Successful treatment requires the death of the therapist’s ego;
recovery requires the death of the patient’s ego.
Sorry to be super brief again today because I am currently in Canada on the second day of the four-day intensive. If you missed it this year, you can find an announcement for the annual San Francisco intensive at the bottom of this blog! It’s coming up in August so you still have time to register.
So, what’s the solution to yesterday’s puzzle?
One of the unique features of TEAM-CBT is that patients rate therapists in the waiting room immediately after the session is over, using the Brief Mood Survey and Evaluation of Therapy Session forms. Patients leave the completed surveys before they go home. This gives the therapist the chance to review the ratings when the session is still fresh in the therapist’s mind so he or she can find out how effective, or ineffective, the session was.
The Empathy and Helpfulness scales are extremely sensitive to the smallest errors or failures of the alliance, and most therapists will get failing grades from most of their patients when they first start to use the Brief Mood Survey and Evaluation of Therapy Session. This can be painful, as it bursts the therapist’s bubble of optimism and self-confidence.
But if you, the therapist, process the information with your patient at the start of the next session in the spirit of humility, warmth, and curiosity, it can have a tremendously beneficial effect on the treatment. I’ve experienced this amazing phenomenon more times than I can remember! But it can be very painful to have to face your errors and shortcomings. That’s because the patient’s criticisms of the therapist will always contain, not just a grain of truth, but a whole lot of truth!
Yikes! That sucks!
So, the death of the therapist’s ego will often be required. This, to me, is a good thing, because it gives therapists tremendous opportunities to grow and learn at the same time that their patients are growing and learning. But the negative feedback does hurt at times. And the pain can be fairly intense.
For the patient to recover, the death of the ego may also be required. A great deal of depression and anxiety results from the idea that we aren’t good enough, so we beat up on ourselves relentlessly, thinking perhaps that if we punish ourselves enough, we will grow and eventually attain some goal of perfection or superiority.
But this mind-set is the problem; it is not the cure. Recovery more often results from what I call the Acceptance Paradox–which means the death of the patient’s ego. That means accepting that you are, and always will be, quite flawed, and accepting this with a sense of inner peace, or even humor. In fact, once your ego has died, you can join the Grateful Dead, and that’s incredibly freeing and cool!
More later, and sorry to offer you so little in the last couple weeks. I’ve been working hard on the new book, so I’m kind of short on time, but there will be a ton on this topic when the book is released, so hang in there!
Hey, folks, my San Francisco summer intensives is nearly always my BEST training program of the year because the group is quite small, giving you lots of chances for Q and A and schmoozing. In addition, many individuals from my Tuesday group at Stanford join me to provide feedback during the small group exercises. Here are the specifics:
* * *
Coming in San Francisco in August
High Speed, Drug Free Treatment of Depression and Anxiety Disorders–
A Four-Day TEAM-CBT Advanced Intensive
August 6 – 9, 2018, South San Francisco Conference Center, California
For more information, click here
or contact http://www.iahb.org/
If you can only attend one of my workshops, consider this intensive! it is simplly
Seating is limited. Register now if you want to get in on the action!
Self-acceptance is the greatest change a person can make.
Sorry to be super brief today on such an important topic, but desperately pressed for time due to my upcoming trip next week for the Canada intensive. See below if you think you might want to attend! The intensives are usually great experiences. If you can’t make the Canadian intensive in July, think about the San Francisco intensive in August.
Some of us struggle with perfectionism, thinking we can become something GREAT if we just try hard enough and beat up on ourselves when we fall short or screw up. But this can sometimes be the cause of nearly all of our suffering.
Still, we don’t want to accept our flawed selves because we don’t want to “settle” for second best, because that sounds just awful! But when you accept yourself, that’s when the magic happens.
In my Stanford Tuesday training group last night, one of the participants revealed her fear of speaking up or role-playing a technique in group for fear she might not be “good enough,” and then feared that everyone in the group will judge or dislike her. Tears were flowing down her cheeks. Paradoxically, revealing her vulnerability made everyone feel incredibly close to her, and she set the tone for an evening of magical training. And all she did was to reveal her fears, flaws, and insecurities.
As many of you know, I learned an important lesson from my wonderful cat, Obie. He’s the one who taught me that “when you no longer need to be special, life becomes special!”
More later, sorry to offer so little right now. Obie and I deeply apologize!
This is the first several podcasts on the Role-Playing Techniques David has created. They include:
Externalization of Voices (with Acceptance Paradox and Self-Defense Paradigm)
Paradoxical Double Standard Technique
Man from Mars
David’s explains that he began developing role-playing techniques in the early days of cognitive therapy because many of the Beckian techniques, such as Examine the Evidence and the Socratic Technique–while sometimes very helpful, were sometimes a bit dry, and he wanted to include punchier and more powerful and dynamic techniques in his therapeutic toolkit. These role-playing techniques are just one part of what sets TEAM-CBT apart from traditional, Beckian CBT.
Today, he explains and demonstrates the Externalization of Voices, which is always combined with the Self-Defense Paradigm and the Acceptance Paradox. He is joined by Fabrice, of course, and “Sarah,” one of the members of his Tuesday training group at Stanford. Sarah has volunteered to use a personal example in the podcast to help demonstrate the Externalization of Voices.
Sarah has brought a partially complete Daily Mood Log to the session. The Upsetting Event was that Sarah has decided to move to Austin, Texas in two weeks. She has many moderately strong negative feelings about the move, including sadness (30), anxiety and nervousness (75), inadequacy (60), loneliness (75), self-consciousness, and discouragement (70). She also felt stuck and defeated (70). The numbers in parentheses indicate how strong each type of feeling was on a scale from 0 (not at all) to 100 (extremely.)
Her Negative Thoughts include:
“All of my friends are ahead of me in life (careers and relationships).”
“I should be further along in my career and I should be 100% certain this is the best career for me in the long term.
“For the most part, I haven’t helped most of my clients very much.”
“My anxiety over the past year indicates that I’m in the wrong profession.”
“I’ll never get back in the great shape, physically and emotionally, that I was in three years ago.”
“Moving to California set my life back by a year.”
“I won’t be able to make new friends in Austin.”
“I will be lonely and without friends.”
“I won’t be able to cope with stress.”
“My therapy skills aren’t good enough,”
and more. Her belief in many of her Negative thoughts is quite high, in the range of 70% to 100%. However, her belief in one of them, “Moving to California set my life back by a year,” was only 20%.
Although David did not intend this to be a live therapy session, but rather a practice session to demonstrate how the Externalization of Voices works, David does some brief paradoxical Agenda Setting first, since Sarah’s example is real, and not made up. David uses several techniques to melt away Sarah’s Outcome Resistance, including:
The Miracle Cure Question
The Magic Button
During the Positive Reframing, David asks Sarah two things about her negative thoughts and feelings:
What does each negative thought or feeling reveal about you and your core values that is positive and awesome?
What are some advantages, or benefits, of each negative thought or feeling?
They come up with a list of ten positives, including these: “My negative thoughts and feelings show that
I’m realistic and honest.
I’m committed to self-care, since I want to have good mental and physical health.
I’m motivated to grow and improve my therapy skills.
I have compassion for my clients and want to give them the best care that I can.
I’m honest about my shortcomings.
I have high standards.
I want to connect with others.
I’m committed to my career.
They conclude the Paradoxical Agenda Setting with the Magic Dial. Sarah decides to lower her negative feelings f to much lower levels, in the range of 5% to 15%.
Then, David asks Sarah which Negative Thought she wants to work on first. She chose the thought about never being able to get back into top physical and mental shape again. They identify the many cognitive distortions in the thought, such as All-or-Nothing Thinking, Overgeneralization, Mental Filter, Discounting the Positive, Fortune-Telling, Magnification and Minimization, Emotional Reasoning, Should Statements, and self-Blame.
Then David explains how the Externalization of Voices works, and they launch into the technique. David starts out as the “Negative Sarah,” and attacks her with the Negative Thought she wanted to attack first, using the second-person, “You.” Sarah responds in the role of the “Positive Sarah,” using the first-person, “I.”
Sarah fairly quickly knocks the ball out of the park, and easily crushes the Negative Thought David has attacked her with. Then David attacks Sarah with the rest of her Negative Thoughts, one at a time, doing occasional role-reversals to illustrate different ways to attack the thought. They continue doing role-reversals until Sarah described her victory over each Negative Thought as “huge.”
This only takes a few minutes. Then Sarah re-rates her negative feelings on the Daily Mood Log, and nearly all have been reduced to zero. David cross-examines Sarah to find out if this amazingly rapid and dramatic change was real, or if she was just being “nice” to try to produce a good role-play for David!
Fabrice raps up the podcast with his (as usual) great interview with David and Sarah, bringing out many of the teaching points during the session. He emphasizes that you can actually use many of David’s 50 Methods when doing Externalization of Voices, and points out the power of “Let’s Be Specific” that David demonstrated during the role-playing.
Next week: The Paradoxical Double Standard Technique!
We warmly invite you to attend this fabulous, one-day workshop by Drs. David Burns and Jill Levitt on Sunday, May 20th, 2018. Click on the link above for registration and more information.
6 CE Credits
The cost is $135
You can join in person or online from wherever you live!
You will enjoy learning from David and Jill, working together to bring powerful, healing techniques to life in a clear, step-by-step way. Their teaching style as a team is entertaining, funny, lucid, and inspiring. This is a day you will remember fondly!
In the afternoon, you will have the chance to do some personal healing so you can overcome your own feelings of insecurity and self-doubt. David and Jill promise to bring at least 60% of the audience into a state of spiritual and psychological enlightenment, WITHOUT years of meditation. That’s not a bad deal at all!
You will LOVE this workshop. Seating for those who attend live in Palo Alto will be strictly limited, and seats are filling up fast, so move rapidly if you are interested.
Jill and I hope you can join us!
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
The Psychotherapy Networker Conference Drs. David Burns Saturday, March 21, 2020 (Depression Workshop) and Sunday March 22, 2020 (Anxiety Workshop) PLUS unveiling and advance orders for Dr. Burns’ new book, Feeling Great!