Podcast 59, Live Therapy with Marilyn, The Tune-Up

This podcast was recorded eight weeks after the initial session with Marilyn. As you may recall, Marilyn became severely depressed when she discovered that she had Stage 4 Lung cancer. In spite of that horrific and real trauma, she completely overcame her negative feelings in the first session, which was broken down into a series of three consecutive podcasts, with commentaries as the session unfolded.

Sadly, Marilyn experienced severe pain in her left rib cage from a metastasis from her lung cancer roughly two months later. This physical relapse triggered an understandable emotional relapse as well, with an understandable return of severe depression, anxiety and anger, so Marilyn agreed to record another podcast to illustrate how a tune-up works following the initial treatment.

I would like to point out that the Relapse Prevention Training was critically important, so that Marilyn would know that relapses are a certainty, and that they can be dealt with effectively using the same techniques that worked the first time. This message is important so that the patient does not feel broadsided when the negative feelings return. Some patients have the false expectation that they’ll be happy forever after they’ve recovered.

But no one is entitled to be happy all the time! If the therapist and patient know how to deal with a relapse, and have practiced ahead of time, it will still be painful, but the patient and therapist will know what to do to make sure the patient can recover from the relapse quickly, instead of getting caught in another length episode of depression or anxiety.

The entire session has been included in this single podcast. That’s why we’ve offered this as a bonus session between our weekly podcasts. You will need nearly two hours to listen to it, but I think you will find it’s a great investment of your time.

In addition to her anxiety about the metastasis, and the fairly strong physical pain that is now with her constantly, Marilyn was flooded with intense Negative Thoughts and feelings that revolved around a number of familiar themes, including:

1. Her belief that her life is now over, and that she has nothing more to live for.
2. Her conviction that she is a burden to Matt, Fabrice, and David, who would prefer (she thought) to be relaxing with their families, instead of sitting down with Marilyn on a Saturday morning.
3. Her anger that God has abandoned her.
4. Her belief that she should not be so angry with God.
5. Her despair and fatigue at constantly struggling with pain.
6. Her urge to drink again.
7. Her self-criticisms and feelings of intense shame about her life and her relapse into depression.
8. Her conviction that things are hopeless.
9. Her belief that she’s selfish.
10. He belief that she should not be watching so much TV.
11. Her ambivalence that on the one hand she is afraid of dying, but at the same time she wants her suffering and struggling to be over.

After the initial T = Testing, Matt and David walked Marilyn through the E = Empathy, A = Agenda Setting, and M = Methods portion of the session, using techniques such as the Five Secrets of Effective Communication, Positive Reframing, the Magic Dial, Identify the Distortions, the Externalization of Voices, Acceptance Paradox, and more.

They also used the Interpersonal Downward Arrow, highlighting Marilyn’s view of her relationship with the two therapists—the “Rules and the Roles” that we’ve discussed in a previous podcast. Keep in mind that in the analyses below, we are talking about how Marilyn views her relationships with two people she cares deeply about. We are not talking about what’s “real,” but rather how we view and experience our relationships with othes.

The adjectives Marilyn used to describe her role in her relationships with David and Matt included:

• Stupid
• Inferior
• Needy
• Lazy
• Unimportant

The adjectives she used to describe the role that David and Matt played in the relationship included:

• Superior
• Critical
• Demanding
• Phony
• Rejecting
• Important
• Uncaring

And the rules that Marilyn believed she must follow in this (and all) relationships included:

1. I have to suffer in silence.
2. I am not allowed to ask for help.
3. I need to stay alone.
4. I have to be quiet.
5. I have to behave in an extremely submissive manner.
6. I have to be guarded at all times.
7. I have to be invisible and hide all my feelings.
8. I cannot be assertive or I’ll be put down.
9. I must always put myself last and put others first.
10. I cannot be important.
11. I cannot expect or accept kindness and love.
12. I can’t be weak, emotional, real or vulnerable in front of you.
13. I cannot express any anger or loneliness for fear of retaliation.

Once again, Marilyn experienced another rapid, inspiring and rather mind-boggling transformation in her thoughts and feelings during the session. Then, Matt, David and Marilyn discussed the spiritual implications of her “dark night of the soul,” and emphasize the incredible gift Marilyn is giving to all of us through these recordings, as well as the enormous growth she is still experiencing during this phase of her life.

A few potentially important teaching points include:

1. We will all “relapse” back into spells of depression, anxiety, shame, hopelessness, and anger from time to time. No one is entitled to be happy all the time! This is a practical and spiritual reality for human beings. But it does not have to be a problem if you have the tools to climb back out whenever you fall into a black hole of self-doubt or despair.
2. Our painful feelings do not result from the events in our lives–in this case, a painful metastasis–but from out thoughts about these events.
3. Even when an event is genuinely horrific, the negative thoughts that trigger our feelings of depression and anxiety will nearly always be distorted and unrealistic. However,  we may not realize this, and firmly believe that our negative thoughts are absolutely true. This way of thinking may contain a grain of truth but makes us victims of forces beyond our control.
4. For each of us, the negative thoughts that trigger our occasional “relapses” into depression and anxiety will usually be very similar, if not identical, from episode to episode. Of course, we will all have our own unique patterns of negative thinking, and no two people will have the exact same negative thoughts. That’s why formulaic approaches to treatment may sometimes fall short–because the therapist does not pinpoint or target the specific negative thoughts that trigger the patient’s distress.
5. The techniques that worked for the patient the first time s/he recovered will nearly always work for the patient when the negative thoughts return.

David and Matt were grateful and thrilled to receive this email from Marilyn the day after they recorded the podcast:

Greetings David,

Much gratefulness to you, Matt, and Fabrice. It was a profound experience. At my AA meeting this am, a number of people came up to me and commented on how good I looked—relaxed & glowing. Yesterday was magical! It is a privilege working with you. Matt, and Fabrice. Thank you for taping.

Thank you also for the book, The Inner Eye of Love. It is very good. I also left a bag of honey somewhere in your home – one for you & Melanie, one for Matt, and one for Fabrice.

I will listen to the podcast of our first therapy session (two months ago) tomorrow—today was busy. I will get back to you with feedback.

Thank you also for your company at the Intensive and paying for my meals. I so enjoy your company, and if I may be so bold, your friendship.

Lastly, please e-mail the Therapist’s Toolkit upgrade.

Don’t worry about my not feeling hungry at lunch. I ate a big breakfast for me. I did eat dinner!

Again, thank you for helping me. Please thank Melanie for making your home available. Pets and kisses to your new kitty, Ms. Misty.

I hope you’re having a rest-filled weekend. Enjoy the Sunday hike! I look forward to listening to the podcasts.

With much gratitude and love,

Marilyn