Empathy Check: Patient Grades Therapists

Today, we are pleased to present one of our favorite podcast topics—live work with a real human being who is suffering. We will be working with Madeleine, a woman who read a disturbing article while at the hairdresser and freaked out, sensing that one of her daughters might be in mortal danger.

This live and unedited session was first presented as part of a free webinar on September 11, 2025. There was no preparation or role-playing—everything was absolutely real and spontaneous, exactly as it evolved in real time. We present Part 1 as our final Feeling Good Podcast for our 2025 season. This is our most powerful and popular type of podcast, and we hope you enjoy it. We also give a big thanks to our courageous "patient," Madeleine.

My co-therapist will be Dr. Jill Levitt, a clinical psychologist and Director of Training at the Feeling Good Institute in Mountain View, California. Jill and I greatly enjoy working together as co-therapists when we teach and we typically see our "patient" for an extended, two-hour session.

We find that this is the most effective format for teaching, and that way, we can frequently complete a course of therapy in a single session. However, you do not need more than one therapist to do effective TEAM CBT, and you can do it in conventional 50 minute sessions as well. But often, you can do vastly more in a double session.

We will not be engaged in an ongoing therapeutic relationship with Madeleine. When we work with therapists, they are doing personal work as a part of their training. We feel that this experience is vital for every therapist who hopes to do world-class TEAM CBT with their own patients / clients.

More than 2,000 individuals registered for this workshop. Although the workshop was open to everyone, only 13% of the participants identified as general public, while 87% identified as mental health professionals.

In Part 1, which we present today, we focused on T = Testing and E = Empathy phases of the TEAM session.

In Part 2, which you will hear next week, we will focus on A = Paradoxical Agenda Setting and M = Methods. We will also show you the changes in her scores on the Daily Mood Log (DML) and Brief Mood Survey (BMS) from the start to the end of the session, as well as Madeleine's scores on the Evaluation of Therapy Session (EOTS) at the end, including what she liked the most and least about the session. That way, we can see clearly how much improvement there was (or wasn't) during the session, and how Jill and I did in terms of empathy, helpfulness, and other scales that evaluate the patient's view of the session.

In Part 3, which you will hear in two weeks, we did more Externalization of Voices along with Cognitive Exposure, since we had some loose ends we wanted to tie up before completing our work with Madeleine. This follow-up session occurred many weeks after the initial session at the workshop, and will also serve as a follow-up to see how Madeleine did in the days following the live work.

Our "patient," Madeleine, is a courageous woman who experienced sheer panic after being triggered at the hair salon while reading an article about a young woman who was abducted. Since Madeleine's oldest daughter's is away at college, taking a year abroad, Madeleine realized she could not protect her from predators and freaked out, thinking about all the horrible things that could happen to her.

In addition, Madeleine had many self-critical thoughts about ways she thought she had failed her daughter when her daughter was growing up, and worried about her daughter's judgement:

She hasn't always made the best decisions about guys she's gone out with, and she's shared everything with me. She says, 'Don't worry mom. I've learned from this.'"

At the start of the session, we reviewed Madeleine's scores on the Brief Mood Survey (BMS). This indicated only minimal depression (5/20), with no suicidal urges or anger, but her anxiety was still extremely elevated (18/20).

In addition, her Positive Feelings score was only 20 out of 40, with 0 meaning no positive feelings at all, and 40 being the highest possible feelings. However, her Relationship Satisfaction score with her husband was 25 out of 30, which indicates strong satisfaction, with just a little room for improvement.

We will ask Madeleine to complete the BMS again, along with the EOTS, so we can see precisely what changed, and by how much, during the session. Our goal, of course, with TEAM CBT, is nearly always to cause a near-complete, or complete, elimination of symptoms during a single, extended therapy session.

In addition, we want every patient to have a crystal clear understanding of how and why they got upset, along with how to use the tools that were the most helpful to them in the session. That way, they'll be armed to deal with future relapses, which are inevitable for all human beings.

And here's the big point. Our goal in sharing this session with you is so you can feel inspired, and see that rapid recovery really IS possible. And if you're a therapist, we hope that you will feel motivated to learn TEAM CBT so you can significantly improve your outcomes with your own patients.

You can see the Daily Mood Log Madeleine prepared just prior to the session if you

The upsetting situation was reading the article about the young abducted woman in the hair salon. On the Emotions table she indicated that she was feeling sad, down, and unhappy (85%), anxious, frightened and panicky (100%), inadequate (100%), frustrated (90%), and angry and upset (100%). These extremely high ratings tells us that Madeleine's negative feelings were about as intense as a human being can experience.

Although your life is undoubtedly very different from Madeleine's, perhaps you, too, have felt panic and helplessness when you thought the life of a loved one might be in danger.

Madeleine generated several additional negative Thoughts during the empathy phase of the session, including,

6. I'm totally responsible for how she's turned out. 95%
7. I was not present enough for her. 95%
8. She may not trust that I'm there for her. 60%
9. She's anxious and insecure and a people-pleasure, and she's also perfectionistic, and it's all my fault. 75%
10. I should have been more sensitive when she was growing up. I expected too much. 100%

Again, if you're a parent, you may have had similar negative thoughts about your own parenting. I know that I have!

During the Empathy phase, Madeleine described her horrors when reading the article at the hairdresser's, with thoughts of Natalie Hollaway's brutal murder as well as other women who were abducted and murdered.

Madeleine explained that she and her husband both married late, and felt somewhat insecure as parents:

"It wasn't easy having children late in life. . . . When our first baby was born, the milk was not coming down. My daughter would look deep into my eyes, and I had the thought, 'I'm letting my daughter down.'"

She said she had a rough time when she was growing up and her parents got divorced:

"My heart was broken, and I had to learn to be strong. I had to learn not to let so much emotion through. I had to learn how to keep guys at arm's length. I had to protect myself from getting hurt."

She said that wanted her daughters to grow up being strong and independent, but as she reflects back, she thinks she may have failed them and not provided enough warmth and support.

Our goal during E = Empathy is not to help or even try change anything, but simply to go with our patients to the gates of hell, so they can vent, cry, and express their deepest and most private feelings. At the end of the Empathy portion of the session, we asked Madeleine to grade us on the three key elements of empathy, using letter grades:

1. How accurately did we understand how you were thinking?
2. How accurately did we understand how you were feeling inside?
3. To what extent did we convey the spirit of trust, warmth, and acceptance?

She gave us 3 A's, indicating it was time to move on to A = Paradoxical Agenda Setting, which you will hear next week. We will want to find out what Madeleine might want help with. We will also try to melt away her resistance to change using the Miracle Cure Question, the Magic Button, Positive Reframing, and the Magic Dial.

Why would we anticipate resistance? After all, Madeleine is asking for help.

But remember, the desire for change cannot always be take for granted in anyone. Nearly all of us have mixed feelings about change. After all, a loving and concerned mother might NOT want to stop worrying about a beloved daughter who seems to be in grave danger! But if you deal with this resistance in a compassionate way, you may open the door to the possibility of rapid healing when you come to the M = Methods portion of the session.

We can check it out at the exciting conclusion of the work with Madeleine next week!