I Don't Have a Self, I'm Just a Psychiatrist

Today's Ask David features four terrific questions.

1. Kevin asks: Why is the concept of worthwhileness and worthlessness so important to people and their emotional health?
2. Vallejo asks: Does the statement, "WHY AM I ALWAYS THE LAST ONE TO FIND OUT ABOUT ANYTHING?" correspond to overgeneralization, or self-blame? I've been listening to the early podcasts on the ten positive and negative cognitive distortions.
3. David P asks: Do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log?
4. Harvey asks: I don't see how Positive Reframing actually contributes to the therapy.

1. Kevin asks: Why are the concepts of worthwhileness and worthlessness so important to people and their emotional health?

Hi David,

I have a quick question about the concept of being a worthwhile human being. Suppose a person believes they are unconditionally worthwhile, what are the implications of this? Why are the concepts of worthwhileness and worthlessness so important to people and their emotional health?

Best Regards,

Kevin

Hi Kevin,

Thanks! That's a very important question. However, it is abstract and philosophical. I have found that philosophical discussions tend to go on endlessly with resolve. In contrast, when someone asks for help with a specific moment when she or he was upset, then I can usually show that person how to change the way she or he is feeling. And when that happens, the person generally suddenly "sees" the solution to some very profound philosophical or spiritual questions.

All that being said, I'll take a crack at it. The goal of TEAM therapy is not to go from thinking that you're a worthless human being to thinking that you're a worthwhile human being, but to give up these concepts as nonsensical. Specific activities, talents or thoughts can be more or less worthwhile, but a human being cannot be more or less worthwhile. We can judge specific events, actions, and so forth, but not humans. At least I am not aware of how to validly judge a human being, or a group of humans. We can only judge their actions, attitudes, thoughts, and so forth.

Unconditional self-esteem is definitely better than conditional self-esteem, since you don't have to be perfect or a great achiever or a great anything to be "worthwhile," but you are still focused on being "worthwhile."

I'm not sure what that means, but there is a downside, to my way of thinking. If you think you are worthwhile because you are a human being, does that mean that you are more worthwhile than animals? Lots of people abuse animals, hunt animals, and so forth, which many people find immensely disturbing. These are some of the consequences of thinking that animals are less worthwhile, for example.

Not sure that helps, but like your line of questioning!

David

Kevin follows up: What is the implication then of giving up these concepts at all? I assume that thinking that you have unconditional worthwhileness because you are alive or to drop these concepts entirely have the same emotional implications for people. What are these implications? For example, if I think that worthwhileness and worthlessness are meaningless concepts, so what? What's the point? What do I gain?

Hi Kevin,

Let me start by saying, once again, that I am not an evangelist spreading the "gospel," so to speak. My goal is simply to help people who are struggling with feelings of depression, anxiety, and self-doubt. So, if your way of thinking about things is working for you, there's no reason to change.

But my focus is always on someone who is suffering, and that's where these concepts can sometimes be important.

I can tell you what I gained by giving up the idea that I could be, or needed to be "worthwhile" or "special." I gained a great deal of joy. It was a lot like escaping from a mental prison. It freed me to find incredible joy in the "ordinary" events of my daily life. It also freed me from fears of "failure" or not being "good enough."

Depression always results from Overgeneralization--you generalize from failing at something specific to thinking you are a failure as a human being. Without Overgeneralization, I think it is safe to say that it is impossible to be depressed.

For example, if you measure your worthwhileness based on your achievements and success, you may feel excited when you succeed and devastated or anxious when you fail, or when you are in danger of failing. I'm not sure if this addresses your excellent question!

A young woman told herself that she was "unloveable" when she and her boyfriend broke up after two years of going together. Can you see that she thinks she has a "self" that can be "loveable" or "unloveable?" This thought was very disturbing to her, as you might imagine.

Relationships do not break up because someone is "unloveable," but because of specific factors or events that drive people apart. Once you zero in on why the relationship failed, or more correctly, why the two of you broke up, then you can pinpoint the causes and learn and grow so you can make your next relationship even better. There are tons of specific reasons why people break up!

But if you think that you're "unloveable," or tell yourself that the relationship was "a failure," then you may get stuck in a morass of negative feelings. But it's not even true that the relationship was a failure." That's All-or-Nothing Thinking, since all relationships are a mixture of more or less successful aspects. You could even tell yourself that a "failed" relationship was a partial success, since you successfully learned that this isn't the person you're going to spend the rest of your life with.

What's in it for you to give up Overgeneralization and All-or-Nothing Thinking, as well as the concepts of being a "worthwhile" or "worthless" human being? That's a decision each person can make. There are benefits as well as problems with these ways of thinking.

For example, let's say you're depressed and think of yourself as "defective." This is a common negative thought, and it is based on the idea that a human being could be more or less worthwhile, or thinking that your "self" can be judged or rated.

So, you could do two Cost-Benefit Analyses.

1. 1. First, you could list the advantages and disadvantages of thinking of yourself as a "defective" human being. Then balance the advantages against the disadvantages on a 100-point scale, assigning the larger number to the list that seems more important or desirable.
   2. Second, you could list the advantages and disadvantages of thinking of yourself as a human being with defects, and once again balance the list of advantages against the disadvantages on a 100-point scale.

This is just a subtle change in semantics, but the emotional implications can sometimes be pretty powerful.

As I mentioned at the top, philosophical debates are just debates. Fun, perhaps, but not terribly useful.

I'm more interested in magic, or miracles. That's what happens at the moment of profound change, which can ONLY happen by focusing on one specific moment when you felt upset and needed help. When you do that, everything becomes radically different, and real change can occur. And at that magic moment of change, the solutions to all of the problems of philosophy will often suddenly become crystal clear. Or, to put it differently, the philosophical debates will suddenly become, without meaning to sound harsh, almost a waste of previous time.

Our current semi-feral cat loves my wife, but is only starting to trust me, so I've been working at gaining her trust and learning to understand her non-verbal and somewhat complex efforts to communicate. Yesterday she roller over on her back and stretch out her front and back paws to expose her tummy to the max, and she let me pet her tummy for quite a long time, purring loudly the whole time.

I don't care if she's "worthwhile," or if I'm "worthwhile," and have no idea what those terms could even mean. But petting her tummy—now, that's something that's REALLY worthwhile!

david

Hi David,

You and Albert Ellis are my heroes. Without your books, I always wonder what path I would have taken in life! Thank you.

I had a quick question about self-acceptance. One of the reasons I feel that I'm fully unable to embrace it (and I think this is common) is that I'm afraid that I will lose out on motivation to work hard towards my goals. I think this partially true because my conditional self-esteem has caused me to work hard on a lot of things including CBT!

Do you have any good ways to combat this exact notion, that if I accept myself I will simply become complacent and therefore I can't?

Looking forward to Feeling Great!

Best Regards,

Kevin

Hi Kevin,

There's a lot of truth in what you say. Early in my career I also had a tendency to base my self-esteem on my achievements and productivity, both in my research and in my clinical work as well. I did accomplish quite a lot, but things were a bit of a roller coaster. When I thought I was doing well, I felt terrific, but when I thought my research was failing, or when I was stuck with a patient, I got quite anxious and frustrated. These feelings didn't always foster positive outcomes.

Now I no longer feel that my "worthwhileness" as a human being depends on my successes. In fact, I don't even have the concept anymore.

Now, I think my writing skills are very good, especially my skills in explaining complex ideas in fairly simple terms. But I do not think this makes me "more worthwhile." Sometimes my writing, or my interactions with people, or my jogging, and many other things I do aren't very good. But I don't think these problems and flaws make me any less "worthwhile."

Take our little adopted feral cat, Miss Misty, that I mentioned in my last email. Misty does not care how "worthwhile" I am. However, she's totally delighted if I pet her, let her out in the back yard to explore, or give her a piece of cat candy, or if I play with her.

She is enlightened because she judges what I "do," not what I "am."

Will you become less productive or unmotivated when you give up these concepts of "worthwhileness?" That has not been my experience. I am the busiest and most productive now than at any previous time of my life. I'm now 78, and life is a ball. I have tons of fabulous colleagues to collaborate with and we're working on all kinds of super-exciting and challenging projects.

When we don't have "selves" that we need to protect, or feelings of "worthwhileness" that we need to defend, we can listen to criticisms and collaborate without feeling threatened, and use the information to improve what we're doing!

Hope that makes sense!

david

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2. Vallejo asks: Does the statement, "WHY AM I ALWAYS THE LAST ONE TO FIND OUT ABOUT ANYTHING?" correspond to overgeneralization, or personalization cognitive distortion? I've been listening to the early podcasts on the ten positive and negative cognitive distortions.

Hi Vallejo,

Rhetorical questions are technically not considered Negative Thoughts because they contain no distortions. However, this question is actually a Hidden Should Statement, and a great example of Other Blame as well.

You need to change rhetorical questions into statements, like: "It's unfair that I'm always the last one to find out about anything. This shouldn't happen all the time!" And, as you point out, it is also a gigantic Overgeneralization.

Thanks, Vallejo!

On the podcast, David will talk about some of the rules for generating Negative Thoughts.

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3. David P asks: Do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log?

Dr. Burns, I'm a big fan of your work, and have now finished "Feeling Great" and loved it. I know you approach depression from a clinical background, but do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log? It seems like my negative thoughts are automatic, and I have to work to counter them. Maybe, if I have to force myself to think of a few things I really am grateful in my life, instead of only focusing on countering the negative automatic thoughts, it would be beneficial? Also, is there a role for altruistic volunteering in alleviating depression? Thank you.

david p

Hi David P,

Anything that works for you is strongly recommended. I do a lot volunteer teaching, and also treat therapists and students for free, and i enjoy that a great deal!

So go for it and let me know if it is effective! I often feel grateful for a lot of things, and people, and animals, like our cat, who "almost" loves me!

As for me, I never use non-specific, formulaic approaches that one practices over time, hoping some good will come from it. So I never prescribe meditation, a daily gratitude log, prayer, aerobic exercise, dietary considerations, vitamins, and so forth. You can do these things if you like, but they are not "therapy" to my way of thinking. I only use specific techniques to crush a patient's unique negative thoughts of dysfunctional ways of communicating with others during conflicts.

Therapy is a lot like learning to play the piano, or going to a tennis coach to improve your game. Specific practice is needed, not prayer, gratitude journals, or the like. And my focus is on high speed, total and lasting change right now, if possible.

david

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4. Harvey asks: I don't see how Positive Reframing actually contributes to the therapy.

Hi Dr Burns:

Thank you for this great podcast.

I was particularly impressed by and related to the idea of "Beating Up On Yourself." I think it is so easy to fall into that trap.

My question is that I don't see how the positive reframing aspect of TEAM actually contributes to the therapy.

Once you did the reframing with Neil, you didn't seem to go back to it. So why is that a necessity thing to do?

I understand that the positive side of negative thoughts could cause resistance to give up the negative thoughts, but that didn't seem to be dealt with.

Thank you so much for these podcasts and I have just started to read "Feeling Great".

Maybe you go into the positive reframing aspects and benefits more in the new book.

Thanks,

Harvey.

Hi Harvey,

The session you are referring to was a while back, but by memory my thinking was that the Positive Reframing was not a particularly powerful tool for Neil, and I think he thought that also. It is not the case that any one tool--and I have created / learned more than 100 methods--will be effective for everyone.

That's why it's so great to have a huge palette of tools and techniques, so you can find the path forward for many patients, and not just a few! Some people think that if a technique is not helpful for one patient, then it is no good.

Some people also think that one technique, like meditation, or exercise, or medication, should be "the answer" for everyone. My experience is radically different, and it is hard for me to even comprehend how people can get sucked into some of these notions--but they do!

Positive Reframing is one of the great breakthroughs in TEAM-CBT, and it opens the door to ultra-rapid recovery. In fact, I usually (but not always) see a complete or near-complete elimination of negative feelings in one extended (two-hour) therapy session.

Here are some reason why Positive Reframing can be helpful:

• • • When you see that your negative feelings are the expressions of your core values, rather than your defects, this reduces feelings of shame, so you might feel a little better right away.

• • • You don't have to shoot for perfection, or complete recovery, but rather a reduction in your negative feelings. This is pretty sensible, and more realistic and relaxing than shooting for total change. In addition, you are no longer fighting against your negative thoughts and feelings.

• • • Your resistance to change will diminish because you can honor your negative thoughts and feelings, and work to reduce them rather than thinking you have to change completely.

• • • You're in control—the therapist is not trying to "sell you" on something. "Selling" nearly always triggers fairly strong resistance.

• • • You may suddenly see the benefits of many of your negative thoughts and feelings, so you no longer feel so "broken" or defective.

• • • When you "listen" and finally hear what your negative thoughts and feelings are trying to tell you, the volume and intensity of your negative thoughts and feelings will suddenly diminish, like a balloon with a hole in it.

Thanks for listening today!

Rhonda and David