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

 

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

 

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

 

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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100: The New Micro-Neurosurgery–A Remarkable Interview with Dr. Mark Noble!

100: The New Micro-Neurosurgery–A Remarkable Interview with Dr. Mark Noble!

How Does TEAM-CBT Affect the Brain?

The famed neuroscientist, Dr. Mark Noble, from the University of Rochester, has developed a strong interest in TEAM-CBT and has visited our Tuesday group and Sunday hikes on three occasions this year. I (David) feel very fortunate to have his collaboration and interest!

IMG_2402

Mark and David at the Cupertino Plaza for a sumptuous dim sum feast at the Joy Luck Palace following a Sunday hike.

Mark is a Stanford-trained geneticist and molecular biologist who is considered one of founders of the field of stem cell research. He has been developing a model of how TEAM-CBT affects the brain, and graciously agreed to present his model at our Tuesday evening Stanford TEAM-CBT seminar last week. Although his model is not yet fully polished and refined, and involves considerable speculation, it is an exciting first step, kind of like the time when astronomers broke away from the Catholic church and started trying to make sense of the universe. In this instance it is the “inner universe” Dr. Noble, all of us, are trying to understand. His model will evolve and get more and more refined over time.

The participants in the seminar really liked his concept that we are doing micro-neurosurgery for depressed patients with TEAM-CBT! He is convinced that the rapid recovery we see with TEAM-CBT will probably never be equaled by medication, since the brain circuits that modulate happiness and unhappiness tend to use the same neurotransmitters. But with language, you can affect brain circuits far more selectively and effectively, almost like a micro-neuro-surgeon.

Dr. Noble describes brain function in terms of the SNEFF model. This stands for Structures, Networks, Emotions, Frames and Filters, and links these concepts to the prefrontal cortex, amygdala and sympathetic nervous system. Then he describes the four steps of TEAM (T = Testing, E = Empathy, A = (Paradoxical) Agenda Setting, and M = Methods), and links each step to the SNEFF model, making interesting speculations on how TEAM works and what makes it so effective.

Dr. Noble also discusses David’s “fractal” theory about psychotherapy and relates that to brain function as well as to the mathematics of complex structures. He describes how and why some people get stuck in the “homeostasis” of chronic, refractory depression and explains why TEAM-CBT is usually able to trigger sudden and dramatic changes in the brain, as well as in the way the depressed and anxious individual thinks, feels, and behaves. He also explains why conventional talk therapy is unlikely to be helpful for individuals struggling with depression and anxiety, and may, in some cases, make the depression worse.

This is because neurons that “fire together wire together.” In other words, if you go to therapy and complain or emote about your life and your problems over and over, without taking action to change, the circuits in your brain that support complaining and feeling depressed will just get more and more intensely wired together.

Dr. Noble also speculates on why Paradoxical Agenda Setting is such an important key in ultra-rapid-recovery and in the sudden transformation of brain function as well.

Years ago, when I was kid on vacation in Minnesota, I saw an article in a small newspaper published in a rural area. A local scientist had speculated that one day we would have guided missiles and satellites and drew a simple diagram for the newspaper of how they would work. At the time it seemed a bit like science fiction, and I wondered if an unknown scientist from a small rural Minnesota town could actually predict a major scientific development. But now we see that he was right.

Will we someday think about Dr. Noble in the same way? Listen to this exciting podcast, and you can decide for yourself!

You might be interested in some of the comments from individuals who attended the Stanford seminar and heard Dr. Noble’s talk:

  • Mark’s work was wonderful in helping me understand the map of TEAM onto the brain. We’re all micro-neurosurgeons!! Everyone has honorary MDs!
  • Loved the presentation!
  • Mark’s presentation was fascinating! I got really excited about all of the interesting research that could come out of it.
  • I absolutely appreciated Mark’s presentation on his research and how made the connections with TEAM. This was truly very interesting and helpful, and made me realize how fortunate I am to belong to this Tuesday group!
  • Interesting new perspectives brought in by our guest speaker
  • I highly enjoyed Mark’s visit and was captivated by the information! Thank you!
  • Loved learning how frames and filters interact to build experience.
  • AWESOME PRESENTATION! It was wonderful to hear Mark’s presentation. He did an outstanding job and I was extremely fascinated with the information he presented to us. He did a fantastic job in describing brain functioning in relation to TEAM CBT. Loved every minute of it!
  • I loved the concept of fractals in creating the concentrated surge of change into the next “valley” rang true.
  • I resonated with the importance of “storytelling” and the value of a client being heard and respected when the therapist uses the Five Secrets of Effective Communication, and how this induces a sense of the client being equal, and how that can quiet the agitated brain!

David

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Attend my 2018 Summer Intensive in San Francisco!

This year, I am again offering my annual SF summer intensive in August at the South San Francisco Conference Center. This four-day intensive is almost always my most exciting and rewarding workshop of the year.

Here are the details:

David’s TEAM-CBT Summer Intensive

August 6 – 9, 2018, South San Francisco Conference Center, California

For more information, click here, or call IAHB.org at 800-258-8411

Here are just a few of the really cool things about this intensive:

  • You will have the chance to practice techniques in small groups after I demonstrate each technique with a live demonstration in the front of the room.
  • You will get immediate feedback and personal grooming from me and from many of my colleagues from my weekly TEAM-CBT training group at Stanford. They’ll be there to help you, and I’ll be there to help you, too!
  • There will be a live demonstration on the evening of day 1. The amazing Dr. Jill Levitt will be my co-therapist. Last year’s live demonstration, and in fact all of them in recent years, have been jaw-dropping and incredibly inspirational!
  • You’ll get a chance to practice TEAM-CBT in real time the evening of day 3. This will be an incredibly challenging but rewarding “solo flight.”
  • You will be able to do your own personal work on the last day of the workshop using the Externalization of Voices and Acceptance Paradox. In previous workshops, at least 60% of the participants indicated they experienced jubilant enlightenment during this exercise. Their fears and insecurities suddenly vanished!
  • You’ll learn how to do Relapse Prevention Training (RPT).
  • You’ll learn how to improve your empathy skills.
  • You’ll learn tons of powerful cognitive, behavioral, and motivational treatment techniques for depression and all of the anxiety disorders.
  • You will have the abundant opportunities to schmooze with colleagues, network, and have fun.
  • You will have two fabulous free luncheon banquets featuring talks by Sunny Choi, LCSW, who is using TEAM-CBT successfully with an underserved population in primary care with limited resources and language skills (“I must apologize for my success.”), and the wonderful Vandana Aspen, PhD, who will speak on “New Treatment Strategies for Eating Disorders.”)
  • And much more.

If you can only attend one of my workshops this year, the South San Francisco August intensive is the one to attend!

 

099: Nicole Bell’s Incredible Interview with Dr. David Burns

099: Nicole Bell’s Incredible Interview with Dr. David Burns

Behind His Brilliance: Critical Thinking

Lisa Nicole Bell is the host of the highly regarded podcast, Behind the Brilliance. In this lively interview, Nicole and David talk about

  • David’s path into the mental health field
  • the difficulties and rejections David faced getting his first book, Feeling Good, published
  • David’s advice to listeners interested in therapy
  • how he approaches perfectionism, depression, and anxiety with patients
  • the joys of a life free from the need to be special—
  • and much more!

Click here if you’d like to learn more about Nicole and hear more of her fantastic interviews! Lisa’s show delivers a smart and funny take on pursuing ambitions, designing a life, and living joyfully. Lisa’s most recent media work includes producing an Australian documentary on identity and gender politics within sports and a digital docu-series produced by Academy Award-winning actress Viola Davis.

098: Live Session with Lee, Part 3: The Rebirth

098: Live Session with Lee, Part 3: The Rebirth

 

The last of 3 podcasts illustrating
the TEAM treatment model for a relationship conflict

With Drs. David Burns and Fabrice Nye, and special guest Dr. Jill Levitt,
Director of Training at the Feeling Good Institute in Mtn. View, California

In this final podcast featuring the TEAM therapy session with Lee, David and Jill do M = Methods, and show Lee how to respond to his wife more skillfully, using the Five Secrets of Effective Communication. Like everyone who is trying to learn the Five Secrets, Lee struggles with several blind spots:

  • “I Feel” Statements. Lee has tremendous difficulties sharing his feelings openly, in a respectful manner. He seems indoctrinated with the cultural idea that men should not be vulnerable and express feelings.
  • Lee makes the common error of “problem solving” instead of asking his wife to share more of her feelings.
  • Lee makes another common error of apologizing and using the trite phrase “I’m sorry” instead of encouraging his wife to open up. David discusses the different between dysfunctional and effective apologies.

David and Jill do lots of role-play practice with Lee and give him a homework assignment.

T = Testing. After the session is over, Lee completes the Brief Mood Survey again. His scores indicated that his feelings of  anxiety and anger have completely disappeared, and he also has a perfect score  Positive Feelings Survey and the Relationship Satisfaction Scale. He also gave David and Jill perfect scores on the Empathy and Helpfulness scales and wrote what he liked the best about the session:

“My epiphany came at the moment I realized I had been afraid of emasculating myself and realizing that my vision of what a “man” should be was completely inaccurate.”

At the end, Jill reads an emotional email from Lee describing how he relapsed and started arguing with his wife, and then remembered to empathize use the Five Secrets instead, with an amazing result!

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Lee Davy is the creator and founder of “The Truth about Alcohol.” He offers free weekly webinars for people who need help and support with their drinking. Check it out!

Attend my 2018 Summer Intensive in San Francisco!

This year, I am again offering my annual SF summer intensive in August at the South San Francisco Conference Center. This four-day intensive is almost always my most exciting and rewarding workshop of the year.

Here are the details:

David’s TEAM-CBT Summer Intensive

August 6 – 9, 2018, South San Francisco Conference Center, California

For more information, click here, or call IAHB.org at 800-258-8411

Here are just a few of the really cool things about this intensive:

  • You will have the chance to practice techniques in small groups after I demonstrate each technique with a live demonstration in the front of the room.
  • You will get immediate feedback and personal grooming from me and from many of my colleagues from my weekly TEAM-CBT training group at Stanford. They’ll be there to help you, and I’ll be there to help you, too!
  • There will be a live demonstration on the evening of day 1. The amazing Dr. Jill Levitt will be my co-therapist. Last year’s live demonstration, and in fact all of them in recent years, have been jaw-dropping and incredibly inspirational!
  • You’ll get a chance to practice TEAM-CBT in real time the evening of day 3. This will be an incredibly challenging but rewarding “solo flight.”
  • You will be able to do your own personal work on the last day of the workshop using the Externalization of Voices and Acceptance Paradox. In previous workshops, at least 60% of the participants indicated they experienced jubilant enlightenment during this exercise. Their fears and insecurities suddenly vanished!
  • You’ll learn how to do Relapse Prevention Training (RPT).
  • You’ll learn how to improve your empathy skills.
  • You’ll learn tons of powerful cognitive, behavioral, and motivational treatment techniques for depression and all of the anxiety disorders.
  • You will have the abundant opportunities to schmooze with colleagues, network, and have fun.
  • You will have two fabulous free luncheon banquets featuring talks by Sunny Choi, LCSW, who is using TEAM-CBT successfully with an underserved population in primary care with limited resources and language skills (“I must apologize for my success.”), and the wonderful Vandana Aspen, PhD, who will speak on “New Treatment Strategies for Eating Disorders.”)
  • And much more.

If you can only attend one of my workshops this year, the South San Francisco August intensive is the one to attend!