“I’m a failure. . . I’m not good enough. . . My life will be empty and meaningless without . . . “
Sound familiar? Sometimes, the messages we get from society, and the impossible standards that we accept, can lead to enormous, intense suffering.
Several months ago I received a compelling email from a young woman named Daisy who asked about the message we get from society that lead to suffering. Fabrice and I were so inspired that we devoted an entire Feeling Good Podcast to it (Podcast 038: Negative Messages from Society) The theme of the podcast, as well as the three subsequent podcasts, was how to pinpoint and modify the Self-Defeating Beliefs (SDBs) that lead to depression, anxiety, and relationship problems.
At the time, I did not know who Daisy was, and was not aware that she was living in this area. Now, Fabrice and I are thrilled and honored to present an entire TEAM-CBT therapy session with Daisy, along with her husband Zane.
The focus of the session was a problem that many young couples face–infertility. In spite of heroic, costly, and exhausting efforts to conceive using IVF (in vitro fertilization), Daisy and Zane have still not been blessed with a pregnancy. And Daisy is finding herself between a cognitive rock and a hard place. She is suffering, on the one hand, from intense feelings of failure, shame, and inadequacy because she has not yet become pregnant. But at the same time, she has mixed feelings about having children, and feels that if she can find happiness with children, she will be ostracized by society and seen as some kind of oddball.
Daisy’s scores on the Brief Mood Survey, which she completed just before the session began, indicated mild to moderate depression, severe anxiety, mild anger, and a profound loss of pleasure and satisfaction in her life–indicating an almost complete absence of any strongly positive feelings.
Daisy brought a partially complete Daily Mood Log to the session. The upsetting event she recorded at the top was “four years of infertility; three years of failed treatment. Daisy mentioned that a fifth upcoming trial with IVF was planned in a couple weeks, and that she was feeling intense anxiety. The negative feelings she circled on the Daily Mood Log, plus her intensity estimates, included:
- sad, blue, depressed, down, unhappy: 90%
- anxious, worried: 100%
- ashamed: 70%
- inferior, worthless, defective, incompetent: 100%
- lonely, alone: 70%
- hopeless, discouraged, pessimistic, despairing: 100%
- thwarted, defeated: 90%
As you can see, all of these feelings intense. These feelings did not result from the real problem, the infertility, but rather from Daisy’s Negative Thoughts about the problem, including:
- My life will be empty and meaningless without children. 90%
- People with children live happier and more fulfilling lives. 100%
- I am defective and inferior to people who can have children. 70%
- I’m missing out on the most important part of life. 100%
- If this treatment doesn’t work, my life will be a failure. 80%
- I should have done more in my career, given that I don’t have kids. 100%
- Without children, there isn’t much to look forward to. 100%
- It’s unfair that this treatment doesn’t work for us. 70%
- I’m a disappointment to my family. 80%
- If I don’t want kids, that means there is something wrong with me. 100
As you listen to the session unfolding, Dr. Burns reviews the T = Testing, followed by E = Empathy. Dr. Burns uses the Five Secrets of Effective Communication to acknowledge Daisy’s tremendous pain, without trying to save, help, or rescue her. Then he uses several Paradoxical Agenda Setting techniques to melt away any potential resistance to change, including the Miracle Cure Question, the Magic Dial, Positive Reframing, and the Magic Dial. She decides she wants to dial down her negative emotions to much lower levels, without necessarily making all of them disappear completely. Then Daisy and David complete the “% Goal” column on the Daily Mood Log, indicating the ideal level for each type of feeling that she hopes to achieve by the end of the session.
- sad, blue, depressed, down, unhappy: 90% / 30%
- anxious, worried: 100% / 30%
- ashamed: 70% / 10%
- inferior, worthless, defective, incompetent: 100% / 5%
- lonely, alone: 70% / 20%
- hopeless, discouraged, pessimistic, despairing: 100% / 40%
- thwarted, defeated: 90% / 40%
As you can see, she wanted to reduce some of her feelings dramatically, such as shame, inferiority, and loneliness, and wanted to reduce other feelings moderately, including depression, anxiety, hopelessness, and feeling defeated.
At this point David and Daisy used the Downward Arrow Technique to pinpoint the underlying beliefs that were triggering this problem, starting with a new Negative Thought that popped into Daisy’s mind:
- If the IVF doesn’t work, we won’t have kids, we won’t have kids coming home for holidays and milestones–it will just be the two of us.
- Then our lives will be lacking connection.
- Then our lives won’t be meaningful.
- Then there would be no purpose in life.
As you can see, these chain of negative thoughts reveals at least two Self-Defeating Beliefs:
- A woman must have children to have a purposeful, meaningful, rewarding life.
- You must have a meaningful, purposeful life to feel happy and fulfilled.
Then David and Daisy use a variety of M = Methods to help Daisy challenge her negative thoughts, as well as these underlying beliefs, starting with the first negative thought, “My life will be empty and meaningless without children.” The Methods included Identify the Distortions, Examine the Evidence, the Paradoxical Double Standard Technique, the Externalization of Voices with role-reversals, and the Acceptance Paradox as well as the Self-Defense Paradigm.
Fabrice noticed that at one point David switched from the Paradoxical Double Standard to the Acceptance Paradox, and then went back to the Paradoxical Double Standard before switching to the Externalization of Voices for a second chem. David explains his strategy.
At the end of the session, which lasted less than two hours, Daisy was dramatically improved. If you review her completed Daily Mood Log here, you will see that she achieved or exceeded all of her emotion-reduction goals for the session. In addition, her end-of-session scores on the Brief Mood Survey indicated dramatic reductions in depression, anxiety and anger, an a huge boost in Positive Feelings. On the Evaluation of Therapy session, she gave David perfect scores on the Empathy and Helpfulness scales, and indicated what she liked least and most about the session.
What she liked the least: “It took me a while to reveal my ambivalence about having kids.”
Actually, David overlooked this as well until half way through the session, and this did make for a kind of turning point in the session. Things seem to get more immediate and real at that point.
What she liked the best: “I feel completely different–more hopeful, less anxious, and less despairing.”
Fabrice and I are deeply grateful to Daisy and Zane for allowing us to share their story with you. Although the facts of your life are likely to be very different, you may also sometimes feel down or inadequate because you, too, have not measured up to some “requirement” based on messages from society. And perhaps Daisy’s experience can inspire you to break out of your own inner prison as well, believing that you, too, are perhaps inferior, or “not good enough,” because of this or that flaw!
The next day, I received this email from Daisy:
I was planning to send you a thank you email, and you beat me to it. Thank you so much for taking the time to work with me on what has been an excruciating situation for years. Both Zane and I are extremely grateful for all the opportunities we have to spend time with you and learn from you. I actually thought it was amazing how quickly you were able to zero in on my ambivalence towards having children as well as the anger I have towards my mom and her expectations. It’s really hard for me to acknowledge either of those things, even to myself, and I thought it was so brilliant how you were able to pull those out so quickly.
There were so many “aha” moments for me last night but a couple really stand out. One was about self-compassion being the most important part of life. The other was about how it makes no sense to judge ourselves as “defective” in a global way. Those insights really hit me at a gut level last night. I’m sure I’ll be drifting out of enlightenment soon and am very grateful for your very generous offer to give me a tune-up, especially as we go through all these treatments again!
I will work on my Daily Mood Log and send it to you later this evening.
Also, many thanks to Fabrice for his insights and for making the recording possible!
I also received this wonderful email from Zane:
I also wanted to thank you for having us on the show. I really enjoyed hearing your views about what a “meaningful” life means (or doesn’t mean). It was my “aha” moment. I’ve often seen that way of thinking as a slippery slope, but only had a vague sense as to why. Hearing you describe it as a trap really made a lot of sense. Daisy and I were talking it over this morning and the thought occurred to me that meaning could often be defined as having enjoyment or interest (in one’s life or work). Therefore, looking to the world, a relationship, an experience, or a job, or [fill-in the blank] is a hidden should statement (e.g. “My life should be meaningful, and if it’s not, it’s not very good.”). Having this thought or belief kind of takes responsibility to make life fun and interesting off of oneself, and places it on external circumstances or others. Am I understanding this concept correctly?
I’m also grateful for the books and DVD you hooked me up with. And extra-large thanks to Fabrice the “Fab Man” for being the man behind the magic in orchestrating these podcasts!
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
At least one listener has had problems leaving an iTunes review from his i-phone, so Fabrice has created some simple to follow instructions if you need help.