Therapists and Human Connection in Therapy

Ask David, Rhonda and Matt Assertiveness, Suppressing your Feelings, and the "Miracle Cure" question Questions for today’s Ask David podcast.

1. Chris asks if I have a book about assertiveness.
2. Brian asks: Is there anything to the theory that "suppressing emotions" is harmful or is that just Freudian mumbo jumbo?
3. Matt asks about the “Miracle Cure” question in the Assessment of Resistance portion of a TEAM therapy session.

Rhonda began with a lovely endorsement and a cool reminder of the classic book, Robinson Crusoe, who created cognitive therapy (the double column technique) when he was stranded on a deserted island! I believe I wrote about it in one of my books, possibly Feeling Good. It’s pretty cool! You will hear Matt playing the role of the “evil” thoughts, like, “I am stranded alone on a deserted island,” and Rhonda will play the role of the “good” thoughts, like, “Yes, but my life was spared, and all of my shipmates died.”

Here's what it looks like in the novel:

Evil. Good. I am cast upon a horrible, desolate island, void of all hope of recovery.     But I am alive; and not drowned, as all my ship’s company were. I am singled out and separated, as it were, from all the world, to be miserable.     But I am singled out, too, from all the ship’s crew, to be spared from death; and He that miraculously saved me from death can deliver me from this condition. I am divided from mankind—a solitaire; one banished from human society.     But I am not starved, and perishing on a barren place, affording no sustenance. I have no clothes to cover me.     But I am in a hot climate, where, if I had clothes, I could hardly wear them. I am without any defence, or means to resist any violence of man or beast.     But I am cast on an island where I see no wild beasts to hurt me, as I saw on the coast of Africa; and what if I had been shipwrecked there? I have no soul to speak to or relieve me.     But God wonderfully sent the ship in near enough to the shore, that I have got out as many necessary things as will either supply my wants or enable me to supply myself, even as long as I live.

I know this novel is a couple hundred years old, so it certainly deserves nomination of the earliest cognitive therapy!

Now, for the answers to today’s Ask David questions. Keep in mind that these answers were written BEFORE today’s recording, so the actual live answers will differ in some regards from the written answers below.

 

1. Chris asks if I have a book about assertiveness.

Hi Dr. Burns,

I hope you're doing well. Do you have a book on assertiveness training?

I've used your books to help me with my hidden "should" statements, which has enabled me to be less angry or anxious whenever someone treats me less than satisfactorily.

While this has helped immensely, I realize it's still in my interest to reduce the behavior I disagree with. For example, my sibling scheduled an early morning shift after I had a long day of work. Because they can't drive, they expect me to take them to work, which means I'll only get about 5 hours of sleep; this in itself isn't a bad thing... except this is the 3rd time in a row they've done this.

After using your techniques, I'm less angry and anxious, but I still want to address the behavior to reduce the likelihood that they do something like this again, which is why I'm reaching out.

Thanks for your help.

Kind regards,

Chris

David’s Reply

Sure. I like my own book, Feeling Good Together, and have often recommended Manuel Smith’s When I Say NO I Feel Guilty.

There is a LOT to be said about assertiveness training, including the fact that it doesn’t always work! I can give a great personal account of that!

Sometimes, or always, skillful listening is also effective. Assertiveness without listening makes it sound like only your own feelings are important, which is obviously pretty self-centered.

One of the most helpful things to me is the difference between healthy and unhealthy anger, and how to express tough messages in a loving, respectful way.

Can discuss more on the show. For example, what are the problems with the assertiveness movement? And where can it be helpful?

And what mistakes do unassertive individuals make when trying to be more assertive? Do they sometimes overdo it?

Warmly, david

 

2. Brian asks: Is there anything to the theory that "suppressing emotions" is harmful or is that just Freudian mumbo jumbo? Thanks!!

David’s reply.

Thanks, Brian. Great question!

You can listen to the podcasts on the Hidden Emotion Technique, or read about it in my book, When Panic Attacks.

Will make this an Ask David question if that’s okay!

 

3. Matt asks about the “Miracle Cure” question in the Assessment of Resistance portion of a TEAM therapy session.

Hi David,

I've noticed that when I ask the 'miracle cure' question or 'magic wand' question, I'll sometimes get a response that isn't all that useful and I might waste time trying to figure out what the person is really asking for.

An example might be, 'I want to be able to support and understand my husband, who is addicted to video games and spends a lot of our money on games'.

I've found it helpful, in such situations, to ask, 'let's imagine you could achieve that goal, you were perfectly understanding and supportive, at all times, of your husband, who is addicted to video games and spends a lot of your money on games...what would change, in your life, if all your dreams came true?'

I think this might help in a lot of cases where the agenda is a bit fuzzy and unclear.

Wishing you the best!

Matt

 

David’s response

Matt and I exchanged several emails we’ll discuss on the podcast. Essentially, I don’t think this woman is asking for understanding why her husband is addicted to video games and spends money on them. Instead, she is secretly blaming him and is probably angry with him for not spending time with her! She wants to change him.

Matt agreed with this and has proposed a new tool therapists can use when setting the agenda.

I, David, also raised the problem of “hearing the music” behind the patient’s words. This is incredibly important—but hard for therapists to learn—when using the Disarming Technique. They have a tendency to agree with the patient’s words in a literal way without “hearing” what the patient is really trying to say.

If you use any form of therapy literally, with really grasping the patient’s feelings, your treatment will not be effective or helpful. There is a human art to therapy, and following rigid formulas simply won’t come across as compassionate or genuine most of the time.

That’s why I am dubious about testing different therapies with outcome studies with human therapists. You are actually testing the impact of a miscellaneous group of therapists with potentially widely divergent skill sets. This is one of the many reasons why psychotherapy outcome studies for depression all come out about the same—somewhat better than placebos, but not much better.

And there’s been no one winner when using human therapists.

Dr. Paul Crits-Christoph from the University of Pennsylvania Department of Psychology once published a study showing that the differences between therapists within each arm of an outcome study were grater than the differences between the two schools of therapy!

That’s why I’ve been so excited about analyzing data from our beta tests with the Feeling Great App. Each “patient” gets the exact same shrink! This makes the “dose” of the TEAM done by the computer the same for each patient, much like an outcome study of a medication.

TEAM is a actually series of metaphors! If you don’t “get” the metaphors, and try to apply TEAM in an overly literal way, you’ll have a lot of trouble learning TEAM!

David

 

Matt’s Musings:

David is incredibly gifted when it comes to ‘hearing the music’ behind what folks are saying, verbally. I suspect this is partially an innate gift, like someone who’s a prodigy at math, only for emotional states and understanding people.

After years of practice, I’m not quite as good as David. However, I think there were specific forms of experience that helped me improve my skill ‘hearing the music’.

In addition to using measurement and processing feedback with my patients, one thing that helped me a lot was using a lot of ‘uncovering techniques’. These include the ‘What If’ technique, to expose hidden fears, the ‘Individual Downward Arrow’, to expose hidden insecurities, the ‘Interpersonal Downward Arrow’, to expose hidden assumptions about how we ‘should’ act in our relationships.

Seeing several thousand of these has helped me with ‘pattern recognition’, which I think is related to ‘hearing the music’. I’m proposing that beginning therapists might also benefit from an ‘Uncovering Technique’ for agenda-setting, following the ‘Miracle Cure Question’, which keeps asking, ok, let’s say you got that, what would you hope for, if you got absolutely everything you wanted? Ok, and let’s say you also got that, what would you hope for, in your wildest dreams?

This might expose hidden agendas which can be super important if we want to be able to anticipate resistance and identify the ‘cost of recovery’.

Thanks for listening today!

Rhonda, Matt, and David