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Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
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Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

Author: David Burns, MD

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This podcast features David D. Burns MD, author of "Feeling Good, The New Mood Therapy," describing powerful new techniques to overcome depression and anxiety and develop greater joy and self-esteem. For therapists and the general public alike!
255 Episodes
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The Night My Childhood Ended, Part 1 In today’s podcast, we present the first half of a therapy session with Todd, who describes a traumatic event that ended his childhood when he was eight. Next week, you will hear the exciting and inspiring last half of Todd’s session. My co-therapist is Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, CA, and one of the co-leaders of my weekly training group at Stanford. We are deeply indebted to Jill and Todd for making this incredible and extremely personal podcast possible. Todd hopes, and we all hope, that it will be helpful to many people around the world who are suffering, and perhaps hiding the scars from your own traumatic experiences. As we always do in TEAM, Jill and I went through T, E, A, M in consecutive order, and I will give an overview of each phase of the session. T = Testing and E = Empathy Todd started by saying: I’m uncomfortable with all the attention I’m getting right now, and I’m worried about derailing the group, since our plan was to have teaching on exposure tonight. I’m going to describe one of the worst nights of my life, when I was 8 years old. It was the last night our family lived together, and my childhood essentially ended. But I’m not looking for a pity party. When I think about that night, I feel 100% sad and shitty. My life isn’t shitty. but when I think about that night, it’s incredibly discouraging. Here’s what I’m telling myself right now: I’m more screwed up than anyone else in this group. 100% I worse than all of the others. 100% My parents got married very young, when they were 18. I was raised in the 1970’s, which wasn’t the child-centered world like it is today. My parents drank all the time. and they’ve both had lifelong challenge with addictions and mental health. In fact, my mom got arrested for a DUI just last week. I have one older brother, and we were on our own most of the time. My parents had a horrible fight one night. It was the last night our family was together. They were both drunk and screaming at each other. They began physically fighting in their bedroom, and I thought my dad was going to kill my mom. My brother and I were scared, and we hid in the bedroom and created a fort with our bunk beds. Then things got quiet, so we decided to see what had happened, and went into their bedroom. Mom was badly beaten up, her face was all bruised, and dad seem horribly embarrassed and ashamed. It was devastating, because I told myself that I should have done something to help her, to save her, and I felt, and still feel, like a frickin’ coward. I believe that 100%, and have felt ashamed every time I think about it. I feel all alone. I’m here, but I’m not here. That was the end of my childhood. I don’t like to think about it. My father moved out, and my brother lived with him. I lived with our mom. The idea at home was always, “don’t speak unless you’re spoken to.” Dad was very angry and controlling. He was angry at my mom for not taking better care of my brother and me. He was angry at life, and I’m also angry and disappointed in her for not taking better care of us. I want to be able to get in touch with my vulnerability and my emotions. Then I stop myself and say, “I’m not allowed to have these feelings.” I want to be consoled, comforted, and not be so hard on myself. Maybe I want people to feel closer to me. You can see Todd’s Daily Mood Lot at the start of the session (link). As you can see, he was incredibly upset, and had eight Negative Thoughts, and his belief in all of them was strong, with most at 100%. Next week, you will hear the dramatic conclusion of Todd’s personal work, including the A and M of TEAM! If you would like to contact Todd, you can reach him at:  todd.daly@gmail.com david and rhonda
Ask Rhonda, Matt, and David! Tips for Joy and more! In today’s Ask David, we are honored to feature Matthew May, MD, a former student of David’s during his psychiatric residency training, and now esteemed colleague. Rhonda and David are thrilled that Matt can join us, not only because he is a dear and loved colleague, but also because he is one of the greatest therapists on planet earth! Plus, he’s an incredibly gentle and compassionate man. Rhonda Asks: What is the most effective way to help a suicidal patient? Rhonda Asks: How would you teach, the technique, Thinking in Shades of Grey to therapists or patients? Brian Asks: Any tips for joy? ThisLife asks: "Could you possibly explain why Albert Elis thinks the three valid uses of shoulds are valid, and provide the source where he explain this point, if convenient?” Mark Asks: Why is trying to change a person or help fix a person's emotional problems insulting? And how can I stop this habit? Along the same lines, EJG asks, “What’s the best way to help people who don’t want any help?” Rhonda and David
The Paradoxical Nature of TEAM In today’s podcast, we are honored to feature Matthew May, MD, a brilliant and beloved colleague of Rhonda and David. Rhonda suggested the topic for today’s podcast on the Paradoxical Nature of TEAM, and Matt and I were more than excited to dive into this cool topic! We reviewed the paradoxical nature of the four components of TEAM. As you will see, each paradox requires one of the four "great deaths" of the therapist's "self," or "ego." The Paradoxes in T = Testing TEAM therapists assess how the patient is feeling “right now” in at least six dimensions just before the start and just after the end of every therapy session using brief, extremely accurate scales for negative feelings like depression, suicidal urges, anxiety, and anger, as well as happiness and marital / relationship satisfaction. These scales are like an emotional X-ray machine so therapists can see, for the first time, exactly how effective or ineffective they are in every single therapy session. You can also see exactly what happens to the patient’s feelings between therapy sessions. Therapists may make several potentially disturbing discoveries during Testing. His or her perception of how the patient feels are frequently wildly inaccurate. The therapist’s perceptions of the degree of improvement in his patients may be shocking, since the therapist will often discover that patients have not improved, and may even feel worse. These “disturbing” discoveries can be celebrated, because the therapist, if humble and open, can accept the fact that his or her therapeutic strategies are not sufficient, and that meaningful change has not yet happened. The therapist can search for and try different treatment methods that may be more helpful for each patient. Paradoxically, the therapist’s failures become golden opportunities for learning and growth every day, and your patients will become the greatest teachers you’ve ever had. This involves the first of four “great deaths” for the TEAM therapist—the death of the “self” that has expert understanding of how patients actually feel. You will discover that your perceptions are very inaccurate in many or even most situations. This discovery can transform the way you practice if you have the courage and humility to try something new! The Paradoxes in E = Empathy At the start of the session, the therapist attempts to listen and provide an empathic, compassionate connection with the patient, reflecting back how the patient is thinking and feeling and convey acceptance and warmth. But here’s what happens in TEAM. When assessing empathy with the “What’s My Grade Technique” during the session, the therapist will often / nearly always discover that you didn’t really “get” the patient. When you review your scores on the Empathy and Helpfulness Scales that patients complete at the end of every session, most therapists are shocked to see that they get failing grades from most or nearly all patients after most or nearly all therapy sessions. Paradoxically, this is a big plus because it allows the therapist to explore his / her failures with the patient in a spirit of humility and curiosity at the start of the next session. If done skillfully, this can lead to therapeutic breakthroughs as well as a significant deepening of the therapeutic alliance. But this also requires a second “great death” of the therapist’s ego, because patients’ criticisms on the feedback forms will nearly always be accurate, and often biting. If you have the courage and skill to acknowledge that truth, the therapeutic relationship can be instantly transformed. Learning skillful empathy skills, using the Five Secrets of Effective Communication, requires tremendous commitment and practice, and the “beginner’s mindset.” The Paradoxes in A = Assessment of Resistance (formerly called Paradoxical Agenda Setting) During this phase, the therapist brings the patient’s subconscious resistance to conscious awareness, and melts the resistance away using approximately 20 “resistance melting” techniques, such as Positive Reframing, the Paradoxical Invitation, the Acid Test, the Gentle Ultimatum, the Externalization of Resistance, Sitting with Open Hands, and more. During this phase, the therapist, paradoxically, does NOT try to “help” the patient, but instead assumes the voice of the patient’s subconscious resistance, helping the patient suddenly “see” why she or he actually should NOT change. Paradoxically, the moment the patient “gets it,” there will be an illumination, and the patient will suddenly lose his or her resistance and become way more open and collaborative. This what makes the rapid recovery in TEAM-CBT possible. The patient also discovers, paradoxically, that his or her symptoms, like depression, hopelessness, and feelings of worthlessness, anxiety, or rage, are NOT the expression of what is wrong with him or her, like a “mental disorder” or “chemical imbalance in the brain--but the manifestation of what is right with him or her. In other words, there are tremendous benefits hidden in every negative thought and feeling. In addition, every negative thought and feeling reveals something positive and awesome about the patient and his or her core values. These discoveries can be mind-blowing for the patient and therapist. Matt and Rhonda do an entertaining role play of a woman who is enraged with her husband, and blames him for all of the problems in her marriage. Matt beautifully illustrates (as he always does!) exactly how to “Sit with Open Hands” and transform her angry resistance into enthusiastic collaboration and a willingness to examine her own role in the problem. Matt and David also discuss an amazing concept called “therapeutic entanglement,” borrowed from quantum physics. They explain how the minds of the therapist are often connected, constantly mirroring each other during the session. So, the more the therapist becomes the resistant and oppositional part of the patient’s subconscious mind, the more the patient assumes the helpful mind an role of the therapist. This phase of the therapy involves the third “great death,” because the therapist’s “helping” or “rescuing” ego has to die. That’s because your job is to see exactly why the patient should not change, and to help the patient discover this as well. The moment the patient “sees” this, and “gets it” at the gut level, recovery will be just a stone’s throw away. The Paradox in M = Methods. At this stage, the therapist focuses on one of the patient’s negative thoughts, like “I’m a loser,” or “I’m unloveable,” or “I’m a hopeless case,” and selects ten or fifteen M = Methods to challenge and crush the thought. Methods might include Explain the Distortions, Examine the Evidence, the Paradoxical Double Standard, the Externalization of Voices, the Acceptance Paradox, and more. TEAM-CBT includes more than 100 methods drawn from more than a dozen schools of therapy. The goal is not therapeutic success, but therapeutic failure. That’s because the faster you fail, the faster you’ll get to the technique that works. And the very moment the patient stops believing the Negative Thought that’s causing his or her negative feelings, the feelings will change. This phenomenon can sometimes be dramatic, even mind blowing. But even in this process, the therapist is almost always playing the role of the patient’s negative thoughts, and the patient is the one who is arguing for change. The M = Methods involves the death of the therapist’s “expert self,” thinking that you’re going to help, rescue or save the patient with your favorite brand or school of therapy, or the exciting new method you learned in some workshop and taught by some charismatic guru. TEAM involves giving up all the schools of therapy, and the spirit of “failing joyously” using a wide variety of methods drawn from more than a dozen schools of therapy. TEAM is not a new school of therapy, but a science-based, data-driven framework for how all therapy works. And so, that’s a little peek into the extensively paradoxical nature of TEAM-CBT! What’s the point in having such a paradoxical approach to therapy? I (David) can only speak from personal experience, I love having tools that can work dramatically and quickly for the vast majority of my patients. That’s because the moment they “recover,” I “recover,” too, and we both become euphoric. So I’m highly motivated to push for rapid and dramatic changes, and this is usually (but not always) possible. I love having a form of therapy that makes patient resistance virtually impossible. I no longer have to deal with resistance. It is impossible for a patient to resist, due in large part to the Buddhist concept of “sitting with open hands.” I love empowering my patients so that they don’t have to hang around with me for months or years waiting for change that never happens. It’s exciting to put the tools for change in their hands, so they’ll know how to deal with the inevitable relapses of negative thoughts and feelings that all human beings will experience, from time to time, for the rest of their lives. 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) Rhonda and David
Ask Rhonda, Matt and David! Ask David #243 May 24, 2021 David and Ronda answer your questions about the role of hope, treating court-ordered patients, suicide threats, being a virgin, and moral scrupulosity. Guest expert, Dr. Matthew May, joins us for this fascinating podcast featuring questions from fans like you!  V3A asks: What is the role of hope? EdG asks: How would you deal with a patient who doesn’t like you or doesn’t want to come for treatment, but has been required by either an employer or the courts? Preetika asks: Recently, a client said she felt suicidal and that made me feel suicidal about anything untoward happening on my watch! I was ‘scared stiff!’ Please do a podcast if possible on therapist fears and dilemmas. Dale asks: How would you do Positive Reframing with someone who is suicidal? Miho writes: From church and from my parents, I have been told repeatedly I need to save myself for marriage thus this has been my core belief when I am dating. Although it had never bothered me before, now that I am in my last 20s it seems I have heightened anxiety and misaligned expectations when dating as literally no one around me thinks in this way, and I have been told I do not "look" like I am inexperienced. May I know which would be the best tool for combatting other people's opinions when it really does seem that their opinion is the "truth" of the world? Robyn writes: I would very much like to hear about how you treat patients suffering OCD with moral/religious scrupulosity. * * * V3A asks: What is the role of hope? Hi David, how do you fit the cultivation of hope into TEAM-CBT? Being such an important aspect of recovery, it seems to be most needed in those that most need help, creating a seemingly unwinnable situation for those people. If someone has enough hope to seek treatment, is that enough to make a recovery? * * * EdG asks: Just listened to Podcast 025 on how to relate to a patient you dislike, Very useful! What about the opposite situation? How do you deal with a patient who may have a hidden agenda, like coming to you in order to avoid a legal problem or because s/he was ordered by an employer or the courts? Thanks, EdG. That's sometimes fairly easy, and might make this an Ask David. I once told such a patient that if he wanted to work with me he'd have to have an agenda of something he really wanted to change, and he would also have to do tremendous amounts of psychotherapy homework, and that this was non-negotiable, and that he or she might prefer going to another therapist who would be more of a pushover! In my limited experience, this was very effective, and seemed to motivate the man who came to me. He did, in fact, work tremendously hard! david PS We can get Rhonda's take on it, as she does forensic work. * * * Preetika asks: Recently, a client said she felt suicidal and that made me feel suicidal about how anything untoward happening on my watch! I was ‘scared stiff!’ Please do a podcast if possible on therapist fears and dilemmas. Dear Dr Burns, Thanks for sharing your wonderful podcasts, they are of immense value. I have been using your brief mood surveys and though I found it tiresome initially, I realized its value when I I uncovered suicidal thoughts in a patient that came forth only because of repeating the mood survey each session. Further, do you think a brief behavior survey at the start of a session is beneficial to record sleep, eating, and self harm patterns is needed to assess how clients are doing in between sessions? Does it have value? Recently, a client said she felt suicidal and that made me feel suicidal about how anything untoward happening on my watch! I was ‘scared stiff!’ Please do a podcast if possible on therapist fears and dilemmas. Thanks for so many continuing insights and for making therapy feel real, Preetika Hi Preetika, Perhaps you can search on website using search function and find the podcast on suicide prevention. Then let know what you think. When you use the Brief Mood Survey and Evaluation of Therapy Session, you said it was tiresome at first. What were your scores on the Empathy Scale? Scores below 20 are failing grades. Most of my colleagues, and myself, find this anything but "tiresome," but rather dynamic and fantastically challenging. Also, what percent reduction do you see in patient's depression scores within sessions? This shows your level of skill and effectiveness. 25% to 35% reduction within a session is a fairly good benchmark of sorts. This is called the Recovery Coefficient. Have you looked at that? I find it pretty exciting, and also challenging, especially when the scores don't change, and also when they do1 Thanks for the great question. David * * * Dale asks: How would you do Positive Reframing with someone who is suicidal? Would you suggest that it says that they have a strong self-awareness of the severity of their hopelessness that protects them from more disappointments? Or perhaps a wake-up call message from there awareness of some kind? All the best Dale Hi Dale, Suicide is handled differently, in part due to the legal stipulations that make therapists guilty, and you can use the search function to find and listen to my podcasts on this topic. Thanks! David * * * Miho writes: From church and from my parents, I have been told repeatedly I need to save myself for marriage thus this has been my core belief when I am dating. Although it had never bothered me before, now that I am in my last 20s it seems I have heightened anxiety and misaligned expectations when dating as literally no one around me thinks in this way, and I have been told I do not "look" like I am inexperienced. May I know which would be the best tool for combatting other people's opinions when it really does seem that their opinion is the "truth" of the world? Hello Dr. Burns, First of all, thank you (and Rhonda!) so much for providing us with a great podcast. It has helped me tremendously and it is great to hear both of your voices. Your book "Feeling Great" is amazing as well and I just can't find enough words to express my gratitude for all that you do. I have 2 questions regarding romantic relationships and your opinion would be much appreciated if you have time. (I am a female in my late 20s) 1) I feel that I tend to associate past events to the present, for example when a guy tells me that he is busy with work, even if he is genuinely busy and there is proof, I remember the time my ex-boyfriend made that excuse to actually hide the fact that he was going out clubbing and doing drugs. It is not that I don't trust the person in front of me, but rather the feelings of anxiety from past creeps up on me due to those thoughts and makes me insecure (if that makes sense). I am not sure which tool I should use to get over this kind of thinking, as in the moment when I reframe my thoughts it works, but soon after another example would set me off again. 2) From church and from my parents, I have been told repeatedly I need to save myself for marriage thus this has been my core belief when I am dating. Although it had never bothered me before, now that I am in my last 20s it seems I have heightened anxiety and misaligned expectations when dating as literally no one around me thinks in this way, and I have been told I do not "look" like I am inexperienced. May I know which would be the best tool for combatting other people's opinions when it really does seem that their opinion is the "truth" of the world? Warmest regards, Miho Hi Miho, Thanks. I will add this to the Ask David list. It will take some time, as we have lots of great questions listed at the moment. I resonate, though, as I was raised in a religious family and told not to kiss girls, etc. which was, I think, damaging.. Sex is natural and inevitable, and perhaps best left “undemonized.” At any rate, you would need to decide on your own moral values, and then we could deal with any fears of disapproval from one side or the other. Really love and appreciate your openness. d * * * Robyn writes: I would very much like to hear about how you treat patients suffering from OCD with moral/religious scrupulosity. Dear David and Rhonda: Thank you so much for your calming, effective and often laugh-out-loud funny podcasts, filled with a generosity of wisdom. I deeply appreciate them and recommend them to others also. They have helped shape my view of CBT into something far more empathetic and human. I would very much like to hear about how you prefer to treat patients suffering OCD with moral/religious scrupulosity. I understand that exposure with response prevention is considered the standard treatment, but I don't understand how this works directly with fears about things that are unethical or immoral. For example, a deeply law-abiding person who is afraid of accidentally breaking the law ("was I speeding? I need to check if that was a police camera! what if I was doing something illegal and I didn't realise it?") or a very kind person who goes out of their way not to kill anything due to fear of consequences in the afterlife ("did I just step on an ant? I'd better check the soles of my shoes in case! I don't want to wash my hands in case it kills skin mites!") And would it change anything in your approach if the patient was someone who had had negative experiences with the law through no fault of their own (ie validating their fear)? Or who had a sincere belief that they should pray to be forgiven or purified for their perceived "sins" (a coping behavior which isn't negative in itself)? How do you even go about creating willingness in the patient to see these behaviors as problematic? It seems like it is much easier to treat for a fear of cats - it's easy to make an exposure ladder to the actual fear, it's ethical and safe to expose the patient, and the experience can ultimately be very positive - which is quite reinforcing. But what do you do when the patient is suffering from a good quality taken too far (obeying the law, refraining from killing etc.)? Obviously you can't invite them to break the law or kill things because that's not moral or ethical, so I'm assuming you can only ask them to sit with the discomfort of uncertainty? Is that just as good as working with the direct object of fear itself? Or have I missed something? I'd love it if you could talk about scrupulosity sometime! Thank you very much again. Kind regards Robyn Hi Robyn, If you like, I will include in an ask david. The short answer is one that I give every week on the podcasts—I don’t throw techniques at folks based on a diagnosis or problem. As often as I say it, people don’t seem to get it, and this is the biggest problem in our field—trying to figure out how to “help” or rescue our patients. Of course, cognitive flooding might be one of 15 or 20 methods I might use, and there are tons of others, but first one has to find out what, if anything, the patient wants, and then deal skillfully with Outcome and Process Resistance. This MUST come before trying any methods. More on this when Rhonda and I discuss your excellent question. d Matthew May MD practices in Menlo Park, California. He is on the adjunct faculty in the department of psychiatry at Stanford and practices in Menlo Park, California. Although most psychiatrists rely primarily on medications, Matt tells me that the majority of his depressed and anxious patients recover rapidly without medications as a result of his proficiency with TEAM-CBT. He is also a superb teacher and has a weekly online supervision group for mental health professionals interested in learning and refining TEAM therapy skills. You can contact him via his website. Next week, Matt will join us again in a fascinating podcast on the paradoxical Nature of TEAM-CBT! Don’t miss it! Rhonda and David
Professor Yehuda’s TEAM-CBT Israeli Initiative! Today’s podcast is the latest in a series Rhonda has created featuring people who are doing interesting and creative things with TEAM-CBT. In today’s episode, we feature Yehuda Bar-Shalom, D.H.L, TEAM CBT level 4 trainer and therapist, who will teach us all about the use of TEAM in the school system. Yehuda, who is an associate professor appointed by the Council of higher education in Israel, is the first person we know to teach TEAM to school counselors in a practical way. (We also refer you to our podcast episode 152 where we interviewed Amy Spector, MFT, who is a TEAM therapist providing TEAM therapy to “at-risk” teen-agers at a high school in the San Francisco Bay Area.) Yehuda is an educator, psychotherapist and researcher. He has served as president of Hebraica University in Mexico City, the only Jewish University in Latin America which is open to students of all religious faiths. When he became the president of Hebraica University, he adapted the psychology and wellbeing department so that it became a training program for TEAM therapists. When he returned to Israel in 2020, Yehuda’s former student Victoria Chicurel, and several others, continued the Mexico TEAM training program. Yehuda has authored seven books and almost 70 academic articles on education and society, with a focus on Jewish education, social entrepreneurship and consulting in psycho-educational settings, mostly from a CBT perspective. He has been the Vice President of the David Yellin College in Jerusalem, and the Dean of Education at the Ono Academic College. His book, Educating Israel: Educational Entrepreneurship in Israel’s Multicultural Society was published in 2006. Yehuda is married to Amira Bar Shalom, and has three children. Yehuda, who in his professional life is both a therapist, educator, and researcher, earned his doctorate in education in 1997, conducting research on applying Bion’s theory in group work with adolescents.  When he was teaching school counselors, he realized he wanted to become a counselor, so, 20 years after earning his research doctorate, he went back to school and earned a Master’s degree in school counseling, and later another Master degree in the treatment of addictions. He also studied for a two-year certificate in cognitive behavioral therapy at the Psagot Institute, where he met Maor Katz, MD, Director of the Feeling Good Institute, and one of the Psagot instructors who taught TEAM therapy. Yehuda also learned about TEAM therapy by listening to the Feeling Good Podcasts. When he started listening, he thought TEAM therapy was “like a miracle.” Yehuda then attended several of David’s TEAM training workshops, as well as on-line trainings sponsored by the Feeling Good Institute (FGI). He has also studied one-on-one with Level 5 TEAM therapist, Daniel Minte. Yehuda currently teaches at a master’s level training program for school counselors at the Ramat Gan College in Israel. He is committed to teaching TEAM to school counselors for many reasons. One is that using TEAM provides school counselors with an immediate way to create a fast connection to students. In addition, TEAM can more quickly help students who are struggling with their moods, behaviors, relationships, or habits and addictions. Yehuda emphasizes the importance of T = Testing for the school counselors, and teaches them how it helps create empathy. For example, the school counselor might say this to a new student, “Oh, I see your score on anger is such and such. Tell me about that.” Yehuda explained that school counselors are like primary care physicians. They have the immediate pulse on the student’s needs and feelings. He is training the school counselors to speak with their students using the Five Secrets of Effective Communication. He also shows the counselors how to teach the Five Secrets, so their students can use this tool in their lives. He gave an example of how a school counselor might use the Disarming Technique when interacting with a child who feels angry and wants to escape. The counselor might say, “Wow, I can see that you’re feeling really angry about being sent to me for counseling and that you want to escape! I want to escape, too!” Then the child feels understood and opens up. Yehuda is also teaching the school counselors how to identify their own distorted negative thoughts, and how to positively reframe and challenge them. Once the counselors learn these skills for themselves, they can teach them to their students so that the students can learn to challenge their own distorted thoughts. The school counselors are also learning the use of paradox, so prominent in TEAM therapy, in order to help them understand their students’ motivations about why they feel and act the way they do, and how their understanding of their students’ motivations can lead to the change. The school counselors Yehuda trains are often quite skeptical and don’t believe him or David, which is understandable. He encourages them to maintain their skepticism but do an experiment and try these tools so they can see what happens. They are often pleasantly surprised by the results. Yehuda describes the counselors he trains as humble, down-to-earth, and hungry to master new techniques that can boost their effectiveness when working with troubled students. If you want to learn more about Yehuda’s work, visit his website at: https://sites.google.com/view/yehudabarshalom Rhonda and David
Live Work with Elizabeth, Part 2 (of 2) “I’m tired of being terrified. I want to be at peace!” Last week, we brought you Part 1 of a session with a women who's been struggling with anxiety and the fear of poverty every since she was 13 years old. that included T = Testing and E = Empathy, including an empathy error that David and Jill corrected. Today, we bring you the conclusion of that amazing session! After the empathy correction, Elizabeth suddenly said: “I don’t talk about this stuff very much as an adult. I’m feeling overwhelmed in a good way right now. A sense of peace is opening up.” You can review the partially completed Daily Mood Log Elizabeth gave us at the start of the sess if you click here. Her goal for the session was to get some relief from the constant pressure she put herself under to function and to keep her practice full. A = Assessment of Resistance Together, we did Positive Reframing with her negative thoughts and feelings, asking: What does this thought or feeling show about you and your core values that’s positive and awesome? What are some benefits, or advantages, of this thought or feeling? Together, we came up with this list of the positives. They keep me moving. They are very familiar. They show I’ve got a good work ethic. They show I’m a responsible human being. They show I care deeply about my family and my business. They show I’m determined to change the family history of failure and deprivation. The anxiety protects me from failure. It has kept me alive. It has paid the bills. Keeps me independent and self-supportive. Shows I’m strong and confident. Shows my love for my daughter. You can see Elizabeth’s Daily Mood Log with her goals for each negative feeling cluster if you click here. M = Methods Next we helped Elizabeth challenge her negative thoughts using Identify the Distortions, Explain the Distortions, and Externalization of Voices, starting with her seventh Negative Thought, “I need the pressure to function,” which she initially believed 100%. She identified the following cognitive distortions in this thought: All-or-Nothing Thinking, Jumping to Conclusions (Fortune Telling), Emotional Reasoning, and Magnification / Minimization. She decided to challenge the Negative Thought with this Positive Thought: I do not need pressure to function. I have functioned many times without pressure just fine. She believed this thought 100%, and this reduced her belief in the Negative Thought to 10%. Then we did Externalization of Voices with this thought and many others. Then David suggested Cognitive Flooding. The idea is to flood yourself with anxiety by imagining whatever it is that terrifies you the most. Every minute or two you record the time, your anxiety (0 to 100), and any fantasies you are having. The goal is to make yourself as anxious as possible for as long as possible. Over time, your anxiety falls, and eventually disappears. This can be frightening, and requires some courage on the part of the therapist and patient, but it can be extremely helpful and often works rapidly. Cognitive Flooding Flow Sheet   Time Anxiety Fantasy Comment 6:34 100 I am looking at my appointment schedule, which is only half full, and the phone is not ringing with new patients   6:35 100 Only two patients are scheduled, no one is calling to inquire about therapy   6:36 110 My throat is getting tight, and I’m telling myself that other clinicians in our practice rely on me, and I’m letting them down.   6:37 Eliz can fill in anxiety ratings, perhaps I’m asking myself, “What will we do? What’s going to happen?”   6:38 Eliz can fill in anxiety ratings, perhaps My schedule is drying up. My associates don’t have any patients. Jill begins with the What-If Technique. What’s the worst that could happen? 6:39 Eliz can fill in anxiety ratings, perhaps The economy is crashing. I have to let go of my associates. This is devastating. And then what? What’s the worst that could happen? 6:40 Eliz can fill in anxiety ratings, perhaps I’m standing in my office by myself. Everyone is gone. I’m alone. No one is calling for training or treatment. And then what? What’s the worst that could happen? 6:42 50 I have to keep working alone in a dark office until I’m 80 years old. And then what? What’s the worst that could happen? 6:43 30 Now I’m 85 years old, still trying to make things worse. My husband has a heart attack and Parkinson’s Disease. Now I have to treat people for free.   At this point something unexpected happened. Elizabeth burst into tears, and said: “I’m angry because this is what I’ve always wanted to do. . . I don’t want to have to charge people for therapy. I just want to treat people for free. She said the flooding was powerful, and melted the conflict she’d been experiencing: “I want to embrace therapy, and do something for free. I love doing therapy. And my biggest fear is that I cannot do that!” David suggested doing the cognitive flooding whenever she felt a pang of anxiety about her practice. You can see Elizabeth's end-of-session Daily Mood Log if you click here. Jill suggested a homework assignment for Elizabeth after the session: You can develop a cognitive flooding script with the What-If Technique. Record it on your phone, and listen to it daily until you get bored and your anxiety no longer flares up. Here is Elizabeth’s follow-up report: I did two rewrites on the script and listen to it daily for about two weeks. The in vivo exposure was to take my schedule offline for at least two weeks and stop trying to keep it full.  I took my schedule offline until Saturday, March 13th thru Tuesday, April 6th.  I have not scheduled anyone new or additional clients during this time.  And clients have not had access to my online schedule during this time. I have gone through varying degrees of anxiety and woke up once in the wee hours of the morning to worry, but overall, there has been a significant decline in my anxiety, worry and checking to see if my schedule is full. This exposure has been very powerful! Jill added this teaching point about Cognitive Flooding: You have the patient imagine the worst thing that could possibly happen and tell it in the narrative form, so it sounds like the What-If Technique playing out...For example, someone with OCD and fears of contamination can tell the story of the worst thing that could happen... "and then I would be dirty, and then I would contaminate my child, and she would get sick, and end up in the hospital, and . . . " etc. At the same time, you also focus on the patient's negative thoughts and feelings and take anxiety ratings every minute or so. The M = Methods illustrated in the podcast include: What’s my grade? What-If Technique Downward Arrow Technique. Daily Mood Log Positive Reframing Identify the Distortions Examine the Evidence Externalization of Voices Cognitive Flooding (combined with What-If Technique) In vivo exposure and response prevention (Jill’s homework assignment for Elizabeth) After each Tuesday group, we get quantitative and qualitative feedback from the members about the quality of the teaching. You can see some of the teaching feedback for the session if you click here. Rhonda and I, and all the members of our Stanford Tuesday training group, and all of our thousands of podcast fans, want to thank you, Elizabeth and give you a great virtual hug! Rhonda and David Follow-Up I just received this lovely note from Elizabeth to report on what has happened since her session in the Tuesday group. Hello Group, Last week April 7th, my schedule went back online after being offline for three weeks.  The process was seamless, my practice did not fall apart.  The other clinician's schedule did not become empty and we did not get a bad reputation.   I no longer fear I will be 80 years old, desperate with a handful of clients and supporting my husband who has a terminal illness.  Or my daughter having to financially support us both.  Even as I write this I am smiling and laughing a bit.  I do not feel driven by the fear of financial ruin nor have I compulsively checked my schedule making sure it is full.  I have more brain space for other things. I believe I have the peace I requested in my miracle cure.  Of course, I will relapse, I already have a couple of times and I have quickly recentered. A deep heartfelt Thanks to David, Jill, and all of you who participated with feedback or witnessed my personal work. My Warmest Regards, Elizabeth
“I’m tired of being terrified. I want to be at peace!” Live Work with Elizabeth, Part 1 (of 2) This podcast features Elizabeth Dandenell, LMFT, who runs a successful treatment clinic in Alameda, California for anxiety disorders, The East Bay Center for Anxiety Relief (www.eastbayanxiety.com.). She is a certified Level 4 TEAM therapist and trainer, and also helps teach mental health professionals at our Tuesday psychotherapy training group at Stanford. We are deeply indebted to Elizabeth for allowing us to publish the very personal, dramatic and inspiring work she did that evening. I also want to thank Jill Levitt, PhD, who was my co-therapist in the work with Elizabeth. Jill practices at the Feeling Good Institute in Mt. View, California (link)  where she is Director of Clinical Training, and teaches with me at Stanford. Like most mental health professionals, Elizabeth occasionally struggles with feelings of anxiety, stress, and self-doubt, and wanted to do some personal work in a recent Stanford Tuesday group. The personal work takes courage, but is crucial to the training and personal growth of all therapists. She was hoping for help with fears that have haunted her since her father died when she was just 13 years old. She explains: I started working when I was 13 years old and that is when the pressure to make money began because my father was an unsuccessful businessman. We were all just scraping by. I started working because my father was unable to pay basic bills at times like phone and electric.  Or our car didn't always run. He was not good at running his own business and money flow was very inconsistent. I discovered when I started working that I could have some control with financial stability if I had my own money and would help out paying the phone bill occasionally. This is when the anxiety of not having enough to survive kicked in and developed the" pressure" I discussed in the podcast and in my daily mood log.. This pressure to survive has has fueled my anxiety for years. My father died from Parkinson’s Disease in a nursing home when he was 77. He wa on Medicaid because he had lost everything. I was 50 when he died. You will hear many techniques that Jill and I used during the session, including Cognitive Flooding. This is, to the best of my knowledge, one of the first times that we have captured this type of Exposure live on a Feeling Good Podcast. Combining Cognitive Flooding with the What-If Technique (pioneered by Dr. Albert Ellis) makes the confrontation with your deepest fears especially powerful.  Listening to that portion of the session will be illuminating for many therapists and patients alike, especially if you are not familiar with, or confident in, the use of exposure  in the treatment of anxiety. Elizabeth’s anxiety was triggered by an exercise we did called “No Practice” in one of the David and Jill workshops for mental health professionals. Essentially, you practice saying “no” to someone who is pressuring you and making unreasonable demands on you. But in Elizabeth’s case, and perhaps for you, too, those demands are internally generated. If you click here, you can see the partially completed Daily Mood Log that Elizabeth brought to the session. T = Testing We began our session by reviewing Elizabeth’s scores pre-session scores on the Brief Mood Survey. The scores indicated only mild anxiety and minimal anger, but these scores probably do not reflect the intensity of the anxiety and terror she often feels. We then went on to: E = Empathy Elizabeth said, “That workshop exercise (“No Practice”) got me thinking about an unresolved issue I’ve been struggling with my entire life.” She explained that I’m doing too much in my life. I complain and then I take too much on and get overwhelmed. I fill my plate too much, and I tell myself that my patients need me, so I’m always taking on new patients to keep my schedule full . . . At times I get really anxious and don’t feel competent or confident. Who I am today is due to constant pushing, pushing, pushing, and never letting up. She explained that the problem started when she was 13: We didn’t have much money, and my father died penniless, in poverty in a skilled nursing facility. I’m always pushing for fear of meeting the same fate, telling myself that if I slow down I might not have enough money for my daughter’s college education, or for our retirement. I work so hard I was once even treated for adrenal fatigue. But my husband and I are not in any financial danger now, and things are fine, and I’d love to have time for more walks, for more meditation. But I’m terrified of slowing down. We did the What-If Technique to explore Elizabeth’s fear of slowing down. What was at the root of her fears? David: What would happen if you slowed down? What are you the most afraid of? Elizabeth: We might not have enough for my daughter’s college and for our retirement. David: And then what? Elizabeth: Our daughter would have to take out student loans. David: And if you did not have enough for your retirement, and your daughter had to take out student loans, what then? What are you the most afraid of? Elizabeth: My father’s life collapsed at the end, and he ended up in a skilled nursing facility with nothing. (tears) Jill pointed out a belief at the root of Elizabeth’s fears. “If I slow down, we won’t have enough money for survival. This fear has been haunting and driving me since I was 13.” Elizabeth said it felt unjust, and that she was angry that she could not take a break without feeling a sense of panic. She said, “it’s all about family values. I wish the work ethic hadn’t been driven into me so hard.” She said she’s struggled with constant worries about money, and wondering whether she can pay her bills ever since she was 13. She said, “It’s not about having fancy things—that doesn’t interest me. It’s all about survival.” Although Elizabeth and her husband are doing really well, and her treatment center is doing really well, she constantly worries, keeps her schedule more than full, and cannot say no to a new patient. She gives herself the message that she should be working longer hours, and that she can work overtime to make room for every new patient. She said, “For years I’ve wanted not to be so overwhelmed, and I’m still stuck with so much on my plate. . . ‘I’m tired of being terrified and want to be at peace. I want to learn to let go of this constant fear, but I don’t know if I can let it go. I want to feel differently, and not just do differently. “I want to be at peace with my business. I want the freedom to say yes or no. I want the freedom of choice. “If I have a day off, I don’t know what to do. It feels weird. My greatest fear is ending up in a nursing home on Medicaid, like my father.” I decided to explore this fear once again, using the Downward Arrow Technique. David: And then what would happen? What would that mean to you? Elizabeth: My daughter would see me and realize she would have to support herself. David: And then what? What would that mean to you? Elizabeth: That would mean I was worthless. (tears) That would mean I was not enough. And then I’d be rejected. Now I’m feeling so ashamed! (more tears) At this point, we summarized what Elizabeth and been saying and feeling, and asked her to grade us on our empathy so far. Would she give us an A, a B, a C, a D, or what? This “What’s My Grade” technique is powerful and helpful, but a bit intimidating for the clinician. Elizabeth said she’d give us an A- or B+. That’s not bad, but it is really a failing grade, because we’re aiming for an A. When this happens you can ask, “What am I missing?” Elizabeth explained that we’d done a great job on the thought and feeling empathy, but she did not feel as much warmth and acceptance as she was hoping for because she was feeling very ashamed about her story Jill reminded us of the need to include “I Feel” Statements to our empathy (my bad), and then we shared our feelings of sadness and admiration for Elizabeth, and quickly got an A. As a teaching point, your perceptions of how empathic you are, if you are a therapist, will not be accurate. That’s why the “What’s My Grade” technique can be so valuable. When you fall short, the patient will tell you why, and can easily make a correction and greatly enhance the therapeutic relationship. Superb empathy is desirable, and necessary if you want to do top-notch clinical work, but it won’t cure much of anything. So we’ll need something more! Next week you will hear the amazing last half of the session, starting with A = Assessment of Resistance and then going on to M = Methods, and end of session T = Testing. In next week's podcast, you'll hear the final half of Elizabeth's session and, if you like, you can also listen to some of the Q and A from the participant's in the Tuesday group who watched the session live. Rhonda and David
239: Ten Days to Self-Esteem, Featuring Dawn O’Meally Dawn O’Meally is a licensed mental health professional from Westminster, Maryland who purchased my book, Ten Days to Self-Esteem workbook (link) as well as the Ten Days to Self-Esteem Leader’s Manual for at a workshop she attended in 2002. This is a 10-class self-esteem training program for patients and the general public. The groups can be led by a therapist or lay person. This book was the basis of a large and successful treatment program at the hospital where I practiced in Philadelphia. Dawn described reading the books and telling herself, “I can do this!” Since that time, she has conducted roughly four Ten Days groups per year. The improvement in her patients has been phenomenal, due, in large part, to her spark, creativity, and gift for teaching and inspiring individuals struggling with depression, anxiety, and low self-esteem. In the podcasts she takes us through the first seven steps of the ten-step program, and reads testimonials from patients like Julie who wrote: “I had many WOW moments. This book is my bible!” If you are interested in setting up a similar program in your area, feel free to contact Dawn at dao@tcc4change.com. I think it is fair to say that today’s podcast is electrifying, and filled with the same excitement that Dawn brings to her patients! Dawn describes herself as a little like Miss Frizzle with her Magic Schoolbus. I’m not personally familiar with Miss Frizzle but it does sound like fun, exciting, and creative, three strong characteristics of Dawn. She describes how she makes patients accountable, requiring a $50 deposit they can earn back by coming to groups on time and doing their homework (HW). As a group, they also do a Cost-Benefit Analysis (CBA) on the Advantages and Disadvantages of doing the HW, and review the list of really GOOD reasons for NOT doing the HW in the book, with each member ticking off the ones that resonate with their own thinking. She said some of the most popular ones are: I’m afraid of what might happen if I DO change. I believe that others are to blame for my problems, so why should I have to change? I don’t trust Dr. Burns! I’m not convinced the exercises in this book will really make a difference in my life. Dawn described several of the “steps” in the group, including the exciting steps on “You FEEL the Way You THINK” and “You can CHANGE the Way You Feel.” She said that members found the lesson on healthy vs unhealthy negative feelings illuminating, and the lesson on the Acceptance Paradox was mind-blowing. The group trains participants in 15 techniques for crushing distorted thoughts, and some of the popular ones include the CBA, Examine the Evidence, the Double Standard Technique, and the Acceptance Paradox. She described the feared and famous “Mirror Method,” where patients pass a mirror around the group and each one has to look into it and verbalize his or her negative thoughts, like “I’m a failure,” and “I’m the worst mother on the planet.” Then they have to talk back to that thought, using the second person, “You,” as they talk to themselves in a more realistic and compassionate manner. She also does the T = Testing at each group session, tracking changes in depression, anxiety, and relationship satisfaction and sees significant reductions in scores on the mood tests by the end of the program. She also gives each participant a “report card” at the end of the program so they can see how much they progressed. Participants FEEL so much better! At the start of the group she tells participants, “If you attend the groups and do the exercises in the book, you WILL change. This material can’t not have a huge impact on your life.” She said that at the end of the ten sessions, the participants see that this really did happen. She emphasized that she greatly prefers treating people in groups, but calls them “classes” due to the stigma of “group therapy.” I, David, strongly agree, as this has been my experience as well. With a skillful group leader, and great material, magic becomes possible! Dawn has done much more, creating follow-up groups for interested patients, as well as a new program based on my new book, Feeling Great (link), so we hope to have an encore appearance from this bubbly and brilliant woman! Rhonda and David
238: Feeling Great Book Club Featuring Drs. Sharon Batista and Robert Schacter In today's podcast, Drs. Sharon Batista and Robert Schacter describe their visionary 16-week Feeling Great Book Club for mental health professionals that we mentioned in a podcast several months ago. The group was a great success, and I am super thankful to them for creating it! Sharon described how the group came into being. She’d been looking forward to Feeling Great and ordered the hardbound and the audio version as well. But she found, like so many mental health professionals, that it is difficult to keep up with career and family, and sent out a post to colleagues suggesting a possible book group to make the process of learning easier. Bob wrote back and said, “What a brilliant idea! Let’s do it!” Sharon and Bob reported that the more than 40 therapists signed up for the Book Club, which consisted of 90-minute sessions every other week. The participants ranged in experience from Level 1 to Level 4 certification in TEAM-CBT. Sharon explained that “People liked learning the parts of TEAM piece by piece. Being assigned to read 1 chapter per week gave them enough time to read and digest the material in small chunks. And people had a myriad of questions at every group.” Sharon and Bob graciously said that “a highlight for the group was the time David attended and generously gave us over two hours for Q and A.” For me (David) it was also a peak experience. Due, in part, to my narcissism, I just love answering questions, and they asked tons of really good ones! The other phenomenon they described was that “we became a group. It was comforting to see each other every two weeks with a common purpose and sense of community. People felt the group was relaxed and said they gained more understanding than from the training groups they’d been in. People were relieved to discover that they weren’t the only ones who thought TEAM-CBT was very complex.” Sharon added; “As therapists, we face lots of challenges and sometimes make mistakes. The participants got a lot of support and engaged in a process that involved learning and personal growth.” The questions from book club members began with clarifying the descriptions of the ten Cognitive Distortions. People asked questions like these: What is the difference between Overgeneralization and Mental Filtering? Why is a Should Statement a cognitive distortion? Why do some methods work better than others for various distortions? How do we know which ones to use? What is Unconscious Resistance? Why does the therapist need to become the voice of that resistance? What do you do when nothing seems to be working? Can you explain how the Magic Button leads to the “Switch” that makes someone decide to get better. How do you show empathy to someone who is suicidal? Can you explain the Death of the Ego? (This was a big question) When you are dealing with the spiritual side, how do you take the path of acceptance? What is the path of acceptance? What is the difference between a low-level and high-level solution? How can you be happy if the negative thoughts are true? How can you do TEAM-CBT when only 50-minute sessions are possible? Tell us what Enlightenment is! A major question was: Why do some people seem to not want to get better? How do you figure out what the resistance is, and how do you work through it? We shot the breeze about some of these questions in today’s podcast. If you would like to start your own Feeling Great Book Club for therapists or for lay people, and need more information, feel free to contact Sharon or Bob. Sharon M. Batista, M.D., FAPA, FACLP, FAMWA Medical Director, Balanced Psychiatry of New York  (212) 869-0515 drbatista@balancedpsychiatry.com Rhonda and I want to thank both of them and send them a big virtual hug!
Podcast 237: The Gentle Ultimatum: Can We Make Our Patients Accountable? April 12, 2021 At the top of the podcast, Rhonda reads several beautiful and thoughtful comments from listeners like you. One was an enthusiastic listener who found us on YouTube and wondered why we don’t have vastly larger audiences, since the quality of what we offer is not only free, but it beats out all the other “self-help gurus” by a large margin. Thanks for that. We are not experts in market and could use all the help we can get. So if you can spread the word for us, we’d appreciate it! David announced that his next workshop with Dr. jill Levitt will be on May 16, 2021, featuring David and Dr. Jill Levitt working with two audience volunteers who are struggling with depression and anxiety. Link to Registration Information It should be dramatic, inspiring, and profoundly educational, so you can see how TEAM-CBT really works in a live and spontaneous setting with no role-playing. This will be the real thing! One of the unique features of TEAM Therapy is the Gentle Ultimatum. At the beginning of therapy, we tell patients what will be required of them, and how the therapy works, if we accept them as patients. That way, they can make an informed decision about whether or not they want to work with us. This table illustrates what they’ll be asked to do. Problem What the “Gentle Ultimatum” involves Rationale Depression Psychotherapy homework David’s published research indicates that psychotherapy compliance has massive causal effects on recovery from depression. Anxiety Exposure Extensive research shows that Exposure is effective in the treatment of all forms of anxiety. Clinical experience indicates that full recovery from depression is difficult, if not impossible, without exposure. A Relationship Problem Giving up blame and focusing on your own role in the problem Research and clinical experience indicate that blame is probably the main cause of troubled relationships.   In the podcast, David and Rhonda discuss the rationale for the Gentle Ultimatum, as well as how to do it skillfully, and when. David describes his own reluctance to make patients accountable during the first seven or eight years of his practice, and what happened to change his mind, and how that led to the emergence of TEAM-CBT. David also describes the correct and incorrect way of presenting this to patients at the initial evaluation in a kindly, collaborative way. This requires therapist integrity, skill, and compassion. You cannot simply issue a crude “my way or the highway” demand. David also describes the Concept of Self-Help Memo that he created and began sending to patients prior to their first visit. The memo explains the rationale for requiring psychotherapy homework, briefly describes the ten most common forms of homework, and asks patients if they are willing to do homework if accepted into the clinical. The memo also asks how many days per week they’ll agree to, how many minutes per day, and how many weeks she or he will keep it up. The memo concludes with a list of “35 GOOD Reasons NOT to do Psychotherapy Homework,” and patients indicate how strongly they agree with each one. David illustrates how he discusses the memo, and the topic of homework, with new patients. David compares the Gentle Ultimatum with what happens when you go to the doctor with a broken leg. He or she might say you have to get an X-ray, and then we’ll give you a cast. If they patient protests and says that she or he is against X-rays and casts, and wants to be treated with “talk therapy,” the doctor would politely decline and explain that s/he is using a medical model of treatment, and that “talk therapy” is not offered for broken limbs. David and Rhonda explore the fairly intense resistance of many, and perhaps most therapists to making patients accountable. Rhonda describes her own inner fight about this, and how she had to terminate a patient recently because s/he refused to do homework, and opted for pure “talk therapy” from another therapist instead. The table above indicates that if the patient is struggling with anxiety, Exposure is the focus of the Gentle Ultimatum. If the patient wants effective treatment, Exposure will be required, and not an option. If, in contrast, you want help with a relationship problem, like a troubled marriage, you will have to agree to stop blaming the other person, and focus on pinpointing your own role in the problem, which can be immensely painful and humiliating. But it’s also liberating, because when you change yourself, instead of blaming the other person, you can transform trouble relationships into loving ones. Rhonda points out a potential conflict of interest with TEAM-CBT and the Gentle Ultimatum. It can lead to such rapid recovery that therapists need a large flow of patients. David mentions that one of the therapists in Rhonda’s FeelingGreatTherapyCenter.com, Sunny Choi, has this exact problem. His patients are getting better so fast he can’t keep his practice full. David urges potential patients to contact him, if interested, since Sunny is not only remarkably skillful, but he has a big heart and low fees, with a sliding fee scale, too. Thanks for listening today! Rhonda and David
Upcoming Workshops The Cognitive Distortion Starter Kit With David Burns, MD A One-Day Workshop on May 5, 2021 Click here for more information including registration! 8:30 AM to 5:00 PM West Coast Time: 7 CE Credits   Bringing TEAM-CBT to Life in Real Time Two Live Therapy Demonstrations with Drs. David Burns and Jill Levitt REGISTRATION CLOSES AT 5:30 PM PACIFIC TIME ON SATURDAY 5/15/21. NO EXCEPTIONS. Live Online Workshop with David Burns, MD and Jill Levitt, Ph.D. Click here for more information including registration! May 16, 2021 | 7 CE hours. $135 8:30 AM to 4:30 PM West Coast Time   Binoy asks: How does one know that a thought is a good one or a bad one? Or put in another way, how do I know if my fortune telling thought is really a fortune telling one? What is the basis? Binoy also asks: Is there something called “objective truth” that we can all agree on? Kristina asks: I have been labeled codependent in therapy. Is it a true label? . . . Do you believe in highly sensitive or empathetic people that can feel others energy? Fabrice asks: What do you think about this definition of the “self?” Don asks: Is TEAM as effective as you say? Binoy asks: I live in an Arab country and some of the things on your list of Shame-Attacking Exercises could get me arrested. Is there a better way to overcoming anxiety? * * * Binoy asks: Hi David, I just listened to podcast 079: “What's the Secret of a "Meaningful" Life? Live Therapy with Daisy." One of the questions that came across my mind is, how does one know if a negative thought is a good one or a bad one? Or put in another way, how do I know if my fortune telling thought is really a fortune telling distortion? What is the basis? Hi Binoy, thanks! Excellent question I might address on a future Ask David podcast. However, I would need you to give me a specific example of a thought you want help with. Specifics typically lead to illumination, whereas abstract thoughts sometimes lead to endless pontification. Binoy also asks: “Hi David, I did listen to the podcast #20 on “The Truth About Antidepressants.” I wish everyone agreed that there is something called objective truth. This is a question about truth or the existence of objective truth. Is the popular ideology that there is nothing called objective truth (everything is relative) correct? How can we talk about truth in a way that will help us be on the same page? So, I hope to hear from you again! Hi Binoy, this is also an abstract question, best answered through specific examples. For example, I can explain the concept of controlled outcome studies to test a drug against placebo, but even there you can find lots of ways to challenge any scientific study. We can also talk about distorted negative thoughts that trigger negative feelings like depression and anxiety. These thoughts are not really true. but we always focus on one specific thought at a time, and only from someone asking for help. I do not pontificate about “truth” in some abstract sense! All the best, david * * * Kristina asks: I have been labeled as codependent in therapy. Is it a true label? Hi Dr. Burns, Thank you so much for all your services and help that you offer Dr. Burns. It has been life changing and I’m just starting to help myself out of this anxiety and depression. I wanted to ask how you feel about the terms, codependency and boundaries. I have been labeled codependent in therapy and is it a true label? Do you believe in highly sensitive or empathetic people who can feel others’ energy? Thanks again for all you do! Thank you, Kristina   Hi Kristina, I had to look up the term. According to dictionary.com, someone who is codependent “is in a relationship in which one person is physically or psychologically addicted, as to alcohol or gambling, and the other person is psychologically dependent on the first in an unhealthy way.” David and Rhonda can mention: the “codependency” and compulsion to “help” or “rescue” that often gets therapists into trouble with patients. This is a kind of addiction that therapists have, and is the main cause of therapeutic failure. that I work with specifics more than labels. For example, if a patient wanted help with “codependency,” I would ask him or her to describe a specific time on a specific day when this seemed to be a problem. Then I’d figure out what was going on, and find out if it was an individual mood problem or a relationship problem. After empathizing, I would find out what, if anything, the patient wanted help with, and then I’d bring the resistance to change to conscious awareness. My research on empathy indicates that even therapists are not accurate in sensing how their patients feel. The same is true, I believe, of the general public. People vastly overestimate their capacities to understand how others are thinking and feeling, and this is super easy to demonstrate with simple experiments using rudimentary statistical analyses. David * * * Fabrice asks. What do you think about this definition of the “self?” Hi David & Rhonda, Start with this: When I refer to my "self," I am speaking of the sum of my experiences and the trails they have left in my mind, my body, and my life circumstances, as well as the material things that are associated with me, beginning with my body, symbolized by the name printed on my ID card. This "self" has certain characteristics, including past actions, habits, patterns, qualities, flaws, etc. So, the first question is, how can you say that this "self" does not refer to anything? I know very well who I am, and I am distinct from any other "self" that presents him/herself to me. The second question is, based on the previous definition, why can't I pass judgment on the different attributes of that "self"? If that self has never been able to solve a linear equation, can't I call it "bad at math?” If that self almost always turns in its assignments after the deadline, can't I call it "slow" or "procrastinating?” And so on. I agree that passing negative judgment on a self can lead to that self having some unpleasant emotions, but that doesn't mean that those judgments are meaningless. I suspect that some listeners were turning over thoughts like these in their minds. I hope that gives you something to sink your teeth into. I'll try to be more specific about future episodes. Take care, Fabrice Nye Hi Fabrice, Thanks! When I get time to redo the deleted chapter on the “self” from Feeling Great, I can perhaps include these questions, although I did pretty much cover them in several of the later chapters in Feeling Great on the impossibility of judging the “self,” as opposed to things we think, do, or say. My problem is that people don’t “get” or “grasp” what I’m trying to say. Below, you seem to think I believe the “self does not exist,” and you have some excellent attempts to define it and prove that it does exist. At least that’s my take on it. My position is radically different. To me, the statement “the self does not exist” and “the self does exist” have no meaning. The statement, “I don’t know if the self exists” also has no meaning to me. This is language that is “out of gear,” so to speak, as Wittgenstein might say. You can press on the accelerator all you want, but the car won’t move forward when it is not in gear. But most people, nearly everybody in fact, have tons of trouble grasping this. You probably “get it,” I don’t know! I am just referring to your email, where you say the self is such and such. Nouns do not always refer to “things” that could “exist” or “not exist.” Still, when I say this, it goes in one ear and out the other, I’m afraid! And that was why Wittgenstein was intensely lonely and frustrated, and often depressed, and perhaps why he never attempted to publish anything during his life. You can certainly say, “I’m not very good at math. In fact, I’m below average at math.” This means that your math skills are below average. Does it also mean that your “self’ is below average? Many of my skills and attributes are below average, but that does not upset me or threaten my feelings of self-esteem for two reasons: I don’t believe that my worthwhileness as a human being depends on anything. I don’t believe that “worthwhileness as a human being” has any meaning. I don’t believe the statement, “the self exists,” has any meaning. What would it be like if “the self” didn’t exist? What are we actually talking about? But if I judge my “self” to be “inferior” or “worthless” or “below average,” that type of self-critical thinking can cause a lot of emotional pain, and can, in extreme cases, even lead to suicide, thinking that “I am not good enough.” david I asked Fabrice if he wanted to comment on my response above, and if I should include it in the show notes. He gave a really cool answer: Hi David, Yes, you can absolutely include it. From your response here, you ought to make it clear that your point is that the language is not meaningful, therefore the word, "self," is not meaningful. But you may need to delve deeper into this. If you do that, you're going to end up at the same place the Buddha ended up when he discovered the ultimate emptiness of things. Of course, he didn't talk about "things," since that's meaningless too, just emptiness. Fabrice Nye By the way, you may enjoy Fabrice’s new podcast. Here’s the link: https://podcasts.apple.com/us/podcast/peace-at-last/id1496573038 The following email might also help. Hi Rhonda, Here is the other Ask David with the remainders from our last one. If we use this one, let’s please be sure to include your through about your “self” as “a mom,” “a psychologist,” and so forth, and how I responded to it, as I thought that was really helpful. We can judge and talk about what we DO, and not what we ARE. We can use the word, “self,” in a variety of ways that are meaningful. For example, Behave yourself. This means stop behaving badly. Just act like yourself on the date. This means don’t try to impress your date. Instead, show an interest in him / her. Why you write, try to tune I on your true “self,” and stop acting so fake. This means you need to change your tone of voice when you write. Share more of your feelings and vulnerabilities. All these uses have specific meanings. They are not metaphysical or philosophical claims, just attempts to influence someone’s thinking, feelings, or behavior. “Self” is just a sound that comes out of your mouth. It is not an esoteric or metaphysical “thing” that could “exist” or “not exist.” Aristotle thought that nouns were descriptions of “things” that existed in some ideal alternative reality. For example, he thought that tables are just imperfect examples of some perfect essence of “tableness” that exists somewhere. This erroneous view of language gave rise to most of the problems in philosophy, as well as most of our emotional problems of feeling we have a “self” that isn’t important, or isn’t worthwhile, or isn’t good enough, and so forth. d * * * Don asks: Is TEAM as effective as you say? Hi Dr. Burns, I feel compelled to say, with the greatest respect and affection, that the very concept of successfully treating my lifelong battle with depression, anxiety, and ocd within a few hours seems, at face value, far too good to be true! Is it really possible? I've endured countless disappointments and treatment failures from many, many therapists, all of whom wasted months or even years of my time, essentially to no avail. Tell me again: Is short term treatment, as described, as potent as TEAM promises. It's just so hard to believe! DBs Comment: Don went on to describe chronic severe mood problems and recent intense feelings of anxiety due to medical problems in his family. Hi Don, Good questions. Here are some thoughts. Effectiveness depends on the skill of the therapist, and TEAM is challenging to learn. I’ve been at it for more than 40 years, and have used T = Testing at every session with every patient. This has been my greatest teacher—my patients. Some of my students have achieved high levels of skill, and they are the ones who have put in tremendous effort to learn. There are not yet many of them, sadly, and that’s why I’m working on an app. . . . So I can make these tools available to large numbers of people who are suffering. We will be starting a new beta test in a few weeks. It is in progress, and very labor-intensive to develop, but if it works, it will be fantastic. An inexpensive way to find out if TEAM is for you, and you have perhaps done this already, would be to read Feeling Great and do the written exercises while reading. Then you’ll find out if you like the new methods, and if they are helpful for you. I assume you’ve already read Feeling Good and done the exercises. Is that correct? The results I report are the results of my work with patients, using TEAM. I only report truthful things, and don’t fabricate results! I am analyzing a huge data base of thousands of TEAM therapists at the Feeling Good Institute, but it is a naturalistic study, and interpreting the results is challenging for a variety of reasons. The mean reduction in depression scores in a large number of severely depressed individuals in four or five sessions was 59%, which is excellent. It is little bit hard to interpret that result because when patients recover, they drop out of treatment, so the mean depression score in the data you analyze at any session is the mean of those who are still in treatment who have not yet recovered. Therefore, the analysis is potentially biased in a negative direction, if you see what I mean. My published research shows that psychotherapy homework is crucial to success. Some patients are strongly opposed to doing homework, and they are likely served better by therapists who do not believe in the value of psychotherapy homework. The rapid recovery I see is in the treatment of depression and anxiety. Relationship problems are much more challenging to treat due to the intense resistance people have to looking at their own role in a problem instead of blaming others. Habits and addictions can be slower and more challenging, too, since the temptations to give are so pervasive and powerful. Thanks! I hope this information in helpful for you. Here’s an afterthought. Sometimes when people ask me if this will really work, they are actually skeptical or even annoyed, and expressing resistance or a lack of enthusiasm for the treatment techniques I have created. I do not try to sell patients on anything, and feel strongly that people should find an approach they are enthusiastic about, even if it is radically different from the methods I have developed! I strongly applaud skepticism and critical thinking, but it is also true that trust and TEAMwork are vitally important dimensions of successful treatment. If a patient is putting up a wall and resisting, that must be dealt with first before there is any chance for success. The approach to resistance is radically different from answering questions as I am doing here. I hope that makes sense! Here’s the type of thing I’m saying, or trying to say. If you’ve been burned in the past, and had negative therapeutic experiences, it would make sense that you’d be reluctant to trust, or to hope, or to collaborate, for fear of being let down yet again. I would want to bring this issue to conscious awareness at the start of therapy with anyone who has strong feelings of skepticism, and anyone who is saying “prove it to me” when we start therapy. Almost all the patients I’ve treated have had months, years, or decades of failed therapy in the past. But that’s not so crucial. The crucial question is, can we work together with some trust and enthusiasm and teamwork? And are you willing to do what will be necessary for a positive outcome? This might include doing regular psychotherapy homework, being willing to use Exposure techniques for anxiety, like OCD, and so forth. Lots of people don’t want to do homework or use exposure, and they may have other objections to the treatment, which I honor. I don’t try to persuade or twist arms, since those approaches are doomed to failure. Not sure if this makes sense, or if I’ve expressed my thinking clearly. david * * * Binoy asks: I checked the list of shame attacking exercises you have suggested for social anxiety. I live in an Arab country. Some of the things on the list could get me arrested. Is there a better way to overcoming anxiety? Hi Binoy, Perhaps you can tell me what Shame Attacking Exercises would get you arrested! Since I’ve listed more than 100, perhaps you could choose ones that will not get you arrested! In addition, I never throw techniques at people based on a diagnosis or problem, but work systematically using T, E, A, and M. In addition, I use four treatment models, and more than 50 techniques, when I am treating any form of anxiety. There is a free anxiety class on my website. Check it out!  
235: Anger in Marriage Several months ago. a professional dancer named Brian emailed me with an Ask David question on how to deal with anger in marriage using the Five Secrets of Effective Communication. I was pretty excited because anger in marriage is a problem nearly everyone can identify with, and something we all need some help with! Brian and his family Brian said that he and his wife, Michelle, have been married since 2009, and while he loves Michelle a great deal, their relationship runs hot and cold, with frequent angry clashes. I asked Brian for a specific example, including a partially filled out Relationship Journal (RJ), so I could get some details on what his wife said to him, and what, exactly, he said next, during one of their conflicts. Brian and his wife, Michelle The analysis of this exchange will provide us with a crystal clear example of the type of problem they are struggling with, along with the opportunity to pinpoint the specific errors Brian is making in responding to his wife’s criticisms. In the example he sent, she said that he wasn’t doing enough to help put the kids to bed one night, and he responded by saying nothing. He analyzed his response with the EAR technique from my book, Feeling Good Together. By ignoring her, it was obvious that failed on E = Empathy (he did not acknowledge how she felt), and A = Assertiveness (he did not share his feelings), and on R = Respect (he did not express any warmth, respect, or love for her.) He was able to see that this response will make the problem worse and force her to keep criticizing him. When he ignores her, she feels even more hurt, ignored, abandoned, and unloved. As a result, she’ll keep criticizing him since he hasn’t yet listened or “gotten it.” So although he feels like an innocent victim, he’s actually the secret creator of his own interpersonal reality. In other words, he forces her to do the very thing he’s complaining about. That’s the purpose of the Relationship Journal (RJ) —to help you see your own role in a conflict. It’s an amazing but pretty painful tool that’s potentially liberating. At my urging over the past several months, Brian worked really hard studying the Five Secrets of Effective Communication (LINK) and doing the written exercises in Feeling Good Together. After a rocky start, with some notable failures in his attempt to improve his interactions with his wife, he slowly began to “get it,” and their relationship began to improve a lot. Brian joins us today to describe his journey, and share his excitement about my first book, Feeling Good, as well as Feeling Good Together. I am really proud of what Brian has accomplished through commitment, practice, and hard work, as well as his courageous willingness to look at his own role in the problem. This is nearly always painful, and requires the “great death” of the “self,” or “ego.” During today’s podcast, we practiced with the “Intimacy Exercise.” This exercise can help you improve your skills with the Five Secrets. Here’s the way it works. To get things started, either Rhonda or David will play the role of Brian’s wife, and Brian will play the role of himself. We will criticize Brian in the way his wife sometimes criticizes him, and then he will respond, using the Five Secrets. For example, she recently said: “When I was on the phone with my best friend, you were rude and selfish, and making too much noise with the video you were creating.” Then he responded and we gave him a grade, and pointed out what he was doing right and what he was doing wrong that needed improvement. If you check your ego at the door, this can be a great, but challenging, way to learn! Brian gave himself a C on his response, which you’ll hear in the podcast, and Rhonda agreed. She also gave him a C. I gave him a B, as I thought he did some pretty cool things while making several errors. Here’s where he needed improvement. His use of the Disarming Technique needed upgrading. He didn’t strongly and directly endorse the truth in his wife’s criticism. For example, he might say something like this: “You’re right, I was being insensitive and selfish, and I’ve done that to you so often over the years.” His response would benefit from the inclusion of some “I Feel” Statements,” since it sounded a bit mechanical. For example, he might say, “I feel really sad and ashamed to hear you say that I was selfish and insensitive, because you’re absolutely right, and I love you so much.” There was no Stroking, and I included one way to do this in the “I Feel” response I just described. His Thought Empathy was good, but there was no Feeling Empathy. In other words, he did not mention how sad, hurt and angry his wife might be feeling. He did not finish with a sound use of Inquiry that would invite his wife to open up even more. For example, he could end by asking her to tell him more about how she feels when he’s being insensitive and selfish, and how hurt, angry, and lonely she might feel. Brian was non-defensive and open to this feedback. Then we did role reversals to give him the chance to try these new approaches and boost his grade. Here’s a comment he wanted me to share with you: Learning and implementing the 5 Secrets of Communication literally helped to save my marriage. The breakthrough came for me when I was really able to grab hold of Feeling Empathy, and really delve deep into understanding how my actions hurt my wife. This was one of the hardest challenges I've ever had in my life but the deeper I got into my wife's heart and mind, the more my anger dissipated and was replaced by empathy, warmth and love for my wife. I am no expert by any stretch of the imagination and in the podcast, both Rhonda and David went over some really cool role play to help sharpen my skills in the 5 Secrets. My hope is that by sharing my story it will help to provoke some helpful thoughts in the listener to help them continue to grow in their relationships. Brian Brian also said that he is a Christian, and loves Jesus, and that one thing he appreciates about the Five Secrets is that it is deeply connected to Christian teachings. For example, here’s a quotation from Matthew 7:3: “And why beholdest thou the mote that is in thy brother's eye, but considerest not the beam that is in thine own eye?” I strongly agree with Brian’s take on this, and believe that the Five Secrets of Effective Communication can be viewed as both a psychological and a spiritual tool. I would add that the Five Secrets, as well as all of the techniques in TEAM-CBT, are compatible with most if not all religious traditions. I have often said that the moment of profound change—the moment you recover from anxiety or depression, for example—will nearly always have a spiritual meaning, but the details of your interpretation will depend on your religious or philosophical upbringing. I like to emphasize this because my father was a Lutheran minister, but he seemed pretty suspicious of psychiatrists, thinking that psychiatry and religion were inherently at odds with one another. Some deeply religious people have seen me, as some kind of pariah, or enemy of religion. When I lived in Philadelphia, I went to Lancaster, Pa, on ten consecutive Saturday mornings to teach CBT at a beautiful religious hospital there. I enjoyed teaching their staff a number of new techniques for treating depression. They told me that one of the local evangelists had a Saturday morning radio show, and that whenever I came to town, he would say, “the snake has returned to Lancaster” on his show! I think it is because I quoted the Buddha on something, and some of the more conservative folks didn’t take kindly to that comment! I guess they thought that the Buddha was the same as the devil! I see religion and psychotherapy, in contrast, as synergistic. Although all of my work is totally secular, and based on research and clinical experience, the overlap of TEAM-CBT with all religious traditions is clear and unmistakable. I love it when clergymen, rabbis, or imams attend my workshops and point out the common grounds with what I’m teaching and their theological beliefs. We did more role playing during the podcast, as Brian also wanted to focus on his feelings of insecurity resulting from relentless self-critical thoughts, like, “I suck at dancing, so I’m worthless”. We used THE Externalization of Voices along with the Acceptance Paradox, the Self-Defense Paradigm, and the CAT (Counter-Attack Technique) to challenge his negative thoughts. We also used Positive Reframing to reduce his resistance to giving up his self-criticisms. We did a number of role plays with role reversals, just as we’d done earlier when practicing the Five Secrets. Brian was incredibly fun to work with, and Rhonda and I developed great affection and admiration from him. We’ll try to post some follow-up, too, once Brian has had the chance to listens to the audio with his wife We can perhaps get her responses to the show and include them in the show notes. There were at least two keys to the rapid progress Brian has made learning to use the Five Secrets of Effective Communication with very little input from me. He is very much in love with Michelle and intensely committed to improving their relationship. He has high standards and is willing to put in the work that is necessary to master the Five Secrets of Effective Communication, not only in his interactions with his wife, but also with people in general. He has also been willing to put in the work to learn to change the way he thinks and feels, so he can modify his internal dialogue as well as the way he communicates with others. Your internal and external dialogues will often fuel each other. You know that Brian is a professional dancer. Can you guess what he does for a living? I was surprised and delighted to learn that Brian runs a Break Dance School in Long Beach, California, for children, teens, and adults. Here is the link in case you want to contact him or sign up for some awesome break dance classes! Webreakdance.com Instagram.com/Webreak Here are some awesome video links you can watch: Webreak Soul Evolution Crew Performance: https://youtu.be/M4FzENnYXj4 Brian Breakdancing Solo: https://www.instagram.com/tv/CHjr8yXhGk7/?igshid=1341ipmr311ho
Announcements / Upcoming Workshops March 24, 2021 Feeling Great: A New, High-Speed Treatment for Depression and Anxiety. A One-Day Workshop by David Burns, MD. sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration!   April 7, 2021 Bringing TEAM-CBT to Life in Real Time, by David D. Burns, MD. A Half-Day Live Therapy Demonstration Sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration! * * * Podcast 234: How To Deal with Whiners and Complainers In today’s podcast, we bring to life two of the earliest CBT techniques I developed way back before I wrote Feeling Good: The New Mood Therapy. The are: The Anti-Whiner Technique The Anti-Heckler Technique they are both based in two of the Five Secrets of Effective Communication: The Disarming Technique: You find truth in what the other person is saying Stroking: You find something positive to say to the person In addition, if appropriate you can include Feeling Empathy, especially in the Anti-Whiner Technique. This means that you acknowledge how the other person is feeling The Anti-Whiner Technique Most of us know someone who tends to whine and complain a great deal, and you might have noticed that when you try to help them, cheer them up, or give them some advice, their whining and complaining just escalates, so you end up secretly frustrated and annoyed. If you’re tired of this pattern, you might want to try the Anti-Whiner Technique, which can be incredibly effective, but it’s anti-intuitive. You simply agree with the person who’s complaining, and give them a compliment. Rhonda and David will illustrate this with complaints like these: Nobody cares about me! I never get to do what I want to do. Nobody likes me. I never get invited anywhere. I never get to do anything fun. I’ve tried everything and nothing seems to help. All the doctors just seem to care about themselves. Nobody listens to me! Life is unfair. People only care about themselves I have to do everything for myself. Nobody helps. I can’t hear very well, my sight is deteriorating, and I’ve got hemorrhoids! What can I do? Preparation H doesn’t help at all! My students just don’t listen. This younger generation is totally screwed up! Nothing helps! I’m depressed all the time. I’ve tried everything. No one every said one kind thing to me! I’ve got so much to do, but I just can’t get started, and everything just keeps piling up! The Anti-Heckler Technique I love treating public speaking anxiety because I used to struggle with this problem myself, but now I totally love public speaking. One of the many reasons that people fear public speaking is because they’re afraid someone in the audience will become critical or hostile, or ask them something they can’t answer. The Anti-Heckler Technique is fairly easy to use, and works like a charm if done skillfully. It’s similar to the Anti-Whiner Technique we just illustrated. Just make a list of hostile things that the audience member from hell might say during your talk, or during the Q and A period, and then respond with the Disarming Technique plus Stroking. Rhonda and I will illustrate this with these kinds of critical comments. You’re full of shit and you know it! What you’re saying isn’t true and doesn’t make sense. You’re a total fraud and a fake. You're not supposed to say that. You talk too fast. You are confusing. You don't know what you're talking about. You are not following the outline you gave us. It's too cold, too hot. You're wrong about that. You are quoting outdated research that's been debunked already. I didn't like it when you made jokes. You don't know enough to teach this class. You're disorganized, incomprehensible, and boring. You always call on the same people in the audience, you play favorites. Rhonda and David also explore why it is so hard to use these techniques in our personal and professional relationships, and why we lapse into adversarial defenses when we could collaborate with others in the spirit of mutual exploration and learning. Most of it has to do with the idea that we have a “self,” or “ego” to defend! As the Buddha so often said, “Selves are cheap. Selflessness is dear!”
Phillip with his brother, (Paul), his mother (Maureen) and Ladybug (Labrador). Phillip Lolonis joins us again with vital information we forgot to explore in his first podcast two weeks ago. Phillip's interest in the treatment of schizophrenia stemmed from his relationship with his brother, who suddenly and unexpectedly developed schizophrenia when he was 19 years old. and Phillip was 26, One of his motivations to become a therapist was his anger and disillusionment with the treatment his brother received that was medication focused and somewhat formulaic. Phillip thought the impact was somewhat detrimental. In today's podcast, we explore how to use the Five Secrets of Effective Communication, and especially the Disarming Technique, in interactions with individuals with schizophrenia. This can be difficult and challenging, because many of the things the patient says are delusional and can't possibly be true, like "I know you're plotting against me!" And yet, as David points out, if you listen to the "music" behind the words, you will see that the individual is saying something that's absolutely true. He or she is just expressing feelings in a symbolic manner. And if you find the truth in what the person is saying, he or she will nearly always calm down and feel heard and respected. Rhonda, Phillip and David demonstrate this in role-playing, using statements like "You're against me!" David recalls his treatment of an angry young university student with severe paranoid schizophrenia who responded beautifully to Dr. Stirling Moorey, a (then) visiting medical student from London who was doing cotherapy with David so he could learn the then-new cognitive therapy. Stirling used the Disarming Technique when the young man insisted that the police were trying to prevent him from seeing John the Baptist who had secrets about the spiritual human of the human race. When Stirling expressed interest and found truth in what the young man was saying, there were immediate and dramatic results. David described this interaction in his first book, Feeling Good. Phillip said he's experienced similar things with his brother, and that this new way of communicating has been helpful. Rhonda commented that we've had many podcasts recently on the Five Secrets of Effective Communication. These techniques are very challenging to learn, for technical and human reasons, but incredibly rewarding if you're willing to learn them and let your "ego," or "self," die. Phillip asked us to add these comments to the show notes:  I'd like to add that the place that has been a godsend for my brother and our family is called the Putnam Clubhouse he regularly attends but not during covid,  it's tough on everyone especially the severely mentally ill, in terms of isolation.  They do have zoom meetings and come by members' homes to deliver food and goodies during covid.   It's a place that provides socialization, work, gatherings with music/poetry and outings like going to a baseball game. They are part of a larger organization world wide.  This is the link to the Clubhouse in Contra Costa County. and this is the link to the international Clubhouse for the severely mentally ill            Rhonda asked me the question if have I ever been afraid of my brother. That was a good question, Rhonda and I didn't answer very well. Only once in the 20 years of my brother's disease have I been afraid of him.  People judge my brother as potentially violent when in fact he’s terrified daily because of the violent voices towards him he hears.  My brother is stigmatized by the world as dangerous when the facts state that most people with schizophrenia are preyed upon, like my brother has been over the years---people taking his money, people crossing the street to avoid him, people calling the police on him, etc.  When he is upset or angry, and I respond with 5-Secrets, especially a strong  "I Feel" Statement, his rage softens immediately. Your question itself, "was I ever afraid?" is a misnomer. Here's a better question: Is my brother afraid? Yes, every day he's afraid of being misunderstood, stigmatized, hospitalized by the police (5150) but mostly he is afraid of the voices hurting him. And my mother and I are afraid someone will eventually hurt him, or he will take his own life because he has stated that he has done enough over the years to defeat the voices but they won't go away.  So at times he feels hopeless.
  Announcements: Feeling Great Book Club We're excited to announce a Feeling Great Book Club for anyone in the world, supporting people in reading and learning from David Burns' powerful and healing TEAM-CBT book Feeling Great with questions and answers, exercises and discussions in large and small groups. It will meet online for an hour at a time for 16 weeks on Wednesdays starting March 17 at 9am and 5pm Pacific Time - which should allow for fairly reasonable hours from anywhere in the world. Note that the group is intended to provide education but NOT therapy or treatment. Cost is 8$ per session paid in advance, but people will be able to pay whatever they can comfortably afford and no one will be turned away for lack of finances. The group will be primarily led by Brandon Vance, a psychiatrist who is a level 4 TEAM therapy trainer who has studied with David Burns since 2011. Please go to https://www.feelinggreattherapycenter.com/book-club to find out more and to register. Your Book Club Teacher: Brandon Vance, MD Upcoming Virtual Workshops February 28, Self-Defeating Beliefs: How to Identify and Modify Them, a one day workshop for mental health professionals. 7 CE credits. Featuring Drs. David Burns and Jill Levitt, sponsored by FGI, Mt. View Click here for more information including registration!   March 24, 2021, Feeling Great: A New, High-Speed Treatment for Depression and Anxiety. A One-Day Workshop by David Burns, MD. sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration!   April 7, 2021, Bringing TEAM-CBT to Life in Real Time, by David D. Burns, MD. A Half-Day Live Therapy Demonstration Sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration!   Today's Questions Brian asks: Can negative thoughts lead to high blood pressure? Thank you Jim asks: I’m having panic attacks! What should I do? Adam asks: Shouldn’t we get rid of the terms, “Positive Thoughts” and “Self-Defeating Beliefs?” Phil asks: Hi David and Rhonda! Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions? Nandini asks: How do I get your Decision-Making Tool for help with habits and addictions? A man from France asks: After listening to Podcast 003: E = Empathy — Does It Really Make a Difference?: “How do we do when the person, we are having a conversation with does not feel comfortable in sharing his/her feelings and thoughts, or does not know how to deal with feelings and thoughts when hearing them? Thomas asks: What would you say to a person who wants more ego strength.? * * * Brian asks: Can negative thoughts lead to high blood pressure? Thank you Thanks Brian. I don’t know the answer to your excellent question. One big problem is that much, if not all, of this type of research is of pretty poor quality. When I review research articles, my focus is not on “what are the implications of these findings,” but rather on “what are the flaws in this research study?” Usually, the flaws are so severe, at least to my way of thinking, that the findings are not worth interpreting. I apologize for this answer, as it is way less exciting than speculation! On minor point would be that if you believe negative thoughts, you will experience feelings like depression, anxiety, anger, and so forth. So the real question would focus on whether elevations in negative feelings are associated with increases in blood pressure. One common phenomenon is that some people get very anxious when their blood pressure is measured, and this, it appears, can lead to temporary blood pressure elevations. So, sometimes the doctor or nurse will ask the patient to sit quietly for a little while, and will then repeat the blood pressure measurement. So, it might be the case that people who are more prone to feelings of anxiety would have more fluctuations in blood pressure. But the question then might be—are these temporary fluctuations associated with generally elevated blood pressure? I don’t think they are, but I’m not up on the latest thinking on this topic. david Brian adds: David Burns Last night, I was having stressful thoughts about family and I checked my blood pressure and it was way up, so I think it does. 🙂 Cool, nice research! You can also see if changing those thoughts and feelings leads to a reduction in BP! d Dr. Burns i did and my stress lowered and so did my blood pressure Way to go, Brian! Kudos! david * * * Jim asks I’m having panic attacks! What should I do? Dear Dr. Burns, I recently bought copies of Feeling Good, Feeling Great, and The Feeling Good Handbook, and studying them has been remarkably helpful so far. Thank you for writing them! I hope this is not too forward, but I am struggling with one immediate difficulty: within the past two weeks, I have had two panic attacks that brought on heart palpitations, and it's created a cycle of anxiety that I can't seem to break. My central issue is that I can't seem to isolate a thought that brings on the initial feelings of worry (followed by flushing of the face and then skipped heartbeats) The first attack happened in the car after visiting a store, and the second happened while waiting on line at a store. I have seen a cardiologist, and so far all my blood work and EKGs have come back normal. Whatever help you can give or resources you can share would be sincerely appreciated. Thank you, Jim David responds by emphasizing: My book, When Panic Attacks, will give you great tools for understanding and overcoming panic. I use four models in treating all forms of anxiety, including panic: the cognitive model the hidden emotion model the motivational model the exposure model You can find podcasts that detail all of these approaches. I describe the kinds of thoughts that typically trigger panic, and how to defeat them! * * * Adam asks: Shouldn’t we get rid of the terms, Positive Thoughts and Self-Defeating Beliefs? I have a few questions about some of the Semantics on the Daily Mood Log and the Self-Defeating Beliefs list: On the Daily Mood Log, there is a section for positive thoughts. My understanding is that the goal isn't necessarily to think positively, but instead to correct distortions so that the person is thinking realistically. A lot of the thoughts I hear reframed on the podcast aren't necessarily positive, but instead capture a more realistic or balanced perspective. If I'm understanding correctly, positive thinking may actually cause your thoughts to be distorted in the opposite direction. My experience has been that often times when you speak with people about positive thinking, they will end up in the territory of positive distortions. I'm wondering what you would think about calling this column 'Realistic Thoughts'? One of my favorite tools that I've used both for myself and for my clients is the list of Self-Defeating Beliefs. So often when I use the "Downward Arrow" technique with a client, it leads to one of these beliefs, and it is really helpful to have clients identify the beliefs on their own accord. With that being said, one thing that I personally feel some reservation about is calling the beliefs "Self-Defeating." Similar to positive reframing, it often seems like the goal of these beliefs is to protect the person or give them some benefit, and that the side-effect of that protection is the self-defeating part. For instance, being perfectionistic may be intended to protect people from criticism (protective and helpful), however never allows them to see that it's okay to make mistakes (unhelpful and self-defeating). This is often revealed through the cost-benefit analysis, and I like the idea that the individual gets to decide if the belief is self-defeating or not after the CBA. In that way, I wonder if calling them "Self-Defeating" from the start may bring up resistance, as it assumes the belief is more unhelpful than helpful before the client has really done the work to decide that. I've had a harder time thinking of another name that captures this, but I'm wondering what you think about the term possibly leading to resistance? As always, I appreciate the effort that you and Rhonda have put into the podcast and I'm looking forward to what you have to offer in the next year! Be well, Adam Holman, LCSW, SUDS Hi Adam. Thanks for your ideas! I’m kind of sticking to the current wording for many reasons. One problem is that any terms you might suggest will have tons of positive and negative aspects, and the art is in the delivery of the therapy, and not so much in the names of things. I have not run into any resistance with SDBs, but rather enthusiasm from most (nearly all) folks. Still, your ideas are all correct. SDBs have huge positives, absolutely. In Philadelphia, we started with “Automatic Thoughts” and “Rational Responses,” which were Beck’s terms. However, 25% of the patients at our inner city hospital had not made it through the fifth grade, and they found these terms intimidating. But they DID understand Negative Thoughts and Positive Thoughts! People used to think the term “psychotherapy homework” was aversive and people would be more compliant ii if we changed the name to “self-help assignments.” But the name was NOT the issue, motivation was the issue, and the term “psychotherapy homework” is actually way more useful, as it lets the patient know what will be required if they want this type of treatment. If they do want a form of therapy that requires “homework,” then I am not the therapist they are looking for! Semantics are important, and different people will perhaps want their own words and terms for things! Sincerely, david * * * Phil asks: Hi David and Rhonda! Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions? Hi Dr. Burns, First of all I want to wish you and Rhonda a very Happy New Year. We are off to a rocky start, but things will get better soon! I loved the podcast on jealousy and anger as it really showcased a ton of TEAM techniques and tools. I had a question that perhaps you'd be willing to answer. Or not! Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions. At least mine do! Obviously writing down the distortions will certainly reinforce the fact that you can pinpoint the distortions at hand, but will it make a big difference either way? Also, way back when I requested and received a few free chapters in your new Feeling Great book and received the chapter on the Decision-Making Tool which I thought was terrific. I can't for the life of me find the email/link which contained the blank Decision-Making Tool but if you could direct me to find it I would very much appreciate it. I knew you said you were planning an App for it so perhaps that's where it might reside. I loved working with you, Jeremy and Alex on the Beta Testing. It was a lot of fun and if there is any more way I can help out, let me know. Keep up the great work! Phil McCormack (Philomablog!) Thanks, Phil, Identifying and explaining the distortions is a great help to many. But if you’re super experienced, you can often take short cuts! When you’re doing this for the first time, it is necessary to write them down, however. David * * * Nandini asks: How do I get your Decision-Making Tool? Hi Nandini, The free chapter(s) offer is at bottom of the home page of my website. d * * * A man from France asks, after listening to Podcast 003: E = Empathy — Does It Really Make a Difference?: “How do we do when the person, we are having a conversation with, does not feel comfortable in sharing his/her feelings and thoughts or does not know how to deal when hearing them? Hello Dr. Burns, Many thanks for this podcast. It's been really helpful. And I do agree that practicing the 5 key of Effective Communication is extremely important. I would like to have your opinion with regard to the 5 Key to Effective Communication. I had a really mild argument with my teenage 17year-old son, last night. I bought him an M size jacket instead of an S size. When I asked him if the jacket suited him, he replied "why don't you ever listen to me! I asked you to get me an S size, but still, you buy me an M size! I replied I got him an M size because the website warned that the clothing size fit small. Then he went back to his room... whereas, I, ran to my Relationship journal and started to work on this little argument I sure did feel bad, and worthless as I wasn't able to get him what he requested. I decided to use the 5 key to Effective Communication and did my best to include the 5 steps, and when I expressed my feeling with regard to what he had said, he snapped right back at me saying "oh, stop acting as if you were a victim there ! Though it is very difficult to express my feelings (as I was taught from childhood to hide them/put them aside), I also can understand how difficult it can be, to hear someone expressing his/her feelings. My son was able to hear the empathy I had towards his thoughts and feelings, but was not ready to hear how I felt about my feelings. Where did I do wrong? How do we do when the person, we are having a conversation with, does not feel comfortable in sharing his/her feelings and thoughts or does not know how to deal when hearing them? Your insights would be greatly appreciated. Warm regards, From France Hi man from France, Send me your Relationship Journal and all will be revealed. That’s the only way to get a handle on the errors you made in the interaction. Thanks! David In the podcast, I emphasize the role of blame in relationship problems. The man in France appears to be blaming the other person for not being comfortable sharing feelings, but in my experience, we are creating the problems in our relationships, and the answer is to examine your own errors. Read Feeling Good Together and do the written exercises if you really want to learn. * * * Thomas asks: What would you say to a person who wants more ego strength.? Thanks Thomas! I would say, “what time of day would you like it,” and ask them to fill out a Daily Mood Log for that moment of insecurity! I focus on specificity, and avoiding big words and abstract concepts. d
This is the first of two podcasts featuring Phillip Lolonis, LCSW, who works with Rhonda at her new FeelingGreatTherapyCenter.com. Some of you may remember my descriptions and photos of my Sunday hikes for people in our training groups for the past ten years. Here's a photo from one my last hikes before the pandemic. Phillip is the one in red in the back row.  I hope to resume the Sunday hikes as soon as people are vaccinated! In today's podcast, you'll meet Phillip Lolonis who has transformed TEAM-CBT hiking therapy into a high and exciting art form on the California trails near Mt. Diablo. Phillip is a licensed clinical social worker and Level 3 TEAM therapists who is a member of Rhonda's new Feeling Great Therapy Center in the East Bay. He describes his love for "nature therapy" and pointed out that the Buddha experienced enlightenment when meditating under a tree. Phillip describes growing up on a farm and feeling at peace and profound connection with nature as he watched his father working in the fields. He said that his ancestors were all farmers in Greece for hundreds of years. Phillip first started "hiking therapy" when he was working with groups of individuals suffering from schizophrenia. One day, he decided to take his group out for a hike in the hills behind the hospital, and noticed the peacefulness and relaxation the patients experienced while hiking, and see the views of the San Francisco Bay from (describe the location at the top of the hike.) He said the patients seemed to experience much less of the internal, distracting stimuli that interfered so greatly with their attempts to connect with others. All of his patients complete David's Evaluation of Therapy Session after each session. This tools encourages patients to rate the therapist's empathy and helpfulness and describe what they liked and disliked about the session. Phillip works with a wide range of individuals, and says that whether they are 10 years old suffering from shyness, or executives from a tech companies who are facing burnout, they often say that they feel more open, honest and willing to go deeper when hiking in nature, than when they are being treated back in his office or on zoom. He pointed out that these days, a great many individuals coping with mental illness end up being "treated" in jails, which are frightening and actually intensify the symptoms of schizophrenia. Phillip has a special tenderness and compassion for individuals with schizophrenia because his younger brother struggles with this affliction. However, his "hiking" therapy is not limited to individuals with schizophrenia, but adults and families with the full range of emotional challenges, such as depression and anxiety. He explained how he integrates the four elements of TEAM: T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods while hiking with his patients / clients. He also discussed some of the ethical considerations, and how to gently create boundaries so that his patients will understand that this is a professional relationship in a natural setting. Phillip is convinced, and probably right, that a beautiful and peaceful outdoor environment actually facilitates treatment and speeds recovery. Here are some photos from his hikes. just to give you an idea of what his special "office" looks like. It's a bit different from the analyst's couch!       Take a look at this incredibly cute video of "talking turkey" on one of his hikes! [videopress McaWCx7u]
Ask David: Questions on self-esteem, recovery from PTSD, dating people with Borderline Personality Disorder, recovery on your own, and more! Jay asks: Is psychotherapy homework still required if you’ve recovered completely from depression in a single, extended therapy session? Is Ten Days to Self-Esteem better than the single chapter on this topic in Feeling Good? Are people who were abused emotionally when growing up more likely to get involved with narcissistic or borderline individuals later in life because the relationship is “familiar?” Many patients can read your books and do the exercises and recover on their own. Is a teacher or coach sometimes needed to speed things up? Is it possible for a person to become happy WITHOUT needing anyone else if they have had depression in past and/or PTSD? Also, how would Team-CBT address treating PTSD? PTSD can involve a person having multiple traumas. * * * Is psychotherapy homework still required if you’ve recovered completely from depression in a single, extended therapy session? Thanks, Jay, I will make this an Ask david, if that is okay, but here is my quick response. Although many folks now show dramatic changes in a single, two-hour therapy session, they will still have to do homework to cement those gains, including: Listening to or watching the recording of the session Finish on paper any Daily Mood Log that was done primarily in role-playing during the session. In other words, write the Positive thoughts, rate the belief, and re-rate the belief in the corresponding negative thought. Use the Daily Mood Log in the future whenever you get upset and start to have negative thoughts again. I also do Relapse Prevention Training following the initial dramatic recovery, and this takes about 30 minutes. I advise the patient that relapse, which I define as one minute or more of feeling crappy, is 100% certain, and that no human being can be happy all the time. We all hit bumps in the road from time to time. When they do relapse, their original negative thoughts will return, and they will need to use the same technique again that worked for them the first time they recovered. In addition, they will have certain predictable thoughts when they relapse, like “this proves that the therapy didn’t rally work,” or “this shows that I really am a hopeless case,” or worthless, etc. I have them record a role-play challenging these thoughts with the Externalization of Voices, and do not discharge them until they can knock all these thoughts out of the park. I tell them to save the recording, and play it if they need it when they relapse. I also tell them that if they can’t handle the relapse, I’ll be glad to give them a tune up any time they need it. I rarely hear from them again, which is sad, actually, since I have developed a fondness for nearly all the patients I’ve ever treated. But I’d rather lose them quickly to recovery, than work with them endlessly because they’re not making progress! People with Relationship Problems recover more slowly than individuals with depression or anxiety for at least three reasons, and can rarely or never be treated effectively in a single two-hour session: The outcome and process resistance to change in people with troubled relationships is typically way more intense. It takes tremendous commitment and practice to get good at the five secrets of effective communication, in the same way that learning to play piano beautifully takes much commitment and practice. Resolving relationship conflicts usually requires the death of the “self” or “ego,” and that can be painful. That’s why the Disarming Technique can be so hard for most people to learn, and many don’t even want to learn it, thinking that self-defense and arguing and fighting back is the best road to travel! * * * Is Ten Days to Self-Esteem better than the single chapter on this topic in Feeling Good? Yes, Ten Days to Self-Esteem would likely be a deeper dive into the topic of Self-Esteem. It is a ten-step program that can be used in groups or individually in therapy, or as a self-help tool. There is a Leader’s Manual, too, for those who want to develop groups based on it. * * * Are people who were abused emotionally when growing up more likely to get involved with narcissistic or borderline individuals later in life because the relationship is “familiar?” I was involved with a woman with Borderline Personality Disorder, and it was exhausting! Why was I attracted to her? Thank you for the question, Jay. Most claims about parents and childhood experiences, in my opinion, are just something somebody claimed and highly unlikely to be true if one had a really great data base to test the theory. We don’t really know why people are attracted to each other. Many men do seem attracted to women with Borderline Personality Disorder. Perhaps it’s exciting and dramatic dynamic that they’re attracted to, and perhaps it’s appealing to try to “help” someone who seems wounded. Good research on topics like this would be enormously challenging, and people would just ignore the results if not in line with their own thinking. Our field is not yet very scientific, but is dominated by “cults” and people who believe, and who desperately want to believe, things that are highly unlikely, in my opinion, to be true. I do quite a lot of data analysis using a sophisticated statistical modeling program called AMOS (the Analysis of Moment Structures) created by Dr. James Arbuckle from Temple University in Philadelphia, someone I admire tremendously. This program does something called structural equation modeling. In the typical analysis, the program tells you that your theory cannot possibly be true, based on your data. If you are brave, this can lead to radical changes in how you think and see things, especially if you are not “stuck” in your favored theories. But this type of analysis is not for the faint of heart. All the best, David Here is Jay’s follow-up email: HI Dr. Burns, As you know A LOT of people attribute their present problems (depression / anxiety / relationship conflicts / addictions) to their "abusive" or "toxic" relationship with their parents. It is interesting that it seems some people internalize negative beliefs about themselves based on what their parents said to them on a consistent basis. But it seems you are saying the data does not support that theory. Jay Thanks, Jay, I’m glad you responded again. There may be some truth to those kinds of theories. We know, for example, that abused or feral cats often have trouble with trust. So, we don’t want to trivialize the pain and the horrors that many humans and animals alike endure. At the same time, people are eager to jump onto theories that “sound right” to them and serve their purposes, and most of these theories are not based on sound research. Here are two examples from my own research. I tested, in part, the theory that depression comes from bad relationships, and also that addictions result from emotional problems. I examined the causal relationships between depression on the one hand and troubled vs happy relationships with loved ones on the other hand in several hundred patients during the first 12 weeks of treatment at my clinical in Philadelphia, and published it in top psychology journal for clinical research. (will include link) That was because there were at the time two warring camps—those who said that a lack of loving and satisfying relationships causes depression, and those who said it was the other way around, that depression leads to troubled relationships. And the third group said it worked both ways. My study indicated that although troubled relationships were correlated with depression, there were NO causal links in either direction. Instead, the statistical models strongly hinted that an unobserved, third variable had causal effects on both simultaneously. This is the only paper in the world literature that I am aware of that has tested the causal links between intimacy and depression, but because the results did not satisfy anyone, the paper is rarely or never quoted, and did not seem to influence those who were advocates of one or the other theories. As they say, wrong theories die hard. Here’s the reference: Burns, D. D., Sayers, S. S., & Moras, K. (1994). Intimate Relationships and Depression: Is There a Causal Connection? Journal of Consulting and Clinical Psychology, 62(5): 1033 - 1042. I also looked at the causal links between all kinds of emotional problems and all kinds of addictions in 178 or so patients admitted to the psychiatric inpatient unit of the Stanford Hospital. I was unable to confirm any significant causal links between depression, anxiety, loneliness, anger, and so forth and any kind of addiction (overeating, drugs, alcohol, etc.) The only possible causal link I could find was a small causal link of depression on reducing the tendency to binge or overeat. This was a secondary and unpublished analysis of data I collected in validating my EASY diagnostic system. I don’t mean to encourage insensitivity to suffering or and I don’t want to stop or stifle creative thinking about the causes of depression and anxiety and addictions. I simply want to emphasize that the causes of depression, and most other emotional problems, are still totally unknown. That is a very simple statement, but it seems to me that most folks don’t “get it,” or don’t want to hear it. Maybe we all want to explain things, or blame others, or think of ourselves as “experts,” or perhaps we feel uneasy with thinking that we don’t yet know the causes of most psychiatric problems, like depression and anxiety or troubled relationships. It may be comforting to think we do know the causes of negative feelings or human conflict. This is my thinking only, and I’m often off base! Tell me what you think. David
Today’s emotional and inspiring podcast features Mary Stockton, an Level 3 certified TEAM therapist living in Ohio and her daughter, Elizabeth Stockton Perkins, who is 19 years old and a sophomore at Vassar College. They give testament to how the Five Secrets of Effective Communication have transformed their relationship as mother and daughter, as well as their relationships with others. Mary said that the Five Secrets changed her life personally and professionally, and that the tools have been “life-changing.” Mary was first introduced to the Five Secrets of Effective Communication when she attended one of David’s training workshops in 2002 entitled, “And It’s All Your Fault!” However, she did not really dive in and use the techniques until 2017 when she received additional TEAM-CBT training from Rhonda, Jill Levitt, Daniel Mintie, Matt May, and Thai-An Truong. Mary introduced Elizabeth to the Five Secrets when Elizabeth was a junior in high school, and Elizabeth began to use these tools with friends and also in her baby sitting. Mary said it has transformed their relationship, because previously she had been addicted to “helping,” rescuing, advising and problem solving, habits which often prevent closeness in relationships. David pointed out that many if not most mental health professionals, including many reading this at this moment, have been trained in these misguided “helping” methods, and are not even aware of it, or how unhelpful that “helping” can be. The relationship between Mary and Elizabeth is wonderful testament to the power of the Five Secrets. Mary said that using the Five Secrets in their relationship provides them with a wonderful framework that they share and enjoy. Elizabeth said they have zero other-blame or self-blame in their relationship, and that they routinely get a fun, positive charge from the Five Secrets. Elizabeth discussed a distressful situation when Mary responded to her using the Five Secrets and she felt supported, comforted and empowered. She was struggling with negative thoughts and feelings about her body image, telling herself on the one hand that “I should be bird boned and be a size 2 and be super skinny,” while at the same time telling herself, “I should be a strong feminist and not give in to these societal messages about what a woman should be like.” Because her mom relied on the Five Secrets of Effective Communication and other TEAM skills, Elizabeth suddenly found that she could open up about feelings she'd been hiding, and their relationship changed dramatically. Elizabeth suddenly found that she could open up about feelings she’d been hiding out of a sense of shame, and felt love and accepted. She said that “mom was the first person I’d been able to open up with. I felt relief that I didn’t have to defend myself.” Elizabeth cried when she described the gratitude she felt when she had the chance to be open and accepted, especially when she described her concern about being a good role model for two younger friends. They also described how Mary used the TEAM process of Empathy, Positive Reframing, and Methods like the Externalization of Voices and Survey Technique to help Elizabeth escape from the self-critical thoughts that had trapped her. It was a beautiful experience just to witness the joy and love in their relationship. They also described a program on the Five Secrets that they presented for other teens and families. We explored how one might use the Five Secrets when interacting with someone on the other side of the political divide who is angrily proclaiming political views that are sharply different from, and opposed to, your own. This is a huge problem in our country right now, with so much focus on blame, labeling others, and wanting to proclaim and insist on your own “truths.” I have not done this podcast justice in my show notes. You’ll have to listen to “get it.” Mary, her elegant daughter Elizabeth, and the always wonderful and delightful Rhonda really hit it out of the park today. I deeply appreciated being included in this terrific experience, and hope you also enjoyed it! David
In today’s podcast, we focus on a request by Tommy, a podcast fan who asked for a podcast on how TEAM evolved from traditional CBT. So here it is! Hi Dr. Burns, I hope you're doing well! I just recently completed Feeling Great and found it incredibly helpful. I found the technique chart that offered specific techniques for each distortion to be incredibly valuable and I've incorporated it into all my Daily Mood Logs. I've also listened to every podcast and have been already exposed to nearly all of the content within the book, but the book did such an elegant job of simplifying everything and putting it into context. I've already gifted it to several family members and am eagerly awaiting the audio version so I can gift it to my grandfather, a psychodynamic therapist of 30 some odd years who's vision impaired. I think he'll really get a lot out of it! Beyond the well-deserved praise, I'm emailing because I just listened to your post recent podcast episode (222) with Dr. Barovsky and you asked for any suggestions the audience might have concerning future episodes. There were two things that you mentioned that made me think an episode on the evolution of TEAM might be really cool and insightful. You mentioned that TEAM was specifically developed to deal with borderline personality patients that you saw at PENN and you also described an interaction with a stranger in California who approached you that inspired the concept of fractal therapy (at least that's how I understood that interaction). I think it would be incredibly interesting if you gave a sort of chronology of TEAM and what problems some of the core components were intended to solve. Obviously, I wouldn't expect you to go through every technique. But some insight into how you came up with positive reframing, the magic dial, perhaps uncovering techniques, and whatever else you'd be willing to share. Besides being interesting, I think it would be valuable because it would provide greater insight into the TEAM processes through demonstrating how it's overcome some of the obstacles that traditional CBT was unable to overcome. Dr. Mark Noble's chapter in Feeling Great led me to think quite a bit about this, particularly where he described how TEAM is really the ideal therapeutic structure from a neurological standpoint. Certainly you didn't just stumble into TEAM and I for one would find anything you'd be willing to discuss on this topic really interesting! Thank you again for everything you do. Best, Tommy Hi Tommy Here are some historical highlights in my thinking. In the podcast I will describe them and dialogue with Rhonda, but in no particular order. Thanks for the great suggestion, and hope you enjoy the podcast. Rhonda also mentioned how the empathy piece evolved, and we discussed that! Psychotherapy homework: Early research and clinical observations on psychotherapy homework and recovery from depression; how I published research on this topic and decided to make patients accountable. Helping: The man who I called at home twice every time he called me with some emergency one weekend, and my conversation with Dr. Wendy Dryden from England. The beauty of depression: The businessman who thought he was responsible for the death of his stepson. The universal importance of Positive Reframing: The time jill said she wished we’d done positive reframing during her session. Fears of therapists that keep them stuck: My observation through supervising psychology and psychiatry graduate students, as well as teaching workshops, how really hard it is for the vast majority of therapists to give up because of their addiction to helping and their intense fears of making patients accountable. Suddenly understanding “resistance.” The meeting of the Stanford voluntary faculty on teaching, and I mentioned making the concept of “resistance” more understandable for the psychiatric residents. They didn’t seem interested, and then I found the answer in a dream. Creating techniques with more “oomph:” The first method I created, Externalization of Voices, how this was inspired by my experiences in psychodrama marathons when I was a medical student. Giving up on “non-specific” techniques: The elderly depressed man who ran up to 12 miles a day. Therapeutic Empathy: What I learned from Stirling Moorey, and how I set up an empathy training program along with a scale to assess empathy after every therapy session. Rhonda and David
Many of you will recall one of our most popular and amazing podcasts of all, the recording of the live therapy with Michael at the Atlanta intensive last year. In today’s recording, which was recorded for a different purpose, Dr. Michael recalls his entire experience that day, with many teaching points. Although I was AT the Atlanta intensive doing the therapy, with the help of my co-therapist, Thai-An Truong, I was fascinated and enlightened by this interviews because: Michael was incredibly warm, genuine and openness. The summary shows clearly and exactly how TEAM therapy works. He recounts not only his recovery, but also how was unexpectedly catapulted into what, by my understanding, is best described as “enlightenment.” Or something awfully darn close to it! He reminds us that even after one has recovered and experienced “enlightenment,” we are still human and never immune to the occasional return of negative thoughts and feelings of insecurity and self-doubt, which are now, for Michael, short-lived! I just got Rhonda’s response after she listened to this recording for the first time. Here’s what she said: I forgot to tell you that I listened to the 30-minute recording of Michael's reflections and I loved it. I think it would be a great podcast. He did a wonderful job summarizing the work, and how it impacted him at various stages. I liked how he included his skepticism and his awe in recovery. Warmly, Rhonda and David PS Rhonda and I are convinced that successful personal work is a necessary part of therapist training. When you’ve done your own work, you are no longer just a “technician,” but a healer, because you can tell your patients, “I know you feel because I’ve been there myself, and I know how painful and lonely that can be. And I’m really excited to show you the way out of the woods, too, so you can get back to feelings of joy and self-esteem, so you can wake up in the morning and say that’s it’s GREAT to be alive!”
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Comments (16)

Milad Sasha

Fuck this for the annoying sound of chain or something

Apr 2nd
Reply

Amy3422

I have tremendous respect for David and his work. However, at various points in this episode, he calls new research "stupid," refers to distressed people as "whiners," dismisses whole studies with personal anecdotes, and uses a derisive mimicking voice. I understand that expertise creates ego, but the sheer lack of empathy here is surprising. It seems to contradict the methods from the early episodes.

Mar 9th
Reply

Amy3422

I never knew there was a name for reading OCD. I hope you do a full episode on it!

Feb 23rd
Reply

Dj Lady K

Women therapists cant take negative feedback. So many are extremely narcissistic. They need more hard-core therapy than their patients.

Jan 3rd
Reply (1)

Dj Lady K

This world needs better therapists that actually do their jobs, don't abuse their patients, try to understand their patients, and care. Half ass therapy doesn't work. So many just want a paycheck. So many cross boundaries and break the confidential laws and get away with it. So many re-traumatize patients. So many false diagnoses and not knowing what they are doing. I wish more people were like Dr. Burns.

Jan 3rd
Reply

Mohamad Hadi Sarafrazi

🙏🙏🙏

Nov 4th
Reply

Mohamad Hadi Sarafrazi

🙏🙏🌻🌻🌻🌻

Nov 2nd
Reply

Clellie Merchant

T does not stand for transsexual. This is basic 2019 knowledge.

Aug 9th
Reply

Amy3422

I really like these podcasts, but I didn't think that David answered the question in this one. It seemed the listener had already dissolved her distorted beliefs and asked about how to prevent relapse when surrounded by circumstances that support the distortions. Fabrice's example of the alcaholic seemed apt, but the other examples and answers didn't address external circumstances.

Jul 27th
Reply

Amy3422

Awesome!

Jul 25th
Reply (1)

Marty Schwebel

I'm truly thankful for this podcast!

Jul 17th
Reply (1)

Djamel Eddine

I'm grateful that I've come cross this Podcast!

Oct 10th
Reply

Avi Ehrman

That was really enjoyable, and rich with valuable teachings. One concern I have with the feared fantasy technique in this particular setting, Since it's being done in such a friendly and supportive environment it doesn't reflect in a meaningful way a real life fear, does that not minimise it's effectiveness? Thanks, Avi

May 16th
Reply
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