Hi everybody! In today’s podcast we answer five challenging questions submitted by fans and listeners such as you!
1. Steven asks about the best route to take if you want to learn and practice TEAM-CBT? Is the degree important? What’s the best degree? Should you go to school to become a psychologist, clinical social worker, addiction counselor, psychiatrist, professional counselor, pastoral counselor, marriage and family therapist, life coach, or what? There are so many degrees and potential paths that my head is spinning!
2. Sandy asks how to overcome long-standing, entrenched perfectionistic tendencies.
3. Rin asks about the Burns Depression checklist and the criteria for depression in the DSM. He is (understandably) confused about the so-called “somatic” symptoms of depression, like insomnia or changes in appetite.
For example, some “experts” would argue that the following are all symptoms of clinical depression:
insomnia or the opposite—sleeping too much;
increased appetite or the opposite–decreased appetite;
loss of interest in sex, or the opposite, sex addiction;
loss of interest in work, or the opposite, being a workaholic.
How can opposite symptoms be symptoms of depression? Does this make sense? Are these really the symptoms of depression, or simply non-specific symptoms? What are the five key symptoms of real depression?
4. Kevin is a therapist with a simple question: How do I get over my desire to help?
5. Amanda asks how to use the Disarming Technique with a patient who thinks he or she isn’t making any progress in the therapy.
Thanks for listening to our Feeling Good Podcasts. Please tell your friends about us or forward this to them so our numbers can continue to grow. We are now in the range of 60,000 downloads per month, thanks to all of you! Fabrice and I greatly appreciate your support!
David and Fabrice
Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world via teletherapy. You can reach him at fabrice@life.net. You can reach Dr. Burns at David@feelinggood.com. If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.
* * *
A Cool Upcoming Workshop for YOU!
Two great locations: SF and Portland
plus Live Streaming from Portland
so you can attend from anywhere in the world.
November 29 and 30, 2018: San Francisco, CA
(in person only)
and
December 3 and 4, 2018: Portland, Oregon
(in person and live streaming)
PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.
In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.
Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…
How to integrate four powerful treatment models to eliminate symptoms.
How to enhance your client’s engagement in therapy.
How to develop a treatment plan that specifically targets each client’s unique problems and needs.
…and so much more!
David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!
Don’t miss this opportunity to learn from one of America’s most highly acclaimed teachers!
One of the goals for our Feeling Good Podcasts is to bring the TEAM-CBT techniques to life for mental health professionals, patients, and the general public as well. I (David Burns) use more than 50 Techniques when I’m working with individuals with depression, anxiety disorders, relationship problems, or habits / addictions. Today we will compare and contrast the four Truth-Based Techniques, including:
Examine the Evidence
The Experimental Technique
The Survey Technique
Reattribution
These were among the first cognitive therapy techniques ever developed, and they were based on the work of Dr. Aaron Beck, from Philadelphia, as well as Dr. Albert Ellis, from New York. Dr. Ellis is the Grandfather of Cognitive Therapy, and he described many of these techniques in the 1950s. He called his treatment Rational Emotive Therapy, and it’s still popular today. During the 1960s, Beck, who is considered the Father of Cognitive Therapy adapted the ideas of Dr. Ellis to the treatment of depression, and called his version of the treatment Cognitive Therapy.
Beck emphasized that depression results from a negative view of the self, the world, and the future. In other words, the patient may think:
I’m a loser. (negative view of the self)
Nothing i do will be successful or rewarding. (negative view of the world)
Things will never change. I’m hopeless. (negative view of the future)
Beck claimed that the negative thoughts of the depressed individual are the actual cause of the depression. He also emphasized that the disturbing negative thoughts of depressed patients are nearly always distorted and illogical; however, depressed individuals don’t realize that they’re fooling themselves, so they think their negative thoughts are absolutely valid. Beck also claimed that depression could be treated without drugs in many cases, and focused his treatment on challenging the patient’s distorted negative thoughts.
Beck often compared depressed patients to scientists who have a theory about the world that simply isn’t true. That’s why scientists learn to test their theories by examining evidence and performing experiments. Beck suggested that depressed patients could also test the validity of their negative thoughts and beliefs by examining the evidence for and against what they’re telling themselves, as well as by doing actual experiments to test their thoughts and beliefs.
David and Fabrice bring the four basic truth-based techniques to life with actual patient examples. They answer the question, “What’s the difference between Examine the Evidence and the Experimental Technique?” And “How does the Survey Technique work?”
They emphasize the tremendous importance of warmth and empathy, as well as melting away patient resistance, before trying to implement any of these techniques. They also emphasize that these techniques, like all of the techniques, are powerful, and must be used with skill and compassion, or else they can backfire.
Thanks for reading this and listening to our Feeling Good Podcasts. Please tell your friends of forward this to them so our numbers can continue to grow. We are in the range of 60,000 downloads per month, thanks to all of you! Fabrice and I greatly appreciate your support!
David and Fabrice
Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world via teletherapy. You can reach him at fabrice@life.net. You can reach Dr. Burns at David@feelinggood.com. If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.
* * *
Two Cool Upcoming Workshops for YOU!
Coming Really Soon!
Act fast if you want to attend.
* * *
Rapid Recovery from Trauma
a two-day workshop
by David D. Burns, MD
November 1-2, 2018–Woodland Hills, CA
You can attend in person or from home via Live Streaming
Includes a dramatic live demonstration on the evening of day 1
For further information, go to www.IAHB.org or call 1-800-258-8411
November 29 and 30, 2018: San Francisco, CA
(in person only)
and
December 3 and 4, 2018: Portland, Oregon
(in person and live streaming)
PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.
In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.
Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…
How to integrate four powerful treatment models to eliminate symptoms.
How to enhance your client’s engagement in therapy.
How to develop a treatment plan that specifically targets each client’s unique problems and needs.
…and so much more!
David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!
Don’t miss this opportunity to learn from one of America’s most highly acclaimed teachers!
We sent this to you with the wrong audio earlier today, so Fabrice kindly fixed it. This version should have the correct audio. Thanks! David
Stephanie James’ Second Interview with Dr. David Burns
Hi everybody!
This is the second of three interviews with Stephanie James on her superb radio show and podcast, The Spark. Stephanie is an experienced therapist and dynamic radio personality from Colorado. She is co-authoring a book on how to live a “spark-filled life.”
This interview with Stephanie focused, in part, on the evolution of the new TEAM-CBT from traditional Cognitive Behavioral Therapy (CBT). Stephanie asks Dr. Burns questions on a wide range of topics, including:
How would you treat a case of social anxiety?
What is “therapeutic whitewashing” and how can therapists get over it? What should therapists do instead?
How would you work with violent teenagers, such as incarcerated gang members?
Why is it so important for therapists who are learning TEAM-CBT to check their egos at the door? What happens to therapists who won’t do this?
After you published your first book, Feeling Good, and the first research study on CBT was published, cognitive therapy swept the world. After your initial euphoria about CBT, your enthusiasm dimmed somewhat. Why? And in what new direction did your research lead?
What are the most common errors that therapists make in thinking about the causes of therapeutic resistance?
How can you overcome a patient’s resistance to change?
Can TEAM-CBT work rapidly for someone with horrific abuse and decades of failed therapy? Or is it mainly for high functioning individuals with mild problems?
How can you prevent or minimize relapses following the patient’s initial recovery?
Dr. Burns’ third interview with Stephanie will be on the interpersonal TEAM model—how to transform conflicted relationships into loving, rewarding ones. It can happen rapidly—but requires the death of the ego, or “self,” along with the willingness to give up blame and the role of victim so you can pinpoint your own role in the problem. This can be liberating—but painful!
[Apologies to our listeners—For a few hours this Monday, the old interview with Stephanie was posted ~Fabrice]
Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world via teletherapy. You can reach him at fabrice@life.net. You can reach Dr. Burns at David@feelinggood.com.
Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop will be highly interactive with many case examples and opportunities for practice using role plays.
Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop will be highly interactive with many case examples and opportunities for practice using role plays.
Join us for a day of fun and inspiring learning from anywhere in the world.
The in person version is now sold out, but limited spaces are still available if you would like to join online. There will be experts to assist the online participants with small group exercises in break out rooms, so you will have the same experience as those who attend in person. But act fast it you want to be included!
SOLD OUT in person, but limited spaces are
still available ONLINE
November 29 and 30, 2018: San Francisco, CA
(in person only)
and
December 3 and 4, 2018: Portland, Oregon
(in person and live streaming)
PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.
In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.
Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…
How to integrate four powerful treatment models to eliminate symptoms.
How to enhance your client’s engagement in therapy.
How to develop a treatment plan that specifically targets each client’s unique problems and needs.
…and so much more!
David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!
Don’t miss this opportunity to learn from one of America’s most highly acclaimed teachers!
Fabrice and David address several challenging questions submitted by individuals who listen to the Feeling Good Podcasts.
Richard: Do you have to get along with everybody? How do you deal with a sociopath?
Dave: Positive distortions can trigger mania, addictions, narcissism, and violence–but how can you get rid of them?
Julia: What can you do if you’ve been depressed all of your life and wake up every morning with your mind flooded with negative thoughts? I spend two hours trying to dispute them, but they just keep coming back the next day.
Omhur: How would you treat “Reading OCD?” I feel compelled to read every sentence and paragraph carefully and repeatedly so I won’t miss anything!
Unnamed fan (who left a negative review on iTunes): Isn’t your concept of the death of the ego potentially dangerous to people with low self-esteem who are being abused?
Thank you for your terrific questions, your frequent praise, and your occasional criticisms and challenges. They keep us on our toes, and we deeply appreciate all of you. So keep your comments coming, as well as your suggestions for shows and topics you want to hear more about!
We are receiving more than 50,000 downloads a month. Please tell your friends about us so we can continue to build our audience.
Thanks! We really enjoy doing these shows for you.
David and Fabrice
* * *
Coming Soon!
October / November / December 2018– Cool Workshops for You!
Sunday October 28th, 2018 (8:30 am to 4:30 pm PST)
Live in Palo Alto plus online streaming
Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop will be highly interactive with many case examples and opportunities for practice using role plays.
Join us for a day of fun and inspiring learning on site in Palo Alto
OR online from anywhere in the world.
The in person version is now sold out, but limited spaces are still available if you would like to join online. There will be experts to assist the online participants with small group exercises in break out rooms, so you will have the same experience as those who attend in person. But act fast it you want to be included!
November 29 and 30, 2018–San Francisco, CA (in person only)
and
December 3 and 4, Portland, Oregon (in person and live streaming)
PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.
In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.
Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…
How to integrate four powerful treatment models to eliminate symptoms.
How to enhance your client’s engagement in therapy.
How to develop a treatment plan that specifically targets each client’s unique problems and needs.
…and so much more!
David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!
Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers!
“I’ve heard Dr. Burns mention that he is most proud of a few of the techniques he’s developed, and he mentioned that the Disarming Technique would be near the top of the list. I believe he said there were three or five of them. I was wondering what the others were. Does he have a top 5?”
Thank you, Tanuj. I got to thinking and actually came up with 10. Fabrice and I will briefly discuss each one on today’s podcast. So here they are!
The list of Ten Cognitive Distortions that I created for my first book, Feeling Good: The New Mood Therapy. This list has been reproduced enormous numbers of times in the media and has been translated into more than 30 languages.
The Disarming Technique and Law of Opposites. This means that you can nearly always put the lie to a criticism by finding the truth in it. However, this can be difficult because it requires the death of the ego, or self, the so-called “Great Death” that the Buddhists have emphasized as a key to enlightenment. This method has transformed my clinical practice and personal life and has been very helpful to many of my patients as well. However, it is not easy to learn, in part because it does involve the death of the “self.”
The Externalization of Voices plus Acceptance Paradox. This was one of the first cognitive therapy techniques I developed, and I have used it more than any other technique during my career. It’s totally mind-blowing.
The two classic Uncovering Techniques: the Individual and Interpersonal Downward Arrow. You can use these techniques to quickly pinpoint the Self-Defeating Beliefs that trigger painful mood swings, such as Perfectionism, Perceived Perfectionism, the Love Addiction, and Brushfire Fallacy, and more.
The Feared Fantasy and Acceptance Paradox. This is a powerful and innovative exposure technique that can help people overcome the fear of being judged or rejected. It can also help people modify Self-Defeating Beliefs like Perfectionism and the Achievement Addiction, and the Approval Addiction.
The Experimental Technique for extremely rapid treatment of patients with Panic Attacks. With this technique, you can sometimes—often—cure Panic Disorder in a single session. But this requires great courage on the part of the therapist and patient, and a great therapeutic alliance with lots of trust.
My published research with colleagues in the mid-1970s did not support the popular notion that depression results from a chemical imbalance in the brain. In other words, we found that depression probably does NOT result from a deficient of the neurotransmitter, serotonin. Although we published this research in the top psychiatric journal, it was largely ignored for 25 years because people were so hooked on the “chemical imbalance” theory of depression. Now the study has been quoted frequently, and most neuro-scientists no longer give that theory a great deal of credibility.
Brief Mood Survey. I believe I was the first, or one of the first, therapists in the world to require testing of every patient at every treatment session. I started with the Beck Depression Inventory, but have since developed briefer and more accurate scales that patients can complete in the waiting room before and after every sessions. These scales indicate the severity of symptoms such as depression, anxiety, anger, suicidal urges, positive feelings, and relationship satisfaction or conflict. Patients also rate therapist empathy and helpfulness after each session. This simple procedure has revolutionized treatment, because therapists can now see, for the first time, how effective, or ineffective, they are in every single therapy session. The testing has also made data-driven, science-based psychotherapy possible. However, it requires courage on the part of the therapist because the information will often be surprising to the therapist, and disturbing!
Positive Reframing, and all of the new, paradoxical Agenda Setting techniques have made super-high-speed TEAM-CBT treatment methods possible. I now see recovery at speeds I would have thought impossible 20 years ago.
The use of extended, two-hour therapy sessions rather than weekly 50-minute sessions has also been huge. That’s because I often see a complete elimination of symptoms of depression and anxiety in a single extended session of TEAM-CBT, as opposed to months or even years of conventional treatment. Many of my students are reporting similar results. This, I think, is truly revolutionary!
Well, that’s it. That’s what I’m the most proud of! I suppose I could also include my first book, Feeling Good: The New Mood Therapy, which has sold more than 5 million copies worldwide, and has helped many people recover, as well as the development of TEAM-CBT.
Thank you again for your question, and please accept my apology if I am bragging too much, which can be really offensive. However, my mother once said, “If you don’t toot your own horn, no one else is going to toot it for you,” so hopefully the podcast and write-up will be okay.
David
* * *
Coming Soon!
October / November / December 2018– Cool Workshops for You!
Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop will be highly interactive with many case examples and opportunities for practice using role plays.
Join us for a day of fun and inspiring learning on site in Palo Alto
OR online from anywhere in the world.
November 29 and 30, 2018–San Francisco, CA (in person only)
and
December 3 and 4, Portland, Oregon (in person and live streaming)
PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.
In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.
Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…
How to integrate four powerful treatment models to eliminate symptoms.
How to enhance your client’s engagement in therapy.
How to develop a treatment plan that specifically targets each client’s unique problems and needs.
…and so much more!
David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!
Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers!
A podcast fan named Chuck asked if we could have a podcast devoted to the concept of the “self,” or the Buddhist concept of “no self,” so here it is.
David emphasizes that there are two issues. First, can your “self” be validly judged as not good enough, as inferior or even worthless? Or, can your “self” be validly judged as more worthwhile, or even superior? And is it really true that some people are more worthwhile, or less worthwhile, than others? Do more worthwhile, or less worthwhile human beings exist?
Second, do we even have a “self?”
Fabrice talks about the history of the concept of ego. For example, Freud divided the human mind into three parts: the id, ego and superego. Do these really exist as “things,” or are they just concepts, or metaphors for talking about the mind? When you try to think about the “ego” or the “self” as a thing, that’s when you get in trouble.
David argues that if you believe that someone people are “more worthwhile” or “less worthwhile,” you’d have to define what a of worthwhile human being is. Once you define it, you can always show that your definition has one of these problems:
It applies to all human beings, and therefore has no meaning.
It applies to no human beings, and therefore has no meaning.
It is inherently meaningless.
It does not apply to you.
David and Fabrice illustrate these traps with one of the most common definitions—thinking that your worthwhileness as a human being depends on your achievements, productivity, or success. They conclude that can only judge specific thoughts, feelings, or behaviors as more or less worthwhile, but there’s no such thing as a more or less worthwhile human being.
Next, they raise the question, “Does the ‘self’ exist?” And “What is the self?” David argues that the notion is nonsensical, or that there is no such “thing” as a “self.”
Although the discussion in today’s podcast is philosophical, and may go over the heads of some people, it has practical importance because most people who are struggling with depression and anxiety do believe that they are “not good enough,” and that their “selves” are somehow defective or flawed. Letting go of this notion can help to speed recovery, as well as what the Buddha referred to as “enlightenment.”
David expressed the hope that we may be able to return to this theme in future podcasts and perhaps find ways of making these potentially healing and liberating concepts more understandable! These concepts can take time to grasp, so be patient with yourself.
* * *
Coming Soon!
October / November / December 2018– Cool Workshops for You!
Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop will be highly interactive with many case examples and opportunities for practice using role plays.
Join us for a day of fun and inspiring learning on site in Palo Alto
OR online from anywhere in the world.
November 29 and 30, 2018–San Francisco, CA (in person only)
and
December 3 and 4, Portland, Oregon (in person and live streaming)
PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.
In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.
Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…
How to integrate four powerful treatment models to eliminate symptoms.
How to enhance your client’s engagement in therapy.
How to develop a treatment plan that specifically targets each client’s unique problems and needs.
…and so much more!
David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!
Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers!
Fabrice and David are pleased to chat with Dr. Taylor Chesney who is an expert in the treatment of children and teenagers with TEAM-CBT. Taylor was a member of Dr. Burns’ Tuesday group at Stanford and his Sunday hiking group for two years before returning to her home in New York in 2014. She opened the Feeling Good Institute NYC, where she and her colleagues offer individual and intensive treatment as well as training for mental health professionals (in person and online). Today she reveals the inside scoop on how to use TEAM-CBT with children and teenagers, and their parents.
Dr. Chesney begins by emphasizing that it is not hard to use TEAM-CBT with kids and teens, and that most of the tools work really well with only minor tweaking. For example, the Empathy tools (the Five Secrets of Effective Communication) work really well with kids and parents, and help you get buy-in so the kids and parents get excited about working together.
The Agenda Setting TEAM-CBT tools also need to be done with children as well as their parents.
Taylor credits Jacob Towery MD, one of her mentors in California, who taught her how to set up a four-session intake, so you get to connect with all family members before implementing any treatment techniques. She explains:
I’ll have two sessions with the child first, and one session with both parents together. This is really important to see how they’re experiencing parenting and how you can support them. The fourth session is the wrap-up session with the parents and the child together.
Empathy is vitally important from the very start. When I meet with the child or teen, it’s all about rapport building—their hobbies, friends, what they like, how they feel about their parents, what kinds of music they like, what apps and TV shows they like. This is their first time talking to you, and you have to get them to want to be with you. Building the relationship, the foundation, gives you so much leverage as you work with the child and the parents.
In the second part of the initial session with the child, we talk about symptoms, problems, and their take on it. Do they want help, or do the parents think they need help?
Fabrice: What if the child does not think they have a problem?
Taylor: I won’t work with a child unless they convince me they want help. I won’t take the parents’ money unless the child convinces me that they want help.
If they don’t want help, I tell the child I’ll work with their parents instead. However, I tell the child I’d prefer to work with them.
Fabrice: So, sometimes, the child cannot convince your that they want help.
Taylor explains:
I saw a child who got scared every night and wanted to sneak into the parents’ room to sleep. This was a problem for the parents, but the child didn’t want to change.
Some therapists might try to work with the child to persuade them to stay in bed, but if you do that, you’ll probably run into resistance. So, I said, “I get it. It’s not fun to sleep in your bed alone. You hear strange and frightening sounds so you naturally want to sleep in your parents’ room, where you feel safe. Still, your parents are saying, ‘this can’t go on.’ If you don’t want help, I’ll work with them, since they are asking for help.”
This got the kid wondering and he asked, “What would that look like if you worked with my parents instead of me?”
I said, “Every family is different, but if I work with you, you’d be in control, rather than your parents.” Then he decided, “I kind of think I want to work on it.”
It’s all the same techniques David has developed in TEAM-CBT—you just put the same concepts and techniques into the child’s language. You Sit with Open Hands, just like with adults. You don’t try to chase or sell the patient anything.
Taylor and Fabrice discuss the importance of motivation and avoiding battles you’re not going to win.
Fabrice asks for an example of how the treatment works, so Taylor continues:
There’s no one size that fits all. Every situation is so different. That’s why is so important to start with the relationship with the child.
A fun case is an 15 year old boy I saw. He was a stellar athlete and student, but was struggling with severe OCD and performance anxiety, including test anxiety. Several previous attempts at therapy had failed, including talk therapy and medications, but nothing had alleviated his severe anxiety and rituals.
I started with good empathy, using the Five Secrets to understand his hobbies, his friends. Then, instead of trying to “help” him, the way his parents and other therapists had been doing, I said something like this: “Your anxiety is part of your identity. It must be annoying to you for people to bug you to get over your anxiety.”
He got excited and seemed relieved, as if to say, “You’re not going to try to convince me to get over my anxiety?”
Everyone else was telling him he shouldn’t be so anxious, so he got to thinking, as we all do, that his anxiety was somehow “bad.” In contrast, we looked at all the great things his anxiety showed about him, and how he cared about his performance, and all the things he had to do each day. How he wants to be successful, and wants to get positive feedback from his teachers and make his parents proud of him.
In other words, we came up with lots of GOOD reasons to hold on to his anxiety. This is exactly how we’d deal with Outcome Resistance in an adult.
The floodgates opened up, and he listed all the many really good reasons to continue to be anxious. He said it was the best session ever, and no one else had ever agreed with him about all the good reasons to be anxious.
Then we talked about the Magic Dial—was there some area where a lower level of anxiety would be enough? He decided to work on test anxiety first, because he froze up on exams. He said he didn’t need that much anxiety!
We also talked about what he’d have to do to overcome his anxiety that he might not want to do. In TEAM-CBT lingo, this is called dealing with Process Resistance. There were lots of things. First, he’d have to risk it and be willing to accept the possibility of getting lower grades and being okay with the outcome of the exam, and he’s also have to use the Daily Mood Log every day to record his negative thoughts and challenge them.
Fabrice: You talked about his willingness to get lower grades. Is that a way of dealing with his Outcome Resistance?
Taylor answers:
I thought of it more as him facing his fears—exposure, in other words. He thought he had to do a certain ritual before each exam and rehearse his answers repeatedly on the exam in order to get a really high grade. If he agrees to give up those rituals, he’ll be facing his fears.
Teenagers can use the same Daily Mood Log that David has developed for adults. He was thinking:
I shouldn’t worry.
I should get 100 every time.
No one else worries.
Everyone will think I’m stupid if I don’t get a really high grade.
Then no one will like me.
Everyone is smarter than me.
Fabrice asked about the Emotions Table on the Daily Mood Log, so Taylor spoke about psycho-education about emotions, and the importance of asking them to circle their negative feelings on the Daily Mood Log. This gives them a better understanding of their emotions, and gives them a vocabulary to talk about how they’re feeling.
Taylor also explains about how to put the Cognitive Distortions in child-friendly language. Instead of All-or-Nothing Thinking you can talk about “all good” or “all bad.” She also makes it a game and asks kids to learn about one distortion each week. Like, making the child a Should Detective for a week, looking for Should Statements in themselves and others. They have fun with this.
Fabrice asked what happened to the anxious teenager once the Empathy and Agenda Setting had been completed.
She described a variety of TEAM-CBT methods that were useful to this boy, starting with the Survey Technique—ask your friends if it is true that no one else worries, or if they’d think less of him or not want to be his friend if he didn’t get a good grade on a test. Taylor also used Self-Disclosure, encouraging him to share his insecurities instead of hiding them.
Taylor said the Double Standard Technique also helped him a great deal, along with the Externalization of Voices, the Feared Fantasy, Acceptance Paradox, and more, so he could practice talking back to his negative thoughts. Taylor explained how to make the role-playing more fun with kids, introducing an element of play.
Fabrice: How do kids take to the Acceptance Paradox? How do they switch their thinking?
Taylor:
They spend so much of their life thinking their anxiety is bad, but in Agenda Setting they see there are really good parts of the anxiety, so they stop resisting and see they no longer have to fight the anxiety. One of his thoughts was, “I shouldn’t feel anxious on exams, I shouldn’t feel this way,” but those Should Statements simply feed his anxiety and make it worse. The Acceptance Paradox moved in the opposite direction, so he could say, “my anxiety is okay.”
He responded well and is no longer my patient. It’s sad to lose patients who recover fairly quickly, but it’s also great to witness the change and get feedback on how well they are doing later on.
Another thing we also did was Exposure, asking him to bring in a test and then we induced anxiety in the office.
In the initial treatment, we only focused on his test anxiety, because that was his agenda. But he came back a year later asking for help on other issues, which also went really well.
Fabrice: It sounds like the initial therapy was a trust builder, giving him what he wanted, and no more. You walked the walk with him and put him in control.
Taylor: Yes. You also have to build a good relationship with the parents, so they trust you and your therapeutic strategy as well. They were on board and let him work with me in this manner.
If you would like to contact Dr.Taylor Chesney with a question, or for treatment or training in TEAM-CBT, you can call her at 516-551-8063, email her by clicking here or visit her website. To register for her next online training group, click here.
If you have specific questions about the treatment of children or adolescents, make sure you contact her, as we may be able to set up a second podcast with Taylor!
Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop is highly interactive with many case examples and opportunities for practice using role plays.
Join us for a day of fun and inspiring learning on site in Palo Alto OR online from anywhere in the world by this dynamic teaching duo!
Sunday October 28th, 2018 (9am-4pm PST) 6 CE*s. $135
Back by Popular Demand Again–Dr. Helen Yeni-Komshian
This is the second podcast on relationship problems. with Dr. Helen Yeni-Komshian. In today’s podcast, we address four questions from listeners like you:
Our marriage lacks intimacy. What can I do? A podcast fan named David explains that his relationship with his wife is no longer intimate; he complains that they only talk about day to day things on a superficial level. David wants to know if he needs to inject some conflict into the relationship to make it more meaningful or exciting.
Why is my wife so critical of me? David wants to know why his wife constantly peppers him and batters him with critical questions, and what he can about it.
Why is my friend so critical and dogmatic? Rajesh describes a friend who argues endlessly and accuses Rajesh of being irritating. His friend says, “Anyone would be upset when they try to talk to you!” What’s up? Why is this happening? Who’s really to blame?
Adarah feels lonely and tells her husband what he can do to make her feel loved–but it just doesn’t seem to work! Why? And what CAN she do to improve her marriage?
I think you will enjoy the lively dialogue between Fabrice, Helen and myself and see us struggling and making some mistakes, too, when we try to model more effective responses based on the Five Secrets of Effective Communication! We also stress, once again, the importance of Interpersonal Decision-Making any time you run into a conflict with a friend, colleague, or loved one.
For more information on healing troubled relationships, you can read my book, Feeling Good Together, which is available as a paperback on Amazon. In addition, you can listen to our previous podcasts on the Five Secrets of Effective Communication, beginning with Podcast #65 (Enjoy Greater Intimacy) and several of the podcasts that follow.
David
PS Listeners who wish to contact Dr. Helen can do so via email: helen at dryeni.com. You can also visit her website, www.dryeni.com.
Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop is highly interactive with many case examples and opportunities for practice using role plays.
Join us for a day of fun and inspiring learning on site in Palo Alto OR online from anywhere in the world by this dynamic teaching duo!
Sunday October 28th, 2018 (9am-4pm PST) 6 CE*s. $135
We have invited Dr. Helen Yeni-Komshian to join Fabrice and me for two consecutive podcasts on questions listeners have asked about troubled relationships. In today’s podcast, we address a question from Mary about how to deal with a husband who constantly complains and exaggerates how awful things are at work, in politics, and in the world. But when Mary tries to dismiss his statements in an effort to “keep the peace,” it just gets worse. His complaints escalate!
This is a common problem and you may have run into it as well. Do you have a friend or family member who loves to complain? And have you noticed that your attempts to help or point out the irrationality of his or her complaints are futile? So what SHOULD you do? What’s the secret of dealing with a whiner or a complainer? Is it even possible.
Helen and David provide a myriad of information and describe techniques such as Forced Empathy, Interpersonal Decision Making, Changing the Focus, and the Five Secrets of Effective Communication. You’ll LOVE this lively dialogue!
For more information on healing troubled relationships, you can read my book, Feeling Good Together, which is available as a paperback on Amazon. In addition, you can listen to our previous podcasts on the Five Secrets of Effective Communication, beginning with Podcast #65 (Enjoy Greater Intimacy) and several of the podcasts that follow.
More relationship questions answered next week. See you then!
David
PS: Listeners who wish to contact Dr. Helen can do so via email: helen at dryeni.com. You can also visit her website, www.dryeni.com.
PPS: In Episode #101 of this podcast, David responded to Dr. Michael Edelstein and Tommy Bateman on their challenge of the TEAM-CBT model vs. REBT. David was invited to be interviewed on their YouTube channel, The REBT Advocate and used his own effective communication skills to answer the challenge in Episode 35 of The REBT Advocate. You might want to listen to it.
Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop is highly interactive with many case examples and opportunities for practice using role plays.
Join us for a day of fun and inspiring learning on site in Palo Alto OR online from anywhere in the world by this dynamic teaching duo!
Sunday October 28th, 2018 (9am-4pm PST) 6 CE*s. $135
How do you treat individuals with pain when there is no organic cause?
Today we answer a challenging question submitted by Anne, who writes:
Hi David,
I’m currently studying counselling/psychotherapy in the UK. Last month I discovered your podcast, then read your book Feeling Good, and it was the first thing that really lit up my eyes and got me obsessively studying! Everything about your TEAM-CBT model is so compelling and inspiring and first I just wanted to thank you for taking the time to share it with all of us.
I also have a specific question which I’d love to hear you answer in one of your “Ask David” episodes. My ambition is to specialize in treating patients who have chronic pain with no clear physical cause. I’ve had that problem myself for several years, so I’d love to hear your thoughts on psychological treatments for pain. How do you apply the TEAM CBT model to those patients? Any wisdom you could share would have me on the edge of my seat!
Thanks so much for listening
Anne
Thanks, Anne, for your terrific question on one of my favorite topics. In this podcast devoted to pain and depression, I describe research on the relationship between physical pain and negative emotions such as depression, anxiety, and anger. Does pain cause depression? Or does depression cause or amplify pain?
And what can we do to help patients with physical pain and intense negative emotions?
In addition, why do so many individuals struggle with somatic problems, such as physical pain, dizziness, or fatigue, when there is no apparent organic cause for the pain? Is there any hope?
I think you will enjoy the show, Anne, at least I hope you do! I really enjoyed answering your question on one of my favorite topics!
