In this Podcast, David answers two intriguing questions posed by listeners, and one question posed by his host and colleague Dr. Fabrice Nye.
- How do you deal with a patient (or friend) who is boring? David describes a technique he learned from a mentor, Dr. Myles Weber, during his second year of psychiatric residency at Highland Hospital in Oakland. The technique works instantly 100% of the time, and is guaranteed to make any boring interaction with any patient instantly exciting! David and Fabrice emphasize that the same technique can be used with a friend, colleague, or loved one who seems boring, including someone you are dating and can’t seem to connect with at anything other than a superficial level.David also describes powerful, shocking and illuminating experiences he had when attending psychodrama marathons sponsored by the Human Institute in Palo Alto during his medical school years, and what he learned about the differences between the off-putting “outer” selves we display to others and the more genuine “inner” selves we often try to hide.
- How do you deal with a patient (or friend) you don’t like? David describes a method he always used with patients he didn’t like, including one who he found intensely offensive—even disgusting. He explains that the patients he disliked the most almost always became the ones he liked the most, and ended up feeling the closest to, once he used this radical technique. The technique can also be effective with friends or colleagues you’re at odds with.Fabrice reminds us that the approaches David describes in this podcast involve several of the Five Secrets of Effective Communication discussed in previous podcasts. He warns us that they require considerable training, skill and practice, and are likely to backfire if done crudely.
- How do you get patients to do their psychotherapy homework? Every therapist who assigns psychotherapy homework is keenly aware that many patients, perhaps most, “forget” or simply refuse to do the homework. And these are the patients who don’t improve much, if at all. Dr. Burns explains how he tried dozens of techniques that didn’t work early in his career, and finally discovered an approach that was almost always effective.
Very useful! What about the opposite situation: how would you deal with a patient that doesn’t like you or doesn’t want to come for tx, but it has been required by either an employer or the courts?
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 or she really wanted to change, and he or she would also have to do tremendous amounts of psychotherapy homework, and that this is 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.
Hi, Dr. Burns,
Thank you for doing this podcast.
I wonder if there is a potential risk of being demoralized if you get close to and like the redneck constructor who enjoys talking about his rape fantasy or INVITATION. (By the way, was he serious, or just talking jokes in a disgusting way ?)
This puzzles me a lot.
I believe, maybe without much evidence, that we may adopt some habits or thoughts from whom we are close to or whom we like, as the relationship progresses. As some proverbs say, “One takes the behavior of one’s company”, or “One takes on the attributes of one’s associates.”
Is it possible to get close to or like someone I ever disliked and stick to my principles on what is right or wrong for me at the same time?
Thanks, you are getting into some really important Buddhist ideas, actually! From a practical perspective. developing a liking for someone you initially found repulsive or offensive puts you in a position of having a massive impact on that person, even without trying. So I have no fear of them adversely “influencing” me. But such a great question.
A colleague named Jeremy Karmel told me a Buddhist story I like. I may get some details wrong, but will do my best.
In ancient India, a serial rapist and killer broke into a home and sadistically murdered a boys parents while he watched. For whatever reason, the boy was spared. The boy was flooded with hatred and made it is only goal in life to kills this man who was never caught.
He became a man and searched and searched, desperate to find and murder this man. One day, a fellow tipped him off and said the man could be found on such and such mountain digging a tunnel. The boy went to that location and sure enough found the horrible man he intended to kill, who was, of course, much older now. He told the man he was going to murder him on the spot, but first asked the man why he was digging a tunnel.
He explained that there were children in a village who had now way to get to school, so he was digging a tunnel through so they’d finally be able to get an education. The serial killer told the younger man that he had every right to kill him, and should kill, but wondered if the younger man might be will to help him for while, so he could finish the tunnel. He said that then he would be willing to let the younger man kill him.
So, instead of murdering this hateful older man, the younger man decided to help him for a while. It was back breaking labor, and took several months to complete the tunnel. Once they were done, the older man said, “I’m ready to die, and want to thank you for your help. I deeply regret my horrible ways as a young man, and I’m ready to die. I won’t try to run or stop you.”
The young man said, “Why would I want to kill my best friend?”