Wonderful Email!

Wonderful Email!

IMG_1288Hi web visitors,

I just got an amazing email that I wanted to share with you! I’m on the road this week teaching my trauma workshop in three east coast cities, and look forward to returning home again so I can do more blogs and podcasts! David PS the picture is from out living room just prior to a Sunday hike, thanks to Maryam Hamidi.

Comment: Dr. Burns,

I just wanted to write a quick note to say thank you! 20 years ago (when I was only 15!) I found your book, Feeling Good, at my local bookstore and brought it home with me. I’ve carried it with me EVERYWHERE I’ve moved (and I’ve moved a lot!) — because it literally changed my life. And it continues to ground me and bring me comfort/relief whenever I have an anxiety or depression relapse.

Recently, I discovered your Feeling Good Podcasts. What a thrill ! I love to put it on after a long day and learn about your new techniques, behind-the-scenes vignettes, and enjoy your humor and humility. What a GIFT you have given so many people for so, so many years.

Thank you, thank you !!

Amy Maloof
Amy,

Thank you, thank you for you kind note!! Means a great deal to me. Will let Fabrice know, too!

All the best,

David

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

 

034: Live Session (Mark) — Methods Phase, cont’d. (Part 6)

034: Live Session (Mark) — Methods Phase, cont’d. (Part 6)

Part 6—M = Methods (cont’d)

 

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Podcast 34: Live Therapy Session with Mark: “I’ve been a failure.”

M = Methods (cont’d)

In the last podcast, David and Jill helped Mark challenge one of his negative thoughts, “There must be a defect in my brain that prevents me from developing a loving relationship with my son,” using Identify the distortions and the Paradoxical Double Standard Technique. In this podcast, they continue encouraging mark to challenge his negative thoughts using additional techniques, including the Externalization of Voices, which is arguably the most powerful Cognitive Therapy technique ever created. The goal of the Externalization of Voices is to create genuine and lasting change at the gut level.

Although it is one of the first cognitive Therapy techniques Dr. Burns created, it is rarely used by cognitive therapists in the United States, perhaps because it is so edgy, or perhaps because it is sophisticated and requires a high degree of therapist skill. The Externalization of Voices is often paired with another technique Dr. Burns created called the Acceptance Paradox. The goal of the Acceptance Paradox is a profound and lasting change in the patient’s core beliefs and values, and it sometimes triggers spiritual enlightenment, although it is an entirely secular method.

Jill and David also use the Semantic Method and Re-attribution in this segment, and end with a brief illustration of how Mark might interact differently with his son using the Five Secrets of Effective Communication. David and Jill emphasize that this is the “External Solution,” and that up to this point in the session they’ve been working on the “Internal Solution.”

In the next podcast, Jill and David will return to T = Testing to find out how Mark feels at the end of the session, and how he rates Jill and David for Empathy, Helpfulness, and other measures of the therapeutic relationship. At the end of the session, Dr. Burns asks Mark if the change was real, or simply something fake for the purpose of the podcast. At that point, something stunning happens, which turned out to be the highlight of the entire session. So stay tuned!

And thank you, so much, for your ongoing support of our efforts! We all greatly appreciate your many kind and encouraging comments and emails on our podcasts. That motivates us to work really hard (and joyously) to bring more of this kind of teaching to you!

One quick note. I do not answer messages from Facebook, as I am getting far more than I could ever attend to. Which is great, but sad for me since I don’t want people to feel ignored. The best way to contact me is to make comments at the end end of my blogs, as I often respond to those, or simply to contact me through my website, feelinggood.com.

David

Yikes! The Feeling Good Podcast Cured 40 Years of Depression! What Happened?

Yikes! The Feeling Good Podcast Cured 40 Years of Depression! What Happened?

Comment: Dear David and Fabrice,

hke photo 3Thank you for the Feeling Good podcasts!

I am 63 years old and have had mild to moderate depression since my 20s. The lowest score I ever got on the BDI in your book, Feeling Good, was 12, when I was seeing a therapist. (David comment. The BDI is the old Beck Depression Inventory, and it goes from 0 to 63. A score of 12 indicates mild depression.) Usually, my depression score was in the 21-22 range. (David comment: moderate depression.)

Four weeks ago, I was having a very bad day, and thought I’d try one of your Feeling Good podcasts. I started listening to one that was a few episodes into the series about cognitive distortions, and it was information I knew, but I thought, “this is good, I’m starting from Episode 1, called “You Feel the Way You Think.” I was in a parking lot and I started to drive and listen to Episode 1. Halfway through the episode I thought, “I don’t think I’m depressed….at all.” It was such a different feeling, like David talks about, but I never believed him.

It’s four weeks later, and I’m still not depressed. I took the BDI and scored a 1. You tell *me* what happened. I don’t know!

I am a little concerned that I don’t really know what “relapse prevention” steps I should take, but I’m taking exercise classes (a miracle in itself), working every week on my novel, and other amazing things. Whatever happened, thank you, thank you, thank you!.
Deepest respect and regards,

Arlene
Hi Arlene,

Thank you for your fantastic email. I really appreciate it. That is SO COOL!

I am about to fly to the east coast for three workshops, so can only give you a brief response now, but will write a more detailed blog for you on Relapse Prevention Training when I return home. Here are the high points of it, with more details later, I promise!

  1. You must know that we will all relapse forever. I define a relapse as one minute or more of feeling crappy. Give that definition, we all relapse all the time. No one is entitled to be happy all the time, and your negative thoughts will try to return over and over. But it does not have to be a problem if you are prepared and know what to do. In fact, bad moods are part of what makes us human, and they give us the potential for emotional (and, arguably, spiritual) growth.
  2. The technique that worked for you the first time will likely always work for you. Initially, when I work with some, I may have to try several techniques before I find the one that works. But after that, it is much easier, as you just use that same method or technique. For example, it might just be writing down one of your negative thoughts, pinpointing the distortions in it from my list of ten cognitive distortions, and then substituting a more positive and realistic thought, perhaps the way you might talk to a friend who was depressed and anxious.
  3. You need to write down the negative thoughts NOW that will almost definitely cross your mind, and every person’s mind during a relapse. they include thoughts like these:
  • a. This relapse proves I’m hopeless.
  • b. This relapse proves the therapy didn’t work. It was just a fluke that I got better.
  • c. I didn’t even really get better, I was just fooling myself.

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

 

Should Therapists Apologize? A Raging Debate!

Should Therapists Apologize? A Raging Debate!

Hi web visitors and friends on social media. Yesterday I got a really interesting email from my esteemed colleague, Angela Krumm, PhD, who created the certification program for TEAM-CBT. Angela’s clinical practice is located at the Feeling Good Institute in Mt. View, California. and they also offer training for therapists. I thought you might enjoy the question, as well as my answer. You will see that the information is relevant to everybody, and not just therapists.

If this topic of developing more loving and satisfying relationships interests you, you can read more about these techniques in my book, Feeling Good Together, available at Amazon and other book sellers.

IMG_1761Hi David,

The TEAM Certified list serve is having a colorful discussion about the use of apologies (specifically, saying “I’m sorry”) within the Five Secrets of Effective Communication. People are pretty engaged and arguing both for and against “I’m sorry.” Would you like me to share the comments with you?

If you’re interested, I’d love to post a response from you about whether you teach people to say “I’m sorry.” I think your general mode (if I remember from past training) is to avoid “I’m sorry” since it’s so generic and less specific than the Five Secrets.

Let me know if you want to see the comments and have a chance to respond.  I can send them to you!

Angela Krumm, PhD

Hi Angela,

To my way of thinking, “I’m sorry” can be effective or dysfunctional, depending on how it is used. In my experience observing clinicians in training, as well as troubled couples in treatment, it is nearly always dysfunctional, but it doesn’t have to be. Let me explain.

I recently treated a troubled couple from Los Angeles who had treated each other shabbily out of anger for many years. Without going into all the details, the husband had an affair with a woman they both knew from their church, and slept with her every night for six months. The affair appeared to be his way of getting back at her for something she had done that hurt him.

His affair was devastating to the wife, and she kept making up excuses for the children why Daddy can’t come home tonight. Every time she tried to express her feelings of being hurt, angry, anxious, humiliated, and betrayed, her husband would say, in a defensive tone of voice, “I’ve said I’m sorry! You have to put that behind you so we can move on! We’ve already talked about this!”

As you can see, he used “I’m sorry” as a way of avoiding listening and hearing how his wife felt. And although they’d bickered about their problems endlessly, he’d never really listened or giving her the chance to be heard.

I don’t want to scapegoat him—she gave the same dismissive and defensive answers when it was her turn to listen to his complaints and feelings. But it seems pretty clear to me that his use of “I’m sorry” was defensive and aggressive. It was his way of saying, “shut up, I don’t want to hear what you have to say.”

Therapists frequently do much the same thing in response to criticisms from patients. For example, a patient might say, “Last session you interrupted our session to take an emergency call, but I’m paying for the time!”

The well-meaning therapist might apologize and say, “I’m really sorry. I’ll remind my secretary to hold calls during our sessions unless it’s something super severe like an actively suicidal patient.”

It should be easy (I hope!) to see that this therapist is also using “I’m sorry” as a way of brushing the patient off, so the therapist doesn’t have to deal with the patient’s anger and hurt feelings. But those kinds of feelings may be a central problem in the patient’s life, and the therapist has missed a golden opportunity to deepen the relationship through the skillful use of the Five Secrets.

I have often said that no therapist in the United States or Canada is able to deal with or acknowledge a patient’s anger. Of course, this is an exaggeration to make a point, but it is SO TRUE most of the time! In my experience, it is very difficult for therapists to master the Five Secrets, for use in therapy, as well as in their personal lives, which can be even harder.

Of course, you can apologize skillfully. Apologies aren’t inherently dysfunctional. For example, you could respond to your patient’s criticism like my example below, which is based on the Five Secrets of Effective Communication. The abbreviations in parentheses at the end of each section indicate the communication technique(s) used in that sentence.

“I felt badly about interrupting the session, too. (IF) This is your time, and any interruption is unfair, and I want to apologize. (DT) The call was from an actively suicidal patient, but still my focus should be on you. (DT) I wouldn’t be surprised if you’re feeling hurt and ignored, and maybe even a bit angry with me, for good reason. (FE; DT) This is especially painful for me, because one of the themes you have described is that ever since you were a kid, the people you care about seem to ignore you, and don’t take you seriously. You said they gave your older brother all the attention, because he was a straight A student, so you end up feeling lonely and rejected most of the time. (IF; FE; DT) Now I’m in the role of ignoring you, and it’s especially painful for me because I respect you tremendously (IF; DT; ST) At the same time, I’m excited, because this is really important and can give us the chance to slay that dragon and deepen our relationship. (ST; Positive Reframing) Can you tell me more what that was like for you, as well as other times I’ve said or done things that hurt your feelings? (IN)”

I’m sure that can be improved upon, and is perhaps too long. But the important thing is that you are honoring your patient’s feelings, and encouraging him or her to open up. In this context, the apology is okay. However, notice that the phrase, “and I want to apologize” probably isn’t even needed.

I would also say that therapists, as well as patients, sometimes polarize things as “this way” vs. “that way,” so they can argue and feel like experts. Sorry if I sound a bit cynical here! Skillful and effective therapy is rarely “this way” vs “that way,” but exists on a higher plane. TEAM-CBT does not consist of simple formulas you can apply. It is an art form that is difficult to master, and simplistic approaches usually won’t be effective.

The bigger issue is that every one of the Five Secrets can be used in a skillful, compassionate, helpful way, or in a dysfunctional way. In fact, this is true of every method and technique in TEAM-CBT. For my two cents, I’d rather hear that people are asking for help in learning, rather than arguing about who is right and who is wrong, but I’m old and probably sound pompous or annoyed, so I will stop babbling!

David

 

 

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationshp conflicts.

Thanks! David

 

Latest Hiking Report

Latest Hiking Report

Hi friends and colleagues,

As you probably know, in addition to the volunteer teaching I do at Stanford each week, I also conduct Sunday morning hikes for therapists who want more time for personal work and practice with various TEAM-CBT techniques. The hikes generally last several hours, and are fabulous, but the “interior hiking” is what really makes them great experiences.

I was lucky to enjoy three hikes in the past week or so—two fabulous Sunday hikes, plus a Saturday hike, which was also great. We worked on so many topics and personal issues that I can’t recall all of them, but these were included:

  1. Therapy problems: How to work with extremely severe patients who are hungry for talking and support, but who resist taking responsibility for their lives, doing psychotherapy homework, or developing a meaningful agenda for their therapy sessions. This is one of the most important and frustrating issues in all of psychiatry and psychotherapy, and is the therapeutic dilemma that inspired me to create the new TEAM-CBT.
  2. Personal relationship problems: How to deal with someone who is pulling away from making a commitment to you, and giving you the run-a-round.
  3. Personal relationship problems: How to help someone who gets mad and resists your efforts when you try to help.
  4. Personal relationship problems: How to deal more skillfully with a romantic partner who I am pursuing and afraid of losing.
  5. Personal relationship problems: How to overcome the fear of rejection or being alone. AND how to help patients who have been rejected.
  6. Personal relationship problems: How to deal with a family member who won’t pay back borrowed money.
  7. Personal relationship problems: How to deal with fears of failing as a father. How to deal with your child’s criticisms, so you can transform a conflict into a deeper and more loving relationship.
  8. Personal insecurities: How to deal with fears of growing old and being alone and thinking you are simply “old and boring.”

If any of these themes interest you, let me know and perhaps I can post on some of them in a little more depth.

There was a lot more, but that will give you a feel for what we do on the hikes. The participation and experiences have been simply fantastic, due to the vulnerability, including the tears, and the compassion and fabulous teamwork people show on the hikes. This is my favorite way of hanging out with folks and getting to know people, and it really beats cocktail parties! Plus the extremely rapid changes we nearly always see make it seem like we are witnessing little miracles on each hike.

One of our beloved group members, Maryam Hamidi, has been taking great photos on Sundays, and in our Tuesday training group at Stanford, so I am including are some of them for you!

david

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationshp conflicts.

Thanks! David

Oops! Forgot to Include Podcast! Now Fixed!

Hi friends,

I apologize for two bloopers today. First, the Feeling Good Podcasts was published later than usual, and we forgot to include the podcast itself! I have now fixed it, so to get the text, links AND the session with our wonderful patient, Mark, CLICK HERE!

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients!

You can also sign up to receive emails every time I post a new blog. You will find the sign-up widget at the top of the column to the right on every page. Thanks so much!

Oh, also, share my posts with friends, and encourage them to sign up i they are interested! I am trying to get the word out to as many people as possible!

David

PS here is a pic from yesterday’s Sunday hike. More on that later.

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033: Live Session (Mark) — Methods Phase (Part 5)

033: Live Session (Mark) — Methods Phase (Part 5)

Part 5—M = Methods

 

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Podcast 33: Live Therapy Session with Mark: “I’ve been a failure.”

M = Methods, part 1

So far, the therapy with Mark had focused on

T = Testing: David and Jill review Mark’s feelings at the start of the session

E = Empathy: David and Jill listen and provide empathy as Mark describes his feelings of shame and discouragement because of his failure to develop a loving relationship with his oldest son.

A = (Paradoxical) Agenda Setting: David and Jill find out what, if anything, Mark hopes to get out of this session, which appears to be complete relief from his negative thoughts and feelings. Then the bring his subconscious resistance to change to conscious awareness, and melt it away using the Magic Dial, Positive Reframing, the Acid Test, and the Magic Dial.

In this session, David and Jill began using M = Methods to challenge the Negative Thought Mark wants to work on first: “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” You may recall that Mark believed this thought 90%.

Do you know what the necessary and sufficient conditions are for feeling emotionally upset? The necessary condition is that you have a negative thought in your mind, such as “I’m a failure as a father,” or “There’s something defective in my brain,” but the mere presence of a negative thought will not generally trigger shame, depression, or anxiety. The sufficient condition for emotional upset is that you believe the negative thought. And if you review his Daily Mood Log from the last session, you’ll see that Mark does have a high degree of belief in all his negative thoughts. When you’re feeling depressed, anxious, inadequate, or hopeless, I suspect that your mind is also flooded with negative thoughts that seem entirely true to you.

Do you know the necessary and sufficient conditions for emotional change?

The necessary condition is that you can challenge the negative thought with a positive thought that is 100% true. Rationalizations and half-truths will never help anyone, at least not in my experience. But having a valid positive thought is not sufficient for emotional change. For example, Mark could tell himself that he’s a very high powered physician in a world-famous medical center, and that thought would be 100% true. But that thought won’t help Mark because he’ll still believe there’s something defective in his brain that prevents him from having a loving relationship with his son.

The sufficient condition for emotional change is that you can generate a positive thought that is 100% true, and in addition it has to crush the negative thought. In other words, the very moment you stop believing the negative thought that triggers your angst, in that very instant you will experience emotional relief, and the change will usually be dramatic.

But how can we challenge Mark’s belief in the NT. Remember, he is incredibly intelligent, and he’s been hooked on this NT for decades. So we can’t just tell him to cheer up, or encourage him to think more positively, or reassure him that his brain is A-Okay. Not only will those simplistic approaches fail, they would likely annoy him because they sound patronizing and might convey the message that’s he’s an idiot for believing something so ridiculous.

Instead, as a TEAM-CBT therapist, I think of 15, 20 or even more powerful and innovative techniques that I can use to gently guide the patient to his or her own discovery that the negative thought is simply not true. That’s what we do during the M = Methods portion of a TEAM-CBT session.

You will listen as David and Jill generate Next, Jill and David generate a Recovery Circle, selecting 16 techniques they could use to help Mark challenge the Negative Thought in the middle of the Recovery Circle. To see the Recovery Circle, CLICK HERE. David and Fabrice discuss the rationale for the Recovery Circle–you never know what technique is going to work, since people are quite different. One of the many unique and arguably powerful aspects of TEAM-CBT is the use of more than 75 techniques drawn from more than a dozen schools of therapy.

One of the first methods we use is so basic that it is programmed right into the Recovery Circle, and it’s called Identify the Distortions. Fairly early in today’s recording, Jill and David will ask Mark to identify the distortions in his Negative Thought (NT), “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” At that point, Fabrice will ask you to pause the recording and see how many distortions you can identify in the thought. You can write them down on a piece of paper, or simply print the linked PDF and identify them with check marks on the list of 10 cognitive distortions from my book, Feeling Good: The New Mood Therapy. CLICK HERE FOR TEN COGNITIVE DISTORTIONS

After Mark identifies the distortions in his Negative Thought, Jill and David encourage him to challenge it, using a variety of techniques on the Recovery Circle, starting with the Paradoxical Double Standard Technique. This is a gentle technique that is often effective for people who are compassionate. Because this technique seems to be helping,  they ask Mark to record his positive thought in the Daily Mood Log, and to indicate how strongly he believes it. Then you will see that Mark’s belief in the Negative Thought is reduced to zero if you CLICK HERE.

In the next podcast, David and Jill will continue with the Methods portion of the session using additional techniques on the Recovery Circle. This will be a unique opportunity to hear many of these techniques in real time with a real person, as opposed to simply reading about them in a book. So–stay tuned to our Feeling Good Podcasts–and thank you so much for your enthusiastic support!

David, Jill, Mark and Fabrice