David’s Tuesday Tips (#13)*

Here’s your paradoxical tip of the day!

Some people think that therapy consists of codependent schmoozing behind closed doors, with the occasional bit of “advice” or “tell me more” thrown in.
Are they right?

Use the Reply / Comment feature below to let us to know how you understand today’s tip.



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




12 thoughts on “David’s Tuesday Tips (#13)*

  1. I so look forward to David’s Paradoxical Tuesday Tips (and the published solutions on Wednesdays)! I am not a therapist; and, I have not been in therapy as a patient – so I can’t really weigh in on today’s tip. Nevertheless, I am confident that I will learn from the solution tomorrow!

    Mike in San Antonio

    • Thanks, Lou. Teaching can be challenging, as sometimes people are not motivated to learn and grow, especially if work or pain is involved, and that includes therapists, too! David

  2. Of course they are right! If you use your approach in responding to criticism—that therapists are codependent and give a little bit of advice and ask patients to “tell me more”—there must be truth in that criticism. Therapists, of course, don’t want to hear that type of criticism and would most likely defend themselves (But you don’t appreciate all my education/training! I’ve worked so hard to help you!). However, if patients do feel this way generally, it suggests that therapists are not as successful as they think in terms of making patients feel understood/expressing empathy. In addition, advice, as you’ve pointed out, is one of the techniques NOT to do. So yes, because criticism always has truth hiding in it, it is a paradox.

  3. I have been a client of this style of therapy and it has it’s place. That said, I’ve grown to love the “self-help” approach in books like Feeling Good in that the client can “heal thy self!”’ And as a therapist, i try to make sure all of my clients learn enough to help themselves without my help (i.e., work myself out of a job). I believe this to be one of the “gold standards” in our field.

    I guess the big downside to traditional talk therapy is that any gain may be attributed to the therapist rather than a change in the client’s cognition. This can be a real shame. Conversely, that’s why an approach like TEAM CBT is so inspirational…it doesn’t just “make” the client feel better; they get better!! Which I can attest to both personally and professionally.

  4. Even though that’s what happens in general, I believe actual effective therapy would consist of effectively practised CBT exercises and homework. However, even traditional CBT has been far behind its potential because most therapists lack the methods to enable them to get the patients to do the homework and to trust them sufficiently during the sessions and afterwards. Your team’s T.E.A.M. CBT is trying to break out of that unfortunate blockage of the therapy that’s the case for apparently most therapists and patients.

    • Yes, exactly. TEAM has, I believed, solved the problem of homework and motivation in a really effective way (or ways). Thanks for the note! david

  5. Well as far as “tell me more” it would be dependent upon your tone and the way you would ask. If it’s just generalized then I’m going to feel as if you are there just to put time in and uncaring. If it’s genuine then I’d more than likely be more inclined to open up on the situation. On the bit of advice it depends on past experiences and results. Sort of if you haven’t dealt with my experiences how can you tell me what to do in order to overcome them.

    • Thanks, Ray, very true. If your words don’t come from the heart, they won’t be very effective! And if you don’t “know” your patient, any intervention is bound to miss the boat, for sure! All the best, david

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