196: Ask David: Is There a Dark Side of Human Nature? Is "Forcefulness" Ever Needed in Therapy? Perfectionism, Racism, Schizophrenia & More!

in today’s podcast, Rhonda and David address eight fascinating questions submitted by fans like you:

1. What’s the difference between David’s Therapist Toolkit, his eBook (Tools, Not Schools, of Therapy), and the EASY Diagnostic system?
2. Is there a dark side to human nature?
3. Is being “forceful” or confronting patients ever important in therapy?
4. What’s the 5-session schizophrenia cure?
5. How do you suddenly switch into “Sitting with Open Hands” during a session?
6. Questions about OCD
7. Questions about racism
8. What if there are more advantages than disadvantages in perfectionism?

1. What’s the difference between the Toolkit, the eBook, and the EASY Diagnostic system?

I am a Licensed Clinical Social Worker (LCSW) and I am interested in either the Toolkit or the EASY diagnostic tool. It looks like the Toolkit includes quite a few questionnaires so I am wondering if I would need both. I would love to have a comprehensive checklist to give to clients during their initial assessment so I originally looked into the EASY Diagnostic tool. I’m just looking for a little guidance on which one would be the most helpful and if I would actually need both.

Thanks so much!

Cindy

2. What do you think about the idea that there’s a dark side to human nature?

Are humans inherently good, as so many mental health professionals seem to believe? It could be entitled, “The Dark Side of Human Nature,” or “Is there REALLY a dark side to human nature?”

Jeremy

Rhonda and David believe that human beings have positive loving impulses and dark violent impulses as well, and that both are an inherent and basic aspect of human nature. They discuss several aspects, including:

The example of cats. They are genetically little serial killers. They love to capture and torture rodents, even if they have had a loving childhood.

Many people love violent revenge movies and video games.

Many people love killing animals, chopping their heads off, and mounting them on the wall, in much the same way that human serial killers get intense excitement from their killing and torturing, and they also keep trophies.

David argues that it is important for therapists to recognize and address the dark side—areas where therapists will typically get in trouble due to blindness / denial / rationalization of negative motives, and excessive idealism. Problematic areas for therapists can include:

1. the suicidal patient
2. the violent patient—David describes a woman who was plotting to kill her husband.
3. disability patients with a hidden agenda of remaining disabled.
4. patients who don’t want to do their therapy homework
5. people, for the most part, don’t get addicted because they’re depressed, anxious, or lonely, but because it’s really awesome to get plastered / high.
6. Many, and perhaps all humans, like to judge others and feel superior to them, and also enjoy exploiting others, but our denial can be intense.
7. People enjoy bullying people. It makes you feel powerful and generates feelings of excitement.

We acknowledge that although the dark side to human nature may be strongly influenced by our genes, the environment we grow up in can also have a strong impact on our thoughts, feelings and impulses.

3. Is being “forceful” or confronting patients ever important in therapy?

This is another great question submitted by Jeremy Karmel.

David gives many examples of times when it is absolutely necessary to be forceful and confrontational in therapy, but this requires a strong therapeutic relationship with the patient and perfect empathy scores and high levels of trust and mutual respect.

Therapeutic examples where forcefulness or confrontation may be important include:

Exposure techniques in the treatment of anxiety. The patient will nearly always “wimp out” at the last minute, and here is where the therapist needs to push—but most therapists will back off out of misguided “niceness.”

Pushing the patient to view his/her own role in a relationship conflict instead of buying into the idea that the patient is the innocent victim of the other person’s “badness.”

The new CAT technique in the Externalization of Voices is yet another example where gentle confrontation can often lead to rapid enlightenment.

Another example is use of Changing the Focus, suddenly drawing the patient’s attention to “Have you notice what just happened here between us?” This can be helpful when there’s an awkward or adversarial or evasive dynamic going on between therapist and patient.

Yet another example is the Gentle Ultimatum in dealing with Process Resistance.

In all of these examples, many, and likely most therapists don’t do well, due to “niceness” and fear of conflict.

4. What’s the 5-session schizophrenia cure?

Hello David:

I recall you saying in one of your trainings given in San Diego a while back that you could "cure Schizophrenia in 5 sessions" using the T.E.A.M. protocol you taught us. Is there a special protocol for this disorder? One of my clients would very much like to know.

I hope that this finds you, your family and everyone at the Feeling Good Institute doing well and being healthy.

Kind regards,

Leslie

David explains that he has always insisted that schizophrenia is an organic brain disorder that sadly cannot be cured with drugs or psychotherapy. However, drugs often plan an important role in treatment, and compassionate psychotherapy can also be extremely helpful. The goal is to help the patient develop greater self-esteem and improved relationships with others. He describes the innovative group CBT program he developed at his hospital in Philadelphia which served a large population of homeless individuals as well as individuals suffer from severe schizophrenia.

He also points out how easily one can get severely misquoted, and appreciates the chance to set the record straight!

5. How do you suddenly switch into “Sitting with Open Hands” during a session?

This is yet another great question from our friend and colleague, Jeremy Karmel.

David and Rhonda compare good therapy to dancing, having to often change courses instantly when the patient begins to resist and fight the therapist.

6. Questions about Obsessive Compulsive Disorder (OCD):

I hope this a place where I can submit questions for "Ask David."

Are there manifestations of OCD that have common links or hidden emotions? Do you hear one person's description of their OCD and immediately have an idea of what might cause it? For example: do a majority of contamination OCD sufferers have a common reason for that specific "type" of OCD?

Do sufferers of something deeply distressing like pedophile OCD all have feelings of shame that manifest in that OCD, where the "what if" would result in probably the most shame they could ever feel?

David and Rhonda discuss the Hidden Emotion Technique which can be invaluable in the treatment of OCD.

7. Questions about racism

Hello David and Rhonda,

Thanks for your amazing podcasts, I have listened to a lot already.

And thanks Rhonda for bringing this important subject to the table. :) What if “Steve” had said that indeed he is racist and can't stand African Americans or South Americans, what would Rhonda answer to that?! It would become difficult for me to keep a friendship-like relationship with someone who is at the extreme opposite on sensitive subjects.

I am open to any point of view, I don't need to be disarmed here. :)

David, I'm so looking forward to your Feeling Great book!!!

Rhonda and David discuss two opposite strategies for dealing with someone with strong racist tendencies.

8. What if there are more advantages than disadvantages of perfectionism when you do a Cost-Benefit Analysis?

This is a question from a user who wishes to remain anonymous. Rhonda and David talk about the fact that perfectionism, like all Self-Defeating Beliefs, has many advantages as well as disadvantages. And if the advantages outweigh the disadvantages, it’s working for you, and it’s not something the therapist would need to help you with.

There’s a difference between neurotic and healthy perfectionism. Many of the great historical figures, like Edison, for example, worked relentlessly and would not settle for failure. And we are all the beneficiaries of that type of genius and intense commitment to the healthy pursuit of excellence!

Therapy is all about helping people who ask for help. It’s not about evangelism!

David and Rhonda