059: Live Session (Marilyn) —The Tune-up

059: Live Session (Marilyn) —The Tune-up


Podcast 59, Live Therapy with Marilyn, The Tune-Up

This podcast was recorded eight weeks after the initial session with Marilyn. As you may recall, Marilyn became severely depressed when she discovered that she had Stage 4 Lung cancer. In spite of that horrific and real trauma, she completely overcame her negative feelings in the first session, which was broken down into a series of three consecutive podcasts, with commentaries as the session unfolded.

Sadly, Marilyn experienced severe pain in her left rib cage from a metastasis from her lung cancer roughly two months later. This physical relapse triggered an understandable emotional relapse as well, with an understandable return of severe depression, anxiety and anger, so Marilyn agreed to record another podcast to illustrate how a tune-up works following the initial treatment.

I would like to point out that the Relapse Prevention Training was critically important, so that Marilyn would know that relapses are a certainty, and that they can be dealt with effectively using the same techniques that worked the first time. This message is important so that the patient does not feel broadsided when the negative feelings return. Some patients have the false expectation that they’ll be happy forever after they’ve recovered.

But no one is entitled to be happy all the time! If the therapist and patient know how to deal with a relapse, and have practiced ahead of time, it will still be painful, but the patient and therapist will know what to do to make sure the patient can recover from the relapse quickly, instead of getting caught in another length episode of depression or anxiety.

The entire session has been included in this single podcast. That’s why we’ve offered this as a bonus session between our weekly podcasts. You will need nearly two hours to listen to it, but I think you will find it’s a great investment of your time.

In addition to her anxiety about the metastasis, and the fairly strong physical pain that is now with her constantly, Marilyn was flooded with intense Negative Thoughts and feelings that revolved around a number of familiar themes, including:

  1. Her belief that her life is now over, and that she has nothing more to live for.
  2. Her conviction that she is a burden to Matt, Fabrice, and David, who would prefer (she thought) to be relaxing with their families, instead of sitting down with Marilyn on a Saturday morning.
  3. Her anger that God has abandoned her.
  4. Her belief that she should not be so angry with God.
  5. Her despair and fatigue at constantly struggling with pain.
  6. Her urge to drink again.
  7. Her self-criticisms and feelings of intense shame about her life and her relapse into depression.
  8. Her conviction that things are hopeless.
  9. Her belief that she’s selfish.
  10. He belief that she should not be watching so much TV.
  11. Her ambivalence that on the one hand she is afraid of dying, but at the same time she wants her suffering and struggling to be over.

After the initial T = Testing, Matt and David walked Marilyn through the E = Empathy, A = Agenda Setting, and M = Methods portion of the session, using techniques such as the Five Secrets of Effective Communication, Positive Reframing, the Magic Dial, Identify the Distortions, the Externalization of Voices, Acceptance Paradox, and more.

They also used the Interpersonal Downward Arrow, highlighting Marilyn’s view of her relationship with the two therapists—the “Rules and the Roles” that we’ve discussed in a previous podcast. Keep in mind that in the analyses below, we are talking about how Marilyn views her relationships with two people she cares deeply about. We are not talking about what’s “real,” but rather how we view and experience our relationships with othes.

The adjectives Marilyn used to describe her role in her relationships with David and Matt included:

  • Stupid
  • Inferior
  • Needy
  • Lazy
  • Unimportant

The adjectives she used to describe the role that David and Matt played in the relationship included:

  • Superior
  • Critical
  • Demanding
  • Phony
  • Rejecting
  • Important
  • Uncaring

And the rules that Marilyn believed she must follow in this (and all) relationships included:

  1. I have to suffer in silence.
  2. I am not allowed to ask for help.
  3. I need to stay alone.
  4. I have to be quiet.
  5. I have to behave in an extremely submissive manner.
  6. I have to be guarded at all times.
  7. I have to be invisible and hide all my feelings.
  8. I cannot be assertive or I’ll be put down.
  9. I must always put myself last and put others first.
  10. I cannot be important.
  11. I cannot expect or accept kindness and love.
  12. I can’t be weak, emotional, real or vulnerable in front of you.
  13. I cannot express any anger or loneliness for fear of retaliation.

Once again, Marilyn experienced another rapid, inspiring and rather mind-boggling transformation in her thoughts and feelings during the session. Then, Matt, David and Marilyn discussed the spiritual implications of her “dark night of the soul,” and emphasize the incredible gift Marilyn is giving to all of us through these recordings, as well as the enormous growth she is still experiencing during this phase of her life.

A few potentially important teaching points include:

  1. We will all “relapse” back into spells of depression, anxiety, shame, hopelessness, and anger from time to time. No one is entitled to be happy all the time! This is a practical and spiritual reality for human beings. But it does not have to be a problem if you have the tools to climb back out whenever you fall into a black hole of self-doubt or despair.
  2. Our painful feelings do not result from the events in our lives–in this case, a painful metastasis–but from out thoughts about these events.
  3. Even when an event is genuinely horrific, the negative thoughts that trigger our feelings of depression and anxiety will nearly always be distorted and unrealistic. However,  we may not realize this, and firmly believe that our negative thoughts are absolutely true. This way of thinking may contain a grain of truth but makes us victims of forces beyond our control.
  4. For each of us, the negative thoughts that trigger our occasional “relapses” into depression and anxiety will usually be very similar, if not identical, from episode to episode. Of course, we will all have our own unique patterns of negative thinking, and no two people will have the exact same negative thoughts. That’s why formulaic approaches to treatment may sometimes fall short–because the therapist does not pinpoint or target the specific negative thoughts that trigger the patient’s distress.
  5. The techniques that worked for the patient the first time s/he recovered will nearly always work for the patient when the negative thoughts return.

David and Matt were grateful and thrilled to receive this email from Marilyn the day after they recorded the podcast:

Greetings David,

Much gratefulness to you, Matt, and Fabrice. It was a profound experience. At my AA meeting this am, a number of people came up to me and commented on how good I looked—relaxed & glowing. Yesterday was magical! It is a privilege working with you. Matt, and Fabrice. Thank you for taping.

Thank you also for the book, The Inner Eye of Love. It is very good. I also left a bag of honey somewhere in your home – one for you & Melanie, one for Matt, and one for Fabrice.

I will listen to the podcast of our first therapy session (two months ago) tomorrow—today was busy. I will get back to you with feedback.

Thank you also for your company at the Intensive and paying for my meals. I so enjoy your company, and if I may be so bold, your friendship.

Lastly, please e-mail the Therapist’s Toolkit upgrade.

Don’t worry about my not feeling hungry at lunch. I ate a big breakfast for me. I did eat dinner!

Again, thank you for helping me. Please thank Melanie for making your home available. Pets and kisses to your new kitty, Ms. Misty.

I hope you’re having a rest-filled weekend. Enjoy the Sunday hike! I look forward to listening to the podcasts.

With much gratitude and love,



050: Live Therapy with Marilyn, Part 2, Is Depression a “Mental Disorder?”

050: Live Therapy with Marilyn, Part 2, Is Depression a “Mental Disorder?”

The Hidden Side of Depression, Anxiety, Defectiveness, Hopelessness and Rage

We nearly always think about negative feelings, such as  severe depression or anxiety, as problems that an expert must try to fix, using drugs and / or psychotherapy. And there are a multitude of theories about why humans become depressed, including, but not limited to:

  • Reality. We think we get depressed because reality sucks. We believe our mood slumps result from the negative circumstances in our lives, such as being alone following a rejection, experiencing the loss of a loved one, not having enough money, education or resources, social prejudice, or (as in Marilyn’s case) facing some catastrophic circumstance, such as severe illness.
  • Upbringing. We think we get depressed because of insufficient love and nurturing in childhood, or because of traumatic childhood experiences.
  • Biological factors. We believe that feelings of depression and anxiety result from problems with our genes, or diets, or because of a chemical imbalance in our brains.

Certainly, there can be some truth in all of these theories. Reality does kick us all in the stomach from time to time, and the pain we feel is understandable. My wife and I lost her father to Parkinson’s Disease a few years ago. We loved him tremendously, and his loss was extremely painful for everyone in our family.

Most of us have experienced less than ideal circumstances when growing up as well, and many have been victimized by horrific experiences, such as child abuse or bullying. And clearly, some psychiatric illnesses, such as schizophrenia, do result from some kind of biological abnormality in the brain.

But the problem with all of these theories is that they put us at the mercy of forces that are largely beyond our control—since we often cannot do much to change reality, rewrite our childhoods, or modify our brains short of taking this or that medication. And, in addition, these theories all suggest that negative feelings like depression and anxiety show that there is something wrong with us.

In this podcast, Matt and David take a radically different approach, and argue that Marilyn’s intense feelings of depression and anxiety are not “mental disorders” that reflect some defect in Marilyn, but rather the expression of what is most beautiful and awesome about her. They also argue that there are large numbers of advantages, or benefits, of feeling the way she does. They use several Paradoxical Agenda Setting Techniques, including the Invitation, the Miracle Cure Question, the Magic Dial, Positive Reframing, and the Magic Dial. The results are stunning and unexpected.

At the end of this segment, David and Matt argue that it might be desirable for Marilyn to continue to feel some of her negative feelings, and ask her how depressed she would like to feel at the end of the session, using the “% Goal” column on her Daily Mood Log. She also indicates how anxious, ashamed, defective, alone, hopeless, frustrated, and angry she would like to feel.

The third and final podcast next week will include the M = Methods phase of the session along with the end-of-session T = Testing and wrap-up, including Relapse Prevention Training.


049: Live Therapy with Marilyn, Part 1, The Dark Night of the Soul

049: Live Therapy with Marilyn, Part 1, The Dark Night of the Soul

You FEEL the Way You THINK! . . . Or Do You?

The next three podcasts feature a therapy session with Marilyn, a woman recently diagnosed with Stage 4 (terminal) non-smoker’s lung cancer. We are enormously grateful to Marilyn for her courage and generosity in making this extremely private and intensely personal experience available to all of us. I believe the session will inspire you, and give you courage in facing losses, traumas and problems in your own life.

At the beginning of the therapy, Marilyn is in shock, experiencing, quite understandably, extreme levels of depression, anxiety, shame, loneliness, hopelessness, and anger. What’s the cause of her negative feelings?

According to the theory behind cognitive therapy, people are disturbed not be events, but rather by the ways we think about them. This notion goes back nearly 2,000 years to the teachings of the Greek Stoic philosopher, Epictetus, who emphasized the incredible importance of our thoughts—or “cognitions”—in the way we feel.

When you’re upset, you’ve probably noticed that your mind will usually be flooded with negative thoughts. For example, when you’re depressed, you may be beating up on yourself and telling yourself that you’re a loser, and when you’re anxious you’re probably thinking that something terrible is about to happen. However, it may not have dawned on you that your thoughts are the actual cause of your negative feelings.

In addition, you may not be aware that your negative thoughts will nearly always be distorted, illogical, or just plain unrealistic. In fact, in my first book, Feeling Good, I listed the cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, and hidden Should Statements, that trigger negative feelings. The notion that depression, anxiety, and event anger result entirely from your thoughts, and not upsetting events, can be enormously liberating, because we usually cannot change what’s actually happening, but we can learn to change the way we think—and feel.

But is this notion really true? Can’t traumatic events upset us? And can we really change the way we think and feel when the circumstances of our lives are genuinely awful? Or is this just a lot of pop psychology?

A lot of people don’t buy into the notion only your thoughts can upset you. It just seems to fly in the face of common sense. For example, you might argue that when something genuinely horrible happens, such as failure, losing a loved one, or being diagnosed with terminal cancer, it is the actual event and not your thoughts, that triggers the negative feelings. And you might also argue, perhaps even with some irritation, that your thoughts are definitely not distorted, since the actual event—such as the cancer—is real.

Would you agree? I know that’s what I used to think! If you’re interested, and you have not yet listened to the first Marilyn podcast, you can take the brief poll on the home page and let us know what you think!

The next three podcasts will give you the chance to examine your thinking on this topic, because Marilyn is struggling with a negative event that is absolutely real and devastating. At the end of the third podcast, you’ll have the chance to take the poll again.

In this podcast, Drs. Burns and May go through the T = Testing and E = Empathy phases of the TEAM-CBT session. If you’d like, you can review the Brief Mood Survey and Daily Mood Log that Marilyn completed just before the session began. You will see that her negative feelings are all severe, and that her negative thoughts focus on several themes, including

  • Her fears of cancer, pain, and death.
  • Her thoughts of spiritual inadequacy, doubting her belief in God, wondering if there really is an afterlife, and feeling that she’s perhaps been duped by religions.
  • Her feelings of incompleteness at never having had a truly loving life partner.
  • Her intense self-criticisms, beating up on herself for excessive drinking during her life.

The next Feeling Good Podcast with Marilyn will include the A = (Paradoxical) Agenda Setting phase of the TEAM therapy session, where David and Matt will attempt to reduce Marilyn’s resistance and enhance her motivation using the Miracle Cure Question, the Magic Button, the Positive Reframing Technique, and the Magic Dial. The third and final podcast will include the M = Methods phase, where David and Matt will encourage Marilyn to challenge her negative thoughts using Identify the Distortions, the Paradoxical Double Standard Technique, the Externalization of Voices, and the Acceptance Paradox, followed by Relapse Prevention Training, the end of session testing, and wrap-up.

Although the subject matter of these podcasts is exceptionally grim and disturbing, we believe that Marilyn’s story may transform your thinking and touch your heart in a deeply personal way. Because Marilyn is a spiritual person who suddenly finds herself without hope or faith, and totally lost, we have called part one, The Dark Night of the Soul, a concept from William Johnston’s classic book on religious mysticism entitled, The Inner Eye of Love.

We are hopeful these broadcasts will stimulate comments and discussions on the philosophical and spiritual messages embedded in the Marilyn session from you and our other listeners. Is it true that only our thoughts can upset us? And is the total loss of faith a necessary step on the path to enlightenment?

Live Session (Marilyn) — The Dark Night of the Soul (Part 1)