I was concerned that our recent “Ten Most Common Therapist Errors” show might antagonize people, but we got quite a lot of positive and encouraging feedback from listeners, which was surprising to me. As a result, Fabrice and I decided to take a chance and publish two more shows on common therapist errors this week and next week. We hope you like these shows!
Make sure you let us know what you think, and let me apologize in advance if I come across as annoying or overly cynical. All of the errors I describe are correctable; the goal is to improve the treatment of individuals struggling with depression, anxiety, troubled relationships, or habits and addictions. Thanks!
Here are the five errors discussed in today’s show.
1. Failure to hold patients accountable. Example, the therapist may let the depressed patient slip by without doing psychotherapy homework, since the patient insists he or she doesn’t have enough time or motivation to do the homework; or the therapist may agree to treatment an anxious patient without using exposure, since the patient may resist exposure; or a patient may treat someone with a relationship conflict without exploring the patient’s role in the problem, and so forth.
David argues that this rarely or never leads to significant change, much less recovery. However, many therapists, and perhaps most, get seduced into this error for a variety of reasons.
2, The “corrective emotional experience.” This is the belief that the patient’s long-term relationship with the therapist will be sufficient for growth and recovery, without having to do any psychotherapy homework or be accountable. Therapist may imagine himself or herself as the loving and nurturing parent the patient never had.
David argues that this caters to the therapist’s ego and feeds into what the patient wants as well—a long-term relationship built on schmoozing.
But does it lead to recovery?
Here’s David’s short answer: Nope! Warmth, empathy, and trust are necessary ingredients for good therapy, but they are simply not sufficient. Your patient may think you’re the most wonderful and supportive listener in the world, but that will rarely or never lead to recovery from depression, an anxiety disorder, or an addiction, and it will not lead to the skills to heal troubled relationships, either.
3. Responding defensively to patient criticisms. David argues that therapists almost always react defensively to criticisms by patients, such “you don’t’ get me,” or “you aren’t helping,” or “you don’t really care about me.” He describes an interesting five-year study of psychoanalysts in Atlanta, Georgia, sponsored by the National Institute of Mental Health (NIMH), to find out how the analysts responded to patient criticisms. You may find the results surprising!
He gives an example of defensive responding during a workshop he conducted at a hospital in Pennsylvania. Therapists can learn to correct this error with lots of practice with the Five Secrets of Effective Communication, but this requires several things:
- Using the Patient’s Evaluation of Therapy Session after each session so can quickly pinpoint empathy / relationship failures.
- Lots of practice with the Five Secrets.
- Humility, and the willingness to see the world through the eyes of the patient. This requires the “Great Death” of the therapist’s ego!
4. Joining a school of therapy and treating everything with the same method or approach. Can you imagine what it would be like if medicine was organized like this, with “schools of therapy,” like the “penicillin school”? David apologetically argues that the abolition of all schools of therapy would be a good thing. Fabrice disagrees, and argues that the treatment of psychological problems is inherently different from the treatment of medical disorders.
Let us know what YOU think!
5. Confirmation paradox. I (David) majored in the philosophy of science in college, and this was one of the first topics, and it definitely applies to our thinking about the causes of emotional problems. I’ll try to make it really simple and understandable.
Here’s the essence of this error. If I have a theory that predicts the patient’s behavior you may conclude that your theory is correct. But this logic can be very misleading. Here’s a general science example
- Your theory: the sun circles around the earth.
- Your prediction: if my theory is true, the sun will come up in the east each morning and set in the west each evening.
- Your observation: the sun DOES come up in the east and set in the west, exactly as predicted.
- Your erroneous conclusion: the sun circles around the earth.
Now let’s consider a psychotherapy example. Many therapists believe that perfectionism and insecurity result from growing up with parents who emphasized hard work and high standards as a precondition for being loved. Now let’s assume that you have a perfectionistic and insecure patient who remembers feeling like s/he wasn’t good enough when growing up. So, you conclude that the patient’s interaction with demanding parents caused the perfectionism and insecurity.
But the perfectionism and insecurity may not have resulted from any childhood experiences or interactions with parents. It may have been strongly influenced by genetic factors, or social / environmental pressures.
We can put this in the same framework as the example about the sun:
- Your theory: Perfectionism and insecurity result from growing up in unloving families that emphasized high standards and achievement rather than unconditional love and nurture.
- Your prediction: Insecure, perfectionistic patients will report childhood experiences with unloving parents who pushed them to work harder, etc.
- Your observation: Your insecure, perfectionistic patients DO describe their parents as demanding and lacking in love and support.
- Your erroneous conclusions: The patient’s childhood experiences caused the perfectionism. 2. The patient will have to “work through” these childhood experiences if s/he wants to overcome the feelings of perfectionism and insecurity.
Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world (but not across U.S. state lines) via teletherapy. You can reach him at firstname.lastname@example.org. You can reach Dr. Burns at email@example.com. If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.
TWO COOL UPCOMING WORKSHOPS FOR YOU
Dr. Jill Levitt and I are offering what I think will be an outstanding workshop on the treatment of unwanted habits and addictions on Sunday, February 10. Our Sunday workshops are tremendously fun, so consider attending if you are interested. We quickly sold out in-person but you can still join online.
THERE WILL BE MANY EXPERTS TRAINERS TO GUIDE THE ONLINE GROUP IN THE SMALL GROUP EXERCISES
During the program, you will have the chance to work on one of your own habits / addictions so you will get the double benefit of learning cool new treatment techniques and doing some personal healing at the same time!
You will develop a deeper understanding of Outcome and Process Resistance, and you will learn how to deal with this twin-horned Devil. As you know, TEAM-CBT features many innovative techniques to reduce Outcome and Process Resistance.
Here’s the BAD news. Very few therapists have the skills, insights, or mind-set to deal with resistance, and this is the main cause of therapeutic failure in the treatment of depression, anxiety disorders, relationship problems, and habits and addictions.
Here’s the GOOD news. Once you acquire these skills, your clinical effectiveness will soar!
Here are the specifics–
Act fast if you want to attend!
Don’t miss out learning from David Burns, MD, one of the great pioneers of Cognitive Therapy, and from the fabulous, Jill Levitt, PhD, Director of Training at the Feeling Good Institute in Mt. View, CA!
TEAM-CBT Methods for Unwanted Habits and Addictions: Step-by-Step Training for Therapists
WHEN: February 10th, 2019, 8:30 am – 4:30 pm PST
(11:30 am-7:30 pm EST)
WHERE: Join us live online or in person at the Creekside Inn, Palo Alto, CA.
HOW MUCH DOES IT COST? $135,
WILL I GET CE CREDITS? YES!
7 CE hours available
WILL I GET CREDIT IN THE TEAM LICENSURE PROGRAM? YES!
Completion of this workshop also counts towards TEAM-CBT Level 1, 2 or 3 Certification
WHO CAN ATTEND? Therapists of all levels are welcome
CAN I REGISTER IF I’M NOT A THERAPIST? In my opinion (Dr. Burns), although the workshop is geared for therapists, it will be taught in a clear and basic way that anyone can benefit from. Please check with the Feeling Good Institute if you want to attend.
CAN I WORK ON MY OWN HABIT / ADDICTION? Absolutely!
Heal yourself, heal your clients!
WILL I HAVE FUN? Yes!
You will also:
- Learn new skills to reduce resistance and boost the motivation to change. This is THE key to the treatment of any habit or addiction.
- Learn how to use Dr. Burns’ powerful Decision-Making Tool and Triple Paradox Technique.
- Practice and master the Devil’s Advocate Technique to help you and your patients overcome difficult-to-stop habits and addictions to drugs, alcohol, overeating, procrastination, and more.
You will love this lively, amusing, and immensely useful day of training with Drs. Burns, Levitt and the Feeling Good Institute Staff. The trainers will use a combination of didactic teaching, live demonstrations, and breakout group practice to enhance skill-building.
This wonderful workshop will stream live and is easily accessible from anywhere in the world on any device with WiFi. To join, just click on the link provided before the workshop.
* * *
If you can’t join us for the addictions workshop, consider this cool program on the treatment of anxiety disorders in the spring. But register soon if you want to attend in person, as the in person slots are limited.
by David D. Burns, MD and Jill Levitt, PhD
May 19, 2019
You can attend in person or from home via Live Streaming