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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

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How to Stop Being a Victim!

How to Stop Being a Victim!

Here’s the link to David’s awesome interview with Neil Sattin on “How to Stop Being a Victim,” which is part of Neil’s podcast series on loving relationships. It has already been downloaded more than 24,000 times. See what you think!

David will soon be doing a second interview with Neil as well. Will let you know when it’s available, like in six weeks or so. Neil is a good guy with a dynamic show!

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

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

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

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

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

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

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

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054: Interpersonal Model (Part 1) — “And It’s All Your Fault!” Healing Troubled Relationships

054: Interpersonal Model (Part 1) — “And It’s All Your Fault!” Healing Troubled Relationships

 

In this podcast, David and Fabrice begin the first in a series of podcasts on how to transform troubled relationships into loving ones–if that’s what you want to do!

David begins with the story of how he got into working with troubled couples as well as individuals with troubled relationships shortly after his first book, Feeling Good, was published. Because cognitive therapy was beginning to generate excitement worldwide as the first drug-free treatment for depression, everyone thought it might also be effective for other kinds of problems, including troubled relationships.

And there were fairly good reasons to suspect that cognitive therapy might be helpful. When you’re in conflict with a loved one, friend, colleague or stranger who you can’t get along with, you’ve probably noticed that you will usually have negative thoughts like these running through your brain:

  1. It’s all his fault. (Blame, All-or-Nothing Thinking)
  2. She’s a jerk. (Labeling, Should Statement, Mental Filter, Hidden Should Statement)
  3. He’ll never change! (Fortune Telling, All-or-Nothing thinking, Discounting the Positive, Emotional Reasoning)
  4. All she cares about his herself. (Mind-Reading, Discounting the Positive, Mental Filter, Over generalization)
  5. I’m right and he’s wrong about this! (Blame, All-or-Nothing Thinking)
  6. She shouldn’t be like that. (Should Statement, Blame)

Sound familiar?

And as you can see, these thoughts contain all the same kinds of cognitive distortions that depressed individuals have, as I’ve indicated in parentheses. If you’re familiar with the cognitive distortions, you may be able to pinpoint even more than the ones I’ve listed. The only difference is that when you’re in conflict with someone, the distortions will usually be directed at the person you’re not getting along with, rather than yourself.

Although these thoughts will usually be distorted, you may not realize this (or even care) when you’re upset. You’ll probably be convinced that the person you’re mad at really is a jerk, or really is to blame, or really is wrong. In addition, these thoughts will tend to function as self-fulfilling prophecies. For example, if you think someone is a self-centered jerk, you will usually treat him or her in a hostile or unfriendly way, and then he or she will get defensive and hostile, and will look like a jerk. Then you’ll tell yourself, “See, I was right about him (or her)!”

David got excited about these insights and wrote a draft of a book called Couple in Conflicts, Couples in Love, and sent it to his editor in New York to see what she thought. The new book was about how to modify the distorted thoughts and self-defeating beliefs that trigger and magnify relationship problems. David’s editor called the next day with an offer of a large advance, exclaiming excitedly that the book was sure to be a #1 best seller.

David was ecstatic, and set out to edit the book for publication. In the meantime, he was using the new approach with troubled couples as well as individuals with relationship conflicts. But after six months of repeated treatment failures, he concluded that cognitive therapy was not at all effective in the treatment of relationship problems. The approach sounded great on paper, but it didn’t work in the real world.

David sadly returned the advance to his publisher and cancelled the contract. He promised that if he could figure out why cognitive therapy didn’t work for troubled relationships, and if he could find a better treatment method, he’d write another book. Figuring it out took 25 years or research and clinical experience, and the name of the book he eventually did publish is called Feeling Good Together, now available on Amazon.com.

David and Fabrice then discuss some of the most popular theories about the causes of relationship problems:

  1. The skill deficit theory: We want loving relationships, but don’t have the communication and negotiation skills to get close to the people we’re not getting along with.
  2. The barrier theory: We want loving relationships, but something gets in the way, such as unrealistic expectations or distorted thoughts about the person we’re not getting along with. Other barrier theories include the idea that women are from Venus and men are from Mars popularized by John Gray, Deborah Tannen, and others. According to this theory, women use language to express feelings, and men use language to solve problems, so they both end up frustrated and not understanding one another. Another popular theory is the idea that we project childhood conflicts with our parents onto others, and thus recreate the same dysfunctional patterns repeatedly in every new relationship.
  3. The self-esteem theory: You can’t develop loving relationships with others if you don’t know how to love yourself.
  4. The motivational theory: We have troubled relationships because we WANT them!

David emphasizes that the first three theories are all very optimistic–they all are based on the idea that human beings are basically good and want loving, peaceful, joyous relationships. But something gets in the way, such as a barrier of some type, or the lack of communication skills, or the lack of self-esteem. And they are all very hopeful, since we can teach people better skills, or remove the barriers to intimacy, or help people develop better self-esteem.

David also emphasizes that these theories have only two problems. First, the theories that they’re based on are false. Second, the treatments that have evolved from these theories are not effective. David and Fabrice describe research on the validity (or total lack of validity) for these theories as well as the effectiveness (or lack of effectiveness) of the treatment techniques and schools of therapy that have evolved from these theories.

David then discusses the motivational theory which is much less optimistic about human nature, and emphasizes that humans have competing positive and negative motives.

In the next podcast, they will discuss the basics assumptions of the new treatment approach David has created for relationship problems, based on the motivational theory.

References

Baucom, D. H., & Hoffman, J. A. (1986). The effectiveness of marital therapy: Current status and application to the clinical setting. In N. S. Jacobson and A. Gurman (Eds.), Clinical handbook of marital therapy (pp. 597-620). New York: Guilford Press.

Baucom, D. H., & Epstein, N. (1990). Cognitive behavioral marital therapy. New York: Brunner/Mazel.Burns, D. D., Sayers, S. S., & Moras, K. (1994). Intimate Relationships and Depression: Is There a Causal Connection? Journal of Consulting and Clinical Psychology, 62(5): 1033 – 1042.

Burns, D. D. (1993; revised 1999). Ten Days to Self – Esteem. New York: Quill. 1993 – present. (Also published worldwide).

Burns, D. D. (2009). Feeling Good Together. The Secret of Making Troubled Relationships Work.  New York: Broadway Books.

Iverson, A., & Baucom, D. H. (1990).  Behavioral marital therapy outcomes: Alternative interpretations of the data. Behavior Therapy, 21, 129-138.

Spangler, D., & Burns, D. D. (1999). Is it true that women are from Venus and men are from Mars? A test of gender differences in dependency and perfectionism. Journal of Cognitive Psychotherapy, 13(4): 339-357.

 

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

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

 

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040: Uncovering Techniques (Part 2) — The Interpersonal Downward Arrow

040: Uncovering Techniques (Part 2) — The Interpersonal Downward Arrow

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The Roles and the Rules—Psychoanalysis at Warp Speed!

Most of us run into conflicts with other people from time to time, or even frequently. In this podcast, you will discover precisely why this happens, and how you to change the beliefs that get you into trouble, if that’s what you want to do.

Psychoanalysts sometimes help people discover what they call “core conflicts.” According to the highly regarded psychoanalytic researcher Lester Luborsky, PhD, an example of a core conflict might be, “My needs will never be met in my relationships with others.” If you believe this, it will tend to function as a self-fulfilling prophecy, so you’ll constantly feel hurt, lonely, and rejected, and perhaps resentful when you try to get close to others. And you probably won’t realize you’re creating your own painful interpersonal reality. You’ll think that this is just the way it is. Once you bring the painful system to conscious awareness, you can use a variety of powerful techniques to change your expectations and beliefs so you can enjoy far greater satisfaction and intimacy in your relationships with others.

David and Fabrice will illustrate a powerful, high-speed method that to bring your own Interpersonal Self-Defeating Beliefs to conscious awareness. David has called it the Interpersonal Downward Arrow Technique. David and Fabrice will revisit the same clinical example from the last Podcast—the psychologist named Harold who felt devastated when his favorite patient unexpectedly committed suicide, but in this podcast they will examine how Harold sets up his relationships with his colleagues in a way that causes him to feel lonely, anxious, and resentful.

You can use the Interpersonal Downward Arrow Technique to identify anybody’s Self-Defeating Beliefs in five to seven minutes, as opposed to spending five years or more free-associating on an analyst’s couch to get the same information. Not a bad deal!

During the podcast, you may want to download and print “The Rules and the Roles” form that David and Fabrice will be using during the podcast. There will be an exercise for you to do while you are listening. But don’t do the written exercise if you’re listening while driving in your car!

In the next podcast, David and Fabrice will discuss a third powerful uncovering technique developed by the late Dr. Albert Ellis, a former psychoanalyst from New York who is considered the “Grandfather of Cognitive Therapy.” It’s called the “What-If Technique,” and Dr. Burns will bring it to life with an inspiring and dramatic story of a woman from San Francisco who had been suffering from years of mild depression and severe Agoraphobia—the intense fear of leaving home alone.

So stay tuned! And feel free to comment below or ask questions. Fabrice and I greatly appreciate your feedback and guidance!

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

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Why Are Relationship Problems So Tough?

Why Are Relationship Problems So Tough?

Hi David,

Thank you so much for your help and encouragement on the Sunday hike this week. I thought it was interesting how despite my initial sense that I didn’t need help so much with my feelings, once we got into the “Five Secrets” practice it was clear I had more work to do on my anxiety. I guess I couldn’t see that until I owned my role in the dynamic with my son and saw how much I was struggling with the Five Secrets in my interactions with him. Having the layers separated by the discipline of the TEAM-CBT method helped me start to untangle something that has been very confusing.

More musings. During the hike you were talking about how many people can now recover from depression and anxiety really quickly using TEAM-CBT, but that relationship and habit work generally take much more time.  I’d be very interested in hearing you say more about this, because relationship problems feel more complicated (in my case with son, at least). At least consciously, I’ve always felt like I wanted to be closer to my son. Today it’s clearer to me that I’m having a number of Self-Defeating Beliefs (SDBs) that cause me to act in ways that prevent closeness. For example, I’m telling myself that both he and I should be perfect achievers, that he and I should never be angry at each other, and so forth.

Maybe relationships are a place where “the rubber hits the road” so to speak, where our SDB’s display themselves with real world consequences. . . Hmm. I guess the point is that relationship work can be a rich but challenging entry into personal growth!

Gratefully,

–H

IMG_1737Hi H,

Thanks, we could brainstorm on this theme in emails or on a future hike, but to be honest I don’t entirely know why it can be so much harder, even for highly skilled therapists, to deal with our own relationship problems, with family and the people we care about.

However, there is one idea I have had for a long time that may represent a part of the answer. If I’m treating you for depression, you will discover that your painful negative thoughts about yourself (eg. “It’s all my fault,” or “I’m a loser,” or “my problems are hopeless” and so forth) are distorted and wrong. That discovery makes you happy, so it is a pretty easy sell. You discover you are way better than you thought. Not a bad deal! Although treatment resistance always has to be addressed early in the therapy, it is pretty appealing to learn how to let go of self-blame and feelings of depression, anxiety, inferiority, worthlessness, shame, hopelessness, and inferiority.

Relationship problems are quite different. That’s because most of the time, you will be blaming the other person, and thinking about him or her in a distorted manner. For example, you may tell yourself that it’s all his (or her) fault, that he (or she) is a loser, or wrong, and so forth. Then, in the course of treatment with TEAM-CBT, you will discover, when you’re working with the Relationship Journal,  that actually have a huge role in the problem and that you are probably triggering and reinforcing the very problem you have been complaining about. This insight can be incredibly empowering, but it can also feel pretty humiliating, shocking, and painful at the same time. In essence, you will discover that you are far worse than you thought, and that if you want the relationship to improve, you will have to stop blaming the other person and focus all of your energies on changing yourself.

For most of us, it is not particularly appealing to have to let go of other-blame and the feelings of moral superiority that go along with feeling certain that we are “right” and the other person is “wrong.” Pinpointing your own role in the problem when you were so happy blaming the other person is usually very painful. That’s just one reason why intimacy is not an easy sell. I address this in the chapter entitled, “Do We Secretly Love to Hate?” in my book, Feeling Good Together.

That’s a big part of why it’s so hard to deal with personal relationship problems, but I think there are other reasons, too. When I’m helping someone with a relationship conflict, there is usually an “inner problem” and an “outer problem” that need to be solved. The inner problem is all the intense negative feelings you have about your interaction with the other person. These feelings may involve anger, shame, anxiety, loneliness, depression, hopelessness, inadequacy and so forth, and they are usually triggered by your own negative thoughts about yourself as well as the other person, and those thoughts are nearly always distorted. For example, you may be telling yourself that the other person is a self-centered “jerk” who “shouldn’t” be that way, and you may be telling yourself that you “should” be a better partner, or mother, and so forth.

The outer problem involves the dysfunctional way you are probably communicating with the other person. For example, you may be trying to “help” when you need to listen, or you may be arguing defensively instead of finding truth in what the other person is saying, or you may be lashing out aggressively, trying to put the other person down, instead of sharing your anger in a respectful and loving way.

The tools for solving the “inner problem,” such as the Daily Mood Log, Cognitive Distortions, and “50 Ways to Untwist Your Thinking,” are tremendous, but they are radically different from the tools for solving the “outer problem,” which include the Relationship Journal, the Blame Cost Benefit Analysis, and Five Secrets of Effective Communication. So the task is twice as hard, with twice as much to teach the patient. Of course, there is tremendous potential for personal growth, as well, and for developing more satisfying and loving relationships with the people you care about.

Perhaps some who read my blog will have theories about why it can be so much harder to resolve personal relationship problems than to overcome anxiety and depression! Let me know what you think with a Comment if you are so-inclined!

Readers interested in learning more about the methods for combatting depression and anxiety may want to read my Feeling Good Handbook, or When Panic Attacks. Readers interested in learning about how to develop more rewarding personal relationships may want to read Feeling Good Together. But I have to warn you—doing the written exercises while you read will make all the difference in the world! Just reading simply won’t “cut it,” so to speak, especially if you are reading Feeling Good Together and want to get close to someone you are at odds with right now!

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