Thank you so much for your help and encouragement on the Sunday hike this week. I thought it was interesting how despite my initial sense that I didn’t need help so much with my feelings, once we got into the “Five Secrets” practice it was clear I had more work to do on my anxiety. I guess I couldn’t see that until I owned my role in the dynamic with my son and saw how much I was struggling with the Five Secrets in my interactions with him. Having the layers separated by the discipline of the TEAM-CBT method helped me start to untangle something that has been very confusing.
More musings. During the hike you were talking about how many people can now recover from depression and anxiety really quickly using TEAM-CBT, but that relationship and habit work generally take much more time. I’d be very interested in hearing you say more about this, because relationship problems feel more complicated (in my case with son, at least). At least consciously, I’ve always felt like I wanted to be closer to my son. Today it’s clearer to me that I’m having a number of Self-Defeating Beliefs (SDBs) that cause me to act in ways that prevent closeness. For example, I’m telling myself that both he and I should be perfect achievers, that he and I should never be angry at each other, and so forth.
Maybe relationships are a place where “the rubber hits the road” so to speak, where our SDB’s display themselves with real world consequences. . . Hmm. I guess the point is that relationship work can be a rich but challenging entry into personal growth!
Thanks, we could brainstorm on this theme in emails or on a future hike, but to be honest I don’t entirely know why it can be so much harder, even for highly skilled therapists, to deal with our own relationship problems, with family and the people we care about.
However, there is one idea I have had for a long time that may represent a part of the answer. If I’m treating you for depression, you will discover that your painful negative thoughts about yourself (eg. “It’s all my fault,” or “I’m a loser,” or “my problems are hopeless” and so forth) are distorted and wrong. That discovery makes you happy, so it is a pretty easy sell. You discover you are way better than you thought. Not a bad deal! Although treatment resistance always has to be addressed early in the therapy, it is pretty appealing to learn how to let go of self-blame and feelings of depression, anxiety, inferiority, worthlessness, shame, hopelessness, and inferiority.
Relationship problems are quite different. That’s because most of the time, you will be blaming the other person, and thinking about him or her in a distorted manner. For example, you may tell yourself that it’s all his (or her) fault, that he (or she) is a loser, or wrong, and so forth. Then, in the course of treatment with TEAM-CBT, you will discover, when you’re working with the Relationship Journal, that actually have a huge role in the problem and that you are probably triggering and reinforcing the very problem you have been complaining about. This insight can be incredibly empowering, but it can also feel pretty humiliating, shocking, and painful at the same time. In essence, you will discover that you are far worse than you thought, and that if you want the relationship to improve, you will have to stop blaming the other person and focus all of your energies on changing yourself.
For most of us, it is not particularly appealing to have to let go of other-blame and the feelings of moral superiority that go along with feeling certain that we are “right” and the other person is “wrong.” Pinpointing your own role in the problem when you were so happy blaming the other person is usually very painful. That’s just one reason why intimacy is not an easy sell. I address this in the chapter entitled, “Do We Secretly Love to Hate?” in my book, Feeling Good Together.
That’s a big part of why it’s so hard to deal with personal relationship problems, but I think there are other reasons, too. When I’m helping someone with a relationship conflict, there is usually an “inner problem” and an “outer problem” that need to be solved. The inner problem is all the intense negative feelings you have about your interaction with the other person. These feelings may involve anger, shame, anxiety, loneliness, depression, hopelessness, inadequacy and so forth, and they are usually triggered by your own negative thoughts about yourself as well as the other person, and those thoughts are nearly always distorted. For example, you may be telling yourself that the other person is a self-centered “jerk” who “shouldn’t” be that way, and you may be telling yourself that you “should” be a better partner, or mother, and so forth.
The outer problem involves the dysfunctional way you are probably communicating with the other person. For example, you may be trying to “help” when you need to listen, or you may be arguing defensively instead of finding truth in what the other person is saying, or you may be lashing out aggressively, trying to put the other person down, instead of sharing your anger in a respectful and loving way.
The tools for solving the “inner problem,” such as the Daily Mood Log, Cognitive Distortions, and “50 Ways to Untwist Your Thinking,” are tremendous, but they are radically different from the tools for solving the “outer problem,” which include the Relationship Journal, the Blame Cost Benefit Analysis, and Five Secrets of Effective Communication. So the task is twice as hard, with twice as much to teach the patient. Of course, there is tremendous potential for personal growth, as well, and for developing more satisfying and loving relationships with the people you care about.
Perhaps some who read my blog will have theories about why it can be so much harder to resolve personal relationship problems than to overcome anxiety and depression! Let me know what you think with a Comment if you are so-inclined!
Readers interested in learning more about the methods for combatting depression and anxiety may want to read my Feeling Good Handbook, or When Panic Attacks. Readers interested in learning about how to develop more rewarding personal relationships may want to read Feeling Good Together. But I have to warn you—doing the written exercises while you read will make all the difference in the world! Just reading simply won’t “cut it,” so to speak, especially if you are reading Feeling Good Together and want to get close to someone you are at odds with right now!
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True. It’s harder to solve personal relationship problems than treating our anxiety or depression. Because its easier to work on us, dig deep and find our sdb’s and correct them. When it comes to others in close relationships, we have expectations from them and vice versa. These expectations when they become strong, we easily start demanding and then create problems for ourselves and others. Also, in close relationships our emotions are high and they cloud our intellect thus results in emotional reasoning. We think from our point of reference not theirs. If their point of reference does not confirm with our goals and values, we personalize it and either blame them that they dont love us or become anxious about loosing them or even become indifferent as we may secretly resent them for some hidden reasons. The list can go on ….. ☺
YUP! You are right!
Thanks David. Expert’s acknowledgment means a lot ☺.
You are very welcome, Rajesh! david
Is bipolar disorder amenable to cognitive behavioral therapy and other cognitive approaches? From conversations with other family members of individuals with “bipolar disease”, it appears that it is even harder to treat than depression and anxiety.
Bipolar 1 disorder with full blown manic episodes is a biological disorder of unknown cause. One day, we will know the cause but not yet. When I was in clinical practice in Philadelphia, and also when I was a resident, I treated quite a few individuals with bipolar disorder, both in inpatient and outpatient settings. I usually treated them with a combination of medication plus cognitive therapy, and that worked tremendously well, and way better than medications alone. I used just one medication at low dose, lithium, but upped the dose a bit and added a second sedative agent for a week or so when the patient started developing mania. In most cases, this prevented the need for hospitalization, and my patients did really well. Most individuals with bipolar illness were stricken with perfectionism, thinking they had to be great to be worthwhile, and to be loved. Helping them develop unconditional self-esteem seemed tremendously helpful! david
Thanks David. What about obsessive compulsive personality disorder, Can this be cured hundred percent?It also seems to be organic. I have seen its very hard to get rid of some compulsive rituals for the patient with ocd. Which cbt techniques work best? I know exposures techniques works but, there is relapse as well. Besides the patient might lack motivation to work on their compulsive ritual due to some benifits percieved by them that they hold on to neurotically. What best can be done.
Fabrice and I are now recording several Feeling Good Podcasts on drug-free treatments for OCD using TEAM-CBT. david