056: Interpersonal Model (Part 3) — “And It’s All Your Fault!” Interpersonal Decision-Making and Blame Cost-Benefit Analysis

056: Interpersonal Model (Part 3) — “And It’s All Your Fault!” Interpersonal Decision-Making and Blame Cost-Benefit Analysis

Podcast 56, “And It’s All Your Fault!” (Part 3)

David begins this podcast with a story of a psychiatric resident named Bob who was treating a divorced woman who complained bitterly about her ex, and constantly argued with him whenever he came to visit with the children.

Their relationship was clearly acrimonious, so Bob asked the woman if she wanted some help with the way she was communicating with her ex. She bristled and said that she was an attorney and that she could communicate just fine, thank you! Bob’s error was the same that many therapists make—of thinking that people with troubled relationships want help. Clearly, Bob’s patient was not asking for help. She just wanted Bob to agree that her ex was a bum!

In many cases, and perhaps most, individuals who aren’t getting along with someone—such as their spouse, sibling, parent, colleague, or friend—aren’t really asking for help. They just want to vent and persuade you to buy into their negative view of the person they aren’t getting along with. They just want you to know what a loser the other person is!

So how do we help people with troubled relationships? David emphasizes that empathy is always the first step. You try to see the world through the eyes of the patient without jumping in to try to “help.” Empathy, of course, is the “E” of TEAM therapy.

Once the person feels understood and supported, the next step is called Agenda Setting. That’s the A of TEAM. One of the most important tools in Agenda Setting for individuals with troubled relationships is to first ask, “Is this relationship conflict something you want help with?” In many cases, the patient will say no, so you can ask if there’s something else he or she wants to work on.

In the language of TEAM, this is called “Sitting with Open Hands.” The therapist has to let go of his or her attachment to “helping.” This is difficult for many therapists, due to the therapist’s compulsive urges to help.

If the patient does want help, the next step is called Interpersonal Decision-Making. You ask what kind of help the patient wants, and make it clear that the patient has three choices.

  1. To leave the relationship.
  2. To improve the relationship.
  3. To stay in the relationship and behave in a way that will guarantee that the relationship will remain miserable.

David emphasizes that the last choice is by far the most popular. The second most popular choice is the decision to leave the relationship. And occasionally, you’ll find a person who wants help improving the relationship. As you can see, Interpersonal Decision-Making is simply a more sophisticated way of asking the patient if she or he wants help!

If the answer is still yes, the next Agenda Setting step is the Blame Cost-Benefit Analysis (CBA). You can ask the patient something along these lines:

“Who, in your opinion, is more to blame for the problems in the relationship? You? Or the other person? And who, in your opinion, is the bigger jerk? You? Or the other person?”

At least 80% of the time, the patient will say, “the other person!” You may feel the same way if you’re in a conflict with someone right now. However, blame is the most formidable barrier to intimacy, so before we can continue with the treatment, this issue must be skillfully addressed, or the treatment will probably fail.

David and Fabrice guide the listener in doing a written Blame CBA, listing the advantages and disadvantages of blaming others for the problems in our relationships with them. They encourage you to pause the recording and to the written exercise during the podcast, but warn you not to do it if you are driving!

Then they discuss how to process the results of the Blame CBA. If you would like to see a completed Cost-Benefit Analysis, click here. As you can see, the weightings at the bottom have not been filled out, so you can do that for yourself if you like. Make sure you put two numbers that add up to 100 in the two circles. Put the larger number in the circle under the column that feels more desirable. For example, if the advantages of blame greatly outweigh the disadvantages, you might put a 70 in the circle on the left and a 30 in the circle on the right.

If the patient concludes that the disadvantages outweigh the advantages, you can proceed to the M = Methods phase of the TEAM therapy session, which involves the Relationship Journal (RF). This is a powerful tool that David has designed to create interpersonal enlightenment and the death of the ego. David and Fabrice will discuss and illustrate the RJ in the next podcast.

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!

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 forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David


055: Interpersonal Model (Part 2) — “And It’s All Your Fault!” Three Basic Assumptions

055: Interpersonal Model (Part 2) — “And It’s All Your Fault!” Three Basic Assumptions

In this podcast, David describes the three assumptions of the Interpersonal TEAM Therapy he has developed”

  1. We cause the very relationship problems we are complaining about, but don’t realize this, so we blame the other person and feel like victims of his or her“badness.” David describes a man who endlessly complained about his wife during therapy sessions–she didn’t like having sex with him, she spend money behind his back, and never bragged about him when they were out to dinner with friends. He had even taken notes for years on all the “bad” things his wife had been doing every day throughout their marriage, but overlooked the many hurtful and self-centered things he was doing to break her heart every single day.
  2. We do not want to have to look at our own role in any relationship conflict because it is too painful to have to confront our “shadow,” to use a Jungian concept, and because we want to do our dirty work in the dark. So we will deny our role and angrily punish anyone who tries to shed light on our role in the problem. David describes a severely depressed woman who complained that she was the victim of “loneliness in marriage,” a concept she’d just read about in a popular women’s magazine. She explained that her husband would not and could not express his feelings, and felt that he was to blame for their marital problems as well as the severe depression and loneliness she’d been struggling with for 25 years. And yet, in a therapy session when he tried to express his feelings, she exploded angrily and told him to shut the F__ up! When Doctor Burns asked her to reflect on what had happened in the session with her husband, she angrily threatened to fire him if he ever brought up the topic again!
  3. The first two principles paint a dark picture of human nature. The third principle is more optimistic—namely, that we have far more power to heal a troubled relationship than we realize, and this can often happen quickly, but there’s a stiff price to be paid.  First, we have to be willing to stop blaming the other person so we can examine and pinpoint our own role in the conflict. Second, we have to focus all of our energy on changing ourselves, rather than trying to change the other person. This can be extremely liberating and joyful, but it involves the exceedingly painful death of the ego. The Buddhists have called this type of enlightenment “the Great Death.’

In the next podcast, David and Fabrice will show you how to transform your own troubled relationships into loving ones–if that’s what you want to do!

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!

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 forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David


030: Live Session (Mark) — Empathy Phase (Part 2)

030: Live Session (Mark) — Empathy Phase (Part 2)

After reviewing Mark’s scores on the Brief Mood Survey, the Empathy phase of the session unfolds. During this phase of the session, David and Jill will not try to help, rescue, or save Mark. They will simply try to see the world through his eyes and provide some warmth and compassion.

Mark explains that he had two goals in life when he was a young man. He hoped to have a large, loving family; and wanted to become a skillful and compassionate physician. Although he has achieved the second goal, he has felt sad and guilty for decades because of his failure to develop a loving relationship with his oldest son from a previous marriage.

While Mark tells his story, David and Jill encourage him to record his negative thoughts and feelings on a form called the Daily Mood Log, and to rate how strong each feeling is, on a scale from 0% (not at all) to 100% (the most extreme).

Click here and you will see Mark’s Daily Mood Log.

As you can see, Mark has many different kinds of negative feelings ranging in severity from 30% (moderate) to 80% (severe).

If you’ve been listening to the Feeling Good Podcasts, you know that negative feelings do not result from what’s actually happening in our lives, but rather from our negative thoughts about what’s happening. David and Jill encourage Mark to record his negative thoughts on the Daily Mood Log as well, and to indicate how strongly he believes each one on a scale from 0% (not at all) to 100% (completely).

You can also see that Mark is telling himself that he’s been a failure as a father, that his brain is defective, and that he is not doing a good job for David and Jill. These thoughts all involve self-blame. You’ll notice that he also has two other-blaming thoughts. This is not unusual. When you’re not getting along with someone, you may spend part of your time telling yourself that the problem is all your fault, and part of your time telling yourself that it’s someone else’s fault. As a result, your negative feelings may shift back and forth from guilt and shame to anger and resentment.

Most therapists would not interrupt and ask their patients to record their negative thoughts and feelings while they are venting. However, this information will prove to be incredibly valuable later in the session.

Jill and David ask Mark how they’re doing on empathy. If Mark gives them a high rating, they will go on to the next phase of the session, called Paradoxical Agenda Setting. That’s where they will find out what, if anything, Mark wants help with, and see if he has any conscious, or subconscious, resistance to change.


015: The Five Secrets of Effective Communication (Part 2)

In Podcast #14, David and Fabrice discussed the Five Secrets of Effective Communication. You can remember them with the acronym, EAR:

E = Empathy

A = Assertiveness

R = Respect

If used skillfully, the Five Secrets can resolve nearly any relationship conflict and transform hostility, resentment and mistrust into intimacy and warmth, often with amazing speed. And although this may seem easy when you first learn about the Five Secrets, it’s extremely difficult in real world situations.

In this Podcast, David and Fabrice discuss a number of predictable emotional and mental errors nearly everyone makes when trying to use the Five Secrets to get close to someone he or she is at odds with.

012: Negative and Positive Distortions (Part 3)

In this final podcast on the ten cognitive distortions, David and Fabrice discuss Should Statements, Labeling, and Blame. He brings these distortions to life with a case of a severely depressed woman who felt profoundly guilty and devastated after her brother’s tragic suicide. Dr. Burns also describes the negative thoughts of an individual who experienced horrific childhood abuse, and concludes with a surprising vignette of an elderly woman who was absolutely convinced that the problems in her marriage over the past 35 years were entirely her husband’s fault.

Error #4: Reverse Relationship Hypnosis

* ©2012 by David D. Burns, MD

Do not copy, publish or reproduce without the written permission of Dr. Burns.

When a patient complains of relationship problems—such as a troubled marriage or a conflicted relationship with a family member, colleague, neighbor, or friend—the patient usually depicts himself or herself as the victim and implies that the other person is to blame for the problem. For example, the patient may emphasize the other person’s insensitive or self-centered behavior, and insist that the other person is a jerk who really shouldn’t be that way. Therapists frequently buy into this way of thinking about the conflict. We do this because of our desire to support and help our patients, and also because this is politically correct. And, after all, there is an enormous amount of violence and bad behavior in the world. So when the patient points out all the annoying things the other person said or did, on some level, he or she is right

However, in most cases, you have succumbed to the patient’s hypnotic spell. And once you’ve bought into the idea that the patient really is the innocent victim, the therapy will have little chance of being effective. I’m not aware of any tools powerful enough to help individuals who blame others for their problems.

It is not easy for therapists to escape from this type of trap. In fact, most therapists don’t even realize they’ve fallen into a trap. And it’s somewhat addictive, too. It can feel good to collude with the patient and scapegoat the other person. I see therapists falling into this trap over and over again.

In my psychotherapy eBook[2] (Tools, Not Schools of Therapy) and in my relationship book for the general public (Feeling Good Together), I describe the three basic principles of what I call Cognitive Interpersonal Therapy (CIT). CIT is based on three principles:

  1. We forcefully create the relationship problems that we complain about so intensely, but we’re not aware of this, so we feel convinced that we’re innocent victims.
  2. We’re not interested in discovering our role in the problem. We want to maintain the façade of innocence so we can continue to do our dirty work in the dark.
  3. We have far more power than we think to transform troubled relationships into loving and joyous ones. Furthermore, this can often be done amazingly quickly. However, there will be a price to pay. You’ll have to be willing to pinpoint your own role in the problem and focus all of your efforts on changing yourself, rather than blaming the other person or trying to change him or her. This can be painful, because it requires the death of the ego, or what the Buddhists call “the Great Death.”

I once gave a half-day workshop in Seattle on relationship problems for the general public. It was sponsored by a local hospital as a part of their public outreach program. At the start of the workshop, I asked the participants to think of one person they didn’t like or get along with, and to write down one thing the other person had said to them during an argument or disagreement, and exactly what they said next. I explained that this brief exchange was all we would need to pinpoint the exact cause of the problem and illustrate how to transform hostility and defensiveness into trust and love.

Then I asked if anyone would like to describe the difficult person in his or her life. A woman who was sitting in the first row was waving her hand in the air excitedly, so I called on her first. She said that her name was Martha, and that her husband was the difficult person in her life. She explained that he’d been relentlessly critical of her all day every day for the past 35 years. She said she’d come to the workshop to find out why men were like that.

I explained that scientists don’t yet know why men are the way they are, or why women are they way they are, but if she’d read what she wrote down, perhaps we could get some insight into the cause of her marital problem. What, exactly, had her husband said to her, and what, exactly, did she say next?

She said, “Well, just this morning, he said ‘You never listen!'”

I asked what she said next. What had she written down?

She replied, “Oh, I just said nothing and ignored him!”

The audience erupted in laughter. They could immediately see something pretty obvious that she did not seem to be aware of.

When you use CIT, you examine your own response to the other person instead of blaming him or her, and you ask yourself three questions based on the EAR acronym:

E = Empathy—Did I use good listening skills? Did I find some truth in what the other person said? Did I acknowledge how she or he was thinking and feeling?

A = Assertiveness—Did I share my own feelings openly and directly?

R = Respect—Did I convey warmth and caring to the other person, even in the heat of battle?

Well, it isn’t hard to see that Martha was 0 for 3. First, there was no empathy. She didn’t acknowledge her husband’s feelings or acknowledge any truth in what he’d said. In addition, she didn’t share her own feelings openly and directly—instead she ignored him and froze him out in a passive-aggressive manner. And finally, she clearly didn’t convey any warmth or respect.

This analysis will be threatening to most patients. Martha came to the workshop to find out why her husband was so screwed up. She was blaming him. Suddenly, the finger of blame is pointing at her. This may not be what she had in mind! Because the method is very powerful, it requires lots of trust and warmth, because the patient ends up in a very vulnerable position.

When you use CIT, you also ask the question—what will the impact of my response be on the other person? How will my husband think and feel if I respond this way? What will he conclude? How will he behave?

Once again, the answer is pretty obvious. Martha’s husband will conclude that he was absolutely right—once again, Martha didn’t listen. Since she hasn’t yet gotten it, he’ll have to try again, and again, and again.

So now, Martha knows the answer to her question—why are men like that? Why are they so critical? Sadly, it’s because Martha forces him to be like that. And she’s done that all day, every day, for the past 35 years.

This insight can be extremely painful. I have done this type of analysis myself on many occasions when I was in conflict with a family member, patient, or colleague. And it is always painful for me, too. I HATE having to do this. But it can be very liberating. That’s because of the third principle of CIT—we have far more power than we think to change a troubled relationship. Since we are triggering the problem, we also have the power to change things.

I’ve used this approach with more than 1,000 individuals with troubled relationships, including many mental health professionals who have attended workshop for training and personal growth. In virtually every case, the person who is complaining has failed to empathize, express his or her feelings, or convey respect. So he or she is always 0 for 3 on the EAR analysis. In addition, when you examine the consequences of the patient’s response to the person she or he isn’t getting along with, you discover that the patient is forcing the other person to behave in exactly the way the patient is complaining about.

And we can see that clearly in the example Martha provided. However, this doesn’t mean that Martha’s husband is innocent. If he’d come to the workshop, and Martha had stayed at home, I would have helped him pinpoint his role in the conflict, and he would have made the same painful discovery—that he actually forces Martha not to listen.

I call this the theory of interpersonal relativity. Probably that’s too fancy of a term, but it means that the person who is asking for help will always turn out to be the entire cause the problem.

This approach requires enormous therapist empathy, gentleness and compassion, because the discovery will nearly always be shocking for the patient. Some patients will resist or even decide that they don’t want this type of therapy. But if patients have the strength and good will to endure the discovery that they are triggering the problems they complain about, there will be two huge rewards. First, they will suddenly understand the cause of all of the problems in all of their relationships, because they are almost certainly doing the same thing to other people they don’t get along with. This represents a kind of enlightenment—they discover that they are not, in fact, victims, but are instead creating their own interpersonal reality at every moment of every day. This is a Buddhist principle, but it’s also embedded in practically every religion, including Christianity, the Jewish religion, and many others.

And finally, and perhaps of greatest importance, I can show them how to solve the problem using the Five Secrets of Effective Communication. But that’s a topic for another day.

In a nutshell, most of our patients, and most of us as well, have one or more troubled relationships. Even if patients are seeking treatment for depression, or anxiety, or a habit or addiction, there’s a good chance that at some point in the therapy, they’ll begin to talk about some person who they’re at odds with. They’ll usually try to convince you that the problem is the other person’s fault. If you find yourself agreeing with the patient, ask yourself if you’ve been hypnotized. Once you recognize this, you can break out of the trance and help your patient pinpoint what’s really going on—if she or he is willing. Those of you who want to learn more about the nuts and bolts of doing this may want to read my eBook or Feeling Good Together.

I do not mean to imply that other people are always innocent, and that the patient is the only one who is to blame. In fact, other people often DO act like jerks. We all know that. The patient’s description of how the other person’s annoying behavior is likely to be true. But the patient is nearly always leaving something of vital importance out of the description—and that’s his or her role in the problem.

Thanks for listening! I suspect this blog might stir up a little controversy. Let me know if you have any feedback.

The next blog will cover Error #5, which is by far the greatest therapeutic error of all. So stay tuned!

All the best,

David Burns, MD


[1]     Copyright © 2012 by David D. Burns, MD. Do not quote or copy without written permission from Dr. Burns.

[2]        For an order form, send an email to david@feelinggood.com.