How to Get From a B to an A

Intense Performance / Public Speaking Anxiety, Part 1 of 2

This Is podcast features the first of the two live therapy demonstrations that Dr. Jill Levitt and I did at our psychotherapy workshop on Sunday, May 16th, 2021. I hope you enjoy this dramatic and inspiring session!

Jill and I believe that doing your own personal work is vitally important to the growth and credibility of a mental health professional for many reasons. First, when you’re in the patient role, you can see things from a radically different perspective, including a far greater, first-hand appreciation of the errors that shrinks make as well as what is especially helpful.

Second, if you are successful in your own work, you can tell your patients, “I know what you’re going through, and how intensely painful it is, because I’ve been there myself, and I can show you how the way out of the woods as well!” This is a message that most patients welcome.

And finally, the personal work you do with TEAM-CBT is a fantastic way of comprehending how this new approach really works.

Our “patient” today is Michelle Wharton, a forensic and clinical psychologist from Australia. I want to thank Michelle for her tremendous courage in sharing a very personal experience with all of us. I also want to thank Dr. Levitt, who practices at the Feeling Good Institute in Mountain View, California, where she serves as Director of Clinical Training. Jill is also a co-leader at my TEAM-CBT training group at Stanford.

I am especially thrilled to share Michelle’s live session with you, since only mental health professionals are allowed to attend the workshops sponsored by the Feeling Good Institute. Many non-therapists were eager to attend, and disappointed when they learned that only shrinks could attend. By way of compensation, this podcast will give all of you the chance to hear what you missed, and I think you will NOT be disappointed!

When Jill and I asked for volunteers for the live demonstrations in the workshop, Michelle sent us this email, describing her situation.

Hi Jil and David,

I’ve just seen your email on the listserv asking for volunteers for the live therapy training on 16 May and thought I’d put up my hand. I’m an Australian clinical and forensic psychologist with Level 2 TEAM-CBT certification based in Adelaide, South Australia.

I had been thinking about volunteering to do some work on social anxiety and feelings of inadequacy. I know this has impacted me at different points in my life like

• • holding back my career
  • contributing to perfectionism, and
  • causing high anxiety in social settings.

My anxiety is probably more work-related but does impact personal relationships where I just assume I’m not particularly important. After reading your post, it just kept playing thru my mind that I wouldn’t be a very good volunteer. This thought was keeping me awake, which paradoxically also made me think I might actually be a good volunteer.

Also, from the fractal perspective, the anxiety triggered by just thinking about volunteering is probably reflective of all of my inadequacy concerns. So, I’ve attached a Daily Mood Log (DML)/ If you think it might be useful let me know.

Since I’m in Australia, the workshop will be from 1am-8am in my part of the world.

We scheduled Michelle at the start of the workshop, due to the tremendous time difference, but it still required enormous commitment on her part to work with us in the middle of the night! That kind of motivation is extremely helpful and often predicts rapid changes, but it’s no guarantee and we’ll have to see what happens in the session.

This will be a two-part podcast. In today’s podcast, you will hear the first portion of Michelle’s session (T = Testing and E = Empathy). Next week you will hear the fantastic conclusion (A = Assessment of Resistance) and M = Methods.)

I hope you enjoy the session as much as we did. Again, a big hug and thanks to Michelle, the superstar of the podcast!

T = Testing

To get started, take a look at the Daily Mood Log (LINK) that Michelle shared with us at the start of her session.

As you can see, most of Michelle’s negative feelings were intense, especially the anxiety and embarrassment, which she rated at 100%. You would not have known how overwhelming her suffering was if you had met her in daily life because she comes across as warm, bright, personable, and likeable. But inside, a part of her is dying, and that’s the part she’s been hiding and fighting desperately to change. Her actions today—opening up and become completely vulnerable in front of a large live audience of mental health professionals—required incredible courage and was a fantastic gift to all of us.

That’s one of the really important reasons for Testing. You can see exactly what you’re dealing with, in terms of the type and severity of negative feelings. Of course, we’ll ask Michelle to rate her feelings again at the end of the session. That way, we’ll know how effective—or ineffective—the session was. This information can sometimes be humbling to therapists, especially when you see that things didn’t improve during your session, but it is always illuminating.

Neither Jill nor I could conceive of doing therapy without the Testing! At the end of today’s session, we’ll also ask Michelle to rate us on Empathy, Helpfulness and other dimensions, using brief but sensitive scales that will highlight even the smallest therapeutic errors that most therapists would not otherwise be aware of.

Using these scales also requires therapist courage, because the information is often disturbing and unexpected, but it is always illuminating and potentially super helpful. That’s because you can discuss any low ratings you received at the start of the next session. If you do this skillfully and non-defensively, with warmth, respect and curiosity, the dialogue can greatly deepen the therapeutic relationship.

So, in an odd way, we often “hope” for failing grades on the Empathy and Helpfulness Scales!

But processing poor scores often involves the “great death” of the therapist’s ego. This information can be shocking, especially if you thought, as most therapists do, that your empathy skills were good or even excellent.

In fact, you will witness such a failure in today’s session! Yikes!

But you can also ask yourself the question—did Jill and David have to be afraid of their “failure?” Or was it actually a gift in disguise?

And if you’re a therapist, and you start using “What’s My Grade,” will you have to be afraid of grades lower than an A, which is the lowest passing grade?

E = Empathy

During the empathy phase of the session, Jill and I empathized while Michelle described her struggles with intense and incapacitating public speaking anxiety, which is particularly intense in professional situations. Michelle was visibly shaking and tearful as she said she was grateful and horrified to have overwhelming anxiety that has had a horrible impact on her career and has held her back. She’s avoided promotions to more senior positions that might require a good bit of public speaking.

She said,

“I can feel myself sweating, with a dry mouth, and wondering, ‘what are they thinking?’ They’re probably wondering how I got my qualifications, and thinking I’m stupid!

”I feel distant, and the audience feels distant, and I find myself thinking that the people in the audience are critical and judgmental. I have the image of feeling isolate, alone, and crying while people are watching.

“My fears have even stopped me from doing clinical supervision, which is something I would totally love doing.

“There’s a lot I’m holding back. . . but I’m not sure what.”

During the Empathy phase, Michelle poured her heart out, and both Jill and I did really careful empathy, summarizing her words, acknowledge her feelings, and using “I Feel” Statements to convey warmth and support. I’m not always the best at empathy, but Jill is a true master, and that is one of many reasons I love teaching and doing co-therapy with her.

At the end of the Empathy phase, when we were reasonably certain we’ve done a good job, we asked Michelle to rate us on Empathy. This technique is called “What’s My Grade,” and it is frightening but can be extraordinarily helpful.

And we spell it out, by asking, “Would you give as an A, a B, A C, a D?” This is a thousand times better than asking, “How are we doing,” because the patient will just say “fine.” But if you ask for a grade, you’ll get the truth.

And sure enough, Michelle gave us a B! That means we’d vastly missed the mark.

Was this a good or bad result?

From a Buddhist perspective, it’s a great result, because “failure” does not actually “exist.” Michelle actually just gave us some information that was fantastically important.

So, we simply asked, “Can you tell us about the part we missed?” And then patients will tell you something really important.

Here's what she said:

“The sensation in my body right now is huge. . . I can feel it in my stomach . . . And I’m asking myself what the hell am I doing?

“I’m holding my hands tightly. . . I feel pressure on my throat . . . a knot in my stomach, shaky hands, and tears are streaming down my face. . . . The volume is turned way up right now.

“You’re over there on one side, and I’m on the other side. . . . I feel alone. . . I feel distance. . . . This is just like standing at a podium, with a gaping divide between me and the audience. . . . I’m in a spotlight. . . . but I want to feel emotionally held.

“A part of me pushes support away, because I don’t want any cheerleading. . . and I want to be able to do this for myself, and I think that I should be able to do this for myself.

“I want to share something that I’ve been hiding. I’ve been holding back. Do I dare to do this?”

Then Michelle tearfully described a problem she’d had with bedwetting up until she was thirteen years of age. Her parents took her to a GP and a hypnotherapist, and thought she’d grow out of it. The message she heard was, “You should get over this.”

She described waking up every morning with shame, washing the sheets each morning and taking them outside to dry.

And, she said,

“That’s where this all started! The language I used at this time in my life was so hurtful, telling myself I couldn’t even get this right. I know that the internal bully really came to life in this moment but I had never seen it until this moment.”

David made a joke at this point and asked if the bedwetting ever stopped – it took a second for that to sink in then we all laughed and discussed the value of humor within therapy.

David advises that humor, like any powerful healing tool, must be used with thoughtfulness, and never to hurt a patient or put him or her down. In addition, humor is usually not a good idea with a patient who is feeling angry, as it may seem like the therapist is belittling the patient.

After a bit more empathy and Jill offered an “I Feel” statement about her own nervousness prior to the start of the group and I then Jill then asked for our grade on empathy. Michelle says, “I gave you both an A and at that point and you asked if I felt ready to get to work and I said yes!”

Next week, you will hear the exciting and dramatic conclusion to this session, include A = Assessment of Resistance, M = Methods, and T = Testing at the end of the session to assess changes in negative feelings, if any, as well as how Michelle graded us on Empath and Helpfulness during the session.

We will also give you a live multi-week follow-up, to see if the effects stuck, or were just a flash in the pan, and what the most important keys to relapse prevention might have been!

Rhonda, Jill, Michelle, and David

End of Part 1