Rhonda and David interview Garry, a veteran who David treated for PTSD several years ago at a trauma workshop in Michigan. Garry describes how a repressed horrific memory from his childhood suddenly and forcefully re-emerged when he smelled some Queen Anne’s Lace that were in blossom. He suddenly remembered how a school bus he was riding home on hit a horse with a boy, Tommy, who was riding bareback, when the horse suddenly lurched in front of the bus. Tommy was Gary’s classmate.
The bus driver said, “Don’t look!” But Garry watched as his friend, who was trapped under the dead horse, “bled out” and died.
Once this totally forgotten memory re-emerged decades later, roughly 18 months prior to Garry’s session with David, it constantly intruded into Garry’s every interaction for the next year and a half. Garry says,
“I was seeing Tommy all the time, and having symptoms of anxiety, intrusive memory and dissociation experiences. I would often see the image of Tommy lying on the pavement superimposed over conversations I was happened with people in an intimate way. It was quite disturbing and anxiety provoking.”
Garry tearfully describes what he experienced during his TEAM-CBT session with David, including his dissociation at one point during the session, and the profound changes he experienced by the end of the session.
Can severe PTSD be treated in a single therapy session? Did Garry really improve? Were the changes real? Did they last? And how did the therapy work?
You’ll find out when you listen to this amazing and inspiring interview! We are incredibly indebted to Garry for his courage and openness to share this experience with all of you!
You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com.
If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.
The famed neuroscientist, Dr. Mark Noble, from the University of Rochester, has developed a strong interest in TEAM-CBT and has visited our Tuesday group and Sunday hikes on three occasions this year. I (David) feel very fortunate to have his collaboration and interest!
Mark and David at the Cupertino Plaza for a sumptuous dim sum feast at the Joy Luck Palace following a Sunday hike.
Mark is a Stanford-trained geneticist and molecular biologist who is considered one of founders of the field of stem cell research. He has been developing a model of how TEAM-CBT affects the brain, and graciously agreed to present his model at our Tuesday evening Stanford TEAM-CBT seminar last week. Although his model is not yet fully polished and refined, and involves considerable speculation, it is an exciting first step, kind of like the time when astronomers broke away from the Catholic church and started trying to make sense of the universe. In this instance it is the “inner universe” Dr. Noble, all of us, are trying to understand. His model will evolve and get more and more refined over time.
The participants in the seminar really liked his concept that we are doing micro-neurosurgery for depressed patients with TEAM-CBT! He is convinced that the rapid recovery we see with TEAM-CBT will probably never be equaled by medication, since the brain circuits that modulate happiness and unhappiness tend to use the same neurotransmitters. But with language, you can affect brain circuits far more selectively and effectively, almost like a micro-neuro-surgeon.
Dr. Noble describes brain function in terms of the SNEFF model. This stands for Structures, Networks, Emotions, Frames and Filters, and links these concepts to the prefrontal cortex, amygdala and sympathetic nervous system. Then he describes the four steps of TEAM (T = Testing, E = Empathy, A = (Paradoxical) Agenda Setting, and M = Methods), and links each step to the SNEFF model, making interesting speculations on how TEAM works and what makes it so effective.
Dr. Noble also discusses David’s “fractal” theory about psychotherapy and relates that to brain function as well as to the mathematics of complex structures. He describes how and why some people get stuck in the “homeostasis” of chronic, refractory depression and explains why TEAM-CBT is usually able to trigger sudden and dramatic changes in the brain, as well as in the way the depressed and anxious individual thinks, feels, and behaves. He also explains why conventional talk therapy is unlikely to be helpful for individuals struggling with depression and anxiety, and may, in some cases, make the depression worse.
This is because neurons that “fire together wire together.” In other words, if you go to therapy and complain or emote about your life and your problems over and over, without taking action to change, the circuits in your brain that support complaining and feeling depressed will just get more and more intensely wired together.
Dr. Noble also speculates on why Paradoxical Agenda Setting is such an important key in ultra-rapid-recovery and in the sudden transformation of brain function as well.
Years ago, when I was kid on vacation in Minnesota, I saw an article in a small newspaper published in a rural area. A local scientist had speculated that one day we would have guided missiles and satellites and drew a simple diagram for the newspaper of how they would work. At the time it seemed a bit like science fiction, and I wondered if an unknown scientist from a small rural Minnesota town could actually predict a major scientific development. But now we see that he was right.
Will we someday think about Dr. Noble in the same way? Listen to this exciting podcast, and you can decide for yourself!
You might be interested in some of the comments from individuals who attended the Stanford seminar and heard Dr. Noble’s talk:
Mark’s work was wonderful in helping me understand the map of TEAM onto the brain. We’re all micro-neurosurgeons!! Everyone has honorary MDs!
Loved the presentation!
Mark’s presentation was fascinating! I got really excited about all of the interesting research that could come out of it.
I absolutely appreciated Mark’s presentation on his research and how made the connections with TEAM. This was truly very interesting and helpful, and made me realize how fortunate I am to belong to this Tuesday group!
Interesting new perspectives brought in by our guest speaker
I highly enjoyed Mark’s visit and was captivated by the information! Thank you!
Loved learning how frames and filters interact to build experience.
AWESOME PRESENTATION! It was wonderful to hear Mark’s presentation. He did an outstanding job and I was extremely fascinated with the information he presented to us. He did a fantastic job in describing brain functioning in relation to TEAM CBT. Loved every minute of it!
I loved the concept of fractals in creating the concentrated surge of change into the next “valley” rang true.
I resonated with the importance of “storytelling” and the value of a client being heard and respected when the therapist uses the Five Secrets of Effective Communication, and how this induces a sense of the client being equal, and how that can quiet the agitated brain!
David
Attend my 2018 Summer Intensive in San Francisco!
This year, I am again offering my annual SF summer intensive in August at the South San Francisco Conference Center. This four-day intensive is almost always my most exciting and rewarding workshop of the year.
Here are the details:
David’s TEAM-CBT Summer Intensive
August 6 – 9, 2018, South San Francisco Conference Center, California
For more information, click here, or call IAHB.org at 800-258-8411
Here are just a few of the really cool things about this intensive:
You will have the chance to practice techniques in small groups after I demonstrate each technique with a live demonstration in the front of the room.
You will get immediate feedback and personal grooming from me and from many of my colleagues from my weekly TEAM-CBT training group at Stanford. They’ll be there to help you, and I’ll be there to help you, too!
There will be a live demonstration on the evening of day 1. The amazing Dr. Jill Levitt will be my co-therapist. Last year’s live demonstration, and in fact all of them in recent years, have been jaw-dropping and incredibly inspirational!
You’ll get a chance to practice TEAM-CBT in real time the evening of day 3. This will be an incredibly challenging but rewarding “solo flight.”
You will be able to do your own personal work on the last day of the workshop using the Externalization of Voices and Acceptance Paradox. In previous workshops, at least 60% of the participants indicated they experienced jubilant enlightenment during this exercise. Their fears and insecurities suddenly vanished!
You’ll learn how to do Relapse Prevention Training (RPT).
You’ll learn how to improve your empathy skills.
You’ll learn tons of powerful cognitive, behavioral, and motivational treatment techniques for depression and all of the anxiety disorders.
You will have the abundant opportunities to schmooze with colleagues, network, and have fun.
You will have two fabulous free luncheon banquets featuring talks by Sunny Choi, LCSW, who is using TEAM-CBT successfully with an underserved population in primary care with limited resources and language skills (“I must apologize for my success.”), and the wonderful Vandana Aspen, PhD, who will speak on “New Treatment Strategies for Eating Disorders.”)
And much more.
If you can only attend one of my workshops this year, the South San Francisco August intensive is the one to attend!
Building Self-Esteem and Overcoming Toxic Shame–as well as feelings of depression, anxiety, inferiority, hopelessness, and anger!
Let’s face it–nearly all of us fall into the black hole of depression, anxiety, shame, and self-doubt at times. Then it’s time to ask yourself what you’re telling yourself, write down your negative thoughts, identify the distortions in them, and substitute thoughts that are more positive and realistic. Sound too easy? The results can be mind-blowing!
David and Fabrice discuss a therapy session with a woman who had been hiding something about herself for nearly ten years due to feelings of shame. When she receives a phone call from someone in her church, her feelings of anxiety and shame hit the ceiling. Learn how she overcomes her feelings of angst and self-doubt using TEAM-CBT.
David hopes to make the actual video of this dramatic therapy session available soon right here at www.feelinggood.com in his new Feeling Good Store! (still under development at the time of this write-up.)
While listening, you can download pdfs about each of seven steps to help you break out of bad moods and boost your self-esteem:
Step 1. Identify the Upsetting Event
If you click on Melanie’s Daily Mood Log you will see that the Upsetting Event was something seemingly innocuous.
Step 2. Rate Your Negative Feelings
If you click on Melanie’s Daily Mood Log again, you will see how she circled her feelings and rate each type of a feeling on a scale from 0% to 100%. You will see that her negative feelings were actually incredibly intense.
Cognitive therapists, going all the way back to the Greek Stoic philosopher, Epictetus nearly 2,000 years ago, say that we are upset, not by things, or events, but by our thoughts about them. If you click on Melanie’s Daily Mood Log with Negative Thoughts yet again, you will see what she was telling herself about the phone call from the member of her church.
Step 4. Positive Reframing
This is one of the many powerful new features of TEAM-CBT. Before trying to change the way you think and feel, focus on your negative thoughts and feelings one at a time and ask yourself two questions:
What are some benefits, or advantages, of this negative thought or feelings?
What does this negative thought or feeling show about me and my core values that’s positive and awesome?
Briefly stop the recording and review Melanie’s Daily Mood Log. Then see how many positives you can list. For example, what does Melanie’s shame show about her that is awesome and positive? And what are some really beautiful things about her sadness and depression? What are some potential benefits of her anxiety?
Step 5. Identify the Distortions
After the Paradoxical Agenda Setting (in this case, Positive Reframing), I asked Melanie what Negative Thought she wanted to work on first. She selected the second negative thought, “She’ll tell other people who will judge me.” See how many distortions you can find in this thought, using the list of ten distortions on her Daily Mood Log.
When you’re done, you can see how Melanie identified the distortions in this thought, using abbreviations, in the Distortion column of her Daily Mood Log. However, on the podcast, David identified one additional distortion he had overlooked during the live session with Melanie. Can you figure out which one it is?
Step 6. Challenge the Negative Thought
There are more 50 techniques that you can use to challenge a Negative Thought. After listing roughly 17 promising methods during the session, Melanie decided that she wanted to start out with a gentle method called the Paradoxical Double Standard Technique. If you click on Melanie’s Daily Mood Log again, you can see the Positive Thoughts Melanie came up with to challenge the Negative Thought, “She’ll tell other people who will judge me.” You will also see how strongly she believed them. Remember that the Necessary Condition for Emotional Change is that the Positive Thoughts all have to be 100% true. Rationalizations and half-truths will rarely, if ever, give anyone genuine relief or mood elevation.
Now the question is this: Did the Positive Thoughts reduce Melanie’s belief in the Negative Thought? Remember the Sufficient Condition for emotional change: the Positive Thoughts must drastically reduce the belief in the Negative Thoughts. That’s the whole goal, in fact, of cognitive therapy. Remember, when you change the way you THINK you can change the way you FEEL!
If you click on Melanie’s Daily Mood Log again, you’ll see that her belief in the Negative Thought was, in fact reduced. Sometimes, you will want to reduce your belief in a Negative Thought all the way to zero. But in this case, 35% was sufficient, since some people may, in fact, judge Melanie, although most people probably will not.
Step 7. Outcome: Re-rate Your Negative Feelings
Once you’ve clobbered one negative thoughts, it’s generally much easier to knock the rest of your Negative Thoughts out of the park. This was the case with Melanie. If you review her final Daily Mood Log, you can see how she challenged the rest of her Negative Thoughts and the incredible impact this had on her feelings.
Coming Soon!
Next week we will have something very special and very precious for you–
Podcast 079: What’s the Secret of a “Meaningful” Life? Live Therapy with Daisy
This will be a dramatic and inspiring podcast that Fabrice and I feel very grateful to be able to share with you. The podcast will be based on an actual therapy session with a young woman who is struggling with depression, anxiety, and self-doubt because of fertility issues, due to strong. societal messages that women shouldhave children and should want children. This will be a unique opportunity to go behind closed doors to see TEAM-CBT live and real with someone like yourself who is struggling with intense negative thoughts and feelings.
The live therapy sessions we have published previously–with Mark, who felt like a failure as a father, and with Marilyn, who was confronted by a sudden and totally unexpected horrific diagnosis of Stage 4 lung cancer–received tremendously positive feedback from all of you. Now we are proud to present yet another live therapy session next week! So mark your calendars!
March 22 and 23, 2018 Rapid Recovery from Trauma,(David D. Burns, MD)J&K Seminars, Lancaster, Pa 15 CE credits, includes live evening demonstration on the evening of day 1. You can join in person or online from wherever you live!
Additional Resources for the General Public (all available at Amazon.com, as well as other booksellers)
Feeling Good: The New Mood Therapy
The Feeling Good Handbook
Feeling Good Together
When Panic Attacks
General public and mental health professionals might enjoy the recent article about David in Stanford Magazine authored by Robert Strauss entitled “Mind Over Misery.”
Additional Resources for Mental Health Professionals
David’s Tuesday evening TEAM-CBT meets at the Behavioral Sciences Building, 401 Quarry Road, Room 2209 from 5:00 to 7:30 PM, and is free. It is open to all SF Bay Area mental health professionals as well as graduate students in any mental health field, including but not limited to Stanford graduate students. There are teachers include:
David Burns, MD
Helen Yeni-Komshian, MD
Jill Levitt, PhD
Daniele Levy, PhD
For information, requirements, and consent form, contact our Greeter, Sara Swedorski, saraswedorski@gmail.com.
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
I wanted to contact you to tell you how tremendously informative, interesting, moving and inspiring I find your work and your podcasts.
I have listened to all the podcasts—many twice. I find that on the 2nd listening, I pick more up. I get out on my bike and the miles just fly by as I listen to these!
One day my wife returned just as your wonderful episodes with Mark were concluding. As she walked in, I was weeping tears of relief as I also understood (at the same time as Mark did) that my depression and anxiety said something beautiful and awesome about me, rather than only indicating something broken and weak.
I struggled (through the tears) to tell her that these were tears of joy and relief, and not sadness.
Also, I found your book Feeling Good and the Feeling Good Handbook most helpful for my own depression and anxiety. Your wisdom about Action leading to Motivation is something I use every day personally and professionally.
I would be extremely grateful if you could help me with something that has been bothering me professionally for years. I work at the Scottish Government as a personal trainer specializing in eating for weight loss. I have used your own and other CBT based books to help people with stick to weight loss eating plans with some success. But I really get the sense that your TEAM methods might “turbo-charge” the CBT methods.
Can you detail how the paradoxical agenda setting / outcome and process resistance stage might work in eating for weight loss scenarios to help people get (and stay) motivated to stop overeating (even if it’s not a huge overconsumption, just enough to keep them overweight). How can the TEAM approach help them stick to a sensible weight loss plan?
With 35 million people (in the UK alone) in these overweight/obese categories and no signs of a slowdown, I really feel that a large-scale adoption of a “turbo-charged” approach to motivation may help turn this around.
Your very gratefully,
Greg
P.S. I look forward to watching your next live interview on Sunday which I missed this week.
Hi Greg,
Thank you for your thoughtful email and kind comments about the Feeling Good Podcasts, which I will pass along to our “patient,” Mark, and Dr. Jill Levitt, my co-therapist, and my host, Dr. Fabrice Nye. I was inspired and touched by the tears you experienced while listening to the podcast, and I’m so glad you enjoyed the live therapy with Mark!
You asked some questions about the treatment of habits and addictions, such as overeating. The Outcome Resistance issue for habits and addictions is having to give up your greatest, or only, source of pleasure and reward. The Process Resistance issue involves discipline and deprivation. That’s not a very appealing deal, because you have to give up intense and frequent instant gratification in exchange for discipline and deprivation, and this explains why treatment programs are so ineffective.
Incidentally, most treatment programs focus on trying to “help,” as opposed to focusing on why the patient really does not want to give up the habit or addiction. Without a really strong focus on motivation and resistance, nearly all treatment programs will be doomed to failure, or mediocre results at best.
And that’s what you see if you examine the controlled outcome studies that have been published. I am not aware of any really effective treatment program for any habit or addiction. Of course, every approach has advocates, and every approach works for some folks—but I’m talking about controlled outcome studies with an experimental group and a control group, in terms of short-term and long-term results. Most treatments barely outperform placebo treatment, at best.
Of course, the advocates of these approaches do not like to admit this, because they have a heavy intellectual, emotional, or financial commitment to their approach, which might be AA for alcohol misuse, or this or that commercial weight loss program that’s advertised heavily on television. Once your income, ego, or name gets invested in a particular approach, it can be very difficult, or nearly impossible, to let go and look at things objectively and admit that your favorite approach really doesn’t have much merit! Sadly, the needs of market and the needs of science often clash, and in our field, marketing usually wins.
So what do we do in TEAM-CBT? I can only give you some hints about it here, but I’ll take a stab at it and hope for the best.
Recently, several people I’ve hiked with have asked for help with their overeating. One fairly easy approach to learn is called the “Double Paradox,” and I touched on it briefly in last Sunday’s live Q and A on Facebook. You can do it on paper most effectively. First, I ask the person to list all the advantages of eating as much as you like of whatever you like whenever you like.
There are tons of advantages, including:
That Cinnabon (or whatever food you love) will taste SO GOOD!
I’m entitled to a little treat after a hard and frustrating day at work.
That treat will make me feel so good.
Eating will help me cope with negative feelings of depression loneliness, frustration, anxiety, boredom, and disappointment.
Eating good food is a deeply meaningful social activity with friends and family, and shows my love for others.
Good food tastes SO GOOD, and that’s my favorite kind of mint chocolate (or whatever.)
Eating is easy and rewarding.
Being overweight gives me an excuse to avoid dating and risking rejection.
Cooking and preparing wonderful food for my family is a source of great source of pleasure.
I’m too old to have to worry about being thin.
Why should I have to follow the rules of society? I have the right to be any way I want to be.
etc. etc.
Most individuals who are overweight should be able to come up with at least a dozen overwhelming benefits and advantages of overeating.
If the patient cannot or will not do this, then you might as well give up, because you’re already defeated by his or her denial. The fact is, overeating REALLY IS one of the great pleasures in life. You can prime the pump a little by suggesting one or two benefits of overeating, but the patient should do most of the work on this.
Then I ask the patient to list the many disadvantages of diet and exercise. For example:
It’s hard to diet.
I’ll have to struggle with cravings and temptations.
It’s unfair because life is already hard.
It’s no fun to go out and jog when it’s cold and rainy.
I never get a runner’s high anyway.
I hate exercising and I love eating!
It’s way more rewarding to watch TV and eat Doritos.
Even if I lose weight, I’ll just gain it all back later on anyway.
Losing weight is hopeless, so I might as well give up.
Other people can eat whatever they want and still be thin. Why should I have to suffer?
Etc etc etc.
Most individuals who are overweight should be able to come up with at least a dozen or more overwhelming disadvantages of diet and exercise.
Once we have these lists, I use another technique I’ve created called the Acid Test, which involves saying something like this:
“Gee, Jim (or Mary), given all those tremendous advantages or overeating, and the many powerful and real disadvantages of diet and exercise, it’s not at all clear to me why you’d want to change.”
Now it’s up to the patient to decide that he or she actually does not want to diet and exercise, or that he or she does want to. In most cases, your work will be done. If the patient decides he or she does not want to change, you can just “Sit with Open Hands” and ask if there’s anything he or she does want help with. This requires a therapeutic attitude of “non-attachment,” which is challenging for co-dependent therapists who are addicted to “helping.”
If the patient can convince you that he or she does want to change, in most cases he or she will run with the ball and not require any further help from you. There are tons of ways to diet, and tons of ways to exercise, and it does not make much difference what approach the patient takes if he or she is motivated. In my experience, most will know what approach they want to pursue.
Notice that this approach requires the therapist to become the voice of the patient’s conscious or subconscious resistance, and give up the role of “helper.” Some therapists can learn how to do this; most cannot, due to their own compulsive addiction to throwing “help” at patients.
I do have many more techniques, but this is getting long so let it be an introduction of sorts. Let me know if you liked this blog, and if you want more techniques to combat habits and addictions.
In addition, if you like or decide to use some of these techniques, such as the Double Paradox, the Acid Test, Sitting with Open Hands, and other approaches I have described in my podcasts, blogs, workshops, and books. I always appreciate some acknowledgement that I created them. I say this because sometimes people have taken my ideas and techniques, given them a slightly different name, and claimed them for their own. Quite a few have even started their own schools of therapy, based on one of the techniques I’ve created, without giving me any credit. I find this annoying!
I’m not criticizing you, just blowing off some steam! One of the reasons I always admired Dr. Albert Ellis is that he never did that. He always gave credit where credit was due, and had tremendous integrity. He was, arguably, a bit eccentric, but totally honest!
Thanks again, Greg!
David
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At most of my workshops, I do a live demonstration with a volunteer from the audience who has been struggling with feelings of depression, anxiety, or just simply being “not good enough.” That includes nearly all of us, including mental health professionals! I know I’ve felt like that on many occasions.
I’m a firm believer that when you do your own personal work, and heal yourself, you have vastly more to offer your patients. You are no longer just a technician but a healer, and you say this to your patients: “I know how you feel, because I’ve been there myself. And I can show you the way out of the woods, as well!”
That’s why I always include personal work in the training I offer in TEAM-CBT, both at Stanford, and at my workshops around the US and Canada, and on the Sunday hikes as well. Live demonstrations have proven to be one of the most effective and inspiring teaching methods–but they aren’t entirely without controversy.
The main problem is that when I do live demonstrations, I often see a dramatic reduction in symptoms, or even a complete elimination of symptoms, in a single therapy session lasting approximately two hours. And sometimes, the results are so dramatic that some people in the audience insist that it could not be real.
That’s what happened at my summer intensive in Burlingame, California, this year. A wonderful young woman who we can call “Holly” volunteered for the live demonstration. Although she’d been struggling with intense feelings of anxiety and low self-esteem throughout her entire life, she responded so dramatically that a few people in the audience thought it was a hoax, and that she was a paid actress. I know this because I received some angry comments on the written feedback form that participants filled out at the end of the demonstration. Most people were thrilled and inspired by what they saw, fortunately, but some were clearly not convinced.
Well, now you can judge for yourself. Our “Holly” kindly volunteered to do a brief video describing her experiences at the workshop, and how she’s been feeling ever since. I think you’ll enjoy it, and find her comments to be mesmerizing. The video was shot, unknown to me, by a colleague, Lisa Kelley, who happened to run into Holly a week or two after the workshop.
You can watch the video here. Then afterwards, you can read more below and I’ll show you exactly what happened, step by step, when Jill and I were working with Holly.
Some mental health professional are understandably very skeptical about such extremely rapid recovery because most of us have been trained to believe that recovery from depression is an inherently slow process that unfolds only after many years of treatment, or may even require more than a decade of treatment. So when they see an extremely rapid elimination of symptoms, they simply cannot accept it, and feel the need to explain it away. There was a time when I felt this way, too!
In addition, when I was growing up in Phoenix, faith healers often came to town, or appeared on television, doing miraculous healing in front of huge audiences of true believers. But most people realized that these charismatic faith healers in white suites with Bibles in hand were, for the most part, frauds.
My co-therapist for the session at the workshop was Dr. Jill Levitt, who teaches with me at the Tuesday group at Stanford. Jill is a phenomenally skillful and compassionate clinical psychologist, and I always treasure the opportunity to work with her. When we work together, magic seems to happen. I feel very fortunate to teach with Jill and to have her as a colleague. We will be presenting two workshops together this fall at the ABCT conference in San Diego. Here’s the link if you want to check it out!
Although her depression score is only moderate, you can see that her feelings of worthlessness and low self-esteem were extreme, and that her feelings of anxiety were quite also intense. In addition, her score on the Positive Feelings test was very low, indicating very few positive feelings about herself and her life.
Jill and I started the TEAM-CBT session with T = Testing. If you click here, you can see the Daily Mood Log that Holly filled out just before the session started. As you can see, Holly was struggling with a myriad of negative feelings and intensely negative thoughts. Holly told us that she’d really always felt like that and had never really felt happy or good about herself, although she usually kept her negative thoughts and feelings hidden. This was especially sad.
At the start of the session, Jill and I empathized (E = Empathy), and we seemed to develop excellent rapport with Holly very quickly. After only about 20 minutes or so, she gave us an “A” on empathy, and said she felt understood and accepted.
Then we went on to A = (Paradoxical) Agenda Setting. The goal is to find out what, if anything, the patient wants help with during the session, and then to melt away his or her resistance to change. Holly said that she wanted to feel better about her life, if possible, so Jill and I used the Magic Button. Essentially, we asked Holly to imagine there was a Magic Button, and if she pressed it, all of her negative thoughts and feelings would instantly disappear, with no effort, and she’d be flooded with feelings of joy.
Would she press it?
Like almost every person I’ve worked with, she said she’d press it immediately!
Then Jill and I said that while we had some fabulous tools to help her, we weren’t convinced it would be such a good idea to press that Magic Button, because we might lose something very valuable at the same time.
Then we introduced a tool that proved exceptionally helpful called Positive Reframing. We asked Holly to list, with our help, two things about each of her negative thoughts and feelings:
What does this negative thought or feeling show about me and my personal values that’s beautiful and positive, or even awesome?
What are some advantages, or benefits, of this negative thought or feeling?
If you like, you can take a look at Holly’s Daily Mood Log and see what you can come up with! Make your own list before you continue reading.
This exercise may be really hard for you at first, because this is not the way we usually think about psychiatric “symptoms!” We don’t usually ask ourselves what’s really GREAT about feelings worthless, or hopeless, or ashamed or enraged. And we don’t usually ask ourselves what’s really wonderful about our own self-critical thoughts, such as “I’m an idiot” or “I’m fat and ugly.”
The idea is that since your negative thoughts and feelings are beneficial, and reflect your core values, it might not be such a good idea to press the Magic Button and make them disappear entirely. To resolve this dilemma, we introduced the idea of the Magic Dial. We explained that since Holly’s negative thoughts and feelings revealed so many awesome things about her, and had helped her tremendously during her life, may she might instead prefer to dial her negative feelings down to some lower level, rather than getting rid of them entirely.
Essentially, Jill and I have made a “deal” with Holly’s subconscious mind. We’ve said, “We’ll lower them only to these levels.” This also puts Holly in charge of the session, so that we’re not pushing or selling anything, and so that we’re following her agenda. This is one of the most important parts of TEAM-CBT.
The “% Goal” column on the Daily Mood Log is not written in stone, and is actually a kind of illusion. That’s because Holly’s goals for each negative feeling might change once she begins to crush her negative thoughts.
We then went on to the M = Methods phase of the TEAM-CBT session, and helped Holly challenge each of her Negative Thoughts using several powerful techniques, including:
Identify the Distortions
Externalization of Voices
Acceptance Paradox
Self-Defense Paradigm
As it turned out, these techniques were incredibly effective, and her recovery was rapid and, I think it is fair to say, fantastic, and almost immediate. This is why some in the audience found it so hard to accept or believe. What happened, really, was like a miracle.
You can see Holly’s end of session scores on the Brief Mood Survey if you click here. In addition, all of her negative feelings on the Daily Mood Log fell all the way to zero. Holly was more than simply “improved” by the end of the session. I think it is fair to say that she was (and still is) jubilant.
And she now has so much more to bring to her own patients, the troubled teenagers she treats. And that’s why I’m a firm believer that doing your own personal work is vitally important to therapists. Because then, like Holly, you can tell your own patients, “I know what you feel like, because I’ve been there myself, and know what that pain is like. And I can show you the path out of the woods, and what a joy that will be!”
Fortunately, by the end of the four day program, most of the participants had changed their thinking and realized that the live demonstration had been absolutely real. I hope you feel the same way! I was humbled and thrilled to receive a standing ovation, something that only occasionally happens, and something that means a lot to me.
Holly graciously gave me permission to post the video here for you. I hope you have enjoy it!
I am very indebted to Holly for her courageous and deeply meaningful contribution to the workshop, and now you will have a chance to share the joy that she is feeling!
All the best,
David
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3. The Annual South San Francisco Intensive
August 10 – 13, 2020
Small Group Practice with Personal Feedback and Mentoring, and Chances for Personal Work and Healing
