019: Ask David — The Defiant Child: A Secret All Parents Should Know

In this short podcast, David and Fabrice address a question submitted by a listener named Preeti who benefitted from his book, Feeling Good Together. She wants to know whether the same EAR techniques described in that book could help her deal more effectively with a defiant, oppositional child. Dr. Burns reveals a fantastically helpful secret that he and his wife stumbled across in raising their own children. If you have ever struggled in your attempts to deal with an oppositional child or adolescent, you will find this podcast enlightening!

Feeling Good about Poker

You might enjoy a humorous but serious link from a poker player who was helped by reading about the Approval Addiction in my book, Feeling Good. To check it out, CLICK HERE. Apparently, the link has gotten considerable spin in the poker world. Who knows, reading Feeling Good might lead you to riches playing poker! Not my goal when I wrote it, but I’ll take it! david

Pioneers of Cognitive Therapy

Hi web visitors,

Dr. Robert Schachter, from New York, recently interviewed with for his series on the Pioneers of Cognitive Therapy, sponsored by the Association for Behavioral and Cognitive Therapies (ABCT.org).  I was very honored to be included, and have great respect for Dr. Schachter. The interview provides a nice overview of  TEAM-CBT and explains the thinking that lead to its development. If you’d like to check it out, CLICK HERE!

Thanks!

david

Questions from a thoughtful listener

The following is an email I received from Dan Prine, a therapist receiving TEAM-CBT training from Dr. Maor Katz at the Feeling Good Institute in Mt. View, California. Dan had several questions about my recent podcast on single-session therapy with Fabrice Nye and Lisa Kelley.

Good morning David,

As I continue to learn and study the TEAM approach to CBT, I find it challenging and see it as so complex that it will present itself as a career long learning process. I have attended several of your intensive workshops, am currently involved in 2 web based programs and am receiving 1:1 supervision with Dr. Katz. I have several questions / thoughts I would like to get your thoughts on.

  • In the 1999 introduction to your workbook, “Ten Days To Self Esteem,” your referred to patients with schizophrenia and to those experiencing hallucinations who were treated at your hospital in Philadelphia (page 8). Most of the rest of your introduction has a focus on depression and anxiety. Perhaps you were referring to improvement in psychotic individuals who also were experiencing depression. If not, I am interested in knowing if your workbook was found to be helpful with symptoms of psychotic disorders without concurrent depression.
  • There was recently a challenge to your copyright policy on the list serve. [David’s explanation: Several therapists were rather forcefully asking permission to distribute the assessment tests and treatment tools from my Therapist’s Toolkit electronically. This would put me at great risk for online piracy, which is a huge problem for me already, and also risks violating HIPAA laws about sending confidential patient information electronically, with potentially huge fines, including jail time. I responded in strong language that this was not going to work for me.]
  • Dan Prine continues: I 100% understand and agree with all your arguments to maintain status quo. Based on the writer’s response, I think he now also agrees with your stance. It is refreshing in your books when you describe your humanness and talk about when you decide to back up, rethink your response and employ the Five Secrets to get a more productive result. You were “right” and your approach to the writer’s thoughts seem to have changed his perspective. I wonder if upon reflection you would convey the same message in a more gentle way. Just wondering.
  • In response to your recent post and podcast about the 2 hour “miracles” we see in your workshops, I am wondering if think a clinician in a private practice, offering a 2 or 3 hour initial sessions, could achieve the same results you have experienced so frequently?
  • Do you administer the EZ Diagnostic survey and /or the BMS before and after your demonstrations?
  • Could the following, in addition to the TEAM CBT, be responsible, at least in part, for the rapid changes you are seeing in your clinical demonstrations in workshops?
  1. Since your workshops are for therapists, your volunteers are psychologically-minded and reasonably high functioning—could this be a factor?
  2. Could there be a placebo effect, since the “patients” are receiving treatment from an expert?
  3. Could increased motivation play a role, since they are willingness to volunteer for personal work in front of a live audience, which takes courage and determination?
  4. Could your empathy and acceptance of them as humans be a contributing factor?
  5. How important is it that you melt away their resistance during the live session?

If these factors play a major role in the improvements you have been experiencing, do you really believe that we, as private practice therapists, could ever achieve the same kinds of phenomenal results in 2 hour therapy sessions? I do acknowledge you made it clear none of us could ever expect these purported results consistently, no matter how skilled.

Thanks in advance for any response you might offer.

And as I have mentioned before, thank you for your kindness, perseverance and pioneering efforts you offer in promoting therapists worldwide to help the many who suffer from mental illness and their distortions.

dan prine

If you’d like to read my response to Dan Prine’s thoughtful questions, and the email exchanges that followed, CLICK HERE. I really enjoyed the correspondence with Dan (aka Danny) and hope you enjoy it as well!

018: Ask David — Overcoming the Fear of Death

In this short podcast, David and Fabrice address this question submitted by a listener:

Dear Dr. Burns,

I read Feeling Good twenty years ago. It was a wonderful relief and help to me. Your book has helped me live a better and balanced life. The best part was passing the knowledge on to my daughter. I thought I read a wonderful description of how to handle death anxiety in the book. I was describing it to a friend, but could’ find it in the book.

Is it in another book?

Your reply would be considered an act of generosity.

Thank you! Mary

Existential Therapists believe that the fear of death is universal and is at the root of most emotional problems. Dr. Burns argues that the fear of death is actually quite rare, but does occasionally occur and is extremely treatable. In this podcast, David’s describes his quick, three-part “cure” for the fear of death.

Oddly, every patient he treated in this way insisted at the end of the session that it didn’t help. And even stranger is the fact that 100% of them returned the next week and announced that they actually had been cured and were, in fact, no longer afraid of death!

Taken a listen and see what you think!

Should Statements: Is there a moral / ethical dimension?

Hi Website visitors,

I got an interesting email from a brilliant colleague, Rabbi Joel Zeff, who joined one of the Sunday hikes a year or so ago. He asked about the ethical implications of one of the ten cognitive distortions: Should Statements. This is a cool topic, and I hope you enjoy the exchange! Feel free to comment, too, as usual!

David

Dear Dr. Burns,

You might remember me from one of the Sunday morning walks. (I am the rabbi being trained by Leigh Harrington.) I am most pleased to report that I completed the TEAM-CBT Level One training in November. Leigh was absolutely marvelous and I look forward to continuing my training with this powerful approach towards healing.

Meanwhile I have returned to Israel and am completing my dissertation for the doctorate in pastoral counseling from the San Francisco Theological Seminary (Presbyterian), an affiliate of the Graduate Theological Union in Berkeley. I recently posted the following inquiry, for my dissertation work, on the TEAM listserv and wonder if you would consider addressing it (many thanks!):

Dear Friends,

I am currently working on a doctoral dissertation in pastoral counseling. I am creating a source book for Jewish pastoral counseling which presents examples of cognitive re-framing found in the Jewish mystical thinking of Rabbi Abraham Isaac Kook, the Chief Rabbi of Israel during the “Pre-State” period of the British Mandate (died in 1935).

My point of reference is the wonderful TEAM training I received from Dr. Leigh Harrington (thank you so much Leigh!). As part of my writing, I want to address the interface of ethics and cognitive distortions. One gets the impression that cognitive distortions are not defined by ethical considerations. The primary criteria seems to me whether or not the cognition is firmly rooted in reality and to what extent it is helpful in living a relatively happy and productive life.

Do ethical considerations play a role in defining a “distortion” and/or impact on the course of therapy?

This question was particularly accentuated with regards to “Should Statements.” Ethics would posit that people “should,” for ethical reasons, behave in certain ways. Why should we not expect certain standards of conduct, on ethical grounds? I can understand why we might work on not becoming overly emotionally reactive, but that is not the same as saying “why should he/she behave otherwise?”.

I would very much appreciate your thoughts on this, as well, any references to writing on this particular issue that I could incorporate into the dissertation.

If you are able to address the issue, might I have permission to quote you referenced as “in private correspondence?”

Many thanks,

Joel Zeff,

Hi Rabbi Joel,

Good to hear from you! I still have vivid memories of the Sunday hike you joined not long ago!

In my writings (books, blogs, etc.) and teachings (workshops, podcasts) and therapy work, I have always emphasized that there are three valid uses of the word, “should”—the legal should, the laws of the universe should, and the moral / ethical should.

  • Legal should: You should not drive at 100 miles per hour because you’ll get a ticket.
  • Laws of universe should: If I drop this pen, it should fall to the floor due to the law of gravity.
  • Moral / ethical should: “Thou shalt not kill,” which is straight from the Ten Commandments.

Other uses of the word, “should,” are generally not valid, and they can be painful, too. When you say something like this–“I should be a better teacher (or therapist, or Dad, etc.),” or “I shouldn’t be so screwed up,” or “I shouldn’t have made that investment,” or “I shouldn’t be so shy,”—these are not valid uses of the word, should.

Let’s say you have a fear of bridges, like a psychologist I once treated. She told herself that she “shouldn’t” have this fear, and therefore was “screwed up,” and “shouldn’t be screwed i[.” Is this a valid use of “should?”

Well, it is not illegal to be “screwed up,” or to have a fear of bridges. Also, having a fear of bridges does not violate any of the laws of the universe. Nor is it immoral or unethical to have a fear of bridges. For example, you don’t see , “Thou shalt not fear bridges,” listed in the Ten Commandments, or in any of the holy texts from any religion.

If you look up the word, “should” in one of those huge dictionaries, you will see that it’s origin traces back to the Anglo-Saxon word, “scolde.” So, essentially, you are scolding yourself for having some flaw or shortcoming when you use the word, “should.”

You can combat these painful types of self-criticisms in many ways, but one of the easiest is the Semantic Method—you simply substitute gentler language, such as “I would like to be a better teacher” (or therapist, or Dad, or whatever). Then you can focus on the specifics of what you are doing in your teaching, for example, that’s effective, or ineffective, and make a plan for improvement, if needed.

But in a clinical situation, other methods will almost always be needed, especially Paradoxical Agenda Setting techniques, along with empathy and all the rest of the TEAM-CBT treatment techniques. There are numerous techniques that can be used to combat these dysfunctional uses of “Should Statements.” For example, you can say, “It would be great if I could get over my fear of bridges,” and then you can use a variety of techniques to overcome your fear of bridges, if that is your goal. But that is radically different from beating up on yourself.

Should Statements will generally double your trouble. First, you have some flaw, and second, you are filled with self-hatred because you are telling yourself that you “should not” have that flaw. Then you may feel ashamed and defective, or inferior, or even hopeless.

Shoulds directed toward others cause anger, but are equally irrational. Other directed “shoulds” are usually combined with other-directed blame, and are sometimes difficult to combat. That’s because anger and blame usually make people feel morally superior to others—for example, the blame may be directed at certain religious, political, or ethnic groups, and you may enjoy feeling morally superior to the group or the person you are angry with.

The late Albert Ellis, PhD, humorously called this “shoulding on yourself” (or others.) He also called it the “shouldy” approach to life. He tried to show the “shoulding” patient why these statements are irrational, using the technique called Examine the Evidence. He often said things like, “Where is it written that you shouldn’t have this or that problem?” Or “where is it written that your spouse should be different from the way s/he is?” He often made these statements with considerable force and charisma. Those who remember seeing him when he was still alive will know exactly what I mean!

Some people could see his point, and bought it, while others simply could not “see” it, and got turned off by Ellis. That’s why I’ve developed motivational approaches, like Paradoxical Agenda Setting, that therapists can used before trying to modify the patient’s negative thoughts. You can use techniques like Paradoxical Cost-Benefit Analysis and Sitting with Open Hands, for example. This protects the therapist from having to “sell” something to a reluctant “customer,” and greatly boosts therapeutic effectiveness..

There is no conflict I have ever detected between any form of spirituality, religion, or ethics and good, effective therapy. In my experience, individuals who have resolved and recovered from depression, anxiety, relationship problems, or habits and addictions frequently become more spiritual, and have a deeper understanding of spiritual / mystical / theological / philosophical concepts at the moment of recovery, although that probably sounds vague and maybe goofy. That would have to be the topic of another conversation.

I wrote an article on Should Statements that I might publish on my website at some point.

Albert Ellis was one of the first individuals who taught about the problems with Should Statements, back in the 1950s. He pointed out the three valid uses of shoulds that I listed above. The idea that there are valid uses of shoulds, including Moral Shoulds, is an old and well established concept that is embedded in all of the cognitive therapies.

The feminist psychiatrist, Karen Horney, wrote about the “Tyranny of the Shoulds” in the 1950s as well. My mother was struggling with some depression then, and found the books of Karen Horney to be helpful. I was just a kid at the time. I’m still a kid, but more of an old kid now!

Good luck with your dissertation. I’m sure it will be thought provoking, and interesting to many people!

Hope you can come on a hike again one day!

David