The featured photo shows Dr. Carly Zankman
vacationing with her husband, Jeff, in Positano

Podcast #269 : An Ectopic Pregnancy (Part 2 of 2)

October was Pregnancy & Infant Loss Awareness Month. We are dedicating this and last week’s podcast to

all the mothers and fathers who have lost infants or struggled with pregnancy complications and tragedies.

This will be the second of two podcasts featuring a live therapy session with Dr. Carly Zankman, a courageous young psychologist. Dr. Zankman has been struggling with the aftermath of a traumatic ectopic pregnancy and some intense fears that she may never get the chance to be a mother. In addition, she is 100% convinced that she can never feel happy or fulfilled in life unless she becomes a mother.

Last week, we featured the first half of her session with Dr. Jill Levitt and me at one of our Tuesday Stanford training groups. If you have not yet heard part one, you can link to it (podcast #268) at the list of Feeling Good Podcasts on my website. In this podcast, you will hear the conclusion of our work with Carly. We are also delighted that Carly could join us in person today to tell us what has transpired since the end of her session some months ago.

You can see Carly’s Daily Mood Log (DML) and Brief Mood Survey (BMS) at the start of the session as well as her Brief Mood Survey and Evaluation of Therapy Session at the end of her session.

You can also review her completed Daily Mood Log so you can see her final mood ratings along with how she challenged each Negative Thought.

There were a number of teaching points in Carly’s session:

1. Depression nearly always results from telling yourself, and believing, that you have lost, or don’t have, something you believe you “need” in order to feel happy and fulfilled. It could be something internal, like greater intelligence or talent, or something external, like a baby, or a family, or greater wealth or status.
2. There is a difference between a high-level and a low-level solution to most depression. In a low-level solution, you find happiness by getting what you want. For example, you learn that you are pregnant, or that you got an important promotion at work, or that someone you’re attracted to has accepted a date with you. In a high level solution, you discover that you can feel happy and fulfilled without the thing you were so certain that you “needed.”
3. Although therapeutic empathy alone has limited healing powers, it can be absolutely precious and essential. Sometimes, people have a desperate need to be heard and given the space to express their feelings and to be accepted. In addition, people who have experienced a traumatic event or series of events often need the time to describe their experiences in detail. This can function like exposure, allowing the anxiety to diminish.
4. Therapy without a meaningful agenda is highly likely to fail. And sometimes, a therapist has to “sit with open hands,” even when the patient’s agenda may be a bit different, or even radically different, from you own. Our task is not to force the patient to conform to our standards and expectations, but to help the patient find happiness on their own terms, pursuing their own goals.
5. The Downward Arrow Technique was helpful and revealing during the Empathy phase of the session. This technique allowed us to pinpoint Carly’s core belief, which was also a Negative Thought on her DML: “I’m never going to feel fulfilled in life without children.”
6. It is okay for therapists to struggle with, and discuss, moments of confusion or uncertainty during a session. This type of dialogue can involve the patient and can often help you find your path forward.
7. There were some additional steps that could have been taken but we were limited by time. For example, we could have explored the interpersonal dimension of how to enhance the communication of feelings between Carly and her husband, as well as between Carly and other family members. She sometimes feels ignored and hurt. This problem is exceptionally common and can be addressed with tools like the Relationship Journal, the Interpersonal Downward Arrow, and the Five Secrets of Effective Communication. However, this can take some time, and also requires an agenda for the patient to be willing to examine his / her role in the problem and practice some new communication skills.
8. Our negative feelings always result from our thoughts and beliefs, and not from the actual events in our lives. However, sometimes patients can be extremely fixated on certain beliefs that trigger their pain and may even put up a powerful wall to protect those beliefs. This is human nature, and part of what makes the job of therapy incredibly challenging, fascinating, and rewarding.

We are all extremely grateful to Carly for her courage in sharing this intensely personal part of her life with us. She received, as you might imagine, incredibly support from all the members of the training group during and after her session, as others had struggled with similar fears as well. You can find her Brief Mood Survey at the end of her session here, along with her Evaluation of Therapy Session.

You can also review her completed Daily Mood Log so you can see her final mood ratings along with how she challenged each Negative Thought.

For more on this topic, you might want to give a listen to one of Carly’s favorite podcasts, #79: “What’s the Secret of a Meaningful Life: Life Therapy with Daisy.” (https://feelinggood.com/2018/03/12/000-live-team-therapy-with-daisy/)

After the group, Carly received this email from one of the Tuesday group members:

Good afternoon Carly,

I want to let you know what I enjoyed the work you did yesterday. Despite the challenging and emotionally charged topics you spoke with great clarity and poise. I suspect some of the points were uncomfortable to talk about at times. You went into great detail and I never felt disconnected or lost. It all seemed very fluid and I found myself following along closely to the story. That was quite impressive. I suspect this talent is very helpful for your clients.

I was curious if I could get your viewpoint about the exchange you had with Jill that brought up an emotional response on your part. Burns seemed to describe it as more self-defense while I think you described it as more acceptance. Perhaps my memory is off here so feel free to correct me.

To me it sounded like you didn’t want to give up the idea of having a baby and tying that to fulfillment so, with Jill’s lead, you stated that one way or another you will be a mother. That is important to you and you will make that happen. Perhaps this was the “self-defense” part.

I am thinking that maybe the Acceptance part was the acceptance of the emotion of the strong desire to be a mother and how important this is for you. Acceptance that you have this strong desire and that is ok to feel that way. Maybe the tears you felt were the tears of liberation in realizing that it was ok to have this desire because you believe in it strongly while many people may have been pushing you to let go of that. So you may not have accepted the idea of not having kids and being ok with that but you have accepted the strong emotion that is driving you to have kids. I suppose this is also captured to some degree in the positive reframe and the dial of that emotion and NT. Am I reading the situation right? Does this make any sense or am I totally off?

Thank you for any thoughts you may have. This was a great experience for me.

Warm regards,

Jason

This was Carly’s response:

Hi Jason,

Thanks for reaching out with your kind words. I’m CC’ing the Tuesday group because I think your question is great and imagine others might wonder, too. I don’t know whether it was self-defense or acceptance, but let me try to explain what happened in that moment.

During the Externalization of Voices, Jill took a turn at arguing against the thought, “I will never be fulfilled without children,” but instead of arguing against it, she accepted it and then proceeded to list all these ways that I could make having children possible.

I don’t remember exactly what she said now (I wish someone had written it down), but hearing her say what she said led to an “a-ha” moment for me where I realized that she was right; no matter what, I will make it happen because that’s what I do and that’s who I am. She tied it back to my values that were brought out during the positive reframe, and I accepted that I don’t want to change that thought because it’s motivating for me.

Hope that helps clarify!

Warmly,

Carly

Some weeks after the session, I sent this email to Carly:

Hi Carly,

I don’t know if we considered this during the session, and it might not have any value now, but do you see any difference between intensely wanting to be a mother vs needing to be a mother, in terms of the advantages and disadvantages of each belief / mind set? I know I’ve been voted out on this topic by you and Jill long ago, but I just wanted to get your take on this.

Personally, I find the WANTING approach works well for me and does not have the potential for the painful mood swings that are sometimes associated with the MUST HAVE or NEED mindset.

When I was younger, success (in research and in clinical work) was kind of in the MUST category, and it was an emotional roller coaster, but now I am much more in the WANT category. So, for example, I’m pouring my heart, mind and soul into the app I’m working on, but don’t feel that success with this project is a need or a must. The WANT (as opposed to NEED) mindset actually makes it easier to succeed, and to get what I want, although nothing is guaranteed, of course. I would say that my passion for my goals is just as strong as ever, if not stronger, without the “need” and the angst that can sometimes go along with “needing.”

If this sounds pushy or dorky or intrusive, just ignore it. But it has been kind of eating away at me, and I’ve been feeling a bit like a “reject” with poor clinical skills, so I wanted to share my thinking with you, just to clear the air, and hopefully this will not offend you or Jill, but deepest apologies if it is off-putting. I really want to see you become a mother, and know what an incredible mother you will be! And what an incredible person you are, too!

And no need to respond. You may now be happily traveling to Italy or something really cool, and I hope you have an awesome time!

Warmly, david

This was Carly’s response:

Hi David,

I love what you are saying here and 100% agree. I think I mentioned the shift I’ve had from need to want briefly during our podcast update meeting but wished afterwards that we had expanded on this idea more during our recording because of how powerful it can be. I think my thought changed from “I need to be a mother to be fulfilled” to “I want to be a mother,” and this is very motivating to me. As you just described, it’s similar to previous very motivating and driven thoughts I’ve had such as, “ I want to be a psychologist” or “I want to graduate college early so I can go live in Israel.” It’s almost like “want” thoughts give you a strong sense of empowerment and control to make things happen how you want them to vs. “need” thoughts that cause those painful mood swings and hopelessness when something in life doesn’t happen how you think you NEED it to.

I love getting emails like this so you can send them anytime! We just arrived in Positano yesterday and are enjoying the breathtaking views. Here’s a pic like you requested!!

Warmly, Carly

That is the gorgeous picture that is featured in today’s podcast!

David

Dr. Jill Levitt practices at the Feeling Good Institute (www.feelinggoodinstitute.com) in Mountain View, California, where she is the Director of Training. She can be reached at jilllevitt@feelinggoodinstitute.com.

Dr. Rhonda Barovsky practices in Walnut Creek, California. She sees clients mostly via Zoom, and in her office.  She can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her website: www.feelinggreattherapycenter.com.

Dr. Carly Zankman has a telehealth clinical practice in Mountain View, California and is currently working towards Level 3 Certification in TEAM-CBT. She specializes in the treatment of teenagers and young adults throughout California who are struggling with anxiety (especially perfectionism), depression, relationship problems, and insomnia. She can be reached at info@drcarlyzankman.com.

You can reach Dr. Burns at david@feelinggood.com.

This is the cover of my new book, Feeling Great. The kindle and audio versions are available now too! 

It’s currently on sale at Amazon and ridiculously cheap! Act fast if you want a copy!