David’s Answer to Tuesday Tips #4*

This was yesterday’s paradoxical tip of the day–

Last week, we discussed the idea that therapists’ empathy skills tend to be poor, but therapists are not usually aware of this. If your patients complete the “Evaluation of Therapy Session” in the waiting room after each session, you’ll see, exactly what’s happening, and you can address alliance failures right away. . .  if you dare!

Failures of the alliance (the patient’s poor ratings of therapist empathy and helpfulness)
are actually extremely positive—
if you know how to respond skillfully!

In fact, you’ll often discover that your greatest therapeutic failures
are your greatest successes in disguise! But how can that be?

And here’s my answer!

Therapists who require their patients to complete my Evaluation of Therapy Session after every session (plus the Brief Mood Survey before and after every session) will be rated on Empathy and Helpfulness Scales, and several other scales that are tremendously sensitive to the tiniest therapeutic errors. You will discover that you often get less than stellar ratings on warmth, trust, understanding, and helpfulness. These low ratings may surprise you, especially if you are used to (wrongly) thinking that your empathy skills are excellent or even outstanding.

I have set the scales up so that even a 1 point deduction from a perfect score on any scale is defined as a failing grade. There are two reasons for this. First, anything less than a perfect rating indicates some dissatisfaction on the part of the patient that needs to be explored. For example, the patient may think you did a super job of using listening skills, but may indicate that you did not completely understand how she or he was feeling inside. If this failure of understanding is not addressed and corrected, it may have a corrosive effect on the treatment.

Without the written feedback on the evaluation scales, the therapist would never know he or she was failing in this way. That’s because if you ask the patient how things are going, he or she will nearly always say, “fine,” and keep his or her dissatisfaction secret. But if you look at the written feedback on the Evaluation of  Therapy Session, you will see right away what’s going on.

So how can it be good to discover that you are failing with your patient? There are several positives:

  1. When therapists use my scales for the first time, most will get failing grades on nearly every scale at nearly ever session with nearly every patient. This can be quite disturbing. But if you learn to process the feedback in a relaxed, non-defensive, warm way, using the Five Secrets of Effective Communication, you will find that your scores will increase dramatically, and your therapeutic skills will soar as well. Many of my students report that after using the scales for several weeks with all their patients, and practicing how to process the information in one of our online or in person training groups, they receive perfect scores on most if not all of the scales with as many as 80% or their patients.
  2. When you learn you are failing with a patient, you can immediately discuss the problem, if you have the courage, and this will can lead to significant improvements in the treatment. That’s because you will have accurate information for the first time on how your patients feel, how much progress they make (or fail to make) in every single session, and how they really feel about you.
  3. When they rate you poorly on warmth, support, trust, or understanding, it will ALWAYS be the case that their negative feedback is 100% accurate. When they say, “You don’t really understand me or care about me,” they are saying something that is true. You ARE failing in that exact way! But if you listen, and disarm, using the Five Secrets, and genuinely and skillfully acknowledge the (often painful) truth in what the patient is telling you, your “failure” will usually become his or her first “success” at getting close to someone. That’s because they patient may have felt rejected or abandoned by everyone in his or her life, so this may be his or her first experience of real intimacy and trust. In other words, the problem the patient experiences with you will usually be his or her “core conflict,” to use a psychoanalytic term.  And if you have the desire and the skill, you can find out about it right away and work to quickly repair the lesion that has been causing so much pain.

This type of communication with patients about their criticisms of the therapist often involves the death of the therapist’s ego. That’s because you have to realize and acknowledge that you really have failed at something you thought you were really good at, something central to your sense of identity. But if you do it skillfully, you and your patient will both “die” at the same time, and you’ll also be reborn with a new sense of connection.

Well, that’s my goofy tip for today. I’m kind of rushed today, so will send it out without much if any editing, and hope it’s not too bad, or too corny!



* Copyright © 2018 by David D. Burns, MD.

Coming Soon! Move Fast if You Want to Attend this Terrific Program coming up a week from Sunday!

Sold out in person, but we still have room for you online. Those who attend online will have opportunities for small group practice in break out rooms, with supervision!

High-Speed TEAM-CBT for Depression and Anxiety Disorders 

I 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 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 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!

You will leave this workshop with renewed confidence as well as specific, powerful tools that you can use right away to improve your clinical outcomes!

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. Online slots are also limited.

Jill and I hope you can join us!

Coming in June! One of my best two-day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”

Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada

You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety:

  • Generalized Anxiety
  • OCD
  • PTSD
  • Phobias
  • Social Anxiety
  • Agoraphobia
  • Panic Disorder
  • and more

You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises.