228: Reflections on the Evolution of TEAM

In today’s podcast, we focus on a request by Tommy, a podcast fan who asked for a podcast on how TEAM evolved from traditional CBT. So here it is!

Hi Dr. Burns,

I hope you're doing well! I just recently completed Feeling Great and found it incredibly helpful. I found the technique chart that offered specific techniques for each distortion to be incredibly valuable and I've incorporated it into all my Daily Mood Logs. I've also listened to every podcast and have been already exposed to nearly all of the content within the book, but the book did such an elegant job of simplifying everything and putting it into context. I've already gifted it to several family members and am eagerly awaiting the audio version so I can gift it to my grandfather, a psychodynamic therapist of 30 some odd years who's vision impaired. I think he'll really get a lot out of it!

Beyond the well-deserved praise, I'm emailing because I just listened to your post recent podcast episode (222) with Dr. Barovsky and you asked for any suggestions the audience might have concerning future episodes.

There were two things that you mentioned that made me think an episode on the evolution of TEAM might be really cool and insightful. You mentioned that TEAM was specifically developed to deal with borderline personality patients that you saw at PENN and you also described an interaction with a stranger in California who approached you that inspired the concept of fractal therapy (at least that's how I understood that interaction). I think it would be incredibly interesting if you gave a sort of chronology of TEAM and what problems some of the core components were intended to solve.

Obviously, I wouldn't expect you to go through every technique. But some insight into how you came up with positive reframing, the magic dial, perhaps uncovering techniques, and whatever else you'd be willing to share. Besides being interesting, I think it would be valuable because it would provide greater insight into the TEAM processes through demonstrating how it's overcome some of the obstacles that traditional CBT was unable to overcome.

Dr. Mark Noble's chapter in Feeling Great led me to think quite a bit about this, particularly where he described how TEAM is really the ideal therapeutic structure from a neurological standpoint. Certainly you didn't just stumble into TEAM and I for one would find anything you'd be willing to discuss on this topic really interesting!

Thank you again for everything you do.

Best,

Tommy

Hi Tommy

Here are some historical highlights in my thinking. In the podcast I will describe them and dialogue with Rhonda, but in no particular order. Thanks for the great suggestion, and hope you enjoy the podcast.

Rhonda also mentioned how the empathy piece evolved, and we discussed that!

1. Psychotherapy homework: Early research and clinical observations on psychotherapy homework and recovery from depression; how I published research on this topic and decided to make patients accountable.
2. Helping: The man who I called at home twice every time he called me with some emergency one weekend, and my conversation with Dr. Wendy Dryden from England.
3. The beauty of depression: The businessman who thought he was responsible for the death of his stepson.
4. The universal importance of Positive Reframing: The time jill said she wished we’d done positive reframing during her session.
5. Fears of therapists that keep them stuck: My observation through supervising psychology and psychiatry graduate students, as well as teaching workshops, how really hard it is for the vast majority of therapists to give up because of their addiction to helping and their intense fears of making patients accountable.
6. Suddenly understanding “resistance.” The meeting of the Stanford voluntary faculty on teaching, and I mentioned making the concept of “resistance” more understandable for the psychiatric residents. They didn’t seem interested, and then I found the answer in a dream.
7. Creating techniques with more “oomph:” The first method I created, Externalization of Voices, how this was inspired by my experiences in psychodrama marathons when I was a medical student.
8. Giving up on “non-specific” techniques: The elderly depressed man who ran up to 12 miles a day.
9. Therapeutic Empathy: What I learned from Stirling Moorey, and how I set up an empathy training program along with a scale to assess empathy after every therapy session.

Rhonda and David