029: Live Session (Mark) — Introduction & Testing Phase (Part 1)

Podcast Live Therapy Session: “I’ve been a failure.”

Introduction

Jill & DavidThis is the first in a series of podcasts that will feature live therapy. As you listen, you’ll have the opportunity to peak behind closed doors to see how TEAM-CBT actually works in a real-world setting, and not role playing.

The patient is a physician named Mark who has been haunted for decades by a problem with his oldest son, and he feels like a failure as a father. Although the facts of your life are likely to be very different, you might understand what it’s like to feel like a failure, or to tell yourself that you’re defective, or simply not good enough.

The two co-therapists include David and his highly-esteemed colleague, Dr. Jill Levitt. We have broken the session down into a number of podcasts that will include excerpts from the session along with commentaries on the thought patterns of these two master therapists as the session unfolds.

Part 1—T = Testing

As the session begins, David and Jill review of Mark’s scores on the Brief Mood Survey (BMS), which he completed just before the session began. The scores indicate that Mark is only feeling mildly depressed, anxious, and angry, but is extremely dissatisfied with his relationship with his son.

Click here to view Mark’s initial Brief Mood Survey.

At the end of the session, David and Jill will ask Mark to complete the BMS again. By comparing his patient’s scores at the start and end of the session, they will be able to see exactly how effective, or ineffective, the session was. Mark will also rate David and Jill on Empathy, Helpfulness, and several other important dimensions.

Testing at the start and end of every therapy session is one of the new and unique components of TEAM therapy. The testing can revolutionize psychotherapy, because therapists can fine-tune their therapeutic strategies based on the scores, and make critical important changes if the session was not particularly helpful. However, the assessment instruments are extremely sensitive and pick up the smallest therapeutic errors. This can be quite threatening to therapists who don’t want to be held accountable.

5 thoughts on “029: Live Session (Mark) — Introduction & Testing Phase (Part 1)

  1. How can you be sure of the accuracy of the BMS? It seems there is a lot of room for error depending on a persons reason for being at the therapy session. Did their spouse want them to go, is it their last hope, are they able to even recognize how they are truly feeling or looking for the “A” on the quiz. To me it’s like asking the patient in an ER “what do you think is wrong with you”, instead of the Dr. giving the diagnosis. Or is it the same? “From what you describe I’d say you are suffering from..,”. Regarding rating the therapist, again I would not trust the answers. Thinking of myself, if I were asked to answer such a survey I would be thinking of how my answer would affect my relationship with the therapist from then on. Can people “subconsciously” want to appear ok, or the opposite- sicker than they are to gain more sympathy, medication, etc. How are you able to tell if the BMS is truthful?
    Thanks, Chrissy

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    • Thanks, Chrissy,

      Great and thoughtful question! Appreciated!

      I had all those same concerns when I first began testing patients in clinical settings in the mid-1970s. What I discovered was so different from what I initially thought. Like you, I thought the data from patients would have some value, but that I was the expert who really knew how they felt. The opposite turned out to be true. First, looking at therapists’ assessments of how patient feel, without the tests, based on the therapists’ perceptions and experience, are less than 10% accurate in the research I did on this at the Stanford inpatient unit. This included depression, suicidal urges, anxiety, anger, therapeutic empathy, and therapeutic helpfulness. I can go more into the details of the study if you’re interested, but that was the bottom line.

      In contrast, the self-assessment tests I have developed are exceedingly sensitive and have re liabilities, as assessed by coefficient alpha, averaging around 95%. We are, by the way, not asking patients for diagnoses, but rather for how they feel.

      Right now, for example, you know how you feel. Since I am saying things quite different from your expectations, you might be feeling skeptical, or even annoyed. Which is totally okay–but you do know how you feel. So do I! When I’m happy I know it. When I’m anxious and fearful, I KNOW it! When I feel ashamed, I know how I feel.

      My problem is that patients are TOO honest when they fill out the assessments. For example, the empathy and helpfulness tests that patients take at the end of sessions are so sensitive to the smallest therapeutic failures, that most clinicians using my scales get failing grades on every scale from every patient at every session. This can be deeply wounding to the therapist’s ego, and many therapists refuse to use the tests for this reason. The good news is that with training and continual use of the scales with every patient at every session, most therapists experience marked improvements in their scores fairly quickly, sometimes within a few weeks.

      Now, there are important exceptions that every clinician must be aware of. First, I am treating outpatients on a voluntary basis. If someone is coming to therapy involuntarily, with a hidden agenda, he or she will fake responses any test, medical or psychological. So if a patient is applying for disability (which, by the way, represents a therapist conflict of interest and potential ethics violation), or if the patient has a lawsuit pending, then he or she will likely fake negative. And if the patient is involuntarily hospitalized, and trying to get discharged, or is involved in a custody battle, or applying for work, then he or she will fake positive. But aside from these fairly obvious dilemmas, the results of the tests are incredibly accurate.

      This is exciting, as it opens a revolution in psychotherapy and psychiatric treatment as well, but also quite challenging to clinicians who are not used to being accountable for causing rapid and hopefully fairly dramatic improvements in their patients! It takes tremendous courage for therapists to use these assessment instruments, but the dividends can be enormous.

      Thanks again for your very thoughtful question! The best way, in my opinion, to check this out is by using the scales with your patients. That’s what turned my head around completely 35 years ago when I started out doing this, using the old Beck Depression Inventory. I thought it would only have limited value, but required every patient to complete it between sessions and to give me the test at the start of each session. Wow. I found out how off base my perceptions were! I could give many examples, but have limited time right now. Still happy to dialogue more if you have the interest. I think this is one of the two or three most important issues at this time in psychology / psychotherapy.

      If you order my Therapist’s Toolkit, you will be licensed to use a wide variety of scales without having to pay royalties for the rest of your life. If you do check it out, let me know what you discover! Here is the link for order forms: https://feelinggood.com/resources-for-therapists/

      David

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      • Thank you so much for your response. I am not a therapist, just a success story from your book “Feeling Good” who enjoys following your work. ~ Chrissy

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