Mon, 27 Feb 2017 06:00:00 +0000
David answers these questions: How do you deal with a patient (or friend) who is boring? How do you deal with a patient (or friend) you don’t like? How do you get patients to do their psychotherapy homework?
- How do you deal with a patient (or friend) who is boring?
- How do you deal with a patient (or friend) you don’t like?
- How do you get patients to do their psychotherapy homework?
Mon, 24 Dec 2018 09:00:00 +0000
This is David and Fabrice's top ten list for the worst errors therapists make.
1. Failure to Measure 2. Trying to help, “save,” “rescue” or “reassure” patients. 3. Reverse Hypnosis.
- Depressive hypnosis. The patient persuades the therapist that s/he really is worthless, inferior, and hopeless, and the therapist false into a trance and believes it! This dooms the therapy.
- Anxiety hypnosis. The patient persuades the therapist that s/he is to fragile to use exposure, or that the exposure is too dangerous, and the therapist buys right into it! This also dooms the therapy. Recovery from anxiety is more or less impossible without exposure.
- Relationship hypnosis. The patient persuades the therapist that s/he is the victim of some other person’s bad behavior, and that the other person is entirely to blame for the relationship conflict. Therapists almost always buy this message, and this also dooms the therapy. 4, Believing therapy must be slow and last a long time. This is taught in most graduate school programs, and tends to function as a self-fulfilling prophecy. 5. Believing that the purpose of therapy is to get in touch with your feelings (Emotional Reasoning).
- I’ve never seen much validity in this point of view. People can express their anger, their panic, and their feelings of worthlessness until the cows come home, but they’ll still be just as angry, panicky, and they’ll still feel worthless!
- There is at least one notable exception to this rule. Most anxious patients are exceptionally “nice” and sweep their feelings under the table. Then the feelings come out indirectly, as OCD, panic attacks, GAD, or a phobia, or even as somatic complaints such as chronic pain, fatigue, or dizziness. Bringing the suppressed feelings to conscious awareness and expressing them is the basis of my Hidden Emotion Technique, and it often leads to a sudden and complete recovery from any form of anxiety.
6. Confusing your own feelings for how the patient feels.
7. Believing therapists should never express their feelings.
How can we validly encourage our patients to be more genuine and open with their feelings if we are hiding our own at the same time? Of course, there is an art form in how to share your feelings during therapy. It is a high skill, requiring training, and one that can lead to more human and effective treatment. 8. Believing that you are an expert and know the causes of things, and why patients think, feel, or behave as they do. There are lots of theories, but none has been confirmed, and almost all have been disproven. I simply tell my patients that we don’t yet know the causes, but have really terrific treatment tools now for rapid recovery. 9. Confusing the process of therapy with a good outcome. Therapists have all kinds of things they’ve been trained to do, like hypnosis, or EMDR, or cognitive therapy, exposure therapy, or meditation, or an exploration of childhood traumas, or whatever it is you do and believe in. But if you’re not seeing rapid and dramatic recovery in your depressed and anxious patients, as documented with session by session testing, you’re not really “helping.” 10. Believing that insight will lead to change. usually, much more will be required. That’s why I have developed 50 methods to help patients change the way they think, feel, and behave. Correction—I have recently developed 51 additional powerful techniques, so now we have 101 ways to untwist your thinking so you can enjoy greater happiness, intimacy, and productivity!
Mon, 20 Aug 2018 08:00:00 +0000
In this podcast, I focus on two things. First, how can the clinician identify and evaluate a new (or old) patient who is struggling with suicidal thoughts and fantasies and determine if the patient is at risk for a suicide attempt? Second, how can the therapist make the patient accountable and guarantee that the patient will not now, or ever, make a suicide attempt? The “defensive psychotherapy” I recommend will sound unfamiliar to many therapists but can save lives and make your practice far more peaceful and rewarding! The approach to the suicidal patient involves Paradoxical Agenda Setting techniques, including the Gentle Ultimatum and Sitting with Open Hands.
Mon, 14 Jan 2019 09:00:00 +0000
1. Failure to hold patients accountable. 2, The “corrective emotional experience.” Warmth, empathy, and trust are necessary ingredients for good therapy, but they are simply not sufficient. 3. Responding defensively to patient criticisms. 4. Joining a school of therapy and treating everything with the same method or approach.
Can you imagine what it would be like if medicine was organized like this, with “schools of therapy,” like the “penicillin school”? David apologetically argues that the abolition of all schools of therapy would be a good thing. Fabrice disagrees, and argues that the treatment of psychological problems is inherently different from the treatment of medical disorders. 5. Confirmation paradox. If I have a theory that predicts the patient’s behavior you may conclude that your theory is correct. But this logic can be very misleading.
Let’s assume that you have a perfectionistic and insecure patient who remembers feeling like s/he wasn’t good enough when growing up. So, you conclude that the patient’s interaction with demanding parents caused the perfectionism and insecurity.
But the perfectionism and insecurity may not have resulted from any childhood experiences or interactions with parents. It may have been strongly influenced by genetic factors, or social / environmental pressures.
- Your theory: Perfectionism and insecurity result from growing up in unloving families that emphasized high standards and achievement rather than unconditional love and nurture.
- Your prediction: Insecure, perfectionistic patients will report childhood experiences with unloving parents who pushed them to work harder, etc.
- Your observation: Your insecure, perfectionistic patients DO describe their parents as demanding and lacking in love and support.
- Your erroneous conclusions: The patient’s childhood experiences caused the perfectionism. 2. The patient will have to “work through” these childhood experiences if s/he wants to overcome the feelings of perfectionism and insecurity.
Mon, 21 Jan 2019 09:00:00 +0000
1. Confusing psychoeducation with psychotherapy.
- Pyschoeducation can be helpful, but it's rarely curative. Effective psychotherapy requires much more.
- Psychotherapy means helping people CHANGE the way they think and feel, or helping people develop more loving and satisfying personal relationships. 2. Belief in Gurus.
- Believing that the individuals who start schools of therapy are nice and well-balanced individuals! David describes conversations with the late Albert Ellis, PhD, who argued that many, and arguably most, are incredibly narcissistic and manipulative.
- David argues that it might be more desirable to have a science-based, data driven, systematic approach to psychotherapy, as opposed to a field dominated by therapeutic schools, which sometimes function almost like competing cults. 3. Reverse / “backward” statistical reasoning.
- Most therapists who work with patients with Borderline Personality Disorder as well as Multiple Personality Disorder, as well as patients who are prone to violence, believe that childhood trauma, deprivation, or abuse is the main cause of these problems. They believe this because patients with those diagnoses frequently describe traumatic experiences in their past, so they assume those experiences caused the patient's disorder.
- This information is not easy for many people to accept. For example, I just found this statement on WebMd:
“As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood (usually before age 9)."
- Here’s another web comment:
“Several studies have shown that a diagnosis of BPD is associated with child abuse and neglect more than any other personality disorders [[7]((https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472954/#CR7), [8]((https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472954/#CR8)], with a range between 30 and 90% in BPD patients [7, 9].” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472954/
- The same source also stated that:
“. . . Widom and collaborators [12] followed 500 children who had suffered physical and sexual abuse and neglect and 396 matched controls, and they observed that . . . the presence of a risk factor, such as adverse childhood events, was not necessary or sufficient to explain the reason why some individuals developed BPD symptoms in adulthood, whereas others did not.”
Here is one way of understanding this error. Childhood sexual abuse is far more common in the population (typically estimated in the range of 15% of men and 25% of women), and if you add childhood trauma or neglect, these percentages increase even more. AT the same time, the incidence of Borderline Personality Disorder or Dissociative Identity Disorder are typically estimated around 1%. That means that most individuals who have experienced childhood sexual abuse, neglect or trauma do not develop these disorders.
My only point, and perhaps it is an overly humble one, is that we simply do not know the causes of most (or any) of the problems listed in the DSM5 (Diagnostic and Statistical Manual of the American Psychiatric Association.) 4. Believing in Mental Disorders.
- Do the so-called Mental Disorders” described in the DSM actually exist? Or are they simply the fabrics of our imagination?
- Years ago, Thomas Szasz, a psychiatrist and psychoanalyst, wrote a popular and controversial book called The Myth of Mental Illness, in which he claimed that mental disorders do not exist. David argues that Szasz was only partially right. Most of what we see in the DSM are simply arbitrary constructs, and not real "disorders."
- The American Psychiatric Association will take the group who worry the most, and give them a label of "Generalized Anxiety Disorder." But there is no such "thing." It is not a real brain disorder. The same problem afflicts a great many of the so-called "disorders" listed in the DSM. These are problems, not brain disorders.
- Most non-MD therapists do not make the mistake of confusing symptoms with "mental disorders." It seems likely to me (David) that psychiatrist are more likely to make this mental error, since psychiatry, as I understand it, is emulating the medical model of diagnosis followed by medication treatment or some other kind of biological intervention. 5. Ignoring a Diagnostic Evaluation.
- The EASY Diagnostic Survey provides a fresh and helpful option. patients can complete it on their own, between sessions, and it automatically diagnoses more than 50 of the most common "disorders" in DSM5. Then the therapist can review it during a session and assign the diagnoses in less than ten minutes in most cases.
Therapists who are interest in purchasing a license to use the EASY in your clinical work can check this link.
Mon, 17 Jun 2019 08:00:00 +0000
Today’s podcast will be an introduction to the use of paradox in TEAM therapy, a kind of overview.
- T = Testing
- E = Empathy
- A = (Paradoxical) Agenda Setting
- M = Methods
In today's podcast, Dr. Rhonda and I will explain why each of these components is inherently paradoxical. For example, when you do the T = Testing, you assess changes in the patient’s symptoms from the start to the end of the session, and the patient rates you on the Empathy and Helpfulness scales as well, When you look at the ratings, you will probably discover that you aren’t helping your patient much, if at all. You may also discover that your perxceptions of how the patient feels, and how the patients feels about you, are off-base, and sometimes alarmingly so.
David D. Burns, MD, Rhonda Barovsky, PsyD and Kyle Jones (PhD candidate)
Mon, 29 Jul 2019 08:00:00 +0000
In today’s podcast, Rhonda and David interview Kyle Jones, a brilliant 5th year PhD student at Palo Alto University. Kyle has been a member of David’s training group at Stanford for the past four years, and now sees patients at the Feeling Good Institute in Mt. View, California. Today’s program is based on Kyle’s doctoral research on the treatment of LGBTQ patients.
Kyle emphasizes that the therapeutic approach is largely the same for gay and straight patients. In TEAM, we first provide strong empathy, so the patient feels understood and accepted. This, of course, is crucial for all patients. Then we set the agenda, asking the patient if she or he wants help, and if so, what is the problem that he or she wants help with?
In TEAM, we do NOT treat disorders, diagnoses, or “types” of patients. We treat humans in a highly individualize way, using the fractal approach described in a previous podcast. In other words, we ask the client to describe one specific moment when he or she was upset and wants help. Then the treatment flows from the exploration of that specific moment, because all the patient’s problems will be encapsulated in how she or he was thinking, feeling, and behaving at that moment. The treatment might then focus on depression, anxiety, a relationship problem, or a habit or addiction.
The message of this podcast turned out to be pretty simple and basic. The key to the effective treatment of all of our patients is acceptance. The therapist needs to accept the patient, and the patient needs to learn to accept himself or herself. In fact, acceptance seems to be the path to recovery and enlightenment for all of us, whether gay or straight!
Mon, 05 Aug 2019 08:00:00 +0000
In today's podcast, Rhonda and I interview the incredibly brilliant, funny, and creative Amy Spector. Amy is a licensed marriage and family therapist and credentialed school counselor with over a decade of experience working with adolescents and their families. She is passionate about providing school-based mental health services and advocates for legislation to mandate universal mental health care for youth.
Amy works with "at risk" teenagers at Vicente High School in Martinez, California. This is a continuation high school, as well as teens at Briones School, an independent study school. Her students are credit deficient and at risk of not graduating from high school. Nearly all have experienced significant trauma and most are severely depressed, anxious and angry when first referred to Amy, and some have suicidal thoughts or urges as well.
Although you might think that this would be an exceptionally challenging, oppositional, and frustrating group to work with, Amy has had tremendous success treating these teenagers with TEAM-CBT.
This is prototypical TEAM, which is difficult for many therapists to learn, because therapists are so used to, and addicted to, "helping." Amy has developed expertise in aligning with the resistance of her students. paradoxically, she ends up on the same page, and this allows some awesome TEAMwork to emerge.
www.gamefulmind.com. VMHS Psychology Club. rapid and profound mental health growth and learning in teens.
Mon, 09 Sep 2019 08:00:00 +0000
You may recall our recent interview with Kyle on his interesting research and perspective on the treatment of LGBTQ individuals several weeks ago.
During today’s interview, Kyle, Rhonda and I focus on many critically important training and treatment issues. Kyle states that he has been exposed to many fine teachers promoting a wide variety of popular treatment “packages” at the Palo Alto University and at his practicum sites, including traditional CBT, ACT, EMDR, psychodynamic therapy, and more.
Paradoxical Agenda Setting, which is the secret spice of TEAM Therapy, was never mentioned in his training at Palo Alto University. When you do Paradoxical Agenda Setting, you bring the patient’s subconscious resistance to conscious awareness, and then you melt it away with a variety of innovative techniques like the Magic Button, Positive Reframing, Magic Dial, Acid Test, Gentle Ultimatum and more. The rapid reduction the patient’s resistance often leads to the high-speed, mind-boggling recoveries we frequently see in TEAM-CBT.
Kyle emphasized that he has not see a single teacher or therapist even use the simple Invitation Step in therapy, in spite of the fact that it is so incredibly basic. Essentially, after empathizing with your patient, you ask if there is something she or he wants help with during the session, or if the patient needs more time to talk and get support. Most therapists wrongly believe that this question is unnecessary since the patient is coming to therapy, so he or she MUST want help.
Kyle also emphasizes the incredible value of the Brief Mood Survey and Evaluation of Therapy Session with every patient at every session, and yet most teachers and therapists in his graduate program, as well as those at his practicum sites, are not using these instruments.
I predict that within ten years, all therapists will be required by licensing agencies and insurers to use these kinds of assessment instruments.
David, Rhonda, and Kyle