475: Ask David: Are You Getting Old and Cranky Now? TEAM CBT and Spirituality

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.

1. Jenn asks: Are you getting old and cranky now?
2. Jenn also asks: How did you get involved with / develop the spiritual and enlightenment aspect of TEAM?

Dear Dr. Burns,

Let me start by saying thank you for all of your hard work and diligence in creating a method which is so user friendly. Completing the book, When Panic Attacks, changed my life and helped me reach enlightenment.

My Ask David question is inspired by the last few podcasts, the live session with Rhonda and the live session with Madelaine which David just did with Jill.

David has clearly worked so hard to create TEAM and has dedicated so much time to perfect it. I was lucky enough to have been introduced to the podcast when it first started. Some of my favorite episodes to listen to are the live therapy sessions. I've gained insight and felt heard through many of these such as when David told Lee how lonely enlightenment can be because I agree with that!

Recently I have noticed that David's demeanor has changed and was hoping to ask about it. I can imagine David might feel lonely in his expertise sometimes. I might be on the wrong track here too but I wonder if David might be feeling frustrated with the lack of understanding from people around him.

He has been dedicating his life to this and still people do not understand certain aspects of his research and teaching. On recent podcasts, David had mentioned that he gets more irritated with teaching now too and it has seemed like he is irritated with Rhonda at points.

He has mentioned that he feels disappointed if he doesn't see change in 2 hour sessions.

Recently I watched a live session with Madelaine and some of the techniques (for example, calling her negative self sociopath during counter attack) did not seem to land or resonate with her and that wasn't addressed with David's usual love and tenderness and warmth with empathy. It seemed rushed and not necessarily focused on the patient outcome but the timeline.

I did not find it to be David's usual work of patience and warmth. I could be completely off the rails but I am wondering if this is resonating with David and if he could share more about what it's been like for him recently.

I also am wondering if it is difficult to navigate being seen as "a great leader" in a field. Do people see you as "David" simply a dedicated expert in your field or do people treat you like a "God" that has all the answers? I can imagine people would want help from you 24/7 and if you could speak to that.

I am hoping David can look at some of those thoughts and comments he's made on the podcasts and become the client for us listeners! I would love for David to show us how to experience TEAM from the client's perspective for all to hear.

I have used TEAM-CBT for 10 years and recently started the Fast Track Program which I am very excited for! Thank you again for this truly amazing process!

Jenn

David's reply

Thanks, Jenn,

You are right, I DO feel quite a bit of irritation with our field and can identify a bit with Martin Luther, who nailed his treatise / ideas on someone's door hundreds of years ago, and also Jesus who angrily threw the money changers out of the temple a couple thousand years ago. I know that sounds narcissistic, but that's how I feel sometimes.

My frustration has several dimensions:

1. The field, to my way of thinking, is incredibly screwed up and anti-scientific, divided into irrational cults called "schools" of therapy.
2. Nobody seems to notice this "elephant" in our room! Hey, are you all sleeping? Did you learn critical thinking in college?
3. When challenged by research that seriously questions the validity and effectiveness of current psychotherapies for depression and anxiety, for example, no one seems to care or notice. It seems like wrong theories die hard.
4. People do not like being criticized and got angry when I criticize the field of psychotherapy. So, there is a kind of a "let's be politically correct" and be super "nice" to everyone, so as not to stir them up or hurt their feelings.
5. There is a potential for massive change and improvements in psychotherapy and psychiatric treatment, but it would require a revolution and the acceptance of totally new approaches which would threaten many therapists' thinking and survival at a very basic level.

Are you or others interested in my thinking? Let me know. If so, more later, maybe on a podcast or two with Jill and Matt, and of course, Rhonda.

And here are the answers to some of your other questions. You say, "He has mentioned that he feels disappointed if he doesn't see change in 2 hour sessions."

We're not on the same page here. I nearly always see dramatic change in 2 hour sessions, and I'm dramatic that I have created a therapeutic approach that makes this possible. When I was a young man, a psychiatric resident, I use to dream about that, and wondered if it was even possible, since I almost never saw meaningful change, much less recovery and joy, in any of my patients using the methods I was talk (supportive listening and antidepressants.)

You also wrote:

I also am wondering if it is difficult to navigate being seen as "a great leader" in a field. Do people see you as "David" simply a dedicated expert in your field or do people treat you like a "God" that has all the answers?

Cool question. I think many people see me as a dedicated expert, but I think a few, particular from some of the Asian countries, to like to see people as "gurus" or something on that level. Sometimes I may even encourage that, as I am a strong believer that therapy, at its deepest level, does become spiritual.

So, questions about spirituality and enlightenment do interest me greatly, and many of the techniques I've created are designed to facilitate rapid improvement, in minutes, vs. years of meditation. The Externalization of Voices would be an example, and it was actually the first CBT technique I created, around or even prior to 1975.

You say,

Recently I watched a live session with Madelaine and some of the techniques (for example, calling her negative self sociopath during counter attack) did not seem to land or resonate with her and that wasn't addressed with David's usual love and tenderness and warmth with empathy. It seemed rushed and not necessarily focused on the patient outcome but the timeline.

You are partially correct and perhaps somewhat "off." Where you are right is that I miscalculated the time for the webinar, and thought we had to stop at 12:30. I later figured out we had until 1 PM, and we could have spent more time on EOV.

Where you're perhaps wrong is that sometimes a confrontation can "jar" a patient into enlightenment. Few therapists use confrontation, but I have always used it, ever since my days in psychodrama as a medical student. Madeleine commented in her follow up evaluation on the things most helpful to her during the session, and that was one of them.

Research has consistently proven that the observers of therapy cannot accurately assess the quality of the therapeutic alliance, as reported by the patient, or the effectiveness of what's happening during a session. I sometimes wish therapist observers had a bit more humility about the accuracy of their observations, based on research that's been replicated over and over!

But there I am, whining again so I will stop!

At any rate, Jenn, thanks for the wonderfully informative critical thinking, and great questions!

Warmly, david

Jenn's response to David

Hi Dr. Burns,

Thank you so much for your fast response. I am really honored that you took the time to reply to me!

Thank you for your honesty too and I can imagine it's super frustrating! I do not think that sounds narcissistic, I think you are right. I find it extremely frustrating too and I am just a user and learner of TEAM. I think I "see it" sometimes since I've done some personal work. I'm still human with many flaws as I am sure you caught on to a few in my email.

I completely agree with all of your points. I genuinely do not understand how TEAM-CBT is not the go-to. It is finally a scientific method that is proven to be effective. It truly leaves me speechless and I could ramble about TEAM for hours to be honest!

I am a registered nurse and I have a difficult time seeing my patients being "thrown" anti-depressants etc. The biological theory was the go-to in mental health and about 10 years ago as I was finishing my nursing degree I read When Panic Attacks. It was mind blowing to me. At the time I was working on a Stroke Rehab unit and the psychologist would recommend our depressed and anxious patients be put on medication. When I asked if she had heard about your work she scoffed at it and it made me so mad! I wanted to scream at her to read your work but she was resistant to even listening and perhaps that will not surprise you based on your points (and also how I incorrectly tried to sell it to her!). I would see so many of my patients put on antidepressants and left alone afterwards as if that would solve everything. Even recently during my labour and delivery training we had a psychologist speak to us about post partum mood "disorders" and she specifically mentioned her patients "yes-butting" her and made a joke about how resistant they are to change and I just had this thought HELLOOOOO has agenda setting not been around for years????? Do people not search out solutions and try to be better? I could Google "my patient is yes-butting me" and your work would come up and it is not easy but it is spelled-out and so accessible to learn. Anyway, I could rant forever. I'm on the same page with you, Dr. Burns!

Thank you for the follow-up email as well. You are right on this one for sure- my therapist observer totally was inaccurate! And I was thinking "I wonder what her EOV is here and if that was effective". I had asked that question in the chat after the webinar but it was at the end and we did not get to it So next time I will ask that as a question in my email instead. I had not seen confrontation used like that and it did seem off-putting and that just shows how well-versed you are in its use and how I am a learner. Thank you for the feedback. This is making me laugh because I am in the Fast-Track course and I really strive on feedback, and I like getting errors over with. In my nursing career I always had "med error" as the thing I never wanted to do and it felt so good when I finally made one (and it also helps the patient was fine haha). So, I had this thought about learning TEAM and how I know that the therapists are never accurate and how I never want to be the therapist that assumes their thinking. So, I am very happy to have done it already and I have not even started the course really.

I want to comment and ask about the spiritual aspect of TEAM. Did you find the spirituality came after personal work or did you see the spiritual aspect before or just as you were developing the whole process?

Externalization of voices and a daily mood log is what got me to enlightenment, but it is hard to put into words. I had blips of the euphoria enlightenment over the years but about 5 years ago I had this "big one" and it was not euphoric. It was nothing (but everything) and it was like I became an observer and absolutely none of my thoughts had emotional attachments. It was instant relief of human suffering for sure. Sorry if this is bizarre and I am not sure if this resonates or if I sound like a crazy person.

In your podcast with Lee you mentioned that enlightenment is lonely and so I thought maybe you have been here. When it first happened it was an overwhelm of being just matter and being everything and nothing all at once. I could see humanity from an outside perspective almost. I was raised catholic and everything that I learned made sense but in a very different way than I was taught - it was like I understood what Buddha and you and the bible talks about but the deeper meaning if that makes sense. And I sat in the observer role for a couple of days and it was fine because I had no emotional attachment.

Actually, as a test I looked at my husband when he got home from work the day it happened and I recognized him of course but I just felt the baseline contentment or a peace overall. The nothingness and the everythingness all at once. When I looked at him I had no emotions or gut reactions or anything and when I thought "that is my husband" I had no emotional ties but I could recognize that my human self loves him but even that love was all created from nothing and everything. This sounds so bizarre!

Day 3 or 4 I went to a house party and again I was just an observer and recognized that my human ego is very tied to wanting others to like me, when I attempted humor it would be to serve my ego, before I'd try to make people laugh for me rather for them and a lot of our actions are tied to our egos. After this party, maybe the next day or something I also saw that as I was observing that although I had no emotional ties that also means…I had no emotional ties! It came to me that to live a human life I cannot be in this enlightenment stage. It was lonely even though that did not bother me at the time and seeing humans from this outside perspective is incredibly hard to describe and was overwhelming.

So in my enlightenment it was almost like I had to decide to step back into trying to be human so I could carry on with life and try and find these emotional ties and what to do with this awareness of my flaws and what even my personality is. It has rocked me a bit! I have decided to just follow things that I find fun or challenging or have become an interest and the flaws quickly followed!

Have you heard of anyone having a bit of fear in reaching enlightenment again? Although the initial hit was so awesome and a huge relief of suffering, I experienced truly what it is like to not have flaws and not have any emotional ties to thoughts. I do have some interesting anxious thoughts about going "back there" and this was the perfect example of "everything in moderation". I must love my flaws haha.

Thanks for your time, Dr. Burns! I thought I had heard you mention during a podcast that you feel disappointed if you don't see change in a 2 hour session maybe while you were empathizing with another therapist so I apologize that I was wrong there. I am most likely remembering it incorrectly or I presented the context incorrectly -it's a common flaw of mine haha usually I need to write things down.

Looking forward to hearing back,

Jenn

David's response to Jenn

Thanks, Jenn. Awesome email. In the context of my empathizing with another therapist, I could well have said something like that for sure!

You are dipping into enlightenment. Way to go. Very exciting, and now YOU will be the expert.

When I lived in Philadelphia, I was lucky to audit a class by James Arbukcle at Temple University on structural equation modeling. It was unbelievably exciting for me, and even though I was in private practice, I went once a week for the three hour seminar and did 20 hours of homework every week. I could not believe my good fortune, as he made everything super simple and clear. It was a wow experience every week.

For quite a while, I would ask him question when I got stuck or puzzled analyzing my data with his AMOS program, and he seemed to know everything. Which was also cool.

Then, one day, he started answer my questions by saying, "Actually, I don't know the answer to that." Like, the first time this happened I asked him the cause of Heywood cases. That where you get a seemingly impossible result, like a correlation greater than one.

But then, an odd thing happened. I found that if I worked at it, I could figure these things out for myself. And often, the answers would come to me in a dream, in the middle of the night.

So, like James, I probably can't answer all your questions anymore, although hopefully I can still answer a few of them!

By the way, James Arbuckle was one of the most amazing teachers I've ever had, and I will forever be grateful for his generosity in letting me audit his class--I was not even a student at Temple--two years in a row for free. And what I learned forever changed my career and my life, especially my way of thinking about research and statistical analyses.

Warmly, david

Thanks for listening today!

Rhonda, Matt, and David