the intense anxiety they must endure and their belief that something terrible will happen if they don’t avoid their fear, and most therapists are also afraid that the patient is too fragile, or the procedure is too extreme, and something terrible will happen. However, I (David) have never had a bad outcome when using exposure. I am convinced that poor therapy skills, and not exposure, cause negative outcomes in the treatment of anxiety.
4. Excellent empathy is extremely important in treatment of Anxiety. Danielle mentioned the importance of her trust in Matt, and in his modeling of the exposure in the treatment. I (David) strongly agree with this, as I have had to use exposure in the treatment of my own fears and phobias and have also benefitted from doing exposure with someone I trust and admire.
5. Once you’ve beaten a phobia, and no longer fear the thing that once caused terror, fears have a way of creeping back in, especially if you do not continue to face the thing our feared. To prevent this, ongoing exposure is needed. Although Dr. May treated Danielle for this problem successfully in the past, Danielle’s intense fear of leeches had returned during the COVID pandemic. While some form of relapse is almost always inevitable, the good news is that facing your fear frequently can massively reduce the frequency and intensity of relapses.

Danielle seemed pleased with her session and agreed to do ongoing exposure on her own every day with the leeches as homework. The next day, we received this email from Danielle.

Hello!

I had a fantastic time yesterday with you and I am so grateful for all of your support and guidance. Thank you so much for taking the time to help me overcome my fear and help others do the same!

It was so wonderful and special seeing you all again in person.

Here are some awesome photos from the session as well as our lunch at the Phoa Cabin, and this link contains two videos.

Rhonda, Danielle, Matt, and David

How to Get Laid! (With a Little Help from the Five Secrets of Effective Communication)

One of our top TEAM-CBT teachers and therapists, Thai-An Truong, LPC, LADC from Oklahoma City, is featured in today’s podcast. Thai-An is the owner of Lasting Change Therapy, LLC, a TEAM-CBT group practice in Oklahoma that focuses on using TEAM-CBT to help women overcome depression, anxiety, and relationship problems, so they can live happier lives and have more satisfying relationships. She is passionate about working with postpartum women after overcoming her own personal struggles with postpartum depression and anxiety. She is also passionate about spreading TEAM-CBT and training therapists in this awesome treatment approach.

Thai-An suggested a podcast on how one could use the Five Secrets of Effective Communication to deal with critical comments from your spouse or partner during marital conflicts. She submitted specific examples from several troubled couples she has worked with, and Rhonda submitted an example as well.

1. Wife continues to bring up things that needs to be addressed, e.g., baby's medical needs, how he needs to set boundaries with his mom, precautions to take because of the pandemic.

Husband says: "All you do is talk about stressful things. You don't even care about being romantic anymore."

Wife’s typical response: "How can I be romantic with you when you aren't doing what you need to for our family?"

2. Sex often comes up with every couple, and the criticism is typically from the husband, as in the first couple and this second couple as well.

Husband says: "You never want to have sex. It's like we're roommates instead of husband and wife."

Wife’s typical response: "I'm tired, and I can't just get in the mood when you haven't been nice to me all day."

3. This couple had been trying unsuccessfully to have a baby.

The wife was very critical of her husband and said: “If it wasn’t for you, I’d have a baby. I should have married someone else."

Husband’s response: He said nothing and walked away.

4. Infidelity: In this couple, the wife had an affair three years ago and the husband continues to bring it up when they get into arguments.

Husband says: "Oh, you say I'm so bad because I did x. How about you cheating on me? You're the one who did the worst possible thing, and I can never trust you again."

Her typical response: "It's been 3 years, why can't you just let it go so we can move on with our lives? I'm tired of you throwing this shit in my face all the time."

During the podcast, we critiqued the responses to the criticisms in these four cases, using the EAR algorithm. It was easy to point out that the responses of the partner who was criticized typically failed in all three categories:

• No effective E = Empathy.
• No effective A = Assertiveness.
• No effective R = Respect.

We also spelled out the consequences of these responses to criticism, and showed how the respondents were actually forcing their spouses to treat them in exactly the way they were complaining about.

Then we used the “Intimacy Exercise” to practice more effective responses, based on the Five Secrets. This is, by far, the best way to learn the Five Secrets.

Your Turn to Practice

Now, here’s another example that Thai-An provided, and you, the listener, can practice with it. This wife was talking about how her friend had hurt her feelings. The husband typically goes into the advice-giving and problem-solving mode.

Her criticism: "You suck at listening. I don't need you to fix it."

His typical response: "I'm just trying to help."

First, see if you can explain why the husband’s response was ineffective, using the EAR acronym.

Ask yourself:

1. Did he use E = Empathy and acknowledge how she was thinking and feeling?
2. Did he use A = Assertiveness and express how he was feeling at that moment?
3. Did he use R = Respect to convey some warmth, respect, or love during the heat of battle?

Next, ask yourself about the consequences of his response. What will his wife think? What will she conclude? How will she feel? How will she likely respond to his defensiveness?

Finally, put yourself in his shoes and see if you can write out a more effective response, using the Five Secrets of Effective Communication

Thanks!

Rhonda, Thai-An, and David

Photo features Taylor and her husband, Gregg, who is an ER / ICU physician in NYC.

263:  OCD in Kids, Featuring Dr. Taylor Chesney

Rhonda starts this podcast by reading two incredible endorsements from fans like you. Thanks so much for the many kind and thoughtful emails we receive daily!

Today’s podcast features Dr. Taylor Chesney, the founder and director of the Feeling Good Institute of New York City. Taylor was a member of my Tuesday training group at Stanford for several years during her doctoral training in psychology. Then she and her husband, Gregg, who is an ICU / intensive care unit doctor, returned home to NYC where she opened her clinical practice.

We have featured Taylor on a number of two previous podcasts: Corona Cast 4 (published 4-09-202) and Corona Cast 6 (published 4-30-2020). We always benefit greatly from Taylor’s wisdom, warmth, and superb teaching. Taylor specializes in TEAM-CBT for children and teens, and tells us today about the upsurge in OCD (Obsessive-Compulsive Disorder) in young people, and how she approaches this problem using TEAM-CBT along with some family therapy.

Taylor describes OCD as a pattern of intrusive thoughts, fears, and images that trigger feelings of anxiety. In addition, the patient engages in a series of repetitious, supposititious behaviors in an effort to avoid the fear. Sometimes the parents may get caught up in the child’s fears as well and engage in the compulsive rituals as well.

The fears Taylor sees in children are similar to the fears reported by adults with OCD, such as the fear of contamination, and the compulsive habit of repeated handwashing, and more. But especially common in kids are fears that loved ones, like parents, won’t come home or will be hurt.

Common OCD rituals in children include wanting things to be a certain way; for example, organizing your desk meticulously, arranging your pencils, and so forth. The patient often feels that he or she can’t stop or something terrible will happen.

Another common fear is getting sick, and needing repeated reassurance that the food the child is eating is safe.

David asked about the Hidden Emotion Model that is common and often helpful in adults with OCD, or any anxiety disorder. For example, if a child fears that a parent will be hurt, might this suggest that the child has repressed angry feelings toward the parent?

Taylor confirmed that this dynamic was, in fact, common in children as well as adults with OCD. She emphasized the need for an alliance with the parents as a part of the treatment team. This might include urging the child to express his or her anger, wants, and so forth.

Taylor speculated that the increase she’s seen in OCD may be the result of the COVID pandemic, and the uncertainty we all feel. Children have a great need for love, empathy, structure, and certainty, and OCD is just one pattern that the increase in anxiety can take.

At the start of treatment, Taylor does an initial intake session with the parents, followed by two sessions with the child, and in both cases attempts to empathize and form an alliance via the Five Secrets of Effective Communication. She also wants to find out who the “patient” really is. Who is asking for help? Is it the child? Or the parents?

She also wants to know who will do the work of the therapy. If the child doesn’t see the OCD symptoms as a problem, she will work with the parents.

Sometimes there’s a mismatch as to what the problem is. The parents might want the child to get help with procrastination on schoolwork or household chores, but the child might want help with shyness and relationships with other kids.

She describes how she uses TEAM to show the child that his or her symptoms reflect his or her core values, but that they can turn down the intensity of the fears using the Magic Dial. She emphasized a role for psychoeducation in the treatment as well, explaining the evolutionary and protective role of anxiety. It’s just that sometimes the volume gets turned up to unnecessary levels.

She said that the parents are a huge part of the treatment, since the problem “lives in the house,” and the parents may fear what might happen if the child does not engage in the rituals.

And, of course, Exposure and Response Prevention are important keys to successful treatment, just as they are in adults.

Taylor described a compelling example of a teenager with an intense fear of vomiting in the middle of the night, who had resorted to a variety of rituals including avoiding dinner, secretly sleeping in his bathroom just in case. and more. Together, she guided him in the creation of a hierarchy of exposures as well as Positive Reframing of his symptoms. He successfully completed his treated in just six sessions.

Taylor offers a 12-week introductory course on TEAM-CBT with children and adolescents, and is a superb and highly esteemed teacher. For more information, you can contact Taylor@FeelingGoodInstitute.com or look for her on the website of the www,FeelingGoodInstitute.com

Rhonda and David

A Country Doctor, Part 2 of 2

A = Assessment of Resistance

At the end of the moving and tearful empathy phase, we asked Jillian about her goals for the session, which included the ability to

• enjoy my work
• to give away all of my certificates
• set limits with my patients
• feel happy with what I do
• not have to fear my work anymore!

After Jillian said she would be willing to press the Magic Button to achieve all these goals instantly if we had one, we suggested Positive Reframing first. to see what might be lost of she suddenly achieved all these goals. You can creview the Positive Reframing that we did together.

Here’s Jillian’s Emotions table at the end of Positive Reframing, showing her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering while still allowing you to preserve all the awesome things about you!

Jillian said that the Positive Reframing really opened her up, especially when we read the list of positives out loud. It kind of shocked her in a good way so see that her negative feelings were not really problems, defects, or symptoms of one or more “mental disorders,” but the expression of what was most beautiful and awesome about her as a human being, and as a physician.

This Positive Reframing is one of the unique aspects of TEAM-CBT. Although we are encouraging the patient to keep the symptoms, rather than pressing the Magic Button that makes them disappear, it paradoxically eliminates or drastically reduces the resistance to change, and opens the door to the possibility of ultra-rapid recovery.

M = Methods

We asked Jillian what Negative Thought she wanted to work on first, and she chose #9: “I’m not having a big enough impact.” She believed this thought 100%.

First, we asked Jillian to identify and explain the cognitive distortions in this thought, and she focused on these: Should Statement; Self-Blame, All-or-Nothing Thinking, Mental Filtering, and Discounting the Positive.

In retrospect, I think I spotted two additional distortions: Emotional Reading (I feel I’m not having a positive impact, so I must not be having a positive impact) and Mind-Reading (my patients expect me to have the answers to all their problems and judge me when I don’t have all the answers.)

Then we challenged the Negative Thought, and Jillian she was able, with a little help and a role reversal, to crush it, as you can see here.

Usually, crushing one Negative Thought is about all you really have to do, because once the patient blows one Negative Thought out of the water, there is usually a kind of “cognitive click,” and the brain suddenly changes, and all the positive circuits suddenly get fired up. It’s amazing to behold, and you will hear it for yourself!

The damn did suddenly break, and Jillian could clobber the rest of her Negative Thoughts fairly easily, using a combination of Self-Defense, Self-Acceptance, and a lot of the CAT technique. She suddenly appeared to be a radically and delightfully different person during the Externalization of Voices. You can see her final Daily Mood Log here.

You can see her feelings on the Emotions table at the end of the session.

Jillian’s scores on my Happiness Test on the Brief Mood Survey also soared to 100% and her ratings of Jill and David on Empathy and Helpfulness tests were also perfect.

After the workshop, Jillian sent this email.

Hi Jill and David,

As I drove home tonight from my office, I actually felt like my heart had been opened. My chest didn't feel as tight and locked-up like it normally does. It felt so relaxed. I put my baseball cap on, rolled the windows down, and listened to 90's country music (my favorite) on my drive and sang loudly. I have spent the last hour checking my new superpowers. There have been negative thoughts, but telling them to "shut the heck up. I am not listening to you" has been quite liberating. I even was greeted by my 4 year old when I got out of the car. I knelt down and hugged her without the worry of being a rotten mom, but rather one of feeling like I am the perfect mom for her, flaws and all.

Thank you for this opportunity. I took a chance to email you in the first place after listening to a podcast weeks ago. I thought there would be no chance in heck that I would be selected. I am glad I had this remarkable opportunity and grateful to have worked with both of you.

Much love and admiration,

Jillian

I hope you enjoy it as much as we did. Again, a big hug and thanks to the star or our podcast, Dr. Jillian Scherer who gave us all an incredible gift today!

Thanks for listening. I hope you learned a ton and were moved emotionally. Write and let us know what you think!

Jillian and Jill joined Rhonda and me for a two plus month follow-up at the end of the recording of part 2. She is still glowing and doing great, and emphasized the three main experiences that led to her amazing breakthrough: 1. When we did the Downward Arrow, she discovered that she had an underlying belief that she "should" or "must" make some kind of enormous, amazing contribution through her clinical work. Letting go of that internal demand was an enormous relief. I (David) think of this as one of the four "Great Deaths" of the "self," or "ego." 2. Learning to talk back to the relentless inner chatter that is always saying, "you're not good enough," using the CAT (Counter Attack Technique.) 3. Reframing the negative thoughts and feelings, and seeing the inner beauty in her suffering.

David again emphasized that TEAM-CBT is not just about improvement, or feeling less depressed, but magic, and enlightenment.

Jill summarized her new 11-hour home study course in TEAM-CBT with video and audio illustrating and teaching the four components of TEAM-CBT, Testing, Empathy, Assessment of Resistance, and Methods. This class sells for $187 and is suitable for therapists as well as the general public, and offers continuing education credit as well as certification credits in TEAM-CBT. I (David) believe that Jill is one of the truly great psychotherapy teachers, and urge you to check it out if you'd like to hear more!

Rhonda, Jill, Jillian, and David

A Country Doctor, Part 1 of 2: "Nothing I do makes a difference!"

This is the first of two podcasts on one of the live therapy demonstrations that Dr. Jill Levitt and I did at our psychotherapy workshop on Sunday, May 16^th, 2021. I think you will find the session interesting and incredibly inspiring!

Our patient is a physician in a small town in the mid-west. I want to thank Dr. Scherer for her tremendous courage in sharing this very personal experience with all of us. Dr. Levitt practices at the Feeling Good Institute in Mountain View, California, where she also serves as Director of Clinical Training. She also teaches at our weekly TEAM-CBT training group as Stanford.

I am thrilled to share the audio of Jillian’s live session as a two-part podcast, since only mental health professionals are allowed to attend the workshops sponsored by the Feeling Good Institute. Many non-therapists were eager to attend, and disappointed when they learned that only shrinks could attend. But this gives all of you the chance to hear what you missed, and I think you will NOT be disappointed!

When Jill and I asked for volunteers for the live demonstrations in the workshop, Jillian was the first to respond with an offer to volunteer. This was her email, describing her situation..

Hi Dr. Burns,

I am writing to you offering to be a volunteer for the live demonstrations in the workshop on 5/16, if you need one.

I am learning TEAM CBT, and have been enjoying it personally as well as trying to do more of it professionally. I am a family medicine physician, but I have my own direct primary care clinic. This means that I can spend 1-2 hours with a patient if needed. I have been slowly offering this to patients who want to do the work to improve their mood or anxiety.

As for why I am writing, my anxiety and need to please people is huge and disruptive to my enjoyment of life. I keep striving and achieving things likely to get the attention of others. I fear not knowing the answer and making a mistake with my patients.

This had caused me to develop anxiety and insomnia at my last job. I sought counseling and physician coaching, but ultimately I wound up leaving that job, moving to another state [due to intense stress and demands of that job], and starting my own practice. My current practice is going well, but I am annoyed when patients come in or call with questions I don't know the answer to.

I constantly worry that I will not be able to figure something out by myself and that the patients will leave me. In addition, I continually strive for [yet another] training certificate.

As you know, I did medical school, residency, and fellowship, but I also have a lactation consultant certificate, training in lifestyle medicine, and now a Level 1 TEAM-CBT certificate with enough hours for Level 2, and most recently I started a 3-year program to become a pastor for our church. And I realize that I will not have the time to sustain all of these. It is as if I love the journey of getting the certificates, but I am not great at implementing them, so I move on to something else.

As for the rest of life, I have a great life, but I am melancholy most of the time. My husband is terrific, sensitive, understanding, loving, and yet, I am constantly reading marriage books because I think it could be better. My 2 children, aged 8 and 4, are smart and funny, but I live constantly thinking I am going to screw them up and so I read even more parenting books.

My family medicine practice is thriving and offers me part-time work at great pay with autonomy, yet I dread Monday mornings. Overall, my life should be an A+ and enjoyable, but somehow I make it seem like everything is going wrong all the time.

I have sought counseling and even TEAM-CBT earlier this year via teletherapy from FGI. I continue to do a Daily Mood Log about 3-4 times a week. I feel like we got so far, but not to complete recovery.

My FGI therapist was the eighth therapist I have been to, but the others were mainly talk therapists. I just thought I would reach out in the hope that maybe you need a volunteer, and maybe I would have the opportunity to work with you live. It would be nice if my anxiety and faulty core beliefs didn't steal my joy.

Sincerely,

Jillian

As you can see, Jillian is an incredibly dedicated physician, but feels like she is never doing enough for her patients. At the start of her session, she described her incredibly stressful previous job, when she was often on call for 72 hours at a time, often going long hours without sleep. She said, “I used to walk to work, hoping I’d get hit by a car.”

Although, as you saw in her email, she finally quit, and set up her own practice in another state, she continued to struggle with depression and the belief that she wasn’t doing enough. Her constant self-criticisms robbed her of happiness, in spite of the fact that she had a fabulous practice, superb medical and human skills, and a wonderful husband and children.

Her unhappiness confirms what Epictetus taught us nearly 2,000 years ago: we are upset, not by things, or events, but by our views of them. In this case, the facts of Jillian’s life are all stellar. In fact, she rates her life and practice as A+. And yet, she was still lacking in the most important dimension: happiness and self-esteem.

Because of her constant and intense feelings of insecurity, Jillian heroically pursued more and more specialty trainings and certifications, thinking that eventually she would develop feelings of competence, confidence, and happiness. She even enrolled in a three-year training program to become a minister, in addition to enrolling in the certification and training program for TEAM-CBT, and more.

But nothing was ever enough. That’s because, as the sages have taught through the ages, the answer is within. No amount of expertise or accomplishments will ever solve Jillian’s problem.

Jillian’s life was perhaps like trying to get the elusive brass ring on the Merry Go Round, except her ride was far from merry. She told us that she sometimes had fantasies of escaping to a remote tropical island.

Perhaps you, too, have sometimes felt like you’re not good enough, or that you or your accomplishments are just not good enough. Let us know what you think about the answer that Jillian found in front of a live audience that day, and whether it might apply to you as well.

In today’s podcast, you will hear the first portion of her session (T = Testing and E = Empathy), and next week you will hear the fantastic conclusion (A = Assessment of Resistance) and M = Methods.)

T = Testing

To get started, take a look at the Daily Mood Log that Jillian shared with us at the start of her session.

As you can see, Jillian’s negative feelings were all intense. You would not have known how powerful her suffering was if you had met her in her daily life. In person, she comes across as you might expect from her email: exceptionally warm, thoughtful, human, conscientious and likeable.

That’s one of the really important reasons for Testing. You can see exactly what you’re dealing with, in terms of the type and severity of negative feelings. In addition, we’ll ask Jillian to rate her feelings again at the end of the session. That way, we’ll know how effective—or ineffective—the session was. This information can sometimes be humbling, but it is always illuminating.

Neither Jill nor I could conceive of doing therapy without the Testing! At the end, we’ll also ask her to rate us on Empathy, Helpfulness and other dimensions using exceptionally sensitive scales that can highlight even the smallest therapeutic errors that the therapist would not otherwise be aware of.

E = Empathy

During the empathy phase of the session, Jill and I empathized while Jillian described her struggles with negative feelings and a lack of happiness and self-confidence.

During the empathy portion, I did the downward arrow technique to learn more about Jillian’s fears and Self-Defeating Beliefs. The goal was not to change Jillian, but simply to understand the root of her suffering at a deeper level.

We started with the thought, “I should know how to fix people who come to me with a problem like depression, anxiety, headaches, or headaches, or even the lack of money to pay for the medications I prescribe.”

Here’s how the Downward Arrow dialogue evolved:

David: And if you sometimes do not have the solution for your patients, what does that mean to you? Why is that upsetting to you?

Jillian: Then people will be disappointed and leave me.

David: And then what? What are you the most afraid of?

Jillian: My practice will deteriorate.

David: And then?

Jillian: My patients will think I’m a failure.

David: What would happen then? What are you the most afraid of?

Jillian: Then the whole town will think I’m a failure.

David: Of course, no one would want something like that to happen, but we might all experience it differently? What would that mean to you if the whole town thought you were a failure? Why would that be upsetting to you?

Jillian: That would mean I’m a loser.

David: And if that were true, what would that mean to you?

Jillian: That would mean that I don’t mean anything to anybody.

David: And then? What would happen if you didn’t mean anything to anybody?

Jillian: Then there’d be no point in life.

That was pretty much the bottom of the barrel. The purpose of the Downward Arrow Technique is to uncover the Self-Defeating Beliefs at the root of your suffering. Once you’ve generated your Downward Arrow list, all you have to do is review it, and then look at my list of 23 Common Self-Defeating Beliefs and circle all the ones that seem to fit.

As an exercise, you might want to take a look at the list and see how many you can find before you see the ones that Jillian found!

Here’s Jillian’s list:

1. Perfectionism
2. Perceived Perfectionism
3. Achievement Addiction
4. Approval Addiction
5. Fear of Rejection
6. Pleasing Others (Submissiveness)
7. Worthlessness
8. Spotlight Fallacy
9. Brushfire Fallacy
10. Superwoman

A Country Doctor, Part 2 of 2

A = Assessment of Resistance

At the end of the moving and tearful empathy phase, we asked Jillian about her goals for the session, which included the ability to

• enjoy my work
• to give away all of my certificates
• set limits with my patients
• feel happy with what I do
• not have to fear my work anymore!

After Jillian said she would be willing to press the Magic Button to achieve all these goals instantly if we had one, we suggested Positive Reframing first. to see what might be lost of she suddenly achieved all these goals. You can creview the Positive Reframing that we did together.

Here’s Jillian’s Emotions table at the end of Positive Reframing, showing her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering while still allowing you to preserve all the awesome things about you!

Jillian said that the Positive Reframing really opened her up, especially when we read the list of positives out loud. It kind of shocked her in a good way so see that her negative feelings were not really problems, defects, or symptoms of one or more “mental disorders,” but the expression of what was most beautiful and awesome about her as a human being, and as a physician.

This Positive Reframing is one of the unique aspects of TEAM-CBT. Although we are encouraging the patient to keep the symptoms, rather than pressing the Magic Button that makes them disappear, it paradoxically eliminates or drastically reduces the resistance to change, and opens the door to the possibility of ultra-rapid recovery.

M = Methods

We asked Jillian what Negative Thought she wanted to work on first, and she chose #9: “I’m not having a big enough impact.” She believed this thought 100%.

First, we asked Jillian to identify and explain the cognitive distortions in this thought, and she focused on these: Should Statement; Self-Blame, All-or-Nothing Thinking, Mental Filtering, and Discounting the Positive.

In retrospect, I think I spotted two additional distortions: Emotional Reading (I feel I’m not having a positive impact, so I must not be having a positive impact) and Mind-Reading (my patients expect me to have the answers to all their problems and judge me when I don’t have all the answers.)

Then we challenged the Negative Thought, and Jillian she was able, with a little help and a role reversal, to crush it, as you can see here.

Usually, crushing one Negative Thought is about all you really have to do, because once the patient blows one Negative Thought out of the water, there is usually a kind of “cognitive click,” and the brain suddenly changes, and all the positive circuits suddenly get fired up. It’s amazing to behold, and you will hear it for yourself!

The dam did suddenly break, and Jillian could clobber the rest of her Negative Thoughts fairly easily, using a combination of Self-Defense, Self-Acceptance, and a lot of the CAT technique. She suddenly appeared to be a radically and delightfully different person during the Externalization of Voices.

You can see her feelings on the Emotions table at the end of the session.

Jillian’s scores on my Happiness Test on the Brief Mood Survey also soared to 100% and her ratings of Jill and David on Empathy and Helpfulness tests were also perfect.

After the workshop, Jillian sent this email.

Hi Jill and David,

As I drove home tonight from my office, I actually felt like my heart had been opened. My chest didn't feel as tight and locked-up like it normally does. It felt so relaxed. I put my baseball cap on, rolled the windows down, and listened to 90's country music (my favorite) on my drive and sang loudly. I have spent the last hour checking my new superpowers. There have been negative thoughts, but telling them to "shut the heck up. I am not listening to you" has been quite liberating. I even was greeted by my 4 year old when I got out of the car. I knelt down and hugged her without the worry of being a rotten mom, but rather one of feeling like I am the perfect mom for her, flaws and all.

Thank you for this opportunity. I took a chance to email you in the first place after listening to a podcast weeks ago. I thought there would be no chance in heck that I would be selected. I am glad I had this remarkable opportunity and grateful to have worked with both of you.

Much love and admiration,

Jillian

I hope you enjoy it as much as we did. Again, a big hug and thanks to the star or our podcast, Dr. Jillian Scherer who gave us all an incredible gift today!

Thanks for listening. I hope you learned a ton and were moved emotionally. Write and let us know what you think!

Rhonda, Jill, Jillian, and David

Podcast 260

TEAM-CBT Games, featuring Amy, Heather, and Brandon

In today’s podcast, three of our most creative TEAM therapists describe a number of innovative games they’ve created to facilitate learning key TEAM-CBT techniques in group settings. Our guests are:

Amy Specter: Amy is a Level 3 certified TEAM therapist, licensed marriage and family therapist and credentialed school counselor. She works with at-risk youth in schools and has an online private practice specializing in shyness and breakup recovery. She can be reached at amy@amyspecter.com. For a free copy of Flirty Dice or to purchase Tune In, Tune Up head over to https://www.feelinggreattherapycenter.com/

Amy Spector

Brandon Vance, MD: Brandon is a Level 4 certified TEAM trainer and therapist for individuals, couples and groups.  His most recent TEAM related project is an international book club to support people in reading Feeling Great. He can be reached at: brandonvance@gmail.com

Brandon Vance, MD

Heather Clague, MD

Heather Clague, MD is a Level 4 certified TEAM therapist and psychiatrist who works in private practice and at Highland General Hospital in Oakland.  In addition to teaching and writing about TEAM CBT, she runs Berkeley Improv that holds in-person and online improv classes for all levels. You can reach Heather at: heatherclaguemd.com

Tune In / Tune Up, a card game which features spontaneous speaking situations using the Five Secrets of Effective Communication.  Heather, Brandon, and Amy guided us while we played and explained each of the following games during the podcast:

• Love Feast, where you make fake, over the top introductions of other people in the group
• Flirty Dice, where you have to flirt with some using a specified facial expression, a specified type of question, and a specific affect.
• Future Projection, where you talk back to a Negative Thought from the perspective of your wiser, happier self from the future.

The group also discussed how these types of games can help individuals with social anxiety develop greater courage, spontaneity, and interpersonal skills.

We also did a group Shame Attacking exercise and briefly described the use of this tool in the treatment of social anxiety.

You can also reach Heather, Brandon, and Amy at the Feeling Great Therapy Center, where you’ll find links to Tune In / Tune Up, Flirty Dice and more Improv Games.

Thanks!

Rhonda and David

Podcast 259

TEAM-CBT for Eating Disorders, featuring Donna Fish

In today’s podcast, Rhonda and David are delighted to welcome Donna Fish, LCSW, a New York mental health professional who’s doing pioneering work applying TEAM-CBT to eating disorders such as overeating / obesity, binging and vomiting (bulimia), and anorexia nervosa (starving oneself in combination with excessive exercising). These problems appear to be more prevalent in modern society, perhaps because of the emphasis on physical beauty as well as the availability of fattening foods and the financial resources to purchase them.

Donna is an LCSW and Level 4 TEAM-CBT therapist. She is a guest lecturer on eating disorders at Columbia University and Harvard University, and author of Take the Fight Out of Food. She has been a popular guest on many radio and television shows, writes for Psychology Today magazine, and more.

Donna began the interview on a personal note, reflecting on one of Dr. Burns’ workshops in 2014. She volunteered for a role-play with David illustrating the Externalization of Voices, a powerful cognitive therapy technique David developed during the mid-1970s. That experience pointed Donna in the direction of learning more TEAM-CBT.

Here’s how she described her experience at the workshop:

It blew my mind! I don’t easily follow any one particular ‘school of therapy, but I joined a TEAM-CBT training group that Dr. Taylor Chesney had just begun in NYC and then continued my online training until this day!

I am thrilled to combine my eating disorder training and experience with the TEAM approach, and have been training therapists at Elise Munoz’s Feeling Good Center in NYC, so that they can use TEAM with the common problem of Binge/Restricting.

Donna started her career as a professional dancer, and struggled with her own eating and body image issues. She saw these problems in her many peers and colleagues working as performers as well.

She said:

I was always on a diet, and saw foods as “good” or “bad.” I would restrict (fasting) during the week and then binge on all the “bad” foods on weekends. My life was a yo-yo of binging and restricting.

Later, I taught myself how to eat in a healthy way, and how to say, “Yes, I can have that food and I can have it right now if I want it (which I do). But do I really need it right now?”

This simple change in how I talked to myself freed me and cured me! When I became more accepting and less rigid in my “eating rules,” I paradoxically began to feel happier and more in control.

I saw so many actors and dancers who used up tremendous amounts of emotional energy struggling with body image issues and problems with eating. That’s why I did a 3-year training program in working with eating disorders.

When some of my patients who had recovered became pregnant, they worried about giving their own children an eating disorder. That’s why I wrote my book incorporating the methods that had been so helpful to them. This included a 4 Step Program to help them to give their kids a healthier relationship for life.

These are the four steps:

Step One: Talk To Your Kids About Nutrition

Step Two: Reboot the Connection Between the Belly and the Head

Step Three: Separate Hunger and Fullness from Other Feelings

Step Four: Teach Your Child Skills and Develop Confidence in Decision Making

I incorporated many of the ideas and techniques in TEAM-CBT, including Dr. Burns’ Decision-Making Tool, as well as his “Addiction and Habit Log.” (link to the free chapters on these tools available on the home page of my website).

Donna emphasized the role of restricting in the maintenance of eating disorders. She explained that restricting and fasting actually cause and perpetuate the problem because the cognitions become ‘Tempting Thoughts’ to binge such as:

“I will definitely re start my diet tomorrow, and I won’t eat that cake that I shouldn’t have had, so I may as well eat more now since I’ve already blown it.”

She explained:

If you commit to having a piece of that cake tomorrow as well, and in fact every single day, you are less vulnerable to the Tempting Thought of “I won’t have that ‘bad food’ tomorrow’ which tempts you to eat the cake, and then every other food that you ‘won’t eat tomorrow or again’, since you’ve already had a piece.

In fact, learning how to eat a piece of cake, or whatever food you deem ‘bad,’ is imperative to learning how to eat well and balanced in order to modulate your weight. The Tempting Thought that you will Restrict Tomorrow, seduces you to binge.

The Focus needs to be on Reducing the Tempting Thoughts to Restrict!  A Method like ‘Examine the Evidence’ can be used to see if Thoughts like:  “I won’t eat tomorrow or have that food again,” evolve into Tempting Thoughts that promote the ’binge’ in that moment of temptation, and it becomes a circular game of ‘Restrict/Binge’.

Donna described some of the dangerous medical consequences of restricting and severe weight loss that you see in young people with anorexia, including brain shrinkage. She said that parents are sometimes ambivalent about treating their children who have anorexia for a variety of reasons, including the fact that anorexic teenagers are typically perfectionistic high achievers. But when the parents learn about the medical consequences, it sometimes changes their thinking.

David adds that two parents will frequently be in conflict about the best way to deal with any problem in a child, and this conflict is nearly always the cause of the “stuckness.” When, and if, the parents decide to work together as a team, the problem nearly always improves significantly. This, in fact, is the whole idea behind the fairly successful “coercive treatment” for anorexia nervosa pioneered at the Maudsley in England.

This program involves both parents sitting on the two sides of the child, and forcing him or her to eat, and not giving in to the child’s attempt to manipulate and insist that she or he cannot, or will not, eat. Although the program sounds crude, and most parents initially resist, this type of forceful intervention is effective for roughly 50% of the children with anorexia nervosa, and can be life-saving. This is critical since a significant proportion of these children ultimately die from anorexia nervosa if they don’t have effective treatment.

Donna described additional medical consequences of various eating disorders, as well as the cycle of binging and vomiting, which leads to dehydration and actually causes the patient to feel bloated.

One of the key cognitions in patients with bulimia and anorexia is the fear of losing control and gaining a great deal of weight, so they engage in many ritualistic activities in an attempt to gain control. However, most of these efforts actually trigger a loss of control. One of the main goals of Donna’s treatment is to change this rigid mind set which is the actual cause of the eating disorder.

Donna emphasize the importance of the TEAM-Therapist’s mind set as well:

I don’t need any of my patients to change. . . The use of paradox in TEAM is powerful. I work with my patient to list the many GOOD reasons for overeating.

Donna described how she integrates the tools and strategies of TEAM into her brilliant work with patients with eating disorders, including David’s Triple Paradox technique.

David described the Triple Paradox, which is one of the latest tools he has developed for any habit or addiction, including the eating disorders. If you'd like two never-published chapters on these tools, you will find a free offer for them on the very bottom of my home page at feelinggood.com! These two chapters were originally intended for my book, Feeling Great, but removed due to length. They are intended for therapists and the general public alike.

Donna also uses the Brief Mood Survey, testing patient’s moods at the start and end of every therapy session, along with the Assessment of Resistance, the Miracle Cure question, Dangling the Carrot, and more.

She also emphasized the vitally important “fractal” concept, focusing on one specific moment when the patient wants help. The idea is that all the patient’s suffering will be encapsulated in one brief moment when the patient was struggling, and the solution in that brief moment will often be the solution to all of the patient’s suffering.

If you would like to contact Donna, you can email her at Donna@DonnaFish.com, or visit her website, www:DonnaFish.com.

Thanks for listening today! And thank you, Donna, for illuminating how we can use TEAM-CBT in our work with individuals who are struggling with eating and body image problems.

I was personally impressed with Donna, not only for her obvious and impressive mastery of the treatment of eating disorders, but also for her warmth, grace, and vulnerability, which will definitely inspire trust and positive expectations in her many patients!

Rhonda and David

Dr. Rhonda Barovsky practices in Walnut Creek, California. She sees clients mostly via Zoom, and in her office.  She can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com.

You can reach Dr. Burns at david@feelinggood.com.

Podcast 258: Doctor, I know you’re secretly sexually attracted to me! / How to Agree with Criticisms that are Just Plain Wrong!

Today’s podcast features the incredibly brilliant and kindly Dr. Matthew May, who has become a semi-regular on the Feeling Good Podcast. Our show was the result of an email from Ana Teresa Silva, who is running a new and totally free weekly practice group for the Five Secrets of Effective Communication. If you want to learn those invaluable techniques, contact her immediately before they fill up at ana silva ateresasilva6@gmail.com.

Her question had to do with the incredibly important Disarming Technique, which means finding the truth in a criticism, even when the criticism seems absolutely incorrect. I’ve posted her letter and my response at the end of these show notes.

Today we tackled two kinds of incredibly difficult attacks, with lots of role-playing and (hopefully) useful feedback and teaching. One was the one listed in Ana’s email, where you are accused of stealing money, but you didn’t actually steal any money. So how can you agree with that?

The other was perhaps even harder—what do you do when a patient accuses you of being sexually and secretly attracted to him / her?

Matt, Rhonda and David illustrate a variety of strategies for responding with the Disarming Technique as well as the rest of the Five Secrets. The role-playing is challenging and immensely interesting!

David emphasizes that if you want to learn the Five Secrets, three things are mandatory:

1. An intense desire to learn.
2. Humility.
3. Tons of practice.

David also emphasized the intense resistance nearly all humans have to all three components of EAR:

• E = Empathy
• A = Assertiveness
• R = Respect.

I have attached a document listening 12  GOOD Reasons NOT to Listen, Not to Share Your Feelings, and NOT to treat the other person with respect.

If you want to master the Five Secrets, my book, Feeling Good Together, will be an invaluable resource. If you read it, you MUST do the written exercises while reading to get any deep understanding of this approach. Simply reading will not “do it!”

I want to thank Dr. May once again for hanging out with us today. In our next podcast with Dr. May, he will describe his work with a young professional woman who loved fly fishing but had an intense fear of leeches. Make sure you tune in, it will be extremely interesting, and his patient will join us, too!

If you want to contact Dr. May, you can reach him at:

Here’s Ana’s email:

Hi, David.

Hope you are recovering well!!

I got stuck with the Disarming Technique.

Last week, in the Five Secret Practice Group meeting, something came up and I didn`t know how to answer. How do we “disarm” someone who blames us for a very specific behaviour that is not true? For example:

“Why did you steal my money from the drawer?”

I thought we could try to find some truth in the attack noticing some reasons why the person could be mad at us or doesn`t trust us, or maybe we could ask if we did something to offend or upset her, but, at some point, we have to say that we didn't steal the money, right? And we`ll be defending ourselves.

Can you help me with this?

Thank you! I appreciate it.

ana silva

Ana

Here’s my response:

Hi Ana,

We’ll do some practice on this on today’s show. You might say,

“I’m afraid I’ll have to plead guilty to your criticism. Although I didn’t and would never steal money from you, I clearly have done a terrible job of winning your trust and providing genuine warmth and support.

“It’s painful for me to hear how I’ve failed, and I feel ashamed, especially since I like you so much and value our friendship. I wouldn’t be surprised if you’re feeling angry, frustrated, and disappointed, and perhaps alone, too, and perhaps even anxious.

“Can you tell me more about what happened, and how you feel, and all the ways I’ve let you down and come across as untrustworthy?”

This is just a try, and the details will be different depending on who the person is and what the situation is.

Hope this helps!

Also, Podcast 161 might also be helpful. It’s all about “hearing the music behind the words” (https://feelinggood.com/2019/10/07/161-listening-to-a-different-kind-of-music/)

david

Rhonda, Matt, and David (without Dr. Rutherford Knows)

Rhonda and I are convinced that Dr. May is one of the greatest therapists on the planet earth. If you have a question or would like to contact Dr. May, please check out his website at: (www.matthewmaymd.com)

Dr. Rhonda Barovsky practices in Walnut Creek, California, but due to Covid-19 restrictions is working via Zoom, and can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com.

You can reach Dr. Burns at david@feelinggood.com.

Podcast 257: What's an Intensive?

Today’s podcast features Dr. Lorraine Wong and Richard Lam who describe the intensive TEAM-CBT treatment program at the Feeling Good Institute in Mountain View, California. Dr. Wong is a board certified clinical psychologist and the Clinical Director of The Feeling Good Institute in Mountain View.

Richard Lam is TEAM Certified Therapist, Trainer and Certification Program Manager at the Feeling Good Institute.

An intensive is a departure from the conventional weekly 50-minute session and compresses an entire course of therapy into a brief period of time. David describes how he created this treatment approach accidentally at his hospital in Philadelphia when one of the world’s most famous and beloved actors, a man who was a great fan of Dr. Burns first book, Feeling Good: The New Mood Therapy, contacted him and asked for treatment.

However, there was a catch. He only had two days available, and asked if he could fly from Hollywood to Philadelphia and book all of my sessions for two days. I was delighted to do that, and scheduled 17 back-to-back 45-minute sessions on a Thursday and Friday.

He came in a disguise, and explained that fans and the paparazzi were constantly hounding him, and that he felt like a hunted animal. I asked if the disguise was effective, and he said it wasn’t working at all. People still hounded him and asked why he was wearing the disguise and asked for autographs.

Because he was a powerful actor, the roleplaying techniques I have developed, like Externalization of Voices, were tremendously effective, and he actually made a complete recovery within a couple hours.

Later on, I developed an intensive program for the patients in our inner-city neighborhood, with the help of the president of our hospital, and it was also incredibly effective for our patients who had few resources. However, they loved cognitive therapy!

Richard and Lorraine explain how they are implementing the intensive concept at the FGI, working with people from around the United States and the world who come to Mountain View for several days for the treatment. They describe their work with a severely and chronically depressed man who came from Europe who seemed incredibly challenging at first. He was super skeptical and said that that he’d had tons of failed therapy but nothing and no one had ever helped him.

He was telling himself things like this:

• Life isn’t worth living.
• I’m a special case and no one will be able to help me.
• Life shouldn’t be so hard.
• I should be able to enjoy life more.

However, once they blew away his resistance using Paradoxical Agenda Setting, Richard explains that “it was a breeze to blow all of his negative thoughts out of the water.”

The treatment is costly in the short-term, but can be extremely cost-effective in reality because recovery often happens rapidly. It is my impression, too, that in the hands of a skillful therapist, extended sessions and intensive treatment with TEAM-CBT can often be amazingly effective.

If you would like to contact them, you can go to the FGI website (www.feelinggoodinstitute.com) or email them: Richard@feelinggoodinstitute.com or Lorraine@feelinggoodinstitute.com.

Thanks for listening, and thanks to Richard and Lorraine for being especially fun and gracious guests on today’s podcast!

Rhonda and David

Dr. Rhonda Barovsky practices in Walnut Creek, California. She sees clients via Zoom, and in her office.  She can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com.

You can reach Dr. Burns at david@feelinggood.com.

Intense Performance / Public Speaking Anxiety, Part 2 of 2

Last week we presented the first half of the session with Michelle Wharton at the Live Therapy workshop on May 16, 2021. Michelle had been struggling with years of intense public speaking anxiety, especially in professional settings. So far, we’ve commented on the T = Testing and E = Empathy portions of the session. Today, we present the exciting and inspiring conclusion of that session.

A = Assessment of Resistance

At the end of the moving and tearful empathy phase, we asked Michelle about her goals for the session, which included

• Not to have to feel this terror at full volume.
• Not to be stopped from volunteering for things that require public speaking and teaching, and to be able to feel some excitement in my career!

After Michelle said she would be willing to press the Magic Button to achieve all these goals instantly, with no effort, we suggested a round of Positive Reframing so we could see what might be lost of she suddenly achieved all these goals.

You can click here  to review the Positive Reframing that we did together, as well as Michelle’s Emotions table at the end of the Positive Reframing. You can see her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering, while still allowing you to preserve all the awesome things about you!

The Positive Reframing is one of the unique aspects of TEAM-CBT. Although we are encouraging the patient to keep the symptoms, the Positive Reframing typically eliminates or drastically reduces the patient’s resistance to change, and opens the door to the possibility of rapid recovery. This will be true even if the patient has been struggling with a problem unsuccessfully for years or even decades, as was the case with Michelle.

M = Methods

We asked Michelle what Negative Thought she wanted to work on first, and she chose #5: “People will think you are selfish and self-preoccupied.” She believed this thought 100%.

First, we asked Michelle to identify and explain the cognitive distortions in this thought. As you can see on her Daily Mood Log (LINK), she found all ten distortions.

Of course, the most prominent distortion in this thought is Mind-Reading. That’s because Michelle thinks she knows how other people will be thinking and feeling about her when they find out about her intense public speaking anxiety. This distortion is nearly always present in any form of social anxiety.

I know this from my clinical work and personal experience, since I have personally suffered from at least five forms of social anxiety, including extremely public speaking anxiety, when I was young. You feel absolutely certain that you’re flawed and that people will judge you!

Then we challenged the Negative Thought, and Michele she was able, with a little help and a couple of role reversal, to crush it. Take a look. (LINK)

Here were Michelle’s reflections on that portion of the session.

First we used the Double Standard and I think that’s when I said this to the imaginary friend with the exact same problem: “I think you’re being kind of brave.”

Then it evolved into Externalization of Voices. Both David and Jill played the negative Michelle and I had a little difficulty talking back to my Negative Self. I connected on a logical level, but didn’t yet have the ammunition or determination I need to blow my Negative Thoughts out of the water.

David spotted my ambivalence immediately, and suggested that maybe it wasn’t something we should work on. Before he made that comment, I didn’t even realize that I had mixed feelings about giving up my intensely self-critical thoughts.

At that point, I found myself making the decision to fight back and felt myself getting stronger. The next time David (as the Negative Michelle) asked if he could talk to me for a minute I told him he had only 30 seconds to make his point because it was time to back off. I had some hesitation about only using the Counter Attack to defeat the thought but David said he liked the feisty response.

Then David and Jill both told me of all the positive feedback that was coming through the chat, and I was given the opportunity to use the Survey Method with a couple of audience members. I think I asked two or three people if they thought I was using up valuable time, since that was one of my painful Negative Thoughts.

The both commented that they found the session incredibly helpful and that they could relate to these feelings of anxiety and shame, and that they weren’t judging me harshly at all!

Here you can see how Michelle challenged thought #9. As you can see, her belief in this thought fell from 100 to 50, and then to 0.

You can see Michelle’s Emotions table at the end of the session, after she had crushed all of her Negative Thoughts.

After the workshop, Michelle sent us this email.

HI David and Jill,

I was going to write to you and tell that I would probably be happy to go ahead with the podcast but that I wanted to do a DML on some concerns about judgements as well as concerns about crossing of professional boundaries (worrying that I’m ‘oversharing’ with clients). Then, I just so happened to have supervision scheduled with Robyn Blake-Mortimer (another Level 4 therapist in Adelaide - I think she was Robyn Fowler when working in New York) this morning and she suggested we do some TEAM personal work on it. It was incredibly helpful and I’ve decided that I’d be happy for you to share the podcast, if Jill and Maor give permission.

Robyn helped me to see that there was probably (intentional distortion!) a large impact on my life from the fact that my family survived Cycle Tracy (Christmas 1974) despite our house being 99% destroyed.

Our lives were hugely affected and I (now) see a strong connection between this and the bed wetting. Which is not to say it changes the ‘ok-ness’ of the issue, rather that it helped me to see the amount of cognitive distortions that were in my worries about broadcasting the podcast (that ‘my problems should all be fixed by now’). Another liberating moment for me, thanks again to TEAM.

Here’s what was left of our house after the Cyclone - just the bathroom where we were.

Thank you again.

M.

This was my response to Michelle:

Wow, Michelle, that’s fantastic, kudos, I really like the way you’ve caught the pass and you’re running for a touchdown, like a speedy wide receiver (if you follow football.) I really like all of your thinking and plans!

Also, something both of you might want to consider is if we might consider turning each session into two consecutive podcasts. People love and are helped the most by live work podcasts. This is not required, and is just a thought.

So proud of both of you!

Warmly, david

Michelle’s scores on all the scales on the Brief Mood Survey at the end of the session were zero, and her scores on the Happiness Test soared to 100%. Her ratings of Jill and David on the Empathy and Helpfulness tests were perfect as you can see at this link.

Here’s what she wrote on the question on “what did you like the least about your session?”

"Absolutely nothing!! This was such a gift and I feel so fortunate and incredibly grateful."

Here’s what she wrote on the question on “what did you like the best about your session?”

"Addressing the ambivalence, the Positive Reframing, the warmth from you both, and how it helped me to soften into and accept these feelings."

On the audio, you will also hear the amazing follow-up interview we had with Michelle many weeks after this session.

Thanks for listening. I hope you learned a ton and were moved emotionally and inspired. Write and let us know what you think!

And thanks, too, to Michelle for giving all of us a gift that’s worth far more than gold!

Rhonda, Jill, Michelle, and David

Intense Performance / Public Speaking Anxiety, Part 1 of 2

This Is podcast features the first of the two live therapy demonstrations that Dr. Jill Levitt and I did at our psychotherapy workshop on Sunday, May 16^th, 2021. I hope you enjoy this dramatic and inspiring session!

Jill and I believe that doing your own personal work is vitally important to the growth and credibility of a mental health professional for many reasons. First, when you’re in the patient role, you can see things from a radically different perspective, including a far greater, first-hand appreciation of the errors that shrinks make as well as what is especially helpful.

Second, if you are successful in your own work, you can tell your patients, “I know what you’re going through, and how intensely painful it is, because I’ve been there myself, and I can show you how the way out of the woods as well!” This is a message that most patients welcome.

And finally, the personal work you do with TEAM-CBT is a fantastic way of comprehending how this new approach really works.

Our “patient” today is Michelle Wharton, a forensic and clinical psychologist from Australia. I want to thank Michelle for her tremendous courage in sharing a very personal experience with all of us. I also want to thank Dr. Levitt, who practices at the Feeling Good Institute in Mountain View, California, where she serves as Director of Clinical Training. Jill is also a co-leader at my TEAM-CBT training group at Stanford.

I am especially thrilled to share Michelle’s live session with you, since only mental health professionals are allowed to attend the workshops sponsored by the Feeling Good Institute. Many non-therapists were eager to attend, and disappointed when they learned that only shrinks could attend. By way of compensation, this podcast will give all of you the chance to hear what you missed, and I think you will NOT be disappointed!

When Jill and I asked for volunteers for the live demonstrations in the workshop, Michelle sent us this email, describing her situation.

Hi Jil and David,

I’ve just seen your email on the listserv asking for volunteers for the live therapy training on 16 May and thought I’d put up my hand. I’m an Australian clinical and forensic psychologist with Level 2 TEAM-CBT certification based in Adelaide, South Australia.

I had been thinking about volunteering to do some work on social anxiety and feelings of inadequacy. I know this has impacted me at different points in my life like

• • holding back my career
  • contributing to perfectionism, and
  • causing high anxiety in social settings.

My anxiety is probably more work-related but does impact personal relationships where I just assume I’m not particularly important. After reading your post, it just kept playing thru my mind that I wouldn’t be a very good volunteer. This thought was keeping me awake, which paradoxically also made me think I might actually be a good volunteer.

Also, from the fractal perspective, the anxiety triggered by just thinking about volunteering is probably reflective of all of my inadequacy concerns. So, I’ve attached a Daily Mood Log (DML)/ If you think it might be useful let me know.

Since I’m in Australia, the workshop will be from 1am-8am in my part of the world.

We scheduled Michelle at the start of the workshop, due to the tremendous time difference, but it still required enormous commitment on her part to work with us in the middle of the night! That kind of motivation is extremely helpful and often predicts rapid changes, but it’s no guarantee and we’ll have to see what happens in the session.

This will be a two-part podcast. In today’s podcast, you will hear the first portion of Michelle’s session (T = Testing and E = Empathy). Next week you will hear the fantastic conclusion (A = Assessment of Resistance) and M = Methods.)

I hope you enjoy the session as much as we did. Again, a big hug and thanks to Michelle, the superstar of the podcast!

T = Testing

To get started, take a look at the Daily Mood Log (LINK) that Michelle shared with us at the start of her session.

As you can see, most of Michelle’s negative feelings were intense, especially the anxiety and embarrassment, which she rated at 100%. You would not have known how overwhelming her suffering was if you had met her in daily life because she comes across as warm, bright, personable, and likeable. But inside, a part of her is dying, and that’s the part she’s been hiding and fighting desperately to change. Her actions today—opening up and become completely vulnerable in front of a large live audience of mental health professionals—required incredible courage and was a fantastic gift to all of us.

That’s one of the really important reasons for Testing. You can see exactly what you’re dealing with, in terms of the type and severity of negative feelings. Of course, we’ll ask Michelle to rate her feelings again at the end of the session. That way, we’ll know how effective—or ineffective—the session was. This information can sometimes be humbling to therapists, especially when you see that things didn’t improve during your session, but it is always illuminating.

Neither Jill nor I could conceive of doing therapy without the Testing! At the end of today’s session, we’ll also ask Michelle to rate us on Empathy, Helpfulness and other dimensions, using brief but sensitive scales that will highlight even the smallest therapeutic errors that most therapists would not otherwise be aware of.

Using these scales also requires therapist courage, because the information is often disturbing and unexpected, but it is always illuminating and potentially super helpful. That’s because you can discuss any low ratings you received at the start of the next session. If you do this skillfully and non-defensively, with warmth, respect and curiosity, the dialogue can greatly deepen the therapeutic relationship.

So, in an odd way, we often “hope” for failing grades on the Empathy and Helpfulness Scales!

But processing poor scores often involves the “great death” of the therapist’s ego. This information can be shocking, especially if you thought, as most therapists do, that your empathy skills were good or even excellent.

In fact, you will witness such a failure in today’s session! Yikes!

But you can also ask yourself the question—did Jill and David have to be afraid of their “failure?” Or was it actually a gift in disguise?

And if you’re a therapist, and you start using “What’s My Grade,” will you have to be afraid of grades lower than an A, which is the lowest passing grade?

E = Empathy

During the empathy phase of the session, Jill and I empathized while Michelle described her struggles with intense and incapacitating public speaking anxiety, which is particularly intense in professional situations. Michelle was visibly shaking and tearful as she said she was grateful and horrified to have overwhelming anxiety that has had a horrible impact on her career and has held her back. She’s avoided promotions to more senior positions that might require a good bit of public speaking.

She said,

“I can feel myself sweating, with a dry mouth, and wondering, ‘what are they thinking?’ They’re probably wondering how I got my qualifications, and thinking I’m stupid!

”I feel distant, and the audience feels distant, and I find myself thinking that the people in the audience are critical and judgmental. I have the image of feeling isolate, alone, and crying while people are watching.

“My fears have even stopped me from doing clinical supervision, which is something I would totally love doing.

“There’s a lot I’m holding back. . . but I’m not sure what.”

During the Empathy phase, Michelle poured her heart out, and both Jill and I did really careful empathy, summarizing her words, acknowledge her feelings, and using “I Feel” Statements to convey warmth and support. I’m not always the best at empathy, but Jill is a true master, and that is one of many reasons I love teaching and doing co-therapy with her.

At the end of the Empathy phase, when we were reasonably certain we’ve done a good job, we asked Michelle to rate us on Empathy. This technique is called “What’s My Grade,” and it is frightening but can be extraordinarily helpful.

And we spell it out, by asking, “Would you give as an A, a B, A C, a D?” This is a thousand times better than asking, “How are we doing,” because the patient will just say “fine.” But if you ask for a grade, you’ll get the truth.

And sure enough, Michelle gave us a B! That means we’d vastly missed the mark.

Was this a good or bad result?

From a Buddhist perspective, it’s a great result, because “failure” does not actually “exist.” Michelle actually just gave us some information that was fantastically important.

So, we simply asked, “Can you tell us about the part we missed?” And then patients will tell you something really important.

Here's what she said:

“The sensation in my body right now is huge. . . I can feel it in my stomach . . . And I’m asking myself what the hell am I doing?

“I’m holding my hands tightly. . . I feel pressure on my throat . . . a knot in my stomach, shaky hands, and tears are streaming down my face. . . . The volume is turned way up right now.

“You’re over there on one side, and I’m on the other side. . . . I feel alone. . . I feel distance. . . . This is just like standing at a podium, with a gaping divide between me and the audience. . . . I’m in a spotlight. . . . but I want to feel emotionally held.

“A part of me pushes support away, because I don’t want any cheerleading. . . and I want to be able to do this for myself, and I think that I should be able to do this for myself.

“I want to share something that I’ve been hiding. I’ve been holding back. Do I dare to do this?”

Then Michelle tearfully described a problem she’d had with bedwetting up until she was thirteen years of age. Her parents took her to a GP and a hypnotherapist, and thought she’d grow out of it. The message she heard was, “You should get over this.”

She described waking up every morning with shame, washing the sheets each morning and taking them outside to dry.

And, she said,

“That’s where this all started! The language I used at this time in my life was so hurtful, telling myself I couldn’t even get this right. I know that the internal bully really came to life in this moment but I had never seen it until this moment.”

David made a joke at this point and asked if the bedwetting ever stopped – it took a second for that to sink in then we all laughed and discussed the value of humor within therapy.

David advises that humor, like any powerful healing tool, must be used with thoughtfulness, and never to hurt a patient or put him or her down. In addition, humor is usually not a good idea with a patient who is feeling angry, as it may seem like the therapist is belittling the patient.

After a bit more empathy and Jill offered an “I Feel” statement about her own nervousness prior to the start of the group and I then Jill then asked for our grade on empathy. Michelle says, “I gave you both an A and at that point and you asked if I felt ready to get to work and I said yes!”

Next week, you will hear the exciting and dramatic conclusion to this session, include A = Assessment of Resistance, M = Methods, and T = Testing at the end of the session to assess changes in negative feelings, if any, as well as how Michelle graded us on Empath and Helpfulness during the session.

We will also give you a live multi-week follow-up, to see if the effects stuck, or were just a flash in the pan, and what the most important keys to relapse prevention might have been!

Rhonda, Jill, Michelle, and David

End of Part 1

#254, Ask Matt, Rhonda, and David
(with the famed Dr. Rutherford Knows)

Today we are again joined by the fantastic Dr. Matthew May for an Ask David. Rhonda and I are thrilled that Matt will be joining us every month. His input will give you a broader range of insights and answers to your many excellent questions!

Here are the questions we will address on today’s podcast.

Karine asks: How can I help my daughter with anorexia?

Shirley asks: How can you deal with people who are emotionally abusive, using the Five Secrets of Effective Communication?

Guy asks: Are there any Five Secrets practice groups I could join?

* * *

Karine asks: How do I help my daughter with anorexia?

Hello Dr. Burns,

I am trying to help my daughter who is starting to have anorexia with your book as the consultations are not working and we are waiting on a list for a specialist which can take months or even year here in Quebec.

I have read both of your last books and i am getting good to use it for social anxiety. However. i can’t see exactly how to apply it for eating disorder.

I asked her to list the benefits she gained from not eating and i am trying to help her see the cognitive disorder in it but it is much harder (ex: i loose weight quickly...which will do ... ) i may help her see the cognitive disorder in the « which will do ... » but not in the « i will lose weight » statement ).

Could you help me see the pattern i should follow please as i really think your technique can help her faster and better than the traditional psychologist conversation.

Regards

Karine

* * *

Shirley asks: How can you deal with people who are emotionally abusive, using the Five Secrets of Effective Communication.

Hello David and others,

I have been convinced how important using the Five Secrets of Effective Communication are. I do have a question about living with a person who is emotionally abusive. He uses his criticisms of others to manipulate and control them. How do you accept the criticism of such a person who is taking advantage of you accepting the criticism. My soul wants to rebel against these criticisms and against the person who is trying to manipulate me.

How do you navigate such a relationship when the abuser will never acknowledge that they are abusing others. He lives in a fantasy world of excuse making and blaming others. Also, how do I acknowledge my weakness and allow the “death” of my ego to happen?

Thanks for your consideration and help.

Shirley

We reviewed this problem and describe how we treat relationship conflicts using TEAM-CBT. This involves giving up blame and examining your own role in the problem. You will discover--and this might be disturbing, or enlightening, or both--that you are contributing in a BIG way to the very problem you're complaining about.

You can review Shirley’s partially completed Relationship Journal if you link here.

* * *

Guy asks: Are there any Five Secrets practice groups I could join?

David,

Please consider asking one of your skilled therapists to create a Five Secrets of Effective Communication "Practice Group." Possibly the group could be run weekly (virtually) and it would be an opportunity to repeatedly practice each of the secrets.

I practice on my own, but I know that learning is often strongest when working with others.

Guy Marshall

David’s Response

Hi Guy,

Ana Teresa Silva has a five secrets zoom practice group. Check with her! They are just getting started.

ateresasilva6@gmail.com

We have an exciting podcast scheduled the next time Matt visits. We will address the many controversies around exposure therapy, and will be joined by a patient Matt recently treated with the fear of leaches! We will also address some of the hundreds of questions submitted by the more than 6,000 fans who registered for my free 90-minute presentation on rapid Recovery from Anxiety which was sponsored by PESI.

All the best,

Rhonda, Matt, and David (plus Rutherford)

If you would like to contact Dr. May, you can reach him at: www.MatthewMayMD.com. Matt added that people interested in treatment can schedule a free 15-minute phone call there, my schedule permitting.

Dr. Rhonda Barovsky practices in Walnut Creek, California, but due to Covid-19 restrictions is working mostly via Zoom, and can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com.

#253: Sadness as Celebration, Part 2

In today’s podcast, Rhonda and David present Part 2 of their work with a young woman named Rose who has been struggling with profound feelings of grief since learning of a discouraging update on her father’s struggles with multiple forms of cancer.

A = Assessment of Resistance

At the end of the moving and tearful empathy phase, Rhonda asked Rose if she felt ready to do some work, or needed more time to talk and share her thoughts and feelings.

She said she was ready to do some work, and described her goals for the session:

I know I cannot change the facts, and I would not want to eliminate the grieving, but I would like to dial down the intensity of some of my emotions, particularly when I’m triggered.

Next, we did some Positive Reframing to highlight what was positive about Rose’s feelings. You can click here review the list of positives that we generated.

Rose’s Positive Reframing Table*

Now you can review Rose’s Emotions table at the end of Positive Reframing, showing her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering, while still allowing you to preserve all the awesome things about you!

As you can see, she wanted to dial all of her feelings down to low levels, with the exception of her sadness, which was an expression of her love for her dad.

M = Methods

We used Explain the Distortions, the Double Standard Technique, and the Externalization of Voices, including the CAT (Counter-Attack Technique).

Here’s how Rose challenged Negative Thought #1.

David discussed healthy vs unhealthy grief, and shared some stories of love and loss. He also talked about the concept of sadness as celebration. In this case, a celebration of Rose’s love for her Dad. The impending loss, of course, is tragic, but the wonderful father daughter relationship is beautiful and perhaps somewhat scarce, as so many people have not had such a beautiful relationship with their parents.

At the end, Rose said the session was “incredible and special” You can take a look at her end of session scores on the Daily Mood Log (link).

After the session, Rose sent the following email:

Hello David and Rhonda,

Thank you so much for that amazing session today. I am feeling so much more contentment and gratitude after talking with you both. I even feel lighter and more hopeful.

The key insight for me was realizing how special and precious this relationship is that I have, and rather than focusing on what I won't have. It sounds like a cliché, but it is true for me and seems to have freed up a weight.

I will definitely do my homework, and will can send you the completed DML after listening to the session as that may help. And as for sharing with my dad, I'm going to be calling him to tell him what a wonderful session I had and that when it is published he can listen to it so as to have and share this beautiful experience.

Thank you so much once again!

Rose Markotic

Thank you for listening today!

Rhonda, Rose, and David

#252: Sadness as Celebration, Part 1

In today’s podcast, Rhonda and David present Part 1 of their work with a young woman named Rose. Rose is a 38-year-old mother of two boys aged 2 and 5. She works as a Therapist at an outpatient clinic, the East Bay Center for Anxiety Relief, and is a member of our Tuesday training group at Stanford.

Rose sought help because of her profound grief after talking to her mother about her father’s recent visit to his oncologist. Her father has had many severe health problems in the past several years. He’s been a survivor, but suddenly the outlook seems bleak, and Rose feels tremendous sadness and fear, because of her deep love for her father.

In most cases, grief does not need treatment. Clearly, grieving is healthy and even necessary when you lose someone you love. However, it can be helpful to distinguish healthy from unhealthy grief.

From a cognitive therapy perspective, all feelings, including grief over the loss or impending loss of someone you love, result from your thoughts. Healthy grief results from negative thoughts that are not distorted. For example, if a loved one dies, you may think of all the things you loved about that person and the experiences you will no longer be able to share. Your sadness is actually an expression of your love.

Healthy grief, in contrast, results from distorted thoughts. For example, in my book, Feeling Good, I described a young physician who became suicidal when her brother committed suicide because she told herself; “I should have known he was suicidal that day. His death was my fault, and so I, too, deserve to die.”

This thought triggered intense guilt, and it contains many of the familiar cognitive distortions, including Self-Blame, Emotional Reasoning, Should Statements, and Discounting the Positive, and Fortune-Telling, to name just a few. With my help, she was able to challenge and crush her distorted thoughts, and her depression disappeared.

Then she was then able to grieve his tragic death. Paradoxically, the distorted thoughts that triggered the unhealthy grief had actually prevented her from grieving in a healthy way. Today’s podcast is illuminating because Rose is experiencing a combination of healthy and unhealthy grief resulting from a mix of undistorted and distorted thoughts.

The work that Rose did is incredibly inspiring, and sad. Today we will publish the first half of the session, including T = Testing and E = Empathy.

Next week, we will publish the second half of the session, starting with the question, “What do we have to offer our patients once we’ve empathized?” Then you will hear the A = Assessment of Resistance and M = Methods portion of our work with Rose.

T = Testing

Take a look at the Daily Mood Log (LINK) that Rose shared with us at the start of her session. You will see that she had very elevated scores in 8 different categories of negative feelings, suggesting she was in pretty intense distress. We will ask her to rate these feelings again at the end of the session so we can see if she experienced any changes during the session.

I’m a firm believer that all therapists should use testing at every session, and many are now doing this, but lots of therapists still refuse for a variety of reasons. I was going to say “bogus reasons,” but didn’t want to sound harsh or dogmatic!

To me, the refusal of psychotherapists or psychiatrists to measure symptoms at every session is the “unforgiveable sin!” I don’t believe it is possible to do good therapy, much less world class therapy, without Testing, for a wide variety of reasons:

1. Therapists perceptions of how patients feel, and patients feel about them, are not accurate.
2. Measuring suicidal urges at the start and end of every session can save lives.
3. Seeing how effective. or ineffective, you were at every session allows you to fine tune the therapy and abandon strategies and methods that aren’t working in favor of better techniques. This turns your patients into the greatest teachers you’ve ever had—IF you can take the heat!
4. You will see, for the first time, how your patients rate your Empathy and Helpfulness at every session. At first, this information can be incredibly shocking, but if you process it with your patient at the next session in the spirit of humility, warmth, and curiosity, the experience can be transformative.

E = Empathy

Rose explained that she was feeling acute grief because of her father’s health problems. He had extensive surgery to remove a cancerous kidney in 2014, but the surgeons found additional unusual growths around his spleen.

Her dad has also had open heart surgery, surgery to remove a bone tumor, and many other serious medical problems. She said, “he’s like a cat with nine lives, but we’re concerned that now he’s near the end.”

He experienced GI distress and vomiting in September of 2020, and was hospitalized again in February of 2021, but they found nothing. In March, he was again hospitalized, and the doctor found an aggressive cancerous liposarcoma in his abdomen.

Then they found more tumors in his back, and determined that it was Stage 3. The usual treatment would include radiation and more surgery, but he simply cannot stand any more surgeries, so we began to lose hope.

Rhonda commented that he’s suffered greatly, and the family has suffered as well, since 2014.

Rose and her family finally got to visit him in San Diego on Memorial Day, and this was helpful. She said he’s still really active with the activities he loves, including golf and gardening, and treasures every moment, and loves spending time with his two grandsons.

Rose painfully described the impact of the pandemic, which meant they were only able to visit him twice in the past year. That made it especially nice to connect and see his grandsons during their Memorial Day visit. She said he was especially “present” and cherished those moments.

She said:

He was doing pretty well, and was telling his friends that he’s happy with what he’s accomplished in his life. He grew up in Bosnia, and was poor, with many challenges, so family is really important to him. Catholicism was the center of his culture. The whole family feels more connected now. The grief has brought us closer together.

He’s started chemotherapy, but I’m pessimistic. The doctor said it was only 20% effective, and it’s expensive: $3,000 a month. I do not really know what the timeline is, but it was helpful to visit in person and to see that he can feel joy.

My negative feelings typically run in the range of 50 to 60, but they can be suddenly triggered and spike much higher; for example, when I tell myself that he won’t get to see his grandchildren and share so many important moments with them when they’re growing up.

He tries to comfort us when we ask how he’s doing, and he says, “I’m okay; I’m just a little tired.”

My anxiety fluctuates because so much is not known. I’m not sure how this will affect him. What will the impact be? I’m afraid he’ll get depressed because he may not be able to do the activities he loves, like golf.

I also struggle with feelings of guilt. Should we have visited more? Should we move from the Bay Area to San Diego?

We’ve been having some zoom calls, but they’re hard. The boys compete for his attention on the calls.

Rhonda asked: “You seem to have so much love for him. What has it been like to have him for a dad?”

Rose answered:

I have two brothers, and I’m the only daughter, so there’s always been a special connection between my dad and me, and his values of hard work and family. Soccer has been really important, and he was so proud when Croatia won the world cup.

Connection has always been so important. I wanted to go to South America when I was in my 20’s, because I wanted to learn more Spanish and seek adventure. Everyone said it could be dangerous, so don’t go alone. So my dad went with me, and we had our own wonderful adventures. When I think about that, it makes the feelings of loss all the more painful, because we’re losing that connection.

Rhonda and I asked for a grade on empathy. She said: “The session feels warm and I feel connected with both of you. A+”

End of Part 1

Next week, you can hear the inspiring and moving conclusion of today's session.

#251, Ask Matt, Rhonda, and David
(with the famed Dr. Rutherford Knows)

Today we are again joined by the fantastic Dr. Matthew May for an Ask David. Rhonda and I are thrilled that Matt will be joining us every month. His input will give you a broader range of insights and answers to your many excellent questions!

Today’s questions were submitted by the more than 6,000 people who registered for my free talk on July 8, 2021 on the Rapid Treatment of Anxiety Disorders which was sponsored by PESI. I was very grateful to PESI for organizing this event, since it was open to shrinks as well as the general public, and that is the same audience that Rhonda and I are trying to reach with our Feeling Good Podcast.

By the way, thank you for your ongoing support of the Feeling Good podcasts. Our four millionth download should happen in August! Please keep telling friends about the podcast if you think they might be interested.

The very shy but erudite Dr. Knows may again join us and make an occasional comment. Let us know if you like his input and want to hear more from him in future podcasts. If you don’t like him, we can quietly sweep him to the sidelines.

Here are the questions we’ll answer today:

• Hello Dr Burns, excited to be here at your talk today. Could you tell us more about dependency on anti-anxiety medications (benzodiazepines like Valium, Librium Ativan, Xanax, and so forth) and how to inform the client about the dangers of addiction?
• If this treatment you describe for anxiety disorders is 'rapid' does it linger?
• Is this rapid response you describe in your treatment of anxiety disorders merely first-aid? Am I right in assuming that the sustained work of psychodynamic therapy, body work, and so forth will still be required?
• Can you discuss any published or ongoing empirical research on the efficacy of TEAM-CBT compared to other therapy techniques?
• How does Rational Emotive Behavior Therapy (REBT), developed in New York by the late Dr. Albert Ellis in the 1950s, fit into the picture?
• How does the cognitive distortion, Fortune Telling, apply to specific phobias?

Rhonda, Matt, Rutherford, and I thank you for joining us today, and hope you enjoyed the dialogue!

Rhonda, Matt, and David (plus Rutherford)

#250: How to Tell Someone, “You Suck!”

Featuring special guests, Dr. Matthew May and the always exciting but pedantic Dr. Rutherford Knows, plus our podcast regulars, Rhonda and David

Rhonda begins the podcast with a wonderful email from a woman who asked how you might use the Five Secrets of Effective Communication when you have to deliver give negative feedback to someone.

Hi David and Rhonda,

I’m an avid listener of the podcast and reader of Dr. Burns’ material. I’ve been working my way backwards listening to all the podcasts, and I now own all of Dr. Burns’ books and am working my way through those, too!

I’ve especially found the live therapy on the podcast and role-play using the Five Secrets incredibly useful.

The Five Secrets of Effective Communication are like a cheat code for life. As I’ve been applying it in my own life, every conflict has had a phenomenal outcome and I end up closer with the other person. It’s incredible.

You’ve given many useful examples of using the Five Secrets on the podcast to respond to someone, for example, who is attacking you and you use the disarming technique and inquiry to hear more about how it’s been for them.

My question is, how would you use the Five Secrets to initiate a conversation where you have to be the one to bring up something that the other person doesn’t want to hear, or that it may be painful for them to hear?

I started to think about this when consulting for a CEO who needed to fire someone, but needed to keep the relationship amicable, as well as consulting with another business owner whose employee had been deceitful and she needed to have a "come-to-Jesus" talk with him.

Similarly, I’ve always struggled to bring up something that's bothering me to a spouse or loved one, because I didn't know how to initiate the conversation, and keep it from devolving into an argument (my greatest fear!).

Could you perhaps do a role play on the podcast to demonstrate using the Five Secrets of Effective Communication to initiate a difficult conversation, such as:

• • Firing or correcting an employee?
  • Telling a spouse (or loved one) when you’ve felt hurt or angry because of something they did?

Obviously you would still use all the same techniques (Stroking, I Feel statements, Inquiry, etc.), but I would love to hear an example. I find the role plays especially useful and would love to hear your expert wording for how you would approach this.

Thank you to both of you for all your tremendous work!

Rosemary

We loved this request, and model how to deliver the bad news to someone using the Five Secrets.

David mentioned that when he was in clinical practice, several women he treated were reluctant to give clear negative signals to men who were chasing them, for fear of hurting their feelings. So, out of excessive “niceness,” they ended up leading the man on, sometimes for months, and hurting him even more. It is probably far more merciful and caring to be honest with someone in a kindly way, so he or she can let go and move forward with his or her life.

Rhonda, Matt, and David illustrate David’s “Intimacy Drill.” In this exercise, the person delivering the bad news is Person A, and the person receiving the bad news is Person B. The drill involves four steps.

1. First, Person A delivers the bad news to Person B, trying to use the Five Secrets of Effective Communication (link). The bad news might be telling Person B that she or he has been fired, or that you’re angry with Person B, for example.
2. Then Person A gives himself or herself a letter grade on how well she or he did. Was it an A,  B,  C,  D, or an F? Then Person B and the observers give a letter grades to Person A as well..
3. Next, everyone points out what Person A did that was effective, and what was ineffective, using Five Secrets terms. For example, you might say that the Feeling Empathy and Stroking were great, but there was no “I Feel” Statement or Inquiry at the end.
4. Then you can do a role-reversal, and try to model an improved response.

This is, by far, the best way to learn the Five Secrets of Effective Communication. However, it requires non-defensiveness on the part of all who participate, and the philosophy of “joyous failure.” This means that you view your errors as opportunities for learning and growth instead of shame and defensiveness!

If you want to master the Five Secrets for use in ANY situation, the “Intimacy Exercise” is a fantastic way to practice. However, remember to check your ego at the door, because you’ll probably gets some low grades and make plenty of errors, especially if you’re a beginner. But if you work at it, and keep practicing—which very few people do—you can develop some fantastic communication skills that can help you in personal and professional relationships.

Today, we also introduced, in a small way, the very shy and erudite, and somewhat pompous, Dr. Rutherford Knows, who makes an occasional comment. He may agree to participate in future podcasts as well.

Dr. Knows could be a really great podcast enhancement, since he (hopefully) makes the rest of us look really good! Let us know what you think!

Rhonda and I are really pleased to work with Dr. May again. He is a dear friend and colleague, and, according to David and Rhonda, Matt is one of the finest therapists and teachers on planet earth!

I strongly agree with this assessment of Dr. May. If you wish to contact him, you can reach him at: www.MatthewMayMD.com. Matt added that people interested in treatment can schedule a free 15-minute phone call there, my schedule permitting.

Thanks!

Rhonda and David

Rhonda, Matt, and David (with Dr. Rutherford Knows)

Podcast 249

Update on the Amazing Feeling Great Book Clubs!

July 5, 2021

Today we report on the first two Feeling Great Book Clubs, with Dr. Brandon Vance and Sunny Choi, LCSW. Brandon explained that more than 200 people signed up for the groups, and that he 100 people on the waiting list for a future book club. The first two clubs have been a tremendous success.

Brandon explained why he started the Book Clubs:

It’s because these are tools in the book that people who are struggling with depression and anxiety can use to get better. Roughly 10% of the people in the world have significant mental health problems causing functional problems in their lives. That’s eight hundred million people! I have asked myself how we can spread these tools to people around the world.

Since I finished my psychiatric residency in 2003, I’ve been mostly working with individuals, but seeing factors influencing their mental health, like oppression, inequality, injustice, lack of safety, prejudice and othering, and environmental destruction with ensuing lack of resources. This has inspired my activism towards changing these things. I feel like we need to take action on those levels as a society.

At the same time, we have powerful and empowering skills people can learn on an individual level, and these skills can be taught in group settings to relieve suffering. I think we actually need an “owner’s manual” for the mind, and could teach mental health to children, right along with the basics of reading, writing, and arithmetic, as well as adults.

Some people have more access to these tools in psychotherapy, but many people in the world may not.  I would love to make these tools like those in Feeling Great more accessible to people worldwide.  The book, Feeling Great, does that, and I created the Feeling Great Book Clubs, as a way to reinforce those concepts, so people can come together in groups during this period of isolation, and learn these techniques, get support, and have their questions answered.

Rhonda asked several questions, including

• Where do the book club members come from?
• Who helps them?
• What happens during the hour.

The participants come from all over the world, including North and South America, Europe, Asia, Oceania, Africa, and the Middle East. Most are lay people, but 15% are therapists. A number of certified TEAM-CBT therapists help out voluntarily, including:

• Phillip Lolonis
• Katie Dashtban
• Sunny Choi
• Heather Clague

Brandon described the breakout groups:

The typical group starts with music, followed by meditation, and a general check-in on how people are feeling. This is followed by answers to questions members have submitted concerning the assigned reading for the week, and reviews of the chapters.

Then everyone joins their breakout groups, which are the same each week. This facilitates the development of trust and bonding among the members in each group.

There are specific instructions for the breakout groups that relate to the material in the chapters that were assigned for the week. They may discuss questions related to the chapters, or work on a skill presented in Feeling Great. For example, they may work on identifying the cognitive distortions in their thoughts. Then they may use the “Straightforward Technique” or other techniques to challenge their thoughts with “Positive Thoughts.”

Last week while reading the chapters on Fortune Telling and Anxiety, we had a check-in circle, where one member describes a mildly embarrassing experience and shares some feelings she or he had. Then the other members practice responding with a couple of the Five Secrets of Communication. For example, they may use “Thought Empathy” to repeat a bit of what the person said along with an “I Feel” Statement and say, “I’m feeling sad to hear that.” In future weeks, we will use this same format but add more of the 5 secrets, including Feeling Empathy, the Disarming Technique, Stroking, and Inquiry.

Sunny mentioned that it is neat to see people from the most remote corners of the globe connecting and developing friendships.

He said that Brandon’s genius is in how he has created a safe environment to open up and has made the groups really fun, with singing and sharing that have made the groups a powerful and unique personal experience.

Sunny explained that when he grew up in Hong Kong, he had anxiety and panic attacks, but you don’t always need a therapist to feel better.

One of the most powerful groups was when Sunny shared his grief about a painful personal experience in the group, when his cousin’s restaurant was targeted and vandalized in an act of anti-Asian violence. Working with Sunny in front of the group as if he were a patient, Brandon demonstrated the Feared Fantasy Technique that they’d read about in Feeling Great that week.

Brandon said Sunny’s vulnerability opened people up and made it easier for them to share their feelings and experiences.

Sunny explained that many Asian people have an anti-therapist bias, but they are very receptive to learning how to use TEAM-CBT techniques in the context of a book club.

The club has also stimulated the creativity of people in the group. For example, one member has started a weekly Daily Mood Log practice group and another made visual diagrams of the patient sessions discussed in the book.

Sunny said that most of the group members began with the popular belief that therapy has to take a long time, but have discovered that this is not true, and that most people can improve and recover rapidly.

At the end of the podcast Brandon played a beautiful audio with touching endorsements for the book club, and for Feeling Great, from people around the world.

If you’d like to contact Brandon, you’ll find him at: www.brandonvancemd.com

If you’d like to contact Sunny, you’ll find him at: www.bettermoodtherapy.com

In the fall, Brandon will be leading two more book clubs starting in mid-August and running through mid-December. If you’d like to learn more about the book clubs or get on the waiting list for the next book club in the fall, please visit www.feelinggreattherapycenter.com/book-club.

This would be a good to get on the waiting list for that group, since it is filling up rapidly!

Rhonda and David

Podcast 248

Ask David and Rhonda!

In today’s podcast, Rhonda and David answer some fascinating questions submitted by listeners like you! We both thank you for your interest in our show, and for your kind comments and terrific questions!

The Questions

1. Kati asks: I notice that in your therapy sessions, the negative feelings of most of your patients are reduced all the way to 0%, and many become euphoric. I was wondering whether this somewhat contradicts the idea that our negative feelings are useful to us in some way?
2. Kati also asks: Do you believe that empathy can be ‘taught’?
3. Yiftah asks: How could one dangle the carrot effectively and responsibly when offering a cognitive exposure exercise?
4. Yiftah also asks: From your experience can you give examples of cases in which cognitive exposure may not be as safe or as effective?
5. Esther asks: You say there is no convincing or consistent evidence to support most psychodynamic claims about the causes of things. What you said resonates, but aren’t you also just making claims? I have a psychodynamic supervisor, and am struggling to choose between empirically validated treatments and traditional psychodynamic approaches.
6. Sean asks: Burns, what can you do when you are using the disarming technique and the person keeps interrupting you?
7. Ben asks: Since exercise improves the mood of some people who are feeling down, doesn’t this prove that physiologic changes can improve mood, as opposed to changing negative thoughts?

The Answers

 Note: The answers below were based on David’s email exchanges with the people who asked the questions and were created before today’s podcast. Therefore, the podcast may contain new and different information from these show notes. Hopefully, both the show and the notes will be helpful to you.

Rhonda and David

1. Kati asks

I notice that in your live therapy sessions, the negative feelings of most of your patients are reduced all the way to 0%, and many become euphoric. I was wondering whether this somewhat contradicts the idea that our negative feelings are useful to us in some way.

David responds

Hi Kati, thank you for the kind comments!

It is great to get negative feelings to zero and experience enlightenment and joy. However, no one can be happy all the time, so you will have plenty of opportunities to "learn" from negative feelings again. In addition, there is a difference between healthy and unhealthy negative feelings. Healthy sadness is not the same as clinical depression, healthy fear is not the same as a phobia or panic attack, healthy and unhealthy anger are quite different, and so forth. There will bumps in the road of life for all of us at times.

* * *

2. Kati also asks

Do you believe empathy can be “taught?”

As a mum (of a 15 and a 10 year old girls) and a (HS) teacher I notice some people seem to have it more ‘innately’ than others but would also love to think it is an aspect that can be intentionally developed in others in some way. If you think like me, I would love to hear your thoughts on how that could be done (i.e. what practices or strategies would be most helpful to use with young people in particular).

I am still in awe that we can have a sort of conversation with such a brilliant and creative mind and I humbly hope you can address these two questions either in one of your podcasts or by responding to this message.

In admiration,

Kati

David responds

Thanks again, Kati,

With regard to empathy, it is something that can be learned, but it takes commitment and practice. A good first step is the book I wrote on this topic called Feeling Good together. In addition, there is, as you say, an "aptitude" that people have for this or any skill, with a tremendous variability in the population.

But regardless of your natural aptitude or lack of it, you can learn and grow tremendously. I started out with very poor listening skills. You can also search for Five Secrets of Effective Communication on the website, using the search function, and you'll find lots of podcasts teaching these skills.

david

* * *

3. Yiftah asks

How could one dangle the carrot effectively and responsibly when offering a cognitive exposure exercise?

Dear Dr. Burns,

I love your podcast and books. They have completely changed my practice and had helped my personally. In particular it was great to hear you working with Dr. Levitt with cognitive exposure, and your discussion about it.

I have two questions regarding cognitive exposure with PTSD (for the podcast.

First, how could one dangle the carrot effectively and responsibly when offering a cognitive exposure exercise?

David responds

Hi Yiftah,

I try to deal with the Outcome and Process Resistance issues prior to agreeing to help any patient with anxiety. I might say something like this:

“Jim, I’d really love to help you with your fears of X (whatever it is), and I’m pretty convinced that if we work together, you can make some great progress in overcoming your fears. I have more than 30 great tools to help you overcome anxiety, and you’re probably going to love all of them except for one, exposure. Confronting your fears is just one tool among many, but is a vitally important part of the process, and cure is usually impossible without exposure.

“For example, I may ask you to do is (I explain the type of exposure we might use.) I know that will be terrifying, and it needs to be terrifying to be effective. I’ll be with you every step of the way, of course. But I need to know if you’d be willing to do that type of thing if I agree to work with you.

“I know you’ve told me that you’ve had many therapists in the past who did not use exposure, and that might be why their treatments were not as effective as you’d hoped. And if you absolutely don’t want to use exposure, I would totally understand and support you, but sadly could not agree to treat your fear of X.”

* * *

4. Yiftah also asks

From your experience can you give examples of cases in which cognitive exposure may not be as safe or as effective?

You have a lot of experience with successful exposure treatments, but I had never worked with PTSD. And I hear some "PTSD experts" say that cognitive exposure is a dangerous process that can backfire. And according to papers I've read it doesn't always help.

In other words, assuming that one had worked correctly with the Empathy and Assessment of resistance phases: how safe and how effective is prolonged cognitive exposure with severe PTSD?

From your experience can you give examples of cases in which cognitive exposure may not be as safe or as effective? I mean are there some conditions or distorted thoughts that categorically need to be dealt with successfully before going for exposure?

For example, would there be any special considerations when working with patients with thoughts connected to shame, self-blame and hopelessness, as well as habits and addictions, or relationship issues?

Thank you

Yiftah

David responds

Thanks again!

Let’s assume that you are treating a veteran who is paranoid and living alone in the woods, who tells you that he is afraid of “losing it” and blowing people away with his automatic rifle. I would not want to have him fantasize blowing people away in order to overcome his fear, especially if he is prone to violence and has poor impulse control, and is psychotic. This could conceivably trigger him to do something violent, and I’d have a hard time explain my therapy methods to the police after he kills many people in the local mall.

At the same time, the vast majority of anxious people who are afraid of doing something horrible or violent have OCD, and are totally safe. So, it takes judgment. Powerful techniques require therapists with exceptional skills, training, and thoughtfulness.

It ALWAYS pays to be thoughtful and cautious! And this has nothing to do with cognitive exposure per se, but all of the > 100 techniques that I use. They can all hurt, including empathy, if not done skillfully, and with compassion.

Backfiring occurs when therapists don’t do or know how to prepare the patient for the methods you plan to use. Anytime you “throw” techniques at patients, you are asking for trouble.

Remember, TEAM is a systematic, step-by-step package that is done as a sequence. Your patient has to give you an “A” on empathy before you can even go on to the Assessment of Resistance. My experience has shown me that most therapists, including the so-called experts, do not know how to get an A grade on empathy, and may not have outstanding empathy skills.

Trust is so important in the treatment of anxiety, and always has to come first. Before using any M = Methods, you will need to address the patient’s Outcome and Process Resistance, and get some agreement on what you plan to do and how you plan to do it.

Should we not use a technique because it doesn’t always work? All techniques often fail. TEAM is based on “failing as fast as you can!” If you can’t use a technique that sometimes fails, then you can’t use ANY technique!

Also, I never treat anxiety with one technique. I use a great many techniques drawn from four very different treatment models:

• the Cognitive Model
• the Motivational Model
• the Exposure Model
• the Hidden Emotion Model

I sometimes get tired / annoyed with so-called experts who love to spout off, saying things that to my ear sound like half-truths. But then again, I do the exact same thing!

At any rate, neither Jill nor I have ever had a bad outcome with any form of exposure, but we are both pretty careful, and try hard to be compassionate and to prepare the patient. You have to be thoughtful and careful. For example, Shame Attacking Exercises can be life changing, but they require half a brain on the part of the therapist. For example, I wouldn’t throw someone with poor interpersonal skills into a potentially awkward or hurtful Shame Attacking Exercise.

All powerful techniques have the potential to heal or harm. The same scalpel that a surgeon uses to save a life can also be used by a murderer to slit someone’s throat.

d

* * *

5. Esther asks

You say there is no convincing or consistent evidence to support most psychodynamic claims about the causes of things. What you said resonates, but aren’t you also just making claims? I have a psychodynamic supervisor, and am struggling to choose between empirically validated treatments and traditional psychodynamic approaches.

Hi David,

I absolutely love your stuff! I’ve used some parts of feeling good in my practice as a therapist and in my personal life for some time, but I’ve recently gotten much more into your teachings and I’ve been thinking a lot about TEAM-CBT. And thank you for providing all these free resources for the public!

In episode 230 (about 22 minutes in) Rhonda asked you about a common psychodynamic type of claim-

“a child of alcoholics either become an alcoholic, marries an alcoholic or becomes a therapist of an alcoholic.”

You responded by saying

“people love those kinds of theories because people want to think they know the causes of things.”

Then you went on to disagree, claiming that there isn’t much evidence to support these types of claims.

At first what you said very much resonated with me, and yet I began to think about it and realized the irony in your response: you had explained people’s tendency to come up with such theories with your own cause (“people want to think they know the causes of things”), something which I doubt you’ve been able to test in a research study (though perhaps I’m wrong!)

And yet what you said still resonates with me and highlights the crux of my question: isn’t there any value in intuition (without any evidence) in determining the causes of things? For instance, I think your causal explanation here is highly intuitive. (Even though an alternative explanation could have involved something not inherently psychological, like “people err because they think correlation implies causation” or something.

This is not just a theoretical question for me. I currently work under a wonderful supervisor who takes a psychodynamic approach to many issues, and I am very suspicious of some his theories, but it seems that he is a great therapist. Further, I think that many people in school and in the early stages of practice (including myself) are conflicted about whether or not they wish to train further in evidence-based approaches or in a psychodynamic type of school.

I think this important question is sometimes at the root of the issue. (Although psychodynamic theories are sometimes not at all intuitive.)

For a practical example- something I always found intuitive is the role low self-esteem seems to play in people with inflated egos or the role it can play with those who have anger issues (In which the ego or anger serve to “compensate” for the low self-esteem).

When I was working with a client who suffered in these two areas, I began by educating him about this notion (which resonated with him) and we began to address his low self-esteem. Later, however, I happened across an article claiming that this intuitive notion is not supported by research. It called into question many of my intuitions when conceptualizing cases and treating my clients.

Finally, I just picked up a copy of “Feeling Great” (it’s awesome, by the way!) and I noticed you talked about the hidden emotion technique. Once we’re on the topic of evidence; do you have any evidence that this particular technique is helpful? Is there research backing such a technique? (I’m particularly suspicious of it given its psychodynamic flavor :)

I apologize if you’ve addressed these questions somewhere already- I’ve only just begun to avidly read your stuff and listen to your podcast.

Thank you so much!

Esther

David responds

Hi Esther,

This is an important email and if I can find the time, and may address it in an Ask David. You write:

“This is not just a theoretical question for me. I currently work under a wonderful supervisor who takes a psychodynamic approach to many issues, and I am very suspicious of some his theories, but it seems that he is a great therapist.”

It’s great that he is a great therapist, and it will be fun for you to learn from him. There are two caveats, perhaps. First, therapists’ views of changes in the negative feelings of their patients, like depression, are not especially accurate, so his self-report of his effectiveness may not have a lot of credibility. I have measured therapist accuracy in a study at the Stanford Hospital, and found an accuracy of only 3% in detecting changes in depression, even after exhaustive, systematic interviews with patients about how they feel.

Second, most therapists have only a placebo effect, although they will strenuously insist it ain’t true! And their effectiveness is almost definitely not the result of the specific tools they are using, but other factors. Many outcome studies have been consistent with this type of conclusion.

But still, learning from the wisdom of an older therapist can be awesome!

With regard to the Hidden Emotion Technique, it IS a kind of modernized psychodynamic technique. I don’t think it has been studied, but I no longer keep up with research. I find it exceptionally helpful in myself (I am anxiety prone) and in about 50% or more of anxious patients. And I have found I can engage in really rewarding conversations with psychodynamic therapists when I describe this technique.

I enjoy this type of dialogue, challenging our favorite ideas. Have you ever heard of the “confirmation paradox?”

My memory is that if theory A predicts observation B, and you see observation B, you may wrongly conclude that theory A is confirmed.

For example, the theory that the sun revolves around the earth predicts that the sun will come up in the east in the morning and set in the west in the evening. So, we do see that every day, and we wrongly conclude that we have confirmed our theory that the sun revolves around the earth.

Same is true for psychological theories about the causes of depression or whatever. The problem is that your observations also confirm a large number of alternative theories that all would have predicted the same thing.

You can disconfirm a causal theory with data based on an experiment or natural observation, but you cannot actually confirm any theory in science. You can only say that your data are consistent with this or that theory, and that you have failed to disprove your theory based on your observations.

I tested many theories about the linkages between Self-Defeating Beliefs (SDBs), like Perfectionism, and changes in negative feelings over time in several hundred patients treated at my clinic in Philadelphia. The data was not consistent with causal linkages between SDBs and negative feelings, even though there were strong correlations between them at both time points, and even though changes in SDBs were strongly correlated with changes in SDBs.

david

PS

You might enjoy this psychoanalysis poem by another Esther who is a member of our Tuesday TEAM training group at Stanford.

GOODBYE TO ALL THAT:

THE JOY OF PRACTICING PSYCHOANALYSIS

No more forms, no need for technique

No more brain strain week after week,

Ditch those methods — fifty, a hundred,

A thousand ways I might have blundered.

So long agenda, don’t mention homework

Just perfect that withering shmirk.

Surveys, grades, throw them away

You know it’s sex, whatever they say.

Gone for good are your twelve distortions,

Out with charts and their crazy proportions.

Is that a purse I see before me? Nope!

It’s your mother’s vagina. You think that’s a joke?

Such progress we are making you must admit

Only ten years and we are ready to dip

Into that complex where troubles all lie

The mom you must marry, the dad who must die.

Two hundred sessions a year and each one two hundred

Over ten years $400,000! I sundered… WHAT?