109: David’s Top 10 List!

109: David’s Top 10 List!

A fan named Tanuj asked:

“I’ve heard Dr. Burns mention that he is most proud of a few of the techniques he’s developed, and he mentioned that the Disarming Technique would be near the top of the list. I believe he said there were three or five of them. I was wondering what the others were. Does he have a top 5?”

Thank you, Tanuj. I got to thinking and actually came up with 10. Fabrice and I will briefly discuss each one on today’s podcast. So here they are!

  1. The list of Ten Cognitive Distortions that I created for my first book, Feeling Good: The New Mood Therapy. This list has been reproduced enormous numbers of times in the media and has been translated into more than 30 languages.
  2. The Disarming Technique and Law of Opposites. This means that you can nearly always put the lie to a criticism by finding the truth in it. However, this can be difficult because it requires the death of the ego, or self, the so-called “Great Death” that the Buddhists have emphasized as a key to enlightenment. This method has transformed my clinical practice and personal life and has been very helpful to many of my patients as well. However, it is not easy to learn, in part because it does involve the death of the “self.”
  3. The Externalization of Voices plus Acceptance Paradox. This was one of the first cognitive therapy techniques I developed, and I have used it more than any other technique during my career. It’s totally mind-blowing.
  4. The two classic Uncovering Techniques: the Individual and Interpersonal Downward Arrow. You can use these techniques to quickly pinpoint the Self-Defeating Beliefs that trigger painful mood swings, such as Perfectionism, Perceived Perfectionism, the Love Addiction, and Brushfire Fallacy, and more.
  5. The Feared Fantasy and Acceptance Paradox. This is a powerful and innovative exposure technique that can help people overcome the fear of being judged or rejected. It can also help people modify Self-Defeating Beliefs like Perfectionism and the Achievement Addiction, and the Approval Addiction.
  6. The Experimental Technique for extremely rapid treatment of patients with Panic Attacks. With this technique, you can sometimes—often—cure Panic Disorder in a single session. But this requires great courage on the part of the therapist and patient, and a great therapeutic alliance with lots of trust.
  7. My published research with colleagues in the mid-1970s did not support the popular notion that depression results from a chemical imbalance in the brain. In other words, we found that depression probably does NOT result from a deficient of the neurotransmitter, serotonin. Although we published this research in the top psychiatric journal, it was largely ignored for 25 years because people were so hooked on the “chemical imbalance” theory of depression. Now the study has been quoted frequently, and most neuro-scientists no longer give that theory a great deal of credibility.
  8. Brief Mood Survey. I believe I was the first, or one of the first, therapists in the world to require testing of every patient at every treatment session. I started with the Beck Depression Inventory, but have since developed briefer and more accurate scales that patients can complete in the waiting room before and after every sessions. These scales indicate the severity of symptoms such as depression, anxiety, anger, suicidal urges, positive feelings, and relationship satisfaction or conflict. Patients also rate therapist empathy and helpfulness after each session. This simple procedure has revolutionized treatment, because therapists can now see, for the first time, how effective, or ineffective, they are in every single therapy session. The testing has also made data-driven, science-based psychotherapy possible. However, it requires courage on the part of the therapist because the information will often be surprising to the therapist, and disturbing!
  9. Positive Reframing, and all of the new, paradoxical Agenda Setting techniques have made super-high-speed TEAM-CBT treatment methods possible. I now see recovery at speeds I would have thought impossible 20 years ago.
  1. The use of extended, two-hour therapy sessions rather than weekly 50-minute sessions has also been huge. That’s because I often see a complete elimination of symptoms of depression and anxiety in a single extended session of TEAM-CBT, as opposed to months or even years of conventional treatment. Many of my students are reporting similar results. This,  I think, is truly revolutionary!

Well, that’s it. That’s what I’m the most proud of! I suppose I could also include my first book, Feeling Good: The New Mood Therapy, which has sold more than 5 million copies worldwide, and has helped many people recover, as well as the development of TEAM-CBT.
Thank you again for your question, and please accept my apology if I am bragging too much, which can be really offensive. However, my mother once said, “If you don’t toot your own horn, no one else is going to toot it for you,” so hopefully the podcast and write-up will be okay.

David

Subscribe

* * *

Coming Soon!
October / November / December 2018–
Cool Workshops for You!

TEAM-CBT Methods for the Treatment of Relationship Difficulties

Step by Step Training for Therapists

by David Burns, MD and Jill Levitt, PhD

Sunday October 28th, 2018 (9 am-4 pm PST)

Live in Palo Alto plus online streaming

Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop will be highly interactive with many case examples and opportunities for practice using role plays.

Join us for a day of fun and inspiring learning on site in Palo Alto
OR online from anywhere in the world.

Learn from David and Jill–a dynamic teaching duo!

6 CE*s. $135

To register, go to the Feeling Good Institute

or call  650-353-6544

* * *

Rapid Recovery from Trauma

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Pasadena, CA

and

November 1-2, 2018–Woodland Hills, CA

The November workshop includes Live Streaming
if you cannot attend in person)

For further information, go to www.IAHB.org
or call 1-800-258-8411

Register Now!

* * *

TREAT ANXIETY FAST–
Powerful, Fast-Acting, Drug-Free Treatment Techniques
that Defeat Anxiety & Worry

a 2-day workshop by David D. Burns, MD

November 29 and 30, 2018–San Francisco, CA (in person only)

and

December 3 and 4, Portland, Oregon (in person and live streaming)

PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.

In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.

Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…

  • How to integrate four powerful treatment models to eliminate symptoms.
  • How to enhance your client’s engagement in therapy.
  • How to develop a treatment plan that specifically targets each client’s unique problems and needs.
  • …and so much more!

David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!

Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers!

Sponsored by PESI

To register, or for more information, call: 800-844-8260

Solution to David’s Tuesday Tip #13*

Solution to David’s Tuesday Tip #13*

This was yesterday’s paradoxical tip of the day!

Some people think that therapy consists of codependent schmoozing behind
closed doors, with the occasional bit of “advice” or “tell me more” thrown in.
Are they right?

Hi everybody,

I am trying, perhaps without complete success, to say this politely, without enraging anybody too much . . . . but

I am sad to say that I think this Tuesday comment is somewhat correct. Many therapists just talk with patients for months or years without much change, often without specific goals, and without measuring anything from session to session to document change, or the lack of change. When I was a psychiatric resident, this type of treatment actually had a name. It was called “supportive emotive therapy.” The patient talks, the therapist listens and provides support, and encourages the outpouring of emotion at times.

Some experts claim that this type of therapy provides a “corrective emotional experience.” The idea is that the relationship with the therapist will correct some shortcoming or void in the patient because of his or her childhood and lack of support and nurture while growing up.

I’m not convinced this non-directive approach corrects much, if anything. In addition, while I know I have lots of helpful techniques to offer, and some reasonably good empathy, I’m not convinced that a relationship with me will ever correct much of anything, to be honest! I’m quite surprised, actually, that so many individuals–colleagues, clients, and students–are even willing to put up with me.

I can be, to be honest, kind of annoying and difficult at times. I don’t see myself as a “corrective emotional experience” much of the time!

I favor therapy that works rapidly, with specific goals and changes that can be documented by assessments of the patient’s feelings at the start and end of every session. This includes testing feelings of depression, suicidal urges, anxiety, and anger,as well as the patient’s feelings of satisfaction with his or her spouse or partner. The assessment of the therapist’s empathy and helpfulness by the patient after every session is also invaluable and, to my way of thinking, mandatory.

While skillful listening will always be an important part of therapy, it will rarely or never be sufficient to help a patient recover from severe depression, or any anxiety disorder, or a troubled marriage, or a habit or addiction. Much more is required, including specific techniques to help the patient change his or her life, as well as resistance-melting techniques to boost the patient’s motivation and collaboration.

Patient homework between sessions will also be a must, in my opinion. You cannot, for the most part, change your life or learn new skills without practice, any more than you could learn tennis or how to play the piano without practice between lessons with your coach or teacher.

All human beings are corruptible, and we all have a kind of inherently lazy streak. So if a therapist has a full-fee private patient, and the patient just wants to schmooze and vent every week for months or years, without being accountable and without doing psychotherapy homework, the therapist will have a guaranteed income and an easy job, since there isn’t a whole lot the therapist has to learn in order to provide this type of non-specific talk therapy, or if you prefer, “non-treatment.”

I apologize deeply if my skeptical / cynical streak is showing, but I sincerely believe our field is in need of reform, and I am saddened and sometimes frustrated, even angered, by the overall poor skill level among mental health professionals.

On the positive side, last week’s intensive in Whistler, Canada was just awesome. Oops, Lisa Kelley has urged me not to go over the top with language, so let me say it was a bit above average. In fact, the ratings for all four days were the highest I’ve received–by a big margin, actually–in the last 25 years or more of doing workshops. I was thrilled and grateful to have such a warm and responsive group.

My dear colleague, Jack Hirose, who organized the conference, said the ratings were also the highest he has seen in the many hundreds of workshops he has sponsored in Canada. I was helped by my dear colleague, Mike Christensen, who attended and assisted with the teaching. Mike was also my co-therapist in the live demonstration with an audience volunteer who had experienced severe trauma and abuse.

Working with her was an inspiring and riveting experience. We were fortunate to due a high definition video of the session, and I hope it will be available for some type of teaching program for you.

If you would like to attend a similar conference, consider my upcoming San Francisco intensive in a few weeks. I will try my hardest to make it a little above average, too! See the details below.

Thanks!

David

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

 * * *

Hey, folks, my San Francisco summer intensive will start in a few weeks. it is always one of my BEST training programs of the year. The group will be quite small, giving you lots of chances for Q and A and personal connection with me, plus networking with your colleagues. In addition, many individuals from my Tuesday group at Stanford will join me to provide feedback for you 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/
phone: 800-258-8411

If you can only attend one of my workshops, consider this intensive! it is simplly

THE BEST!

Seating is limited. Register now  if you want to get in on the action!

Hope to see you in San Francisco in August! David

 * * *

Also coming up soon on David’s Sunday FB Live Broadcasts

Sunday, July 15th, 2018, at 3 PM: The Disarming Technique–Taking a Deeper Dive, with special guest, Mike Christensen

Sunday, July 22nd, 2018, at 3 PM: The Shouldy Approach to Life–How to Crush Should Statements, with special guest, Jill Levitt, PhD

If you attend live, you can ask questions and be a part of the show. However, they are all recorded so you can tune in anytime on my Public FB page!

Solution to David’s Tuesday Tip #12*

Solution to David’s Tuesday Tip #12*

This was yesterday’s paradoxical tip of the day!

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!

Thanks!

David

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

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/
phone: 800-258-8411

If you can only attend one of my workshops, consider this intensive! it is simplly

THE BEST!

Seating is limited. Register now  if you want to get in on the action!

Hope to see you in San Francisco in August!

David

David’s Answer to Tuesday Tips #4*

David’s Answer to Tuesday Tips #4*

This was yesterday’s paradoxical tip of the day–

Last week, we discussed the idea that therapists’ empathy skills tend to be poor, but therapists are not usually aware of this. If your patients complete the “Evaluation of Therapy Session” in the waiting room after each session, you’ll see, exactly what’s happening, and you can address alliance failures right away. . .  if you dare!

Failures of the alliance (the patient’s poor ratings of therapist empathy and helpfulness)
are actually extremely positive—
if you know how to respond skillfully!

In fact, you’ll often discover that your greatest therapeutic failures
are your greatest successes in disguise! But how can that be?

And here’s my answer!

Therapists who require their patients to complete my Evaluation of Therapy Session after every session (plus the Brief Mood Survey before and after every session) will be rated on Empathy and Helpfulness Scales, and several other scales that are tremendously sensitive to the tiniest therapeutic errors. You will discover that you often get less than stellar ratings on warmth, trust, understanding, and helpfulness. These low ratings may surprise you, especially if you are used to (wrongly) thinking that your empathy skills are excellent or even outstanding.

I have set the scales up so that even a 1 point deduction from a perfect score on any scale is defined as a failing grade. There are two reasons for this. First, anything less than a perfect rating indicates some dissatisfaction on the part of the patient that needs to be explored. For example, the patient may think you did a super job of using listening skills, but may indicate that you did not completely understand how she or he was feeling inside. If this failure of understanding is not addressed and corrected, it may have a corrosive effect on the treatment.

Without the written feedback on the evaluation scales, the therapist would never know he or she was failing in this way. That’s because if you ask the patient how things are going, he or she will nearly always say, “fine,” and keep his or her dissatisfaction secret. But if you look at the written feedback on the Evaluation of  Therapy Session, you will see right away what’s going on.

So how can it be good to discover that you are failing with your patient? There are several positives:

  1. When therapists use my scales for the first time, most will get failing grades on nearly every scale at nearly ever session with nearly every patient. This can be quite disturbing. But if you learn to process the feedback in a relaxed, non-defensive, warm way, using the Five Secrets of Effective Communication, you will find that your scores will increase dramatically, and your therapeutic skills will soar as well. Many of my students report that after using the scales for several weeks with all their patients, and practicing how to process the information in one of our online or in person training groups, they receive perfect scores on most if not all of the scales with as many as 80% or their patients.
  2. When you learn you are failing with a patient, you can immediately discuss the problem, if you have the courage, and this will can lead to significant improvements in the treatment. That’s because you will have accurate information for the first time on how your patients feel, how much progress they make (or fail to make) in every single session, and how they really feel about you.
  3. When they rate you poorly on warmth, support, trust, or understanding, it will ALWAYS be the case that their negative feedback is 100% accurate. When they say, “You don’t really understand me or care about me,” they are saying something that is true. You ARE failing in that exact way! But if you listen, and disarm, using the Five Secrets, and genuinely and skillfully acknowledge the (often painful) truth in what the patient is telling you, your “failure” will usually become his or her first “success” at getting close to someone. That’s because they patient may have felt rejected or abandoned by everyone in his or her life, so this may be his or her first experience of real intimacy and trust. In other words, the problem the patient experiences with you will usually be his or her “core conflict,” to use a psychoanalytic term.  And if you have the desire and the skill, you can find out about it right away and work to quickly repair the lesion that has been causing so much pain.

This type of communication with patients about their criticisms of the therapist often involves the death of the therapist’s ego. That’s because you have to realize and acknowledge that you really have failed at something you thought you were really good at, something central to your sense of identity. But if you do it skillfully, you and your patient will both “die” at the same time, and you’ll also be reborn with a new sense of connection.

Well, that’s my goofy tip for today. I’m kind of rushed today, so will send it out without much if any editing, and hope it’s not too bad, or too corny!

Thanks!

David

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

Coming Soon! Move Fast if You Want to Attend this Terrific Program coming up a week from Sunday!

Sold out in person, but we still have room for you online. Those who attend online will have opportunities for small group practice in break out rooms, with supervision!

High-Speed TEAM-CBT for Depression and Anxiety Disorders 

I 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 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 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!

You will leave this workshop with renewed confidence as well as specific, powerful tools that you can use right away to improve your clinical outcomes!

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. Online slots are also limited.

Jill and I hope you can join us!

Coming in June! One of my best two-day workshops ever!

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

Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada

You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety:

  • Generalized Anxiety
  • OCD
  • PTSD
  • Phobias
  • Social Anxiety
  • Agoraphobia
  • Panic Disorder
  • and more

You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises.

 

Solution to David’s Tuesday Tip #3*

Solution to David’s Tuesday Tip #3*

Here’s yesterday’s paradoxical tip #3

Therapists’ perceptions of how patients feel–the severity of symptoms–tend to be extremely inaccurate, at best, but most therapists are not aware of this.

What does this mean? Is it true? And if so, what are the consequences?

Is there a solution to this problem? And what, if anything, does the solution have to do with the first of four “Great Deaths” of the therapists ego?

Here’s Dr. David’s solution

My research and clinical experience have indicated that therapists’ perceptions of how their patients feel, and their patients feel about them, can be (and usually are) extremely inaccurate. What this means, in practical terms, is that a patient may be feeling intensely depressed and even suicidal, and yet the therapist thinks the patient is doing well. Or, the patient may be doing reasonably well, but the therapist thinks he or she is still severely depressed.

This inaccuracy involves all the negative emotions–such as depression, anxiety, and anger–and all the positive emotions as well. But since most therapists do not routinely assess patients’ feelings with brief accurate tests at every session, therapist do no know how “off” their perceptions can sometimes be. And while I do not mean to be alarmist, this can sometimes result in a failure of the therapy, or even the death of a suicidal patient.

In addition, although most therapists feel they are experts at communication, my research and clinical experience have indicated that therapists perceptions of the therapeutic alliance are also typically way off. In addition, many therapists grossly overestimate their clinical and communication skills, but they do not realize this!

To solve this problem, I have developed the Brief Mood Survey (BMS), and require all my patients to complete it in the waiting room before each session begins, and once again after the session is over. The BMS asks patients how depressed, suicidal, anxious, and angry they are feeling “right now,” at the start and end of the session. The comparison of the scores gives therapists an extremely accurate assessment of how effective, or ineffective, the session was.

It is, in a sense, like having an emotional X-ray machine available for the first time. The data are extremely valuable, regardless of whether you are doing psychotherapy, psychopharmacology, or a combination of the two.

At the end of the session, patients also complete the Evaluation of Therapy Session in the waiting, and rate the therapist on empathy, helpfulness, and other important dimensions. This only takes about one or two minutes of the patient’s time and provides the therapist with more invaluable, but potentially shocking, information.

So what does all of this have to do with the first of the four “deaths” of the therapist’s ego? Therapists who use these scales will probably make a number of uncomfortable discoveries, including, but not limited, to these:

  1. Therapists will discover that their perceptions of how their patients feel, and how their patients feel about them, will often be wildly and alarmingly inaccurate.
  2. They will often discover that the session was not at all helpful to the patient–in other words, there was little or no improvement in how the patient felt during the session.
  3. The therapist will likely receive failing grades on the Empathy and Helpfulness Scales most patients at every single session, especially if they are using these scales for the first time.

And that’s what I mean by the “death” of the therapist’s ego. You may discover, to put it in street language, that you suck! It’s happened to me often, and I usually find it painful to discover that my perceptions were off and my efforts were not effective.

But here’s the cool thing. This information can empower you to grow and change your therapeutic approach, so you can begin to deliver true healing. If you review the information with your patients in a warm and open way, it can transform the quality of the therapeutic relationship and vastly boost your effectiveness. And that’s pretty darn cool! I’ve been doing this for forty years, and my patients have proven to be my best teachers–by far!

Well, that’s it for today. Thanks so much for reading this, and if you like my blogs and Feeling Good Podcasts and FB Broadcasts, and the many other free features on my website, www.feelinggood.com, please use your sharing buttons to tell your friends. I am trying to build up my numbers as much as possible, and don’t know a great deal about social media, so anything you can do to spread the word will help.

AND you HAVE BEEN helping a lot already! Last month, (April 2018) my Feeling Good Podcasts with my esteemed host, Dr. Fabrice Nye, had more than 52,000 downloads. That’s a new record for us, so THANK YOU! I’d love to see those numbers soar even higher!

David

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

Coming in less than three weeks!

High-Speed TEAM-CBT for Depression and Anxiety Disorders 

I 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 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 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!

You will also leave this workshop with renewed confidence as well as specific, powerful tools that you can use right away to improve your clinical outcomes!

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. Online slots are also limited.

Jill and I hope you can join us!

 

 

052: Your Responses to the Live Work with Marilyn — Are People Honest in Their Ratings, and Do the Improvements Stick?

052: Your Responses to the Live Work with Marilyn — Are People Honest in Their Ratings, and Do the Improvements Stick?

The responses to the Marilyn session were extremely positive. At the start of the podcast, Fabrice reads a response from a listener who was moved and inspired by the work Marilyn did.

David and Fabrice discuss two questions commonly raised by people who have seen David’s live demonstrations with individuals experiencing severe depression and anxiety. Since the change in Marilyn’s scores were so fantastic, some skeptical listeners have asked, “Was this real, or was it staged?” Others have asked if patients are simply giving favorable answers on the Brief Mood Survey and Evaluation of Therapy Session forms as a way of being “nice” to the therapist.

David points out that the opposite is true. If patients are in treatment voluntarily, without some kind of hidden agenda such as applying for disability, they tend to be exceptionally honest in the way they fill out the forms. In fact, most therapists find that they get failing grades from nearly every patient on every scale at every session at first. This can be very upsetting, especially to therapists who are narcissistic and defensive about criticism. But if the therapist is humble and open to the feedback, the patient’s feedback on the Brief Mood Survey as well as the Evaluation of Therapy Session forms can provide a fabulous opportunity for growth and learning.

So in short, it is not true that patients fill out the forms just to be “nice” and to please the therapists. The scores are brutally real! If you are a therapist and a doubters, you can give the assessment instruments a try, and I think you’ll be surprised, and perhaps even shocked when you review the data!

Still, David acknowledges that the rapid and phenomenal changes he now sees most of the time when using TEAM-CBT are hard to believe, especially when you’ve been trained to think that recovery is a long, slow process. David discusses a model of brain function proposed by a molecular biologist / geneticist, Dr. Mark Noble, that allows for extremely rapid change.

David and Fabrice also address the question—can these kinds of miraculous results last, or are they only a flash in the pan? David emphasizes the importance of ongoing practice whenever the negative thoughts return. The “one and done” philosophy is not realistic. Part of being human is getting upset during moments of vulnerability, and that’s when you have to pick up the tools and use them again!

David describes experiencing three hours of panic just a few days ago, and Fabrice asks what techniques he used to deal with his own negative feelings, including Identify the Distortions, Examine the Evidence, Reattribution, and the Acceptance Paradox.

David agrees with the Dalai Lama that happiness is one of the goals of life, but emphasizes that it is not realistic to think one can be happy all the time. Fortunately, you can be happy most of the time–but you have to be willing to pick up the tools and use them from time to time when you fall into a black hole!

David and Fabrice

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 Podcast 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

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Can We Prevent Suicide Attempts?

Can We Prevent Suicide Attempts?

tHi www.FeelingGood.com friends and colleagues,

I just received the following email from a therapist who was shocked to discover that her patient was suicidal after reviewing his scores on the Brief Mood Survey. Her intervention likely saved his life.

Patient suicides are not uncommon, sadly, and represent the dark side of our profession. The death of any patient is an enormous tragedy for the patient, obviously, and is devastating for the family and friends as well. Patient suicides can be incredibly demoralizing and anxiety-provoking for the therapist, too. It is imperative, in my opinion, that therapists have the best, state-of-the-art tools for detecting the emergence of suicidal urges so that we can intervene and have the greatest chance of preventing these horrible events.

In two upcoming Feeling Good Podcasts, Fabrice and I will discuss what happened to a psychologist named Harold who thought he did not need to use the Brief Mood Survey to track his patients’ symptoms at the start and end of every therapy session. Like so many therapists, Harold  was convinced that he was sensitive and empathic and really understood how his patients felt with reasonable accuracy. When his favorite patient unexpectedly committed suicide following a particularly “good” therapy session, Harold was understandable devastated. He felt intensely depressed, anxious, ashamed, inadequate, alone, hopeless, and angry. You may find these two podcasts interesting and sobering.

My research and training experience indicate that therapists’ perceptions of how their patients feel (in terms of suicidal urges as well as severity of depression , anxiety and anger) are often way off-base, but therapists don’t realize this because most of them are not assessing assessment scales to track progress at every session. In addition, therapists’ perceptions of how empathic and helpful they are also way off-base much of the time for the same reason. They don’t measure empathy, and most don’t even ask patients to rate how warm and understanding they are.

That’s why I developed tools like the Brief Mood Survey, so therapists can track patient progress in multiple dimensions before and after every therapy session. I believe it’s use represents a major breakthrough in psychotherapy, because it’s like having an emotional X-ray machine to inform the therapist about what’s really going on, and to guide the treatment. Of course, I’m more than a little biased on this point! And the use of the BMS requires lots of courage, because the vast majority of patients are shockingly honest in the way they rate their therapists on these scales, and while the information can be invaluable, and even life-saving, it can also be quite disturbing and threatening to the therapist’s ego.

David

Hi David,

I just wanted to let you know that I recently started using the THERAPIST’S TOOLKIT and found myself in a similar situation you described. I recently had a patient whose scores were virtually ZERO on the Brief Mood Survey one week (meaning no symptoms at all), so I was convinced he was doing well. However, the following week I was alerted to high scores on your two-question “suicidal impulses” scale, which, to my chagrin, I nearly missed. That’s because I am in a new office with low lighting and I am visually impaired. But when I looked more closely, I discovered there my patient not only had suicidal thoughts and urges, but an actual plan for suicide!!!

Boy was I grateful having on hand the full blown Suicidal Urges Survey and Suicide Assessment Interview, which I proceeded to do in a two-hour session the following day. Just as surprising, his scores following THAT session were all ZERO again (except for Empathy and Self Help:-)

(David’s explanation. Scores of zero on the Depression, Suicide, Anxiety and Anger Scales are the best possible scores, indicating no symptoms at all. In contrast, scores of 20 out of 20 on the end-of-session Empathy and Helpfulness Scales are the best possible scores, indicating that the therapist was tremendous empathic and helpful during the session.)

Although I was/am at least temporarily relieved by the rapid reversal, I can’t say I know how to account for it, since most of the interview was assessment based, unless I just ooze TEAM-CBT without realizing it!

All that came to mind was “Hawthorne Effect.” As an aside, I know the “Suicidal Urges” survey is one of the “experimental” ones, but I saw no scoring sheet; I imagine they generally correspond with the BMS, the higher the worse.

Also, in answer to your query, I for one would LOVE to learn more about the Self-Defeating Beliefs survey and/or any info you impart in this regard. I was focused on that with the patient when I almost missed his staggering scores on the two questions on suicidal impulses. But I would like to return to it, and I will plan to give it for homework on a weekly basis to check his “emotional temperature” which is vitally important for this patient as you can imagine, I will consult some colleagues as well who have expertise in ethics and legal issues.

My TEAM CBT group (with Lynne Spevack) meets tomorrow, and we will focus on Testing, yay! And on Monday I will be starting Taylor Chesney’s TEAM CBT group! Both groups meet 2x/month. If only there were a group that met every day:-)

Meanwhile, I hope you’ve received my check by now for the EASY Diagnostic System which I cannot wait to get my hands on and need it desperately!!! When might I expect to receive the email with this valuable info?

I am enjoying your Feeling Good Podcasts, as well as your Feeling Good Blog and newsletter. I am more than fairly certain, were it not for your inventory (the Brief Mood Survey), I would have missed this potentially life-saving intervention. I’d even done a brand new Intake the week before. Although we do not have the power 100% to prevent a person from committing suicide, if we do not detect it we don’t have a fighting chance. I at least have the peace of mind now that with this knowledge, I can do everything in my power to insure this patient gets all the help he needs and hopefully the right help.

Thank you for being you and your contributions for making such a meaningful difference in the world for our patients and us therapists!

Kathy

PS I also really appreciated your podcast on anti-depressants, which I LOVED and wasn’t surprised. I’m sure that took tremendous courage, along with your well-intact integrity to speak your truth. I wish more Psychiatrists were like minded. Until there is such a paradigm shift, which I think is coming, such decisions will have to be decided between the patient and their doc largely comprised of big Pharma mentality. who’ve drunk the cool aid, sadly.

Hi Kathy,

Thank you for your enlightening email. I greatly enjoyed reading it, and kudos to you for saving your patient’s life.

You asked about the scoring of the two-item Suicidal Urges scale. I intentionally don’t have a strict numerical scoring key, as I want the therapist to attend to it thoughtfully. There are some guidelines in the massive update to the Therapist’s Toolkit. You probably have it already, but email me if you need it.

The first of the two screening items asks about suicidal thoughts and fantasies. Most depressed individuals will have these thoughts, such as the idea that they might be better off dead, but this is not generally alarming if there are no suicidal urges. Of course, you will always want to back up the survey with some questions to make sure.

The second of the two screening items asks about suicidal urges or plans. Any endorsement of this item is more worrisome, and usually merits a suicide assessment interview, just as you did. In general, you will only have to do this once with any particular patient, and it should ideally be done at the beginning of therapy, at the initial evaluation.

A third thing is to note changes in how the patient answers these two items, since any increase in the scores can indicate the development of increased suicidal urges. And as you say, we cannot 100% prevent suicide attempts in our patients, but the Brief Mood Survey will give you vastly improved information, since you will have the patient’s scores at the start and end of every therapy session.

One additional point, most versions of the Brief Mood Survey ask how the patient is feeling right now, just prior to the start of the session, and once again right after the end of the session. This is so the therapist can find out how effective, or ineffective, the session was. Such information is incredibly valuable! However, you can also ask if the scores reflect how the patient was feeling during the week, between the sessions. This is important, because the patient may have had times when he or she was feeling more suicidal, and this might merit a more intensive interview to assess the risk.

When you receive you EASY Diagnostic System from me (I assume you’ve already don this), you’ll find a structured screening interview for suicidal patients at the end of the diagnostic manual. This can be very helpful. There’s also a chapter in my psychotherapy eBook (Tools, Not Schools, of Therapy) on “The Prediction and Prevention of Suicide and Violence” that can be helpful as well. I have also included that chapter in the upgrade to the Therapist’s Toolkit.

Finally, please give Lynne Spevack my regards. She is a terrific teacher and therapist! I enjoyed catching up with her at the Newark workshop and encouraged her to meet more frequently with her training group. I agree that twice a month is not really enough. Keep in mind we now have three TEAM-CBT training centers in New York (for links, check out my referral page), plus numerous weekly online training groups that therapists around the world can join.

All the best,

David

 

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

Thanks! David

035: Live Session (Mark) — Final Testing, Wrap Up (Part 7)

035: Live Session (Mark) — Final Testing, Wrap Up (Part 7)

Part 7: T = Testing Revisited, Conclusion of the Live Therapy Session with Mark

This is the last live therapy podcast with Mark, the physician who was convinced he was a failure as a father because of his difficulties forming a close, loving relationship with his oldest son. Although the session appeared to go well, we can’t be sure until we see Mark’s end of session mood ratings on the Daily Mood Log and on the Brief Mood Survey and and Evaluation of Therapy Session. David emphasizes that therapists’ perceptions of patients are notoriously inaccurate, but most therapists are unaware of this because they don’t use the rigorous testing procedures at the start and end of sessions.

To review Mark’s partially completed Daily Mood Log, CLICK HERE. Jill and David will ask him to complete the additional negative thoughts on his own after the session.

To review mark’s end of session Brief Mood Survey and Evaluation of Therapy Session, CLICK HERE.

After David review’s the phenomenal changes Mark reported from the start to the end of the session, David asks if the ratings were genuine, or, as some listeners might suspect, faked in order to try to please the therapists. Mark bursts into tears and says, in a choked voice, that it was a life-changing experience.

After the end of the session, David and Fabrice discuss a number of highlights from the work with Mark:

  • The testing indicated a complete or near-complete elimination of symptoms. In 2 ½ hours, Jill and David have essentially completed an entire course of psychotherapy. Although there may still be some work to be done with Mark, the hard part has already been completed.
  • David emphasizes that he now views psychotherapy as a procedure to be done at one sitting, much like surgery, with brief follow-up visits, rather than a long, drawn out procedure meeting once pre week for months or even many years. And although a single 2 or 2 1/2 hour session may be more costly than a traditional 50-minute hour, it can be vastly more cost-effective Than dozens of sessions with little or no progress. In addition, it is vastly better for the patient who walks out feeling good today, rather than having to endure weeks, months, or even many years of traditional talk therapy or antidepressant drug therapy.
  • David and Fabrice talk about the fact that no one is permitted to feel happy all the time, and that Mark’s negative thoughts and feelings WILL return, David defines a “relapse” as one minute or more of feeling lousy. Given that definition, we will ALL relapse forever! But it doesn’t have to be a problem for Mark if he is prepared for this, and knows how to pop out of the relapses quickly, rather than getting stuck in them. This is where Relapse Prevention Training (RPT) becomes so important following the initial dramatic recovery. RPT only takes about 30 minutes and is easy to learn, and will perhaps be the topic for a future Feeling Good Podcast if our listeners express an interest in it.
  • David discusses the difference between an Internal Solution and an External Solution. In this session, David and Jill have guided Mark in the Internal Solution—this means crushing the negative thoughts that triggered Mark’s feelings of unhappiness, anxiety, shame, failure, and anger for years, if not decades. Now that he is feeling so much better about himself, he may want some help with the External Solution. This will involve learning how to develop a more loving relationship with his son using tools like the Relationship Journal and the Five Secrets of Effective Communication. This will be far easier now that Mark is no longer using up all his energy beating up on himself and feeling depressed and inadequate.
  • David wraps up by talking about the true wealth we have as therapists. Although we won’t develop the riches of a Bill Gates doing psychotherapy, we do have the fabulous and precious opportunity to see people as they really are inside, and to witness miracles like the one we saw in the session with Mark.
  • David expresses the hope that listeners have benefitted by listening. Although we are all different, most of us have had the painful experience, like Mark, of believing we were somehow failures, or inferior, or defective, or simply not good enough. We are deeply indebted to Mark’ courage and generosity in giving us the opportunity to see the solution to this ancient and almost universal human problem!

There are many resources for listeners who want to learn more about TEAM-CBT, including:

  • David’s exciting two-day and four-day training workshops, listed on his website, feelinggood.com.
  • Tons of free resources for patients and therapists at feelinggood.com. Please sign up using the widget in the upper right hand corner of any page on his website and you will receive email notifications and links to every post.
  • David’s psychotherapy eBook entitled Tools, Not Schools of Therapy.
  • David’s Tuesday psychotherapy training groups at Stanford, which are co-led Jill Levitt, PhD and Helen Yeni-Komshian, MD. The training is free of charge to Bay Area and northern California therapists. You will have the chance to do free personal work, too!
  • David’s famous Sunday hikes, also free to members of the training groups.
  • Paid online and in-person weekly TEAM-CBT training groups, plus intensive TEAM-CBT treatment programs, at the Feeling Good Institute in Mt. View California.
  • In addition, many TEAM-CBT training and treatment programs are now offered in many cities throughout the US and Canada. For more information, visit feelinggood.com or www.feelinggoodinstitute.com.

029: Live Session (Mark) — Introduction & Testing Phase (Part 1)

Podcast Live Therapy Session: “I’ve been a failure.”

Introduction

Jill & DavidThis is the first in a series of podcasts that will feature live therapy. As you listen, you’ll have the opportunity to peak behind closed doors to see how TEAM-CBT actually works in a real-world setting, and not role playing.

The patient is a physician named Mark who has been haunted for decades by a problem with his oldest son, and he feels like a failure as a father. Although the facts of your life are likely to be very different, you might understand what it’s like to feel like a failure, or to tell yourself that you’re defective, or simply not good enough.

The two co-therapists include David and his highly-esteemed colleague, Dr. Jill Levitt. We have broken the session down into a number of podcasts that will include excerpts from the session along with commentaries on the thought patterns of these two master therapists as the session unfolds.

Part 1—T = Testing

As the session begins, David and Jill review of Mark’s scores on the Brief Mood Survey (BMS), which he completed just before the session began. The scores indicate that Mark is only feeling mildly depressed, anxious, and angry, but is extremely dissatisfied with his relationship with his son.

Click here to view Mark’s initial Brief Mood Survey.

At the end of the session, David and Jill will ask Mark to complete the BMS again. By comparing his patient’s scores at the start and end of the session, they will be able to see exactly how effective, or ineffective, the session was. Mark will also rate David and Jill on Empathy, Helpfulness, and several other important dimensions.

Testing at the start and end of every therapy session is one of the new and unique components of TEAM therapy. The testing can revolutionize psychotherapy, because therapists can fine-tune their therapeutic strategies based on the scores, and make critical important changes if the session was not particularly helpful. However, the assessment instruments are extremely sensitive and pick up the smallest therapeutic errors. This can be quite threatening to therapists who don’t want to be held accountable.

The Ten Worst Errors Therapists Make–and How to Avoid Them

The Ten Worst Errors Therapists Make–and How to Avoid Them

The Ten Worst Errors Therapists Make–and How to Avoid Them*

©2012 by David D. Burns, MD

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

Really good therapy may tend to go against human nature to a certain extent. Unfortunately, therapists keep gravitating toward familiar approaches that are comfortable but ineffective. I have created a list of the ten most common errors therapists make, with the solutions I have proposed for each error. In today’s blog, I will focus on the first of these errors.

Error #1. The Failure to Measure

The great majority of therapists want to work “intuitively,” without quantitative assessment of changes in symptoms each session, and without a quantitative assessment of the quality of the therapeutic alliance. This failure to measure results from the belief that we “know” fairly accurately how our patients are thinking and feeling, based on our training as well as our own feelings and perceptions during the session.

My research and clinical experience have indicated that this belief may be misguided and, in some cases, even dangerous. Therapists’ perceptions of how their patients feel tend to be inaccurate. In other words, your patient could be enraged, and yet you may believe that she or he is not at all angry. Or your patient could have significant negative feelings about you as well as the treatment you are offering, but you may be convinced that you have developed warmth and understanding with that patient. Or, your patient could be planning a suicide attempt within the next couple days, but you may think that he or she is making good progress and feeling a lot better.

Here’s my solution to this problem: My colleagues and I require all patients to complete the Brief Mood Survey (BMS) in the waiting room immediately before each sessions begins, indicating how they feel right now. The BMS includes brief, highly accurate scales that measure depression severity, suicidal urges, anxiety, anger, relationship problems, and positive feelings such as joy, self-esteem, and productivity. It only takes about one minute to complete the BMS.

The patient hands the BMS to the therapist at the start of the session, and the therapist will instantly know exactly how the patient is feeling. The therapist records the scores on a flow sheet in the chart—this takes less than 15 seconds, and a glance will show the therapist exactly how much, or how little, the patient has been progressing since the first session. The therapist also knows exactly how disturbed the patient is feeling right now, at the start of the session, so any serious problems can be addressed.

After the session is over, the patient completes the BMS once again in the waiting room, indicating how she or he feels right now. The patient also rates the therapist on warmth, empathy, helpfulness, and other therapy process dimensions, using extremely sensitive scales, and writes down what he or she liked the least, and the most, about the session. It takes the patient about two minutes to complete the end-of-session assessments. The patient leaves these end-of-session assessments in the therapist’s box before going home.

You can review this information right away, when the session is still fresh in mind. It is like having the world’s greatest supervisor providing specific and accurate feedback at the end of every single therapy session. You will discover exactly how effective you were (or weren’t), and how much your patient improved (or failed to improve) during the session. If you are courageous, this information has the potential to transform your clinical work. However, humility will be required, because the information will often be disturbing to you.

In the Bible, there is mention of the “unforgiveable sin.” Theologians have debated about what this sin might be. I have to confess that I don’t know the answer, but I do believe there is an “unforgiveable sin” that therapists make—and that is the failure to measure. I am convinced that it is impossible to do world-class therapy without measuring at each session. I also believe that the failure to measure reflects a kind of therapist arrogance, or narcissism—the belief that we are “experts” and that our own perceptions of how patient feel (or feel about us) are somehow more accurate than the patient’s perceptions of how they actually do feel. In most cases, nothing could be further from the truth.

Some therapists resist the use of the assessment scales, arguing that patients won’t be honest in the way they fill them out, and will simply tell therapists what they think the therapist wants to hear. Once again, nothing could be further from the truth. When my students (psychiatric and psychology graduate students) use the assessment scales initially in the clinical work, most get failing grades from nearly every patient at nearly every session. So their patients are NOT telling them what they want to hear—they are telling them what they DON’T want to hear!

How about seasoned clinicians like yourself? Unfortunately, your experience will probably be similar. Initially, most seasoned clinicians receive failing grades on the therapeutic empathy and therapy helpfulness scales from almost every patient as well. This can be a huge blow to the ego, and it is one of the reasons that many clinicians refuse to use the scales. They can’t stand the heat.

But there is a silver halo around this cloud. Most students and community clinicians who use the scales with every patient at every session, and who do some Empathy Training using methods I’ve developed, report that within a few weeks, they receive perfect scores 80% of the time, rather than failing scores nearly 100% of the time. So there is hope for a remarkable transformation in your clinical skills—if you have the courage to take this huge step!

Thanks for listening. David Burns, MD