At most of my workshops, I do a live demonstration with a volunteer from the audience who has been struggling with feelings of depression, anxiety, or just simply being “not good enough.” That includes nearly all of us, including mental health professionals! I know I’ve felt like that on many occasions.
I’m a firm believer that when you do your own personal work, and heal yourself, you have vastly more to offer your patients. You are no longer just a technician but a healer, and you say this to your patients: “I know how you feel, because I’ve been there myself. And I can show you the way out of the woods, as well!”
That’s why I always include personal work in the training I offer in TEAM-CBT, both at Stanford, and at my workshops around the US and Canada, and on the Sunday hikes as well. Live demonstrations have proven to be one of the most effective and inspiring teaching methods–but they aren’t entirely without controversy.
The main problem is that when I do live demonstrations, I often see a dramatic reduction in symptoms, or even a complete elimination of symptoms, in a single therapy session lasting approximately two hours. And sometimes, the results are so dramatic that some people in the audience insist that it could not be real.
That’s what happened at my summer intensive in Burlingame, California, this year. A wonderful young woman who we can call “Holly” volunteered for the live demonstration. Although she’d been struggling with intense feelings of anxiety and low self-esteem throughout her entire life, she responded so dramatically that a few people in the audience thought it was a hoax, and that she was a paid actress. I know this because I received some angry comments on the written feedback form that participants filled out at the end of the demonstration. Most people were thrilled and inspired by what they saw, fortunately, but some were clearly not convinced.
Well, now you can judge for yourself. Our “Holly” kindly volunteered to do a brief video describing her experiences at the workshop, and how she’s been feeling ever since. I think you’ll enjoy it, and find her comments to be mesmerizing. The video was shot, unknown to me, by a colleague, Lisa Kelley, who happened to run into Holly a week or two after the workshop.
You can watch the video here. Then afterwards, you can read more below and I’ll show you exactly what happened, step by step, when Jill and I were working with Holly.
Some mental health professional are understandably very skeptical about such extremely rapid recovery because most of us have been trained to believe that recovery from depression is an inherently slow process that unfolds only after many years of treatment, or may even require more than a decade of treatment. So when they see an extremely rapid elimination of symptoms, they simply cannot accept it, and feel the need to explain it away. There was a time when I felt this way, too!
In addition, when I was growing up in Phoenix, faith healers often came to town, or appeared on television, doing miraculous healing in front of huge audiences of true believers. But most people realized that these charismatic faith healers in white suites with Bibles in hand were, for the most part, frauds.
My co-therapist for the session at the workshop was Dr. Jill Levitt, who teaches with me at the Tuesday group at Stanford. Jill is a phenomenally skillful and compassionate clinical psychologist, and I always treasure the opportunity to work with her. When we work together, magic seems to happen. I feel very fortunate to teach with Jill and to have her as a colleague. We will be presenting two workshops together this fall at the ABCT conference in San Diego. Here’s the link if you want to check it out!
The before session testing indicated that our “patient,” Holly, was struggling with very significant depression and anxiety, and she said she’d struggled with these painful feelings unsuccessfully for many years. You can see Holly’s scores on the Brief Mood Survey that she completed just before the session began if you click here.
Although her depression score is only moderate, you can see that her feelings of worthlessness and low self-esteem were extreme, and that her feelings of anxiety were quite also intense. In addition, her score on the Positive Feelings test was very low, indicating very few positive feelings about herself and her life.
Jill and I started the TEAM-CBT session with T = Testing. If you click here, you can see the Daily Mood Log that Holly filled out just before the session started. As you can see, Holly was struggling with a myriad of negative feelings and intensely negative thoughts. Holly told us that she’d really always felt like that and had never really felt happy or good about herself, although she usually kept her negative thoughts and feelings hidden. This was especially sad.
At the start of the session, Jill and I empathized (E = Empathy), and we seemed to develop excellent rapport with Holly very quickly. After only about 20 minutes or so, she gave us an “A” on empathy, and said she felt understood and accepted.
Then we went on to A = (Paradoxical) Agenda Setting. The goal is to find out what, if anything, the patient wants help with during the session, and then to melt away his or her resistance to change. Holly said that she wanted to feel better about her life, if possible, so Jill and I used the Magic Button. Essentially, we asked Holly to imagine there was a Magic Button, and if she pressed it, all of her negative thoughts and feelings would instantly disappear, with no effort, and she’d be flooded with feelings of joy.
Would she press it?
Like almost every person I’ve worked with, she said she’d press it immediately!
Then Jill and I said that while we had some fabulous tools to help her, we weren’t convinced it would be such a good idea to press that Magic Button, because we might lose something very valuable at the same time.
Then we introduced a tool that proved exceptionally helpful called Positive Reframing. We asked Holly to list, with our help, two things about each of her negative thoughts and feelings:
- What does this negative thought or feeling show about me and my personal values that’s beautiful and positive, or even awesome?
- What are some advantages, or benefits, of this negative thought or feeling?
If you like, you can take a look at Holly’s Daily Mood Log and see what you can come up with! Make your own list before you continue reading.
This exercise may be really hard for you at first, because this is not the way we usually think about psychiatric “symptoms!” We don’t usually ask ourselves what’s really GREAT about feelings worthless, or hopeless, or ashamed or enraged. And we don’t usually ask ourselves what’s really wonderful about our own self-critical thoughts, such as “I’m an idiot” or “I’m fat and ugly.”
It was also hard for Holly, but she got into the swing of things pretty quickly, and together, we came up with a pretty impressive Positive Reframing List that you can review by clicking here after you’ve completed your own list.
The idea is that since your negative thoughts and feelings are beneficial, and reflect your core values, it might not be such a good idea to press the Magic Button and make them disappear entirely. To resolve this dilemma, we introduced the idea of the Magic Dial. We explained that since Holly’s negative thoughts and feelings revealed so many awesome things about her, and had helped her tremendously during her life, may she might instead prefer to dial her negative feelings down to some lower level, rather than getting rid of them entirely.
Holly listed her ideal levels for each negative feeling in the “% Goal” column of her Daily Mood Log, as you can see if you click here. Her ideal levels for each feeling were much lower, in the range of 10% to 30% for each feeling.
Essentially, Jill and I have made a “deal” with Holly’s subconscious mind. We’ve said, “We’ll lower them only to these levels.” This also puts Holly in charge of the session, so that we’re not pushing or selling anything, and so that we’re following her agenda. This is one of the most important parts of TEAM-CBT.
The “% Goal” column on the Daily Mood Log is not written in stone, and is actually a kind of illusion. That’s because Holly’s goals for each negative feeling might change once she begins to crush her negative thoughts.
We then went on to the M = Methods phase of the TEAM-CBT session, and helped Holly challenge each of her Negative Thoughts using several powerful techniques, including:
- Identify the Distortions
- Externalization of Voices
- Acceptance Paradox
- Self-Defense Paradigm
As it turned out, these techniques were incredibly effective, and her recovery was rapid and, I think it is fair to say, fantastic, and almost immediate. This is why some in the audience found it so hard to accept or believe. What happened, really, was like a miracle.
You can see Holly’s end of session scores on the Brief Mood Survey if you click here. In addition, all of her negative feelings on the Daily Mood Log fell all the way to zero. Holly was more than simply “improved” by the end of the session. I think it is fair to say that she was (and still is) jubilant.
And she now has so much more to bring to her own patients, the troubled teenagers she treats. And that’s why I’m a firm believer that doing your own personal work is vitally important to therapists. Because then, like Holly, you can tell your own patients, “I know what you feel like, because I’ve been there myself, and know what that pain is like. And I can show you the path out of the woods, and what a joy that will be!”
Fortunately, by the end of the four day program, most of the participants had changed their thinking and realized that the live demonstration had been absolutely real. I hope you feel the same way! I was humbled and thrilled to receive a standing ovation, something that only occasionally happens, and something that means a lot to me.
Holly graciously gave me permission to post the video here for you. I hope you have enjoy it!
I am very indebted to Holly for her courageous and deeply meaningful contribution to the workshop, and now you will have a chance to share the joy that she is feeling!
All the best,
David
If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, https://feelinggood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!
Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.
Thanks! David