035: Live Session (Mark) — Final Testing, Wrap Up (Part 7)

035: Live Session (Mark) — Final Testing, Wrap Up (Part 7)

Part 7: T = Testing Revisited, Conclusion of the Live Therapy Session with Mark

This is the last live therapy podcast with Mark, the physician who was convinced he was a failure as a father because of his difficulties forming a close, loving relationship with his oldest son. Although the session appeared to go well, we can’t be sure until we see Mark’s end of session mood ratings on the Daily Mood Log and on the Brief Mood Survey and and Evaluation of Therapy Session. David emphasizes that therapists’ perceptions of patients are notoriously inaccurate, but most therapists are unaware of this because they don’t use the rigorous testing procedures at the start and end of sessions.

To review Mark’s partially completed Daily Mood Log, CLICK HERE. Jill and David will ask him to complete the additional negative thoughts on his own after the session.

To review mark’s end of session Brief Mood Survey and Evaluation of Therapy Session, CLICK HERE.

After David review’s the phenomenal changes Mark reported from the start to the end of the session, David asks if the ratings were genuine, or, as some listeners might suspect, faked in order to try to please the therapists. Mark bursts into tears and says, in a choked voice, that it was a life-changing experience.

After the end of the session, David and Fabrice discuss a number of highlights from the work with Mark:

  • The testing indicated a complete or near-complete elimination of symptoms. In 2 ½ hours, Jill and David have essentially completed an entire course of psychotherapy. Although there may still be some work to be done with Mark, the hard part has already been completed.
  • David emphasizes that he now views psychotherapy as a procedure to be done at one sitting, much like surgery, with brief follow-up visits, rather than a long, drawn out procedure meeting once pre week for months or even many years. And although a single 2 or 2 1/2 hour session may be more costly than a traditional 50-minute hour, it can be vastly more cost-effective Than dozens of sessions with little or no progress. In addition, it is vastly better for the patient who walks out feeling good today, rather than having to endure weeks, months, or even many years of traditional talk therapy or antidepressant drug therapy.
  • David and Fabrice talk about the fact that no one is permitted to feel happy all the time, and that Mark’s negative thoughts and feelings WILL return, David defines a “relapse” as one minute or more of feeling lousy. Given that definition, we will ALL relapse forever! But it doesn’t have to be a problem for Mark if he is prepared for this, and knows how to pop out of the relapses quickly, rather than getting stuck in them. This is where Relapse Prevention Training (RPT) becomes so important following the initial dramatic recovery. RPT only takes about 30 minutes and is easy to learn, and will perhaps be the topic for a future Feeling Good Podcast if our listeners express an interest in it.
  • David discusses the difference between an Internal Solution and an External Solution. In this session, David and Jill have guided Mark in the Internal Solution—this means crushing the negative thoughts that triggered Mark’s feelings of unhappiness, anxiety, shame, failure, and anger for years, if not decades. Now that he is feeling so much better about himself, he may want some help with the External Solution. This will involve learning how to develop a more loving relationship with his son using tools like the Relationship Journal and the Five Secrets of Effective Communication. This will be far easier now that Mark is no longer using up all his energy beating up on himself and feeling depressed and inadequate.
  • David wraps up by talking about the true wealth we have as therapists. Although we won’t develop the riches of a Bill Gates doing psychotherapy, we do have the fabulous and precious opportunity to see people as they really are inside, and to witness miracles like the one we saw in the session with Mark.
  • David expresses the hope that listeners have benefitted by listening. Although we are all different, most of us have had the painful experience, like Mark, of believing we were somehow failures, or inferior, or defective, or simply not good enough. We are deeply indebted to Mark’ courage and generosity in giving us the opportunity to see the solution to this ancient and almost universal human problem!

There are many resources for listeners who want to learn more about TEAM-CBT, including:

  • David’s exciting two-day and four-day training workshops, listed on his website, feelinggood.com.
  • Tons of free resources for patients and therapists at feelinggood.com. Please sign up using the widget in the upper right hand corner of any page on his website and you will receive email notifications and links to every post.
  • David’s psychotherapy eBook entitled Tools, Not Schools of Therapy.
  • David’s Tuesday psychotherapy training groups at Stanford, which are co-led Jill Levitt, PhD and Helen Yeni-Komshian, MD. The training is free of charge to Bay Area and northern California therapists. You will have the chance to do free personal work, too!
  • David’s famous Sunday hikes, also free to members of the training groups.
  • Paid online and in-person weekly TEAM-CBT training groups, plus intensive TEAM-CBT treatment programs, at the Feeling Good Institute in Mt. View California.
  • In addition, many TEAM-CBT training and treatment programs are now offered in many cities throughout the US and Canada. For more information, visit feelinggood.com or www.feelinggoodinstitute.com.
031: Live Session (Mark) — Agenda Setting Phase (Part 3)

031: Live Session (Mark) — Agenda Setting Phase (Part 3)

Part 3—A = Paradoxical Agenda Setting (PAS), Initial Segment

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In the early days of my career, I (Dr. Burns) would have assumed that Mark definitely wanted to change–after all, he’d been in a lot of pain for a long time, and he came to the session because he wanted help. So, following the empathy phase of the session, I would have jumped in with a variety of cognitive therapy techniques to help Mark challenge his Negative Thoughts, such as “I’ve been a failure as a father,” or “my brain is defective.” Although this might have been effective, there’s a good chance that it might not have worked. That’s because Mark might have “yes-butted” me or insisted that he really was a failure and that I just wasn’t “getting it.”

In fact, the attempt to help the patient without first dealing with the patient’s resistance is the cause of nearly all therapeutic failure. But most therapists make this mistake over and over–and don’t realize that their well-intentioned efforts to help actually trigger and reinforce the patient’s resistance.

Instead, TEAM Therapists use a number of Paradoxical Agenda Setting (PAS) techniques designed to bring the patient’s subconscious resistance to conscious awareness. Then we melt the resistance away before attempting to change the way the patient is thinking and feeling. I (DB) have developed 15 or 20 PAS techniques, and Jill and I  used several of them in our session with Mark:

  • The Invitation Step
  • The Miracle Cure Question
  • The Magic Button
  • Positive Reframing
  • The Acid Test
  • The Magic Dial

When Jill and I use Positive Reframing, we are hoping that Mark will make an unexpected discovery–that his negative thoughts and feelings, such as his sadness, shame, discouragement, and inadequacy actually reflect his core values and show what a positive, awesome human being he is. In other words, he will discover that his core values are actually the source of his symptoms as well as his resistance to change.

This approach represents a radical departure from the way many psychiatrists and psychologists think about psychiatric symptoms as well as resistance.  When I was a psychiatric resident, I (DB) was trained to think about resistance as something negative. For example, we may tell ourselves that resistant patients cling to their feelings of depression and worthlessness because they want attention, because they want to feel sorry for themselves, because they fear change, or because they are afraid will lose their identity if they recover. While there’s some truth in these formulations, they may not be helpful because they tend to cast the patient in a negative light, as if their symptoms and their resistance to change were somehow bad, or childish, or based on some kind of chemical imbalance in their brains. As you will see, the TEAM-CBT approach approaches resistance is radically different manner.

We will give you the chance to pause the podcast briefly and try your own hand at Positive Reframing before you hear it live during the session. Specifically, we will ask you to review Mark’s Daily Mood Log, and ask yourself these two questions about each of his negative thoughts and feelings:

  • What does this negative thought or feeling show about Mark that is beautiful, positive, and awesome?
  • What are some benefits, or advantages, of this negative thought or feeling? Are there some ways that this thought or feeling is helping Mark?

As you so this, make a list of as many Positives as you can on a piece of paper. See what you can come up with.

I want to warn you that it may be difficult to come up with your list of Positives at first. If so, this is good, because when you hear the next podcast, you’ll have many “ah ha!” moments and it will all become quite obvious to you. Then you will have a new and deeper understanding of resistance–an understanding that can help you greatly if you are a therapist or if you are struggling with your own feelings of depression and anxiety.

Jill gives a great overview of why the paradoxical approach is necessary during the Paradoxical Agenda Setting phase of the session.

To learn more about Paradoxical Agenda Setting, you can read David’s featured article in the March / April 2017 issue of Psychotherapy Networker entitled “When Helping Doesn’t Help.” You will see how he helped a woman struggling with intense depression, anxiety and rage due to decades of horrific domestic rape and violence.

 

Why Does Therapy Fail? What’s the Solution?

Hi Web Visitors,

One of my colleagues, Dr. Daniele Levy, who helps teach the Tuesday training group at Stanford, created a neat brief quiz for members of the TEAM-CBT list-serve. I have modified it slightly. If you want to submit your answers, I will try to publish a few of them!

  1. What is the #1 cause of therapeutic failure?
  2. What is the therapist’s role in addressing therapeutic resistance?
  3. What is the patients role?

She is offering free wine and cheese to the winner. I’m not offering that, but you might still enjoy taking a crack at it. And if you like the quiz, I might create some more of them for you!

By the way, I have an article on this topic that will be featured in the March, 2017 edition of Psychotherapy Networker. The title is “When Helping Doesn’t Help.” If possible, I will try to link to it when it appears, but don’t yet know if they permit this. If not, I might be able to print the final draft here.

David

David’s Video Interview with Lee Davy

Hi Web visitors,

If you’d like to take a peak at my recent video interview with Lee Davy, CLICK HERE!

Here’s Lee’s description, with a tad of editing from David: “In this episode, David and I talk about the role that tears and laughter play in therapy, Resistance and some tips and techniques to melt it, the importance of developing metrics to understand if therapy is working, relapse prevention, the human condition, how a cat taught him about to transcend the need to be special, or even to need ‘self esteem,’ and much more.” Thank’s Lee. It was really fun shooting the breeze with you, and I wish you the best in your podcasts on overcoming addictions.

David

 

021: Ask David — Shameful Sexual Fantasies

In this podcast, David and Fabrice discuss a question posed by a listener with Obsessive-Compulsive Disorder who is plagued with intrusive and shameful sexual fantasies. David discusses his treatment strategies for a young man from Argentina who was struggling with forbidden fantasies of Jesus having sex with the Virgin Mary in all positions of the Kama Sutra, but the harder he tried to control them, the more intense and tantalizing they became. Being a good Catholic lad, he was terrified and tearful he would burn in hell if he didn’t overcome this problem.

If you’ve ever struggled with shameful sexual fantasies, you might be intrigued by this fascinating discussion of Cognitive Flooding, therapeutic resistance, and the Hidden Emotion Technique!

016a: Special Interview: Can Depression and Anxiety Be Treated in a Two-Hour Therapy Session? with Lisa Kelley

In this Podcast, David and Fabrice are joined by Lisa Kelley, a certified TEAM-CBT therapist and former journalist from Littleton, Colorado. Lisa interviews David about an interview / blog David has just published on this website. For the full PDF of the article, click here.

Lisa begins by asking how people responded to a survey on David’s website asking this controversial question: “Do you believe that a depressed individual could experience a complete elimination of symptoms in a single, two-hour therapy session?” More than 5,000 individuals completed the survey and most were extremely skeptical.

David states that ten years ago, he would have felt exactly the same way, and would have dismissed anyone making such a claim as a con artist. However, he has now changed his mind and believes that sometimes it is possible.

David explains that he has done more than 50 live demonstrations in workshops and other teaching settings with individuals who are struggling with severe feelings of depression, anxiety, shame and anger. Many of these individuals who volunteer to be the patient have experienced horrific personal traumas. This gives David the opportunity to demonstrate how TEAM-CBT works with someone who is really suffering, and not just a role-playing demonstration. Usually, these live demonstrations are the highlight of a workshop because they are intensely emotional and real. Surprisingly, in the vast majority of these sessions, the individuals who were in the patient role experienced a complete, or near-complete, elimination of symptoms in roughly two hours.

David emphasizes that while we would not expect this to generalize to a clinical practice situation, it does seem to suggest significant improvements, or even breakthroughs, in psychotherapy. Many of the new developments have to do with helping patients overcome their resistance to change. Although David makes these techniques look easy, they are challenging to learn, and require a radically new and different way of thinking about why patients sometimes resist change and fight the therapist.

Lisa, Fabrice, and David explain exactly how the new techniques work, using as an example an Asian-American woman who had experienced decades of domestic violence and rape.

016: Ask David — How can I cope with a complainer? How can I help a loved one who is depressed?

In this episode, David and Fabrice bring the Five Secrets of Effective Communication to life, based on a question submitted by two listeners: How can you help a depressed friend or family member? You may be surprised to discover that the attempt to “help” is rarely effective, and may even make the problem worse. In contrast, the refusal to help is nearly always helpful. But to understand that paradox, you’ll have to give a listen to this fascinating edition of “Ask David!”

David and Fabrice also address a related problem nearly all of us confront from time to time: How do you deal with a friend who is a relentless whiner and complainer? When you try to help them or suggest a solution to the problem, they just say, “That won’t work” and keep complaining. You end up feeling frustrated and annoyed, because the other person just won’t listen! David and Fabrice illustrate a shockingly easy and incredibly effective solution to this problem.

Finally, David discusses some disturbing recent research indicating that the ability of therapists—as well as friends or family members—to know how suicidal someone is, is extremely poor. David and Fabrice explain how to assess how suicidal someone actually is, and what to do if you discover that he or she really is at risk of a suicide attempt.