Psychotherapy Homework

272 Ask David, with Special Guest, Dr. Matthew May: Shoulds, Free Treatment, Blame, and More!

Here are the questions for today’s Ask David, featuring special guest, Dr. Matt May, and, of course, Dr. Rhonda Barovsky!

1. How can I turn off my Shoulds!?
2. Is there a downside to treating people for free?
3. What’s the difference between Feeling Great vs Feeling Good?
4. Isn’t it important to blame the other person when that person really IS to blame? 

How can I turn off my Shoulds!?

Nice podcast! (Maurice is referring to Part 2 of “I want to be a mother.”) It’s refreshing to see that we sometimes mix our needs with wants.

I also have a huge problem with regret and shame, saying to myself

• “I should be far more ahead in life.”
• “I should have dated more.”
• “I should have used my energy to create art and being productive.”

I pinpointed the moment in my daily mood log, and it occurs usually when I compare myself with people online or with people in my friend group who seem to be far more ahead in life than me in terms of career and achievements or that they used their energy of their younger years more constructive than me because they didn’t deal with depression.

I tried the semantic method to soften my thoughts regarding my should statements but telling myself “I wish I did xyz,” is carrying the same weight of regret as when I “should” myself.

These thoughts also seem very realistic to me and pinpointing the distortions in them is not helping me much because there is so much resistance and weight to the thought, plus the positive thought that I subsequently come up with does not crush the negative thought.

I often ask myself: ”Am I really a failure?”

Maurice

David’s Reply

Thanks, Maurice

You are struggling with resistance, which is the cause of virtually all therapeutic failure. You can use Search on my website to look up podcasts on Positive Reframing, Assessment of Resistance, and Paradoxical Agenda Setting.

I usually select ten to fifteen or more methods to crush any Negative Thought, but would only use them after the resistance issue has been successfully addressed.

For example, we could use “Let’s Define Terms,” as one of 15 or 20 potentially helpful techniques. It might go like this:

Is “a failure” someone who fails all the time, or someone who fails some of the time.

If you say, “some the time,” then we’re all “failures,” so we don’t need to worry about it.

If you say, “all the time,” then no one is a “failure,” so we don’t need to worry about it.

If that technique is not effective, we’d have tons more to try.

You can read one of my books, like Feeling Good or Feeling Great, to learn more about the Assessment of Resistance and the use of various techniques to crush distorted thoughts.

Might also use this on an Ask David. Can use a fake first name, too, if you like. Please advise.

david

 

Is there a downside to treating people for free?

Dear David and Rhonda,

I live in England, and I’m close friends with a team CBT therapist in Bristol (Andy Perrson), and I’ve been listening to your podcasts for the last year. I have found them to be stimulating, thought-provoking, often really humorous but above all enormously helpful in helping me journey with other people.

I have just embarked on counselling training and would love to steer myself down the same avenues as my friend Andy. I’d also like to use your methodology at a later date.

In the meantime, I have a question for you.

I am conscious that almost all of your work now is done on a free, pro bono basis. I think that would be my preference as well especially as I have managed to cover the economics of life from other things and it would remove any feeling of conflict, or ambiguity around my motivations in helping people.

But, I am also aware that there are so many advantages in there being a financial commitment from clients. Sadly, things that are free and that spring from generosity are not always valued by the recipient, things like commitment and timekeeping become relaxed. It can be awfully irritating for the therapist (a bit like making someone a cup of tea and them not drinking it), and probably a waste of time for the client. A bit like the example you often give around the outcomes for clients who don’t do homework.

I would be very interested in your view on this and on balance whether it is better to charge or not charge for treatment, in the scenario where a therapist does not have a desire to charge.

David comment: I think the word “therapist” in the line above was supposed to be “patient.”

I hope that makes sense.

Thank you again to you and Rhonda for all your hard work.

Kind regards

Brad Askew

(Bristol, England)

David’s Reply

We can reply live on the podcast. The thrust might be that you can make patients accountable even if you treat them for free.

 

What’s the difference between Feeling Great vs Feeling Good?

Dear Dr Burns,

First of all, thanks for the great work that you do and also all the podcasts you did,

I am planning to order a copy of Feeling Great, your latest book. I have a quick question below.

I have been searching the answer on the web but still can't find the answer. Does Feeling Great cover ALL the key concepts that were discussed in your previous book, Feeling Good? Or does one need to read BOTH books to get a fuller picture?

I already own a copy of Feeling Good. However, if Feeling Great already covers all the concepts discussed in Feeling Good and also comes with updates, i may just order Feeling Great and start with that instead.

Thanks.

Best,

Calvin

David’s Reply

It really depends on the intensity of your interest. There is some overlap, but also significant differences. Even though Feeling Great is way newer, there are still tons of gems in Feeling Good.

David

 

Isn’t it important to blame the other person when that person really IS to blame?

Hi David,

I’ve been listening to the show for awhile. Thank you for everything you do.

I just listened to episode 254, and I’m not quite sure what to think about it in the context of my situation. I think it makes sense that people are afraid to look at their own faults and what brings them to a relationship and what they contribute to a situation. And that they tend to want to blame the other person to avoid working on themselves.

But what about situations of more extreme abuse? How do you not blame the other person?

I recently got out of a relationship where I was raped. While in the relationship, there was a lot of coercive sex where he ignored my signals to stop and then afterwards told me that things happened because I had wanted them to. Eventually his behavior escalated to the point where he drugged and raped me while I was unconscious.

It’s only been 2 months since I figured out that the relationship was too unhealthy for me and left it. I’ve been in counseling 2-3 sessions per week since then. So at least I am working on myself. And I have no contact with him.

Does that mean there is not a point in using the 5 secrets? Is that only for use on other people? But the things you said about blame rang true to me. I think I avoided working on my own issues for a long time, but this situation was like a giant neon arrow saying “work here!”

I think I blame myself and him both. But I also worry about blaming myself too much—I think me blaming myself is one of the reasons I felt trapped and unable to leave the relationship in the first place. Because I felt at fault and ashamed of that, I didn’t tell anyone for a long time and that normalized his behavior and allowed the relationship to continue and escalate to its extreme.

By not placing enough blame on him, I also didn’t consider that he might be acting selfishly, lying, or not have my best interests at heart. Which also led to the relationship continuing longer. So I am wary about where and how to place blame.

Anyway, I don’t know what else to say about this except that it has all been very emotionally difficult and I never want it to happen again, so I am diligently working on myself and looking for help in all the places.

Thanks,

Rachel

David’s Reply

The thrust of the response could focus on the idea that Self-Blame and Other-Blame are both dysfunctional. I prefer the concept of accountability, and talk about this in Feeling Good Together, which might be helpful.

I think Rachel is doing well to get help for herself and her own tendencies toward Self-Blame, and think that a lot of practice with the Five Secrets could also be tremendously helpful, especially for future relationships.

David

Rhonda, Matt, and David