Secrets of Overcoming Romantic Rejection Part 1 of 2 In today’s podcast we are proud to interview Dr. Kyle Jones from the Feeling Good Institute in Mountain View, California. Kyle Jones, PhD is a clinical psychology postdoctoral fellow affiliated with Feeling Good Institute in Mountain View, California where he provides individual psychotherapy in a private practice. He co-leads a monthly consultation group with Maggie Holtam, PhD where therapists can get help with exposure methods for anxiety. He has recently become an Adjunct Professor of Psychology at Palo Alto University - teaching Clinical Interviewing in the clinical psychology PhD program. Kyle wrote: “Here are some questions from patients of mine for our podcast today - we don't have to go through all of these bust just some talking points!" We will publish part of the questions in today's podcast, and several more next week. There are even more questions, so let us know if you would want a Part 3 on this topic at some time in the future. Below you will find the list of questions with some responses by David and Rhonda BEFORE the podcast. To get the true scoop, listen to the podcast, as most of the comments below were simply ideas that popped into our heads prior to the podcast. Although we focus on romantic rejection in these two podcasts, the idea really pertain to rejection in all segments of our lives. 1. Why do you think it’s so hard for us humans to handle rejection/why do you think we are so afraid of it? David THE LOVE ADDICTION SDB. LOOKING TO EXTERNAL SOURCES FOR FEELINGS OF SELF-WORTH AND HAPPINESS. THE CBA IS CRUCIAL, SINCE PEOPLE MAY NOT WANT TO STOP LINKING SELF WORTH WITH LOVE. Rhonda Plus, it hurts.  And our brain is wired to experience pain when rejected.  We are wired that way. Evolutionary psychologists believe it all started when we were hunter gatherers who lived in clans. Since we could not survive alone, being ostracized from our clan was basically a death sentence. As a result, we developed an early warning system to alert us when we were at risk of being rejected by our tribemates. People who experienced rejection as more painful were more likely to change their behavior, remain in the clan, and pass along their genes. Kyle Getting dumped sucks! We aren’t really taught how to handle rejection very well in our culture. 2. Are we capable of overcoming the fear of rejection and how do we accomplish that?  David You can face your fear with REJECTION PRACTICE. The FIRST SECTION OF INTIMATE CONNECTIONS IS ON OVERCOMING THE FEAR OF BEING ALONE. Rhonda Is part of the fear of rejection also a fear of being alone?  You can use the “What If” technique to uncover more about those fears.  Then put the thoughts in a Daily Mood Log, and challenge them with a variety of techniques you can select for a Recovery Circle. You can also face your fears with Rejection Practice and/or Exposure. 3. When it comes to getting dumped do you guys believe there is a good way to approach it communicating wise? David YOU CAN USE FIVE SECRETS TO FIND OUT WHY THE OTHER PERSON IS REJECTING YOU. OR, PERHAPS BETTER, YOU CAN TURN THE TABLES ON THE REJECTOR, SINCE IT IS PART OF A CHASE GAME. Rhonda If you want to know more about why you were “dumped,” will you trust the other person to be honest with you?  Will you believe them when they respond?  You might want to do a Cost Benefit Analysis to decide whether or not you even want to ask them to explain why you were “dumped.” Kyle It depends on the situation. If you have gone through a divorce and have children, you may still need to talk with you ex-partner. Generally, I don’t think it’s a good idea to stay in touch and keep chatting with an ex who dumped you! 4. If we are caught off guard with the breakup and don’t see it coming and all of a sudden one day our partner decides to end the relationship, how do we not let our emotions get the best of us in that moment in that very moment? David WHEN YOU SAY, “GET THE BEST OF US” IT SOUNDS LIKE YOU’RE NOT ACCEPTING YOUR FEELINGS. IS IT OKAY TO FEEL FEELINGS? THIS QUESTION SOUNDS LIKE EMOTOPHOBIA. Rhonda It’s perfectly reasonable to be sad, to cry, to be shocked and angry.  Why not have those feelings?  You also don’t have to expect to respond with a “perfect 5-Secrets.”  Maybe you need to take a break from each other, breathe, walk, calm down, and then meet again to talk talk, if that is what you want to do. Kyle If you get blindsided by a breakup it can really be shocking and overwhelming. It’s okay to feel how you feel in that moment I would think. 5. When it comes to recovery after being broken up with, how do you fight the urge to go back to your ex? David THIS URGE IS DUE TO THE BURNS RULE: WE ONLY WHAT WE CAN’T GET, AND NEVER WANT WHAT WE CAN GET. ALSO, CAN DO A CBA ON CHASING. Rhonda Also, look at the thoughts that are leading you to want to get back together.  What do they say about you that is awesome?  Then examine them for Cognitive Distortions, and talk back to them with Dbl Standard or Ext of Voices. Do a “Time Projection,” see yourself in 5 years, in 10 years, in 20 years.  Have a conversation with your future selves to talk about what you want, what kind of person you want to be with, how you want to be treated in the future. Practice “Distraction,” when you start thinking about your “ex” distract yourself by concentrating intensely on something else, music, work, friends, cooking, another hobby. Kyle Come back to reality and remember all the crummy ways an ex may have been treating you, instead of letting your mind ruminate on how great things were during the first few weeks of dating. Come up with all the good reasons to continue wishing/hoping you and your ex will get back together and talk back to those. My book, Intimate Connections, will help you with dating and rejection issues! Stay tuned for Part 2 next week.

How Skillful is your Shrink! Now you can find out! The Exciting Recovery Coefficient-- and the FEAR the grips the hearts of the therapists who are afraid to use it! People often wonder how skillful or effective their therapist is, but until now, there was no very valid or precise way to know. But now there is, and it has fantastic implications for psychotherapy. Today, we feature an interview with Kevin Cornelius, a therapist at the Feeling Good Institute in Mountain View, California.  Kevin Cornelius is a Licensed Marriage and Family Therapist in private practice at Feeling Good Institute, with in-person counseling for teens .Kevin is a Certified Level 4 Advanced TEAM-CBT Therapist and Trainer. I asked Kevin to write a brief description of his evolution from a career in acting to his career as a shrink. Here’s what he wrote: After many years of working as an actor I was ready for a change. After some painful personal events, I saw a therapist who was quite helpful to me. She helped me see that changing to a career as a therapist could be a great thing for me. I went to school and got my Master's in Marriage and Family Therapy. Just before I began applying for internships to complete licensure, I learned that the children's theatre group I had grown up in was looking for a new supervisor to lead the group following the death of its beloved founder and leader. This was a wonderful opportunity for me to use my theatre skills and my desire to help young people in their growth and development. I was very fortunate to be hired and worked as the director of the children's theatre group for 19 years. Towards the end of my years with the children's theatre, I was ready for a change and thought it might be time for me to finish getting my therapy license. It had been 15 years since I had worked with a patient in a therapy session, so I had a lot to learn! I was so lucky to discover David Burns and his amazing TEAM-CBT. The testing element of TEAM enabled me to see right away where I needed to improve so I could focus my efforts on improving specific skills. Being able to study with David in his Tuesday group at Stanford was a golden opportunity. Here was a framework designed to make therapy as effective as possible being taught (for free!) by one of the world's greatest therapists. I'm so happy I followed David's advice to get involved at Feeling Good Institute while I was still pre-licensed. Learning TEAM while I was completing the process to earn my license as a therapist enabled me to start my career in private practice with confidence and a stable foundation. Now, I get to continue learning from mentors at Feeling Good Institute, from the wonderful Feeling Good Podcast, and the valuable lessons I get from my patients. I'll sum up my good fortune with a theatre reference and quote the Gershwins: "Who could ask for anything more?" Kevin recently made the courageous decision to find out exactly how he was doing as a therapist. And the results surprised him tremendously. Background Information for today’s podcast Outcome studies with competing schools of psychotherapy in the treatment of depression have been disappointing. They all seem to come out about the same, slightly better than placebos, but not much. For example, in the British CoBalT study of 469 depressed patients treated with antidepressants vs antidepressants plus CBT, only 44% of the patients treated with antidepressants plus CBT experienced a 50% improvement in depression after six months of treatment, and the multi-year follow-up results weren’t any better. This was better than the patients treated with antidepressants alone, (only 22% experienced a 50% improvement), but still—to my way of thinking—very poor. We see more improvement than that in just one day in patients using the Feeling Good App. Here are just two of many online references to that landmark study: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00495-2/fulltext https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(15)00495-2.pdf Because of the disappointing results of research on the so-called "schools" of psychotherapy, the focus is switching, to some extent, to the effects of individual therapists, since even within a school of therapy, there can be huge differences in therapists’ effectiveness. Some therapists seem to have the proverbial “green thumb,” with many patients improving rapidly, while others seem much less effective. Is there a way to measure this? Now there is! And do patients have a right to know how effective their shrinks are? That’s what I’m proposing! For at least twenty years or more, I’ve been trying to sell therapists on my Brief Mood Survey with every patient at every session. That’s because you can see exactly and immediately how depressed, anxious, or angry, etc. your patient was at the start and end of today’s session. This allows therapists to see, for the first time, exactly how much the patient improved in various dimensions within the session, as well as how much the patient relapsed or continued to improve between sessions. Here’s a simple example. To make things really clear, let’s imagine that your depression test goes from 0 (not at all depressed) to 100 (the worst depression imaginable, and your patient has an 80 at the start of today’s session. That would indicate a horrendously severe depression, similar to patients hospitalized with depression. And yet, your patient might be functioning effectively, and might appear reasonably happy. So, bonus #1, you can see exactly how your patient was feeling at the start of the session. You might think of the BMS as an “emotional X-ray machine.” Now, let’s assume you have an excellent session, and feel like you’re clicking with the patient, and the patient scores 40 on the end-of-session BMS. That would be a phenomenal 50% improvement. Of course, a score of 40 means that the patient is still moderately depressed, and has a way to go, still the goal is a score of 0 on the depression test and a huge boost in the patient’s score on the happiness test on the BMS. Keep in mind that in the dozens of psychotherapy outcome studies that have been published worldwide, the very highest levels of improvement in months and months of therapy are  never higher than this. So, I call this the Recovery Coefficient (RC), and it is a very precise measure of any therapist’s effectiveness in treating anything you can measure accurately. In an informal study of de-identified data of more than 10,000 therapy sessions at a local treatment center about two years ago. I discovered that the RC the first time therapists met with their patients predicted the improvement over the entire course of therapy. In addition, different therapists had vastly different initial RC scores, which can range from -100% in a single session (meaning a complete elimination of symptoms)  to +100% in a single session (meaning severe worsening.) Sadly, because all patient or therapist identifying information was removed to protect identities, I had no way of letting the therapists know their skill levels! But today, we are joined by a therapist who had the guts to calculate his RC in ten patients to see how he was doing. He was initial incredibly demoralize with his percent reductions (RC) of 45% for depression and 47% for anxiety in 50 minute sessions,  He reasoned that a 44% in a class would be a failing grade, but I pointed out that this isn’t the right comparison. After all, if you had a contract to build the Brooklyn Bridge, and could complete nearly half of it in 50 minutes, you’d be doing something incredibly amazing. Kevin's Depression and Anxiety Recovery Coefficient Calculations     Depression Anxiety Empathy 1 Before 6 14 20 After 3 1   % Change -50.00% -92.86%       Depression Anxiety Empathy 2 Before 5 6 20 After 1 3   % Change -80.00% -50.00%       Depression Anxiety Empathy 3 Before 12 10 20 After 9 9   % Change -25.00% -10.00%       Depression Anxiety Empathy 4 Before 10 5 20 After 5 3   % Change -50.00% -40.00%       Depression Anxiety Empathy 5 Before 5 9 18 After 3 5   % Change -40.00% -44.44%       Depression Anxiety Empathy 6 Before 18 15 20 After 10 9   % Change -44.44% -40.00%       Depression Anxiety Empathy 7 Before 14 12 20 After 10 6   % Change -28.57% -50.00%       Depression Anxiety Empathy 8 Before 2 9 18 After 4 5   % Change 50.00% -44.44%       Depression Anxiety Empathy 9 Before 2 1 20 After 0 1   % Change -100.00% 0.00%       Depression Anxiety Empathy 10 Before 6 5 20 After 1 0   % Change -83.33% -100.00%       Depression Anxiety Empathy Recovery Coefficient   -45.13% -47.17% 19.6                     And indeed, Kevin’s scores actually showed he was outperforming all the published outcome studies on depression by a factor of several hundred. Which was, I think, a well-deserved pleasant shock to his system! I’ve always had tremendous admiration and respect for Keven because of his obvious great skill and intelligence combined with world-class compassion and humility. In addition, patients complete the Evaluation of Therapy Session (ETS) immediately after the session, and rate the therapist on Empathy, Helpfulness, and other crucially important dimensions. Kevin’s Empathy score was 19.6 (96.5%), indicating near perfect empathy ratings from his patients. This is extremely impressive, since most therapists get failing Empathy scores from nearly all of their patients when they start using the ETS scales. However, what was really cool is that Kevin brought the Daily Mood Log he prepared prior to the podcast. As you can see if you check the link, recording his intense negative feelings and self-critical thoughts when he initially completed his calculations. This helps to explain the fear that so many therapists—nearly all—feel when it comes to being accountable for the first time in the history of psychotherapy. Here's what he was telling himself: I’m not doing well enough. I’m fooling myself. I’m letting my patients down. I’m a fraud. I should be better. I should charge less. I suck! During the podcast, we used some TEAM-CBT to deal with these concerns live, in real time, using Positive Reframing, Identify the Distortions, Examine the Evidence, and Externalization of Voices to smash these thoughts. If you’d like to see the Positive Reframing Table he brought to the session, you can check here. In Kevin’s case, the RC calculations, which are simple and only take a minute, gave him a huge gift—the confirmation of his immense technical therapeutic skills as well as his empathy. But what if you’re not like Kevin, and you discover that your RCs are not so great, and that your Empathy ratings are in the failing range. Isn’t that kind of terrible? Well, it depends on how big your ego is, and how motivated you are to improve. I’ve gotten plenty of horrible ratings on the ETS, and have had lots of sessions with poor outcomes, including sessions when I wrongly believed I was doing a great job. It DOES hurt. But over the years, my patients have dramatically shaped my therapy approach, and have become my greatest teachers by far. I now enjoy pretty tremendous outcomes with the vast majority of the people I treat, but could never have improved without the constant feedback. Psychotherapy skills are a lot like athletic workouts, and they say, “no pain, no gain.” This is definitely just as true for shrinks. Are you a shrink? Do you have the courage to check out your skills? Here are a couple more random comments. Over the years I’ve seen the scores of many therapists in training, and many established shrinks in the community. And sometimes I’ve been surprised that some of the big name, flashy people were actually very unskilled in real therapy situations. And I’ve also seen that some of the giants of our field, were humble, kindly individuals, like Kevin, who were quietly working miracles, but not even realizing it. And I also had this brainstorm. If you’re a patient, and your shrink refuses to use the BMS and ETS, for whatever reason, you could take the test prior to and after each session, and calculate your therapist’s Empathy Scores and Recovery Coefficient scores. Mmm. I am thinking there might be a business model in here somewhere! Like a website where you could take the tests and get all the calculations automatically. And maybe that type of information could be published... After all, wouldn’t patients LOVE to have this information BEFORE going to a new shrink for treatment. And isn’t that EXACTLY where our field should be moving? Accountability and transparency? I hope you enjoyed meeting the incredible Kevin Cornelius today. Thank you for listening and supporting our Feeling Good Podcasts! Warmly, david

Yikes! Do I REALLY have to share my feelings?  Last week, we featured Part 1 of a live therapy session with Keren Shemesh, PhD,  a licensed clinical psychologist who began having intense panic attacks when her mother and father visited from Israel.  Today, we feature the exciting conclusion of that session, with follow-up. If you are interested, you can listen to the follow-up with Keren and Jill who joined us st the end of today's podcast. They comment on the session as well as the details of what happened following the session. I (David) raised the question of why so many of us have trouble being honest and open with our feelings, especially anger. Jill suggested that it might be due to the false dichotomy people see, contrasting aggression with love. But you can be honest and loving at the same time, including when you express feelings of anger. Of course, we make the Five Secrets of Effective Communication sound easy, but these powerful tools actually require an enormous level of skill as well as commitment. Part 2 of the Keren session: M = Methods We began the Methods part of the session with a bit more Paradoxical Agenda Setting, and listed some really GOOD reasons NOT to open up more to her mother. I want to protect her because it may be hard and upsetting to her. I’m not used to being vulnerable with my parents. I don’t want to rock the boat or change the status quo. I’m not sure I want a closer relationship with my mother. NOTE: David and Jill were thinking that we often resist intimacy because we have negative pictures in our mind of what real closeness is. For example, if you think it means something yucky and upsetting, you obviously won’t want to get “close.” Jill tried to finesse around this by suggesting Keren might aim for a more “honest” relationship instead of a “closer” relationship. There are things about me that they’ve rejected, like the fact that I don’t really want children. And I’m not so sure I want to make myself vulnerable and get rejected again! I’m afraid I’ll get swallowed up and enmeshed. We asked Keren what kinds of feelings she was hiding from her mother. My feelings of nervousness and intense anxiety, and the intense somatic symptoms, like the knot in my stomach. I am scared for her future, since she is not in good health and she’s not taking care of herself. I have feelings of anger and resentment about the fact that I’m not the kind of daughter they wanted. I’m sad about her health and seeing her struggle. I feel hurt when I think how I have failed them and let them down. I sometimes feel like I don’t really belong. At this point, I became so absorbed in the session that I stopped taking notes, so you will have to listen carefully to the recording of the session which was fascinating. I do recall, however, that we began working on communication, using the Five Secrets of Effective Communication (LINK), as well as tips on how to proceed, taking it one step at a time and not trying to do it all at once, and role playing practice. Then we did some Externalization of Voices with the thoughts on Keren’s Daily Mood Log, using several strategies: Self-Defense, the Acceptance Paradox, and the CAT, or Counter-Attack Technique. You can see the Daily Mood Log she completed after the session, based on the work we did in the session, at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session In addition, Keren and Jill will be with us to record the follow-up. T = End-of-Session Testing You can review Keren’s BMS and EOTS (Patient’s Evaluation of Therapy Session) at the end of the session at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session As you can see, her depression score fell to 1, indicating substantial improvement, while her suicidal thoughts and urges remained at 0. Her feelings of anxiety vanished, but her feelings of anger remained fairly elevated, falling from 7 to 4. We would not expect further improvement in this dimension until she’s had the chance to share more of her feelings with her mom. Her feelings of happiness only increased from 10 to 13, again any further improvement would not be expected until she’s had the chance to do her “homework” following the session. However, her satisfaction with her relationship with her mom increased from 19 to 26 out of 30, which is substantial, while still leaving some room for improvement. On the EOTs, you will see that our Empathy and Helpfulness scores were perfect, along with our scores on the Satisfaction with Session, Commitment to homework, unexpressed Negative Feelings, and honesty scales. Here’s what she like “the least” about the session: “Nothing. This has been a powerful experience.” Here’s what she like “the best” about the session: “This has been empowering. The hidden emotion is like a blind spot. I know it is there, but I cannot see it. I loved when David pointed to my avoidance, and I am glad we focused on the hidden emotion. Jill and David were able to see the depth in situation and I feel seen and understood.” Follow-Up We exchanged a number of emails following the session, and will also talk to Keren and Jill live on the podcast so you can catch up on what happened. But here is an excerpt from one of Keren’s emails: Here is what has happened so far: On Friday morning, she made some comments about my gray hair and that the fridge gasket was not properly clean. I got really annoyed, but did not say anything. To be honest, I was too angry to use the 5 secrets and needed time to cool off. About after half an hour later, on our way to the acupuncturist, I told her that I love having her over and that it is special to me that we spend time together. She thanked me for everything that I am doing for her on this trip. Then I added: "this morning, when I came to check on you, you commented on my hair and then you told me to clean the fridge gasket..." I was going to follow up with 5 secrets, but before I was able to finish, she interrupted me and said "Gosh, I am so critical! I am sorry, I didn't mean it that way. I can see now why your sister gets upset with me. I can't believe myself." I told her that I love her honesty and while her criticism comes from a caring loving place the how and when she says things sets tone. This was a breakthrough because even though I did not finish using the 5 secrets I got through to her and felt heard. It was encouraging for me to feel that I could be understood and accepted by her.  I have clients who say that they love the 5 secrets, but like to call it the 3 secrets because they find it effective enough to use only 3. (I still encouraged them to use all 5). I can see now what they mean, I did not finish my 5 secrets spiel and got some good results. I believe that my conservation with my mother will further trickle during her stay. Perhaps because there is a lot to cover, or perhaps it's the way we communicate. In either case, I feel good about having the talks that I previously dreaded. I have not had any panic attacks since, but I don't think they have completely gone. I believe they will be there to remind me to address certain emotions that need addressing.. . . I will keep you posted and may even send this to the group. Just need to think about it a bit longer. Responses from the Tuesday Group who observed our work with Keren Here are just a few of the comments from the 35 therapists who observed the session. This is part of the feedback we get on the quality of our teaching at the end of every Tuesday training group. Please describe what you specifically disliked about the training/ Nothing. The live work was fascinating to watch. David and Jill were masterful as always! This was a truly moving and inspiring and helpful session. I can't think of anything I didn't like about it. Nothing I disliked. I think I would have liked to see Keren do more deliberate practice with the 5 secrets with grading and more roleplaying. Conceptualization was a bit hard to follow. Please describe what you specifically liked about the training. Thank you for such an authentic, moving, beautiful session. And tour-de-force demonstration of TEAM therapy. Observing David and Jill as co therapists in service of Keren was an amazing learning opportunity! The power between them was exponential and felt like they successfully addressed every angle. . .  I had not considered using EOV and loved how effective that was in crushing Keren's thoughts. I also loved how Jill finessed gently guiding her to address Hidden Emotion, having clear conviction that this was where the "action" was. I can understand what Keren said that she wants to be closer but does not want to be enmeshed. I think that it helped us in our work with immigrants and those who live away from where they were born. The discussion about the desire to be a parent or not, was another aspect of the work that I really respected. Excellent class tonight! Keren's gift to the class was priceless and David and Jill's masterful teaching was outstanding as always. Thank you!!! I got to feel closer to her and to several group members through their sharing. David touched me with the notion that opening up to one's parents is an important gift that many of them don't get to receive. Thanks for listening today! Rhonda, Keren, Jill, and David

When the Hidden Emotion isn't Hidden! Today’s podcast will feature a live therapy session on September 13, 2022 with Keren Shemesh, PhD,  a licensed clinical psychologist and certified TEAM-CBT therapist. The entire session was recorded and will be presented in two consecutive podcasts. The two co-therapists are Jill Levitt, PhD, a clinical psychologist, and Director of Clinical Training at the FeelingGoodInsititute.com. Part 1 of the Keren session I will summarize the work that Dr. Jill Levitt and I did with Keren according to the familiar sequence of a TEAM-CBT Session: T = Testing, E = Empathy, A = Assessment of Resistance (formerly Paradoxical Agenda Setting), and M = Methods, with a final round of T = end-of-session Testing. In today’s podcast, we will include the T, E, and A. In Part 2, we will include M = Methods and the final T = Testing. T = Testing Just before the start of the session, Keren completed the Brief Mood Survey (BMS) which you can review at this link: Keren's Pre-Session BMS As you can see, her depression score was only 3 out of 20, indicating minimal to mild depression. There were no suicidal thoughts, and her anxiety score was 10 out of 20, indicating moderate anxiety. She was also moderately angry (7 out of 20) and her happiness score was 10 out of 20, indicating very little happiness. Her relationship satisfaction level with her mother was 19 out of 30, indicating lots of room for improvement. However, she rated “degree of affection and caring” at 6 for “very satisfied,” which is the highest rating on this important item. We will ask her to take the BMS again at the end of the session, along with the Evaluation of Therapy Session, so we can see what the impact of the session was on her symptoms, as well as how empathic and helpful we were during the session. These ratings will be important, because the perceptions of therapists can be way off base, but the perceptions of our patients will nearly always be spot-on. Keren also brought a partially completed Daily Mood Log, which you can see at this link: Keren's Daily Mood Log (DML) at the start of the session As you can see, the upsetting event was her mother’s visit from Israel. She had moderately to severely elevated negative feelings in nine categories, along with 17 negative thoughts, along with her rather strong beliefs in all of them. Most of her thoughts were of a self-critical nature, with lots of Hidden Should Statements as well. E = Empathy At the start of our session, which took place in front of our Tuesday evening training group at Stanford, Keren described her struggles like this: On Wednesday I woke up at 3 AM with panic attacks, one after another, and no way of getting back to sleep. I get somatic symptoms, I felt weak, nauseated, with no strength, almost paralyzed, and emotionally unstable. This was four days after my mother arrived form Israel. In the last 20 years, she and my dad visited me only once, on my graduation. I always had to visit them in Israel every year and was frustrated they none came to visit me in the Bat Area. On my last visit in May, I expressed my frustration about them not visiting me. They took it to heart and made plans to come for the Jewish high Holidays. My mom arrived first a few days ago and It’s my first time alone with her. She’s a Jewish mom and she stresses me out. Of course, I was really excited when she first arrived, but after four days I feel overwhelmed. This is SO MUCH WORK! I feel sad. I’m afraid I won’t be able to function. I just cannot seem to enjoy my time with her. I feel fragile, but I’m hiding it. She’s 73, and the signs of aging are obvious now. She needs more care, and it’s tough to see her aging. Dad has always been super athletic, and he’s in great shape, but she doesn’t exercise or take care of herself. She’s frustrated about aging and is angry with us for not accepting her as she is. I don’t want to seem unhappy. I’m overwhelmed and just feel bad! David and Jill empathized, and Jill emphasized how much her parents must love her, coming from such a great distance to be with her, but also acknowledged how hard it must be for them and for Keren to be living at such a great distance. Jill pointed out that one of the issues Keren may be struggling with is the belief that their time together should be fun and conflict-free, since the time is so precious. Keren continued: My biggest problem is that I feel I cannot be me when I’m around them . . . . They want me to be a different version of myself. . . . They want me to be a mother, and they want grandchildren. But I’m in the 5% of women who don’t have any interest in having children. I’m 46 years old now, and I guess I could see myself adopting, but having a family is a big job, and I’ve never had the passion. So, I feel like I’m a disappointment to them. But we never talk about it. I sometimes feel invisible and unseen when I’m around them. They’d be so much prouder of me if I had children they could brag about. Keren also shared her frustration and anger with her mom for not taking better care of her health. Since her mom has been in town, Keren has arranged all kinds of fun activities for them to do together, but Keren’s joy is dampened by the many unspoken feelings she is constantly trying to hide, for fear of conflict and upsetting her parents. A = Assessment of Resistance Keren gave us an A+ in Empathy, so we went on to the Assessment of Resistance phase of the session, where we set the Agenda. Keren’s goal was to get over her panic attacks, and we discussed three possible treatment strategies with Keren: The Hidden Emotion Technique: This technique would be based on our hunch that Keren’s panic attacks are the direct result of the many feelings she is consciously, and subconscious trying to hide and sweep under the rug. Dealing with the self-critical thoughts on the Daily Mood Log she provided at the start of the session. LINK Using Forced Empathy to help her see the world through her mother’s eyes, as we did in a fairly recent podcast with Zeina, another member of our Tuesday training group who was in conflict with her mother. Keren expressed considerable enthusiasm for options 2 and 3. I (David) pointed out that she appeared to be ignoring / avoiding the first option, and raised the question of whether that meant it might be the most productive, but scariest, of the three options. Keren conceded that this rang true, and wanted to start out with learning to express her feelings more openly and directly, but in a respectful and loving way. In next week’s podcast, you’ll find out what happened! Part 2 of the Keren session: M = Methods We began the Methods part of the session with a bit more Paradoxical Agenda Setting, and listed some really GOOD reasons NOT to open up more to her mother. I want to protect her because it may be hard and upsetting to her. I’m not used to being vulnerable with my parents. I don’t want to rock the boat or change the status quo. I’m not sure I want a closer relationship with my mother. NOTE: David and Jill were thinking that we often resist intimacy because we have negative pictures in our mind of what real closeness is. For example, if you think it means something yucky and upsetting, you obviously won’t want to get “close.” Jill tried to finesse around this by suggesting Keren might aim for a more “honest” relationship instead of a “closer” relationship. There are things about me that they’ve rejected, like the fact that I don’t really want children. And I’m not so sure I want to make myself vulnerable and get rejected again! I’m afraid I’ll get swallowed up and enmeshed. We asked Keren what kinds of feelings she was hiding from her mother. My feelings of nervousness and intense anxiety, and the intense somatic symptoms, like the knot in my stomach. I am scared for her future, since she is not in good health and she’s not taking care of herself. I have feelings of anger and resentment about the fact that I’m not the kind of daughter they wanted. I’m sad about her health and seeing her struggle. I feel hurt when I think how I have failed them and let them down. I sometimes feel like I don’t really belong. At this point, I became so absorbed in the session that I stopped taking notes, so you will have to listen carefully to the recording of the session which was fascinating. I do recall, however, that we began working on communication, using the Five Secrets of Effective Communication (LINK), as well as tips on how to proceed, taking it one step at a time and not trying to do it all at once, and role playing practice. Then we did some Externalization of Voices with the thoughts on Keren’s Daily Mood Log, using several strategies: Self-Defense, the Acceptance Paradox, and the CAT, or Counter-Attack Technique. You can see the Daily Mood Log she completed after the session, based on the work we did in the session, at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session In addition, Keren and Jill will be with us to record the follow-up. T = End-of-Session Testing You can review Keren’s BMS and EOTS (Patient’s Evaluation of Therapy Session) at the end of the session at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session As you can see, her depression score fell to 1, indicating substantial improvement, while her suicidal thoughts and urges remained at 0. Her feelings of anxiety vanished, but her feelings of anger remained fairly elevated, falling from 7 to 4. We would not expect further improvement in this dimension until she’s had the chance to share more of her feelings with her mom. Her feelings of happiness only increased from 10 to 13, again any further improvement would not be expected until she’s had the chance to do her “homework” following the session. However, her satisfaction with her relationship with her mom increased from 19 to 26 out of 30, which is substantial, while still leaving some room for improvement. On the EOTs, you will see that our Empathy and Helpfulness scores were perfect, along with our scores on the Satisfaction with Session, Commitment to homework, unexpressed Negative Feelings, and honesty scales. Here’s what she like “the least” about the session: “Nothing. This has been a powerful experience.” Here’s what she like “the best” about the session: “This has been empowering. The hidden emotion is like a blind spot. I know it is there, but I cannot see it. I loved when David pointed to my avoidance, and I am glad we focused on the hidden emotion. Jill and David were able to see the depth in situation and I feel seen and understood.” Follow-Up We exchanged a number of emails following the session, and will also talk to Keren and Jill live on the podcast so you can catch up on what happened. But here is an excerpt from one of Keren’s emails: Here is what has happened so far: On Friday morning, she made some comments about my gray hair and that the fridge gasket was not properly clean. I got really annoyed, but did not say anything. To be honest, I was too angry to use the 5 secrets and needed time to cool off. About after half an hour later, on our way to the acupuncturist, I told her that I love having her over and that it is special to me that we spend time together. She thanked me for everything that I am doing for her on this trip. Then I added: "this morning, when I came to check on you, you commented on my hair and then you told me to clean the fridge gasket..." I was going to follow up with 5 secrets, but before I was able to finish, she interrupted me and said "Gosh, I am so critical! I am sorry, I didn't mean it that way. I can see now why your sister gets upset with me. I can't believe myself." I told her that I love her honesty and while her criticism comes from a caring loving place the how and when she says things sets tone. This was a breakthrough because even though I did not finish using the 5 secrets I got through to her and felt heard. It was encouraging for me to feel that I could be understood and accepted by her.  I have clients who say that they love the 5 secrets, but like to call it the 3 secrets because they find it effective enough to use only 3. (I still encouraged them to use all 5). I can see now what they mean, I did not finish my 5 secrets spiel and got some good results. I believe that my conservation with my mother will further trickle during her stay. Perhaps because there is a lot to cover, or perhaps it's the way we communicate. In either case, I feel good about having the talks that I previously dreaded. I have not had any panic attacks since, but I don't think they have completely gone. I believe they will be there to remind me to address certain emotions that need addressing.. . . I will keep you posted and may even send this to the group. Just need to think about it a bit longer. Responses from the Tuesday Group who observed our work with Keren Here are just a few of the comments from the 35 therapists who observed the session. This is part of the feedback we get on the quality of our teaching at the end of every Tuesday training group. Please describe what you specifically disliked about the training/ Nothing. The live work was fascinating to watch. David and Jill were masterful as always! This was a truly moving and inspiring and helpful session. I can't think of anything I didn't like about it. Nothing I disliked. I think I would have liked to see Keren do more deliberate practice with the 5 secrets with grading and more roleplaying. Conceptualization was a bit hard to follow. Please describe what you specifically liked about the training. Thank you for such an authentic, moving, beautiful session. And tour-de-force demonstration of TEAM therapy. Observing David and Jill as co therapists in service of Keren was an amazing learning opportunity! The power between them was exponential and felt like they successfully addressed every angle. . .  I had not considered using EOV and loved how effective that was in crushing Keren's thoughts. I also loved how Jill finessed gently guiding her to address Hidden Emotion, having clear conviction that this was where the "action" was. I can understand what Keren said that she wants to be closer but does not want to be enmeshed. I think that it helped us in our work with immigrants and those who live away from where they were born. The discussion about the desire to be a parent or not, was another aspect of the work that I really respected. Excellent class tonight! Keren's gift to the class was priceless and David and Jill's masterful teaching was outstanding as always. Thank you!!! I got to feel closer to her and to several group members through their sharing. David touched me with the notion that opening up to one's parents is an important gift that many of them don't get to receive. Thanks for listening today! Rhonda, Keren, Jill, and David

Ask David: Featuring Matt May, MD Can hypnosis be used for evil? Can you fall out of love? Why does cheerleading fail? In today’s podcast, we discuss three intriguing questions from listeners like you: Can hypnosis be used for evil? Matt says no, David mainly agrees, but isn’t entirely convinced. Is it possible to fall out of love? This can and will happen. What can we do about it? Empathy vs. Cheerleading: What’s the difference between cheerleading and genuine empathy with someone who’s upset? Can hypnosis be used for evil? David and Matt describe their experiences, both as kids and later as shrinks, with hypnosis. David and Matt both used hypnosis early in their careers, especially in David’s one-session treatment for smoking cessation, which Matt also used. But as their TEAM-CBT skills have grown, both of them use it much less frequently. It can be used for many purposes. In a recent podcast # (link) with Dr. Jeffrey Lazarus, we learned that it can be used for warts as well as a wide range of psychosomatic problems, like Irritable Bowel Syndrome and tics, as well as bedwetting, school phobia, performance anxiety, and more. Matt strongly believes that agenda setting (also called Assessment of Resistance) is just as important in hypnosis as in TEAM-CBT. You have to first bring the patient’s subconscious resistance to conscious awareness and melt it away using paradoxical techniques in order to optimize the chances of success with hypnosis. Matt pointed out that hypnotic states can be quite powerful, and can even be used for surgery, but emphasizes that people will never td what they genuinely don’t want to do when hypnotized. He says that hypnosis is really a form of willful collaboration between the hypnotist and the hypnotic subject. Although stage hypnotists seem to have some kind of “Svengali” power over the volunteers who come up to the stage to be hypnotized, these people are actually subconsciously volunteering to act silly and have fun in front of the audience. This doesn’t mean they are faking it, but it does put these shows into a slightly different perspective. David described many goofy things he did as a teenager after he purchased a book called “25 Ways to Hypnotize Your Friends” at a magic store in Phoenix for 25 cents, and found that the techniques actually worked with many of his friends. He sometimes had a lot of fun giving post-hypnotic suggestions, and that he and his friends found hypnosis to be incredibly exciting and fascinating. Once he hypnotized a friend named Jerry and told Jerry that after he woke up, every time he heard the word, “TV,” he would shout out “Boing” in a loud voice without realizing it. In addition, his subconscious mind would keep track of how many “TVs” he heard, and then he’d should Boing that exact number of times. David explains: Then we went to the local Dairy Queen a few blocks away all ordered at the window, one by one. When it was Jerry’s turn to order, and the lady asked him what he wanted, we all started saying “TV, TV, TV” as fast as we could, and Jerry would shout out “boing, boing, boing” in a loud, confident voice! She said, “I didn’t quite get what you want to order,” and when Jerry tried to order, we did it again. It seemed incredibly funny, and fun, but in retrospect I WAS using hypnosis to kind of take advantage of someone, so you might say it CAN be used for evil, perhaps. However, Jerry didn’t seem to mind, and we all thought it was a pretty exciting adventure. When I was a senior in high school, one of my teachers said that hypnosis was dangerous and told me to stop hypnotizing my friends, so I got scared and gave it up until I became a psychiatrist years later. Like anything, hypnosis is just a tool, and it can be helpful for suggestible individuals, but we have more than 100 techniques in TEAM-CBT, because no one tool has the answer for everybody and every problem. David and Matt both agree with anxiety, depression, and anger are very much like self-induced trances, since you are giving yourself and believing messages (hypnotic suggestions) that aren’t actually true. For example: The depression trance: “I’m no good. I’ll be depressed forever.” The anxiety trance: “Something awful is about to happen. I’m in incredible danger.” The anger trance: “You’re no good!” Psychotherapy can be seen as an attempt to get each patient to “wake up” from the trance that has trapped them. In David’s opinion, politicians sometimes put their followers in trance-like states, getting them to believe repeated suggestions that are blatantly untrue. We saw this in WWII, where Hitler essentially “hypnotized” an entire nation to believe some horrific lies and to spur them to unspeakably horrific actions. Of course, as Matt has pointed out, you have to WANT to be hypnotized, so possibly the German people wanted to see themselves as superior human beings who had been victimized unfairly by evil forces that needed to be eradicated. So, killing and the abuse of him beings became the focus and purpose of the nation. Is this possibly also happening today? And is that why narcissistic leaders want to control the media, so they can control the “hypnotic messages” that people get, and why they lash out in such a hostile way at anyone who dares to challenge or contradict them? Is it possible to fall out of love? A podcast listener says she often falls out of love with her husband, but after they talk things over, and resolve their differences, she falls in love again. She wants more on this topic, so Matt, Rhonda and David discuss the pitfalls of pursuing perfect, romantic love. David reminds us that some of the most successful marriages are in India, where the parents decide who you will marry. David said that when he was in private practice in Philadelphia, 60% of the patients he saw did not have a loving partner, and most were trying to find someone to love. That’s why this is one of his favorite topics. Then Matt, Rhonda and David contrast healthy vs unhealthy love, and Matt created the following table that contrasts them. Perfect Love By Matt with a little editing from David Unhealthy Love Healthy Love You rush to put the other person on a pedestal without knowing them. You fantasize that they are perfect and wonderful in every way. You take your time getting to know each other in a curious, vulnerable and respectful way, recognizing that neither of you is perfect. You believe that you need the other person and couldn’t be happy without them. You’re confident and content on your own but also enjoy the company of the other person. You selfishly focus on getting what you want from the other person. You focus on what you can give the other person, and what you can do, to improve the relationship. You imagine you will be in love forever. You accept that relationships require careful tending and nurturing, and realize that there will be moments of conflict, disappointment, and hurt feelings, which can sometimes be intense. You tell yourself that you’ll never and should never have any conflicts or disagreements. You see conflict as opportunities, in disguise, for greater understanding and closeness.   Cheerleading vs. Empathy Rhonda describes a recent traumatic experience which was profoundly disturbing to her. However, when she tried to tell a friend how upset she was, her friend did “cheerleading,” telling her that she shouldn’t be so upset, that she’d feel better again soon, and so forth. Rhonda said it was very annoying to be on the receiving end, and her friends efforts to cheer her up actually made her feel worse. Then, when two friends simply used the Five Secrets of Effective Communication to “listen,” it was a great relief. David recounted a similar experience when his beloved cat, Obie, disappeared in the middle of the night, and was likely killed by a predator animal in the woods behind his house. When David told his Tuesday group what had happened, one member of the group similarly tried to cheer him up, which triggered an angry rebuke from David, who told her NOT to try to take his grief away. He said, “My grief is my loving connection to Obie, who was my best friend in the whole world. I will grieve his loss for the rest of my life. And to this very day, I talk to Obie, as well as my good friend Marilyn Coffy who passed away recently, every time I go out slogging. This is not a problem that I need help with, but a gift of love.” We’ve touched on the codependent urge to cheerlead that so many people, including shrinks, have. For example, our podcast on “How to help, and how NOT to help,” covers this topic pretty thoroughly. However, we decided to focus on cheerleading again today, since it is such an important topic, and is a bit of an addiction that many people have. The following is a chart we discussed during the podcast, and you might find it helpful. Cheerleading vs. Empathy by David , Rhonda, and Matt Cheerleading Empathy You’re trying to cheer someone up to make them feel better. You are not trying to cheer them up. Instead, you acknowledge how they’re thinking and feeling, and you encourage them to vent and open up. You don’t acknowledge the validity of the person’s negative thoughts and emotions. In fact, when you try to cheer them up, you’re essentially telling that they’re wrong to feel upset. It’s a subtle put down, or even a micro-aggression. You find the grain of truth in what the person is saying, even if you think they’re exaggerating the negatives in their life.   Paradoxically, when you agree with them in a respectful way, they will typically feel some relief and support. The effect is irritating to almost everybody who’s upset, because you aren’t listening or showing any compassion or respect. You’re telling them that you don’t want to hear what they have to say. Cheerleading is condescending. Listening and acknowledging how they feel is a form of humility and an expression of respect. You’re trying to control the other person. You’re telling them how they should think and feel. There’s no acceptance. You’re sitting with open hands and not trying to change or control the other person. You’re just trying to understand and support them in their suffering. Cheerleading is cheap and easy to learn. You’re like a used car salesman, trying to promote your product. Empathy is difficult and challenging to learn because you have to let go of the idea that you know what’s best for other people. Listening requires going into the darkness with the other person, this requires courage and vulnerability. You say generally nice things about someone, like you’re “a good person,” or “a survivor,” thinking those formulaic words will somehow change the way the other person is thinking and feeling. You might also say, “don’t be so hard on yourself,” or “think of all the positive things in your life,” or “you’ll be fine.” You focus on the other person’s specific thoughts and zero in on exactly what they’re saying and how they might be feeling, rather than throwing vague, general positives at them. These positives are simply an annoying attempt to distract the person from their genuine feelings. You encourage the person to share and experience their negative thoughts and feelings. You believe your role is to “help,” “fix” or “save” the other person, who is broken. Your role is to be with the other person in a loving way without trying to help or save them. You are being self-centered because you’re essentially preaching the gospel and exclusively promoting your own ideas. You are being other-centered, focusing entirely on what the other person is saying. You’re talking “at” the other person. You are NOT talking AT them, you are being WITH them. When you empathize, you give the other person zero, and zero in, instead, on how they’re thinking and feeling. That’s why I (David) call Empathy the “zero technique.” But, paradoxically, when you give them “nothing” you are giving them “everything.” In case you’re interested in honing your own empathy skills, you can take a look at the Five Secrets of Effective Communication (link). To develop these skills, you might want to read Feeling Good Together (link), but make sure you do the written exercises while reading. Otherwise, you’ll only get intellectual understanding of them, whereas skill is what you actually need, and that can only be developed with practice! Sadly, most people, including therapists, believe that their empathy skills are already excellent, but that is rarely valid! In fact, there’s a ton of room for improvement in ALL of us! We thank you for joining us today. Please keep your excellent questions and warm comments coming in. Rhonda and David want to thank Matt for his frequent, brilliant, and heart-warming appearances on the Feeling Good Podcast. Remember that we’re still trying to grow our show, and recent hit 6 million downloads. We are currently getting around 160,000 downloads per month, which is terrific. It would help us a lot if you give a five star review for our show wherever you get your podcasts, as that might boost our ratings. We love our fans and thank you for listening!

Horrific World Events: Can TEAM-CBT Help Us? Featuring Live work with Meina Last week, we presented Part 1 of the session with Meina, a young woman struggling enormously because of her feelings about the new Iranian revolution. Today, we present the exciting and unexpected conclusion and follow up of the incredible session with Meina. Part 2: The Conclusion When Meina returned, her mood scores were very similar to what they’d been at the start of the previous session. This indicated that empathy alone was not sufficient to trigger any meaningful changes in how she felt. She said that she’d had some fears about what listeners might think, since, as we mentioned, Meina rarely, if ever, opens up about how she’s feeling inside, so talking openly on the podcast definitely means facing her fears and venturing into some radically new territory. The ineffectiveness of Empathy alone is important, because she graded our Empathy as an A+. Many therapists wrongly believe that empathy is the most healing tool we have in therapy. This is idealistic, but wrong. Empathy is definitely important, but without the A and the M of TEAM-CBT, very little, if anything, will change. And, in most instances, patients appreciate good listening, that’s for sure, but they want more. They want tangible changes in how the feel and interact with others. Today, Meina showed more emotion. She mentioned that she’d been a Michael Jackson fan, and liked his song about how our (inner) voices don’t get out. She was feeling tearful, and angry, and said that in her work, her voice was not coming out, and this was a matter of great distress. She also mentioned that after she cried and expressed her rage about the young woman who was murdered by the morality police, an annoying “eye twitch” that she’d had for six months suddenly disappeared. Meina has also had many experiences in the past of experiencing health anxiety symptoms whenever she’s upset about something and hides or suppresses her negative feelings, like anger. She had participated in many of David’s Sunday hikes before the pandemic, and sometimes had weird somatic sensations, fearing she had some neurologic disorder, only to have her symptoms instantly vanish when she finally expressed her anger. Many of you will recognize this as David’s “Hidden Emotion Technique.” She also said she’s afraid she’ll be seen and stereotyped as an “angry woman” if she shows her anger, and said she may even have an Anger Phobia, thinking that anger shows that you’re a “violent person.” She said that she’s always been quick to get angry, and wanted to focus the session on anger. Her goal for the session had shifted in the two days since we did Part 1, and she now wanted to learn how to express her anger more effectively. M = Methods In the rest of the session, we used the TEAM interpersonal model to deal with an intense conflict Meina had recently when she was trying to get her colleagues to issue a statement on behalf of her institution supporting the women in Iran who were protesting, and had partially complete the Relationship Journal in preparation for today’s session. As you may recall, when you use the RJ, you will discover—and this can be quite shocking—that you are actually causing the very relationship problems that you are complaining about. And this came as a huge surprise to Meina. The remainder of the session was incredibly inspiring, and Mina did some magical work. I’ll let you listen to the rest of the session to see how the work unfolded. If you’d like to review Meina’s RJ, you can click this LINK. End of Session T = Testing If you’d like to see Meina’s end-of-session mood ratings, along with her Evaluation of Therapy Session, you can check this LINK. If you’d like to refresh yourself on the Five Secrets of Effective Communication, you can click this LINK. I was incredibly proud of the brilliant and inspiring work that Meina did during this session. She experienced the “Great Death” of her “self,” along with the “Great Rebirth,” or the “waking up” of the “non-self.” At the start of this podcast, we asked the question of whether TEAM-CBT could be of help when people are struggling because of events that are both real and horrific. Now perhaps you see my answer: a resounding and unexpected YES. However, there are a couple of disclaimers. First, the person has to be asking for help, and Meina definitely was. Having an agenda that makes sense to the patient is always, in fact, one of the most important keys to successful therapy. Second, the therapy will usually be totally unexpected, and the work we do with each person will be highly individual. We’re not in the business of creating simple formulas to deal with this or that problem. Instead, TEAM emphasizes a step-by-step process which will be unique and totally different for every person you work with. And finally, we have to thank our old friend, Epictetus, for once again reminding us that our feelings do not result from what’s happening, but rather from our thoughts about it. And the goal is NOT to blame you for the way you feel, but rather to give you the key to unlock the door and free yourself from the suffering you’ve endured. Meina, Rhonda, and I hope the incredible and brave work that Meina did in this session will be helpful for you, too!

Horrific World Events: Can TEAM-CBT Help Us? Featuring Live work with Meina Today, we see lots of horrific events, and violence and hatred seem to be on the upswing. There are the repeated and horrible mass shootings in the US, the horrific war in the Ukraine, and the extensive protests that are rocking Iran. Those problems are real, and terrible in reality. So, maybe the TEAM-CBT model, with its emphasis on our interpretations of reality, and our relationships with others, might seem like irrelevant and useless tools. Or are they? Let’s check it out. Sometimes, as you’ll see, things can a take sudden and unexpected change in direction in TEAM-CBT if you follow the energy. There is no “formula” for treating anything. We treat humans, not diagnoses or problems. But we do go through the T, E, A, M model in a systematic way so we can find out what, if anything, each patient wants help with, and then design an individualized plan to make that happen, if possible. Part 1 T = Testing Today’s guest, whom we’ll call Meina for protection, migrated to the United States from her mother country, Iran, as a young woman, and she’s definitely upset. In fact, her mood scores are among the most severe that I’ve seen recently. Her depression score of 15 out of 20 indicates severe depression, and her anxiety and anger scores of 19 and 20 out of 20 indicates extreme anxiety and anger. You can see Meina’s Daily Mood Log at the start of the session as well, with nine categories—depression, anxiety, guilt, loneliness, humiliation, hopelessness, frustration and hatred all estimated between 90 and 100 out of 100, again confirming the most extreme upset a human being can experience. As you might expect, her happiness score was 0 out of 20, indicating no happiness at all, and her Relationship Satisfaction Scale score, thinking of her husband, was only 19 out of 30, indicating considerable marital distress. What’s causing those feelings? Well, let’s take a look at her negative thoughts and how strongly she believes them: I’ll always suffer because of being born in Iran: 90% My heart will stop from feeling so much hatred. 80% There’s nothing I can do to help (the women who are protesting.) 100% It is pathetic that I can’t stop feeling so angry. 90% I’m going to get sick because of these feelings. 90% Many young women will be tortured and killed. 100% I’m going to lose all my friends because I’m so angry. 70% My marriage will also be negatively impacted. 100% E = Empathy In the empathy phase of the session, Rhonda and David simply listened, as Meina described terrifying memories of the being a child during the Iran Iraq war, and being left alone to care for her younger sister when her parents were away every day, and bombs were coming down all over the city. She said that on many occasions she was so scared that she wanted to commit suicide by jumping out of the window of their apartment in Iran. And now, all those terrifying memories have come flooding her mind again, triggered by the events in Iran, as well as her fears and run-ins with the “morality police” when she was a young woman. She expressed profound connection with the young women who are now fighting the intense suppression of human rights in Iran, all in the name of religion! Once their car was stopped, and a policeman put a gun to her mother’s head because she had not covered her hair properly. She also described the attempts always to separate the girls and the boys to prevent any type of dating or romantic behavior, and the constant fear of being imprisoned if you did the wrong thing. Meina tells us: I saw friends who were beaten up, and was humiliated for eating an apple. I was arrested for wanting to go to parties to listen to music. I lived in constant fear of being tortured and had panic attacks by night and by day. . . I left Iran when I was 22 and have never gone back, for fear of ending up in prison. . . Then, when I finally escaped to the United States, I never fit in. The young people were interested in the latest music, and did not seem interested in my story, in my experiences. I never felt like I fit in. I think I’ve felt lonely my entire life. Now I feel embarrassed, being from Iran, because it’s such a violent country. . . And I have panic attacks every night. I cope by imagining that I’m in Iran, visiting and counseling girls who have been imprisoned, and giving them tips on how to use the Five Secrets of Effective Communication so they won’t be tortured, raped, and murdered. Meina said she still feels alone, since few people, including her husband, are really interested in her story, including her horrific memories of growing up in Iran, or how she feels now. She said she also feels intensely guilty, since she still has friends and one relative in Iran who are facing desperate circumstances, while she enjoys comfort and safety here in California. She rated us as an A+ on empathy, so that brought us to A = Assessment of Resistance. She added that she always hides her emotions, something she learned to do for survival in Iran, and that she’s afraid to let them out, and continues to hold and hide them. As a result, she struggles with constant tension and anxiety of constantly hiding her anger. David commented on the paradox that she looks chipper and in control, and can be funny at times. But she feels incredible loneliness because other people rarely know or care about how she actually feels. She added: What if I’m just being selfish. Maybe I shouldn’t complain so much! A = Assessment of Resistance Meina said this about her goals for the session: I know I’m not in a position to change what’s happening in Iran, but what I do want help with is the fact that I’m so overwhelmed with negative feelings that I’m losing my effectiveness at work and I also don’t seem to be able to connect with my friends and colleagues. I don’t want to have such hatred and anger for the morality police. And I don’t want all those painful memories to keep coming back and ruining my life, like my uncle and grandmother who suffered from dementia and almost constant terror towards the ends of their lives. At this point, we ran out of time, and had to schedule the remainder of the session two days later. End of Part 1 Tune in next week for the fantastic and unexpected conclusion of the work with Meina!

Audrey Kodye Sunny Choi Diversity: Trauma and Training featuring Sunny Choi and Audrey Kodye Rhonda and I are proud to feature Audrey Kodye, a psychologist with a private practice in Canada, and Sunny Choi, LCSW, who specializes in the treatment of underserved populations in the San Francisco Bay Area. In today’s podcast, these beloved TEAM-CBT therapists bring us an important discussion on the impact of racial, gender, religious and sexual bias, including tips on how to incorporate relevant questions into our initial evaluations of all new patients, as well as illuminating ideas on how to maximize treatment effectiveness with TEAM-CBT. Both Audrey, who was born in Mauritius, and Sunny, who was born in Hong Kong, describe their experiences with bias and violence, both when growing up, and as adults, and how these experiences shaped core feelings of not being “good enough.” Sunny explained that how he incorporated the negative messages that were triggered by his traumatic experiences: I grew up in a privileged family in Hong Kong, and was favored as a male child. When we came to the United States, I was 12 years old and undocumented. I got beaten up because I had slanted eyes, and I was hated because I was gay. I worked super hard, getting a degree in engineering from UCLA and a master's in management from Stanford, and became successful, but got more and more depressed due to my belief that I “wasn’t good enough.” Now I work with marginalized populations, the poor, people of color, LGBTQ, immigrants, and abused women. Audrey said: I’ve also felt like I wasn’t good enough. . . . I’m a light-skinned black woman from Africa, from a lower-class family in Mauritius. . . . My ancestors had to be very resilient due to prejudice, and I’m very proud of them. I’ve also struggled with social anxiety and depression due to the racial trauma I’ve experienced. Sunny and Audrey have both been helped by TEAM-CBT, and feel it has a great dealt to offer and have appreciated that diversity is celebrated in the personal work so many people do in David and Jill’s Tuesday training group. They say that “TEAM has helped us and our patients as well!.” They gave some valuable tips on how to incorporate diversity awareness in to treatment with TEAM, but the same tips would be helpful to anyone interacting with a friend or colleague who may have been the victim of abuse. Sunny added: “I got scared and anxious when thinking about this topic prior to today’s podcast. What I’ve been through has definitely shaped my behavior, my thinking, and my feelings, and the hatred is still happening today.” He tearfully described the experience of his cousin who has a Chinese restaurant in Oakland, and someone threw a rock through the window to act out on their hatred for Asian Americans. Audre said: "I also felt sad and anxious while preparing for the podcast. It’s not easy to talk about racism and discrimination, and I felt a lot of self-doubt about my own experiences with racism and discrimination before the podcast, because they have so often been invalidated. People get defensive and are often incredulous. They don’t believe it. So you run into conflict and opposition and defensiveness when you try to speak out." David agreed and emphasized how sensitive and defensive people can be when our “blind spots” are confronted, especially when we’ve been in a state of denial, thinking of ourselves as totally innocent when we’re not! They discussed three keys in thinking about racism and discrimination: Systemic racism: the Five Secrets of Effective Communication can be helpful. For example, it is important to acknowledge the anger your patients may feel because of the injustices they experience. Micro-aggression: These are subtle put-downs that may sound like compliments, and might even be intended as such, but are really hurtful. For example, when learning that Sunny is gay, someone may say, “Well, Sunny, you certainly don’t act gay!” This statement, which might sound innocent, actually implies that you’re “less than” or “less of a man” if you’re gay! Internalized oppression: This is when the person who is being targeted turns against himself or herself, and internalizes the message that “I’m not good enough,” or “I’m defective.” David points out that this is similar to Freud’s model of depression, which he thought of as “anger turned inwards.” Although Aaron Beck railed against this construct, I have to admit that the negative thoughts of people who are depressed nearly always do have a hostile, bullying tone. David also compares racial discrimination and hatred to the three components of “Abuse Contract” he often explains in his work with abuse victims. There are three parts to the contract: I get to abuse you, physically, psychologically, sexually, or financially for my please. We have to keep it secret. If you ever tell on me, or even imply that I’m doing something wrong, I’ll REALLY hurt you. It’s all your fault. You’re the dirty bad one, and you deserve what I’m doing to you. I’m a god who is superior and without fault. And in spite of the absurdity and cruelty of this “contract,” human beings seem to have the capacity to buy into it, and this includes children and adults as well. Sunny also emphasized that Asians especially are told NOT to be angry, and that’s why it can be so helpful to use the Five Secrets with trauma patients as well as Positive Reframing to encourage acceptance of anger and seeing that it can be entirely healthy and justified. Sunny and Audrey provided additional tips on working with marginalized groups. The most important thing is to ask about trauma and encourage the person to talk about it, as opposed to keeping these experiences hidden, even in therapy. He They said that many patients will open up immediately, and will often use the entire therapy hour just venting. The experience of being heard and supported can be deeply appreciated, and can also provide important clues to the origins of the patient’s feelings of depression, shame, and anxiety. Simple, obvious questions are all that are needed, such as: “Have you ever experienced racism, rape or sexual trauma, or homophobia. Have you ever been bullied or beaten? Sunny gave many additional examples of subtle racism when he was working in Silicon Valley as a manager. But colleagues he didn’t know often thought a person he was supervising was the manager, and he was the person being supervised. Audrey described similar experiences when people told her she was super smart, and that was probably because she was “mixed”--that is, not purely of African descent--or because she’d worked “really hard,” implying others who belong to her ethnic group do not. Again, an apparent compliment which is really a subtle put-down. Sunny tearfully described how he took years and years of voice training, trying to change his accent to sound “less Chinese.” Now he says, “I finally feel okay with who I am!” Although, I think Rhonda and David might say, Audrey and Sunny, we love you, and you’re way more than “okay” in our eyes. You’re our teachers and you’re showing us the way, and making us aware of our own many errors and biases, in a kindly and loving way. Thank you!” Thanks for listening today! Rhonda, Sunny, Audrey, and David

TEAM-CBT with children and teens, featuring Jeffrey Lazarus, MD Tics, Irritable Bowel Syndrome, Chronic Pain, Bedwetting, Fears, Phobias, Performance Anxiety, and more In TEAM, we usually conceptualize four categories of problems: depression, anxiety disorders, relationship problems, and habits and addictions. Although there are similarities in the treatment of each of these targets, there are also important differences. Today’s guest, Jeffrey Lazarus, MD, is a pediatrician who specializes in a fifth category, somatic complaints, which can include physical symptoms like chronic pain, dizziness and fatigue without any known medical cause. This category also includes as irritable bowel syndrome, headaches, tics with and without Tourette syndrome, bed wetting, and a wide range of other problems which are common in kids and sometimes in adults as well. Dr. Lazarus also works with anxiety disorders, such as test anxiety, sports performance anxiety, public speaking anxiety, school phobia and more. Although Dr. Lazarus worked as a general pediatrician for the first 27 years of his career, he switched to hypnotherapy when the painful plantar warts on his feet were unexpectedly cured following a single hypnotherapy session from a colleague. Dr. Lazarus was so impressed that he began studying hypnosis and incorporating it into his work with children, teens, and adults. He now works from a TEAM perspective, incorporating Testing, Empathy, Paradoxical Agenda Setting (also called Assessment of Resistance), and a variety of cognitive methods, along with hypnosis. He began today’s podcast with a case of a young man he was treating for persistent bed wetting, and was surprised when his patient slammed him in the written feedback on the Evaluation of Therapy Session form following the session, labeling Dr. Lazarus as a bit “narcissistic.” At the start of the next session, Dr. Lazarus responded non-defensively with the Five Secrets of Effective Communication. This won the boy over, leading to a successful outcome. Jeff said that the Evaluation of Therapy Session form and the Five Secrets have “saved him” on several occasions with disgruntled patients. Jeff then presented several fascinating cases where motivational factors and resistance played a major role in the treatment, and emphasized that treatment failure would probably have been inevitable if these factors had not been brought to conscious awareness. For example, a teenager who frequently had to go home from school because of somatic symptoms listed, at Dr. Lazarus’ suggested, the many advantages of his symptoms, such as “I don’t have to go to school,” “I get extra attention this way,” and more. After this intervention, the boy decided that it just wasn’t worth it, because there were lots of fun things he was missing out on at school, and his symptoms rapidly subsided. In another case of bed-wetting, Jeff discovered that a 10-year old knew that he wouldn’t be permitted to go on sleep overs at his cousin’s house until he outgrew his bed-wetting problem. But when he “listened” and encouraged the boy to talk about his distress, the boy explained that his cousin had a “creepy dog” that frightened him, so he actually didn’t want to go on sleepovers. Jeff encouraged the boy to tell his parents what was really going on, and when his mother said he wouldn’t have to go on any sleepovers unless he wanted to, his bed-wetting suddenly disappeared. He described many additional cases where motivational factors dominated his patient’s problems, including a promising teenage tennis star who suddenly developed a fear of flying which made it impossible to go with her parents to important weekend tournaments. But with Dr. Lazarus’ support, she confessed that her life was dominated by school, study, and going to tennis tournaments, with no free time to be a “normal teenager.” She finally confided that she was just “tennissed out” and wanted to have more fun in life, to have dates, and so forth. By subconsciously developed a flying phobia, she was subtly going on strike, and saying “I don’t want to do this anymore.” But by developing a symptom, she could continue to be nice and say “I can’t do this,” rather than saying “I don’t want to do this anymore.” These subconscious maneuvers are not manipulative, but automatic. When brought to conscious awareness, the patient finds himself or herself in control, and can decide to go in a different direction. This patient mustered up the courage to tell her parents and her coach, who were understanding, and her fear of flying suddenly disappeared as mysteriously as it had first appeared. Dr. Lazarus emphasized that the child’s complaints are real—they’re not making up the symptoms, and they need empathy and support, and the chance to tell their story. Parents are nearly always focused on “pushing” and “helping,” efforts that just make the problem worse because the child pushes back. Although parents do this out of love, their misguided efforts to “help” can actually be a barrier to successful treatment. Jeff said he often does what he respectfully and affectionately calls a “parentectomy,” which means encouraging the parents to stay out of the picture regarding the individual patient problem and homework he assigns. I have called this tendency of symptoms to be hiding the patient’s actual motives the “Hidden Emotion Phenomenon,” and it’s equally common and powerful with adults with anxiety disorders as well. Essentially, anxiety prone individuals, including children, teens and adults, tend to be exceptionally “nice,” and are often people pleasers. So, they may not always listen to their feelings, which then turn out indirectly, as this or that type of anxiety or somatic complaint. Essentially, the symptoms are saying what the patient’s mouth cannot say! Instead of trying to solve the problem, you can view the symptoms as a subconscious solution to a problem that’s being suppressed and not verbalized. Bringing the problem to conscious awareness can make it possible for adult and young patients to express their needs and feelings directly, which typically leads to a rapid disappearance of the initial complaint. If you’d like to learn more about Jeff’s fascinating clinical work, and perhaps learn more about this ‘Hidden Emotion” phenomenon, and how he integrates hypnosis with TEAM-CBT, you can view a number of resources, including video clips from actual therapy sessions, at his website, JeffLazarausMD.com And, if you’d like, you can contact him directly at JeffLazarusMD@gmail.com. Thanks for listening today! Rhonda, Jeff, and David

Ask David: Featuring Matt May, MD 1. Roy asks: How can I challenge my core belief that there is something wrong with me? 2. Lynn asks: Do you have any recommendations for someone with health anxiety? Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways. 1. Roy asks: How can I challenge my core belief that there is something wrong with me? Hello Dr .Burns, Regarding podcast 294, I had a few quick questions/suggestions on acceptance. Is it possible to do a podcast with you and Matt and Rhonda on one specific core belief? The belief: There is Something Wrong With Me Let me explain. I have dated and had relationships with some very physically attractive women in the past. In the last year I have not been able to duplicate these past successes and I suspect it's because I am at least 10 years or more older than these women ( 23-28). Let's say I NEVER EVER date or have a relationship with my specific type EVER again? This has caused a ton of frustration and some depression ( low) but has been a bit to my self image and self esteem Thoughts? Thanks Dr. Burns Roy David: At my request, Roy provides more information on his Core Belief: There is something wrong with me. Why believe it? 1. My parent said "What's wrong with you?" whenever I got in trouble in school ( infers there IS something wrong with me) 2. It feels like there is something wrong with me 3. I make mistakes and am not perfect so there MUST be something wrong with me I believe this Core Belief to be 100 % True David: I asked Roy to provide a Daily Mood Log. DML Activating Event: 3 specific events A) My ex girlfriend dumped me and ended our relationship B) A woman I suspect is a super model said No to my request to go out on a date C) I have recently struck out with the last 5 women I REALLY want to date. They ALL rejected me Feelings: Depressed/Down/Unhappy (70%) Worthless/Inadequate/Defective (80%) Unloved/Rejected (95%) Hopeless/Discouraged (99%) Frustrated/Defeated (99%) Resentful/Irritated/Upset (99%) Negative Thoughts 1.There is something wrong with me (100%) 2. I must get this specific woman's love and approval to feel good about myself (80%) 3. If I am a sexy charming guy then this woman would find me attractive. I must not be very attractive (100%) 4. If I played in the NBA or NFL then this woman would be attracted to me (100%) 5. The sex would be amazing if I were to be intimate with this woman (100%) 6. I would be so much happier if I was to have a relationship with this woman (100%) 7. Women like her with incredibly sexy attractive bodies only go for high status millionaires. I am not a millionaire. It's awful I am not a millionaire (100%) 8. I am 10 years older than these women and therefore my age turns them off (100%) David wrote back, suggesting that Roy list the benefits of his belief that “there’s something wrong with me.” Positives of believing There is Something Wrong With Me Very easy explanation why these specific types of women reject me I don't have to make any changes about myself ( clothes) or behaviors ( more charming) Familiar feeling and comfort in familiarity I can feel sorry for myself and have a pity party Gives me something to complain about with my friends lol My fantasy ( sexual and relationship) of these specific women remains unchallenged and is a great distraction when bored Shows I accept I am not perfect and defective I accept responsibility for my failings Don't have to get angry or upset about my mother's poor parenting skills Incredibly easy cop out whenever I fail to achieve any type of goal Can quit working towards a goal when face adversity Next, Roy identified some distortions in this belief. Distortions in believing There is Something Wrong with Me -emotional reasoning -self blame -overgeneralization Why? Feels like there is something wrong with me. I am assuming 100% blame. I am not focused on any positive things done in my life I am stuck because my mother said what's wrong with you when I was a kid. I concluded there must be something wrong with me. Whenever I get rejected this core belief surfaces. Is this what you had in mind? All the Best and THANKS Roy David’s response Hi Roy, Thanks for the email. Everything about you and me could be improved. Is that all you mean when you say “there’s something wrong with me?” Or are you saying you have a “self” that is somehow damaged.? If so, was your “self” always damaged, from the time of birth? Or did it “become damaged” at some point? If the answer is yes, at what point did your “self” become “damaged?” To me, conversations about “selves” have no meaning. Conversations about specific flaws or problems do have meaning. You are kind of kicking your dating problem up into the clouds of abstraction, to my way of thinking, when you obsess about a “damaged self.” Lots of colleagues who used to come to my Sunday hikes had dating problems, in your age range, and most eventually solved them. But talk about “damaged selves” was never part of the dialogue that I can recall. I wrote a book on dating, Intimate Connections. Just my thinking! d More from David after an email exchange I don’t think you answered, or attempted to answer, my question. One problem is that you would like to date and have sex with more younger women who are in great shape. That is something specific and clear. I understand it, anybody can make sense of what you are saying. When you say, “In addition, I believe I have a ‘self’ that is defective (or whatever), I don’t “get” what you are talking about. Can you explain this at the fourth-grade level? Do you mean that you get upset when you get rejected? Is that all you mean? Or do you mean that you get frustrated and disappointed when you cannot get a date with X, Y, or Z woman? Nearly all men have these reactions at times. Does this mean there is “something wrong” with their “selves?” There are lots of reasons why woman A might not be attracted to man B. Do you agree? Which reason makes the man’s “self” not good enough. She may not be attracted to him because he is chasing her, for example. This means that his dating style needs some fine tuning, and perhaps that he needs to learn to be happy when he is alone, and that he does not “need” love or her love, etc. Those are specific things, easily changed. But I don’t get the “self” bit! We all having varying qualities and ratings. Take math. Everyone has a certain skill in math. 50% of people are above average, and 50% are below average, in math. Do you agree? Is there some skill level that means that there is something “wrong” with your “self?” Thanks! D On today’s podcast, Rhonda, Matt and David discuss effective and ineffective approaches to dating, including a mind-set that may be a huge turn-off to women. They also illustrate how to challenge some of Roy’s distorted thoughts using three strategies: Self-Defense The Acceptance Paradox The CAT, or Counter-Attack Technique Matt and Rhonda speculate that Roy may be harboring some anger toward his mother, and toward women in general. David is less convinced, but more focused on change in the here-and-now, regardless of causes, which can sometimes be difficult to prove. At any rate, if Roy’s goal is to develop more loving and rewarding relationships., there are many available tools. 2. Lynn asks: Do you have any recommendations for someone with health anxiety? I am a long time fan of your work, and I have a long history of health anxiety. My therapist tells me that this is really death anxiety. I'm not sure I agree...but do you have any recommendations for someone with health anxiety? ( imaginal exposure therapy has not been helpful) I'd be eternally grateful for any insight. David’s reply Thanks for the kind words, Paul. I will try to include this in an upcoming Ask David segment! Matt’s reply: Using uncovering techniques, like the ‘What if’ technique, Hidden Emotion, Downward Arrow and Interpersonal Downward Arrow could help answer this question.  If you had a problem with your health, what would you worry about, most?  If you were having a problem with your health, what would you worry about, in terms of how other people would treat you?  What would it mean, about you, if you had a problem with your health.  Identify the specific negative thoughts behind your suffering will help your therapist identify methods that could help you.  As far as Death Anxiety, you could consider a chapter in Feeling Good, where David breaks this fear down into more specific parts.  Are you afraid of the process of dying?  The moment of Death?  What comes after?  If so, what are you afraid of, specifically?  Most people don’t fear Death, it doesn’t really exist, like a shadow, just the contrast to something real, Life. In the podcast, Matt, Rhonda, and David emphasize the role of the Hidden Emotional Model in the treatment of Health Anxiety, and describe two dramatic cases involving rapid recovery, one of them personal—David’s belief he had a lymphoma in his armpit shortly after completing his psychiatric training. The other involved a college student with a long history of health anxiety who David and Matt hypnotized. While in the trance, she suddenly “remembered” what she was actually upset about, and burst into tears. This was a life-changing moment! Thanks for listening today! Matt, Rhonda, and David