“How fast can I taper off my psychiatric medications?”
In this podcast, David and Fabrice answer five intriguing questions submitted by listeners:
Joshua: How can I cope with panic attacks during job interviews?
Dan: I feel traumatized by criticisms from my boss at work. what can I do?
Susan: How fast can you taper off of anti-anxiety drugs and antidepressants?
Ross: What if a patient who’s been the victim of trauma or abuse asks for a male therapist? Isn’t this a form of avoidance? Should patients be matched to therapists based on gender? Isn’t it best to avoid the situations that trigger you?
Sumit: I think I have “endogenous depression.” Can TEAM-CBT help me? Or will I have to rely on medications? What is endogenous depression?
If you have a question, make sure you email david and we will try to answer your question on an upcoming Ask David Podcast!
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!
I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!
088: Feared Fantasy, Part 2, and the Anti-Brushfire Technique*
Hi everybody!
Fabrice and I are thrilled to share this podcast with you, which I think you will really enjoy! We decided to include a second podcast on the Feared Fantasy Technique since it is so dynamic and powerful. We will also demonstrate the “Anti-Brushfire Technique,” which is another useful role-playing technique for individuals who fear disapproval.
We are joined tonight by two members of my weekly Stanford training group for Bay Area mental health professionals, Alisha Beal and Werner Spitzbaden. Both have brought along lists of some of their negative thoughts, which are based on real concerns.
Alisha has just completed our 12-week introductory “newbies” training group in TEAM-CBT. That group will merge with our “advanced” group next week, and she is feeling anxious and insecure for two reasons:
She is concerned that people in the advanced group will think she’s not up to speed, and she’s worried that she will make a fool or herself when she has to practice techniques and get feedback from her colleague or answers questions in the class.
Alisha blushes easily and is concerned that people will think she isn’t very bright and doesn’t know any anything when they see her blushing.
These concerns feel very real, and trigger fairly strong feelings of anxiety! Her negative thoughts included these:
I’ll mess up.
They’ll think I didn’t learn anything.
I’ll blush and they’ll know I don’t know what I’m doing.
I’ll make a fool of myself.
David will realize that he wasted time and people when he created the introductory training group.
Werner’s concerns are similar. He has been in the advanced group for many months and has been doing a tremendous job of learning TEAM-CBT. However, he hasn’t work as a therapist for several years, but has been doing administrative work for a prominent California health delivery system. Werner is excited about the new TEAM-CBT skills he’s been developing, and wants to get back into clinical work. He has just accepted a part time position at the Feeling Good Institute in Mt. View, California.
This is great, but Werner is worried that his therapy skills won’t be good enough, and he’s afraid that the other staff members may judge him. He’s telling himself:
I won’t succeed.
I should know so much more than I do!
I won’t do a good job!!
I’ll develop a bad reputation, and no one will want to work with me.
They’ll judge me and think that I’m not competent.
As you can see, although the details of his situation are quite different from Alisha’s, the underlying fears are similar.
And perhaps you’ve had similar fears and insecurities at times as well! Have you? I know that I’ve often felt that way! And that’s one of the reasons I find the techniques in this podcast so incredibly helpful and fascinating!
As you listen to the podcast, you will see what happens when Alicia and Werner both enter into an Alice and Wonderland Nightmare World where they will confront the monster they fear the most. I think you will find the results interesting, powerful, and entertaining, as they both suddenly achieve what the Buddhists have called “laughing enlightenment” for 2500 years!
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
Coming in June! One of my best two-day workshops ever!
“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates June 4 -5, 2018 Calgary, Canada June 6 – 7, 2018 Winnipeg, Canada Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!
I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!
In today’s podcast, we will illustrate the Devil’s Advocate Technique, another one of the role-playing techniques in TEAM-CBT. You can use this technique for any habit or addiction, such as:
Drug or alcohol abuse
Overeating / binge eating
Shopping addiction
Internet addiction
And procrastination, which is our problem for today.
David and Fabrice are joined by Sara Shane, a member of David’s Tuesday evening psychotherapy Stanford training group for northern California mental health professionals. Sara has volunteered to demonstrate the technique to see if she can get some help with procrastination.
Sara explains that she has a small clinical practice in the central valley of California working with children but would like to expand her practice to include teenagers and adults, so she can use the exciting TEAM-CBT skills she’s been learning in the Tuesday group over the past year. In addition, Sara is bilingual, so this would open up the possibility that many Spanish speaking individuals could have the opportunity for treatment with TEAM-CBT.
But to do that, Sara would have to start marketing her practice, but she’s been procrastinating. She never seems to get around to it, and always places the wants and needs of others in her family above her own.
David asks her what it is she’d have to do. She says she wants to put together a brochure describing her work so she could send it to people on her mailing list who might send her some referrals. David ask her to list the first few steps of her task, limiting what she would have to do to just to get started, something requiring only about 5 minutes.
Here are the first steps, and time required for each:
Sit down at the computer and turn it on. (30 seconds)
Open a blank document in MS Word. (30 seconds)
Jot down a few names for my practice, even if they aren’t especially good (since they can be revised later). (4 to 5 minutes)
Add my contact information. (1 minute).
So, the total time required would be six minutes or so. David asks if she’d be will to do it tomorrow morning from 9 AM to 9:06 AM. She said she’d actually like to start tonight, but it is already 9 PM and she still has a two-hour drive home. So she agrees to do it first thing in the morning instead. She also agrees to send an email to Fabrice and David and the Tuesday group at 9:06 with one of two messages: “Mission Accomplished” or “I stubbornly refused.”
Now we’re ready for the Devil’s Advocate Technique. David and Fabrice will play the role of the Devil who tempts Sara to procrastinate, using the actual thoughts Sara has when she’s procrastinating. They include:
I’ll do it later.
There’s always tomorrow.
I don’t have any appointments tomorrow, so I can start to work on the marketing materials then.
I have to take Mom to her doctor’s appointment now, so I can work on the marketing materials later.
Right now, I just need some rest and relaxation, some time for myself.
David begins and tells Sara, “Oh, you can do it later. There’s no reason for you to have to do it now!”
Sara’s response is decent, but not super-strong. You’ll hear on the audio that it’s a bit half-hearted, and not overwhelmingly convincing. And if she can’t crush the tempting thought during the session, she definitely won’t be able to resist it when she’s home alone.
Instead of giving Sara some tips on how to improve it—which David says the therapist should never do when working with someone with a habit or addiction—David suggests that maybe the problem of procrastination perhaps isn’t something Sara wants to work on right now.
This is called Sitting with Open Hands, and it’s far more powerful than trying to “help.” Trying to help a patient who’s struggling with a habit or addiction will usually just make the problem more intense.
Fabrice points out that people don’t need to be “taught” how to say “no” to some tempting thought. They just have to make a decision!
When David sits with Open Hands, Sara gets agitated and insists she really does want to defeat her procrastination. That’s the most common reaction to “Sitting with Open Hands.”
Then David asks if she’d like to try again. David verbalizes the first tempting thought again, and Sara immediately hits it out of the park in a convincing way.
David and Fabrice take turns as the “Devil,” verbalizing all Sara’s tempting thoughts. One by one, Sara destroys them. She leaves the session on a glow, quite excited about the new direction for her practice.
David and Fabrice emphasize that the Devil’s Advocate Technique is not a method you would just throw at someone with a habit or addiction. Instead, you would work with the person systematically, going through the T E A M model, one step at a time, just as you would with any patient. The Devil’s Advocate Technique is simply one of the M = Methods in TEAM. And it probably won’t be effective if you haven’t done skillful paradoxical agenda setting first, to find out if the patient really is motivated to give up his or her addiction.
Did it work? Was this little mini-session effective? That’s always the question, isn’t it?
Well, here’s the answer! Fabrice and I received this email from Sara this morning:
Hi Dr. Burns and Fabrice,
Thank you so much for the opportunity to volunteer last night for the podcast. What an awesome experience! I am so inspired and motivated that it was hard to stop creating my business postcard to email you that I had accomplished my mission!!!
This is really funny but truly AMAZING!!! I have done beyond what I agreed to do, and this just makes me feel so HAPPY!!!
THANK YOU, THANK YOU SO MUCH!!!
I’M LOVING THIS!
Sara Shane
Way to go Sara! Fabrice and I are so proud of you, and looking forward to the exciting expansion of your practice!
There are only a few spots left for the live workshop in Palo Alto, but we still have room for you to join us for the online version. We will have helpers to guide the small group exercises for those online, as well as those who attend in person.
Coming in June! One of my best two day workshops ever!
“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates June 4 -5, 2018 Calgary, Canada June 6 – 7, 2018 Winnipeg, Canada Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!
I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!
This is the fourth in a series of podcasts on several powerful role-playing techniques we use in TEAM-CBT. Today, we’re going to highlight the Feared Fantasy Technique.
Here, in a nutshell, is why I created this technique. In order to get over any form of anxiety, exposure is absolutely necessary. Exposure is not a complete treatment for anxiety, and is only one of 40 methods I use to treat anxiety, but it always MUST be included in the treatment package.
However, sometimes, people have fears that you cannot easily confront in reality. For example, you may have the hidden fear that others would judge you if they knew how insecure you felt inside, or if you failed at something, or if they were way more successful than you. You can’t just say to someone, “Do you think less of me because I’m actually quite insecure?” They’ll just deny it, and you’ll feel like a nut!
So I created the Feared Fantasy Technique. Essentially, you invite the patient to enter an Alice-in-Wonderland Nightmare World where their worst fear comes true, and where people not only think of you what you most dread, but they also mercilessly tell it to your face. This gives patients the chance to face the monster. In most, if not all cases, they suddenly discover, at the gut level, that the monster has no teeth.
Like the Externalization of Voices, this is a two-person technique, although I’ve sometimes done it with many people in groups. In this case, there can be numerous feared “monsters.”
In the two-person version, you and another person, who could be your therapist, go into the Alice and Wonderland Nightmare World and act out one of your worst fears, such as being rejected by an exceptionally hostile critic because you aren’t smart enough or good enough. When you face your worst fear, you often gain liberation from it because you discover that the monster has no teeth. Your worst fears don’t usually turn out to be real monsters, but figments of your imagination that you can defeat with a little logic, compassion, and common sense. You use frequent role-reversals until the monster has been totally crushed.
I am joined in this podcast by our own beloved Dr. Fabrice Nye, and two members of my Tuesday training group at Stanford, Liz Richard, a Licensed Marriage and Family Therapist, and Dr. Rhonda Barovsky, a Forensic / Clinical Psychologist, along with Stephanie James, an LCSW psychotherapist and radio talk show host from Fort Collins, Colorado, who is visiting the group. Liz is a member of the “newbie” TEAM training group at Stanford and agreed to bring a list of her own negative thoughts that trigger her feelings of insecurity in the group. I am grateful to all of them for helping out with this podcast!
Sometimes, when I am helping a patient challenge a Negative Thought, like “I’m a bad mother” or “I’m a failure as a father,” or “my colleagues would look down on me if they knew how screwed up I actually am,” I start with a gentle technique like the Paradoxical Double Standard that we illustrated in the first podcast on role-playing techniques. It’s a gentle technique that would almost never threaten or upset a patient.
Once the patient has totally crushed the thought, I typically move up to the Externalization of Voices. This is a more challenging and powerful technique that provides a deeper level of recovery / enlightenment and allows me to model the differences between the Self-Defense Paradigm vs. the Acceptance Paradox.
Once the patient has knocked the ball out of the park with the Externalization of Voices, I often move up to the Feared Fantasy. This is the most extreme and powerful technique of all. And the moment the patient again defeats his or her most terrifying fear, the impact can be positive and extreme, and often ends in a kind of uncontrollable laughter The Buddhists call this “laughing enlightenment. It often happens the moment you suddenly realize that your worst fear was nothing more than a gigantic cosmic hoax!
You may want to read a brief description of how to use the Feared Fantasy Technique that I created several years ago for my training groups and workshops. At the end, you’ll find a comparison of the Externalization of Voices, Paradoxical Double Standard, and Feared Fantasy, along with a table contrasting the Self-Defense Paradigm with the Acceptance Paradox.
The example I am using in the write-up below is not the example in the podcast, but one I sometimes use in teaching. Often, participants are afraid to do role-playing in front of the group because of thoughts like these:
I’ll probably look foolish and make a fool of myself.
I’ll screw up and fail.
People will judge me and think less of me.
They’ll laugh at me and tell other people about what a loser I am!
It is difficult to confront these fears in reality since people generally don’t have these kinds of negative judgements toward colleagues in the group who are feeling insecure. In addition, if someone did have these kinds of thoughts they would deny having them. But in the Alice-in-Wonderland Nightmare World, people DO have these kinds of thoughts about you, and they DON’T deny them! So, it can be challenging at first to have to confront these kinds of mean-spirited perceptions, and incredibly freeing once you defeat them!
Feared Fantasy*
This is a form of Cognitive Exposure
Some fears are not easily confronted in reality
General instructions
Work in dyads. Decide who will play the role of therapist and who will play the role of patient
Use the workshop / seminar performance anxiety example
Therapist Instructions
Explain that you’re going to enter an Alice-in-Wonderland Imaginary world where there are two strange rules:
If you think people are looking down on you, they really are.
Furthermore, they get right up in your face and verbalize all their negative thoughts about you. They aren’t at all nice. They try to humiliate.
Ask the patient which role she or he wants to play first. Explain that you’ll do role-reversals, so the choice is not terribly important.
We’ll assume that you’ve chosen the performance anxiety example, and that you, the therapist, will start out in the role of a rejecting, judgmental audience member or friend. Your patient will play the role of himself or herself.
Now criticize your patient, saying the things that he or she would be afraid to hear, such as:
“Hey, I was in the audience when you did that role-play with Dr. Burns. You really looked foolish and I’ve been laughing at you ever since.”
After your patient responds to each attack, ask who won the exchange. If the patient did not “win big,” do a role-reversal and see if you can come up with a more powerful response.
Tips on Defeating the Imaginary Critic
When you’re under attack, try to defeat the imaginary critic
You can use Self-Defense, the Acceptance Paradox, or a combination of the two
If the Self-Defense Paradigm was ineffective, try
The Acceptance Paradox
Or a combination of Acceptance and Self-Defense
If the Acceptance Paradox was ineffective, try
The Self-Defense Paradigm
Or a combination of Acceptance and Self-Defense
Comparing the Paradoxical Double Standard,
Externalization of Voices and Feared Fantasy*
Technique
Patient’s Name
Your Name
Role-Reversals?
Paradoxical Double Standard
His or her real name
The name of an imaginary dear friend of the same gender as the patient. Preferably, it is not someone the patient actually knows.
No
Externalization of Voices
His or her real name
Same name as the patient
Yes
Feared Fantasy
His or her real name
You play the role of some judgmental or critical person the patient is afraid of.
Yes
Comparing the Self-Defense Paradigm with the Acceptance Paradox*
Strategy
General Concept
Negative Thought
Example of How to Defeat the NT
Self-Defense Paradigm
You defeat the NT by arguing with it and insisting that it’s distorted and not true.
A patient who suddenly relapses several weeks after recovery will often have this thought, “This shows that the therapy didn’t work and that I really am a hopeless case.”
“That’s ridiculous. I had a fight with my wife last night, so it’s not surprising that I’d be feeling upset. The therapy was very effective, and this would be a good time to pull out the tools I learned and get to work.”
Acceptance
Paradox
You defeat the NT by buying into it and insisting that it is true, but you do this with a sense of humor or inner peace.
During a moment of insecurity, a therapist may have the thought, “I’m not as good as I should be.”
“As a matter of fact, I still have tons of flaws and a great deal to learn. Even when I’m 85 years old, there will still be tons of room for learning and improving, and that’s kind of exciting.”
The Self-Defense Paradigm is especially helpful for the types of NTs patients have during relapses, and it’s a good idea to prepare them to talk back to these thoughts when they first recover, and before they actually relapse, using the Externalization of Voices.
The Acceptance Paradox is especially helpful for the types of NTs that lead to feelings of worthless, inferiority, or a loss of self-esteem.
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
There are only a few spots left for the live workshop in Palo Alto, but we still have room for you to join us for the online version. We will have helpers to guide the small group exercises for those online, as well as those who attend in person.
Coming in June! One of my best two day workshops ever!
“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates June 4 -5, 2018 Calgary, Canada June 6 – 7, 2018 Winnipeg, Canada Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!
I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!
In today’s podcast, we will illustrate one of the less known M = Methods in TEAM therapy. It’s called Forced Empathy. Lately, it’s been getting a lot of enthusiastic support from individuals in my training groups, so I thought I’d include it in the podcast series on role-playing techniques.
I’m joined today by our wonderful and brilliant host, Dr. Fabrice Nye, and two individuals from my Tuesday evening training group at Stanford: Rhonda Barovsky, PhD, and Robert Mitchell, PhD, as well as Stephanie James, a psychotherapist and Licensed Clinical Social Worker from Fort Collins, Colorado. Stephanie recently interviewed me for her terrific radio show / podcast called TheSparkPod.com and I was delighted that she visited our training group today.
In the podcast, Robert describes a problem with his 11-year-old son Max, who frequently gets into conflicts with his younger sister. I thought the example was only partially successful. I was struggling with bronchitis the night we recorded it, and others were tired, too. I might repeat a podcast on this technique to let you see it again, as it is potentially powerful. However, it might be somewhat helpful for you to get a bit of a feel for how this potentially powerful techniques works.
After the podcast, I received this wonderful email from Robert:
“On the drive home after the podcast I did remember the sudden insight that was so helpful to me during the Forced Empathy. The reason I touched your arm was that I realized that Max really believes what he’s saying as he says it. When he logically reviews it later, he doesn’t, but in that moment, I suspect he does believe it.
“My aha of the podcast was that I have been negating his feelings, assigning them as misplaced emotions or manipulation. I came to this assessment because in the heat of the conflict, what he is saying appears to involve distorted cognitions, assertions and remembrances. In those moments, I have tried to apply the Five Secrets, but with mixed results, because I realize now that I’ve been trying to get him to see that he’s wrong, as opposed to seeing the world through his eyes.
“Again, thank you for everything you do for both myself and for the group. I really value the training experiences that you’ve created for all of us!”
Robert
The following is a document I wrote several years ago for my Stanford training group. You can review it if you’d like to learn more about this technique.
Forced Empathy*
I want to thank Leigh Harrington, MD for collaboration in creating this document
Goal: To help the patient to see a relationship conflict from the other person’s perspective, and to see his or her own role in the conflict more clearly.
Important note: Forced Empathy can only be used to help someone who has agreed to examine his or her own role in a conflict and stop blaming the other person. The patient must agree to focus entirely on changing himself or herself and to stop trying to change the other person.
Therapists who do not understand this will discover that this, or any, interpersonal technique will fail. Unresolved resistance in relationship problems is extremely powerful and will sabotage any technique designed to enhance intimacy and understanding.
Rationale: Distortions like Mind-Reading, Labeling, Should Statements and Blame, to name just a few, can intensify relationship conflicts. For example, when you’re angry with someone, you may have thoughts like these:
She’s a jerk.
All he cares about is himself.
She always has to be right.
He always has to get his way.
She never listens.
He always has to be in control.
Patients may not be motivated to give up these distortions because they feel good when they are directed at someone else! Angry patients may enjoy seeing the other person in a highly unflattering light, so they may cling to their distortions.
In addition, these kinds of distortions will function as self-fulfilling prophecies. For example, if you think of someone as “a jerk,” you will treat that person like a jerk; then he or she will probably get mad and act like a jerk. You don’t realize you are creating your own interpersonal reality, and you may be convinced that you are seeing the other person as he or she “really is.”
One of the goals of T.E.A.M. therapy is to pinpoint your own role in the problem and to see things through the other person’s eyes. Forced Empathy is one technique that can sometimes help with this.
How to do it: Invite the client to participate in a unique kind of role-play exercise. The patient will play the role of the person she or he is in conflict with and you, the therapist, will play the role of a good friend of the person. Explain that you will ask him or her about this conflict. The patient should do his or her best to answer all the questions honestly.
Here’s a tip: When you are playing the role of the friend, imagine that you are a therapist, and you are asking the person the patient is in conflict with how he or she feels, and why he or she feels that way, using the Five Secrets of Effective Communication and other interviewing techniques. As a therapist, you would do this in a supportive, exploratory way, with no judgment at all. We do this all the time with our patients, so that’s the skill to draw on when you use this technique.
Here’s an example: Let’s imagine our client, Susie, is having a conflict with her friend Paul.
Tell Susie that there are three rules:
“When you play the role of Paul, you have to agree to tell the truth, the whole truth, and nothing but the truth. You are not allowed to rationalize or to be defensive. Do you agree?”
“In addition, I want you to speak from the perspective of Paul’s conscious and subconscious mind as best you can. Do you agree?”
“Finally, I want you to share all of Paul’s feelings, including anger and frustration, in an uninhibited way. Will you do that as well?”
The friend (played by the therapist) starts by saying:
Friend (therapist): “Paul, I hear that you’re having a conflict with Susie. Is that true?
Client (Susie playing the role of Paul): “Yes, I guess we are.”
If the client says no, you tell them they’re not following the rules.
Friend (therapist): “Tell me what’s going on with you and Susie. How has it been for you?”
As the Friend, the therapist can ask Susie questions along these lines:
“Paul, tell me how you feel about Susie.”
“Does she irritate you? Tell me what she does that turns you off.”
“Tell me why you don’t trust her. What are some of the things she’s done or said that seem dishonest or untrustworthy.”
“Why do you think she does that?”
“Tell me more about why this is upsetting to you.” (You can do an informal Downward Arrow Technique here.)
As the Friend, the therapist must empathetically align with Paul, using the Five Secrets of Effective Communication: The Disarming Technique, Thought and Feeling Empathy, Inquiry, “I Feel” Statements, and Stroking.
Therapist (friend) follow-up questions can focus on goals like these:
Identify the thoughts and feelings of Paul, the person the patient is in conflict with.
Highlight the (usually benign) motives of the person the patient is in conflict with: “So you’re telling me that you’re concerned that if you listen to Susie, or give in to her, she’ll take advantage of you and you’ll end up getting hurt? Are you saying that you back off because she sometimes seems kind of pushy?”
Or “So you are telling your daughter you will not go to her wedding because you love her so much and fear she’ll be unhappy with this man?”
Or “So are you saying it’s your desire to give your grandchild things you were unable to give your son that drives you to shower him with gifts?”
You can see that this is the same Positive Reframing technique we often use during Paradoxical Agenda Setting. Essentially, you transform malignant motives into benign motives. This is arguably a Buddhist concept. The idea is for the patient to see that if he or she were the “enemy,” he or she would likely be feeling and behaving in the same manner.
This means giving up the notion that the person the patient is in conflict with is some kind of horrible human being. Some patients will not be willing to do this. That’s why skillful PAS must come first. As I mentioned earlier, it is very rewarding to label and blame others because this makes us feel morally superior. Even therapists sometimes fall into this trap, usually without realizing it!
Pinpoint the precise things the patient does or says that upset the person the patient is in conflict with: “So you are saying that Sam is being too tight fisted with his child, and that is judgmental toward you for being generous?”
Identify and align with the parts of the client the conflict person may appreciate.
“You’re right; I’ve heard Susie is a real go getter.”
Or, “Yes, I’ve heard Sam really wants to teach his son the value of money.”
At the end ask, “You’ve been playing the role of Paul (or Sam, or whoever), how is that for you?”
Responses Dr. Harrington has heard from patients when using this technique:
“I was able to see Paul’s side, and see my part my part in the problem as well.”
“I’m always running my script, and I started to see his script.”
“This gives me some insight and new ideas about how to approach my supervisor.”
Key points: A strong therapeutic alliance will be required. You must empathize with the client skillfully and should be getting a 20 on Therapeutic Empathy Scale before jumping into this method.
Another key point will be skillful Paradoxical Agenda Setting (PAS). Teaching interpersonal techniques to patients without using PAS first will rarely be effective. By the same token, imposing Forced Empathy on a patient who wants to see the “enemy” in a negative light will rarely or never be effective. As a result, you’ll conclude that Forced Empathy isn’t a very good technique when the real problem may simply be unresolved resistance.
The “dark side” of human nature: One concept that seems very difficult for therapists to grasp and accept is that there is a “dark side” to human nature. One the one hand, we are motivated to have loving, peaceful, joyous relationships with others. But at the same time, dark motives often compete with the positive motives, and we may not really want a closer or more loving relationship.
Why would we want bad relationships with others? What are the lower forces that compete with our desires for love and intimacy? there are many benefits to identifying someone as your “enemy,” including:
You can blame the other person (or group) for the problems in your relationship.
You can tell yourself that you are right, and she is wrong.
You can feel self-righteous and morally superior.
You can feel angry and justify getting back at the other person or group.
You can get others to collude with you and agree that the other person is “bad.”
You can put up a wall and protect yourself from the risk of getting hurt.
You can attach pejorative labels to the other person.
You can see other people in black-or-white terms. This makes things simple and clear.
You can feel a sense of excitement.
You don’t have to examine your own role in the problem, which can be shocking and humiliating.
You can play the role of victim, or martyr, and feel sorry for yourself.
If you may discover that your patient does not want help with a relationship problem, can simply Sit with Open Hands and ask if there is something he or she does want help with.
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
There are only a few spots left for the live workshop in Palo Alto, but we still have room for you to join us for the online version. We will have helpers to guide the small group exercises for those online, as well as those who attend in person.
Coming in June! One of my best two day workshops ever!
“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates June 4 -5, 2018 Calgary, Canada June 6 – 7, 2018 Winnipeg, Canada Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!
I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!
The is the second podcast on TEAM-CBT role-playing techniques and features the Paradoxical Double Standard Technique. David describes watching Dr. Maxy Maultsby do a demonstration of the Double Standard Technique when he was a psychiatric resident in the 1970s at the University of Pennsylvania medical school. He was quite surprised when the patient, who was severely depressed and suicidal following a break-up with her boyfriend, improved dramatically within an hour. David modified the technique in several ways, and tonight will present what is probably the most powerful way to use this technique.
The technique is based on the idea that most of us operate on a double-standard. When we are upset about some failure, mistake, or inadequacy, we tend to beat up on ourselves mercilessly. But if we were talking to a dear friend with the exact same problem, we’d be far more compassionate and realistic. Once you make the patient aware of this double-standard, you ask if he or she would be willing to talk to himself or herself in the same way he or she would talk to a dear friend.
But the unique feature of the way David does it, is that you, the therapist, “become” a dear friend of the patient, kind of like a long-list identical twin who is actually virtually identical to the patient, but a different person. Then the therapist (playing the role of the friend) describe the problem the patient is struggling as if it is your own problem.
Then you ask the patient what he or she thinks. Typically, the patient will respond with great compassion. Then you, the therapist, cross examine the patient, to make sure what the patient is saying is the absolute, 100% truth. Finally, you ask the patient to record this in the Positive Thoughts column on his or her Daily Mood Log.
While no technique will work for everyone, this one works for many patients if:
You’ve done excellent Empathy first.
You’ve done skillful Paradoxical Agenda Setting to melt away the patient’s Outcome Resistance.
The patient is reasonably compassionate and actually does have a double standard. On rare occasions, you may have a patient who hates himself or herself, who also hates other people. For these patients, the technique will not be effective.
The special guest tonight is Eleanor Scott, a community therapist who is a student in David’s Tuesday group at Stanford, and who has bravely volunteered to help demonstrate teaching techniques once again. (Eleanor was also feature in an Empathy role-play a couple weeks ago.)
Eleanor has brought a partially completed Daily Mood Log to the group, and the Upsetting Event is simply being in the Tuesday group and feeling insecure while trying to learn TEAM-CBT. These feelings are a fairly common, almost universal, among the therapists who attend David’s training groups. Initially, nearly all of them feel intense anxiety, along with a myriad of other negative feelings, such as shame and inadequacy, due to the belief that they are not “good enough,” along with the fear that others in the training group will notice their ineptitude and judge them!
Eleanor’s Negative Thoughts included:
I should be learning more quickly.
The other students will notice that I don’t know what I’m doing!
I’m never going to get this.
I don’t know what I’m doing.
I sound like an idiot/stupid.
I suck!
David explains how the Paradoxical Double-Standard Technique works, and demonstrates it with Eleanor. Eleanor finds a powerful inner voice and quickly blasts all of her Negative Thoughts out of the water.
David cross-examines Eleanor to find out if this amazingly rapid and dramatic change in her Negative Thoughts and feelings was real, or if she was just being “nice” to try to produce a good role-play for David!
Fabrice raps up the podcast with his (as usual) great interview with David and Eleanor, bringing out many of the teaching points during the session.
Follow-up: The day after the recording, Eleanor sent this fantastic email to our training group, and she gave me permission to share it with all of you.
Hi Tuesday groupers,
I wanted to share a success that I had with everyone, especially my ‘newbie’ group. I received a low grade on an evaluation of a therapy session by a client last week, and I started the session today by discussing this with the client. I used the Five Secrets of Effective Communication to acknowledge that she wasn’t heard (Disarming Technique) and shared how I felt about the session (“I Feel” Statement). I also asked about what I had missed (Inquiry). Throughout her account, I used Thought and Feeling Empathy.
The connection that was created from this was incredible. I was able to truly see this client and hear her story and see the amazing grace with which she lives her life (Stroking).
I also think that I was able to truly be present and vulnerable with my client had a lot to do with the amazing work I experienced being a volunteer on the podcast last night. I can’t thank you enough David… I am STILL feeling good and I’m riding this good feeling as far as it takes me!
If you get a chance… volunteer for the podcasts… it’s such an incredible opportunity for growth!
Thanks,
Eleanor
David’s response: Wow! Way to go, Eleanor! Awesome!
Next week: More of David’s Role-Playing Techniques!
We warmly invite you to attend this fabulous, one-day workshop by Drs. David Burns and Jill Levitt on Sunday, May 20th, 2018. Click on the link above for registration and more information.
6 CE Credits
The cost is $135
You can join in person or online from wherever you live!
You will enjoy learning from David and Jill, working together to bring powerful, healing techniques to life in a clear, step-by-step way. Their teaching style as a team is entertaining, funny, lucid, and inspiring. This is a day you will remember fondly!
In the afternoon, you will have the chance to do some personal healing so you can overcome your own feelings of insecurity and self-doubt. David and Jill promise to bring at least 60% of the audience into a state of spiritual and psychological enlightenment, WITHOUT years of meditation. That’s not a bad deal at all!
You will LOVE this workshop. Seating for those who attend live in Palo Alto will be strictly limited, and seats are filling up fast, so move rapidly if you are interested.
Jill and I hope you can join us!
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
This is the first several podcasts on the Role-Playing Techniques David has created. They include:
Externalization of Voices (with Acceptance Paradox and Self-Defense Paradigm)
Paradoxical Double Standard Technique
Feared Fantasy
Devil’s Advocate
Forced Empathy
Man from Mars
And more
David’s explains that he began developing role-playing techniques in the early days of cognitive therapy because many of the Beckian techniques, such as Examine the Evidence and the Socratic Technique–while sometimes very helpful, were sometimes a bit dry, and he wanted to include punchier and more powerful and dynamic techniques in his therapeutic toolkit. These role-playing techniques are just one part of what sets TEAM-CBT apart from traditional, Beckian CBT.
Today, he explains and demonstrates the Externalization of Voices, which is always combined with the Self-Defense Paradigm and the Acceptance Paradox. He is joined by Fabrice, of course, and “Sarah,” one of the members of his Tuesday training group at Stanford. Sarah has volunteered to use a personal example in the podcast to help demonstrate the Externalization of Voices.
Sarah has brought a partially complete Daily Mood Log to the session. The Upsetting Event was that Sarah has decided to move to Austin, Texas in two weeks. She has many moderately strong negative feelings about the move, including sadness (30), anxiety and nervousness (75), inadequacy (60), loneliness (75), self-consciousness, and discouragement (70). She also felt stuck and defeated (70). The numbers in parentheses indicate how strong each type of feeling was on a scale from 0 (not at all) to 100 (extremely.)
Her Negative Thoughts include:
“All of my friends are ahead of me in life (careers and relationships).”
“I should be further along in my career and I should be 100% certain this is the best career for me in the long term.
“For the most part, I haven’t helped most of my clients very much.”
“My anxiety over the past year indicates that I’m in the wrong profession.”
“I’ll never get back in the great shape, physically and emotionally, that I was in three years ago.”
“Moving to California set my life back by a year.”
“I won’t be able to make new friends in Austin.”
“I will be lonely and without friends.”
“I won’t be able to cope with stress.”
“My therapy skills aren’t good enough,”
and more. Her belief in many of her Negative thoughts is quite high, in the range of 70% to 100%. However, her belief in one of them, “Moving to California set my life back by a year,” was only 20%.
Although David did not intend this to be a live therapy session, but rather a practice session to demonstrate how the Externalization of Voices works, David does some brief paradoxical Agenda Setting first, since Sarah’s example is real, and not made up. David uses several techniques to melt away Sarah’s Outcome Resistance, including:
The Invitation
The Miracle Cure Question
The Magic Button
Positive Reframing
During the Positive Reframing, David asks Sarah two things about her negative thoughts and feelings:
What does each negative thought or feeling reveal about you and your core values that is positive and awesome?
What are some advantages, or benefits, of each negative thought or feeling?
They come up with a list of ten positives, including these: “My negative thoughts and feelings show that
I’m realistic and honest.
I’m thoughtful.
I’m committed to self-care, since I want to have good mental and physical health.
I’m motivated to grow and improve my therapy skills.
I have compassion for my clients and want to give them the best care that I can.
I’m honest about my shortcomings.
I’m humble.
I have high standards.
I want to connect with others.
I’m committed to my career.
They conclude the Paradoxical Agenda Setting with the Magic Dial. Sarah decides to lower her negative feelings f to much lower levels, in the range of 5% to 15%.
Then, David asks Sarah which Negative Thought she wants to work on first. She chose the thought about never being able to get back into top physical and mental shape again. They identify the many cognitive distortions in the thought, such as All-or-Nothing Thinking, Overgeneralization, Mental Filter, Discounting the Positive, Fortune-Telling, Magnification and Minimization, Emotional Reasoning, Should Statements, and self-Blame.
Then David explains how the Externalization of Voices works, and they launch into the technique. David starts out as the “Negative Sarah,” and attacks her with the Negative Thought she wanted to attack first, using the second-person, “You.” Sarah responds in the role of the “Positive Sarah,” using the first-person, “I.”
Sarah fairly quickly knocks the ball out of the park, and easily crushes the Negative Thought David has attacked her with. Then David attacks Sarah with the rest of her Negative Thoughts, one at a time, doing occasional role-reversals to illustrate different ways to attack the thought. They continue doing role-reversals until Sarah described her victory over each Negative Thought as “huge.”
This only takes a few minutes. Then Sarah re-rates her negative feelings on the Daily Mood Log, and nearly all have been reduced to zero. David cross-examines Sarah to find out if this amazingly rapid and dramatic change was real, or if she was just being “nice” to try to produce a good role-play for David!
Fabrice raps up the podcast with his (as usual) great interview with David and Sarah, bringing out many of the teaching points during the session. He emphasizes that you can actually use many of David’s 50 Methods when doing Externalization of Voices, and points out the power of “Let’s Be Specific” that David demonstrated during the role-playing.
Next week: The Paradoxical Double Standard Technique!
We warmly invite you to attend this fabulous, one-day workshop by Drs. David Burns and Jill Levitt on Sunday, May 20th, 2018. Click on the link above for registration and more information.
6 CE Credits
The cost is $135
You can join in person or online from wherever you live!
You will enjoy learning from David and Jill, working together to bring powerful, healing techniques to life in a clear, step-by-step way. Their teaching style as a team is entertaining, funny, lucid, and inspiring. This is a day you will remember fondly!
In the afternoon, you will have the chance to do some personal healing so you can overcome your own feelings of insecurity and self-doubt. David and Jill promise to bring at least 60% of the audience into a state of spiritual and psychological enlightenment, WITHOUT years of meditation. That’s not a bad deal at all!
You will LOVE this workshop. Seating for those who attend live in Palo Alto will be strictly limited, and seats are filling up fast, so move rapidly if you are interested.
Jill and I hope you can join us!
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
In this podcast, David and Fabrice feature David’s recent interview on the topic of “Change your Thoughts, Change Your Life!” The interview was first published on Neil Sattin’s highly regarded Relationship Alive Podcast. Although some of the material may be familiar, there’s much that’s new, and you will enjoy the chemistry between Neil and David as they discuss each of the ten cognitive distortions and raise many challenging questions, such as:
Is it really true that only our thoughts–and NOT external events–can change the way we feel?
If someone has the belief, “I’m unlovable,” isn’t that type of thought immutable? How could you possibly change or modify a thought that may be rooted in traumatic experiences and so deeply embedded in a patient’s psyche?
Should we try to change other people’s cognitive distortions, or just our own?
How can we challenge each of the ten cognitive distortions?
And much more!
David’s first interview with Neil received more than 25,000 downloads in the first month, and this riveting interview promises to be every bit as popular. If you want to download a transcript of this exciting interview, you can do so at www.neilsattin.com/feelinggood2.
Coming Soon!
Next week we will begin an exciting series on the powerful role-playing techniques in TEAM-CBT, including
Externalization of Voices (with Acceptance Paradox and Self-Defense Paradigm)
Paradoxical Double Standard Technique
Devil’s Advocate
Forced Empathy
Man from Mars
And more
These episode will feature students and teachers in David’s Tuesday training group at Stanford, so you will get a taste of what an actual Tuesday group is like and see, first hand, how these methods work. They are unique to TEAM-CBT, and most have been created by Dr. Burns. We will also devote one episode to live Shame-Attacking Exercises, featuring the master of Shame Attacking, Dr. Joseph Towery, and we will all be out on the street doing Shame Attacking ourselves.
These episodes will be designed for therapists as well as your patients, and of course also for the general public.
You will LOVE this workshop because you will learn and practice techniques you can use in your clinical practice, but you will also have the chance to do your own personal work! And you will also have the unique opportunity to experience the tag-team teaching of David and Jill working together!
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
“Do I always have to face my fears? Aren’t some fears healthy?”
In this podcast, David and Fabrice answer five challenging questions submitted by listeners:
Galina asks whether we always have to face our fears? Isn’t it okay to be anxious sometimes?
Courtney asks how to find the supplemental written materials, tests, and diagrams if you have purchased the eBook or audio-book copy of Feeling Good: The New Mood Therapy.
Carlos asks about the best treatment for smoking cessation. During the discussion, Fabrice asks if Paradoxical Agenda Setting is important for therapists using hypnotherapy.
Avi asks whether humans have a dark side, with dark negative motives that sometimes compete with positive, loving motives. And if so, how do therapists help patients deal with their own negative motives?
Ben asks what to do if you’re very anxious but simply can’t pinpoint your negative thoughts.
Coming Soon!
In a couple weeks we will begin an exciting series on the powerful role-playing techniques in TEAM-CBT, including
Externalization of Voices with Acceptance Paradox and Self-Defense Paradigm
Paradoxical Double Standard Technique
Devil’s Advocate
Forced Empathy
Man from Mars
And more
These episode will feature students and teachers in David’s Tuesday training group at Stanford, so you will get a taste of what an actual Tuesday group is like and see, first hand, how these methods work. They are unique to TEAM-CBT, and most have been created by Dr. Burns. We will also devote one episode to live Shame-Attacking Exercises, featuring the master of Shame Attacking, Dr. Joseph Towery, and we will all be out on the street doing Shame Attacking ourselves.
These episodes will be designed for therapists as well as your patients, and of course also for the general public.
You will LOVE this workshop because you will learn and practice techniques you can use in your clinical practice, but you will also have the chance to do your own personal work! And you will also have the unique opportunity to experience the tag-team teaching of David and Jill working together!
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
“I’m a loser. . . I’m a failure. . . Where do my negative thoughts come from? “
In this podcast, David and Fabrice answer several fascinating questions submitted by listeners:
Jackie asks where our distorted thoughts come from, since they are so often irrational and distorted, and inconsistent with the facts. Why do we sometimes beat up on ourselves relentlessly with negative thoughts?
Tyler asks if it possible to do TEAM-CBT in conventional, 45 minute sessions. And if so, how? It seems my patients are just warming up by the end of the session, and then we have to start all over again the next week.
Jess asks if it is possible to use the Five Secrets of Effective Communication in non-therapy settings. For example, if you are in a position of authority, like a high school teacher, will your students lose respect for you if you use the Five Secrets? Could you use the Five Secrets if you are working with violent gang members?
Two Cool Upcoming Workshops for you!
March 22 and 23, 2018 Rapid Recovery from Trauma,(David D. Burns, MD)J&K Seminars, Lancaster, Pa 15 CE credits, includes live evening demonstration on the evening of day 1. You can join in person or online from wherever you live!
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
