Feedback from last week’s workshop from the woman who provided the example of a political conflict with her mother:
Hi David and Fabrice,
I listened to the podcast on the way to work today, I loved it! Felt honored by the kind attention David and Fabrice gave to this.
Using the 5 secrets has led to a much healthier and loving relationship with my mom, and her Xmas visit was so much nicer than others have been, because I understood so much more about what her political stance means to her. I think it is a way for her to stay connected to my dad, who died 5 years ago–they loved to talk about politics together, though he was as brainwashed as she is. 😉
That allowed me to realize that her vote for Trump, and her failure to understand how horrifying he is, wasn’t a personal swipe at me. It was about longing and connection, and although it seems twisted to me, her Faux news/Alex Jones/Sean Hannity group on TV is a reliable community for her.
Anyway, I think she felt more loved and accepted and valued when she stayed with us this year, and I feel really great about that. Thank you all for the guidance and great teaching!
Eileen
Thanks so much for that wonderful note, Eileen! . . . And now for today’s show!
You CAN Defeat Shyness!
Lately, I’ve gotten lots of emails from podcast fans who struggle with shyness, which is categorized in DSM5 (The Diagnostic and Statistical Manual of Mental Disorders) as “Social Anxiety Disorder.” This is one of my favorite things to treat, since I struggled with practically EVERY type of social anxiety early in my life, so I really know how it feels and how to defeat it. It’s incredibly common. In fact, when I give workshops for mental health professionals, I sometimes ask how many of them have struggled with shyness or public speaking anxiety, and nearly all the hands go up.
This podcast will be the first of several on this topic, because it’s so common and relatively easy to overcome–IF you have the courage!
Here the are several different “flavors” of social anxiety recognized by the American Psychiatric Association, including:
Shyness
Public Speaking Anxiety
Performance Anxiety (such as intense anxiety during a musical or athletic performance)
Shy Bladder (or Bowel) Syndrome. This is the fear of peeing or pooing in a public restroom, for fear you’ll freeze up or make too much noise and others will notice.
Test Anxiety
One common theme is the fear that others will notice your anxiety or poor performance and judge you. Another common source of suffering is shame of feeling like you are inherently flawed and will be seen as defective or even as insane by others. Sometimes, these fears become so extreme that they can significantly interfere with relationships and leisure-time activities as well as work.
Dan is a podcast fan who courageously immigrated to the United States from Iran as a young man. When he arrived in America, he had little education and almost no knowledge of English. He also suffered from an extreme case of acne, which eventually cleared up, but left him with severe social anxiety.
In spite of these problems, Dan worked hard, learned English, and became a top student in college and in graduate school as well, and went on to develop an excellent career. But in certain performance situations, such as public speaking or interacting with strangers, he panics and trembles and his heart races; his mouth twitches and his voice gets shaky, and he has thoughts like these:
I’m about to lose control over myself.
Others will see my symptoms and think I’m mentally insane.
In spite of making Herculean efforts to control these symptoms, I have failed.
I will never overcome this.
I am defective for life.
I will lose my job.
David and Fabrice remind listeners that they cannot treat anyone through a podcast, and that there are large numbers of treatment techniques that can be extremely helpful in the context of a compassionate and skillful therapeutic relationship. Since Dan is seeing an excellent therapist, they suggest and illustrate five powerful Interpersonal Exposure Techniques that Dan might want to do under the supervision of his therapist, including:
The Survey Technique
Self-Disclosure
The Experimental Technique
Shame Attacking Exercises
The Feared Fantasy Technique
David and Fabrice also discuss how to address patient and therapist fears of using powerful exposure techniques, and how the avoidance of exposure can sabotage the treatment. They describe four techniques David as developed to help therapists with this, including:
Dangling the Carrot
The Gentle Ultimatum
Sitting with Open Hands
Fallback Position
David describes “Reverse Hypnosis.” This is where the patient hypnotizes the therapist into giving up on exposure thinking that it is “too dangerous,” or that the patient isn’t “ready” or is “too fragile.”
And speaking of anxiety, listeners might want to consider the upcoming workshop by David and his colleague, Dr. Jill Levitt, on the treatment of anxiety disorders on May 19, 2019. Check it out below!
Thanks. Stay tuned for more on Social Anxiety in future podcasts!
David
Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world (but not across U.S. state lines) 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.
Can the Five Secrets of Effective Communication Help Us in this Era of Intensely Polarized Politics?
Clearly, the nation is intensely divided, and passions on both sides of the political divide are characterized by hostility, frustration, and mistrust. Can the Five Secrets of Effective Communication help us communicate with colleagues, friends and loved ones who may have radically different political beliefs?
Find out on this edition of the Feeling Good Podcast, as the David and Fabrice respond to Eileen, a podcast fan who kindly allowed us to share her intensely painful conflict with her mother with all of you. Eileen’s mother is an ardent Trump fan, and Eileen is an equally ardent anti-Trumper, and there have been plenty of tears on both sides of the aisle!
Eileen wrote:
“How can you talk to someone with whom you fundamentally disagree? My Mom is a big fan of the current regime (Trump) and I’m horrified by what’s happened in the past two years and what’s coming. It’s hard for me to get past my rage at her. . . intensely distorted and not-reality based beliefs, fed by right-wing media. To be clear, she thinks exactly the same about my beliefs and information sources. I feel so stuck. . . and I would love to repair this relationship with her before she dies.”
Can you identify with similar conflicts in your own family or circle of friends? I know that I can, and it’s quite painful. Fabrice and I will give you our take on a new approach to this widespread problem this Sunday!
Let us know what you think after you’ve listened to the podcast!
David
Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world (but not across U.S. state lines) 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.
We’ve had many podcasts on the Five Secrets of Effective Communication, and we’ve featured these powerful techniques in the live sessions with Lee (sessions #96 to #98)), a man who was upset because his wife was constantly criticizing him and trying to control him.
Here are the links to the first two podcasts on the Five Secrets (14 and 15). For more practice you can listen to podcasts 54 – 57 and 65 – 69.
Learning to use the Five Secrets skillfully requires strong motivation and lots of practice, but the benefits can be tremendous. The Five Secrets have transformed my clinical work as well as my personal and professional relationships. And they’ve also had a huge impact on my teaching.
But there are even more communication techniques that can be immensely helpful. In this podcast, we discuss three advanced techniques:
Changing the Focus. This technique can be tremendously helpful when there’s an “elephant” in the room.
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.
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.
These techniques may look easy, but they are actually difficult to learn. They require humility, determination, and lots of practice. Success also depends on a strong desire to develop a more loving relationship with the person you’re not getting along with.
People who are serious about learning can read Feeling Good Together and do the written exercises while you read!
Thanks!
David
Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world (but not across U.S. state lines) 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.
Dr. Jill Levitt and I are offering what I think will be an outstanding workshop on the treatment of anxiety disorders on Sunday, May 19, 2019. Our Sunday workshops are tremendously fun, so consider attending if you are interested.
The last Sunday workshop in February sold out quickly so register soon if you are interested. You can join in Palo Alto in person or online from anywhere in the world.
THERE WILL BE MANY EXPERT TRAINERS TO GUIDE THE ONLINE PARTICIPANTS DURING THE SMALL GROUP EXERCISES
WHEN: May 19, 2019, 8:30 am – 4:30 pm PST (11:30 am-7:30 pm EST)
WHERE: Join us live online or in person at the Creekside Inn, Palo Alto, CA.
HOW MUCH DOES IT COST? $135,
WILL I GET CE CREDITS? YES! 7 CE hours available
WILL I GET CREDIT IN THE TEAM LICENSURE PROGRAM? YES! Completion of this workshop also counts towards TEAM-CBT Level 1, 2 or 3 Certification
WHO CAN ATTEND? Therapists of all levels are welcome
CAN I REGISTER IF I’M NOT A THERAPIST? Although the workshop is geared for therapists, it will be taught in a clear and basic way that anyone can benefit from.
WILL I HAVE FUN? Yes!
WILL I HAVE GET TO HANG OUT WITH SOME COOL COLLEAGUES? Yes!
WILL I GET AN AWESOME FREE BREAKFAST AND LUNCH? Yes!
You will love this lively, amusing, and immensely useful day of training with Drs. Burns, Levitt and the Feeling Good Institute Staff. The trainers will use a combination of didactic teaching, live demonstrations, video, and breakout group practice to enhance skill-building.
Answers to More Great Questions from Listeners Like YOU!
Kevin asks: After your initial improvement from treatment or from reading your book, Feeling Good, what can one do moving forward to give yourself “booster shots?”
Umatsagir asks a related question: I feel great right after reading your book, Feeling Good, but the effect diminishes over time. What should I do?
Umatsagir also asks: Is there an anxiety masterpiece equivalent of your book, Feeling Good?
Kyle asks: What can I do, as a therapist, about the passive patient who just shrugs when I ask what he wants to work on, and says, “My Mom thinks I should come to see you.” When I try to dig deeper to try to find out what patients like this want help with, I run into resistance and then they typically drop out of therapy. What should I do?
Benjamin asks a somewhat related question: How do you treat chronic laziness? In your book, Feeling Good, you call this “Do-Nothingism,” which is a lack of motivation that you often see in depression. In your book, you talk about ten different types of procrastination, with a different approach for each. If the patient feels overwhelmed by many things he or she is procrastinating on, how can you help that person, since he or she probably can’t do the psychotherapy homework, either! It’s a Catch-22, since they cannot find the motivation to do anything, but have to do the homework to improve!
Jim asks another related question: How about doing a podcast on psychotherapy homework? “What do you have your patients do for homework? This is particularly important since I have 45 minute sessions and can only see my patients for 45 minutes every two or three weeks.”
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.
The Final Five Therapist Errors (in no particular order)
This concludes our three-part series on Common Therapist Errors. I hope you’ve enjoyed it, and I apologize in advance if any of the ideas I’m proposing in today’s podcast seem “over the top” or simply off base.
I teach with great passion, but I’m not always right! Fortunately, my esteemed host, Dr. Fabrice Nye, challenges me quite a bit, and he is almost always right. Hopefully, you will enjoy our dialogue and the chance to think a bit more critically about psychotherapy.
And when you find I’ve made an error, or said something offensive to you, I hope you will put it in perspective. I’m kind of a mixed bag, to be honest. I believe I have a lot to offer, but I’ve got tons of flaws, too! I fight my flaws, but not always with success.
For better or worse, here are today’s therapist errors!
1. Confusing psychoeducation with psychotherapy. Pyschoeducation can be helpful, but it’s rarely curative. Effective psychotherapy requires much more.
Here are some examples of helpful psychoeducation:
Teaching people about the list of ten common cognitive distortions from David’s book, Feeling Good: The New Mood Therapy
Teaching people how to pinpoint their negative feelings at any moment in time using David’s Daily Mood Log
Teaching people that your thoughts, and not external events, create all of your positive and negative feelings
Explaining the Five Secrets of Effective Communication
etc. etc. etc.
Psychotherapy means helping people CHANGE the way they think and feel, or helping people develop more loving and satisfying personal relationships. That requires a great deal of therapeutic skill and hard work on the part of the patient–during sessions and between sessions. it also requires a warm and trusting therapeutic alliance.
2. Belief in Gurus. Believing that the individuals who start schools of therapy are nice and well-balanced individuals! David describes conversations with the late Albert Ellis, PhD, who argued that many, and arguably most, are incredibly narcissistic and manipulative. Sometimes, individuals who appear incredibly charming and brilliant and inspiring have a dark underbellies they are keeping hidden!
David argues that it might be more desirable to have a science-based, data driven, systematic approach to psychotherapy, as opposed to a field dominated by therapeutic schools, which sometimes function almost like competing cults.
3. Reverse / “backward” statistical reasoning. Most therapists who work with patients with Borderline Personality Disorder as well as Multiple Personality Disorder, as well as patients who are prone to violence, believe that childhood trauma, deprivation, or abuse is the main cause of these problems. They believe this because patients with those diagnoses frequently describe traumatic experiences in their past, so they assume those experiences caused the patient’s disorder.
This is a statistical and conceptual error, because most individuals who experienced traumas when growing up never developed Borderline Personality Disorder or Multiple Personality Disorder. This is not to say that traumas are unimportant—traumatic experiences at any phase of life can be very damaging. What this DOES mean is that most psychiatric problems have other causes.
What are those other causes? They are not known, for the most part.
This information is not easy for many people to accept. For example, I just found this statement on WebMd:
“As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood (usually before age 9).”
“Several studies have shown that a diagnosis of BPD is associated with child abuse and neglect more than any other personality disorders [7, 8], with a range between 30 and 90% in BPD patients [7, 9].” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472954/
The same source also stated that:
“. . . Widom and collaborators [12] followed 500 children who had suffered physical and sexual abuse and neglect and 396 matched controls, and they observed that . . . the presence of a risk factor, such as adverse childhood events, was not necessary or sufficient to explain the reason why some individuals developed BPD symptoms in adulthood, whereas others did not.”
If you are interested, you can find the references to these studies at the end of this blog.
Here is one way of understanding this error. Childhood sexual abuse is far more common in the population (typically estimated in the range of 15% of men and 25% of women), and if you add childhood trauma or neglect, these percentages in crease even more. AT the same time, the incidence of Borderline Personality Disorder or Dissociative Identity Disorder are typically estimated around 1%. That means that most individuals who have experienced childhood sexual abuse, neglect or trauma do not develop these disorders.
I do not in any way mean to minimize the importance of trauma, sexual abuse or neglect. The impact of these experiences can be profound and can include physical as well as psychological problems.
My only point, and perhaps it is an overly humble one, is that we simply do not know the causes of most (or any) of the problems listed in the DSM5 (Diagnostic and Statistical Manual of the American Psychiatric Association.) I think it is great that we have many treatments that can be helpful and effective for individuals, but it might not further our cause to jump to conclusions about the causes of things based on what we see before our eyes when we are doing clinical work.
Sometimes, seeing is believing, but sometimes, our “seeing” can be misleading.
I hope I have not offended anyone!
4. Believing in Mental Disorders. Do the so-called Mental Disorders” described in the DSM actually exist? Or are they simply the fabrics of our imagination?
Years ago, Thomas Szasz, a psychiatrist and psychoanalyst, wrote a popular and controversial book called The Myth of Mental Illness, in which he claimed that mental disorders do not exist. David argues that Szasz was only partially right. Most of what we see in the DSM are simply arbitrary constructs, and not real “disorders.” For example, most people worry about things from time to time. Worrying is unpleasant but normal, and there is a wide range of worrying in the population. Some people rarely worry, and some people almost constantly worry, and most of us are in-between.
The American Psychiatric Association will take the group who worry the most, and give them a label of “Generalized Anxiety Disorder.” But there is no such “thing.” It is not a real brain disorder. The same problem afflicts a great many of the so-called “disorders” listed in the DSM. These are problems, not brain disorders.
However, there are several real brain disorders, such as schizophrenia, Bipolar I Manic-Depressive Illness, and Alzheimer’s Disease. These are disorders of brain tissue or wiring, and are not simply variants of normal human behavior or experience.
When I work with individuals, I measure the severity of symptoms and say things like this, “Jim, I can see you tend to be very shy (or depressed or anxious, or whatever.)” I do not say, “Jim, I want you to know you have a brain disorder called “Social Anxiety Disorder,” because I feel that is potentially upsetting to the patient and not really “true.” In addition, shyness can be fairly easily treated in most cases without medication.
Most non-MD therapists do not make the mistake of confusing symptoms with “mental disorders.” It seems likely to me (David) that psychiatrist are more likely to make this mental error, since psychiatry, as I understand it, is emulating the medical model of diagnosis followed by medication treatment or some other kind of biological intervention.
5. Ignoring a Diagnostic Evaluation. Most therapists skip a formal diagnostic evaluation, because the DSM is so difficult to work with, and since a formal diagnostic interview can be frustrating and time-consuming. And, as I pointed out in my discussion of the previous error, it is somewhat misleading to tell patients they have mental disorders, like “Generalized Anxiety Disorder” or “Social Anxiety Disorder,” when, in reality, the patient is simply shy or has a tendency to worry a lot.
And yet, there can be significant negative consequences of NOT doing a thorough initial evaluation of the patient’s many symptoms, since you can easily overlook something important, like drug or alcohol abuse, or suicidal or violent urges in new patient.
The EASY Diagnostic Survey provides a fresh and helpful option. patients can complete it on their own, between sessions, and it automatically diagnoses more than 50 of the most common “disorders” in DSM5. Then the therapist can review it during a session and assign the diagnoses in less than ten minutes in most cases.
This provides the therapist with an accurate map of the patient’s problems. You do not have to think of them as a variety of “mental disorders,” but rather as areas of suffering and difficulty. I don’t tell myself I’m treating “Generalized Anxiety Disorder,” but rather treating a human being who is troubled by constant and excessive worrying–and fortunately, that is very treatable!
Therapists who are interest in purchasing a license to use the EASY in your clinical work can check this link.
Thanks!
David
Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world (but not across U.S. state lines) 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
Dr. Jill Levitt and I are offering what I think will be an outstanding workshop on the treatment of unwanted habits and addictions on Sunday, February 10. Our Sunday workshops are tremendously fun, so consider attending if you are interested. We quickly sold out in-person but you can still join online.
THERE WILL BE MANY EXPERTS TRAINERS TO GUIDE THE ONLINE GROUP IN THE SMALL GROUP EXERCISES
During the program, you will have the chance to work on one of your own habits / addictions so you will get the double benefit of learning cool new treatment techniques and doing some personal healing at the same time!
You will develop a deeper understanding of Outcome and Process Resistance, and you will learn how to deal with this twin-horned Devil. As you know, TEAM-CBT features many innovative techniques to reduce Outcome and Process Resistance.
Here’s the BAD news. Very few therapists have the skills, insights, or mind-set to deal with resistance, and this is the main cause of therapeutic failure in the treatment of depression, anxiety disorders, relationship problems, and habits and addictions.
Here’s the GOOD news. Once you acquire these skills, your clinical effectiveness will soar!
Here are the specifics–
Coming Soon!
Act fast if you want to attend!
Don’t miss out learning from David Burns, MD, one of the great pioneers of Cognitive Therapy, and from the fabulous, Jill Levitt, PhD, Director of Training at the Feeling Good Institute in Mt. View, CA!
TEAM-CBT Methods for Unwanted Habits and Addictions: Step-by-Step Training for Therapists
WHEN: February 10th, 2019, 8:30 am – 4:30 pm PST (11:30 am-7:30 pm EST)
WHERE: Join us live online or in person at the Creekside Inn, Palo Alto, CA.
HOW MUCH DOES IT COST? $135,
WILL I GET CE CREDITS? YES! 7 CE hours available
WILL I GET CREDIT IN THE TEAM LICENSURE PROGRAM? YES! Completion of this workshop also counts towards TEAM-CBT Level 1, 2 or 3 Certification
WHO CAN ATTEND? Therapists of all levels are welcome
CAN I REGISTER IF I’M NOT A THERAPIST? In my opinion (Dr. Burns), although the workshop is geared for therapists, it will be taught in a clear and basic way that anyone can benefit from. Please check with the Feeling Good Institute if you want to attend.
CAN I WORK ON MY OWN HABIT / ADDICTION? Absolutely! Heal yourself, heal your clients!
WILL I HAVE FUN? Yes!
You will also:
Learn new skills to reduce resistance and boost the motivation to change. This is THE key to the treatment of any habit or addiction.
Learn how to use Dr. Burns’ powerful Decision-Making Tool and Triple Paradox Technique.
Practice and master the Devil’s Advocate Technique to help you and your patients overcome difficult-to-stop habits and addictions to drugs, alcohol, overeating, procrastination, and more.
You will love this lively, amusing, and immensely useful day of training with Drs. Burns, Levitt and the Feeling Good Institute Staff. The trainers will use a combination of didactic teaching, live demonstrations, and breakout group practice to enhance skill-building.
This wonderful workshop will stream live and is easily accessible from anywhere in the world on any device with WiFi. To join, just click on the link provided before the workshop.
If you can’t join us for the addictions workshop, consider this cool program on the treatment of anxiety disorders in the spring. But register soon if you want to attend in person, as the in person slots are limited.
I was concerned that our recent “Ten Most Common Therapist Errors” show might antagonize people, but we got quite a lot of positive and encouraging feedback from listeners, which was surprising to me. As a result, Fabrice and I decided to take a chance and publish two more shows on common therapist errors this week and next week. We hope you like these shows!
Make sure you let us know what you think, and let me apologize in advance if I come across as annoying or overly cynical. All of the errors I describe are correctable; the goal is to improve the treatment of individuals struggling with depression, anxiety, troubled relationships, or habits and addictions. Thanks!
Here are the five errors discussed in today’s show.
1. Failure to hold patients accountable. Example, the therapist may let the depressed patient slip by without doing psychotherapy homework, since the patient insists he or she doesn’t have enough time or motivation to do the homework; or the therapist may agree to treatment an anxious patient without using exposure, since the patient may resist exposure; or a patient may treat someone with a relationship conflict without exploring the patient’s role in the problem, and so forth.
David argues that this rarely or never leads to significant change, much less recovery. However, many therapists, and perhaps most, get seduced into this error for a variety of reasons.
2, The “corrective emotional experience.” This is the belief that the patient’s long-term relationship with the therapist will be sufficient for growth and recovery, without having to do any psychotherapy homework or be accountable. Therapist may imagine himself or herself as the loving and nurturing parent the patient never had.
David argues that this caters to the therapist’s ego and feeds into what the patient wants as well—a long-term relationship built on schmoozing.
But does it lead to recovery?
Here’s David’s short answer: Nope! Warmth, empathy, and trust are necessary ingredients for good therapy, but they are simply not sufficient. Your patient may think you’re the most wonderful and supportive listener in the world, but that will rarely or never lead to recovery from depression, an anxiety disorder, or an addiction, and it will not lead to the skills to heal troubled relationships, either.
3. Responding defensively to patient criticisms. David argues that therapists almost always react defensively to criticisms by patients, such “you don’t’ get me,” or “you aren’t helping,” or “you don’t really care about me.” He describes an interesting five-year study of psychoanalysts in Atlanta, Georgia, sponsored by the National Institute of Mental Health (NIMH), to find out how the analysts responded to patient criticisms. You may find the results surprising!
He gives an example of defensive responding during a workshop he conducted at a hospital in Pennsylvania. Therapists can learn to correct this error with lots of practice with the Five Secrets of Effective Communication, but this requires several things:
Using the Patient’s Evaluation of Therapy Session after each session so can quickly pinpoint empathy / relationship failures.
Lots of practice with the Five Secrets.
Humility, and the willingness to see the world through the eyes of the patient. This requires the “Great Death” of the therapist’s ego!
4. Joining a school of therapy and treating everything with the same method or approach. Can you imagine what it would be like if medicine was organized like this, with “schools of therapy,” like the “penicillin school”? David apologetically argues that the abolition of all schools of therapy would be a good thing. Fabrice disagrees, and argues that the treatment of psychological problems is inherently different from the treatment of medical disorders.
Let us know what YOU think!
5. Confirmation paradox. I (David) majored in the philosophy of science in college, and this was one of the first topics, and it definitely applies to our thinking about the causes of emotional problems. I’ll try to make it really simple and understandable.
Here’s the essence of this error. If I have a theory that predicts the patient’s behavior you may conclude that your theory is correct. But this logic can be very misleading. Here’s a general science example
Your theory: the sun circles around the earth.
Your prediction: if my theory is true, the sun will come up in the east each morning and set in the west each evening.
Your observation: the sun DOES come up in the east and set in the west, exactly as predicted.
Your erroneous conclusion: the sun circles around the earth.
Now let’s consider a psychotherapy example. Many therapists believe that perfectionism and insecurity result from growing up with parents who emphasized hard work and high standards as a precondition for being loved. Now let’s assume that you have a perfectionistic and insecure patient who remembers feeling like s/he wasn’t good enough when growing up. So, you conclude that the patient’s interaction with demanding parents caused the perfectionism and insecurity.
But the perfectionism and insecurity may not have resulted from any childhood experiences or interactions with parents. It may have been strongly influenced by genetic factors, or social / environmental pressures.
We can put this in the same framework as the example about the sun:
Your theory: Perfectionism and insecurity result from growing up in unloving families that emphasized high standards and achievement rather than unconditional love and nurture.
Your prediction: Insecure, perfectionistic patients will report childhood experiences with unloving parents who pushed them to work harder, etc.
Your observation: Your insecure, perfectionistic patients DO describe their parents as demanding and lacking in love and support.
Your erroneous conclusions: The patient’s childhood experiences caused the perfectionism. 2. The patient will have to “work through” these childhood experiences if s/he wants to overcome the feelings of perfectionism and insecurity.
Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world (but not across U.S. state lines) 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
Dr. Jill Levitt and I are offering what I think will be an outstanding workshop on the treatment of unwanted habits and addictions on Sunday, February 10. Our Sunday workshops are tremendously fun, so consider attending if you are interested. We quickly sold out in-person but you can still join online.
THERE WILL BE MANY EXPERTS TRAINERS TO GUIDE THE ONLINE GROUP IN THE SMALL GROUP EXERCISES
During the program, you will have the chance to work on one of your own habits / addictions so you will get the double benefit of learning cool new treatment techniques and doing some personal healing at the same time!
You will develop a deeper understanding of Outcome and Process Resistance, and you will learn how to deal with this twin-horned Devil. As you know, TEAM-CBT features many innovative techniques to reduce Outcome and Process Resistance.
Here’s the BAD news. Very few therapists have the skills, insights, or mind-set to deal with resistance, and this is the main cause of therapeutic failure in the treatment of depression, anxiety disorders, relationship problems, and habits and addictions.
Here’s the GOOD news. Once you acquire these skills, your clinical effectiveness will soar!
Here are the specifics–
Coming Soon!
Act fast if you want to attend!
Don’t miss out learning from David Burns, MD, one of the great pioneers of Cognitive Therapy, and from the fabulous, Jill Levitt, PhD, Director of Training at the Feeling Good Institute in Mt. View, CA!
TEAM-CBT Methods for Unwanted Habits and Addictions: Step-by-Step Training for Therapists
WHEN: February 10th, 2019, 8:30 am – 4:30 pm PST (11:30 am-7:30 pm EST)
WHERE: Join us live online or in person at the Creekside Inn, Palo Alto, CA.
HOW MUCH DOES IT COST? $135,
WILL I GET CE CREDITS? YES! 7 CE hours available
WILL I GET CREDIT IN THE TEAM LICENSURE PROGRAM? YES! Completion of this workshop also counts towards TEAM-CBT Level 1, 2 or 3 Certification
WHO CAN ATTEND? Therapists of all levels are welcome
CAN I REGISTER IF I’M NOT A THERAPIST? In my opinion (Dr. Burns), although the workshop is geared for therapists, it will be taught in a clear and basic way that anyone can benefit from. Please check with the Feeling Good Institute if you want to attend.
CAN I WORK ON MY OWN HABIT / ADDICTION? Absolutely! Heal yourself, heal your clients!
WILL I HAVE FUN? Yes!
You will also:
Learn new skills to reduce resistance and boost the motivation to change. This is THE key to the treatment of any habit or addiction.
Learn how to use Dr. Burns’ powerful Decision-Making Tool and Triple Paradox Technique.
Practice and master the Devil’s Advocate Technique to help you and your patients overcome difficult-to-stop habits and addictions to drugs, alcohol, overeating, procrastination, and more.
You will love this lively, amusing, and immensely useful day of training with Drs. Burns, Levitt and the Feeling Good Institute Staff. The trainers will use a combination of didactic teaching, live demonstrations, and breakout group practice to enhance skill-building.
This wonderful workshop will stream live and is easily accessible from anywhere in the world on any device with WiFi. To join, just click on the link provided before the workshop.
If you can’t join us for the addictions workshop, consider this cool program on the treatment of anxiety disorders in the spring. But register soon if you want to attend in person, as the in person slots are limited.
Do you have trouble saying “no”? Lots of people do—and it can sometimes get you into trouble.
In spite of many best-selling books on assertiveness, like Manuel J. Smith’s classic book, “When I Say No I Feel Guilty,” many people still have trouble saying no. For example, you may have led someone on in a romantic relationship because you were afraid of saying no and breaking the other person’s heart. Or, you feel burned out, because you’re always giving, giving, giving because you can’t—or won’t—say no. Or, you may end up hopelessly over committed at work, putting in long hours and feeling secretly used and resentful, because you don’t know how to say no.
Sound familiar?
In this Podcast, Fabrice and David interview Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mt. View, California. Jill confesses that she sometimes has trouble saying no—to new referrals when her practice is full, to her family, who she loves tremendously, as well as colleagues who request this or that. David admits he sometimes has similar problems.
There are lots of reasons why you may have trouble saying no. Some are negative, but some are actually positive, including:
Conflict phobia. You are afraid that if you say no, the other person will get angry and annoyed with you.
Fear of disapproval or rejection. You are afraid that if you say no, the other person will judge you, disapprove of you, or reject you.
Perceived narcissism. You believe that other people will lash out if you don’t give in to their demands.
Submissiveness. You believe that your role in relationships is to make others happy, even at the expense of your own needs and feelings.
Joy / Love. Jill confesses that she often says yes to this or that request because she feels it will be fun, or because she doesn’t want to let the other person down. One example would be baking brownies for her sons when she’s exhausted. One consequences would be giving in, but resenting the person she’s saying yes to.
Guilt. You may feel that if you say no, it means that you are somehow “bad,” and that it’s your duty to please other people.
Achievement addiction. You say yes to almost everything because you think this or that activity will make you more productive and successful.
Fabrice, Jill and David discuss many strategies for overcoming this problem, including:
Empathy–as a therapist, you always want to start with empathy, without trying to “help.”
Motivational strategies such as the Paradoxical Cost-Benefit Analysis, Positive Reframing, or even the Straightforward Cost-Benefit Analysis. This is crucial to find out if patients really want to change before using methods to help them become more assertive.
Punting. This is a delay strategy that David uses to get himself off the hook when feeling ambivalent about a request. For example, you can say, “I’m really pleased and honored that you’ve invited me to do X. I’m going to check with my schedule and see what might be possible, and I’ll get back to you.” Then, he has a day or two to work up the courage to say “no” in a kindly way.
Write down your Negative Thoughts. when you’re feeling compelled to say yes because you’re feeling anxious or guilty, Ask yourself, “What am I telling myself?” Those thoughts will nearly always be distorted. Then ask yourself how you could challenge and talk back to those thoughts.
Fabrice, Jill and David also discuss how to say no effectively and demonstrate this skill in a role-play with Jill that is surprisingly challenging!
They also demonstrate the Feared Fantasy, a powerful technique to help patients say no, using Jill’s example. Her worst fear is that if she says no to colleagues, they will:
Feel disappointed.
Become angry and demanding.
Will say they won’t work with her in the future if she says no.
Will say they’ll get someone else to do whatever it is, and that Jill will miss out on all the fun.
David and Fabrice play the role of colleagues from hell who put demands on Jill to do another podcast and then get upset when she tries to say no. The dialogue is quite entertaining and dynamic, and Jill finds it helpful, though anxiety-provoking.
They also describe the importance of giving patients homework to actually say no between sessions to requests that are excessive or inappropriate.
Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world (but not across U.S. state lines) 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.
Answers to Great Questions from Listeners Like YOU!
Dylan asks: Do you believe in Freud’s “secondary gain,” in which patients resist change because they benefit from their symptoms?
Juleann asks: Is Seasonal Affective Disorder (SAD) a real thing?
Ismail asks: Should I use the Daily Mood Log just when I’m upset, or at the end of the day, or when? Do I have to stop what I’m doing when I get negative thoughts so I can write them down and work on them?
Abe asks: What about negative thoughts that are valid? For example, I was interested in astronomy and physics as a teenager, but my SAT scores showed I had no aptitude for a career in these areas.
Kevin asks: Can positive flooding be used to change the object of our desires—for example, our sexual desires, like the man in one of your books who had lost sexual interest in his wife?
Valentina asks: Where do cognitive distortions come from? Our parents? Our genes? Societal messages?
Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world via teletherapy (but not across U.S. state lines). 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.
This is David and Fabrice’s top ten list for the worst errors therapists make.
1. Failure to Measure (symptoms, empathy and helpfulness). Research shows that therapists’ perceptions of how their patients feel, or feel about them, are not accurate.
TEAM therapists measure symptom severity at the start and end of every therapy session with brief accurate scales that assess depression, suicidal urges, anxiety, anger, relationship satisfaction, and happiness. This allows therapists to see, for the first time, exactly how effective or ineffective they are in every single therapy session. This can be threatening to the therapist’s ego, but has revolutionized clinical practice.
In addition, TEAM therapists assess the patient’s perception of therapist warmth, empathy, understanding, and helpfulness after every single session. The scales are extremely sensitive to therapist errors, and most therapists receive mostly failing grades from their patients initially when they use these scales, which can be a shock to the system! But dialoguing with the patient about the scores at the next therapy session can lead to breakthroughs in the clinical work and dramatic improvements in the quality of the therapeutic alliance.
2. Trying to help, “save,” “rescue” or “reassure” patients. Most therapists are addicted to this, but it simply triggers resistance. When therapists push in their efforts to help, most patients will push back. No one likes to be “sold” on anything. When patients are hurting, they want to be heard, not saved.
In TEAM we do Paradoxical Agenda Setting before trying to “help.” We emphasize, in a respectful way, all the really GOOD reasons NOT to change. We also highlight what the patient’s symptoms, such as shame, depression, panic, defectiveness, hopelessness and anger, show about him or her that’s positive and awesome, Then we raise the question: “Given all those positives, why in the world would you want to change?”
This strategy has led to breakthroughs in treatment, and I now see recovery from depression and anxiety at rates I would have impossible ten or fifteen years ago.
3. Reverse Hypnosis.
Depressive hypnosis. The patient persuades the therapist that s/he really is worthless, inferior, and hopeless, and the therapist false into a trance and believes it! This dooms the therapy.
Anxiety hypnosis. The patient persuades the therapist that s/he is to fragile to use exposure, or that the exposure is too dangerous, and the therapist buys right into it! This also dooms the therapy. Recovery from anxiety is more or less impossible without exposure.
Relationship hypnosis. The patient persuades the therapist that s/he is the victim of some other person’s bad behavior, and that the other person is entirely to blame for the relationship conflict. Therapists almost always buy this message, and this also dooms the therapy.
4, Believing therapy must be slow and last a long time. This is taught in most graduate school programs, and tends to function as a self-fulfilling prophecy. I met a famous psychoanalyst who was proud that most of her patients had been in therapy for more than ten years, and a few were just now making baby steps, she said, toward change.
With TEAM, I usually see a complete elimination of symptoms at the first therapy session, although it has to be a double session (two hours). In addition, the recover usually occurs in a burst, all at once, in just a few seconds, or in several sudden orbital leaps during the session.
5. Believing that the purpose of therapy is to get in touch with your feelings (Emotional Reasoning). This message has been pushed for years, and was the basis of my training. The idea was that people bottle up their feelings, like anger, and then it comes out as depression. The message is still pushed today!
I’ve never seen much validity in this point of view. People can express their anger, their panic, and their feelings of worthlessness until the cows come home, but they’ll still be just as angry, panicky, and they’ll still feel worthless!
There is at least one notable exception to this rule. Most anxious patients are exceptionally “nice” and sweep their feelings under the table. Then the feelings come out indirectly, as OCD, panic attacks, GAD, or a phobia, or even as somatic complaints such as chronic pain, fatigue, or dizziness. Bringing the suppressed feelings to conscious awareness and expressing them is the basis of my Hidden Emotion Technique, and it often leads to a sudden and complete recovery from any form of anxiety.
6. Confusing your own feelings for how the patient feels. This is a psychoanalytic error. I read an article on the psychoanalytic view of empathy, which was defined as the analyst’s feelings when in the presence of the patient. This is a misguided and almost delusional notion. The analyst’s feelings are the complete creation of the analyst’s thoughts! And those thoughts will often be distorted and completely misleading.
Therapist’s perceptions of how their patients feel are less than 10% accurate if you put it to an empirical test! If you ask patients, “How are you feeling right now,” and you ask therapists the exact same question, “How is your patient feeling right now,” the therapist’s answer will usually be way off base.
The only way to find out is to use assessment instruments at the start and end of each session, like I described in the first answer above, on failure to measure.
7. Believing therapists should never express their feelings. I was trained never to reveal how I was feeling. But when you think about, that’s nutty! How can we validly encourage our patients to be more genuine and open with their feelings if we are hiding our own at the same time? Of course, there is an art form in how to share your feelings during therapy. It is a high skill, requiring training, and one that can lead to more human and effective treatment.
8. Believing that you are an expert and know the causes of things, and why patients think, feel, or behave as they do. The causes of all psychiatric disorders are unknown. End of discussion. And yet, almost all therapists promote some fraudulent theory about causality. For example, what is the cause of depression?
There are lots of theories, but none has been confirmed, and almost all have been disproven. For example, there is no evidence whatsoever that depression results from a “chemical imbalance in the brain,” or from “anger turned inward,” and so forth. Those are just theories that someone made up.
I simply tell my patients that we don’t yet know the causes, but have really terrific treatment tools now for rapid recovery. That’s more than enough for the people I treat!
9. Confusing the process of therapy with a good outcome. For example, as a therapist, you could be doing really great job of listening, and give yourself high marks as a therapist because you believe in the importance of empathy, even though your patient is not improving.
Therapists have all kinds of things they’ve been trained to do, like hypnosis, or EMDR, or cognitive therapy, exposure therapy, or meditation, or an exploration of childhood traumas, or whatever it is you do and believe in. But if you’re not seeing rapid and dramatic recovery in your depressed and anxious patients, as documented with session by session testing, you’re not really “helping.”
10. Believing that insight will lead to change. This has only happened once in my career! It was a woman who discovered that she thought she always had to be submissive servant in intimate relationships. Not surprisingly, she always felt burned out and broke up with her partners after a while. She said that the discovery of this pattern when we did the Interpersonal Downward Arrow Technique during our first and only session transformed her life.
But usually, much more will be required. That’s why I have developed 50 methods to help patients change the way they think, feel, and behave. Correction—I have recently developed 51 additional powerful techniques, so now we have 101 ways to untwist your thinking so you can enjoy greater happiness, intimacy, and productivity!
Now, here’s the 60 thousand dollar question. Can therapists learn to stop making these errors? In most cases, the answer is NO! It’s not so much a problem with intelligence or aptitude, although those are important factors, but it has to do with motivation. Many therapists simply do not want to change, and are committed to what they’re already doing, in much the same way that people are committed to their religious beliefs, which they are unwilling to challenge.
That’s why it is so much easier to train young therapists, whose minds are still open, as well as lay people who do not have so much prior “training” they have to overcome.
Well, that’s my cynical side coming out, and I apologize! Still, I think I’m right for the most part.
Hey, if you liked my rant, I have at least five more common therapeutic errors on my list, so let Fabrice and me know if you’d like to hear about therapist errors in a future podcast. In addition, if you’d like to add to our list of therapist errors, let us know what your “favorite” (or most annoying) therapist error is!
Thanks!
david
Dr. Fabrice Nye currently practices in Redwood City, California and also works with individuals throughout the world via teletherapy (although not across U.S. state lines). 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.
In today’s show, Fabrice and David focus on this question: How can you get rid of Self-Defeating Beliefs?
Although any of the 100 + TEAM-CBT methods can be used to modify an SDB, four methods will be highlighted in today’s show.
Cost-Benefit Analysis
Semantic Method
Experimental Technique
Feared Fantasy
For more information on how to change SDBs, you might want to watch the extremely popular David and Jill FB Live show on Overcoming Perfectionism (recorded on November 11, 2018).
What research has been done on SDBs?
This topic was not discussed in the show, but individuals with an interest in research might want to read David’s study with Dr. Jackie Persons on the causal connections between depression and SDBs about dependency (attachment) as well as achievement (perfectionism) in several hundred patients in Philadelphia during the first 12 weeks of their treatment at David’s clinic.
The study confirmed That both types of SBS were significantly correlated with depression severity at intake and at the 12-week evaluation. In addition, changes in depression were correlated with changes in SDBs. However, a sophisticated statistical analysis with structural equation modeling techniques did not confirm that SDBs had causal effects on depression, or that depression had causal effects on SDBs. Instead, SDBs and feelings of depression appeared to share an unknown common cause.
Persons, J. B., Burns, D. D., Perloff, J. M., & Miranda, J. (1993). Relationships between symptoms of depression and anxiety and dysfunctional beliefs about achievement and attachment. Journal of Abnormal Psychology, 101(4): 518 – 524.
Dr. Fabrice Nye currently practices in Redwood City, California and also works with individuals throughout the world via teletherapy (although not across U.S. state lines). 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.
