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

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Thanks! David

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Is it Possible to be Happy All the Time?

Is it Possible to be Happy All the Time?

A frequent web visitor commented on a blogger who said that the propensity to feel depressed or anxious never really leaves a person. He asked if I agreed with this.

Here’s the answer. I am convinced that being flawed and having moments of irritability, depression, anxiety, and so forth is an inherent part of the human condition, at least for most of us, and probably everybody. It is not possible to be happy all the time, nor is this a realistic or useful goal–at least that’s my take on it.

We all fall into these black holes of self-doubt or anger from time to time. What I do is to create a ladder for each patient, so you can quickly climb out of the black hole whenever you fall in. That’s why the psychotherapy homework is so vital—so you can practice and learn these tools, so you can use them in the future whenever you need them. It is like riding a bicycle. The skill never really leaves you once you’ve learned how, but you won’t develop the right “brain muscles” without the written practice between sessions, using tools like the Daily Mood Log, the Relationship Journal, and so forth.

There are two goals in TEAM-CBT: Feeling better and getting better. Feeling better is the initial recovery, when the symptoms of depression and anxiety completely disappear, and you feel fantastic. This is a tremendous experience for the patient and for the therapist as well. The recovery usually happens suddenly during a session, and with the new TEAM-CBT techniques, if often happens very early in the treatment.In my experience, it often happens in the first session, assuming I can work with the patient for two hours or so if needed.

Getting better means that you have the tools to deal with the inevitable “relapses” that affect all human beings. To me, I define a “relapse” as one minute or more of feeling lousy. Given that definitions, we all “relapse” all the time! But it does not have to be a problem if you know exactly how to deal with it.

One minute of feeling upset is okay. Or an hour, a day, or a week. But I don’t want my patients to have to struggle with weeks, months, years or decades of misery.

I always tell my patients that we are all entitled to five happy days per week. If you aren’t having your five happy days, you need a little mental “tune-up!” But if you’re having more than five happy days per week, that could be a problem, and we may have to put you on lithium!

I will edit and post a partially completed blog on Relapse Prevention Training (RPT) before too long. RPT is fairly easy and only takes about 30 minutes in most cases. However, if the therapist fails to do RPT, the patient may be shocked, overwhelmed and devastated when the negative thoughts and feelings return. But if you have prepared the patient properly, he or she will know exactly what to do, and the “relapse” will be short-lived.

As an aside, my thinking is consistent with the thinking of the late Dr. Albert Ellis, the New York psychologist who founded a school of therapy call REBT (Rational Emotive Behavior Therapy). Dr. Ellis once wrote a paper on “The Impossibility of Maintaining Consistently Good Mental Healthy,” or some such title. He was making the same point, that we are flawed, and cannot achieve perfection.

Dr. Ellis pioneered much of the thinking that triggered the development  of CBT (Cognitive Behavior Therapy), and now TEAM-CBT, although he approached treatment in a radially different manner. Those who still remember him, and attended one or more of his wild workshops or talks, or his $5 admission fee Friday night live therapy demonstrations at his center in NY, will know what I mean!

Dr. Ellis was quite the character, very controversial, but his contributions were tremendous, and he had a great sense of integrity. He did not steal from others, as some in our profession have done, but always gave credit where credit was due. That was one of the main reasons I became a fan of his!

david