030: Live Session (Mark) — Empathy Phase (Part 2)

After reviewing Mark’s scores on the Brief Mood Survey, the Empathy phase of the session unfolds. During this phase of the session, David and Jill will not try to help, rescue, or save Mark. They will simply try to see the world through his eyes and provide some warmth and compassion.

Mark explains that he had two goals in life when he was a young man. He hoped to have a large, loving family; and wanted to become a skillful and compassionate physician. Although he has achieved the second goal, he has felt sad and guilty for decades because of his failure to develop a loving relationship with his oldest son from a previous marriage.

While Mark tells his story, David and Jill encourage him to record his negative thoughts and feelings on a form called the Daily Mood Log, and to rate how strong each feeling is, on a scale from 0% (not at all) to 100% (the most extreme).

Click here and you will see Mark’s Daily Mood Log.

As you can see, Mark has many different kinds of negative feelings ranging in severity from 30% (moderate) to 80% (severe).

If you’ve been listening to the Feeling Good Podcasts, you know that negative feelings do not result from what’s actually happening in our lives, but rather from our negative thoughts about what’s happening. David and Jill encourage Mark to record his negative thoughts on the Daily Mood Log as well, and to indicate how strongly he believes each one on a scale from 0% (not at all) to 100% (completely).

You can also see that Mark is telling himself that he’s been a failure as a father, that his brain is defective, and that he is not doing a good job for David and Jill. These thoughts all involve self-blame. You’ll notice that he also has two other-blaming thoughts. This is not unusual. When you’re not getting along with someone, you may spend part of your time telling yourself that the problem is all your fault, and part of your time telling yourself that it’s someone else’s fault. As a result, your negative feelings may shift back and forth from guilt and shame to anger and resentment.

Most therapists would not interrupt and ask their patients to record their negative thoughts and feelings while they are venting. However, this information will prove to be incredibly valuable later in the session.

Jill and David ask Mark how they’re doing on empathy. If Mark gives them a high rating, they will go on to the next phase of the session, called Paradoxical Agenda Setting. That’s where they will find out what, if anything, Mark wants help with, and see if he has any conscious, or subconscious, resistance to change.

 

18 thoughts on “030: Live Session (Mark) — Empathy Phase (Part 2)

  1. I’m 38 minutes into this great podcast. It must be hard to resist the temptation to “rescue the patient.” For example, Jill asked the client if his son had deep meaningful relationships to gather more information/data. I would have been tempted to ask the patient, “Could it be possible that your son has the issue?” I would also be tempted to say that it takes two to form a meaningful relationship, and he shouldn’t blame himself (Ooops…I’m guilty of should statement). Anyway, I can’t wait to see how the session progresses.

    • Thanks, Rob, as usual, you see to the heart of the matter! Yes, most therapists (and family or friends) would jump in to “rescue” or “help” the patient. And this is the most common therapeutic error, and the source of most therapeutic failure. So I will greatly look forward to your comments as the live therapy podcasts continue!

      I’m not sure if you have had the chance to read my article in the current (March / April 2017) issue of Psychotherapy Networker entitled “When Helping Doesn’t Help.” Since you are a serious student of TEAM-CBT, you might find it interesting. I’d put a link but I can’t put links in these exchanges for some reason, or don’t know how. But you can find it easily via Google.

      Always great to hear from you!

      David

  2. ​Dear David (and Fabrice)

    Just wanted to say thank you very much for producing the podcasts – I have really been enjoying them.

    I have struggled with anxiety and depression for more than 10 years, and have found the techniques in David’s books to be very helpful during this time.

    I have been finding the live session podcasts with Mark very useful – it brings the theory to life in a way that written words cannot, and it has also been reassuring to hear another person describe their experiences. Makes me feel a bit less isolated! I have struggled to get my own symptoms and scores down as low as I’d like using the daily mood log and methods outlined in When Panic Attacks – so it will be very interesting to see how you do this with Mark using the newer TEAM concept.

    I’m really looking forward to the rest of the parts of the session – it’s a shame to have to wait a week, but I understand that a lot of work has to go into them!

    Thanks again for making these resources available to everyone.

    Paul

    • Thanks Paul, we all greatly appreciate your comment! let us know how you like the additional live therapy podcasts with Mark. I am also hoping to do more of the live therapy podcasts with additional individuals in the future, as so far the podcasts on the session with Mark have been hugely well received, i think! david

  3. I really love what you say about secondary gains. Even when I experienced anxiety or depression as a child, various adults would accuse me of acting that way for the attention. Not only were comments like that not productive, they were hurtful. I would have given a million dollars not to have been depressed or anxious.

    • Thanks, Rob. Yes, we do and say so much as humans that turns out to be insensitive and hurtful to others. Most of the time, sadly, we blind our eyes to this! I always appreciate your thoughtful comments, and am sad at the pain you must have endured when you were growing up. And what a pleasant miracle now that you are feeling different, and hopefully enjoying your life and your terrific contributions on so many levels! david

  4. I think that these live therapy podcasts might probably prove to be most useful because the general public can listen to the patient, and possibly relate to what they’re going through. I also found it helpful that Jill acknowledged that as therapists, you’re not trying to make the patient believe you know how they’re thinking and feeling, but actually seeing life through their eyes.

    I have a question about the empathy phase. Have you ever had stubborn patients who refuse to believe that the therapist can possibly know what they’re going through, unless they themselves have experienced these thoughts and feelings, and if so, do you employ any techniques? I say this because maybe patients do want to believe the therapist, but there may be some hidden forces or whatever, that are preventing them from actually believing the therapist.

    Thank you for the great podcast!

    Eric

    • Yes, Eric, this is just one of many criticisms therapists might receive from patients. For example, a young and somewhat “proper” therapist might find himself or herself under attack from an angry patient who says, “How could possibly know how I feel? You’ve never been homeless! You’ve never had to sell your body for drug money!” There are a thousand versions of this. It might be, “How could you know how I feel? You don’t have children! You’re too young to be my therapist.”

      We practice how to respond to these techniques using the Five Secrets of Effective Communication, including the Disarming Technique. You can read about this in my book, Feeling Good Together, or in the Feeling Good Handbook, or in my therapist eBook, Tools, Not Schools, of Therapy. It takes a lot of commitment, hard work, and practice, to learn the art, but it is tremendously valuable once you learn how to do it. And as you know, in TEAM-CBT, patients rate therapists on empathy at the end of each session using an extremely sensitive scale that picks up even the smallest failures of empathy, so therapists can find out right away if they “failed” during the session.

      Thanks for another great question! Sorry I don’t have time to dive into this in greater detail, but is a big topic and one major focus of the training I do for mental health professionals.

      David

  5. Thank you, David, Jill and Fabio and most importantly, Mark. Mark, thank you for sharing your story.
    I enjoyed the podcast and am grateful for the opportunity to grow as a clinician, in part through this podcast.
    David, I’m new in private practice and I use your Therapists Tool Kit (and now this pod cast) to keep humble and on track in this very precious work that we do. It is so very helpful.
    Thank you.

    • Thanks, jnybrd!

      If you have purchased a Therapist’s Toolkit (and it DOES keep us humble!), make sure you email me for the massive complimentary upgrade.

      All the best,

      david

      • I already have the upgrade, I am a newbie: Jane Mizrahi with GroupsWorks. And,I speak about you and your work at my Therapist Peer Support Group and credit you on the facebook page I created with the same name. Keep up the good work.

  6. I have listened to all the podcasts, many of them several times. I have also listened to the Audible version of “Feeling Good Together” and am currently listening to “Feeling Good”. They have all been a great help in reducing my distorted thoughts and alleviating depression. They are also helping greatly in the way I relate to people.

    Listening to Mark, I guessed he possibly has Aspergers before he mentioned it, as may his son. His problems parallel mine so closely. My wife, having done a lot of reading on the subject, is convinced I have Aspergers, and she is probably correct. One of my son’s may also have it. He, like Mark’s son, appears to make friends easily, but is making lots of poor choices in life that are related to misconceptions he has.

    A large problem I have is empathy with other people. I typically fail to pick up on visual clues when interacting with other people. So, I am trying to get better at thinking about and using EAR in my interactions with others, but it’s not easy.

    So, finally, I just want to say thanks for all the help I’m getting.

  7. Thank you David, Jill, Fabio, and most deeply Mark. To hear a live therapy session is a gift. I feel connected to you all and I’m not there. I love the energy in the room and how caring human beings are to each other especially when telling the painful stories of how we think and feel. An emotional connection is a beautiful way of not having to live in a world alone. To express your longing for it is the start of being in it. I look forward to the next podcast.

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