Navigating Resistance and Accountability in Therapy

Ask David: How to Stop Giving a Crap Motivating a Procrastinator . . . and More The answers to today’s questions are brief and were written prior to the show. Listen to the podcast for a more in-depth discussion of each question. Today’s questions. 1. Chris has a question about Positive Reframing and the Magic Dial. 2. Joe asks: What method would be best to stop giving a crap? 3. Ollie asks: How do you motivate a procrastinating patient to do the hard work of facing the task they’ve been putting off? 4. Owen asks: Should I complete a full Daily Mood Log each day? 5. Owen also asks: Is it okay to copy the positive reframing from a previous DML when relevant?   1. Chris asks about Positive Reframing and the Magic Dial. Hi David! I'm currently on my third re-read of "Feeling Great" and want to thank you for the positive changes and progress I have experienced in my life as a result of the techniques and information present in the book. My question is, when you use positive reframing, and identify all the advantages of a negative thought, but still decide, "Hey I would still like to reduce my suffering, in spite of all these good things. But I would love to keep the advantages too." Does this mean my conviction for change is not strong enough? Or is this when I should transition to the magic dial technique and try to keep the best of both worlds ? Thank you in advance, Christian David’s reply Thanks, do the Magic Dial and you can have it both ways. However, keep this in mind, or perhaps discover it later on. Once you start to challenge your thoughts successfully, and your belief in your negative thoughts diminishes substantially, you may decide to lower your feelings even further, possibly all the way to zero. And at that point, you’re probably ready for Relapse Prevention Training as described in the book. The Feeling Great app is free this summer if you’re in the US, so that might help you along the trail if needed. Warmly, David Can I use this as an Ask David question on one of our Ask podcasts? d Christian responds Hello David, Thank you for your in depth response, that's really handy. Part of me is really hoping I'll want to lower my ratings even further, but I think as you have outlined many times, honoring my resistance is important if I want to get to that point. It's weird isn't it, I know at an intellectual level I want these things to happen, but at the gut level part of me is still holding on. I would love to use the app, however I'm based in the UK and it isn't available to me, I saw on the FAQ on the website that it may be getting released in other parts of the world soon ? I also hope there will be more and more TEAM-CBT therapists available in the UK in future too ! Absolutely, I would love for my question to be featured in the podcast ! Warm Regards, Christian

 

2. Joe asks: What method would be best to stop giving a crap? Hey Dr. Burns, Your two most recent webinars have been very helpful, especially Overcoming Perfectionism, yet I still struggle hard with perfectionism. [To be specific, I put a video out there that people enjoyed (internally) and that I spent a month on, only to get mostly ignored, and I feel defeated.] What method would be best to stop giving a crap? Thanks! Joe David’s Reply As I have said so often, I don’t recommend “methods” for “problems.” I use TEAM, a process. I sometimes have the same problem with media interviews. I am often asked to give three tips on this or that problem, like gaining self-esteem or whatever. For example, a Chinese interviewer asked for “tips” on overcoming depression, like spending more time in nature or more time with friends and the people you care about. I am not happy about such questions, as my answer is that I’m a no tips please type of guy. I have developed many powerful processes for dealing with a variety of common problems. For example, for individual mood problems I find it extremely useful to start out with a partially completed Daily Mood Log, and for a relationship problem a partially completed Relationship Journal can lead to some fantastic and revealing work. But as far as general “tips” for not “giving a crap” if you’re struggling with perfectionism, I can only quote what the Buddha said nearly 2,500 years ago: “General tips suck! Give me something specific and real, please!” Best, david   3. How can you motivate someone who procrastinates? Dear David, I have a question but first I'd like to tell you and the team just how much I'm loving the app. Especially since you gave the AI a voice so now we can speak with it rather than typing out responses. Now it feels so quick and easy. Sometimes, I find it can be hard to motivate myself to do the self-help work but talking to the app makes the process effortless. It really does feel like having a friend who's got your best interest at heart, and they're available to talk to you whenever you need them. My question is about the role of therapists when it comes to patient motivation. I was hoping you could clarify why when patients present with anxiety, we know they will predictably resist doing exposure, but as a therapist it is necessary to press the matter. However, when working with a procrastinating patient, they will almost always show similar process resistance (to doing whatever it is they're procrastinating about), but your recommendation (as far as I understand it) is not to push them to do anything. Not to help motivate them to do the hard work. Is there a reason for this difference, or have I misunderstood entirely? Warmest regards, Ollie David’s Reply I can make this an Ask David question, and thanks. Appreciate the kind comments. As a therapist working with anxiety or depression, I work out the Outcome and Process Resistance before trying to “help.” So, the depressed patient must agree to homework, and the anxious patient must agree to exposure, in order for us to work together on those problems. This is called Dangling the Carrot, Gentle Ultimatum, and Sitting with Open Hands and sometimes with Fallback Position at the end. If a patient wants help with procrastination, they must agree to the five-minute rule, to get started at a specific time today, even if they don’t feel motivated. I see it as the same thing: making the patient accountable and giving the patient free will to decide what they are willing to do—or not willing to do. I would never try to motivate a procrastinating patient! That’s not on the menu. However, I can help them get started if they need help, but I the first five things they have to do into simple things taking 15 seconds each, like sit in my chair might be the first step in organizing you desk. Then reaching for a piece of paper that needs filing. Etc. Five minutes work of little things. You might want to listen to / search the podcasts for this process. We’ll mention a bit more on the podcast. Warmly, david If I missed it, try again!    4. Owen asks: Should I complete a full Daily Mood Log each day? Hi Dr. Burns, Thank you again for all the incredible content you've been sharing—both the Feeling Good podcast and your Feeling Great videos. You’re so engaging and natural on camera, it’s hard to believe you were ever camera-shy! The Ask David segments are always a highlight of my Mondays. I just had two quick questions about the Daily Mood Log. I often find it takes me several hours to complete one fully, including the positive reframing. Should I aim to complete a full log each day for maximum benefit, or is it okay to work through one gradually over several days? I often get unrelated negative thoughts while still working on a previous log, which means I can't get to the new ones right away. David’s Reply Hi Owen, Yes, you can spread it out for sure. david   5. Owen asks: To speed things up, is it okay to copy positive reframing from a previous DML when relevant, or is it better to start fresh each time? Thanks so much in advance, Owen (assumed name) David’s Reply Hi Owen, Yes, you can use previous PR! Will include your questions at the upcoming Ask David podcast. Can we use your first name? david At our next Ask David, we’ll start out with this question: 1. Zainab asks: Is friendship a basic human need? What do you think? Yes? No? Maybe? We did a survey among our group in preparation for the next Ask, and it was two “no’s” (Matt and David) and one “yes” (Rhonda). So stay tuned next week for the discussion of this question that comes up often in different disguises. For example, we often hear heated proclamations on whether love is an adult human “need.” What do you think about that question? Thanks for listening today! Matt, Rhonda, and David