145: The TEAM Therapy Paradoxes

145: The TEAM Therapy Paradoxes

Hi Listeners:

Many of our podcasts are inspired by listeners like you who send us really cool emails with show ideas. Sometimes the emails are from people wanting self-help with emotional or relationship conflicts. And sometimes, they are from therapists wanting more training and information about TEAM. Rhonda and I love your emails!

Yesterday, I got the following email from Dipti Joshi, one of our listeners and TEAM-CBT therapists from India. Dipti flew all the way from India to Canada with her lovely daughter last summer for my intensive in Whistler, Canada. I am hopeful that Dipti will one day create the first TEAM Treatment and Training Center in India. How cool would that be!

Here’s the email that Dipti sent me:

Dear David,

I am really enjoying all the educational materials available on your website. Thank you! I will soon be taking my Level 3 TEAM certification exam, and am seeking your kind blessings for the same!

Also, I have a special request for you. Is it possible to have a workshop or podcast on “paradoxical techniques?” I feel this is a very challenging area, and that a lot of skill is needed. Perhaps you can also talk about why paradoxical techniques can be so effective.

Meanwhile can you suggest me something to read or listen to for this?

Regards, Dipti 

Thanks, Dipit! Today’s podcast will be an introduction to the use of paradox in TEAM therapy, a kind of overview. When my new book, Feeling Great, comes out, I am hoping to do a series of workshops on a variety of powerful paradoxical techniques. And of course, the new book will have a great deal of instruction on paradoxical techniques as well.

These are the four key components of TEAM:

T = Testing

E = Empathy

A = (Paradoxical) Agenda Setting

M = Methods

In today’s podcast, Dr. Rhonda and I will explain why each of these components is inherently paradoxical. For example, when you do the T = Testing, you assess changes in the patient’s symptoms from the start to the end of the session, and the patient rates you on the Empathy and Helpfulness scales as well, When you look at the ratings, you will probably discover that you aren’t helping your patient much, if at all. You may also discover that your perceptions of how the patient feels, and how the patients feels about  you, are off-base, and sometimes alarmingly so.

This can be very disturbing, especially if you’re not use to this kind of information. However, in TEAM, we are actually hoping for failure, and welcome that kind of “disturbing” information. Why is this? Isn’t therapy all about recovery and making positive changes? Why in the world would the therapist want to know that he or she is not helping?

It’s because many of the most important breakthroughs in therapy come from the therapist’s discovery that he or she is failing. We WANT to fail! Why? 

David illustrates this paradox by describing his discovery that he was not actually helping a patient he thought he’d helped enormously. David explains how and why this shocking information led to a tremendous breakthrough.

When you review how your patient rated you at the end of the session, you may discover that your patient gives you failing grades on the E = Empathy scale. The patient’s ratings may indicate that he or she didn’t experience you as sufficiently warm and caring, or completely trustworthy, and that you didn’t really “get” how she or he was feeling inside.

Once again, as TEAM therapists we welcome failing grades on the Empathy Scale. Why? It’s because your worst therapeutic failure will nearly always be your greatest success in disguise.

How can this be? It seems absurd, or impossible. Karl Rogers told us that empathy is the necessary and sufficient condition for personality change. So why would a TEAM therapist hope to discover that he or she is failing in this category?

You’ll discover the explanation for this paradox on today’s podcast.

When the patient asks for help during the A = Agenda Setting phase of the session, the TEAM therapist doesn’t jump in and offer to help, using this or that therapy method. In fact, the TEAM therapist will often assume the role of the patient subconscious resistance and argue for the status quo, sincerely encouraging the patient to cling to the feelings of depression, anxiety, shame, worthlessness, hopelessness, and anger. The therapist will bring out all the reasons why the patient should RESIST change.

Why in the world would a therapist want to do that? It sounds crazy! You’ll find out on this podcast.

And finally, during the M = Methods phase of the session, the TEAM therapist will be working with the patient on his or her negative thoughts, like, “I’m worthless,” or “I’m not as good as I should be,” or “I’m hopelessly damaged because of the abuse I experienced as a child.” And the TEAM therapist’s goal is not success, but rather failing as fast as you can, trying technique after technique that DOESN’T work and the patient’s belief in the Negative Thought is still 100%.

Why would a therapist want to fail over and over? Isn’t that the opposite of what a skillful, compassionate, and effective therapist would want to do?

Listen to this podcast and you’ll discover the answer to these questions. You’ll also see that the patient, not the therapist, is the expert in TEAM, and discover how the patient, and not the therapist, guides all the changing.

David and Rhonda talk about the important difference between healthy and unhealthy use of paradoxical ideas and techniques in therapy, and describe how narcissistic therapists may use paradoxical techniques in an effort to manipulate “resistant” or annoying patients. This dysfunctional use of paradox is unfortunately common, and will rarely or never be effective. 

David and Rhonda

Subscribe

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

* * *

There will be three awesome intensives
for you this summer and fall!

 

If you have ever dreamed of bringing extremely rapid healing to your patients, this is a workshop you won’t want to miss. David Burns, MD, will present TEAM-CBT: a new, powerful treatment approach that can produce rapid and lasting changes in mild or severe depression and anxiety. Lectures, videos and live demonstrations by a master therapist will be followed by opportunities to practice the techniques with your colleagues.

These exercises will leave you with a deeper, richer appreciation of the practice of psychotherapy as well as a variety of innovative new tools you’ll be able to apply right away in your clinical work. In addition, you’ll have the opportunity to do your own personal work during the workshop so you can experience greater self-esteem and joy in your professional work and in your personal life as well.

High-Speed Treatment of Depression and Anxiety Disorders

A Four-Day TEAM-CBT Advanced Intensive

w/ David Burns, MD

32 hrs of CE credit available

Workshops in S. San Francisco and Atlanta!

Register with friends and save 20%!

<Register>

There will also be a four-day intensive in Calgary, and it’s coming up SOON, so act fast if you’d like to register. The Calgary intensive will be similar to the SF and Atlanta intensives, but there will be no evening sessions. Instead, Dr. Burns will lead informal evening hikes for those who are interested, followed by dinner. On the hikes, you can do personal work, ask questions, practice techniques, or just schmooze with colleagues and have fun!

Or, you can just relax and unwind every evening, and absorb all the wonderful new ideas and methods you’re learning!

July 15 – 18, 2019
Calgary, Canada four-day intensive
Sponsored by Jack Hirose & Assoc.

David Burns, MD

 

Solution to David’s Tuesday Tip #8*

Solution to David’s Tuesday Tip #8*

This was yesterday’s paradoxical tip of the day–

Therapeutic failure is nearly always your greatest success in disguise!

In TEAM-CBT we test patient’s symptoms at the start and end of every therapy session to find out how much the patient has improved, or failed to improve. In addition, patients rate us on therapeutic empathy, helpfulness, and other dimensions at the end of every session. The scales are exceptionally sensitive to the smallest therapeutic failures, and most therapists get many failing grades from their patients when using these assessment tests.

Some therapists, perhaps most, find failure threatening, since failure in our work feels like a blow to our self-esteem. However, if you relax and process the patient’s negative feelings about you in a kindly and non-defensive way, using the Five Secrets of Effective Communication skillfully, you will nearly always get a perfect score on the Empathy Scale at the end of the session. This means your relationship with the patient has improved dramatically. That’s good for sure!

But in addition, the way you failed the patient may be similar to problems the patient is having with everybody, so when you repair the relationship with the patient, your “failure” may be his or her first real success, and first taste of intimacy!

There is a lot more to be said about the incredible value of therapeutic “failure,” but I’m short on time because I’m teaching in Canada today. Be home soon.

Thanks!

David

* Copyright © 2018 by David D. Burns, MD.

Need some training? I have a really great new workshop coming up on

June 15th, 2018 in Mt. View, California

9:00 AM – 4:00 PM
Michael’s at Shoreline
2960 N. Shoreline Blvd.
Mountain View, CA 94043

Sponsored by the Santa Clara Valley of CAMFT
(California Association of marriage and Family Therapists)

Unlike my usual workshops, which include quite a bit of didactic material and live demonstrations, plus some small group practice, you’ll get a great deal of practice so you can master new skills that can transform you clinical work and your personal life as well. You’ll learn to use the Five Secrets of Effective Communication to transform failed, frustrating relationships into satisfying, trusting ones, and you’ll get plenty of helpful feedback while you learn. You’ll learn how to develop more meaningful and rewarding relationships with your clients as well as the people you care about the most.

I’ll be joined by the brilliant and totally wonderful Kyle Jones, a 3rd year PhD student at Palo Alto University with outstanding clinical skills. Although I’ll be doing the main teaching, Kyle will back me up and help provide helpful feedback to all of you during the small group exercises.

In the morning, we’ll focus on dealing with challenging, difficult clients, and in the afternoon we will take on a far greater challenge: how to deal with challenging, difficult loved ones!

All of that plus:

  • Free breakfast
  • Free lunch
  • 6 CE credits
  • Lots of fun while learning!

Click here for registration and further details

* * *

Coming in August!

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!

David’s Answer to Tuesday Tips #4*

David’s Answer to Tuesday Tips #4*

This was yesterday’s paradoxical tip of the day–

Last week, we discussed the idea that therapists’ empathy skills tend to be poor, but therapists are not usually aware of this. If your patients complete the “Evaluation of Therapy Session” in the waiting room after each session, you’ll see, exactly what’s happening, and you can address alliance failures right away. . .  if you dare!

Failures of the alliance (the patient’s poor ratings of therapist empathy and helpfulness)
are actually extremely positive—
if you know how to respond skillfully!

In fact, you’ll often discover that your greatest therapeutic failures
are your greatest successes in disguise! But how can that be?

And here’s my answer!

Therapists who require their patients to complete my Evaluation of Therapy Session after every session (plus the Brief Mood Survey before and after every session) will be rated on Empathy and Helpfulness Scales, and several other scales that are tremendously sensitive to the tiniest therapeutic errors. You will discover that you often get less than stellar ratings on warmth, trust, understanding, and helpfulness. These low ratings may surprise you, especially if you are used to (wrongly) thinking that your empathy skills are excellent or even outstanding.

I have set the scales up so that even a 1 point deduction from a perfect score on any scale is defined as a failing grade. There are two reasons for this. First, anything less than a perfect rating indicates some dissatisfaction on the part of the patient that needs to be explored. For example, the patient may think you did a super job of using listening skills, but may indicate that you did not completely understand how she or he was feeling inside. If this failure of understanding is not addressed and corrected, it may have a corrosive effect on the treatment.

Without the written feedback on the evaluation scales, the therapist would never know he or she was failing in this way. That’s because if you ask the patient how things are going, he or she will nearly always say, “fine,” and keep his or her dissatisfaction secret. But if you look at the written feedback on the Evaluation of  Therapy Session, you will see right away what’s going on.

So how can it be good to discover that you are failing with your patient? There are several positives:

  1. When therapists use my scales for the first time, most will get failing grades on nearly every scale at nearly ever session with nearly every patient. This can be quite disturbing. But if you learn to process the feedback in a relaxed, non-defensive, warm way, using the Five Secrets of Effective Communication, you will find that your scores will increase dramatically, and your therapeutic skills will soar as well. Many of my students report that after using the scales for several weeks with all their patients, and practicing how to process the information in one of our online or in person training groups, they receive perfect scores on most if not all of the scales with as many as 80% or their patients.
  2. When you learn you are failing with a patient, you can immediately discuss the problem, if you have the courage, and this will can lead to significant improvements in the treatment. That’s because you will have accurate information for the first time on how your patients feel, how much progress they make (or fail to make) in every single session, and how they really feel about you.
  3. When they rate you poorly on warmth, support, trust, or understanding, it will ALWAYS be the case that their negative feedback is 100% accurate. When they say, “You don’t really understand me or care about me,” they are saying something that is true. You ARE failing in that exact way! But if you listen, and disarm, using the Five Secrets, and genuinely and skillfully acknowledge the (often painful) truth in what the patient is telling you, your “failure” will usually become his or her first “success” at getting close to someone. That’s because they patient may have felt rejected or abandoned by everyone in his or her life, so this may be his or her first experience of real intimacy and trust. In other words, the problem the patient experiences with you will usually be his or her “core conflict,” to use a psychoanalytic term.  And if you have the desire and the skill, you can find out about it right away and work to quickly repair the lesion that has been causing so much pain.

This type of communication with patients about their criticisms of the therapist often involves the death of the therapist’s ego. That’s because you have to realize and acknowledge that you really have failed at something you thought you were really good at, something central to your sense of identity. But if you do it skillfully, you and your patient will both “die” at the same time, and you’ll also be reborn with a new sense of connection.

Well, that’s my goofy tip for today. I’m kind of rushed today, so will send it out without much if any editing, and hope it’s not too bad, or too corny!

Thanks!

David

* Copyright © 2018 by David D. Burns, MD.

Coming Soon! Move Fast if You Want to Attend this Terrific Program coming up a week from Sunday!

Sold out in person, but we still have room for you online. Those who attend online will have opportunities for small group practice in break out rooms, with supervision!

High-Speed TEAM-CBT for Depression and Anxiety Disorders 

I warmly invite you to attend this fabulous, one-day workshop by Drs. David Burns and Jill Levitt on Sunday, May 20th, 2018. Click on the link above for registration information.

  • 6 CE Credits
  • The cost is $135
  • You can join in person or online from wherever you live!

You will enjoy learning from David and Jill, working together to bring powerful, healing techniques to life in a clear, step-by-step way. Their teaching style is entertaining, funny, lucid, and inspiring. This is a day you will remember fondly!

In the afternoon, you will have the chance to do some personal healing so you can overcome your own feelings of insecurity and self-doubt. David and Jill promise to bring at least 60% of the audience into a state of spiritual and psychological enlightenment, WITHOUT years of meditation. That’s not a bad deal!

You will leave this workshop with renewed confidence as well as specific, powerful tools that you can use right away to improve your clinical outcomes!

Seating for those who attend live in Palo Alto will be strictly limited, and seats are filling up fast, so move rapidly if you are interested. Online slots are also limited.

Jill and I hope you can join us!

Coming in June! One of my best two-day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”

Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada

You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety:

  • Generalized Anxiety
  • OCD
  • PTSD
  • Phobias
  • Social Anxiety
  • Agoraphobia
  • Panic Disorder
  • and more

You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises.

 

The Solution to Tuesday Tip (#2)*

The Solution to Tuesday Tip (#2)*

This was my “puzzle” (the paradoxical Tuesday tip) for yesterday:

The failure to set the agenda is the cause of nearly all therapeutic failure.

Several of you commented, and a couple of you nailed it. This one was, perhaps, a bit too easy or obvious.

But what it means is that we all have mixed feelings about recovery, or change. If you’re depressed or anxious, you may be miserable, but a part of you may want to hang on to your depression and anxiety. One of the key features of TEAM-CBT is that we bring the patient’s resistance to conscious awareness quickly, and before using any M = Methods to help the patient change. The methods I have developed will be unfamiliar to most therapists, but they can be incredibly helpful and can greatly accelerate recovery.

But most therapists do not know how to reduce resistance, and may not even know that they need to do this. So they jump right in to help, save, or rescue the patient. But if the patient has ambivalent feelings about change, he or she will probably resist the therapist’s efforts. And this is why therapy fails.

Hundreds of therapists have approached me during breaks at workshops, or during my training groups at Stanford, and asked for help with this or that challenging patient who appears to be stuck in therapy. In 100% of these cases, the therapist did not know how to address resistance and did not know how to make the patient accountable.

In all of the many controlled outcome studies for depression that I’m familiar with, using any school of psychotherapy, it seems that a good 50% of the patients, or even more, do not reach the criteria for improvement during the study. I believe this is because tools to deal with resistance are almost never included in these studies.

Well that’s it for today!

Next Tuesday, look for “Tip / Puzzle #3!”

David

* Copyright © 2018 by David D. Burns, MD.

Coming Soon! Live Session Sold Out! Still space online. Register now!

High-Speed TEAM-CBT for Depression and Anxiety Disorders 

I warmly invite you to attend this fabulous, one-day workshop by Drs. David Burns and Jill Levitt on Sunday, May 20th, 2018. Click on the link above for registration information.

  • 6 CE Credits
  • The cost is $135
  • You can join in person or online from wherever you live!

You will enjoy learning from David and Jill, working together to bring powerful, healing techniques to life in a clear, step-by-step way. Their teaching style is entertaining, funny, lucid, and inspiring. This is a day you will remember fondly!

In the afternoon, you will have the chance to do some personal healing so you can overcome your own feelings of insecurity and self-doubt. David and Jill promise to bring at least 60% of the audience into a state of spiritual and psychological enlightenment, WITHOUT years of meditation. That’s not a bad deal!

You will leave this workshop with renewed confidence as well as specific, powerful tools that you can use right away to improve your clinical outcomes!

You will LOVE this workshop. Seating for those who attend live in Palo Alto will be strictly limited, and seats are filling up fast, so move rapidly if you are interested. Online slots are also limited.

Jill and I hope you can join us!