Solution to David’s Tuesday Tip #6*

Solution to David’s Tuesday Tip #6*

This was yesterday’s paradoxical tip of the day–

Few therapists can recognize, or acknowledge, the patient’s anger. Most therapists appear to have a fairly intense “anger / conflict phobia.”

This is true of non-therapists as well. The attempt to avoid anger will cause it to mushroom.

The mean of this tip is pretty straightforward–nearly all therapists don’t do a good job of acknowledging or dealing with patient anger. I didn’t realize this until I began training therapists in the Five Secrets of Effective Communication.

I’ve developed an Intimacy Training exercise that goes like this. Two therapists pair off, and one plays the role of an extremely critical, hostile patient who criticizes the therapist, saying things like:

  • You don’t really care about me!
  • You’re making my marriage worse.
  • All you care about is the money.
  • You don’t understand me.
  • You’re not helping me.

Then the therapist tries to respond, using the Five Secrets. At this point, the role play must STOP. Then we give the therapist a letter grade on his or her response (was it an A? a B? a C? or worse?) along with specific feedback about what he or she did right and what he or she did wrong. Then we model how to respond more effectively, using the Five Secrets.

Here’s the interesting thing. In almost every role-play, the one in the “patient” role is extremely angry. But therapists will almost NEVER acknowledge this.

For example, I did a workshop on empathy and was setting up a demonstration for the staff at a really beautiful Mennonite mental hospital in Lancaster, Pennsylvania and asked for two volunteers for the Intimacy Exercise. Two participants eagerly volunteered, and the one who volunteered to play the therapist role was one of their very most senior clinicians. Before they started the role play, I emphasized the importance of acknowledging the patient’s anger, and mentioned that no therapist in the United States had ever been able to do that. For effect, I added that no therapist in the United States would EVER be able to acknowledge anger. That’s a bit of an exaggeration, but not much of one, I’m afraid!

So we started, and the participant who played the role of the difficult patient really lit into the more senior clinician. Her criticisms were extremely powerful, and even though it was just a role-play demonstration, her criticisms of him sounded real! I was glad I wasn’t in his shoes!

When she stopped, there was a long and awkward silence for about twenty seconds. You could have heard a pin drop in the room.

Then he leaned for and said, in a bit of stuffy voice, “You must have had a VERY troubled childhood!”

Yikes! Sadly, he was zero for five on his use of the Five Secrets, and as I had predicted, carefully avoided any mention of her anger.

Now, if you’re a therapist, you’re probably thinking, “I wouldn’t make that kind of ridiculous error, or respond in such a lame way!” Almost everyone thinks that until they have to do a role-play! It’s really hard to be in the therapist role, but the exercise presents tremendous opportunities for growth and learning if you’re willing to check your ego at the door.

The same problem, I believe, exists in the general public. Although we’re an extremely violent, aggressive society, people do tend to avoid dealing with anger. The anger / conflict phobia that is so widespread (almost universal) among mental health professionals is an interesting and little-known fact.

Well, there’s an awful lot more to learn about communication, and this blog is just one tiny slice. To learn more, check out my book, Feeling Good Together, and do the written exercises while you read. The book can transform the way you related to others, and you can purchase it on if you’re interested in having more loving and satisfying relationships with the people you care about.

You might also want to tune in to my free weekly Feeling Good Podcasts, available right on this website, I’ve had many podcasts on intimacy training and how to use each of the Five Secrets of Effective Communication.



* Copyright © 2018 by David D. Burns, MD.


Coming in June! It’s just around the corner–

One of my best two-day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”

A two-day workshop Sponsored by Jack Hirose & Associates

Register Now!

June 4 -5, 2018 Calgary, Canada

June 6 – 7, 2018 Winnipeg, Canada

Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety.

On the evening of day 1 of each workshop, I will do a live demonstration with someone from the audience who’s been struggling with some type of anxiety, such as social anxiety or public speaking anxiety. Mike Christensen will be my to-therapist. The live work is nearly always the highlight of this workshop.

You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well. In fact, on the afternoon of day 2, I will catapult at least two-thirds of the audience into a state of euphoric enlightenment. You can’t beat that!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!





Should Therapists Apologize? A Raging Debate!

Should Therapists Apologize? A Raging Debate!

Hi web visitors and friends on social media. Yesterday I got a really interesting email from my esteemed colleague, Angela Krumm, PhD, who created the certification program for TEAM-CBT. Angela’s clinical practice is located at the Feeling Good Institute in Mt. View, California. and they also offer training for therapists. I thought you might enjoy the question, as well as my answer. You will see that the information is relevant to everybody, and not just therapists.

If this topic of developing more loving and satisfying relationships interests you, you can read more about these techniques in my book, Feeling Good Together, available at Amazon and other book sellers.

IMG_1761Hi David,

The TEAM Certified list serve is having a colorful discussion about the use of apologies (specifically, saying “I’m sorry”) within the Five Secrets of Effective Communication. People are pretty engaged and arguing both for and against “I’m sorry.” Would you like me to share the comments with you?

If you’re interested, I’d love to post a response from you about whether you teach people to say “I’m sorry.” I think your general mode (if I remember from past training) is to avoid “I’m sorry” since it’s so generic and less specific than the Five Secrets.

Let me know if you want to see the comments and have a chance to respond.  I can send them to you!

Angela Krumm, PhD

Hi Angela,

To my way of thinking, “I’m sorry” can be effective or dysfunctional, depending on how it is used. In my experience observing clinicians in training, as well as troubled couples in treatment, it is nearly always dysfunctional, but it doesn’t have to be. Let me explain.

I recently treated a troubled couple from Los Angeles who had treated each other shabbily out of anger for many years. Without going into all the details, the husband had an affair with a woman they both knew from their church, and slept with her every night for six months. The affair appeared to be his way of getting back at her for something she had done that hurt him.

His affair was devastating to the wife, and she kept making up excuses for the children why Daddy can’t come home tonight. Every time she tried to express her feelings of being hurt, angry, anxious, humiliated, and betrayed, her husband would say, in a defensive tone of voice, “I’ve said I’m sorry! You have to put that behind you so we can move on! We’ve already talked about this!”

As you can see, he used “I’m sorry” as a way of avoiding listening and hearing how his wife felt. And although they’d bickered about their problems endlessly, he’d never really listened or giving her the chance to be heard.

I don’t want to scapegoat him—she gave the same dismissive and defensive answers when it was her turn to listen to his complaints and feelings. But it seems pretty clear to me that his use of “I’m sorry” was defensive and aggressive. It was his way of saying, “shut up, I don’t want to hear what you have to say.”

Therapists frequently do much the same thing in response to criticisms from patients. For example, a patient might say, “Last session you interrupted our session to take an emergency call, but I’m paying for the time!”

The well-meaning therapist might apologize and say, “I’m really sorry. I’ll remind my secretary to hold calls during our sessions unless it’s something super severe like an actively suicidal patient.”

It should be easy (I hope!) to see that this therapist is also using “I’m sorry” as a way of brushing the patient off, so the therapist doesn’t have to deal with the patient’s anger and hurt feelings. But those kinds of feelings may be a central problem in the patient’s life, and the therapist has missed a golden opportunity to deepen the relationship through the skillful use of the Five Secrets.

I have often said that no therapist in the United States or Canada is able to deal with or acknowledge a patient’s anger. Of course, this is an exaggeration to make a point, but it is SO TRUE most of the time! In my experience, it is very difficult for therapists to master the Five Secrets, for use in therapy, as well as in their personal lives, which can be even harder.

Of course, you can apologize skillfully. Apologies aren’t inherently dysfunctional. For example, you could respond to your patient’s criticism like my example below, which is based on the Five Secrets of Effective Communication. The abbreviations in parentheses at the end of each section indicate the communication technique(s) used in that sentence.

“I felt badly about interrupting the session, too. (IF) This is your time, and any interruption is unfair, and I want to apologize. (DT) The call was from an actively suicidal patient, but still my focus should be on you. (DT) I wouldn’t be surprised if you’re feeling hurt and ignored, and maybe even a bit angry with me, for good reason. (FE; DT) This is especially painful for me, because one of the themes you have described is that ever since you were a kid, the people you care about seem to ignore you, and don’t take you seriously. You said they gave your older brother all the attention, because he was a straight A student, so you end up feeling lonely and rejected most of the time. (IF; FE; DT) Now I’m in the role of ignoring you, and it’s especially painful for me because I respect you tremendously (IF; DT; ST) At the same time, I’m excited, because this is really important and can give us the chance to slay that dragon and deepen our relationship. (ST; Positive Reframing) Can you tell me more what that was like for you, as well as other times I’ve said or done things that hurt your feelings? (IN)”

I’m sure that can be improved upon, and is perhaps too long. But the important thing is that you are honoring your patient’s feelings, and encouraging him or her to open up. In this context, the apology is okay. However, notice that the phrase, “and I want to apologize” probably isn’t even needed.

I would also say that therapists, as well as patients, sometimes polarize things as “this way” vs. “that way,” so they can argue and feel like experts. Sorry if I sound a bit cynical here! Skillful and effective therapy is rarely “this way” vs “that way,” but exists on a higher plane. TEAM-CBT does not consist of simple formulas you can apply. It is an art form that is difficult to master, and simplistic approaches usually won’t be effective.

The bigger issue is that every one of the Five Secrets can be used in a skillful, compassionate, helpful way, or in a dysfunctional way. In fact, this is true of every method and technique in TEAM-CBT. For my two cents, I’d rather hear that people are asking for help in learning, rather than arguing about who is right and who is wrong, but I’m old and probably sound pompous or annoyed, so I will stop babbling!




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Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationshp conflicts.

Thanks! David