017: Ask David — Dare to be “average”—The perfectionist’s script for self-defeat

In this podcast, David answers a challenging question posed by a listener:

Dear Dr. David:

In your Feeling Good Handbook, you suggest that the reader just allows himself or herself to be an ordinary person instead of trying to be perfect. Contrary to your opinion in the book, you’re an outstanding therapist in reality. You’ve studied in one of the world’s top colleges, you’re well-educated with a doctor degree, and successful in your career and life. How can I believe your claim? I’m quite confused!

Sincerely, XXX

David first distinguishes perfectionism from the healthy pursuit of excellence, and then describes a painful incident when he was a Stanford medical student. One afternoon, he attended an afternoon Gestalt encounter group at the home of a friend and mentor in Palo Alto. During the group he was ripped to shreds by the other participants. At the end of the group, the other participants seemed elated, but he felt intensely humiliated, ashamed, and discouraged. This led to an unexpected interaction with his mentor that helped to change his life.

David also discusses his clinical work years later with a depressed and anxious professional who had never experienced even one minute of happiness in spite of a life of fabulous success and achievements.

At the end, David and Fabrice promise a future podcast on this topic: “Self-Esteem: What is it? How do I get it? How can I get rid of it once I’ve got it?”

Secrets of Self-Esteem, Part 1

* ©2013 by David D. Burns, MD

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

I’m going to start out with a few postings on the popular subject of how to boost your self-esteem and overcome feelings of worthlessness, inferiority, or inadequacy. These feelings are among the most important symptoms of depression, and most people fall into black holes from time to time when you begin to feel that you’re not as good as you should be.

Therapists are not immune from these feelings, either. In fact, when I give workshops for mental health professionals around the US and Canada, it seems that the vast majority of the therapists who attend have struggled with feelings of depression and anxiety. Cartoons often focus on the theme of therapists who are nuttier than their patients. There’s a lot of truth in that. Many people pursue a career as a psychotherapist primarily because of their own suffering, in the hopes of finding personal healing along the way. And there’s certainly no shame in that. In fact, therapists who have experience profound personal healing have much more to offer their patients than simply tools and techniques. They can say, “I know how painful your suffering is, because I’ve been there myself. And I also know how to show you the way out of the woods, so you can regain joy and self-esteem again.”

To get the ball rolling, I’m providing some information from a short interview I did on this topic for a Toronto newspaper recently. I pointed out that when you’re experiencing low self-esteem, the culprit is always your thoughts. You are giving yourself negative messages, like

  • “I should be better than I am,” or
  • “I shouldn’t have made that mistake,” or
  • “I’m inferior–there’s really nothing special about me.”

You may even tell yourself that you’re defective.

Although you probably believe these painful thoughts with all your heart, they are, in fact, distorted and illogical. You’re telling yourself things that aren’t really true. Depression is the world’s oldest con. You’re probably involved in All-or-Nothing Thinking, Mental Filtering, Discounting the Positive, Emotional Reasoning, Should Statements, and Self-Blame, to name just a few of the “cognitive distortions” that trigger depression and anxiety.

Here’s the good news–when you change the way you THINK you can change the way you FEEL. To find out how, check out one of my books, such as Feeling Good: The New Mood Therapy or The Feeling Good Handbook. Numerous research studies have revealed that roughly two thirds of the people who read one of these books and do the exercises experience substantial, and even dramatic, improvements in mood and outlook within four weeks, even without antidepressants or therapy. These studies included individuals who were moderately to severely depressed.

What was equally startling was that the effects seemed to stick–long-term follow-up studies revealed that patients felt even better at their three-year follow-up evaluation.  So although these books are not panaceas that will cure all depression, they can certainly help. And it’s also good news that we now have powerful, fast-acting, drug-free treatments for depression and all of the anxiety disorders as well.

Most of us fall into black holes of self-doubt from time to time. Recovery from those feelings is one of the greatest feelings a human being can experience. I’d love to show you how to have this experience, too.

For more on overcoming depression and low self-esteem, stay tuned.

Error #2: Reverse Depression Hypnosis

* ©2012 by David D. Burns, MD

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

Last time we discussed the consequences of therapists’ failure to measure changes in symptoms as well as the quality of the alliance at every session. Today, I’m focusing on another common therapist error you may have never heard of—hypnosis of the therapist by the patient!

We all know that some therapists hypnotize their patients, but I’ll bet you’ve never heard of the reverse type of hypnosis—that’s when the patient hypnotizes the therapist, and the therapist doesn’t even realize that he or she has fallen into a trance. It’s important to know about reverse hypnosis, because it can sabotage the therapy.

Of course, the patient doesn’t dangle a pendulum in front of the therapist while saying “You are getting very sleepy, very sleepy”—but we can sometimes fall into trances without realizing it. And when you are in a trance, you will tend to believe things that are not valid.

There are three common forms of reverse hypnosis:

  • Depression Hypnosis—depressed patients convince you that they really are hopeless and worthless.
  • Anxiety Hypnosis—anxious patients convince you that they really are too fragile to confront their fears using exposure techniques.
  • Relationship Hypnosis—Patients with troubled relationships convince you that their relationship problems really are the other person’s fault and that they really are the victims of the other person’s bad behavior.

Depression Hypnosis

Nearly all depressed patients are totally convinced that they are worthless, inferior, or defective. They are usually equally convinced that they are hopeless, that their problems are insoluble, and that they will be miserable forever. If you’ve ever felt depressed, you know how powerful and painful these feelings can be.

The thoughts that generate these demoralizing feelings are nearly always distorted—you may be familiar with the list of ten Cognitive Distortions that I first published in my book Feeling Good. When you fall into the black hole of depression, your thoughts typically involve distortions such as:

  1. All-or-Nothing Thinking—You look at things in black or white categories. If you’re not a complete success, you tell yourself that you’re a total failure.
  2. Overgeneralization—You see a negative event—such as rejection by someone you love, or failure to achieve your goal—as a never-ending pattern of defeat.
  3. Mental Filtering—You focus on some flaw, failure, problem or shortcoming, as if this reflects your entire self. This is like the drop of ink that discolors the beaker of water.
  4. Discounting the Positive—This mental error is even more spectacular. You tell yourself that your good qualities don’t count. In this way, you can maintain the belief that you’re defective, or that you’re a total loser.
  5. Jumping to Conclusions—There are two common forms of this distortion: Fortune Telling involves making dire negative predictions that aren’t warranted by the facts. For example, when you’re depressed you tell yourself that you’re problems are hopeless and that you’ll be miserable forever. Mind-Reading involves telling yourself that others are looking down on you without any good evidence. Shy people do this in social situations, imaging that everyone else feels confident and that everyone can see how anxious and inept they feel.
  6. Magnification and Minimization—Blowing things out of proportion, or shrinking their importance. For example, when you procrastinate you dwell on ALL you have to do (Magnification) and tell yourself that getting started and doing a little bit would just be a drop in the bucket (Minimization).
  7. Emotional Reasoning—This is reasoning from how you feel: “I FEEL worthless (or hopeless), so I must BE worthless (or hopeless).”
  8. Labeling–You label yourself as “lazy” or “a loser,” or you label someone else as “a jerk.”
  9. Overt and Hidden Should Statements—As in, “I SHOULDN’T have made that mistake,” or “I SHOULD be better than I am.” Should Statements directed against yourself trigger feelings of depression, guilt, shame, and inferiority. Should Statements directed against others, or against the world, trigger anger and frustration.
  10. Blame—There are two common varieties. Self-Blame leads to depression, and Other-Blame leads to anger and conflict.

But when you’re feeling depressed, anxious, or angry, you don’t realize that your thoughts are distorted and misleading because they feel and seem overwhelmingly realistic. The goal of Cognitive Therapy is to help the patient put the lie to these distorted thoughts. And the moment you stop believing them, you’ll feel much better.

But here’s the funny thing. Toward the beginning of therapy, I usually buy into the patient’s negative thinking. Patients are extremely good and convincing themselves and others that they really ARE worthless losers who are doomed to lives of mediocrity and misery. So I get panicky for a little while in the first or second session because I start telling myself, “This person really DOES sound like a bit of a worthless loser. Maybe there aren’t any distortions this time!”

I don’t mean to mean to sound cruel or insensitive—it is just that I have fallen into a kind of depressive trance, and most therapists do the same thing. I have bought into the patient’s extremely negative and distorted thinking. You could even think of this hypnotic trance as a form of super-empathy, because the therapist can really SEE the world through the patient’s eyes. The patient’s intensely negative view of himself or herself and the world suddenly seems almost impossible to dispute.

Then, several weeks later, when the patient and I have been working together effectively, and the patient develops the ability to crush the negative thoughts, the patient and I can suddenly see how distorted they were all along. We have both snapped out of the trance, and the patient feels a sudden flood of relief, or even euphoria. At that point, it dawns on me that I had succumbed, once again, to the patient’s depressive hypnosis.

This is not a trivial or rare problem. In fact, therapists are sometimes even trained to buy into the patient’s negative thoughts. At continuing education conferences, for example, therapists might be advised to “educate” patients and their families into believing that the prognosis for depression is guarded, and that while they can be helped somewhat, they may always have to struggle with depression and may need to take antidepressants and other medications indefinitely to correct the “chemical imbalance” in their brains, much as diabetics need to take insulin forever. Or, they may need psychotherapy indefinitely. And, of course, once you give your patients that message, many of them will believe it, and it becomes a self-fulfilling prophecy.

Early in my career, I asked Dr. Aaron Beck, a brilliant pioneer who helped to create and develop cognitive therapy, if some patients REALLY WERE hopeless. He said that he had never once bought into the notion that any depressed patient was hopeless. He said that this optimistic philosophy had worked out well in clinical practice, and that I might have to make a policy decision of my own on whether or not I would buy into that type of thinking.

I settled on the same policy, and it has always paid off for me. I remind myself that no matter how severe or overwhelming the depression might seem, the patient can, in fact, recover and feel joy and self-esteem again. That policy has been invaluable in my clinical work, and it has never let me down.

Of course, the belief alone won’t cure patients. You have to have many good treatment tools to back up your vision.

I could write a chapter or book with examples of rapid recovery in patients who initially seemed hopeless or worthless, but I’ll just give you an extreme and brief one example here. When I was in Philadelphia, we had an intensive program for patients from out of town. The idea was to try to complete an entire course of therapy in a week or even less by seeing patients several hours every day. It was a pretty successful program.

I can recall an incredibly challenging woman named Eve who travelled all the way from Germany for treatment. (I always disguise or change the facts to protect patient identities.) Eve had struggled with intractable depression and OCD for more than 40 years, with no success at all. She’d been treated with every known antidepressant and tons of other drugs, and had been hospitalized on numerous occasions. In addition, she’d received more than 100 ECT (electroconvulsive) treatments. Psychotherapy didn’t work either. Eventually, she was given a frontal lobotomy, but that did not help, either. Two years later, she had a second lobotomy, again with no beneficial effects.

Eve wanted to know if there was any hopeThe situation did not look very promising, to say the least, but I tried to hide my pessimistic feelings. I told Eve that while I couldn’t make any promises, we’d sometimes had surprisingly positive results with even the most severe cases, and that the new treatment techniques that my colleagues and I had developed were definitely worth a try.

I wasn’t able to take her on myself, since my practice was temporarily full, so I referred her to a colleague who was working with me at our clinic. I must confess that I had a sense of relief that I didn’t have to treat. Her situation seemed impossible.

Two days later I asked my colleague how things were going with Eve. He seemed in a surprisingly chipper mood and said that the symptoms of depression and OCD had vanished and that she was feeling happy for the first time in decades. I asked him what in the world he’d done. He said that she was easy to treat and that he just used the same techniques we use all the time, such as the Daily Mood Log, Identify the Distortions, the Paradoxical Double Standard Technique, the Externalization of Voices, the Acceptance Paradox, and several others.

It dawned on me that once again, I had succumbed to a “depressive trance” without realizing it.

Now my colleagues at the Feeling Good Institute in Northern California have created a similar intensive program for people from around the country who want to commute it for short-term treatment. For more information, go to the FeelingGoodInstitute.com website.

Or, to learn more about how to defeat the negative thoughts that trigger depression and anxiety on your own using self-help techniques, check out one of my books, such as Feeling Good.

Thanks for reading this.  In my next blog I’ll discuss Reverse Anxiety Hypnosis.

David Burns, MD