083: Role-Play Techniques (Part 1) — Externalization of Voices / Acceptance Paradox

This is the first several podcasts on the Role-Playing Techniques David has created. They include:

  • Externalization of Voices (with Acceptance Paradox and Self-Defense Paradigm)
  • Paradoxical Double Standard Technique
  • Feared Fantasy
  • Devil’s Advocate
  • Forced Empathy
  • Man from Mars
  • And more

David’s explains that he began developing role-playing techniques in the early days of cognitive therapy because many of the Beckian techniques, such as Examine the Evidence and the Socratic Technique–while sometimes very helpful, were sometimes a bit dry, and he wanted to include punchier and more powerful and dynamic techniques in his therapeutic toolkit. These role-playing techniques are just one part of what sets TEAM-CBT apart from traditional, Beckian CBT.

Today, he explains and demonstrates the Externalization of Voices, which is always combined with the Self-Defense Paradigm and the Acceptance Paradox. He is joined by Fabrice, of course, and “Sarah,” one of the members of his Tuesday training group at Stanford. Sarah has volunteered to use a personal example in the podcast to help demonstrate the Externalization of Voices.

Sarah has brought a partially complete Daily Mood Log to the session. The Upsetting Event was that Sarah has decided to move to Austin, Texas in two weeks. She has many moderately strong negative feelings about the move, including sadness (30), anxiety and nervousness (75), inadequacy (60), loneliness (75), self-consciousness, and discouragement (70). She also felt stuck and defeated (70). The numbers in parentheses indicate how strong each type of feeling was on a scale from 0 (not at all) to 100 (extremely.)

Her Negative Thoughts include:

  • “All of my friends are ahead of me in life (careers and relationships).”
  • “I should be further along in my career and I should be 100% certain this is the best career for me in the long term.
  • “For the most part, I haven’t helped most of my clients very much.”
  • “My anxiety over the past year indicates that I’m in the wrong profession.”
  • “I’ll never get back in the great shape, physically and emotionally, that I was in three years ago.”
  • “Moving to California set my life back by a year.”
  • “I won’t be able to make new friends in Austin.”
  • “I will be lonely and without friends.”
  • “I won’t be able to cope with stress.”
  • “My therapy skills aren’t good enough,”

and more.  Her belief in many of her Negative thoughts is quite high, in the range of 70% to 100%. However, her belief in one of them, “Moving to California set my life back by a year,” was only 20%.

Although David did not intend this to be a live therapy session, but rather a practice session to demonstrate how the Externalization of Voices works, David does some brief paradoxical Agenda Setting first, since Sarah’s example is real, and not made up. David uses several techniques to melt away Sarah’s Outcome Resistance, including:

  • The Invitation
  • The Miracle Cure Question
  • The Magic Button
  • Positive Reframing

During the Positive Reframing, David asks Sarah two things about her negative thoughts and feelings:

  1. What does each negative thought or feeling reveal about you and your core values that is positive and awesome?
  2. What are some advantages, or benefits, of each negative thought or feeling?

They come up with a list of ten positives, including these: “My negative thoughts and feelings show that

  1. I’m realistic and honest.
  2. I’m thoughtful.
  3. I’m committed to self-care, since I want to have good mental and physical health.
  4. I’m motivated to grow and improve my therapy skills.
  5. I have compassion for my clients and want to give them the best care that I can.
  6. I’m honest about my shortcomings.
  7. I’m humble.
  8. I have high standards.
  9. I want to connect with others.
  10. I’m committed to my career.

They conclude the Paradoxical Agenda Setting with the Magic Dial. Sarah decides to lower her negative feelings f to much lower levels, in the range of 5% to 15%.

Then, David asks Sarah which Negative Thought she wants to work on first. She chose the thought about never being able to get back into top physical and mental shape again. They identify the many cognitive distortions in the thought, such as All-or-Nothing Thinking, Overgeneralization, Mental Filter, Discounting the Positive, Fortune-Telling, Magnification and Minimization, Emotional Reasoning, Should Statements, and self-Blame.

Then David explains how the Externalization of Voices works, and they launch into the technique. David starts out as the “Negative Sarah,” and attacks her with the Negative Thought she wanted to attack first, using the second-person, “You.” Sarah responds in the role of the “Positive Sarah,” using the first-person, “I.”

Sarah fairly quickly knocks the ball out of the park, and easily crushes the Negative Thought David has attacked her with. Then David attacks Sarah with the rest of her Negative Thoughts, one at a time, doing occasional role-reversals to illustrate different ways to attack the thought. They continue doing role-reversals until Sarah described her victory over each Negative Thought as “huge.”

This only takes a few minutes. Then Sarah re-rates her negative feelings on the Daily Mood Log, and nearly all have been reduced to zero. David cross-examines Sarah to find out if this amazingly rapid and dramatic change was real, or if she was just being “nice” to try to produce a good role-play for David!

Fabrice raps up the podcast with his (as usual) great interview with David and Sarah, bringing out many of the teaching points during the session. He emphasizes that you can actually use many of David’s 50 Methods when doing Externalization of Voices, and points out the power of “Let’s Be Specific” that David demonstrated during the role-playing.

Next week: The Paradoxical Double Standard Technique!

Coming Soon! Advanced, High-Speed TEAM-CBT for the Treatment of Depression and Anxiety 

We warmly invite you to attend this fabulous, one-day workshop by Drs. David Burns and Jill Levitt on Sunday, May 20th, 2018. Click on the link above for registration and more information.

  • 6 CE Credits
  • The cost is $135
  • You can join in person or online from wherever you live!

You will enjoy learning from David and Jill, working together to bring powerful, healing techniques to life in a clear, step-by-step way. Their teaching style as a team is entertaining, funny, lucid, and inspiring. This is a day you will remember fondly!

In the afternoon, you will have the chance to do some personal healing so you can overcome your own feelings of insecurity and self-doubt. David and Jill promise to bring at least 60% of the audience into a state of spiritual and psychological enlightenment, WITHOUT years of meditation. That’s not a bad deal at all!

You will LOVE this workshop. Seating for those who attend live in Palo Alto will be strictly limited, and seats are filling up fast, so move rapidly if you are interested.

Jill and I hope you can join us!

Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!

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At least one listener has had problems leaving an iTunes review from his i-phone, so Fabrice has created some simple to follow instructions if you need help.

 

 

6 thoughts on “083: Role-Play Techniques (Part 1) — Externalization of Voices / Acceptance Paradox

  1. Another great podcast! Thanks so much for sharing your wealth of insight and knowledge. LOVING the live demos. I related to the comment on some of the typical cbt techniques being too intellectual. The role playing techniques are by far my favorite and I often get the same feedback from my patients. I enjoy turning examine the evidence into a role play in which we play a defense and prosecuting atrorney battling over the “evidence” for a specific negative thought. Much more interactive and fun than just writing it out.

    • Thanks, Tyler. It’s my favorite technique, too, and often very powerful. Sending your kind note to “Sarah.” d

  2. This was amazing podcast, I was helped a great deal using externalisation of voices with Relationship Journal, where I was in blame mode during conflict with a loved one. And it was coming in the way when I tried applying the Five Secrets.

    With externalisation of voices I could see why I was unable to accept my own mistake, and the whole conflict kept raging because of my belief ‘I’m correct !’. Also I didn’t feel ashamed or got into self-blaming as I could see my perspective from outside.

    In the end, when we fight with our loved ones, generally the point of conflict moves away from actual objective disagreement into a power struggle of who is correct or superior. Under such circumstances even if we win the argument, it remains Pyrrhic Victory – As we end up pushing the person away from us by showing them inferior in some way, hurting them deeply.

    This was really great lesson to me, and now I take a brake if I feel the argument is going away from respectful discussion, use externalisation of voices or if I’m mad at that person even Devil’s advocate to see my thoughts. Then using Relationship Journal prepare a revised response, practice it and the talk to the person again.

    I had great success with these tools and not only me but people at odds to my position or opinion also, do feel great after such ‘arguments’ !!!

    Thank you, tremendously.

  3. I really love this technique. It puts aside the seriousness of any situation and saturates it with humor. It is difficult, though, for non therapists to self apply. I will start practicing it. I think this is one that will help me the most in my quest to overcome anxiety. I have been using the daily mood log for 20 years but even when I put the lie to the negative thoughts they keep coming back. But hey that is just human. I think I just used the acceptance paradox, Just thinking of it makes me peaceful.

    Thank you Dr. Burns, Sarah and Fabruce, This was enlightening.

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