107: Meet Dr. Taylor Chesney!

107: Meet Dr. Taylor Chesney!

Secrets of TEAM-CBT with Kids

Fabrice and David are pleased to chat with Dr. Taylor Chesney who is an expert in the treatment of children and teenagers with TEAM-CBT. Taylor was a member of Dr. Burns’ Tuesday group at Stanford and his Sunday hiking group for two years before returning to her home in New York in 2014. She opened the Feeling Good Institute NYC, where she and her colleagues offer individual and intensive treatment as well as training for mental health professionals (in person and online). Today she reveals the inside scoop on how to use TEAM-CBT with children and teenagers, and their parents.

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Dr. Chesney begins by emphasizing that it is not hard to use TEAM-CBT with kids and teens, and that most of the tools work really well with only minor tweaking. For example, the Empathy tools (the Five Secrets of Effective Communication) work really well with kids and parents, and help you get buy-in so the kids and parents get excited about working together.

The Agenda Setting TEAM-CBT tools also need to be done with children as well as their parents.

Taylor credits Jacob Towery MD, one of her mentors in California, who taught her how to set up a four-session intake, so you get to connect with all family members before implementing any treatment techniques. She explains:

I’ll have two sessions with the child first, and one session with both parents together. This is really important to see how they’re experiencing parenting and how you can support them. The fourth session is the wrap-up session with the parents and the child together.

Empathy is vitally important from the very start. When I meet with the child or teen, it’s all about rapport building—their hobbies, friends, what they like, how they feel about their parents, what kinds of music they like, what apps and TV shows they like. This is their first time talking to you, and you have to get them to want to be with you. Building the relationship, the foundation, gives you so much leverage as you work with the child and the parents.

In the second part of the initial session with the child, we talk about symptoms, problems, and their take on it. Do they want help, or do the parents think they need help?

Fabrice: What if the child does not think they have a problem?

Taylor: I won’t work with a child unless they convince me they want help. I won’t take the parents’ money unless the child convinces me that they want help.

If they don’t want help, I tell the child I’ll work with their parents instead. However, I tell the child I’d prefer to work with them.

Fabrice: So, sometimes, the child cannot convince your that they want help.

Taylor explains:

I saw a child who got scared every night and wanted to sneak into the parents’ room to sleep. This was a problem for the parents, but the child didn’t want to change.

Some therapists might try to work with the child to persuade them to stay in bed, but if you do that, you’ll probably run into resistance. So, I said, “I get it. It’s not fun to sleep in your bed alone. You hear strange and frightening sounds so you naturally want to sleep in your parents’ room, where you feel safe. Still, your parents are saying, ‘this can’t go on.’ If you don’t want help, I’ll work with them, since they are asking for help.”

This got the kid wondering and he asked, “What would that look like if you worked with my parents instead of me?”

I said, “Every family is different, but if I work with you, you’d be in control, rather than your parents.” Then he decided, “I kind of think I want to work on it.”

It’s all the same techniques David has developed in TEAM-CBT—you just put the same concepts and techniques into the child’s language. You Sit with Open Hands, just like with adults. You don’t try to chase or sell the patient anything.

Taylor and Fabrice discuss the importance of motivation and avoiding battles you’re not going to win.

Fabrice asks for an example of how the treatment works, so Taylor continues:

There’s no one size that fits all. Every situation is so different. That’s why is so important to start with the relationship with the child.

A fun case is an 15 year old boy I saw. He was a stellar athlete and student, but was struggling with severe OCD and performance anxiety, including test anxiety. Several previous attempts at therapy had failed, including talk therapy and medications, but nothing had alleviated his severe anxiety and rituals.

I started with good empathy, using the Five Secrets to understand his hobbies, his friends. Then, instead of trying to “help” him, the way his parents and other therapists had been doing, I said something like this: “Your anxiety is part of your identity. It must be annoying to you for people to bug you to get over your anxiety.”

He got excited and seemed relieved, as if to say, “You’re not going to try to convince me to get over my anxiety?”

Everyone else was telling him he shouldn’t be so anxious, so he got to thinking, as we all do, that his anxiety was somehow “bad.” In contrast, we looked at all the great things his anxiety showed about him, and how he cared about his performance, and all the things he had to do each day. How he wants to be successful, and wants to get positive feedback from his teachers and make his parents proud of him.

In other words, we came up with lots of GOOD reasons to hold on to his anxiety. This is exactly how we’d deal with Outcome Resistance in an adult.

The floodgates opened up, and he listed all the many really good reasons to continue to be anxious. He said it was the best session ever, and no one else had ever agreed with him about all the good reasons to be anxious.

Then we talked about the Magic Dial—was there some area where a lower level of anxiety would be enough? He decided to work on test anxiety first, because he froze up on exams. He said he didn’t need that much anxiety!

We also talked about what he’d have to do to overcome his anxiety that he might not want to do. In TEAM-CBT lingo, this is called dealing with Process Resistance. There were lots of things. First, he’d have to risk it and be willing to accept the possibility of getting lower grades and being okay with the outcome of the exam, and he’s also have to use the Daily Mood Log every day to record his negative thoughts and challenge them.

Fabrice: You talked about his willingness to get lower grades. Is that a way of dealing with his Outcome Resistance?

Taylor answers:

I thought of it more as him facing his fears—exposure, in other words. He thought he had to do a certain ritual before each exam and rehearse his answers repeatedly on the exam in order to get a really high grade. If he agrees to give up those rituals, he’ll be facing his fears.

Teenagers can use the same Daily Mood Log that David has developed for adults. He was thinking:

  • I shouldn’t worry.
  • I should get 100 every time.
  • No one else worries.
  • Everyone will think I’m stupid if I don’t get a really high grade.
  • Then no one will like me.
  • Everyone is smarter than me.

Fabrice asked about the Emotions Table on the Daily Mood Log, so Taylor spoke about psycho-education about emotions, and the importance of asking them to circle their negative feelings on the Daily Mood Log. This gives them a better understanding of their emotions, and gives them a vocabulary to talk about how they’re feeling.

Taylor also explains about how to put the Cognitive Distortions in child-friendly language. Instead of All-or-Nothing Thinking you can talk about “all good” or “all bad.” She also makes it a game and asks kids to learn about one distortion each week. Like, making the child a Should Detective for a week, looking for Should Statements in themselves and others. They have fun with this.

Fabrice asked what happened to the anxious teenager once the Empathy and Agenda Setting had been completed.

She described a variety of TEAM-CBT methods that were useful to this boy, starting with the Survey Technique—ask your friends if it is true that no one else worries, or if they’d think less of him or not want to be his friend if he didn’t get a good grade on a test. Taylor also used Self-Disclosure, encouraging him to share his insecurities instead of hiding them.

Taylor said the Double Standard Technique also helped him a great deal, along with the Externalization of Voices, the Feared Fantasy, Acceptance Paradox, and more, so he could practice talking back to his negative thoughts. Taylor explained how to make the role-playing more fun with kids, introducing an element of play.

Fabrice: How do kids take to the Acceptance Paradox? How do they switch their thinking?

Taylor:

They spend so much of their life thinking their anxiety is bad, but in Agenda Setting they see there are really good parts of the anxiety, so they stop resisting and see they no longer have to fight the anxiety. One of his thoughts was, “I shouldn’t feel anxious on exams, I shouldn’t feel this way,” but those Should Statements simply feed his anxiety and make it worse. The Acceptance Paradox moved in the opposite direction, so he could say, “my anxiety is okay.”

He responded well and is no longer my patient. It’s sad to lose patients who recover fairly quickly, but it’s also great to witness the change and get feedback on how well they are doing later on.

Another thing we also did was Exposure, asking him to bring in a test and then we induced anxiety in the office.

In the initial treatment, we only focused on his test anxiety, because that was his agenda. But he came back a year later asking for help on other issues, which also went really well.

Fabrice: It sounds like the initial therapy was a trust builder, giving him what he wanted, and no more. You walked the walk with him and put him in control.

Taylor: Yes. You also have to build a good relationship with the parents, so they trust you and your therapeutic strategy as well. They were on board and let him work with me in this manner.

If you would like to contact Dr.Taylor Chesney with a question, or for treatment or training in TEAM-CBT, you can call her at 516-551-8063, email her by clicking here or visit her website. To register for her next online training group, click here.

If you have specific questions about the treatment of children or adolescents, make sure you contact her, as we may be able to set up a second podcast with Taylor!

David

Coming Up Soon–

TEAM-CBT Methods for the Treatment of Relationship Difficulties

Step by Step Training for Therapists

by David Burns, MD and Jill Levitt, PhD

Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop is highly interactive with many case examples and opportunities for practice using role plays.

Join us for a day of fun and inspiring learning on site in Palo Alto OR online from anywhere in the world by this dynamic teaching duo!

Sunday October 28th, 2018 (9am-4pm PST) 6 CE*s. $135

To register, go to Feeling Good Institute

* * *

Rapid Recovery from Trauma

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Woodland Hills, CA

and

November 1-2, 2018–Pasadena, CA

The November workshop includes Live Streaming
if you cannot attend in person)

For further information, go to www.IAHB.org
or call 1-800-258-8411

Register Now!

 

Subscribe

 

106: Ask Dr. David and Dr. Helen — My Husband Doesn’t Make me Feel Loved! What Can I Do?

106: Ask Dr. David and Dr. Helen — My Husband Doesn’t Make me Feel Loved! What Can I Do?

Back by Popular Demand Again–Dr. Helen Yeni-Komshian

This is the second podcast on relationship problems. with Dr. Helen Yeni-Komshian. In today’s podcast, we address four questions from listeners like you:

  1. Our marriage lacks intimacy. What can I do? A podcast fan named David explains that his relationship with his wife is no longer intimate; he complains that they only talk about day to day things on a superficial level. David wants to know if he needs to inject some conflict into the relationship to make it more meaningful or exciting.
  2. Why is my wife so critical of me? David wants to know why his wife constantly peppers him and batters him with critical questions, and what he can about it.
  3. Why is my friend so critical and dogmatic? Rajesh describes a friend who argues endlessly and accuses Rajesh of being irritating. His friend says, “Anyone would be upset when they try to talk to you!” What’s up? Why is this happening? Who’s really to blame?
  4. Adarah feels lonely and tells her husband what he can do to make her feel loved–but it just doesn’t seem to work! Why? And what CAN she do to improve her marriage?

I think you will enjoy the lively dialogue between Fabrice, Helen and myself and see us struggling and making some mistakes, too, when we try to model more effective responses based on the Five Secrets of Effective Communication! We also stress, once again, the importance of Interpersonal Decision-Making any time you run into a conflict with a friend, colleague, or loved one.

For more information on healing troubled relationships, you can read my book, Feeling Good Together, which is available as a paperback on Amazon. In addition, you can listen to our previous podcasts on the Five Secrets of Effective Communication, beginning with Podcast #65 (Enjoy Greater Intimacy) and several of the podcasts that follow.

David

PS Listeners who wish to contact Dr. Helen can do so via email: helen at dryeni.com. You can also visit her website, www.dryeni.com.

 

Coming Up Soon–

TEAM-CBT Methods for the Treatment of Relationship Difficulties

Step by Step Training for Therapists

by David Burns, MD and Jill Levitt, PhD

Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop is highly interactive with many case examples and opportunities for practice using role plays.

Join us for a day of fun and inspiring learning on site in Palo Alto OR online from anywhere in the world by this dynamic teaching duo!

Sunday October 28th, 2018 (9am-4pm PST) 6 CE*s. $135

To register, go to Feeling Good Institute

* * *

Rapid Recovery from Trauma

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Woodland Hills, CA

and

November 1-2, 2018–Pasadena, CA

The November workshop includes Live Streaming
if you cannot attend in person)

For further information, go to www.IAHB.org
or call 1-800-258-8411

Register Now!

 

Subscribe

 

105: Ask David and Dr. Helen — Does Empathy Fatigue Exist?

105: Ask David and Dr. Helen — Does Empathy Fatigue Exist?

Back by Popular Demand—Dr. Helen

We have invited Dr. Helen Yeni-Komshian to join Fabrice and me for two consecutive podcasts on questions listeners have asked about troubled relationships. In today’s podcast, we address a question from Mary about how to deal with a husband who constantly complains and exaggerates how awful things are at work, in politics, and in the world. But when Mary tries to dismiss his statements in an effort to “keep the peace,” it just gets worse. His complaints escalate!

This is a common problem and you may have run into it as well. Do you have a friend or family member who loves to complain? And have you noticed that your attempts to help or point out the irrationality of his or her complaints are futile? So what SHOULD you do? What’s the secret of dealing with a whiner or a complainer? Is it even possible.

Helen and David provide a myriad of information and describe techniques such as Forced Empathy, Interpersonal Decision Making, Changing the Focus, and the Five Secrets of Effective Communication. You’ll LOVE this lively dialogue!

For more information on healing troubled relationships, you can read my book, Feeling Good Together, which is available as a paperback on Amazon. In addition, you can listen to our previous podcasts on the Five Secrets of Effective Communication, beginning with Podcast #65 (Enjoy Greater Intimacy) and several of the podcasts that follow.

More relationship questions answered next week. See you then!

David

PS: Listeners who wish to contact Dr. Helen can do so via email: helen at dryeni.com. You can also visit her website, www.dryeni.com.

PPS: In Episode #101 of this podcast, David responded to Dr. Michael Edelstein and Tommy Bateman on their challenge of the TEAM-CBT model vs. REBT. David was invited to be interviewed on their YouTube channel, The REBT Advocate and used his own effective communication skills to answer the challenge in Episode 35 of The REBT Advocate. You might want to listen to it.

 

Coming Up Soon–

TEAM-CBT Methods for the Treatment of Relationship Difficulties

Step by Step Training for Therapists

by David Burns, MD and Jill Levitt, PhD

Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop is highly interactive with many case examples and opportunities for practice using role plays.

Join us for a day of fun and inspiring learning on site in Palo Alto OR online from anywhere in the world by this dynamic teaching duo!

Sunday October 28th, 2018 (9am-4pm PST) 6 CE*s. $135

To register, go to Feeling Good Institute

or call  650-353-6544 

* * *

Rapid Recovery from Trauma

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Woodland Hills, CA

and

November 1-2, 2018–Pasadena, CA

The November workshop includes Live Streaming
if you cannot attend in person)

For further information, go to www.IAHB.org
or call 1-800-258-8411

Register Now!

 

Subscribe

 

The David and Jill Show Returns!

The David and Jill Show Returns!

Watch FB Live this Sunday, Sept. 9th, 2018, at 3 PM (PT) for a full hour of Q and A with David and Jill

I hope you can join Dr. Jill Levitt and me as we return this Sunday for our Facebook Live Show! We will feature your questions, which you can ask LIVE if you can join us in real time. However, the show will be recorded, as usual, so you can tune in anytime on my Public FB page!

You can ask questions on topics like

  • depression
  • anxiety
  • relationship problems
  • habits and addictions
  • TEAM-CBT

You can ask from the perspective of the therapist, the patient, or the general public. Hope you can join us!

Dr. Levitt is Director of Clinical Training at the Feeling Good institute in Mt. View, California. She is a co-director of my weekly psychotherapy training group at Stanford, and is absolutely superb. When we work together, the chemistry can be pure magic. The photo below was at taken at our recent Sunday workshop on Advanced TEAM-CBT techniques.

Jill and david 2

Here are some exciting workshops for you–

October / November, 2018

TEAM-CBT for Relationship Difficulties

Step by Step Training for Therapists

by David Burns, MD and Jill Levitt, PhD

Sunday October 28th, 2018 (9 am-4 pm PST)

Live in Palo Alto plus online streaming

Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop will be highly interactive with many case examples and opportunities for practice using role plays.

Join us for a day of fun and inspiring learning on site in Palo Alto
OR online from anywhere in the world.

Learn from David and Jill–a dynamic teaching duo!

6 CE*s, $135

To register, go to the Feeling Good Institute

or call  650-353-6544

* * *
Rapid Recovery from Trauma

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Woodland Hills, CA

and

November 1-2, 2018–Pasadena, CA

The November workshop includes Live Streaming
if you cannot attend in person)

For further information, go to www.IAHB.org
or call 1-800-258-8411

Register Now!

* * *

TREAT ANXIETY FAST–
Powerful, Fast-Acting, Drug-Free Treatment Techniques
that Defeat Anxiety & Worry

a 2-day workshop by David D. Burns, MD

November 29 and 30, 2018–San Francisco, CA (in person only)

and

December 3 and 4, Portland, Oregon (in person and live streaming)

PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.

In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.

Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…

  • How to integrate four powerful treatment models to eliminate symptoms.
  • How to enhance your client’s engagement in therapy.
  • How to develop a treatment plan that specifically targets each client’s unique problems and needs.
  • …and so much more!

David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!

Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers!

Sponsored by PESI
To register, or for more information, call: 800-844-8260

* * *

December, 2018

Brief Therapy Conference, December 6 – 9, Burlingame, California

Sponsored by the Milton Erikson Foundation

I will be giving a Keynote Address on

Overcoming Therapeutic Resistance

on Sunday, December 9, 2018, from  2:30 – 3:30 PM

plus a two-hour workshop on Friday, December 7, 2018 from 10:45 AM – 12:45, with Dr. Jill Levitt on

Healing Yourself: A Live Demonstration of TEAM-CBT

plus two other presentations at this fantastic event.

104: Ask David — The Treatment of Acute and Chronic Pain

104: Ask David — The Treatment of Acute and Chronic Pain

How do you treat individuals with pain when there is no organic cause?

Today we answer a challenging question submitted by Anne, who writes:

Hi David,

I’m currently studying counselling/psychotherapy in the UK. Last month I discovered your podcast, then read your book Feeling Good, and it was the first thing that really lit up my eyes and got me obsessively studying! Everything about your TEAM-CBT model is so compelling and inspiring and first I just wanted to thank you for taking the time to share it with all of us.

I also have a specific question which I’d love to hear you answer in one of your “Ask David” episodes. My ambition is to specialize in treating patients who have chronic pain with no clear physical cause. I’ve had that problem myself for several years, so I’d love to hear your thoughts on psychological treatments for pain. How do you apply the TEAM CBT model to those patients? Any wisdom you could share would have me on the edge of my seat!

Thanks so much for listening

Anne

Thanks, Anne, for your terrific question on one of my favorite topics. In this podcast devoted to pain and depression, I describe research on the relationship between physical pain and negative emotions such as depression, anxiety, and anger. Does pain cause depression? Or does depression cause or amplify pain?

And what can we do to help patients with physical pain and intense negative emotions?

In addition, why do so many individuals struggle with somatic problems, such as physical pain, dizziness, or fatigue, when there is no apparent organic cause for the pain? Is there any hope?

I think you will enjoy the show, Anne, at least I hope you do! I really enjoyed answering your question on one of my favorite topics!

David

 

Workshops Coming Up Soon–

TEAM-CBT Methods for the Treatment of Relationship Difficulties

Step by Step Training for Therapists

by David Burns, MD and Jill Levitt, PhD

Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop is highly interactive with many case examples and opportunities for practice using role plays.

Join us for a day of fun and inspiring learning on site in Palo Alto OR online from anywhere in the world by this dynamic teaching duo!

Sunday October 28th, 2018 (9am-4pm PST) 6 CE*s. $135

To register, go to Feeling Good Institute

or call  650-353-6544 

* * *

Rapid Recovery from Trauma

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Woodland Hills, CA

and

November 1-2, 2018–Pasadena, CA

The November workshop includes Live Streaming
if you cannot attend in person)

For further information, go to www.IAHB.org
or call 1-800-258-8411

Register Now!

 

Subscribe

 

Three Awesome Upcoming Workshops for You!

Three Awesome Upcoming Workshops for You!

Coming Up Soon–

TEAM-CBT Methods for the Treatment of Relationship Difficulties

Step by Step Training for Therapists

by David Burns, MD and Jill Levitt, PhD

Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop is highly interactive with many case examples and opportunities for practice using role plays.

Join us for a day of fun and inspiring learning on site in Palo Alto OR online from anywhere in the world by this dynamic teaching duo!

Sunday October 28th, 2018 (9am-4pm PST) 6 CE*s. $135

To register, go to Error! Hyperlink reference not valid.
or call  650-353-6544 

* * *

Rapid Recovery from Trauma

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Woodland Hills, CA

and

November 1-2, 2018–Pasadena, CA

The November workshop includes Live Streaming
if you cannot attend in person)

For further information, go to www.IAHB.org
or call 1-800-258-8411

Register Now!

103: Ask David–How do you deal with harmful, intrusive memories . . . Is depression transmitted by the family?

103: Ask David–How do you deal with harmful, intrusive memories . . . Is depression transmitted by the family?

How do you deal with intrusive thoughts about bullying or a cruel ex-lover?

How do you treat cyclothymic patients?

Where do distortions come from? And more . . .

Today we answer six questions submitted by listeners like you:

  1. Harald: How can I find the Show Notes for the Feeling Good Podcasts?
  2. Kristin: How do you help patients who obsess about past traumatic events, with intrusive thoughts about a cruel ex-lover or bullying by classmates? These thoughts can feed into the idea that their life is miserable and  they can’t move forward because they feel blocked by these harmful memories.
  3. Valentina: How are cognitive distortions, self-defeating beliefs, and feelings of depression transmitted? What you describe in your books seems to describe my mother’s behaviors when I was growing up? Could it be that depression is transmitted by the family?
  4. Alicia: How would you treat someone with cyclothymic disorder who cycles between euphoria and suicidal depression? He’s happy now, so how do I get him to fill out the Daily Mood Log?
  5. Kathy: I’m a big fan, and I have a question about “bibliotherapy.” What’s the best way to use your books and other materials to help yourself?
  6. Matthew: Do you ever use drugs in the treatment of depression? Are medications sometimes necessary or helpful?

David

Coming Up Soon–

Rapid Recovery from Trauma

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Woodland Hills, CA

and

November 1-2, 2018–Pasadena, CA
(with Live Streaming if you cannot attend in person)

For further information, go to www.IAHB.org or call 1-800-258-8411

Register Now!

 

Subscribe

 

102: Helping the Suicidal Patient

102: Helping the Suicidal Patient

The Prediction and Prevention of Suicide

Dr. Maor Katz, the founder of the Feeling Good Institute in Mt. View, California, asked if we’d do a show on the Prediction and Prevention of Suicide, so his staff could learn about the unique approach I have developed. Dr. Fabrice Nye and I were delighted to devote today’s show to this topic.

Suicidal thoughts and urges are very common among depressed patients. The vast majority of depressed individuals have thoughts of suicide from time to time, and some struggle with serious suicidal urges. The experts tell us that 10% to 15% of chronically depressed individuals do eventually commit suicide, even if they are receiving treatment for depression. It is hard for me to believe that suicide is that common, but even if it is only 2% or 3%, that’s still very significant, especially if you have a large clinical practice and you treat lots of depressed individuals.

Suicide attempts are shocking and devastating for the patient, for the family, and for the therapist as well. The loss of a patient through suicide is the dark side of our profession. The loss of life is a horrible and unnecessary tragedy, since the feelings of hopelessness that trigger suicidal urges are always the result of cognitive distortions; the belief that you are hopeless and cannot improve is never valid. Yet, the depressed patient does not realize this, and sometimes turns to suicide as the only way out of his or her suffering.

Sadly, clinicians’ capacity to assess suicidal urges in patients they are treating is very poor. In fact, in a research study I did, experts estimated how suicidal patients were feeling at the end of a several hour diagnostic interview at the Stanford Hospital. The patients recorded how suicidal they were actually feeling at the exact same time. Surprisingly, the patients’ and experts’ assessments were not significantly correlated. In other words, the experts accuracy in detecting suicidal fantasies and urges was zero. that’s one reason so many patients in treatment do commit suicide–because the therapist simply did not realize the patient was feeling that way.

In this podcast, I describe how you can solve this problem with the use of the EASY Diagnostic System and a systematic suicide interview, if needed, at the initial evaluation, and the use of the Brief Mood Survey at all subsequent sessions, with no exceptions.

In this podcast, I focus on two things. First, how can the clinician identify and evaluate a new (or old) patient who is struggling with suicidal thoughts and fantasies and determine if the patient is at risk for a suicide attempt? Second, how can the therapist make the patient accountable and guarantee that the patient will not now, or ever, make a suicide attempt?

The “defensive psychotherapy” I recommend will sound unfamiliar and maybe even shocking to many therapists but can save lives and make your practice far more peaceful and rewarding. The approach to the suicidal patient involves Paradoxical Agenda Setting techniques, including the Gentle Ultimatum, Sitting with Open Hands, and Fallback Position.

I hope you enjoyed today’s podcast on a very serious topic!

David

Coming Up Soon–

Rapid Recovery from Trauma

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Woodland Hills, CA

and

November 1-2, 2018–Pasadena, CA
(with Live Streaming if you cannot attend in person)

For further information, go to www.IAHB.org or call 1-800-258-8411

Register Now!

 

Subscribe

 

Upcoming Training at the Feeling Good Institute

Upcoming Training at the Feeling Good Institute

Online Training and Continuing Education Credit in TEAM-CBT

The Feeling Good Institute (FGI) offers many online and in-person training opportunities, as well as TEAM-CBT consultation groups for therapists. All of their upcoming course offerings are listed here.

Please note my upcoming one day workshop with Dr. Jill Levitt (#5 below) on the treatment of clients with troubled relationships on October 28, 2018. This is one of the most challenging areas of psychotherapy since the resistance to change is almost always intense. It should be really good, since Jill is an esteemed colleague and a fabulous teacher. I always love working with her.

You can come in person or attend online. If you attend online, we will have online breakout groups for you to practice the skills we describe and illustrate live.

  1. Mike Christensen’s twelve week training entitled Comprehensive Live Online CBT Training for Therapists. Mike is a TEAM-CBT Level 4 Clinician and Trainer and a fantastic teacher. Space is strictly limited to fifteen participants to provide an intimate learning experience with lots of opportunity to practice, receive feedback, and improve your skills. This course meets weekly online for 12 weeks and starts Monday 9/10/18 (3:00 – 4:45 PM PST). 21 CE*s. $720.
  2. Jill Levitt’s six week training entitled Practical CBT Methods for Depression, Anxiety, and Unwanted Habits. Jill is a Master Therapist and Trainer in TEAM-CBT and the Director of Training at Feeling Good Institute and a warm and engaging teacher. This course focuses on TEAM-CBT methods and includes didactic teaching as well as ample opportunities for role playing and practice. Jill’s course meets weekly online for 6 weeks and starts Monday 10/8/18 (11am-12:45pm PST). 10.5 CE*s. $360
  3. Taylor Chesney’s twelve week training entitled Comprehensive Live Online CBT Training for Therapists Working With Children and Adolescents. Taylor is a Master Therapist and Trainer in TEAM-CBT and the director of Feeling Good Institute NYC. Her practice focuses on the application of TEAM-CBT to kids and teens. Space is strictly limited to fifteen participants to provide an intimate learning experience with lots of opportunity to practice, receive feedback, and improve your skills. This course meets weekly online for 12 weeks and starts Wednesday 10/3/18 (9:30 AM – 11:15 AM PST). 21 CE*s. $720
  4. Daniel Mintie’s online training entitled CBT Skills, Training, and Practice: A Case-Based Course.This course meets every other week for three months. Daniel is a Level 5 TEAM-CBT Therapist and Trainer with Feeling Good Institute and a warm and thoughtful teacher. Each class in this biweekly series will begin with a presentation of one or more aspects of the TEAM-CBT model, followed by practice using case material from participants clinical work or instructor case examples. Daniel’s course meets every other week online for 3 months and starts Friday 10/5/18 (12-1:45pm PST). 10.5 CE*s. $395.
  5. David Burns and Jill Levitt’s Step by Step TEAM-CBT Methods for the Treatment of Relationship Difficulties: A Daylong Workshop for Therapists.Join us for a day of fun and inspiring learning on site in Palo Alto OR online from anywhere in the world. This workshop will teach you how to set a collaborative agenda with your patients in order to reduce resistance and boost motivation to change. In addition, you will learn and practice skills that will help your patients identify their own communication errors and enhance their communication skills to increase intimacy and closeness with their loved ones. This workshop is highly interactive with many case examples and opportunities for practice using role plays. Sunday October 28th, 2018 (9am-4pm PST). 6 CE*s. $135
101: Therapy Wars–REBT vs TEAM: Mirror, mirror, on the wall . . .

101: Therapy Wars–REBT vs TEAM: Mirror, mirror, on the wall . . .

A fan who wishes to remain anonymous (we’ll call him Jim) wrote a thoughtful question based on an internet video he’d just watched on The REBT Advocate’s YouTube channel, featuring Tommy Bateman and Dr. Michael Edelstein. One of their listeners had asked what they thought about the new TEAM-CBT developed by Dr. David Burns. They said they were not terribly familiar with TEAM, but looked it up on Wikipedia, and had three criticisms:

  1. The T = Testing is not important or desirable since you can just ask patients how they’re doing, and if they keep coming, it must mean you’re doing a good job. Testing, they think, is an artificial attempt to “dress up” the therapy and makes the treatment too clinical and impersonal!
  2. E = Empathy is not important, either, because patients pay good money to get help, and not to feel validated. Self-help books, they say, wouldn’t help if empathy was important.
  3. A = (Paradoxical) Agenda Setting is also unimportant. Resistance does not need to be addressed in treatment, since patients can go elsewhere if they aren’t getting the help they want.

This is what “Jim” concluded after listening to the REBT podcast:

“I don’t think they know as much about TEAM as they claimed. It made me angry that they were dismissing it so flippantly. Maybe you can invite yourself to talk on their podcast!

“I appreciate your approach to therapy a lot, even if I don’t always agree with you. I have watched every episode of your Feeling Good Podcasts and find the live therapy sessions especially intriguing!”

Sincerely, “Jim”

Thanks for the great question, Jim, and I appreciate your comments! Fabrice and I took a quick look at the video you saw on line and I strongly resonated with your assessment. Although there was value in all of their criticisms–there is ALWAYS truth in any criticism– I agree that they perhaps didn’t really grasp TEAM. And, like you, I found the comments flippant and disrespectful, kind of like a series of hurtful put-downs, rather than an attempt to grasp the potential value of something new or an invitation to meaningful and respectful dialogue.

I felt a bit angry, to be honest!

And I might add that in my interactions with Dr. Albert Ellis, the creator of REBT, I always found him to be incredibly respectful, warm, and supportive of my work. He was THE BEST, in my opinion! Toward the end of his career, he actually changed his mind about the importance of empathy, based on my research, and decided that empathy could, in fact, be helpful. I have many fond memories of times we talked and will always be grateful for his work and career; and also for his wonderfully wild, wacky and incredibly genuine and real personality!

Dr. Ellis was famous for his outrageous–and usually brutally honest and accurate–comments about other schools of therapy. And  I have to confess that sometimes I’ve also been guilty of dismissing competing schools of therapy in a flippant way, and I’ve gotten rightfully battered for that at times. People don’t like that type of adversarial dialogue for the most part. When I slip up and try to promote myself in a narcissistic way, it’s mostly thumbs down! But it sure can be tempting!

The perceived lack of empathy in some REBT therapists was actually one of Dr. Aaron Beck’s motivations for creating Cognitive Behavioral Therapy (CBT), which evolved about ten years after Dr. Ellis created REBT. CBT shares much in common with REBT, but with a greater emphasis on research to find out what really works, and empathy and the therapeutic alliance. CBT was also the first school of therapy to emphasize testing at every session to assess therapeutic progress, or the lack of progress.

The adversarial attitude of putting down the competition is at the heart of the “therapy wars,” with everyone claiming to have the “best” approach and dismissing other approaches. But if you look at all of the outcome studies of psychotherapy for depression or anxiety, for the most part, nothing comes out much better than treatment with placebos. So perhaps an attitude of humility, curiosity, and openness to new approaches would be more productive and appropriate.

The comments of Dr. Edelstein and Mr. Bateman were especially hard for me to hear, since I’ve always been a huge fan of Dr. Albert Ellis and I have so many respected friends and colleagues who are REBT therapists. I’ve always felt the contributions of Dr. Ellis to the field were legendary, and I’ve always supported and admired him.

My goal in TEAM has never been to create yet another competing school of therapy, but rather to create a systematic, data-driven approach to therapy based on process research on what works and what doesn’t work. I am convinced that therapists from any school of therapy who use T = Testing and work hard to improve their E = empathy skills will experience improved outcomes.

A = (Paradoxical) Agenda Setting is also important. Learning to melt away patient resistance and boost patient motivation can dramatically speed recovery, and is one of the most important components of TEAM! And I think that virtually all therapists, and especially REBT therapists, will have to admit that they have many patients who DO “yes-but” them and resist their efforts to help or persuade their patients to change.

But what does the research show? Is there any solid evidence for the various components of TEAM? At the end of these show notes, I have compiled a list of just a few of the published, peer-refereed studies that have led to the development of TEAM, and you can hear a summary of some of these studies on today’s podcast.

In a nutshell, here are a few of the highlights from research:

  • Session-by-session testing has been shown to improve therapeutic outcomes.
  • Research indicates that therapists’ perceptions of how their patients feel, and how their patients feel about them, are not accurate, and are frequently wildly inaccurate. This can have life and death implications, for example, in treating depressed patients with episodic suicidal impulses.
  • Therapeutic empathy has a direct causal impact on reducing depression. However, the magnitude of the effect is small. However, therapeutic empathy and trust can enhance, and even make possible, the therapeutic effects of other more powerful techniques.
  • Patient motivation is the only variable in the world literature that has been shown to have large causal effects on recovery from depression.

Finally, I’ll share an email I just received from another Feeling Good Podcast fan. It kind of cheered me up from the funk I was in after watching the REBT folks rip into TEAM!

Hi Dr. Burns,

I really enjoyed the recent Feeling Good Podcast on how you overcame many challenges to get your book published (podcast #99, the interview with Nicole Bell). I love the fact that you require measurement before and after every session as well as homework. Hope you and your great work will continue to take your field out of the Dark Ages. I suspect you won’t have much difficulty publishing your new book, Feeling Great!

Phil

David

T = Testing, E = Empathy, A = (Paradoxical) Agenda Setting–
What can we learn from research?

Research on Testing

Boswell, JF, Kraus, DR, Miller, SD & Lambert, MJ (2013). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, DOI: 10.1080/10503307.2013.817696 (2013)

Hatcher, R. L., Barends, A., Hansell, J. & Gutfreund, M.J. (1995). Patients’ and therapists’ shared and unique views of the therapeutic alliance: An investigation using confirmatory factory analysis in a nested design. Journal of Consulting and Clinical Psychology, 63(4), 636 – 643.

Research on Therapeutic Empathy

Burns, D. D., & Nolen-Hoeksema, S. (1992). Therapeutic empathy and recovery from depression in cognitive – behavioral therapy: a structural equation model. Journal of Consulting and Clinical Psychology, 60(3): 441 – 449.

Burns, D. D., & Auerbach, A. (1996). Therapeutic Empathy in Cognitive – Behavioral Therapy: Does it Really Make a Difference? Chapter 7 in Frontiers of Cognitive Therapy (P. Salkovskis, ed. ) New York: Guilford Press, pp. 135 – 164.

Eisen, K. P., & Burns, D. D. (2007). Getting specific about “non-specific” factors: The role of therapeutic alliance in cognitive therapy. Psicologia Brasil (Psychology Brazil).

Krupnick, J. L. et al. (1993). The role of the therapeutic alliance in psychotherapy and psychotherapy outcome: Findings in the NIMH treatment of depression collaborative research program. Journal of Consulting and Clinical Psychology, 64(3), 636 – 643.

Orlinsky, D. E., Grawe, K., & Parks, B. K. (1995). Process and outcome in psychotherapy–Noch einmal. Chapter 8 in A. E. Bergin & S. L. Garfield (Eds.), Handbook of Psychotherapy and Behavioral Change (pp. 270 – 376). New York: John Wiley & Sons, Inc.

Persons, J., & Burns, D. D. (1985). Mechanisms of action of cognitive therapy: Relative contributions of technical and interpersonal intervention. Cognitive Therapy and Research, 9(5): 539 – 551.

Research on Therapeutic Resistance / Motivation

Burns, D. D., Adams, R., & Anastopolous, A. (1985). The role of self – help in the treatment of depression. Chapter 19 in Handbook for the Diagnosis, Treatment and Research of Depression, (Beckham, E. E. and Leber, W. R., eds. ), Homewood, II: Dorsey Press, pp. 634 – 669.

Burns, D. D., Shaw, B. F., & Crocker, W. (1987). Thinking styles and coping strategies of depressed women: An empirical investigation. Behavior Research and Therapy, 25(3): 223 – 225.

Burns, D. D., & Nolen-Hoeksema, S. (1991). Coping styles, homework compliance and the effectiveness of cognitive – behavioral therapy. Journal of Consulting and Clinical Psychology, 59(2): 305 – 311.

Burns, D. D., & Spangler, D. (2000). Does psychotherapy homework lead to changes in depression in cognitive behavioral therapy? Or does clinical improvement lead to homework compliance? Journal of Consulting and Clinical Psychology, 68(1): 46 – 59.

Burns, D. D., & Spangler, D. (2001). Can We Confirm Our Theories? Can We Measure Causal Effects? A Reply to Kazantzis et al. (2001). Journal of Consulting and Clinical Psychology, 69(6), 1084-1086.

Burns, D. D., & Auerbach, Arthur H. (1992). Do self – help assignments enhance recovery from depression? Psychiatric Annals, 22(9): 464 – 469.

Burns, D., Westra, H., Trockel, M., & Fisher, A. (2012) Motivation and Changes in Depression. Cognitive Therapy and Research DOI 10.1007/s10608-012-9458-3 Published online 22 April 2012

Burns, D. D. (March / April, 2017). When helping doesn’t help. Psychotherapy Networker, 41(2), 18 – 27, 60. https://www.psychotherapynetworker.org/blog/details/1160/when-helping-doesnt-help

Persons, J.B., Burns, D.D., & Perloff, J.M. (1988). Predictors of dropout and outcome in cognitive therapy for depression in a private practice setting. Cognitive Therapy and Research, 12, 557 – 575.

 

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