Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

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360: "You wowed me!" A Mother-Daughter Conflict: Part 2 of 2 Sep 04, 2023

Show notes

360: The Story of Indrani "Why can't I get close to my daughter who I love so much?" Today, we present Part 2 of the awe-inspiring work that David and Jill did with Indrani in the Tuesday group at Stanford. Indrani was a mother with a heart-breaking but all-too-common story of a conflict with her daughter. Sometimes, we love someone tremendously, but every time we try to get close, they seem to push us away. The story should ring true and be helpful to so many people, as nearly everyone runs into conflicts at times with our family members, including our parents, siblings and children. And, as usual, the solution often involves attending to your "inner" dialogue, which is the conversation you're having with yourself about the conflict, and the "outer" dialogue, which is what happens when you try to get close to the person you love. And today's session illustrates not one, but two forms of enlightenment. The changes in the inner dialogue involves challenging and crushing the negative messages you've been giving yourself about h problem with the person you love so much. You can see Indrani's Daily Mood Log if you click HERE. As you can see, she's been telling herself that her daughter has shut her out of her life, and that she'll die alone/ That's incredibly sad! And she's also telling herself that all of her friends have wonderful relationships with their daughters "and I don't" and she's blaming herself for the problem: "I deserve this treatment," and "nothing I do pleases her." You can also see the intensity of Indrani's negative feelings, including sadness, anxiety, inadequacy, loneliness, embarrassment, discouragement, irritation, and more. You can also see a typical exchange with her daughter if you look at her Relationship Journal (RJ). As you may know, the whole theme of my interpersonal model in TEAM-CBT is that we create our own interpersonal reality at every moment of every day. In other words, we unknowingly create and cause the exact relationship problems that we complain about, but just don't realize this, so we think there's something wrong with the other person. But how can this be? If you look at Step 2 of Indrani's RJ, her response to her daughter seems innocent enough! But stayed tuned, because Indrani makes a shocking and mind-blowing discovery during the session, and that discovery requires the exceedingly painful "death" of the "self." But this "Great Death" is instantly followed by a "Great Rebirth.!" At the end of the session, a Tuesday group members named Keren, said this to Indrani: "You wowed me!" One of the men, Ed, could barely speak because he was sobbing. You may also be sobbing for joy when you listen to this heart-warming story. In part 1, today's podcast, you'll hear the initial T = Testing and E = Empathy. In part 2, in next week's podcast, you'll hear the M = Methods, including Jill and David's incredible work with Indrani on her R and her rather sudden discovery, in Step 4, of exactly how and why she'd been driving her daughter away—and how to stop doing that and begin to communicate in a way with a far greater chance of enhancing closeness and love. The Jill and David turn to Imani's Daily Mood Log so she can smash her distorted negative thoughts with the Externalization of Voices, and several role reversals illustrating the integration of Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique.) You can see Imani's initial and final Brief Mood Surveys plus her Evaluation of Therapy Session, We are extremely grateful to Indrani for giving us this very intimate glimpse into her inner life in a way that will illuminate and inspire every person with the good fortune to listen to Indrani's amazing Journey this evening! PS I emailed Indrani this morning to see how she's doing, and recevied this wonderful reply: I'm still feeling great…very light and hopeful. I've listened to the audio. I sound goofy at times but loved re-living the moment when the truth dawned on me and how I felt immediately afterwards. My daughter Soni ( like the Japanese electronic company :) is coming on Thursday. I would've been filled with intense anticipatory anxiety but now I can't wait to give her a big hug and use what I've learnt to connect with her. I'm looking forward to watching the video with Soni. Thank you so much Dr. Burns and Jill! Thanks for listening! Rhonda, Jill, and David

359: "You Wowed Me!" A Mother-Daughter Conflict, part 1 of 2 Aug 28, 2023

Show notes

359: The Story of Indrani "Why can't I get close to my daughter who I love so much?" Today, we present the awe-inspiring work that David and Jill did with Indrani in the Tuesday group at Stanford. Indrani was a mother with a heart-breaking but all-too-common story of a conflict with her daughter. Sometimes, we love someone tremendously, but every time we try to get close, they seem to push us away. The story should ring true and be helpful to so many people, as nearly everyone runs into conflicts at times with our family members, including our parents, siblings and children. And, as usual, the solution often involves attending to your "inner" dialogue, which is the conversation you're having with yourself about the conflict, and the "outer" dialogue, which is what happens when you try to get close to the person you love. And today's session illustrates not one, but two forms of enlightenment. The changes in the inner dialogue involves challenging and crushing the negative messages you've been giving yourself about h problem with the person you love so much. You can see Indrani's Daily Mood Log if you click HERE. As you can see, she's been telling herself that her daughter has shut her out of her life, and that she'll die alone/ That's incredibly sad! And she's also telling herself that all of her friends have wonderful relationships with their daughters "and I don't" and she's blaming herself for the problem: "I deserve this treatment," and "nothing I do pleases her." You can also see the intensity of Indrani's negative feelings, including sadness, anxiety, inadequacy, loneliness, embarrassment, discouragement, irritation, and more. You can also see a typical exchange with her daughter if you look at her Relationship Journal (RJ). As you may know, the whole theme of my interpersonal model in TEAM-CBT is that we create our own interpersonal reality at every moment of every day. In other words, we unknowingly create and cause the exact relationship problems that we complain about, but just don't realize this, so we think there's something wrong with the other person. But how can this be? If you look at Step 2 of Indrani's RJ, her response to her daughter seems innocent enough! But stayed tuned, because Indrani makes a shocking and mind-blowing discovery during the session, and that discovery requires the exceedingly painful "death" of the "self." But this "Great Death" is instantly followed by a "Great Rebirth.!" At the end of the session, a Tuesday group members named Keren, said this to Indrani: "You wowed me!" One of the men, Ed, could barely speak because he was sobbing. You may also be sobbing for joy when you listen to this heart-warming story. In part 1, today's podcast, you'll hear the initial T = Testing and E = Empathy. In part 2, in next week's podcast, you'll hear the M = Methods, including Jill and David's incredible work with Indrani on her R and her rather sudden discovery, in Step 4, of exactly how and why she'd been driving her daughter away—and how to stop doing that and begin to communicate in a way with a far greater chance of enhancing closeness and love. The Jill and David turn to Imani's Daily Mood Log so she can smash her distorted negative thoughts with the Externalization of Voices, and several role reversals illustrating the integration of Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique.) You can see Imani's initial and final Brief Mood Surveys plus her Evaluation of Therapy Session, We are extremely grateful to Indrani for giving us this very intimate glimpse into her inner life in a way that will illuminate and inspire every person with the good fortune to listen to Indrani's amazing Journey this evening! Thanks for listening! Rhonda, Jill, and David

358: Ask David - Depression, schizophrenia, and more! Aug 21, 2023

Show notes

Are the "physical" symptoms of depression specific or non-specific? How do you treat schizophrenia with TEAM? Why don't more shrinks help themselves? Healthy vs unhealthy negative feelings-- what's the difference? Questions answered in this podcast: 1. Laura asks: Why don't you include the physical symptoms of depression in your assessment tests? 2. Fred asks: How would you use TEAM-CBT to treat individuals with schizophrenia? 3. Author not known: Why don't the therapists you treat with TEAM treat themselves using self-help techniques? 4. Zach: How does David understand the difference between healthy and unhealthy emotions? Is there any overlap between EFT (Emotionally Focused Therapy) and David's TEAM-CBT? The following are David's written responses to these questions. However, in the podcast, Rhonda and David discuss them, and their answers together may differ or enlarge on the material below. Also, in some cases, the written answers contain additional information not included in the live podcast. 1. Laura asks: Why don't you include the physical symptoms of depression in your assessment tests? Author: Laura asks a question about post #248: "David and Rhonda Answer Your Questions about Exercise, Empathy, Euphoria, Exposure, Psychodynamic Therapy, and more!" Comment: Fabulous, David. Bless you. Have you done a show on assessments? I'll be honest about my confusion. Some of the measures that you have developed almost seem too simple to be accurate. For example, the depression test isn't sensitive to any of the physical manifestations of the illness. Anyway, I was just curious about that. David's Reply Thanks, Laura! Good questions! First, the so-called physical symptoms of depression are non-specific and not uniquely associated with depression. Only the core emotional symptoms are good indicators of depression: feeling down, hopeless, worthless, unmotivated, and not enjoying life. If you want to measure physical symptoms, they won't give you much information about depression, but at least they need to be worded correctly, which they aren't in most assessment tols. For example, you can measure weight gain, OR weight loss, in single and separate items, but not in the same item. But if you go to a mall and ask how many people have had weight gain, you'll probably find that more than 50% report weight gain, but this is rarely due to depression, rather it is due to overeating! Similarly, a significant fraction will say yes to a question about weight loss, and in the vast majority of cases this will be due to dieting, not depression. Similarly with the other poorly thought out physical symptoms, like trouble sleeping. The reliability of my depression measures has typically been .95 or better, as compared with measures like the Beck or PHQ9 that have only .78 to .80 reliability coefficients (called "coefficient alpha.") I have observed a phenomenal lack of critical thinking behind most current psychological tests for depression, anxiety, and other variables of interest to clinicians and researchers. You also asked about apps for anxiety, like OCD, as opposed to depression. The Feeling Good App causes rapid and significant reductions in, not one, but seven categories of negative feelings, including feelings of depression, anxiety, guilty/shame, inadequacy, loneliness, hopelessness and anger. Thanks so much! Finally, I have to confess my bias toward trying hard to make things simple, so we can all understand what we're talking about! When things are overly complicated or hard to "get," I usually feel fairly suspicious about the person who is trying to "teach." In college I always had the policy that if I can't understand what the teacher is trying to say, the teacher has a problem! My thinking today is pretty similar! I've always appreciated teachers who keep things simple for us mere mortals who appreciate having things explained clearly and in everyday words. Best, david 2. Fred asks: How would you use TEAM-CBT to treat individuals with schizophrenia? Hi David, Do you have any schizophrenia thought experiments? Most of my clients struggle with voices. I tell them there is always a good voice, which I believe is the Holy Spirit woven into every person at birth. I also tell them to welcome the voices and listen for what they need, because the voices need to be welcomed back into the body - the "family" - of the person, according to Internal Family Systems. I welcome your thoughts. I am not a therapist so anything I say or do needs to fit my role as a recovery coach. Fred South Bend, Indiana David's Reply. Thanks, Fred, great question. I have treated many individuals with schizophrenia, but they have rarely or never asked for help with the voices they hear. I like to set the agenda for each patient, finding out what they specifically want help with. And individuals with schizophrenia respond very well to TEM-CBT, both the individual treatment model for depression and anxiety, as well as the interpersonal model for relationship problems. An experience early in my career highlighted the folly of trying to challenge the delusions of individuals with schizophrenia. A young man, a new patient, seemed uncomfortable and when I inquired, he explained that the receptionist, Lucretia, was listening in because she could "hear" our thoughts and our conversation. I explained that Lucretia did not have much money, and that if he wanted we could do an experiment to test his belief. I put a $20 bill on the desk and said that if Lucretia knocked and came into the office, she could have the money. So I did that and Lucretia did not knock on the door or appear in the office. I asked the young man what he concluded from our "experiment." He said that she "knew" it was an experiment since she could "hear" our thoughts, and didn't come in because she didn't want us to know she was "listening in" on our dialogue! That's an excellent example of what happens when the shrink tries to set the agenda, as opposed to helping patients with what THEY want help with! In my experience, you can help individuals with schizophrenia with self-esteem, anxiety, and relationship problems with psychotherapy, and they do feel and function somewhat better, but they still, sadly, have schizophrenia. This is my thinking only, and others may differ. I know that Aaron Beck and many of his followers have done research studies claiming they can help schizophrenia with traditional CBT. I am skeptical, but have not read those studies or evaluated the data with a critical eye! So who knows? Maybe they have some decent results. Best, david 3. Author not known asks: Why don't the therapists you treat with TEAM treat themselves using self-help techniques? Why can't the TEAM-CBT therapists who have done personal work with you on the podcasts do that work themselves in self-help mode?" They know all the techniques and have all the tools. With no qualifications, I have my own theory on that, which is actually based on TEAM. I don't know how to give myself the level of E=empathy required to move on to the next stage. So I guess my question could be reworded as "Is it possible to give yourself sufficient empathy in self-help mode?" or "Are there techniques or tools you can use to give yourself empathy in self-help mode?" David's Response Thanks, cool question!

- Blind spot, especially in relationship problems
- To get experience in the "patient" role
- Sometimes, we all need a little help from a friend, and that can sometimes be vastly faster than trying to do everything on your own.
- But in terms of empathy, I believe you CAN treat yourself with empathy, warmth, and compassion, and that is actually one of the keys to recovery, whether or not you're in treatment with a shrink!

4. How does David understand the difference between healthy and unhealthy emotions? Is there any overlap between EFT (Emotionally Focused Therapy) and David's TEAM-CBT? Hi Dr. David and Dr. Rhonda, I have a question if you have a chance, and maybe this is better for an Ask David. David talks about healthy emotions sometimes, and this feels like a faint through-line to EFT model. Does David have a framework for understanding healthy emotions or emotional needs?

When a client is grieving, David encourages the tears to flow and notes it's an expression of how much the client valued something.
David also demonstrates what EFT would call protective anger, when using the counterattack method, "I'm tired of listening to your BS."
And lastly David demonstrates what EFT labels self-compassion while using the acceptance paradox and 5 secrets responses to critical thoughts.

Thanks, Zach David's Response Thanks for the excellent question. I have to confess that I don't know much about EFT, but I think there's a lot of overlap in different "therapies" since many people "borrow" ideas from other experts, and get so excited about them that they call them their own, and simply give them a new name, claiming to have something entirely new. And it sounds like there are some definitely similarities between my TEAM-CBT and what is called "EFT." If this is true, I'm certain I didn't do the "borrowing" since I don't attend to the work of others in the field, for better or worse. At any rate, I have always taught my students that each negative feeling has a healthy and an unhealthy version, as you can see in the following table. The main difference is that the healthy version results from valid negative thoughts, and the unhealthy version results from distorted negative thoughts. However, in the past 25 years or so, I've taken a new look at so-called "unhealthy negative feelings" in my TEAM-CBT. There, we reframe the negative feelings, showing what's beautiful and awesome about each one. IN other words, we genuinely try to sell the patient on NOT changing. Paradoxically, this approach, which I call Positive Reframing, seems to melt the patient's resistance to change, and that nearly always opens the door to the possibility of rapid change. Healthy vs Unhealthy Negative Feelings Healthy Version Unhealthy Version Sadness, grief when you've lost someone or something you loved Depression, worthlessness, hopelessness Healthy fear when you're in danger Anxiety, nervousness, worry, and panic, and phobias Healthy remorse when you've hurt someone you love Neurotic guilt, blaming yourself for something you're not entirely, or at all, responsible for Healthy inadequacy and awareness of your very real shortcomings and limitations Worthlessness, inferiority Missing someone you love Desperate loneliness, abandonment, feeling unlovable Discouragement when you fail or when things don't work you Hopelessness Sharing your anger in the spirit of love and respect Unhealthy anger, aggression, acting out your anger with the goal of hurting or upsetting the other person, or getting back at them Thanks so much for listening today! Warmly, Rhonda and David

357: Stories from the 60s, Part 1 Aug 14, 2023

Show notes

Podcast 357: Stories from the 60s, Part 1 Today's podcast will be a little different. I had the good fortune to be alive in Palo Alto, California during the late 1960s. For me, it was a magical era of happenings, the Haight-Ashbury District in San Francisco, psychedelics, war protests, civil rights activity, cool music, learning about life, and cutting an awful lot of medical school classes! But what I learned on the streets was far more valuable in my later career as a psychiatrist, working with real people with real problems, than anything I learned in medical school. It was an era of magic, to be honest. In fact, to me, California has always had the feel of magic. And that magic is still alive and well, happening every day, at least in my life. Let me know if you like these stories. I shared them at my weekly Stanford training group, and publish the recording of that evening's training session here, with trepidation. Some of the stories are pretty far out. If you like them, and want more, I have a lot more, which I've listed below. Just let me know, and I'll gladly start babbling again. . . IF I haven't been arrested! If you'd like to see one of the R-rated but gorgeous Larry Keenan photos taken at my "Uptightness" happening, you can see it at this link: Look for the photo called "The Kiss." https://www.larrykeenan.com/prints Larry Keenan, a brilliant young commercial photographer at the time, attended my "uptightness" happening and took many fantastic photos that day. Larry became a famed photographer of many of the greats of the "Hippy Era," like Bob Dylan, Neil Cassady, Lawrence Ferlinghetti, and a host of others. Sadly, Larry passed away several years ago, but I will always be grateful to him for the gorgeous and now-famous photos he created that day in the infamous but glorious 60's! Warmly, david Part 1 (in this podcast) Psychodrama / encounter

David gets put down: Rob Krist's encounter group
The return of tears: My first psychodrama marathon
The pompous professor: False front / tragic surprise

Spiritual

Desert experience: Sadness as celebration

Dating / Relationships / R-Rated

Having fun and making a movie: "Uptightness"

Part 2 (not yet recorded: let me know if you'd like a Part 2!) More Stanford stories not yet covered: let me know if interested!

Husain Chung and the crazy teen from LA: When a stallion wants to run
A frightening encounter with Vic Lovell: And a mentor's advice
Threats from unwanted guests: Fighting back with paradox
Bar next to the Free University Coffee House: Outrageous works, even with Hell's Angels
Inside the Free University Coffee House: How I met my wife
The day we bombed Cambodia: Triggering a riot at Stanford, beaten by police, motorcycle smashed to bits, handcuffed, arrest announced on the campus radio station, escaped
The bearded man on the quad near the Stanford student union—Telling me to "sit with open hands"
Ken Kesey and his merry pranksters in the Stanford student union—they were dressed in pajamas or clown outfits and Neil Cassady was juggling hammers)
The tape recorder experiment: Bizarre week, unexpected conclusion

Medical School

Stanford medical school interview: Unexpected outcome
The day that Gene Altman and I attended class: Totally weird
Broken jaw: Anger, fear, and intense pain that suddenly vanished
Getting kicked out of neuropathology class
Encounter at the Medical School: Psychiatry and Psychotherapy—Are they Relevant or Obsolete? Featuring Hussain Chung
Missing graduation ceremony: Didn't pick up my diploma until years later
Homeless in Carmel Valley: Saved by Ramadan, Subud
Re-entry: The Highland Hospital Emergency Room

Dr. Allen Barbour's Medical Outpatient Clinic

Hidden emotion 1: One of Stanford's first coronary artery bypass patients
Hidden emotion 2: Doc, what happened? I'm not dizzy anymore!
Hidden emotion 3: Help! I need emergency surgery NOW!

Here's the Stanford group feedback from group after telling stories 1 – 5 Positive Feelings about the Training Not at all true Somewhat true Moderately true Very true Completely true N/A 1. I felt I could trust my trainer. 0 0 0 0 17 1 My trainer paid careful attention to what I said 0 0 0 0 7 11 My trainer critiqued my work in a sensitive manner. 0 0 0 0 7 11 I felt good about the training I received. 0 0 0 0 17 1 Overall, I was satisfied with my most recent training session. 0 0 0 0 17 1 Negative Feelings during Training Not at all true Somewhat true Moderately true Very true Completely true Sometimes I felt uncomfortable during the training. 18 0 0 0 0 Sometimes I felt defensive during the training. 18 0 0 0 0 Sometimes I felt frustrated during the training. 18 0 0 0 0 Sometimes I felt anxious during the training. 18 0 0 0 0 Sometimes I felt insecure during the training. 16 2 0 0 0 Helpfulness of the Training Not at all true Somewhat true Moderately true Very true Completely true N/A I expect to use these ideas with patients I am now treating 0 0 2 1 11 4 What I am learning seems useful in my clinical training. 0 0 1 2 13 2 My trainer and I are working together effectively. 0 0 0 2 10 6 The training was helpful to me. 0 0 0 1 16 1 I felt I was learning and growing during the training session. 0 0 0 1 16 1 Respectfulness and Safety of the Training Not at all True Somewhat true Moderately true Very true Completely true N/A My trainer was sensitive to potentially relevant cultural, racial, religious, age, gender, or sexual identity issues that might impact the therapy. 1 0 2 0 13 2 My trainer created a safe and warm space for all identities. 1 0 1 0 14 2 Difficulties with the Questionnaire Not at all true Somewhat true Moderately true Very true Completely true It was hard to be completely honest answering some questions. 16 1 0 0 1 My answers weren't always completely honest. 16 1 0 0 1 Sometimes I did not answer the way I really felt inside. 16 1 0 0 1 Please describe what you specifically disliked about the training? What could have been improved? Were there some things you disagreed with or did not understand?

Nothing
N/A
Was too short
na
I'm starting to catch on to the fact that David has read more than 3 books... Nerd. :)
It is funny coming from David and I believe he used it affectionally... most of use won't get away with the term "Chainaman" perhaps Asian American
Loved the group tonight
n/a
Nothing I disliked. My answer of "somewhat insecure" from above was about my comments and whether they were helpful or "good enough."

Please describe what you specifically liked about the training? What was the most helpful? Were there some things you learned?

I really enjoyed learning from David's stories. Thank you for sharing these personal stories with us.
I had been looking forward to the evening's stories but I didn't know emotional and impactful they would be. I was especially touched by David's & Cai's tears and appreciate how much they both shared. It had to be especially difficult to share over Zoom because sometimes it can sound flat. With most people muted it can be hard to hear the feedback from the audience but the connection still felt very powerful.
I truly appreciate your openness and willingness to show your vulnerable side. Just like many others, I was deeply moved by your heartfelt tears as you shared stories about the woman you believed would succumb to cancer, your beautiful encounter with your wife Sara, and the journey of creating "Uptightness." You didn't have to let us into those deeply intimate and personal experiences, and for that, I am genuinely grateful.
This was absolutely amazing! It couldn't have been more special. Thank you Dr Burns! You are a national treasure and gift to us all. Can't wait for the podcast so that I can re-live it
exposure and being uncomfortable with adult stuff so silly but real for me
I was touched by the depth of emotion David manifested in telling some of the stories, his deep compassion and humility, and the reality of celebration of sadness. I liked feeling closer to David both from his sharing deep feelings and by his telling about life events like how he met Melanie. It was cool to have stories illustrating powerful lessons and even some that illustrate the mundane (e.g. mostly not a lot happened when David spent a week disclosing every feeling).
What a wonderful night. These stories brought that time period alive for me, and having not lived through that era, that was a real treat. The only thing I was surprised about, and a bit sad, was seeing that David appeared to be a little self-conscious or something. David, I hope I can reassure you that even though I was silent and didn't have any questions, you had my full attention. It was like watching a profound and entertaining movie. - Ed W
I really loved hearing about the spiritual connections with others that you had, David. I also loved seeing the photos afterward and you showing us who you were talking about in your stories. What a beautiful, magical time!
Some very interesting and very touching stories. Made me feel closer to the group and gave some insights into the 60s and the development of TEAM CBT
That was beautiful. More and more I'm convinced therapy is art verified by science. This very human tradition of telling stories is so important to our work as therapists/people. I enjoyed this greatly. A two hour work of art I was fortunate enough to have experienced. Thank you, much love.
It was mesmerizing and holy God listening to the stories now I understand how he could have come up with such an amazing Tool
It was lovely to travel back in time and get snap shots of David's live in the 60s. I appreciated the tender moments of sadness and also the spiritual mystical moments. I like David even more knowing that his calling was to council people, and the journey he has taken to become a conventional healer. It is an honor to be part of this training, almost feels like a type of lineage.
I mostly found it just very enjoyable and fun and salacious. But I also liked the tears and the parts about people hiding their suffering and how we all really suffer but often have a hard time showing it. That was beautiful.
Fabulous! How wonderful to learn more about David, learn about his "weird" past and shadow side, and share in his authentic expression of intense feelings. He really opened up and it did make me feel closer to him! The desert story was inspirational to me, and Cai's story as well...I, too, love the book Siddartha. Interesting to learn of the origins of techniques such as Externalization of Voices and Downward Arrow. Really contextualizes it for me. Not to mention bringing the "magic" of California in the 60s back to life. Thank you! Left me yearning for more!
It was a spellbinding evening, and it felt to me like we were right there with you, David, in the desert seeing the multicolored clouds with our tears flowing, or at the psychodrama marathon crying for the woman who was dying, or on in a field with you and lots of naked ladies at the "Uptightness" event. And now it makes so much sense to me how your methods like EoV and the Downward Arrow all grew out of these experiences you shared with us tonight of tapping deeply into that River of Emotions that you talk about. Thank you, David, for sharing this with us!
Seeing David's tears. Love him even more. Learned so much from the stories
I liked this evening very much. I felt very close to you, David, and to the others who shared, and I felt honored to be a part of it. There were so many good stories. I think your story of being in the desert and the woman suddenly giving up drinking might be an example of a powerful prayer-- I know it sounds pretty goofy and I would have thought so too when I was an atheist not long ago, but I've had some experiences that have really led me to believe some seemingly goofy things.

Please describe what you learned in today's group12 responses

It was such a moving & emotional evening filled with incredible stories, some of which seem too wild to be true but you certainly had the pictures to back it up! Even though I'd been working with the pictures they really came to life after hearing the context and learning more about the people in them. Thank you!
It was terrific to hear the origin story of the greatest psychotherapy approach ever developed
the founding go team cbt
I learned it is unnecessary to be uptight except for cinematic purposes.
We are all connected and affect each other on an energetic level <3. Thank you, David!
I need to think about all these things for a bit to say exactly.
In simple words enlightening
It's important to be more raw, more open to others' suffering. But also to have fun, be wild, take chances!
David's amazing stories of his experiences in the 60s.
How David discovered the River of Emotions and how to tap into it.
How being open minded leads to great things including connection to others in kind and loving ways
Too much to say

Thanks for listening today!, David and Rhonda

356: Ask David - Burn Out; When Challenging Thoughts Doesn't Work; and more! Aug 07, 2023

Show notes

Ask David: Burn Out; When Challenging Thoughts Doesn't Work; and more! Featuring Dr. Matthew May In today's podcast, Matt, Rhonda and David discuss four challenging questions from podcast fans like you: 1. Joseph asks if it's okay to take a break when you get "burned out." Below, David expands on this and describes the difference between "healthy" and "unhealthy burnout." 2. Joseph also asks why your feelings might not change when you challenge your negative thought with a positive thought that's 100% true. 3. Dan asks about Step 4 of the Relationship Journal, which is the most difficult and important step in the TEAM interpersonal model—see exactly how you're forcefully causing and reinforcing the very relationship problem you're complaining about. For example, if the person doesn't "listen," you'll see that you're forcing them not to listen. If she or he doesn't open up and express feelings, you'll see that you prevent them from opening up. And if you think your partner doesn't treat you in a loving and respectful way, you'll suddenly see exactly why this is happening—if you have the courage to take look and see: But if fact, this is one of the "Great Deaths" of the "self" in TEAM-CBT, and very few folks are willing to "die" in this way. 4. Finally, Clay asks about EMDR. He's been treated with it without success. David and Matt weigh in with their thoughts about EMDR. This question was not addressed on the podcast, since some practitioners of EMDR might be offended by David and Matt's thinking, but they did describe their thoughts in the show notes below. If you are an EMDR enthusiast, you might prefer NOT to read our comments. Joseph writes: Thanks, David, for sharing so much on the podcasts! I have a couple questions. Personally, I find that when I'm burnt out, I get a lot more anxious automatic thoughts. While it's definitely good to combat these distorted thoughts by replacing them with realistic ones, my takeaway is that it's also sometimes wise to change our lives / circumstances (e.g. to take a break). By the way, I also wanted to ask if you've ever faced a situation where you are convinced that a thought is distorted and irrational (and you know what the realistic thought is), but you still can't shake it off? I sometimes get stuck when I already know the "right answer" (ie. what the realistic thoughts are based on the methods you've taught), but I just can't seem to get my brain to fully believe it. For example, I was recently on vacation and a small blip made me think "my vacation is ruined!". I immediately identified it as all-or-nothing thinking, and replaced it with "my vacation is still going very well even if it's not perfect" (and I'm convinced this thought is true), but somehow my mind kept going back to the automatic thought again and again. Curious if you've ever experienced this. Thanks again so much for your time and your teaching; just wanted to say I really appreciate it! :) Regards Joseph David's Reply to Joseph. Thanks for the great questions. We address both of them on an upcoming podcast. Here's the quick response. Yes, it is okay to take a break when you feel "burned out." However, you can get "burned out" in a healthy or unhealthy way. For example, after I edit for two or three hours, which I love, my brain gets "burned out." So I take a break and come back later, maybe even a day later, and I feel refreshed and filled with enthusiasm about writing and editing some more, because I love these activities. When I was in private practice in Philadelphia, I saw 17 patients back to back on Wednesdays. That way, I could have a three day weekend. Actually, I loved it and as the day went on, I got higher and higher. At the end I was exhausted, but exhilarated. I was never "burned out" because I loved what I was doing, and the clinical work was SO rewarding! However, sometimes I made a mistake and a patient would get very upset, sometimes angry with me, or felt hurt. THAT was when I got suddenly burned out and exhausted. But it wasn't because of my work, or the conflict, but rather my thoughts about it, which generally involved a combination of self criticism and frustration with the patient, both the result of distorted thoughts, generally Self-Directed and Other-Directed Should Statements. And THAT kind of "burned out" won't improve with a break. The answer is challenging and changing your own inner dialogue, as well as your dialogue with the other person, using the "failure" in the relationship as an opportunity to listen and support and create a deeper and more meaningful relationship. With regard to your second excellent question, we explored that in depth in the podcast, and also made it a problem for our listeners to think about. So tune in for the answers! This is a popular question I've been answering for more than 40 years, and the answers tell us a great deal about how cognitive therapy actually works. Thanks so much, Joseph! Subject: Relationship Journal Gem I Found Dan (a former participant in David and Jill's Tuesday training group at Stanford) writes: Hello to the Dynamic Duo (David and Jill), I came across this doc for Step 4 of the Relationship Journal, but I don't really understand it and I don't remember the context. I know it was from the Tuesday Group years ago. It says it's about conceptualizing the problem, just not sure how to utilize this in step 4. Thanks. (You will find this document in the show notes below.) ~Dan (Daniel C. Linehan, MSW, LCSW) David's Reply Hi Dan, Great question. In this document, I am trying to make it a bit easier for folks to see how they are triggering the very problem they are complaining about. So, I have listed three categories of common complaints. For example, an Empathy complaint would be that "My partner doesn't listen," or "always has to be right." Then you ask, "If I wanted to force my partner to behave like this, how could I so?" Well, one good way would be to interrupt when your partner is trying to talk, or argue and insist your partner is wrong when they're trying to make a point, and so forth. This would force your partner to argue and insist that they are right! It is pretty basic and obvious. But most human beings don't "get it," and in part that's because a great many don't want to. Blaming the other person seems way more popular than looking at your own role in the problem these days. Good to hear from you on this important topic! People can usually "see" how step 3 of the Relationship Journal works—you simply examine what you wrote down in Step 2, and you can almost always see no E (Empathy), no A (assertively sharing your feelings with "I Feel" Statements, and no R (conveying respect or liking to the other person, even when you're angry.) But most people don't seem to have the natural mental aptitude or the stomach for Step 4, where you go beyond Step 3 and explain EXACTLY how you FORCE the other person to behave in the exact way you're complaining about. The document in the link is an attempt to help people with Step 4—IF you are willing to examine your own role in the problem. In Step 4, you ask yourself what category you see the other person in, and there are three choices to make it fairly simple. You might feel that they don't listen or try to see your point of view. This would be an E = no Empathy complaint. Or you might feel like they can't, or won't, share their feelings. Instead, they might just keep arguing, or they might refuse to open up. This would be an A = no Assertiveness complaint. Or, you might complaint that they don't treat you with warmth, love, or respect. That would be an R = no Respect complaint. This makes it much easier to "see" how your response to the other person in Step 2 actually causes and reinforces the exact behavior you're complaining about. Lots of people get defensive or annoyed at this step of the RJ, and refuse to continue! That's because Step 4 is all about the third "Great Death" of the "self," or "ego," in TEAM-CBT. Most of us don't want to "die" in this way. It can feel humiliating, or shameful, to pinpoint your own role in the problem. But, there's usually a big reward—you're suddenly "reborn" into a far more loving and satisfying relationship. In the podcast, brave and wonderful Rhonda provided David and Matt with an example when she was visiting her son and daughter in law in Germany last month to help out with their twin baby girls. This example really brings this "Great Death" to life, and we are grateful to Rhonda for helping us in this very vulnerable and real way! Feel free to ask again if I have not made it clear. To me, this phenomenon of causing the very problems we are complaining about in our relationships with others is incredibly fascinating. However, change involves the "death of the self," which is painful, because you have to see, usually for the first time, your own role in the problem you're complaining about. It is based on the Buddhist idea that we create our own interpersonal reality at every moment of every day. In other words, we CREATE our enemies, and then whine and complaint about it! Most people don't want to see this! They want the therapist (or friend they're confiding to) to agree that the other person REALLY IS a jerk, or to blame, or whatever. They just want to complain and blame and feel superior! In my book, Feeling Good Together, I think I said something to the effect that we "want to do our dirty work in the dark." In other words, we don't want to turn the lights on so we can "see" how we're actually causing the conflict. The person asking for help can nearly always be shown to be the 100% cause of the conflict. This technique is one I recommend when working with an individual, and not a couple. Other less confrontational techniques are probably more effective when you are working with both partners at the same time. Warmly, david (David D. Burns, MD) Here's the document: Conceptualizing the Patient's Complaint in Step 4 of the Relationship Journal (RJ) By David D. Burns, MD* Problem Area Specific Complaint—S/he Complaints about the other person's lack of E = Empathy Won't listen Does not understand me Always has to be right Always criticizes me Constantly complains and ignores my advice Constantly brags and talks about himself / herself Doesn't value my thinking or ideas. Is defensive and argumentative Doesn't care about my feelings. Complaints about the other person's lack of A = Assertiveness Cannot (or will not) express his or her feelings Cannot deal with negative feelings Expects me to read his or her mind Clams up and refuses to talk to me Won't be honest with me pouts and slams doors, insisting s/he isn't mad! won't tell me how she / he is feeling. isn't honest with me. suddenly explodes for no reason, out of the blue. Complaints about the other person's lack of R = Respect Always has to get his or her way Is stubborn Is controlling Does all the taking, while I do all the giving Uses me Puts me down Is judgmental Does not care about me or respect me Only cares about is himself / herself Constantly complains and ignores my advice. Explanation. When you are using the Relationship Journal, you will usually have a complaint about the other person. For example, you may complain that she or he "never listens," or "is always si critical," or "constantly complains but never listen to my advice." If you write down one thing the other person said in Step 1 of the RJ, and exactly what you said in Step 2, you can usually easily analyze your response with the EAR Checklist. That shows what you did wrong, and why your response was ineffective. You can also use the Bad Communication Checklist to pinpoint your communication errors, and some people prefer this format. In Step 4, you go spell out precisely why your response will FORCE the other person to keep doing the exact thing you're complaining about. One easy way to conceptualize the nature of your complaint about the other person is with our convenient EAR algorithm. This document can help you "see" the problem you're complaining about when you do Step 4 of the RJ. That makes it much easier to discover exactly how you are triggering and reinforces the exact problem you're complaining about. LMK what you think! Clay writes: Hello David, I know you no longer practice, but could I please get an opinion from you on EMDR? So far I have done about six sessions of EMDR and I feel worse than when I began. Does one typically feel worse before one feels better with EMDR? I know you are for Team CBT, and I think it has a lot of merit and science behind it! It just seems a little magical to me that by alternately tapping that I am going to resolve traumas or anxiety issues that happened a long time ago and maybe even recently, but I am going into it with an open mind and the possibilities. Best to you and your family, David, and thank you for the revolution in cognitive therapy you started with Aaron Beck and Albert Ellis! Kind regards, Clay Wilson Hi Clay, I've never been an EMDR enthusiast. To me, it's just cognitive exposure, which definitely can have value in anxiety, coupled with "eye jiggling." Many of it's proponents seem to think that they have found the holy grail, and I have no doubt that a few will slam me for me non-supportive response! And please remember that I'm a cynic, so take it with a grain of salt. In TEAM, we use more than a hundred M = Methods, and only after doing the T, E, A steps, which are absolutely crucial to success in most cases. Best, david PS I'm copying Rhonda and Matt. If we used your question on an Ask David, would you be open to that, with or without your correct first name? Happy to disguise your name. David D. Burns, MD Dear David, I greatly value your ideas and that you are a cynic. In 6 sessions of the EMDR, I have not felt any better. You are absolutely free to use my name and you don't need to disguise it at all. I live in Columbus, Montana and as far as I know, there is only one person in Bozeman who does Team CBT. I sent her an email but didn't hear back but it's 100 miles from us anyway. Thank you very, very much for your view on EMDR! I was thinking something similar myself. All the very best to you and your family! Most Sincerely, Clay David's Response HI Clay, You're welcome. My website is full of free resources, anxiety class, depression class, more than 300 TEAM podcasts, and more. My book, When Panic Attacks, is pretty cheap in paperback. Also, beta testing of thee Feeling Good App is still free. T = Testing, E = Empathy, A = Addressing Resistance, and M = Methods (more than 100.) A is likely the most important step! Thanks, best, david Matt's Response Hi Dan and David, My guess is that EMDR showed some early results due to the tendency of most therapists to avoid exposure techniques and try to 'smooth over' anxious thinking and trauma, rather than just dive in and explore it, fearlessly. I suspect this created a large cohort of anxious and traumatized patients, waiting in the wings, for such treatment, so it showed immediate favorable data. However, this method is only one of dozens, and the setup is key. Why would you want to overcome something traumatic?…

Full show notes at the publisher

355: Relationship Problems - Be Gone! Featuring Dr. Matthew May Jul 31, 2023

Show notes

355: Relationship Problems: Be Gone! Featuring Dr. Matthew May In today's podcast, Matt, Rhonda and David discuss relationship problems, and how to overcome them. We also give instructions on the Paradoxical Invitation, one of the most important and difficult techniques for TEAM-CBT therapists to learn. We started today's podcast interviewing Tania Ahern and Andy Persson who give a plug for the upcoming TEAM-CBT intensive from August 14 to 17, 2023 in Bristol, and incredible British city with an outstanding TEAM-CBT training program in store for you. Many notable TEAM experts will be presenting, including Drs. Leigh Harrington, Heather Clague, Marius Wirga, Stirling Moorey, Mike Christensen and many other notable teachers. Special thanks to Peter Spurrier for being a fantastic TEAM therapist and organizer! I will also be there virtually doing a keynote address, a Q and A session, and a live TEAM-CBT demo with a workshop volunteer. The amazing Mike Christensen will be my co-therapist. Hope to see you there! Go to TEAMCBT.UK for registration and more information. Today we focus on relationship problems, starting with a real example, which often makes for the best teaching. Rhonda recently spent time with her son and daughter-in-law to help with their new twin babies. Rhonda's daughter-in-law had a very difficult delivery, and was in the hospital for several weeks following the birth of the babies. Rhonda worked relentlessly cooking and cleaning for them, feeding the babies, changing their diapers, and comforting them, and providing help for the new mom, who was overwhelmed and fearful of bathing the babies, thinking she might hurt them when attempting to bathe them. As so often happens in real life, Rhonda ran into a severe conflict with her daughter-in-law and responded with anger, and we all so often do. She reveals how terrible she and her daughter-in-law felt, and how she saved the day after deciding to have a "redo" of the interaction, using the Five Secrets of Effective Communication. Rhonda, Matt and David described one of the most difficult therapy tools in TEAM-CBT, the Paradoxical Invitation Step, and contrasted it with the Straightforward Invitation. Rhonda also mentioned some podcasts for further information on the Relationship Journal and the Interpersonal Model in TEAM-CBT. There are even more, but here are some that might interest you. My book, Feeling Good Together, is also a must-read for anyone wanting to make profound changes in the way you connect with the people you love, as well as your patients if you're a shrink! # Podcast Title Min 054 Interpersonal Model (Part 1) — "And It's All Your Fault!" Healing Troubled Relationships 54 055 Interpersonal Model (Part 2) — "And It's All Your Fault!" Three Basic Assumptions 27 056 Interpersonal Model (Part 3) — "And It's All Your Fault!" Interpersonal Decision-Making and Blame Cost-Benefit Analysis 46 057 Interpersonal Model (Part 4) — "And It's All Your Fault!" The Relationship Journal 44 226 The "Great Death" in a Corporate / Institutional Setting 56 227 Echoes of Enlightenment 43

We finished today's podcast with some entertaining role-playing exercises, using the Five Secrets of Effective Communication in interactions with extremely difficult individuals. This gave me the chance to role-play some incredibly obnoxious and practically impossible to please. My favorite role! Enjoy! Warmly, Rhonda, Matt, and David

354: The Explosion of FREE Help! Jul 24, 2023

Show notes

Grass Roots TEAM-CBT Completely FREE Practice / Training Groups Today we interview four courageous pioneers of free and low-cost TEAM-CBT for the masses, featuring Brandon Vance, MD, Patricia O'Neil, Ana Teresa Silva, DVM and Nicholas Santascoy, PhD. Many of you are already familiar with Brandon Vance and Heather Clague's awesome online Feeling Great Book Clubs which will start again, running from September 13, 2023, through December 6, 2023. The book clubs are popular and have gotten wonderful reviews. They are a fun and engaging way to structure your reading, discuss the book, see demonstrations, practice tools, ask experts questions and connect with others around the world who are working on Feeling Great – and no one is turned away for lack of funds. Sound interesting? You can learn more and join here. But you may not be aware of a growing number of fantastic totally free self-help groups springing up for people around the world. These groups offer training in different aspects of TEAM-CBT. For example, Patricia offers DAILY (!) practice sessions that focus on the use of the Daily Mood Journal. You can also join

free 5-secrets practice groups
groups that focus on changing habits
groups that practice a variety of TEAM tools
a book club focused on When Panic Attacks
and more!

All these groups are free and open to anyone worldwide. To see the growing list, go to https://www.feelinggreattherapycenter.com/free. This list is invaluable, and check the link from time to time because the offerings will likely continue to expand. Keep in mind that these are NOT therapy groups, but layperson-led self-improvement groups. Brandon and Rhonda remarked that these free groups are part of a heart-warming movement which continues the culture of generosity that David has created, starting with David's decades-long free weekly training groups for mental health professionals. The new self-help groups also carry the spirit of relating to others with deep empathy. The goal is to create an atmosphere of giving and support in mutual healing. A second goals is to learn to appreciate each other despite our differences. And so, the ripples that David has created continue to spread, and you can become a part of this process! Nicholas Santascoy is a research psychologist, academic coach and learning specialist who discovered Feeling Good in 2005. He found it tremendously helpful and years later, began working with a TEAM therapist who suggested Brandon's Book Club. When the book club reached the Daily Mood Journal section, he asked if he could start a free DMJ practice group, which he did, and it's still going on each week, more than two years later. He was thoughtful about the group's structure, making it clear to the participants from the beginning that he is NOT a therapist and that this is not therapy. It is simply a place to practice TEAM with support – an important disclaimer for any non-therapist running a practice group. In his groups, each person spends 10 minutes at the start working on some common task, like describing an upsetting event for a Daily Mood Log, or suggesting positive reframing for a negative thought or feelings, and so forth. Or they might go through a sequence starting with one negative emotion, one negative thought, one cognitive distortion, one positive reframe, and one positive thought. His group has also worked with the exercises described in the two free chapters on habits and addictions offered at the bottom of Dr. Burns' website. Nicholas described working with a man with intense performance anxiety who had an upcoming job interview with a panel of eight individuals who were evaluating him. He was intimidated and anxious, but reluctant to give up his anxiety for a number of reasons. First, he was convinced that if he didn't worry, he wouldn't prepare effectively. In addition, he was convinced that he needed anxiety to do his best during the interview. Nicholas encouraged him to test these beliefs with experiments. He discovered, much to his surprise, that he was still strongly motivated to prepare for the interview when he was feeling relaxed and confident. He also recorded his interview and reviewed it afterwards. He was surprised to discover that his best performance during the interview was when his anxiety had dropped to zero. Ana Teresa Silva is a Portuguese veterinary doctor who decided she wanted to work with people and became a coach in 2020. Ana Teresa developed a free Portuguese Five Secrets practice group in May of 2021. This quickly became an international group in English, free and open to anyone, and ran for two years and got rave reviews from participants. After that, she handed over the leadership to Linda Roth, M.Ed. This kind of group, in my (David's) opinion is incredibly important because learning the Five Secrets is a lot like learning to play the piano. It's possible to make beautiful music, but the Five Secrets are challenging to learn. Practice, combined with humility and the intense desire to learn, are the keys to learning and personal change. Patricia O'Neil, a former schoolteacher, loves David's books like Feeling Great, When Panic Attacks, Feeling Good Together and more. Patricia experienced a very severe, prolonged and immobilizing depression, and tried ALL of the standard medical treatments, even including electroconvulsive therapy, but her depression continued. She then started reading Feeling Great and joined Brandon and Heather's Feeling Great Book Club in 2022, and began to pull herself out of depression. After several weeks she asked if there was a group for people who want to work their way through the book together in-between Book Club meetings, perhaps even daily, to "apply the strategies the best we can." Brandon encouraged Patricia to start her own study group. She did! And not only that, she started many other groups as well – all completely free - including a When Panic Attacks Book Club, her daily Daily Mood Journal group, an eating healthy accountability chart, a coaches in training group and her own free advanced Five Secrets Practice group for people who have completed a Five Secrets Deep Dive series. Several of the participants in today's podcast had anxiety about being on the podcast. Patricia generously volunteered some of her negative thoughts, including:

I might not do well. I'm gonna mess up!
Brandon might regret asking me to join the group today.
My flaws and imperfections will be on display.

She said that these thoughts contained many of the familiar cognitive distortions, such as Fortune Telling, Magnification, and Should Statements, to name just a few. She also described some of the strategies she used to challenge these thoughts, including these positive thoughts:

The whole future of the world doesn't depend on how well I do today!
I probably WILL mess up, and that's okay!

Then she bravely and tearfully described her own battles with depression since her retirement several years ago, and her gratitude at having found so many skills to deal with negative mood swings more effectively. Her comments were touching and inspiring, and actually embodied the goal of the practice groups that are rapidly emerging. The goals including:

provide a structure for free ongoing practice and learning
give individuals around the world the chance to join the emerging community of TEAM enthusiasts
provide opportunities to connect with others in the spirit of openness, acceptance, and compassion.

Most humans are hungry, even desperate, for love, learning, and relief of suffering, along with a connection with others who also care. Brandon and his many fans and colleagues are transforming this idealistic vision into a practical reality. At the end of this moving interview, Brandon mentioned a number of additional groups that are rapidly forming including two Signal text groups created by Derek Gurney. "Mission Accomplished or Refused," is a place to "report on plans to tackle aversive tasks" and take accountability – which is an effective tool for changing habits. He has also created an "Exposure Celebration" class, which sounds like a terrific chance to do exposure with the support and reinforcement from others. This is something tremendously helpful for people struggle with all types of anxiety. Again, please click here to see more information about these wonderful and completely free Grassroots TEAM CBT groups! And if YOU have a free TEAM practice group you'd like to start or have started and want to add to the list, please email Brandon Vance, MD (brandonvance@gmail.com). In fact, I've always dreamed of free self-help groups for mood problems, with much the same spirit of lay healing you find in Alcoholics Anonymous. And now, in my old age, it is tremendously encouraging to see this happening. I have to pinch myself, in fact! Thanks, Brandon, Nicholas, Ana Teresa, and Patricia! Warmly, David and Rhonda

353: The Inner Scoop on "No" Practice! Jul 17, 2023

Show notes

353: The Inner Scoop on "No" Practice! The "Inner" and "Outer" Dialogues— The "Inner" and "Outer" Solutions As you know, I have created many powerful communication techniques, including the Five Secrets of Effective Communication and more. One of the additional techniques is called "No" Practice, and it's designed for people who have trouble saying "no," or setting limits with other people. Essentially, you do a role-play with a colleague or therapist who keeps pestering you with pushy demands, and you have to practice saying "No" in a polite but firm and assertive way. Sounds simple, right? But it's not! People have many reasons for not wanting to say "No." For example, you may be afraid of hurting the other person's feelings, or letting them down, or running the risk that they may get mad at you if you don't say, "Yes." In addition, you may feel like you'll miss out on some special activity if you say no, so you end up way over-committed. In this session, you will meet an exceptionally compassionate and highly trained young psychiatrist named Lee, who asked for help with a problem relating to some of his patients. My co-therapist is Dr. Jill Levitt, who is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California. Lee explained how he struggles with saying "no" when patients make inappropriate requests, like pushing for a medication they're addicted to, and wanting premature discharge from the inpatient unit when they have unrecognized safety issues. Instead, he seems to get drawn into long explanations of his thinking and why he's declining the other person's requests, sometimes for half an hour, and ends up frustrated when the other person still doesn't "get it" and with himself for spending the time. People often think that therapy is easy, and that people just need encouragement, advice, or behavioral practice to change the way we interact with others. But as you will vividly see in this session, that is often not the case, and things that may seem simple or obvious can seem almost impossibly difficult to learn. Why does this happen? Why is it so difficult for people to learn new and seemingly simple verbal skills? Well, to find the answer, we have to go back to the teachings of the Buddha and Epictetus, who taught us that our negative feelings do NOT result from what's happening, but from our thoughts. What does this mean? Well, Lee is an incredibly intelligent and compassionate young psychiatrist, and he's clearly highly motivated, and yet he seems very slow in learning how to say "no." Can his thoughts illuminate his apparent resistance to learning a new approach? During the session, Dr. Levitt reminded us of the fact that whenever you are involved in a conflict with someone, or any interaction for that matter, there are always two dialogues going on: the Inner and Outer Dialogues, and if you ignore either one of them, you may have difficulties triggering change. The Outer Dialogue involves what you say to the other person, and what they say next, and how you respond. For example, Patient says: "Doctor, I want to get discharged from the hospital." Lee says: "No, I can't do that because you'd be in danger and without a place to live. You'd be living on the streets, and it wouldn't be safe for you." Patient (who is in a state of psychosis) responds: "No doctor, I'll be okay, because I'm living with Michael Jackson." Then Lee tries to explain his thinking again, and then the patient asks to be discharged from the hospital again. And this cycle repeats itself many times, over and over, for as much as an hour. And they both end up frustrated and a bit miffed. Why is it so hard for Lee to say no in a kindly way and then move on to some other activity? That's where the Inner Dialogue can be so important. It appears that Lee has two types of distortions that interfere with his ability / willingness to say "no." Self-Directed Should Statements. Lee appears to believe that he "should" be able to explain his thinking to any patient. He wants to convey respect, responsiveness, and care when denying a request. This is, of course, an expression of his high standards, his compassion, and his desire to communicate clearly to his patients. But, as is so often the case, Lee takes this goal a little to far, think he should "always" be able to do this, regardless of how psychotic or confused or demanding a patient might be. Essentially, the healthy pursuit of excellence as a psychiatrist has gone a little too far and has arguably morphed into a self-defeating kind of medical perfectionism. Self-Directed Shoulds typically trigger feelings of guilt, shame, anxiety, and inadequacy. They are often accompanied by several other distortions, including All-or-Nothing Thinking, Mind-Reading, and Self-Blame, to name just a few. Other-Directed Should Statements. Lee appears to think that his patients "should" understand and acknowledge his thinking if he's being reasonable and realistic. He may also believe that if he's doing his best, then his patients "should" argue fairly and acknowledge when they understand what he tells them and "shouldn't" be manipulative, unreasonable or argumentative. Other-Directed Shoulds often trigger feelings of frustration and anger, and are often associated with All-or-Nothing Thinking, Mind-Reading, Emotional Reasoning, and Other-Blame, to name just a few. Another teaching point is that we nearly always create our own interpersonal reality, but we don't realize that because we feel like victims and see the problem as coming from outside of ourselves. Lee's urge to continue to try to "win" the arguments with patients actually forces them to keep arguing their case and trying over and over again to get their way. That's just human nature. We've all seen that people can be pretty obstinate and determined to get their way, no matter what. That's why a focus on what you can do to change will often lead to a change in other people; in contrast, repeated efforts to persuade them to change is almost never effective. By way of analogy, my wife and I have recently had a bit of a problem with our cat, SweetiePie. She was a rescue cat, and we love her to death, and do everything we can to make her happy. She loves us intensely and shows her gratitude with loud purring almost all day long when she's not asleep or out in the back yard exploring. BUT, she has been pestering us for cat candy, and has gained too much weight. Here's what happens. She jumps up on my desk, and puts her paw on my keyboard, and stands if front of the computer terminal so I can't see. So, I give her two or three pieces of cat candy on her perch next to me. She jumps up and greedily devours it. Next, she jumps back on the desk and puts her paw on the keyboard. I "explain" to her that she's eating too much candy, and try to put her back on her perch, so she swats me with her claws and draws blood if I'm not quick to pull my hand away. So, I give her a few more pieces of candy, which she devours and then goes to sleep. Similar routine with my wife. She follows her, crying like she's on the verge of death, and swatting at her ankles until she gets cat candy and / or a 30 minute lap snuggle. So, in short, we have been "forcing" her, inadvertently, out of love, to manipulate us for cat candy. In other words, we "reward" her manipulations by giving her cat candy and love. As a result, our pour girl is gaining too much weight. Of course, the solution is simple. Melanie has agreed to give her only four pieces of cat candy per day, and I am limiting her to two pieces, just so she'll know she's still loved. And when she tries to swat me with her claws, I just explain in a kindly way that I don't like that and put her on the floor. She caught on right away and seems to have accepted the new routine. Of course, we continue to give her abundant helpings of love every day, many times a day, as the love has zero calories! So, what's the bottom line? If you're trying to learn the Five Secrets of Effective Communication, and you want to change the way you communicate with others, remember to attend to your Inner Dialogue, as well as what you are actually saying to the other person during the conflict, especially if you're getting anxious, defensive, angry, frustrated or upset. If you write down your negative thoughts, I think you'll find many similar distortions to the ones described above, and this can give you another handle on change the way you think, feel, and connect with the people you care about, as well as the ones you don't! Incidentally, the belief that we are separate from others and from our environment is the essence of evil, according to some Buddhists, and perhaps nearly all of the world's religions have had similar beliefs, though couched in different language. But what this means to me is that when we struggle with friends of loved ones, and we are locked into frustrating conflicts, we typically feel like we are "separate" from the other person who is "doing something" to us. And this perception can not only trigger anger and frustration, but sometimes even violence. As humans, we seem to have great difficulty "seeing" our own role in the conflict. And sometimes, we don't even WANT to, because the so-called "Great Death" of the self can be very painful. This is especially true when we see ourselves as morally superior to the other person who is "bad" or "to blame." We are indebted to Lee for giving us this superb example of a problem that nearly all human beings struggle with, and also sharing his vulnerability and humanness with all of us in such an open and generous way! And we salute and thank Lee for courageously showing us the way with an intensely personal and real example. Contact info Dr. Rhonda Barovsky practices in Walnut Creek and Berkeley, California. She can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 5 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. You can reach Dr. Burns at david@feelinggood.com. You can reach Jill Levitt, Ph.D. at jilllevitt@feelinggoodinstitute.com. She is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California (www.feelinggoodinstitute.com) You can reach Lee at bananaquitting@gmail.com Group Feedback The following are a few of the comments in the feedback at the end of the Tuesday class. These are comments from the mental health professionals who observed the session with Lee. Please describe what you specifically disliked about the training? What could have been improved? Were there some things you disagreed with or did not understand? LOVED it! NOTHING Can't think of anything I only wish that we could have more time for this work with Lee. I kept feeling like I wanted to jump in and try some of these skills myself. Please describe what you specifically liked about the training? What was the most helpful? Were there some things you learned? I liked the externalization of resistance and would've like to see more with that or maybe even a "rules & roles" regarding patient/doctor relationships. I really liked Lee's work. I also struggle with saying no, and I liked all of the role reversals and honest feedback from everyone involved. I found Jill's insight at the end of the session regarding the conceptualization of the problem, particularly the internal versus external solution (during the "no" practice), to be quite valuable. It was clear that Lee was facing conflicting desires - the need to act in the best interests of his clients while also seeking acceptance and approval. Taking the time to delve deeper into those internal factors may have further strengthened the effectiveness of the external solution (the "no" practice). Was helpful to see the miracle cure/goal clarified, as well as the 'acid test'. Good to see the model in action! I just enjoyed Lee's honesty , caring and professionalism. He brought up an issue that has been close to my heart as I worked with schizophrenic patients in clinic and day hospitalization settings and have experienced EXACTELY what Lee described. You feel between the devil and the deep blue sea when the medical staff conveniently toss responsibility to the less professional staff and when those in the trenches need to be there for the patients by saying NO. I LOVED David's comment about being disrespectful to patients with schizophrenia by going on and on with lofty brainy arguments while the loving thing to do is to be empathic stroking and firm. From my experience when I am real with my patients, they feel the best. Thank you, Lee, David and Jill. This was beautiful , heartwarming, and I am so touched to belong in this group. David and Jill's exquisite empathy, the Positive Reframe, and the NO practice. EVERYTHING!!! This was truly incredible! David and Jill are an unbeatable tag "TEAM!" Jill's warmth and empathy and teasing out the variables of Lee's story that were not always apparently obvious. Lee's vulnerability and seeing his depth and caring as a Psychiatrist was heartening and impressive. It helped me understand the flow of TEAM CBT and how things fit together better by seeing a live session from the beginning. I LOVED that Dr. Burns and Jill had to go down several different avenues to see what would work best. This closely reflects my own experience of therapy with my patients. Seeing them struggle a little made me feel even more sure that TEAM is the only approach that makes sense and cures people. This was a really wonderful session. I appreciate Lee volunteering, sharing with us his work challenges, and allowing us to see his kind and caring personality. I loved the masterful work of Jill and David. It seems to me that practicing responding to his patients with the use of the 5 secrets was imperative and I was amazed to see how that helped dropping down the feelings on the DML before we got to work on the Negative Thoughts. Once again, TEAM works like a charm! That this was a powerful real life issue that Lee shared. I enjoyed the empathy and how that led to sorting out conceptualization and miracle cure. David and Jill's combined efforts to go in many directions to help Lee see where he is stuck. I struggle in exactly the way Lee does in these sorts of situations, and it was so helpful and inspiring to me to see him do this work. Thank you, Lee! I was deeply moved by your deep caring for your patients and values around wanting your patients to have agency and understanding when there's so little in their world that they can control. I wish every psychiatrist had more Lee in him/her/them! I appreciate that Lee opened up himself in the group and I could observe the personal work of David and Jill, the amazing masters of TEAM-CBT. I admire Lee's compassion and warm heart toward his patients and I owed a lot to Lee who has very high standards to make things clear, just as he has done in his teaching in our Newbie group. And I think his sadness and anger might be an expression of his passion toward justice and dignity of his hospitalized patients. Appreciated Lee sharing with the group and doing personal work on a challenging problem. Liked when Jill brought up the internal versus external solution and then the session switched gea…

Full show notes at the publisher

352: Ask David: Marijuana, Anger, Ultra-Short Sessions, and more Jul 10, 2023

Show notes

Featuring Dr. Matthew May In today's podcast, Matt, Rhonda and David discuss four challenging questions from podcast fans like you: 1. what do you do with patients who use marijuana excessively but have no interest in changing or reducing their use? 2. How do you help clients control their anger? 3. How can you use TEAM if you are only allowed to see clients for 15 to 20 minutes? 4. If David never went into the medical / mental health field, what career path do you think you would have chosen? The answers on the show are live and will differ considerably from the information below, which is primarily to document the full questions that the fans submitted.

1. When a client expresses concerns in multiple areas of their life, such as mood, relationships, and habits, is there a particular hierarchy that you follow? In particular, what do you do with patients who use marijuana excessively but have no interest in changing or reducing their use? I'm particularly interested in your perspective on the hesitancy within the therapeutic community to treat individuals with co-occurring depression and anxiety, alongside marijuana habits or addictions that they do not wish to address. How do you approach and navigate this complex situation, and what are your thoughts on effectively addressing the client's mental health concerns while considering the impact of their substance use on the therapeutic process? With the increasing acceptance and use of medical and recreational marijuana, do you believe it is still morally or ethically justifiable to turn away clients who use marijuana and express no desire to quit? It appears to be a prevalent practice, and I would appreciate your insights on this matter. Casey Zeigler Matt: Great Question, Casey! For me it depends on the pattern of usage and reasons for using Marijuana. For example, if someone gets anxious and then uses marijuana to reduce their anxiety, then I'd be unable to help them treat their anxiety if they weren't willing to set marijuana aside, for a while, to practice some new methods. I might ask, 'imagine you could feel calm and relaxed, but didn't need marijuana to accomplish this. What would it be worth to you, to have that ability? For example, would you be willing to go through an uncomfortable period of deprivation and awkwardly failing at methods to reduce your anxiety, in order to get there?" David: in a Harvard study years ago, individuals with benzo addictions were randomly assigned to two withdrawal groups: Klonopin-only slow withdrawal, and Klonopin slow withdrawal plus group (I think) CBT. The success in terms of numbers of patients who successfully withdrew was far greater in the CBT group. Or, if they used Marijuana to avoid feeling depressed, I'd wonder if they would be willing to set that aside temporarily, in order to prove that they could feel great without Marijuana. My approach is to identify what the patient wants and to be realistic about the approach to achieve those results. There's also long-term data showing that daily use of marijuana is associated with worse mental health, in the long-term. David: I think these decisions have to be individualized, and consultation with a colleague when in doubt can be very helpful.2. I have a question about anger. How do you help clients control their anger? 2. How do you help clients control their anger? I was going to mention it to you as a good topic to cover anyway in a podcast, because it is the one emotion that has not particularly been dealt with in the podcast. This is ironic, since anger is apparently the one emotion we don't acknowledge!). I did a search and there were only two that touched on it and neither covered how someone can learn to control their anger. I have had several clients who talk of how they snap at their children or partners and want to learn to deal with it. Does it work to use a daily mood log in these cases, as the emotions are more like explosive reactions, and maybe less easy to defeat with distortion-free positive thoughts? Thanks Andy Perrson Matt: Thanks, Andy! I can help people overcome anger, but they probably don't want the type of help I can offer! David: individuals beta testing the Feeling Good app have shown dramatic and rapid anger reductions. In a group or individual therapy context, I would use TEAM systematically. I do not typically "throw methods" at feelings, problems, diagnoses, etc. I treat humans, finding out what's going on in their lives, conceptualizing the problem, melting away resistance, and choosing methods based on all of that. All that being said, the CBA or Paradoxical CBA are almost always the first techniques with anyone who is angry: vignette about the angry doctor and the angry banker. 3. Do you have any tips to use TEAM skills for very short time session(about 15 to 20 minutes). I am not yet running my private practice. I am employed in other person's private clinic as a psychiatrist and usually prescribe pills and the time per patient is at most 20 minutes. Luci Eunkyoung Yang Matt and Rhonda; This would require a focus on 'homework' outside of session. Happy to discuss. David: Can empathize and refer to groups, app, books for those who want more help. 4. If David never went into the medical / mental health field, what career path do you think you would have chosen? A few guesses, a magician (I believe he referenced in a podcast an affinity for magicians), theatre (Brigadoon story - fear of heights), politician (David sometimes has an opinion on a variety of topics), lawyer (David knows all about black/white thinking, as well as being able to see things in shades of grey), scientist (creator of TEAM-CBT), writer (best selling author) or entrepreneur (what couldn't he create/sell?) Whatever the path, he would have been a leader in that field too for sure and I'm so grateful that he chose ours. Best, Todd

351: Free Master Class on Perfectionism, Part 2 of 2 Jul 03, 2023

Show notes

A Second Visit to David and Jill's Tuesday TEAM Training Group at Stanford Last week, you "sat in" on our Tuesday training group at Stanford and learned about two of the four most important techniques in the treatment of perfectionism, or any other Self-Defeating Belief. (For a list of 23 common Self-Defeating Beliefs, click here.)

The Cost-Benefit Analysis (CBA): You weight the advantages against the disadvantages of trying to be perfect.
The Semantic Technique, to find out how to word your new belief if you decide that your perfectionism belief isn't working for you

The purpose of those two techniques is to provide intellectual change. Tonight, you will join us again as we aim for emotional change at the gut level. This will be our agenda for the students in the class you will observe: 1. Please describe an example of a specific time when you felt upset due to perfectionism. What were your negative thoughts? How were you feeling? What was happening? 2. Downward Arrow Technique: Suppose you weren't perfect, or you failed or screwed up in some way. Why would that be upsetting to you? What would that mean to you. 3. Externalization of Voices (Optional: possibly we will do this, maybe just mention it, depending on time.) 4. Experimental Technique / Examine the Evidence 5. Feared Fantasy 6. Wrap-up and Teaching Points As you can see, some exercises will be performed in the large group, with everyone present and contributing, and some exercises will be in the small, breakout groups. The small groups provide more time for participants to practice. We plan on recording both of the small groups so you can observe the training techniques we use for mental health professionals. Last week our focus was motivational, so we asked: is to your advantage to aim for perfection? How will this mind set help you and how will it hurt you? Tonight, one of the key techniques will focus on TRUTH: is it TRUE that you need to aim for perfection? We will be using the Experimental Technique and / or Examine the Evidence to see if we can answer this question. In addition, we will go into an Alice-in-Wonderland Nightmare World and meet an imaginary monster who claims superiority because she or he really is perfect and really has achieved incredibly more than anyone. This can sometimes help us answer two questions: Is it possible to be or become a "more worthwhile" or "superior" human being? Would it be desirable if you could? I hope you enjoyed this new format of "dropping in" on my Tuesday training group at Stanford. Let Rhonda and me know what you think. It was just an experiment, and we want to know what you might have liked or disliked about it. Thanks! Our free weekly Tuesday and Wednesday training groups are open to therapists of all persuasions from all around the world. For information including the requirements, you can contact:

Tuesday night training group with David and Jill, Contact Ed Walton: EdWalton100@gmail.com
Wednesday mid-day group with Dr. Rhonda Barovsky and Richard Lam, Contact Ana Teresa Silva: ateresasilva6@gmail.com

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