# 159: Live Therapy with Marilyn: “What if I die without having lived a meaningful life?”

### The Secret of a Meaningful Life

One of my favorite podcasts of all time, and one of the most frequently downloaded, was the live session with Daisy (podcast #79): “What’s the Secret of a Meaningful Life?” You may recall that Daisy and her husband, Zane, were looking forward with dread to the possibility of childlessness, since their efforts at pregnancy had so far failed, and Daisy was asking if she could possibly have a joyful and meaningful life without children.

In today’s podcast we return to the same type of question from the other end of the spectrum. When we age and look back on our lives, and realize that our days are numbered, we may once again, “Have I lived a meaningful life?”

Do you know how to answer this question? What, in your opinion, is the secret of a meaningful life?

If the answer to this question is important to you, you might enjoy today’s podcast, which features, once again, two beloved friends and colleagues, Dr. Marilyn Coffee and Dr. Matthew May.

Matt and I first treated Marilyn for intense depression, anxiety, and anger two years ago at the time of her unexpected and shocking diagnosis of Stage 4 non-smoker’s lung cancer. Marilyn was incredibly depressed and panicky, as you might imagine. If you are interested, you can listen to our initial treatment of Marilyn in podcast #49, “The Dark Night of the Soul.”

One of Marilyn’s concerns at that time was that she had lost her faith in God and had begun to doubt the existence of an after-life. She was intensely self-critical and ashamed, and was also extremely angry because she began doubting her spiritual teachers and thinking of them as frauds.

These doubts were all the more troubling to Marilyn, since she’d been a devout Catholic for her entire life. In fact, she  even has a Master’s Degree in theology, along with several additional Master’s Degrees plus a PhD in clinical psychology! But now she was terrified by the prospect of her own death.

During that initial treatment session, Marilyn overcome her fears, depression, and doubts, and ended up in a state of joy, and even laughter. This rapid transformation confirmed the basis of cognitive therapy, that our emotional pain results from our thoughts, and not from what is actually happening to us. And the thoughts that cause depression and anxiety will be distorted and cruel–I’ve often said that depression and anxiety are the world’s oldest cons.

Following that session, we were flooded with emails praising Marilyn. Oddly enough, many people said she was their spiritual hero. They said they were stunned and grateful her raw courage, testimony, and honesty.

Now, it’s two years later. Sadly, Marilyn has just learned from her doctors that she’s had numerous metastases, and that her lung cancer has spread to the opposite lung, as well as to her bones, brain, liver, and lymph nodes. Marilyn is understandably paralyzed once again by overwhelming feelings of depression, anxiety, shame, hopelessness, and anger.

Today’s podcast is based on our most recent session with Marilyn about two weeks ago. I have to warn you that the session may be sobering, and even a bit terrifying, but hopefully you will find it to be inspirational and helpful, because sooner or later, we’ll all have to share the prospect of facing our own inevitable death, and asking ourselves, “Have I had a meaningful life?”

We scheduled this follow-up live therapy podcast for three reasons. First, we hoped to provide Marilyn with some relief from the devastating depression that had returned when she learned of her metastases. Second, we wanted to give you, and all of Marilyn’s many fans, an update on what’s happened in the past two years. And third, Marilyn wanted the chance to tell you about some of the positives in her life, since she so often mentions her failures, such as her bouts with alcoholism, and the fact that she never found a loving partner.

Every TEAM session begins with T = Testing. You can see her scores on the Brief Mood Survey she filled out just before the session began. (link) All her scores reflect the most severe negative feelings a human being can experience. Marilyn has extraordinarily severe depression, anxiety, and anger, and her positive feelings are totally absent.

Marilyn brought a partially completed Daily Mood Log to the session. If you take a look, you’ll see all of her intensely Negative Thoughts and devastating feelings about the spread of her cancer.

During the E = Empathy phase, Matt, Rhonda and I gave Marilyn the space she needed to vent and describe her despair and feelings of terror. We did not try to help or cheer her up. Marilyn cried as she described her fear of dying alone, and vividly recalled a friend who died a horrible death from lung cancer 20 years ago. Marilyn says he could barely breathe, and fears a similar horrific fate.

Marilyn cries, and confesses that she has not been able to cry up until now. She says she suddenly felt a spiritual presence being around Matt, Rhonda, and David.

During the Empathy phase, Matt made many tender comments to Marilyn, shared his own profound sadness, and told Marilyn that joining us today is a gift to him, and to all of us.

Matt and I asked Marilyn how we were doing in Empathy, in terms of understanding how she was thinking and feeling, and whether we were providing warmth, acceptance and support. She gave us high grades. When you listen, please notice that we didn’t do anything to try to help Marilyn, or to try to cheer her up. You can hear Matt simply paraphrasing much of what Marilyn had been saying, acknowledging her feelings, and sharing his own feelings of sadness and warmth toward Marilyn.

After about 25 minutes of empathy, we moved on to the next phase of the session called A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) We started by asking Marilyn if she wanted any help with the problems she’d been describing, or if she needed more time to talk while we listened and provided support.

She said that she did want help. Since her remaining time was potentially short, she said she didn’t want to spend it in the misery of overwhelming depression, anxiety, worthlessness, shame, loneliness, hopelessness, and rage.

Then I asked the Magic Button question—If we had a Magic Dial, and all of her negative thoughts and feelings would instantly disappear, with no effort at all, simply by pressing it, would she press the button?

Marilyn immediately said that she WOULD press the button. Almost everybody says this. And it seems obvious. Why would anyone want to feel intense, relentless and overwhelming negative emotions?

Matt, Rhonda, and David debated about whether or not the A = Assessment of Resistance would be needed, since it seemed like Marilyn was suffering so much that she would OBVIOUSLY want help.

We decided to address the resistance, since whenever we’ve skipped it, we’ve usually regretted it.

So just to be safe, we decided to do some Positive Reframing, and asked these two questions about each of the nine categories of intense negative feelings on Marilyn’s Daily Mood Log, such as depression, anxiety, guilt, inferiority, loneliness, hopelessness, rage, and so forth.

1. What does this negative feeling show about you and your core values that’s beautiful, positive and even awesome?
2. What are some benefits of this negative feeling? How might it help you?

Surprisingly, Marilyn came up with a list of more than 20 positives with some help from Rhonda, Matt and me. You can take a look at her Positive Reframing List. This process seemed to have a profound calming effect on Marilyn, just as it does on most people.

I think one reason is that culture / society have trained all of us \to think about our negative feelings as defects, or “mental disorders,” like the many that are listed in the DSM5. Positive Reframing turns all of this upside down, and makes you proud of your negative feelings. Paradoxically, this make it possible for you to get rid of the feelings quickly.

We concluded with the Magic Dial, and asked Marilyn what she might want to dial her feelings down to, without getting rid of them completely, since they did have many benefits, and since they also reflected what was most beautiful about her.

You can see the result of the Magic Dial on her Daily Mood Log, in the “% Goal” column of her table of negative emotions. For example, she wanted to dial her depression down to 10%, but thought that she’d want to keep the anxiety in the range of 20 – 25. But she said she’d be happy to dial the guilt and shame all the way to zero!

After the A = Assessment of Resistance, which seemed to lift her mood considerably, we went on to M = Methods. After easily identifying the distortions in her thoughts, like All-or-Nothing Thinking, Self-Blame, hidden Should Statements, and more, Marilyn was able to challenge and crush her Negative Thoughts pretty quickly using the Paradoxical Double Standard Technique as well as Externalization of Voices. Two strategies seemed important—the Self-Defense Paradigm and the Acceptance Paradox.

I emphasized the overlap between the Acceptance Paradox and Marilyn’s Catholic faith. It is the idea that you cannot, and not have to, earn your way to heaven through your good works. Christianity is based on the idea that we are not saved by our achievements or good work, but rather by the grace of God–which is simply the acceptance of our flawed nature. David emphasizes that these ideas are not exclusive to Christianity, but are woven into most if not all religions.

During this phase of the session, Marilyn reflected on some of the experiences that she’s proud of, things she would like you to know about, like her trip to Nicaragua to attend seminary at the Franciscan School of Theology. During that time, she worked with the oppressed indigenous people in relocation camps following the bombings, and joined the Witness for Peace group.  She describes this as “one of the most transformative and spiritual experiences of my life.”

Many of you are probably not familiar with Marilyn’s fairly extensive arrest record, which she is equally proud of! She explains:

“During the 80s and early 90s, I was arrested several times for political protests, primarily at the Federal Building in San Francisco.  For example, I participated in a major non-violent prayful march at Lawrence Livermore Laboratory.  Several of us were arrested and spent a month in jail (tents on the grounds of Santa Rita Jail.)”

Marilyn also wants to know that she was “a damn good therapist.” That’s something I can attest to, having presented with Marilyn on many occasions, including our empathy workshop at one of the prestigious Evolution of Psychotherapy conferences in Anaheim, California.

And still, all of her amazing accomplishments and contributions do not protect her, or any of us, from falling into a black hole of self-doubt and despair from time to time, and when Marilyn falls, the pain she inflicts on herself can be intense. You may notice that the Negative Thoughts on her Daily Mood Log today are very similar to the Negative Thoughts on her Daily Mood Log from two years earlier, during our first session with Marilyn. This confirms the concept of “fractal psychotherapy.” In other words, all of your suffering will be encapsulated in any one brief moment when you are upset. And when you suffer again in the future, it will be that same fractal–the same exact pattern of negative thoughts, distortions and feelings. This is really good news, because the methods that helped you recover initially will be helpful for you when you again fall into the black hole of depression.

The goal of TEAM-CBT is NOT eternal happiness–no human being is capable of that! Rather, the goal is to understand and master the tools that will be helpful for you.

One important teaching point is that Marilyn’s suffering, once again, does not result from her cancer, but rather from her self-critical thoughts, which are both cruel and distorted. She’s been telling herself that she is not religious enough, that she has lost her faith, and that her life has not been meaningful. Fortunately, these Negative Thoughts can easily be challenged and defeated, as you will hear on the podcast.

The entire basis of cognitive therapy is a spiritual idea, that “the truth shall make you free.” Although this is a core Christian teaching from the New Testament (John 8: 32), it is an idea that’s embedded in many religions, including Buddhism, and probably in every religion.

Toward the end of the session, Marilyn described inspiring moments when she feels the most spiritual and the most alive. It’s when she notices and profoundly appreciates the simple things in her life, like seeing a sliver of the moon in the evening when walking her dogs, watching a sunset on the beach at Santa Cruz, her first sip of latte in the morning or a bite of a delicious peach!

Marilyn also described the intense mourning she feels for people throughout the world who are in poverty or pain. She also grieves for animals who are suffering, and feels devastated by the destruction of our natural resources, such as the rain forests in Brazil.

You can see the final T = Testing . As you can see, she met or exceeded her goals for all of her negative feelings. You may be puzzled by the end of session rating for sadness and depression was “50%, but a GOOD 50%!”

Sometimes, feelings of sadness and grief, once the distortions have been eliminated, are are the experiences that can wake us up, and provide the profound sense of meaning we are craving in our lives. The highest human experience, perhaps, is the compassion we sometimes feel for ourselves and others who are suffering. In fact, this may be the true meaning of spirituality.

I call this feeling, “Sadness as Celebration,” and hope to write and talk more about it in a future podcast.

At the end of the session, Marilyn said, “I feel light!” And gave us all big hugs.

Will it last? Matt wisely suggests some terrific Relapse Prevention Training that you will hear when you listen to the session. Of course, it will be up to Marilyn–and to all of us–to pick up these tools and use them when we again fall into a black hole. This is also an inherently spiritual idea, and is based on the idea that we have the freedom to chose light or darkness.

After the session, Marilyn emailed me and asked if I could include a few additional comments in the show notes. Here’s what she wrote:

Greetings David, my dearest friend,

Words cannot express my gratitude for you, Matt, & Rhonda – what special gifts you are.

I hope the podcast was ok. I am deeply embarrassed because I forgot to express my gratitude and surprise from all the e-mails we received – the compassion and support was/is overwhelming. I hope I can give back! I could never had done this, if I weren’t for you & Matt – and your amazing & compassionate skills.

I also forgot to mention that I probably will never get to New York or Ireland because of finances. I take one day at a time and try to be grateful for the small miracles.

I go to Stanford next Tuesday. I will definitely be in touch.

Thank you again.

I also forgot to mention this – which is VERY important is that I am going through this process sober – not avoiding with alcohol. I am going to more meetings & speaking up.

Thank you again. I cherish our friendship.

With deep gratitude and love. dear friend,

Marilyn

Thank you, Marilyn, for this incredible gift to all of us!

Matt, David, and Rhonda

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding!

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here

# * * *

I also have a tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, that will be potentially life- and career-changing (really!) You will learn powerful skills that will boost your clinical effectiveness and improve your relationships with friends, colleagues, and loved ones.

## The Cognitive Distortion Starter Kit:How to Crush Negative Thoughts

### May 17, 2020 | 7 CE hours. $135 ### Learn More & Register # 158: Changing the Focus: One of the Advanced Secrets of Effective Communication David and Rhonda are joined again today by David’s neighbor, friend, and hiking buddy, Dave Fribush. We appreciate his superb technical skills and thank Dave for his support of our podcasts! Rhonda starts the podcast by reading a question from a podcast fan named Rajesh, who wrote: I have often seen that estranged friends or family members do not talk or resolve a trivial conflict for years because one or both of them have ego issues or have fear of rejection. This problem of unfairness may even exist between a demanding parent and the child, ranging from secretly resenting to not talking at all. They might come face to face in family occasions or professional settings in case of friendship and bear the discomfort, but not attempt to reconcile. They might be suffering deep down emotionally but they refuse to accept that it matters. One or both members might feel they have been treated unfairly and expect apologies. But, both parties are scared to even make the move for the fear of being hurt again or rejected. On a personal level, I have faced such unfairness with a close friend. I see even if you forgive the other party, that element of resentment is still in their somewhere. How do you know you have truly forgiven someone and moved on? Whats the best that can be done at an individual level without involving the other party, at least till the time both are ready to talk it out, if it ever happens. Once again I thank you for all the selfless Good work you do for people through your knowledge sharing. My sincere best wishes to you and great thanks 🙏. Rajesh I appreciate this question, and it is a great introduction for our podcast on Changing the Focus, one of the three Advanced Secrets of Effective Communication. We recently introduced the three advanced secrets in podcast #126, and you can listen to it for review if you like. 1. Changing the Focus. This technique can be tremendously helpful when there’s an “elephant” in the room. 2. Multiple Choice Empathy. This technique can be transformative when you’re trying to connect with a teenager, friend or loved one who refuses to talk to you. 3. Positive Reframing. This technique can be invaluable when you’re fighting with a colleague, patient, friend or family member, and you’re both feeling frustrated, angry, and upset Today we take a deeper dive into Changing the Focus. This technique can be extremely helpful when you feel tense or awkward in your relationship with someone. For example, you may be arguing endlessly, or there could be some unacknowledged feelings that no one is talking about, like shame, anger, hurt, or resentment. When you use Changing the Focus, you gently point out what’s happening, and focus on your feelings, and drawing out the other person’s feelings, instead of continuing in the same pattern of arguing or avoidance. Although this technique can be tremendously helpful, it is very challenging, so I have written two memos explaining the technique in greater detail, with examples. One is for therapists and one is for the general public. If you are interested in learning this technique, this would be a great starting place, and it might not hurt to read both memos. In addition, you have to be skillful with the Five Secrets of Effective Communication before trying this technique. That’s a lot to ask, I know! David, Rhonda, and Dave (our new podcast co-host) model how Rajesh might use Changing the Focus with estranged friends or family members. Then Dave Fribush provides a terrific example of how he used the Five Secrets, plus Changing the Focus, in a troubled love relationship, after arguing and resisting for several years. Then I (David) provide an example with a patient I was failing with, and Rhonda provides two tremendous examples–one from her clinical practice, and one involving her sister. See what you think about our new three-person format! Since our audience consists of therapists as well as the general public, we welcome Dave with open arms and hearts, and feel lucky! David, Rhonda, and Dave 🙂 You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding! Today’s featured photo is courtesy of Nancy Mueller–www.nancymuellerphotography.com. If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here ## * * * ### You may have missed the Calgary and South San Francisco intensives, but there will be two more awesome workshopsfor you this fall. ## High-Speed Treatment of Depressionand Anxiety Disorders ## A Four-Day TEAM-CBT Advanced Intensive ### November 4 – 7, 2019The Atlanta, Georgia Intensive ### Sponsored by Praxis # * * * I also have a tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, that will be potentially life- and career-changing (really!) You will learn powerful skills that will boost your clinical effectiveness and improve your relationships with friends, colleagues, and loved ones. ## Advanced Empathy Tools for Connectingwith Challenging Patients,Colleagues, Friends, and Loved Ones ### With Drs. David Burns and Jill Levitt ### Oct 6, 2019 | 7 CE hours,$135

Do you have a patient, colleague, friend or loved one who:

• Complains endlessly but doesn’t listen to any of your good advice?
• Appears irate, but insists s/he isn’t upset?
• Refuses to express his / her feelings?
• Never listens?
• Argues, and always has to be right?
• Always has to be in control?
• Is relentlessly critical?
• “Yes-but’s” when you try to make a point?
• Insists you don’t really care—or understand—when you think you do?

Then you’re going to LOVE this workshop with David and Jill. You’ll learn about–

• The Powerful “Law of Opposites”
• How to find out how your patients really feel about you–if you dare!
• How to transform therapeutic failure into success
• How to talk to people who refuse to talk to you

You’ll also learn–

• Why your worst therapeutic failure is actually your greatest success in disguise
• The fine points of the Five Secrets of Effective Communication
• Three Advanced Empathy Techniques: Multiple Choice Empathy, Changing the Focus, and Positive Reframing
• And more

There will be lots of small group practice with expert feedback and mentoring to help you refine your skills!

### Attend in person orfrom your home via Live Streaming

Sign up early because we always sell-out for the in-person seats. Of course, there will be lots of skilled trainers to help the online participants with the small group exercises, so you’ll have a great experience either way.

My one-day workshops with Dr. Levitt are usually pretty awesome! It is always an honor to teach with Jill!

# 157: Psychotherapy Training: Poor, Good, or Outstanding?

### One Student’s Experience

In today’s podcast, Rhonda and I are super-pleased to interview Kyle Jones again. For some time now, Kyle has been telling me that he wants to talk about his psychotherapy training experiences on a podcast. This subject is near and dear to my heart, since I do a great deal of training, so Rhonda and I decided to do this second interview with Kyle, and it’s a good one, I think! You may recall our recent interview with Kyle on his interesting research and perspective on the treatment of LGBTQ individuals several weeks ago.

Kyle is a brilliant and super-friendly 5th year graduate student in clinical psychology at Palo Alto University, and has been a member of my Tuesday evening psychotherapy training group at Stanford for the past four years as well. Kyle now sees patients at the Feeling Good Institute in Mt. View, California. He has also been promoted to small group leader in our Tuesday group, and does superb work as a teacher.

During today’s interview, Kyle, Rhonda and I focus on many critically important training and treatment issues. Kyle states that he has been exposed to many fine teachers promoting a wide variety of popular treatment “packages” at the Palo Alto University and at his practicum sites, including traditional CBT, ACT, EMDR, psychodynamic therapy, and more. However, in all cases, the therapist was encouraged to “sell” this or that approach to the patient. Unfortunately, this has a tendency to trigger resistance, and is the main cause of therapeutic failure in clinical settings as well as controlled outcome studies as well.

Paradoxical Agenda Setting, which is the secret spice of TEAM Therapy, was never mentioned in his training at Palo Alto University. When you do Paradoxical Agenda Setting, you bring the patient’s subconscious resistance to conscious awareness, and then you melt it away with a variety of innovative techniques like the Magic Button, Positive Reframing, Magic Dial, Acid Test, Gentle Ultimatum and more. The rapid reduction the patient’s resistance often leads to the high-speed, mind-boggling recoveries we frequently see in TEAM-CBT.

Kyle emphasized that he has not see a single teacher or therapist even use the simple Invitation Step in therapy, in spite of the fact that it is so incredibly basic. Essentially, after empathizing with your patient, you ask if there is something she or he wants help with during the session, or if the patient needs more time to talk and get support. Most therapists wrongly believe that this question is unnecessary since the patient is coming to therapy, so he or she MUST want help.

But in fact, nearly ALL patients have some degree of ambivalence about recovery, and if this ambivalence is ignored, the patient may, and probably will, resist the therapist’s efforts to “help.” Rhonda enthusiastically agrees that the Invitation Step is incredibly powerful and admits that it took her several years to “get it,” and that she also resisted using the Invitation Step it at first, thinking it wasn’t needed. But she failed her Level 3 Certification Exam in TEAM-CBT because she didn’t know how to do it! Once she began using it, her practiced changed dramatically. And then she easily passed her exam with flying colors!

Intense therapist resistance to these new techniques is extremely common. I once supervised a clinical psychology post-doctoral fellow at Stanford who resisted using the Invitation Step with her patients for the first two months of our supervision. All she did was schmooze with her patients.

Finally, I asked her why she wasn’t using the Invitation Step. She told me she was afraid her patients would say, “Yes, I DO want some help with problem X, Y or Z.” And then she might not know how to help them solve whatever problem they had! She said, “As long as I just schmooze with my patients, I know that nothing will change, but they’ll think it’s good therapy!” Fortunately, after we discussed this dilemma, she began using the Invitation Step, along with many other Paradoxical Agenda Setting techniques, and her clinical work improved a ;pt.

Kyle also emphasizes the incredible value of the Brief Mood Survey and Evaluation of Therapy Session with every patient at every session, and yet most teachers and therapists in his graduate program, as well as those at his practicum sites, are not using these instruments. I think this is arguably an ethics violation, since therapists’ perceptions of how their patients feel can be wildly inaccurate. I predict that within ten years, all therapists will be required by licensing agencies and insurers to use these kinds of assessment instruments.

The importance of assessment instruments in clinical work and training was underscored by my experience several days ago with a patient who gave me incredibly poor grades on empathy as well as helpfulness at the end of a free, two-hour phone session. I had sensed the session had not gone especially well, but I didn’t realize just how awful it was until I saw my ratings! The scores on Empathy and Helpfulness were among the worst I’ve received in the past 25 years.

This was illuminating, but disturbing, as I’d been trying my best but I had clearly failed my patient in a big way, and he was ticked off! I would not have known just how angry and upset he was if I had not been using the Evaluation of Therapy Session.

I had a fairly sleepless night, and emailed him the first thing in the morning to find out what emotions I’d overlooked, and urged him to express his angry feelings toward me. This led to a tremendous and highly gratifying therapeutic breakthrough.

Kyle was generous in his praise for the training we do in our Tuesday group, and I feel extremely fortunate to have had the chance to work with Kyle! I am hopeful that the training methods my colleagues and I have been developing over the past 20 years will begin to catch on, but have to admit that I’ve run into fairly strong resistance from many therapists who fight and oppose our new training and treatment methods.

By the way, the Tuesday group is totally free for all clinicians in the San Francisco Bay Area, or from anywhere for that matter. We’ve had commuters and visitors from as far as Denver, Portland, and even China. If you want to dramatically improve your therapy skills, and have an interest in some of the new treatment and training methods we’re using, and want free personal work as well, this might be an option for you, and we’d be really happy to have you visit and maybe even join us!

David, Rhonda, and Kyle

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. Today’s featured photo of Kyle Jones is courtesy of Nancy Mueller–www.nancymuellerphotography.com.

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

# * * *

I also have a tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, that will be potentially life- and career-changing (really!) You will learn powerful skills that will boost your clinical effectiveness and improve your relationships with friends, colleagues, and loved ones.

## The Cognitive Distortion Starter Kit: How to Crush Negative Thoughts

### May 17, 2020 | 7 CE hours. $135 ### Learn More & Register # 156: Ask David: How can I cope with panic attacks and claustrophobia! What if the entire world thinks you’re not worthwhile? ### Plus, Thomas Szaas, TV Shrinks, and more! David and Rhonda are joined today by David’s neighbor, friend, and hiking buddy, Dave Fribush. We thank Dave for his support of our podcasts! We open the podcast with a wonderful email from a fan named Sushant who listened to Feeling Good Podcasts for nine hours during a rigorous hike to the “Tiger Monastery” in Bhutan. You can see Sushant and his phone, showing the podcast icon, just in front of the monastery. Here’s his email: Dear David, Hope you are well. I am now on episode #104 of the podcast and your podcast and books have impacted my life in a big way. I wanted to share a picture with you that I have attached to this email. This picture was taken while trekking up to the “Tiger Monastery” in BHUTAN. It was nine hours of rigorous trekking while I thoroughly enjoyed listening to your podcasts all through the day. Regards, Sushant Rhonda encourages podcast fans from around the world to send photos of yourself listening to the Feeling Good Podcast in additional unusual or exotic locations! Might be fun to see what you send to us! Here are the questions for today’s program: Ann asks: Loved your podcast (on the exposure model, #26)! But I do have a question – I have suffered from panic attacks for years – the past 2 years I’ve become agoraphobic and don’t want to be far away from my house. So, my phobia is now “having panic attacks.” Does that mean I just need to go out and have a bunch of panic attacks in public to get over my fear? The thought seems terrifying. Also, I am severely claustrophobic which affects me anytime I feel trapped (elevators, small cars, traffic, tight spaces, etc.) Is there a protocol you used to treat patients with this? Just wanted to suggest perhaps a podcast on this subject, or agoraphobia, as it does affect many people worldwide. Nathan asks: Dear David, Love your podcasts. I am currently preparing a lecture for psychology honors students here at Monash University on assessment of depression and anxiety. In your podcasts you mention that you conducted a “study on the psychiatric inpatient unit at the Stanford Hospital, in which I evaluated how accurate therapists’ perceptions of patients were after an interaction. Student researchers interviewed patients for several hours as part of a research study on psychiatric diagnosis.” I was wondering if you could provide me with a reference to this study? I could not find a specific reference in your website and I would like to be able to highlight to student’s the results of your research. Richard asks: I listened to your podcast on being worthwhile and found it interesting. You say all people are worthwhile. This may be true but does the whole world think this? If a person is worthwhile but the world thinks they are not worthwhile, isn’t this almost as bad as not actually being worthwhile. Don’t we have to play by the world’s rules, however bad, instead of our own or the Platonic rules? What do you think? Robert asks: Dear David. I am up to podcast #108. I am heading to India next month for a three-week trek and am going to download the rest onto my phone. Perhaps by the time I get back, I will be up to date! I have never heard you mention Tom Szasz, who, as I am sure you know, was making some of the same observations about the constructs of medicalizing you make back in the 1960s and maybe even in the 50s. In particular, his criticism of the psychiatric industry giving the names of diseases or syndromes to behavioral issues was very consistent with yours. Robert also asks: My other question is an idea for future podcasts and it is…How about critiquing the therapeutic approach we see so often on television and in the movies? For the lay audience, these are probably the source of much of what they know about therapy. And because these therapists are well-known and fictional, it would give you an opportunity to make critiques without having to criticize an actual person. And it could introduce some levity into what can often be quite heavy. Some of the Hollywood therapists people know best are: • Judd Hirsch as the shrink in Ordinary People • Lorraine Bracco as the shrink in The Sopranos • Peter Bogdanovich as the shrink’s shrink in The Sopranos • Billy Crystal as the shrink in Analyze This! • Robin Williams in Good Will Hunting • Kelsey Grammer in Frasier I am sure there are many others. These are the ones who quickly came to mind I just found an article about this that might help make the case that what the public sees on TV and in the movies is not really reflective of the therapeutic process or good therapy. Here’s the link: https://www.huffpost.com/entry/therapists-on-the-big-and_b_4263798 Thanks for tuning in! David and Rhonda References for Nathan 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. 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. You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding! If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here ## * * * ### You may have missed the Calgary and South San Francisco intensives, but there will be two more awesome workshopsfor you this fall. ## High-Speed Treatment of Depressionand Anxiety Disorders ## A Four-Day TEAM-CBT Advanced Intensive ### November 4 – 7, 2019The Atlanta, Georgia Intensive ### Sponsored by Praxis # * * * I also have a tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, that will be potentially life- and career-changing (really!) You will learn powerful skills that will boost your clinical effectiveness and improve your relationships with friends, colleagues, and loved ones. ## Advanced Empathy Tools for Connectingwith Challenging Patients,Colleagues, Friends, and Loved Ones ### With Drs. David Burns and Jill Levitt ### Oct 6, 2019 | 7 CE hours,$135

Do you have a patient, colleague, friend or loved one who:

• Complains endlessly but doesn’t listen to any of your good advice?
• Appears irate, but insists s/he isn’t upset?
• Refuses to express his / her feelings?
• Never listens?
• Argues, and always has to be right?
• Always has to be in control?
• Is relentlessly critical?
• “Yes-but’s” when you try to make a point?
• Insists you don’t really care—or understand—when you think you do?

Then you’re going to LOVE this workshop with David and Jill. You’ll learn about–

• The Powerful “Law of Opposites”
• How to find out how your patients really feel about you–if you dare!
• How to transform therapeutic failure into success
• How to talk to people who refuse to talk to you

You’ll also learn–

• Why your worst therapeutic failure is actually your greatest success in disguise
• The fine points of the Five Secrets of Effective Communication
• Three Advanced Empathy Techniques: Multiple Choice Empathy, Changing the Focus, and Positive Reframing
• And more

There will be lots of small group practice with expert feedback and mentoring to help you refine your skills!

### Attend in person orfrom your home via Live Streaming

Sign up early because we always sell-out for the in-person seats. Of course, there will be lots of skilled trainers to help the online participants with the small group exercises, so you’ll have a great experience either way.

My one-day workshops with Dr. Levitt are usually pretty awesome! It is always an honor to teach with Jill!

# 155: Treating Depression, Emotional Eating, and Self-Image Problems with TEAM-CBT

The Story of Lorraine and “Anna”

In today’s podcast, David and Rhonda interview Dr. Lorraine Wong, a board-certified clinical psychologist, and her patient, “Anna,” who sought treatment recently for depression, anxiety, and self-image / self-esteem issues. But first, David and Rhonda answer a question submitted by Estafonia, a “public image consultant,” who asks about the treatment of a woman who sees herself as “fat.”

Estafonia wrote:

“Hi Dr. Burns,

“I am learning TEAM, CBT and implementing your techniques to help my clients change or improve their self-perception. In most cases, your techniques have been very effective. I am very grateful to you and I will happily join your list of fans!

“My question is this—What would be the best method to change someone’s self-image? How can you help people change the idea that they are fat for example?

“I have a patient who can’t defeat the thought, ‘I am fat.’ We tried the method called Examine the Evidence,” and she has already found 20 people who see her as thin. So, the evidence clearly did not support her belief that she is fat. But this did not help.

“We also tried the method called Let’s Define Terms, and we both concluded that she is not fat. But now she tells me, ‘I know I am not fat, but I can’t stop thinking about it.’

“We also did the Downward Arrow Technique to probe her deepest fears and Self-Defeating Beliefs, but that didn’t seem to help, either, and she keeps ruminating about being fat. I would greatly appreciate your guidance on how to help her overcome that thought!

Lorraine, Rhonda, David and Anna quickly diagnose the most likely cause of Estefania’s stuckness—she is trying to “help” her patient without first melting away her patient’s resistance. This is the cause of practically all therapeutic failure, and you’re not really doing TEAM-CBT if you don’t know how to eliminate the patient’s resistance.

That’s because most people are ambivalent about change. As the Jesuit mystic, Anthony DeMello, has said: “We yearn for change but cling to the familiar.” Recognizing and modifying this inherent ambivalence is the heart of A = Paradoxical Agenda Setting, but you can also think of the A as standing for “Assessment of Resistance.”

How could we melt away this woman’s ambivalence / reluctance to stop bombarding herself with the message, “I’m fat”? It is important to realize that this self-critical thought, and, in fact, all of her negative thoughts and feelings have huge advantages for her, and also indicate some really beautiful and awesome things about her and her core values.

For example, telling herself “I’m fat” may motivate her to diet, to exercise, and to make extra sure that she doesn’t get complacent and gain a tremendous amount of weight. In addition, the thought, “I’m fat,” shows that she has high standards, and her high standards have probably motivated her success in many areas of her life. For example, she probably works really hard to stay in good health and in good physical condition.

The thought, “I’m fat,” also shows that she’s humble, and on and on and on. And that’s just one negative thought. But this woman probably has many negative thoughts and feelings, like anxiety, shame, inferiority and depression, and they ALL have tremendous advantages, and they ALL reveal what is beautiful and awesome about her and her core values.

In addition, the thought may be protecting this patient from things she fears, like intimacy. As long as she tells herself, “I’m fat,” she does have to risk trying to get close, or having sex, or risking rejection. So the thought, in a way, is a form of self-love and self-protection.

Once Estafonia and her patient list all these positives, Estafonia could ask her patient, “Given all these advantages and positive qualities, maybe it wouldn’t be such a good idea to stop telling yourself, ‘I’m fat.’ This thought seems to be working for you in a really positive way, and also reflects your core values.”

That’s the essence of Paradoxical Agenda Setting. We try, in a genuine way, to honor the patient’s resistance, rather than trying to sell the patient on change. This is very difficult for therapists to learn because of the compulsion to save, help, or rescue the patient.

In addition, obsessions (recurring illogical negative thoughts like “I’m fat”) frequently result from the Hidden Emotion phenomenon, and this has to be dealt with skillfully when treating any patient with anxiety. Estafonia’s patient may be upset about something she’s not dealing with in her life, and bringing the hidden problem or feelings to conscious awareness can often be incredibly helpful. For more information, see my book, When Panic Attacks, which you can order from my books page (link).

After focusing on Estafonia’s excellent question, David, Rhonda, Lorraine and Anna talk about the emotional challenges that brought Anna to treatment, including severe feelings of depression which came on when Anna returned to the United States after 13 years working abroad. She was also feeling anxious, stuck, angry, and hopeless, and was comforting herself by binging on her three favorite foods.

Anna describes previous partial treatment failures, and explains that her previous cognitive therapist had “the empathy of a prison guard,” and contrasts those experiences with her successful experience with Lorraine. In fact, Anna describes the TEAM-CBT she received at the Feeling Good Institute as “cognitive therapy on steroids.”

I (David) loved hearing that because this is how I think about TEAM-CBT, too! TEAM really is CBT on steroids! But, I’ve been too embarrassed to describe TEAM-CBT in this way, fearing it might sound crass or unprofessional.

Anna and Lorraine explain why the T = Testing and E = Empathy of TEAM were so critical to the success of the therapy. Anna says that Lorraine was, in fact, the first therapist “who really got me, and really understood me!”

Anna emphasizes the enormous importance of the A = Paradoxical Agenda Setting (aka Assessment of Resistance) as well. Lorraine helped Anna discover what was beautiful and awesome about all of her negative feelings, including severe depression, shame, anxiety, anger, loneliness, and even hopelessness. She said, “My depression and feelings of loss when I moved showed that I really care about what I do, as well as the people around me.”

Anna also said that her anger showed that she was overly nice, out of her love for people, but that she had the right to set boundaries and stick up for herself, and didn’t always have to be a people-pleaser.

The Positive Reframing proved to be a positive shock to the system, and Anna’s symptoms started to improve significantly even before starting the M = Methods phase of the TEAM-CBT treatment.

The Positive Reframing made it relatively easy for Anna to smash the negative, self-critical thoughts that triggered her depression, anxiety, shame, and hopelessness, and then they moved on to other goals, such as using the Five Secrets of Effective Communication in her interactions with colleagues and friends.

Finally, they focused on self-image issues, which brings us back to the question Estafonia had posed at the start of the podcast: How you can help patients with self-image problems and addictions to eating?

Anna explained that when she was depressed, she had gained weight because of her addiction to salami (Mmmm!), ice cream (Yummm!), and rice and beans (WOW!) Lorraine used David’s “Devil’s Advocate Technique,” to help Anna challenge the tempting thoughts that always triggered her overeating.

Rhonda and I are incredibly grateful to Lorraine (aka Dr. Wong) and “Anna” for this opportunity to bring TEAM to life in a very real and personal way. Thank you, Lorraine and Anna!

Dr. Lorraine Wong is a certified Level 4 TEAM-CBT therapist and practices at the Feeling Good Institute in Mountain View, California. She specializes in the treatment of body image concerns and emotional eating, as well as depression and anxiety, with TEAM-CBT.

Thanks for tuning in!

David and Rhonda

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding!

Here are some photos from David’s famous Sunday hikes. You can see Professor Mark Noble, a neuroscientist from the University of Rochester, in three of the photos. Dr. Noble is writing a chapter on TEAM-CBT and the brain for David’s new book, Feeling Great

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here

# * * *

I also have a tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, that will be potentially life- and career-changing (really!) You will learn powerful skills that will boost your clinical effectiveness and improve your relationships with friends, colleagues, and loved ones.

## The Cognitive Distortion Starter Kit:How to Crush Negative Thoughts

### May 17, 2020 | 7 CE hours. $135 ### Learn More & Register # 154: Ask David–Relationship Problems: What can you do when people “ghost” you? What can I do when my wife doesn’t want sex? And more! Ask David Five Secrets Relationship Questions Kate asks: I love listening to your podcasts and am currently reading my way through your book, Feeling Good. I appreciate that you have written and spoken about relationship problems at length, but in what I have read and heard so far I do not see how this can apply to the current climate of casual dating and hook up culture which is fueled by apps such as Tinder. I don’t know how it’s possible to build relationships when the dominant mentality is that people are disposable. It feels like no matter how much I find truth in what my date says, stroke them and empathize with them, that they will disappear (‘ghost’) at the drop of a hat. I think this may be a significant problem for many of your listeners, and would greatly appreciate your thoughts, as well as any practical steps on how to date in today’s world. ### * * * Eli asks: Your work has helped me tremendously over the past 2 years. However, recently I’ve discovered something about myself that I don’t know how to change. I’d be really curious to hear your thoughts. For some reason, when it comes to sex, it seems that I have a lot of self-worth wrapped up in my sex drive. I’m realizing when my wife and I have sex I feel like I’m on top of the world afterwards. I feel so positive the following few days and I feel mentally and emotionally healthy. But it’s devastatingly real that the reverse is true as well… when we don’t have sex (and particularly when I reach out and she’s not in the mood) and when a week or so passes that we don’t have sex, I find myself feeling very insecure. I feel ugly, unlovable and generally less valuable as a person. Is there an exercise you would recommend for me to discover possible hidden thoughts/emotions that could be causing this? Is it possible to change this about myself? I want to have a close, intimate relationship with my wife (sexually and non-sexually) but I also want to feel valuable and positive whether or not we’re sexually active. PS – If, by chance, you address this on the podcast, could you refer to me as “Eli” or something else anonymous as you usually do. Thank you for all you have do! ### * * * Susan asks: You seem like a good person to ask this question partly because you are a man. Someone I know, I won’t say whom, told me he felt emasculated when I asked him to take my car to the gas station to get the wipers replaced. He said that he should be able to replace them himself but doesn’t actually know how, so he would prefer if I took the car to the service station. I said that was stupid, granted not very diplomatic, and he said that’s what he gets for expressing his feelings, which I frequently complain he does not do. To me “emasculated“ is more of a concept or a thought. I will not get into toxic masculinity and the patriarchy, but I am curious what you think. By the way, this person and I have benefited a lot from your relationship journal exercise, thankfully we did not need it this time 🙂 ### * * * Knaidu asks: Here’s a specific example which occurred whilst I was trying to use the disarming technique. It is one where I failed to use the technique. Anyway, I was meeting a friend of mine, and was a running a few min late for our lunch appointment. I couldn’t send her text to let her know as I was driving. I arrived at least 5 min late. When I arrived she immediately said “I knew it all along, you really don’t want to meet with me or actually have lunch with me!” I tried to explain that I was stuck in a traffic jam and couldn’t text, but it didn’t work. Here’s what I said: “Please Mrs. X, I was stuck in a traffic jam and that’s why I am late. Have I ever said I don’t want to meet with you? And if I didn’t why have I bothered to arrive at all, I mean I could have just not arrived if I didn’t want to meet you!” After I said that she stormed off. I am afraid I could agree with her idea that I didn’t really want to meet with her, because the truth was I did want to meet but couldn’t help being late. I could agree with something that was not real to me and if I did try to agree, I would be lying to her. Please help me, David and Rhonda! Thanks for tuning in, and keep the great questions coming! David and Rhonda You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding! If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here ## * * * ### You may have missed the Calgary and South San Francisco intensives, but there will be two more awesome workshopsfor you this fall. ## High-Speed Treatment of Depressionand Anxiety Disorders ## A Four-Day TEAM-CBT Advanced Intensive ### November 4 – 7, 2019The Atlanta, Georgia Intensive ### Sponsored by Praxis # * * * I also have a tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, that will be potentially life- and career-changing (really!) You will learn powerful skills that will boost your clinical effectiveness and improve your relationships with friends, colleagues, and loved ones. ## Advanced Empathy Tools for Connectingwith Challenging Patients,Colleagues, Friends, and Loved Ones ### With Drs. David Burns and Jill Levitt ### Oct 6, 2019 | 7 CE hours,$135

Do you have a patient, colleague, friend or loved one who:

• Complains endlessly but doesn’t listen to any of your good advice?
• Appears irate, but insists s/he isn’t upset?
• Refuses to express his / her feelings?
• Never listens?
• Argues, and always has to be right?
• Always has to be in control?
• Is relentlessly critical?
• “Yes-but’s” when you try to make a point?
• Insists you don’t really care—or understand—when you think you do?

Then you’re going to LOVE this workshop with David and Jill. You’ll learn about–

• The Powerful “Law of Opposites”
• How to find out how your patients really feel about you–if you dare!
• How to transform therapeutic failure into success
• How to talk to people who refuse to talk to you

You’ll also learn–

• Why your worst therapeutic failure is actually your greatest success in disguise
• The fine points of the Five Secrets of Effective Communication
• Three Advanced Empathy Techniques: Multiple Choice Empathy, Changing the Focus, and Positive Reframing
• And more

There will be lots of small group practice with expert feedback and mentoring to help you refine your skills!

### Attend in person orfrom your home via Live Streaming

Sign up early because we always sell-out for the in-person seats. Of course, there will be lots of skilled trainers to help the online participants with the small group exercises, so you’ll have a great experience either way.

My one-day workshops with Dr. Levitt are usually pretty awesome! It is always an honor to teach with Jill!

# 153: Ask David: Is it okay to touch patients? Does depression ALWAYS result from distorted thoughts? And more!

1. Kelly asks: Would love to hear a podcast about to use or not to use touch in therapy. I personally feel touch is extremely helpful (what is more natural than to hug or put a hand on someone hurting), however I believe our profession has become so “professionalized” that is leaves out such a power act of healing. Did you ever use touch when you were practicing, and do you feel it is appropriate?
2. Against Machines Taking Over asks: You say that depression always results from distorted thoughts. But the sadness that results from a failure, rejection, or disappointment is not distorted. Can you explain a bit more about this?
3. Against Machines Taking Over also asks: Is there something you used to advocate for before but then you changed your mind?
4. Eduardo asks: How do you treat hypochondriasis. Almost all articles and advices I’ve read for hypochondriasis try to cover the writer’s back by first and foremost telling you that you should get yourself checked for real causes for your concern.
5. Eduardo also asks: I’ve been struggling with anxiety, and after reading When Panic Attacks, I got very interested in giving The Hidden Emotion model a try, but it seems to be structure-less. It seems to require a lot of detective work with no clear sheet or procedure. It’s just Detective Work, and then do something about it. Is there some newer technique to dig into what’s eating you?

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding!

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

# * * *

I also have a tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, that will be potentially life- and career-changing (really!) You will learn powerful skills that will boost your clinical effectiveness and improve your relationships with friends, colleagues, and loved ones.

## The Cognitive Distortion Starter Kit: How to Crush Negative Thoughts

### May 17, 2020 | 7 CE hours. 135 ### Learn More & Register # 152: Treating At-Risk Teens with TEAM-CBT. Can You REALLY Make a Difference? In today’s podcast, Rhonda and I interview the incredibly brilliant, funny, and creative Amy Spector. Amy is a licensed marriage and family therapist and credentialed school counselor with over a decade of experience working with adolescents and their families. She is passionate about providing school-based mental health services and advocates for legislation to mandate universal mental health care for youth. Amy works with “at risk” teenagers at Vicente High School in Martinez, California. This is a continuation high school, as well as teens at Briones School, an independent study school. Her students are credit deficient and at risk of not graduating from high school. Nearly all have experienced significant trauma and most are severely depressed, anxious and angry when first referred to Amy, and some have suicidal thoughts or urges as well. Although you might think that this would be an exceptionally challenging, oppositional, and frustrating group to work with, Amy has had tremendous success treating these teenagers with TEAM-CBT. She measures symptom severity at the start and end of every session, just as we do with adults, and often reports a phenomenal reduction of 60% in depression and anxiety in a single, 30-minute therapy session. Although this may be hard, or even impossible, to believe, it is real, and you’ll see why when you listen to this amazing interview. Amy’s secret involves a combination of superb E = Empathy skills to form a meaningful relationship, along with A = Paradoxical Agenda Setting to reduce resistance, followed by truly creative applications of M = Methods. And, of course, she does T = Testing with every student at every session, and plots her effectiveness over time. Amy describes her work with a severely anxious young man with artistic skills, who drew an “Anxiety Hero” figure who saves the world by worrying constantly about every little thing, plus a “Chilled Out” figure who never worries and ends up getting hit by a bus. In other words, Amy skillfully emphasized the many BENEFITS of the young’s man’s constant anxiety, as well as the downside of getting cured. This paradoxically boosted his motivation, and he improved rapidly. This is prototypical TEAM, which is difficult for many therapists to learn, because therapists are so used to, and addicted to, “helping.” Amy has developed expertise in aligning with the resistance of her students. paradoxically, she ends up on the same page, and this allows some awesome TEAMwork to emerge. Amy, Rhonda and David talk about the idea of teaching TEAM through creative innovations, with many examples of games Amy has created. For example, she created a game with another one of our fabulous TEAM-CBT therapists, Brandon Vance, MD, which can be played with teens and adults, called “Tune In / Tune Up.” This game provides a really fun way to learn the 5-Secrets of Effective Communication. If you’re interested, you can check it out at www.gamefulmind.com. Amy and her students have also created a podcast that you might want check out. Although I (David) have been primarily an adult shrink, I have really enjoyed working with teenagers as well. A few years back, I tested hundreds of juveniles who had been arrested in California, many for violent crimes, including murder, at the request of the probation department, using my Brief Mood Survey to find out how depressed, anxious, suicidal, and angry the kids were. Toward the end of the podcast, I describe what happened when I was invited to visit two groups of incarcerated gang members at the Juvenile Hall in San Mateo, California to find out how they felt about the tests I administered, and to get their take on the causes of so much teen violence. I think you’ll find this episode to be fun, funny, and inspiring! Amy is a strong advocate for including mental health training in high schools, and her experience illustrates the enormous potential for rapid and profound mental health growth and learning in teens. If you would like to contact Amy, she can be reached at babyfreud@gmail.com. You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here. # * * * ### You may have missed the Calgary and South San Francisco intensives, but there will be two more awesome workshops for you this fall. ## High-Speed Treatment of Depression and Anxiety Disorders ## A Four-Day TEAM-CBT Advanced Intensive ### November 4 – 7, 2019 The Atlanta, Georgia Intensive ### Sponsored by Praxis # * * * I also have a tremendous one-day workshops scheduled with my colleague, Dr. Jill Levitt, that will be potentially life- and career-changing experiences (really!) You will learn powerful skills that will boost your clinical effectiveness and improve your relationships with your patients as well as the people you care about. ## Advanced Empathy Tools for Connecting with Challenging Patients, Colleagues, Friends, and Loved Ones ### With Drs. David Burns and Jill Levitt ### Oct 6, 2019 | 7 CE hours,135

Do you have a patient, colleague, friend or loved one who:

• Complains endlessly but does listen to any of your good advice?
• Appears irate, but insists s/he isn’t upset?
• Refuses to express his / her feelings?
• Never listens?
• Argues, and always has to be right?
• Always has to be in control?
• Is relentlessly critical?
• Insists you don’t really care—or understand—when you think you do?

Then you’re going to LOVE this workshop with David and Jill. You’ll learn about–

• The Powerful “Law of Opposites”
• How to find out how your patients really feel about you–if you dare!
• How to transform therapeutic failure into success
• How to talk to people who refuse to talk to you
• Why your worst therapeutic failure is actually your greatest success in disguise
• The fine points of the Five Secrets of Effective Communication
• Three Advanced Empathy Techniques: Multiple Choice Empathy / Disarming, Changing the Focus, and Positive Reframing
• And more, including lots of small group practice with expert feedback and mentoring to refine your skills!

### Attend in person orfrom your home via Live Streaming

Sign up early because we nearly always sell-out for the in-person seats. Of course, there will be lots of skilled trainers to help the online participants with the small group exercises, so you will win either way.

My one-day workshops with Dr. Levitt are usually pretty awesome! It is always an honor to teach with Jill!

# 151: Treating LGBTQ Patients–What’s the TEAM Approach?

Are there some special techniques therapists need
to use when working with LGBTQ patients?

Does the therapeutic approach have to be different?

In today’s podcast, Rhonda and David interview Kyle Jones, a brilliant 5th year PhD student at Palo Alto University. Kyle has been a member of David’s training group at Stanford for the past four years, and now sees patients at the Feeling Good Institute in Mt. View, California. Today’s program is based on Kyle’s doctoral research on the treatment of LGBTQ patients.

To get the interview started, Kyle defines LGBTQ:

L = lesbian

G = gay

B = bisexual

T = transgender

Q = questioning, or queer.

Then Rhonda asks the obvious question: How does the treatment of LGBTQ individuals differ from the treatment of individuals who are heterosexual? What are the key differences? What special techniques or procedures should therapists use? And what does Kyle’s research reveal about the important factors in the treatment of LGBTQ individuals?

Kyle emphasizes that most important factor is the therapist’s attitude toward the patient, as opposed to any special techniques or procedures that are unique to the treatment of the gay population. Sensitivity to and awareness of the unique challenges this population faces in terms of hatred and prejudice are tremendously important. Kyle points out that some therapists place an excessive focus on the patient’s gayness, while some tend to sweep this “uncomfortable” issue under the rug.

Kyle emphasizes that most important factor is the therapist’s attitude toward the patient, as opposed to any special techniques or procedures that are unique to the treatment of LGBTQ people. Sensitivity to and awareness of the unique challenges this population faces in terms of hatred and prejudice are tremendously important. Kyle points out that some therapists place an excessive focus on the patient’s LGBTQ identity, while some tend to sweep this “uncomfortable” topic under the rug.

Kyle emphasizes that the therapeutic approach is largely the same for gay and straight patients. In TEAM, we first provide strong empathy, so the patient feels understood and accepted. This, of course, is crucial for all patients. Then we set the agenda, asking the patient if she or he wants help, and if so, what is the problem that he or she wants help with?

In other words, there is no special “agenda” that the therapist should impose on the treatment simply because the patient is gay, bisexual, transgender or queer. Kyle mentions that this is not a trivial point, because many therapists will try to set the agenda for the patient, thinking there is some “correct” way one should treat LGBTQ people, or some “correct” set of issues that must be addressed. David points out that thinking there is a special approach to gay patients could actually be viewed as a type of bias, thinking that the treatment of members of the LGBTQ community must be somehow “different” or special. However, the therapist using knowledge of the LGBTQ community skillfully in therapy is important.

In TEAM, we do NOT treat disorders, diagnoses, or “types” of patients. We treat humans in a highly individualize way, using the fractal approach described in a previous podcast. In other words, we ask the client to describe one specific moment when he or she was upset and wants help. Then the treatment flows from the exploration of that specific moment, because all the patient’s problems will be encapsulated in how she or he was thinking, feeling, and behaving at that moment. The treatment might then focus on depression, anxiety, a relationship problem, or a habit or addiction.

Rhonda, Kyle and David discuss the problem of therapists who have a strong anti-gay bias, as well as the question of whether gay therapists are obligated to announce this to the patient, and they come up with some pretty cool answers! Rhonda points out that when and how to do self-disclosure is a question therapists face with all patients, and that the goal of the self-disclosure should be on how best to help the patient.

Kyle and David reflect on some of the personal work Kyle did during his training program, and how important that work has been to Kyle as he has evolved into a dynamic, compassionate therapist and teacher. They reminisce about the first personal work Kyle did with David on one of the Sunday hikes. Kyle was feeling depressed because he’d just been rejected, unexpectedly, by his boyfriend, and was able to turn the situation around dramatically and quickly using TEAM-CBT. Kyle also describes his own discovery during college that he was gay, and what happened when he shared his sexual orientation with his parents and brother.

The message of this podcast turned out to be pretty simple and basic. The key to the effective treatment of all of our patients is acceptance. The therapist needs to accept the patient, and the patient needs to learn to accept themselves. In fact, acceptance seems to be the path to recovery and enlightenment for all of us!

For those interested in more depth and breadth (non-TEAM related) on this topic, Kyle recommends the following resources, or feel free to reach out to him at: Kyle@feelinggoodinstitute.com

Balsam, K.F., Martell, C.R., Jones K.P., & Safren S.A., (2019) Affirmative cognitive-behavior therapy with sexual and gender minority people. In Culturally responsive cognitive-behavioral therapy: Assessment, practice, and supervision.  Washington, DC: American Psychological Association Press

Pachankis, J. E., & Safren, S. A. (Eds.). (2019). Handbook of Evidence-Based Mental Health Practice with Sexual and Gender Minorities. Oxford University Press, USA.

David D. Burns, MD, Rhonda Barovsky, PsyD and Kyle Jones (PhD candidate)

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com.

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

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I also have a tremendous one-day workshops scheduled with my colleague, Dr. Jill Levitt, that will be potentially life- and career-changing experiences (really!) You will learn powerful skills that will boost your clinical effectiveness and improve your relationships with your patients as well as the people you care about.

# 150: I’m anxious, but I don’t have any negative thoughts. What can I do?

#### How can I get over my public speaking anxiety?

Rubens, a faithful and enthusiastic Feeling Good Podcast fan, sent me an email with a terrific question that has both  practical and theoretical implications. He wrote:

Dear Mr. David,

I’ve read “Feeling Good” and I’m reading “When Panic Attacks” now. Both have and are helping me immensely.

However, the one thing I have never understood is that my anxieties and worries often don’t come as a thought. For instance, I have an academic presentation tomorrow, and I’m suffering from much anxiety because of that. But the symptoms did not appear because I thought in my mind the sentence “you are going to fail!”. In my case, it is usually silent. I just remember that I have a presentation tomorrow, then I immediately feel worried. My chest hurts before any thought. How do I counter-argument my thoughts, if I have none?

Thank you for replying, Mr. David!

In today’s podcast, Rhonda and I address this question and explain what to do when you can’t pinpoint your negative thoughts. There are  two really good methods.

We will also demonstrate how to deal with some of the negative thoughts that typically trigger public speaking anxiety. The cure involves changing the way you think, and changing the way you communicate with the people in your audience. If you’ve ever struggled with public speaking anxiety, this podcast may be helpful for you!

Thank you again, Rubens, for your excellent question!

David D. Burns, MD / Rhonda Barovsky, PsyD

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com.

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here