Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

Podcast #280: A Beloved and Brilliant Voice from the Past: Dr. Stirling Moorey! Rhonda and I are thrilled to welcome Dr. Stirling Moorey, from London, England, to today’s podcast. Stirling was one of my first students, and he sat in with me my on all my sessions as a co-therapist for a month for two summers in the late 1970s. I wrote about Stirling in my first book, Feeling Good: The New Mood Therapy, which was published in 1980. One of the miracles of the internet, and zoom, is the chance to reunite with friends and colleagues from the past. Needless to say, Rhonda and I were SO EXCITED when Stirling accepted the invitation to join us! Rhonda starts the podcast by saying that “Dr. Stirling Moorey had the good fortune to be trained and supervised by two pioneers in the field of cognitive therapy, Drs. Aaron Beck and David Burns. In 1979, when Stirling was still in medical school in London, he did an elective with Dr. Aaron Beck at the Centre for Cognitive Therapy in Philadelphia.“ I (David) might put it a bit differently. I would say that during the early days of cognitive therapy, I had the fantastic opportunity to do co-therapy together with Stirling with many patients. I learned a tremendous amount from Stirling, even though I was, in theory, the “expert” and he, in theory, was a totally untrained and green novice. But he was phenomenal right out of the gates, and those months were among the happiest of my life. What I learned by observing Stirling’s superb interactions with my patients eventually morphed into my Five Secrets of Effective Communication and my first book, Feeling Good Together! Rhonda continues: "Stirling was one of the first British therapists to study CBT when that discipline was in its infancy. David described their fantastic collaborative work with Stirling in Feeling Good, and has described Stirling’s brilliant empathy skills in dozens of workshops. Stirling is currently a Consultant Psychiatrist in Cognitive Behaviour Therapy, and was the Professional Head of Psychotherapy for the South London and Maudsley Trust from 2005-2013. He has been a Visiting Senior Lecturer at the Institute of Psychiatry, Psychology & Neuroscience in London." Stirling is a highly regarded therapist, trainer / supervisor / teacher and workshop leader. His main research interest is in the application of CBT to life threatening illness and adversity. He was one of the first therapists to develop CBT for people with cancer and has contributed to five randomized controlled trials in both early and late stage cancer. Stirling is also co-author with Steven Greer of The Oxford Guide to CBT for People with Cancer, and has co-edited a book entitled The Therapeutic Relationship in Cognitive Behavioural Therapy, published by SAGE (Moorey & Lavender, eds.) During today’s podcast, Stirling reminds us that one of the aims of cognitive therapy is encouraging patients to examine their distorted negative thoughts and self-defeating beliefs in a way that is not threatening. If patients don’t feel validated, they may feel attacked and become defensive, which, of course, can undermine the therapist’s effectiveness. He also reminded us that the grandfather of cognitive therapy, the late Dr. Albert Ellis from New York, often attacked the beliefs of his patients in a somewhat aggressive manner, and that this can frequently trigger therapeutic resistance. In fact, an overly aggressive therapeutic style can split patients and colleagues into two camps: those who love you, and those who may stubbornly resist and oppose you. During the podcast, we reminisced a bit on shared memories, and Stirling said that “David took me under his wing with such willingness to share his knowledge and experience . . . and I was just an ordinary medical student. We had many great moments!” Although Stirling was tempted to relocate to America, he decided to remain in England, and has never regretted that decision. For one thing, he met and married his beloved Magda. My own wife, Melanie, and I were honored to take our two kids to England to attend their marriage. We all loved England and had a ball! Magda, Stirling's wife We discussed some of Stirling’s amazing work with the patients we saw together in Philadelphia, as well as his visit one summer when we were in California visiting with Melanie’s parents in Los Altos, where we now live. Stirling recalled that when we were out shopping one day, my wife and I tried to persuade him to purchase a large Stetson hat, but he resisted! Stirling described the three ways in which he encourages people to change their negative thoughts using the Socratic Technique of gentle questioning: he  asks if the negative thoughts are realistic, if they are helpful, and if an alternative perspective can be taken. The reality testing approach focuses on the important differences between healthy negative feelings, like healthy sadness or grief, which don’t usually need any treatment, and unhealthy negative feelings like depression, or a panic attack. One key difference is that healthy negative feelings always result from valid, undistorted thoughts. For example, if a loved one dies, you may tell yourself, “I still love him with all my heart, and I’ll miss the many wonderful times we spent together.” In contrast, unhealthy negative feelings result from negative thoughts about the person who died that are distorted. For example, a young woman who’s brother committed suicide told herself, “It’s my fault he was depressed because our parents love me more when we were growing up. I should have know that he was considering suicide the day he died, so I, too, deserve to die.” Of course, the distorted thoughts don’t have to result from a traumatic event. For example, a chronically depressed patient may tell himself, “I’m a loser, and I’ll be depressed forever.” A more pragmatic treatment approach focuses less on whether thoughts are distorted or not, but rather on their effects. It’s possible for a thought to be realistic but unhelpful. If a tightrope walker in the circus thinks during their act, ”If I fall I will die,” this may be realistic but not very helpful! Stirling talked about how the third way to look at changing thoughts is based on the fact that our lives always have a narrative—a story we tell ourselves about what has happened, or what is happening right now in our lives. These stories can have a powerful impact on how we all think, feel, and behave, and may often function as self-fulfilling prophecies. We can change these stories to make them more adaptive for us. For instance, rather than seeing the glass as half empty, we can see it as both half empty and half full; or we may choose to focus on what you can control vs. what you can’t. What I’ve written so far are just some general ideas, summaries of things that we talked about on the podcast. But when you listen to the podcast, you will perhaps notice the warmth, richness, and depth in the way Stirling thinks and communicates. Then you will “see” and experience his true genius and his immense compassion! We hope that we can entice Stirling to present to one of our free weekly training groups, and perhaps even see if he might agree to do another co-therapy sessions with me that we can publish on a podcast, so you can actually see and experience this master therapist in action! Rhonda, Stirling and David

The Feeling Good App: Part 2 of 2-- The Surprising Basic Science Findings-- How Does Psychotherapy REALLY Work? And Why Did Everything Change So Fast?   Feeling Good Podcast Special Edition #2: March 07, 2022 Today’s special podcast features the second part of the recording with David and Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the basic science findings most recent beta test, which included 140 participants. David uses an advanced form of statistics, called Structural Equation Modeling (SEM) to identify causal effects and to learn more about how the app actually works. This information has immense practical and theoretical implications. Here's a portion of what we’ve discovered so far. All seven negative feelings are high correlated because they all share an unknown Common Cause (CC) predicted by David in one of the top psychology research journals in the late 1990’s. Here’s the reference2 Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473. The CC accounts for most of the variance in all seven negative feelings, with R-square values ranging from 66% for anger, and 98% for Anxiety. Since there has to be some error variance in the estimates of the negative feelings, there is practically no room left for any significant additional causes. If you would like to see the standardized output of the SEM model, click here. The CC also has causal effects on Happiness, but these effects are much smaller, with an R-square of only 30%. This proves that Happiness has its own causes that are completely different from the factors that trigger depression. Happiness, in other words, is NOT just the absence of depression. The radical reductions in all seven negative feelings were mediated by the reduction in the user’s belief in their negative thoughts, as predicted by cognitive therapists, like Albert Ellis and Aaron Beck, as well as the Greek Stoic philosopher, Epictetus, nearly 2,000 years ago. This is the first proof of that theory! At least three components of the app have been isolated which appear to have substantial causal effects in the Common Cause, which in turn triggers simultaneous changes all negative feelings as well as happiness. Those three components include: A cognitive variable: the user’s belief in his or her negative thoughts. A motivational variable: measured with extremely precise and sensitive instruments. the user’s liking of the app. The magnitude of all three causal effects was large. However, the motivational variables and user’s liking did not have direct effects on changes in depression and other negative feelings. The changes were ALL mediated via reductions in the user’s belief in his or her negative thoughts. This finding is consistent with the hypothesis that it is impossible to reduce negative feelings without change the belief in the negative thoughts that trigger those feelings. The SEM models were replicated in two independent groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. The fit of the model was outstanding in both groups, and there were few or no significant differences in the parameter estimates. This indicates that the findings are valid and do not represent capitalization on chance. David has reported extremely rapid changes in all negative feelings in his single-session treatment of individuals using TEAM-CBT. Some people have suggested that this is because he often treats mental health professionals as well as individuals who are very acquainted with his work. CLICK HERE FOR THE FULLL REPORT However, data from the beta test indicates this is not likely to be true. Mental health professionals did not respond any differently from non-professionals. In addition, the Familiarity with David or with TEAM variables did have modest effects on the degree of liking of the app, but no direct causal effects on changes in depression or the Common Cause. The basic research is just beginning and ongoing. David believes that the research potential of the Feeling Good App may be as significant as the healing effects documented in the outcome findings with the app in the previous podcast. If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training module, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques for the first time to find out if the improvements last. Research on more than 10,000 sessions by human therapists using TEAM indicates that a portion of the gains patients make during individual sessions dissipates between sessions, but the “staying power” of the gains is facilitated by the patient’s homework between sessions. As a result, patient gains tend to reach a steady state after four or five sessions. We anticipate that something similar may be documented in longitudinal studies with the app, and are eager to see what we can learn in the next study which will extend beyond one day. So, hopefully, the new study will be pretty cool, too! And who knows what we’ll discover, with your help! Make sure you sign up if you’re interested in being one of our beta testers! David and Jeremy Rhonda, Jeremy, and David

Podcast 279: Dr. Leigh Harrington on Goal Setting for Habits and Addictions or Using Habits to Feel Better Today, we are joined by a very special member of the TEAM-CBT family, psychiatrist Leigh Harrington, MD, who will teach us how to set goals that work when battling habits and addictions. Leigh Harrington, MD, MPH, MHSA, is a psychiatrist, TEAM-CBT Therapist and Trainer.  Originally from Michigan, where she completed medical school and graduate school, she had the good fortune to meet Dr. David Burns in 2004 during her psychiatry residency at Stanford University when she joined his original group of Tuesday night students.  She specializes is helping therapists and individuals reach their goals especially in the areas of Interpersonal Exposure, Relationships, and Habits.  She lives in Davis, California with her two beloved daughters. Leigh begins by saying that there are many parts of the TEAM-CBT model than help when battling unwanted habits and addictions. Our habits definitely result from how we think, and the stories we tell ourselves, and treatment can sometimes be more than just treatment, but a transformational experience. She explains that “I gained 20 pounds following my last pregnancy, so I began to set three kinds of goals: Mental goals Physical goals Relationship goals” Mental goals She continues: “I focused on reducing the many Should Statements I was battering myself with, like “I should have done this or that,” or “I should do this or that.” These kinds of statements sounded demanding and triggered feelings of guilt and frustration that actually made it harder to achieve my goals. “So, I decided, instead, to notice my thoughts, and focus instead on appreciating things. This was just one of many approaches to rewiring my brain. “For example, I realized I had been letting my brain run itself each morning. When I woke up my mind would start to tell me all the things I needed to (should) do that day. . . Sometimes I would wake up feeling “okay,” but I was definitely not in a state of bliss, gratitude or joy. “Sometimes it seemed as if my mind would look to find reasons I might not be feeling top-of-the-world: ‘Well there is this issue… or this… and also this…’ “Which told me a story of my unhappiness, or simply a lack of joy. Of course, my mind was well-intentioned, trying to help me out, but it didn’t end in greater joy, but in the weight of ‘shoulds’ and reasons to feel crummy. It had become a habit--a thinking habit. “I was struck by the idea that I didn’t have to let my mind think whatever it wanted and wondered if I could break this thinking habit. In habit work, we determine the new habit we want, check our motivation, plan solutions to any problems, and commit to the new habit. “I thought I would keep my new habit simple, believable, and incorporate gratitude, as that can sometimes be helpful, too. “My new habit was to catch myself while I was still in bed, as soon as I recognized I was having thoughts, and say to myself something I believed that, was non-controversial. When I caught myself thinking any shoulds or telling myself any unhappy stories, I said to myself, ‘I love my bed. I love my house. I love my lamp.’ “This might seem simple, trivial, or silly. But the point of the new habit was not to be profound and brilliant. The point was to change my thinking in the smallest of ways and to prove to myself I could create a new thinking habit. “This simple thought habit has allowed me to start my day on a better note and has allowed me to prove to myself I can change my thinking habits.” Physical goals Leigh explains: “Here’s how I lost the 20 pounds I had gained. Instead of focusing on one strategy – like, “I will only eat vegetables,” or “I will exercise 2 hours per day,” I focused on achieving the goal by any means. I used the experimental technique and went through a series of habit experiments. “First I tried just thinking I’d like to lose the weight. I. This may seem crazy, but there have been times in my life when I’ve seemed to effortlessly loose weigh, so that seemed like an easy first go. “As you might imagine, it didn’t work as well in my 40’s as it did in my 20’s. As long as I kept giving in to my urges to have a sugary treat in the afternoon as a pick-me-up, and refusing to be in deprivation, nothing at all happened with my weight. “I also allowed myself to eat as much as I wanted to, just as I had when I was pregnant and nursing my daughter. “Since that didn’t work,. I experimented with some green juice in place of sugary snacks. I felt healthier, but there was no change in my weight. “Then I decided on a multi-pronged approach. I would keep drinking my fruit-smoothies in the morning, along with a protein shake mid-morning, and a normal lunch, plus a normal dinner – just one serving at lunch and dinner, and no more than one dessert per week, Whenever else I was hungry I would drink a protein drink and lots of water. I also committed to walking every day for 30-60 minutes and going to the gym at least once per week. “And, I committed to doing this until I saw the results I was looking for. I weighed and measured myself. But in two weeks, I had lost only one pound and zero inches. “I was discouraged. “But I was committed to stick with it, no matter what, for as long as it took. “Three weeks in thee was still not much change. “But at 4 weeks I started noticing a difference and by 12 weeks the scale read 20 pounds lighter – the same as I weighed in college. Most importantly I felt great and I experienced a sense of accomplishment! Relationship goals Leigh continued: “I also decided to focus on developing better personal relationships with six people, including my mother. I had always felt that she was critical of me, this thought caused me to distance myself from her. I had a better relationship with my dad. So I decided to focus, instead, on what I loved and appreciated about her. For example, she was amazing with my kids. “This is a little funny, but I was in the middle of a difficult time in life and hired a coach specific to this situation.  I felt sad about the loss of a friend and I found her wisdom really helpful. She suggested, ‘you only need six people, your pall bearers.’ “Since I have a tendency to enjoy and like many people, it made a lot of sense to me to focus my energy on a treasured few. “I had always prided myself on being a loyal and committed friend and didn’t’ want to give any up.  Even though the suggestion of only 6 didn’t ring true for me, it helped me drop the strongly held belief, ‘I must keep all friends forever.’ I found releasing some relationships allowed room for some really awesome new ones to grow. “I’m loving those now. And low and behold, I started enjoying hanging out with my mom, and began to realize I had a kick ass mother!” Leigh summarized some of the keys to successful goal-setting, including the importance of setting small, measurable, and specific goals. She described her upcoming “Boot Camp” on overcoming habits and addictions. For more information, contact Leigh at www.TeamTherapyTraining.com. Following today’s podcast, we received this lovely note from Leigh: Hi David and Rhonda, I so loved being with you both today!! Thank you for being so gracious and welcoming about these ideas on how to modify habits and addictions! I love growing together.  David, it really struck me how you were breaking things down into steps and making so clear for your listeners - it felt like your intellectual mind and your heart were going at the same time. Rhonda, I love how you brought up ideas and framed things in such a clear way. You guys rock!! When we finished up, I thought of a more thorough response to David’s question about slogging today. I was reminded of perfectionism and how I’m trying not to be so perfectionistic. I still remember David’s article on perfectionism from Psychology Today Magazine way back in 1980, when Feeling Good was first released. It was entitled, “The Perfectionist’s Script for Self-Defeat.” I’ve been working on doing “B” work, and I’ve gotten so much more done and - when I don’t fall into perfectionism again - having so much more fun. So, I like the idea of holding ourselves accountable, being committed to ourselves and our goals, and to letting ourselves do B work, instead of aiming for perfection. It seems kind of counter-intuitive, but that combo leads to getting more done and being a lot happier! Maybe you have some insights, David or Rhonda? Much love to you both, Leigh David wrote back: Hi Leigh, Thanks for the beautiful note. I have also struggled with perfectionism, especially when I was younger, and I agree with your conclusions 200%. But perfectionism has many tentacles, and is always lurking in the shadows, waiting to jump out and grab us again!! David Rhonda wrote back: Hi Leigh, I also struggle with perfectionism, and when I am feeling overwhelmed I tell myself, “I have an abundance of time to accomplish all I want to do today, calmly, peacefully, and with unhurried grace.'” That’s not an empty affirmation, but a positive statement created after writing out a Daily Mood Log, seeing the positives in my perfectionism, and looking at the distortions in my thoughts. Rhonda We hope you enjoyed this podcast, Rhonda, Leigh and David

  #278: Buddhist Strategies for Financial Abundance, Featuring Zeina Halim Jan 24, 2022 Today, we feature the work of Zeina Halim, a beloved member and small group leader in our Tuesday training group at Stanford, who specializes in the treatment of anxiety.  This is Zeina’s third appearance on our podcast. Previously she helped us with a fabulous program on family conflicts at the start of the pandemic (Corona Cast 3, 4-06-2020) and later did live some personal work on one of the Self-Defeating Beliefs, the Achievement Addiction (Podcasts 211, 10-12-2020, and 212, 10-19-2020).  Today Zeina brings us something radically different: Buddhist Strategies for Financial Abundance. What in the world does that mean, and why should you care?  She starts by describing her study of Buddhist practices, and cites some books that have inspired her, including The Diamond Cutter:  The Buddha on Managing Your Business and Your Life, by Geshe Michael Roach.   Zeina explains the quasi-mystical concept of “Karma,” which is the idea that you get what you give. In other words, the energy and spirit you convey to others, and to the universe, will come back to you. For example, when clients who are not a good fit for her practice contact her, Zeina goes out of her way to help those clients find a great fit with another therapist.   This “Karmic practice,” she explains, has paradoxically caused many patients to suddenly seem to show up, asking for treatment. In other words, when she meets the needs of others, the universe meets her needs.  She says that she doesn’t need to do very much at all of the kinds of traditional marketing that most other therapists do in an attempt to build their practices. This “karmic practice” has been mostly sufficient and far more effective than traditional marketing methods. This is a theme that I (David) resonated with, since I also give away almost everything for free, and have received an abundance of positive and loving gifts from the universe in return. Zeina cautions that this, and all Buddhist practices, must be done with balance and thoughtfulness: “When I started, I gave too much, and this can actually cause self-harm.”  She said that some people have raised the question: “But isn’t this an inherently selfish practice, since you are hoping for abundance for yourself?”  Her response to this is that when you receive financial abundance, you can give even more to others for free.  She also described another book of Geshe Michael Roach’s, The Karma of Love, where you try to give to the other person and meet their needs instead of worrying about whether they’re loving you enough or meeting your needs.  In a previous relationship, this led to inner peace and, paradoxically, she felt much more loved, although nothing observable had changed in the way her partner treated her. The change in her feeling loved all came from changes SHE made, not her partner. This aligns very closely with the TEAM-CBT approach to relationships, as well as the teachings of most religions. We also discussed group TEAM-CBT vs. individual therapy.  I described my phenomenal experiences in Philadelphia creating a large intensive group therapy program at my hospital, which was in a rough, inner city neighborhood. Most of our patients had few resources, and many could not read or write. Some were homeless. The program was more or less free to all of them, and our patients and their families gave us so much in return.  I was absolutely thrilled that Zeina also loves doing therapy in groups. Many patients and therapists alike think of group therapy as a kind of inferior approach, but my experience has been the opposite. If given the choice, I’d treat everyone in groups. Zeina will be starting a TEAM-CBT anxiety group within a week of this podcast. The group will focus on all the anxiety disorders, such as chronic worrying, shyness, phobias, OCD, PTSD, and more. There will be one group for adults and one for young adults, aged 18-24. If you’re interested, feel free to text Zeina at 1-408-412-5678, email her at ZeinaHalimTherapy@gmail.com or visit her website at ZeinaHalimTherapy.com  As an aside, we’ll find out if Zeina’s Buddhist Karmic Marketing works. She did not ask me to promote her group. I just decided to promote it a little bit because I’m so excited about what she’s doing, and I hope her practice grows and prospers to the max!  Thanks for joining us today! If you like what we’re doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing. This year, we’ll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen!  Rhonda, Zeina and David

Rejection Practice: A Love Story, Featuring Dr. Cai Chen Jan 17, 2022 Rhonda starts today’s podcast by reading two wonderful recent endorsements from listeners. A therapist from San Jose, Ca was moved and inspired by the two podcasts (Episodes 268 & 269, published 11-15-2021 and 11-22-2021) with Dr. Carly on the tragic loss of her baby via ectopic pregnancy, and another listener described TEAM-CBT as “revolutionary” due to the emphasis on reducing resistance. She compared the approach to the indirect hypnotic approach developed by the late Milton Erikson.  Dr. Cai Chen recently completed his psychiatric residency in Texas, and then moved to California to join the TEAM-CBT community and unite with the love of his life, who happens to be a member of our Tuesday group.  Cai attributes much of his dating success to one of the techniques he read about in my book, Intimate Connections, called “Rejection Practice,” because he practiced that technique to successfully defeat his negative thoughts about all the awful things that might happen if he tried to talk or flirt with an attractive woman.  He would tell himself things like: She’ll think I’m being too forward. She’ll be offended and might call the police. People who see me trying to flirt will be offended. I’ll be rejected.  He described what happened when he forced himself to get 20 rejections in a mall in order to overcome his fears. His stories about what happened are both funny and inspiring.  Cai also describes his initial intense resistance to using this technique, giving himself messages like, “I shouldn’t have to learn to flirt because it’s beneath me!” I heard excuses like that all the time when I was in clinical practice, working with shy, lonely men!  Rejection Practice is a powerful and potentially super-effective technique you might want to try if you’re also struggling with social anxiety or if you treat patients with this problem.  We also illustrated the hilarious Feared Fantasy Technique on the podcast, where Cai enters an Alice-in-Wonderland Nightmare World, and meets the “woman from hell” who represents all of his worst fears, and verbalizes things like this to him: You’re assaulting me and I’m going to call the police.  You’re the last person I’d ever date! You’re forgettable! you You’re too forward. I can see that you’re very insecure! In addition, he meets the “observer from hell” who verbalizes things like this to Cai:  I’m terribly offended that you tried to talk to that woman.  It’s highly inappropriate to flirt like that in broad daylight.  You shouldn’t be doing that.  I condemn and reject you! Cai was surprised to discover that the monster has no teeth and experienced some enlightenment and freedom from his fears. Rhonda, Cai, and I had a lot of fun with these techniques, and hope you enjoy them, too. Again, if you’re a therapist, you might consider including these techniques if you work with shy individuals.  We also discuss the idea of “Physician, heal thyself,” a quotation from the New Testament (Luke 4:23). We are all convinced that doing your own personal work can vastly increase your skills and depth as a clinician, because you can tell your patients, “I know what you’re going through, because I’ve been there myself. And what a joy it’s going to be to show you how to overcome your shyness and develop greater confidence, and more loving relationships with others.” And that’s exactly what happened to Cai. He found the love of his life. You’ll hear all about it if you listen to this heart-warming podcast!  Dr. Cai is just starting his TEAM-CBT practice at the Feeling Good Institute in Mountain View, California. However, since he is a trained physician and psychiatrist, he can also prescribe medications if patients need them in addition to the therapy. Dr. Cai Chen is a warm and brilliant young psychiatrist. If you would like to contact him, you can contact him at Cai@FeelingGoodInstitute.com, or call him directly at 1-916-877-4749. Thanks for joining us today! If you like what we’re doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing, since I have refused to monetize the podcasts. So our budget is meager at best.  Still, this year, we’ll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen!  Warmly, Rhonda, Cai and David

Here are the questions for today’s Ask David, featuring special guest, back by popular demand, the extraordinary Dr. Matt May, and of course, our super-special hostess, Dr. Rhonda Barovsky! Why is my dad the way he is? Why are people the way they are? What can you do about positive distortions? More Should Statements! How can you talk to someone who refuses to talk to you?   Why is my dad the way he is? Why are people the way they are? Hi Dr. Burns and Dr. Barovsky! I love your show. Keep up the good work! I'd deeply appreciate your time and insight. My dad is 70, my mom is 67, and I'm 38. Throughout my life my dad has done things like he did earlier tonight. I was at my parent's house and my mom was telling me how Thanksgiving was going to be at my parent's cabin with the whole family like we have in years past at which my point my dad firmly said "No." My mom asked "Why?" and he just shook his head and shortly after walked out of the room to go to the bathroom, shut the door, and said "no" angrily three times in the other room to himself but loud enough for she could hear. He'll seemingly randomly act extremely possessive by angrily forbidding family get togethers, or my mom from doing things, or family to borrow things. He'll just say "No" without further explanation. Always, always, upon asking "Why?" to his "no." He'll either say angrily, "Because I said so!", say nothing, or just repeat "No" further. My mom says sometimes "Can you just gave me a reason?" and it's the same "No", silence, or "because I said so." I don't jump into the aforementioned back and fourth communication because I know such a person can't be changed and don't want to make an argumentative mess. He's never displayed any comfort with expressing the slightest vulnerability. He's very, very silent. All of my life he has displayed bullying type tendencies. Whenever I visit my parents he always shows tremendous eagerness to want to scowl and berate people for the tiniest mistakes (even people he doesn't know in public, like cashiers.) I think even the most skilled of five secrets practitioners might be outmatched. My mom tonight, and all my life, has asked me why is he like this? I've been haunted to try understand this question all my whole life too. So, I'm putting the question to you Dr. Burns and Dr. Barovsky: Why is someone like this? You must've heard of similar situations and have insight? I want to feel compassion and understanding for him. I don't want to live with baggage. And mainly, mainly I just want to relieve myself from anger thinking should, labeling, and overgeneralizing thoughts like "He shouldn't act like this", "He shouldn't be such a bully", "He's being a jerk." Thank you, Mark David’s Reply Thanks, Mark, I can certainly understand your sadness, frustration, and anger, as well as your love and concern for your mom. Scientists don’t yet know why people are the way they are. My focus is on helping people at specific moments of interaction when they want help. You have not asked for help in this email. I do make this type of statement in practically every Ask David episode, but have not had much luck in getting people to listen, because the general questions that have no answers keep rolling in. You say that your dad cannot change. To my ear, this statement is both blaming and untrue. People change at every moment of every day. The real question I always have is this, and it might not interest you. Do YOU want to change the way you interact with him? You and your mom probably both do things that trigger him, like silence, or asking WHY when it is abundantly clear that this response has a 100% guarantee of triggering him. I apologize if this is not the answer you were looking for! David   What can you do about positive distortions? How much information is there in the book (or a particular podcast) on how we address positive distortions most effectively? It is mentioned briefly that these can be more difficult to overcome, because of the more positively perceived "benefits", which may also be re-enforced externally (such as "yes, he is such a nice person, nobody wants him to express any frustration or anger occasionally - not even he himself want to do this!"). It affects motivation to any change, or, at least, creates ambivalence. Some more on this would be great, please. Thanks, Tillerich David’s Reply Hi Tillerich, Good question, and I will schedule it for an Ask David. As you point out, there usually isn’t much motivation for change when it comes to positive distortions. Positive distortions trigger habits and addictions, violence, mania, marital conflicts, and narcissism, to name just a few areas. Each is handled differently, but dealing with motivation / resistance is key in every area. David   More Should Statements Johnny asks: Can you help me disprove my negative thoughts? I manage to disprove them, but they return after a few hours. “A loser is someone who lives at home with his parents after he turns 18.” “I should be bold, confident, and secure.” “I should be better than I am.” David’s Reply Hi Johnny, Sorry you’ve been struggling. The first thing to do is A = Assessment of Resistance, since resistance is the key to nearly all therapeutic failure. Tools would include the Paradoxical Invitation followed by the “Miracle Cure” question: What are you hoping for? What kinds of changes are you asking for? This is important. For example, you mentioned a problem with procrastination. If you have a procrastination problem, the strategies would be completely different. Other tools at the “A” portion of the session would probably include The Magic Button Positive Reframing The Magic Dial The Acid Test. If you decide that you actually DO want to change the way you think and feel, given the fact that you’re still living at home, a few of the many methods that could be used include: Identify the Distortions Explain the Distortions Individual Downward Arrow Technique Semantic Technique Cost-Benefit Analysis Let’s Define Terms Be Specific Examine the Evidence. Double Standard Technique (DST): For example, would you say these things to someone else? Our son has been living with us for a while, but I don’t think of him as “a loser!” My wife and I are actually happy to provide some support while he is sorting out what he wants to do next. Paradoxical DST Externalization of Voices with three strategies: Self-Defense Acceptance Paradox CAT (Counter-Attack Technique) There are many additional techniques that could be used. But first, the action would focus on resistance and motivation. Tackling the distorted thoughts before completing the “A” step is usually not a very good idea! David D. Burns, MD   How can you talk to someone who refuses to talk to you? Hi Dr. Burns, I came across your book and podcasts during a time in which I was having a hard time communicating with my adult son. They have helped me tremendously in acknowledging my part in the problem. While I've done a lot of work on my own self-esteem, anxiety and depression, sadly it has come a little too late as my son does not want to talk to me and we are estranged. Any thoughts or advice on how to reach out to a loved one in this situation? Now that I have been practicing for the 5 secrets I want to better connect with my son and work through our issues? Thanks, Shelly David’s Reply Thanks, Shelly, I’m so sorry that you are estranged from your son. Have you done the written exercises in my book, Feeling Good Together? That’s a good place to start, as this very topic is addressed in the chapter on how to talk to someone who refuses to talk to you. The method that can be helpful is called “Multiple Choice Empathy” or “Multiple Choice Disarming.” We will likely illustrate it on the show. Rhonda, Matt, and David  

Hi everyone! This special podcast features one of our favorite people, Professor Mark Noble from the University of Rochester in New York. Professor Noble is a world-renowned neuroscientist and cancer researcher, one of the pioneers in stem cell research, and all-around good guy. He contributed a brilliant chapter on how TEAM-CBT interacts with the brain for my book, Feeling Great. For the past two years he has been a very beloved member of the Wednesday TEAM-CBT Training group, adding his wisdom and clarity to the teachings.  Rhonda and my co-teachers, Leigh Harrington and Richard Lam, and all of our students feel very honored to have him in our midst. This is our third podcast with Dr. Noble, and the first podcast to usher in the new year. We’re excited to speak with him again today. He will update us on his latest thinking on how the molecular biology of stress and learning are totally consistent with the rapid mood changes we see in TEAM-CBT. He also describes his latest writing project, tentatively entitled, The Brain User’s Guide to TEAM-CBT, and you can download it for FREE if you click here! (LINK) In this booklet Professor Noble presents the “brainological perspective” on TEAM-CBT. He emphasizes that this booklet is written at the 9th grade level so as not to intimidate anyone. If you’re curious, take a look, and feel free to share it with others who might be interested. Professor Noble explains that his new booklet was inspired by patients who ask how TEAM differs from traditional (aka “normal”) talk therapy. Of course, the differences are many and profound, but one of the questions new patients and therapists ask is whether the rapid recoveries we observe during TEAM-CBT treatment are just superficial and temporary, or even fake. Mark asserts that nothing could be further from the truth, and that the thing that makes TEAM-CBT so special is how closely it is aligned with how the human brain actually works. He explains that there are ten essential steps in TEAM, starting with Empathy. He defines Empathy as “being in a safe place, where you can share feelings without being judged.” Empathy allows the patient to access the networks in the brain where the patient’s pain may be stored as memories. The spoken and written language exercises used in TEAM actively and rapidly modify the networks that generate the feelings of depression, anxiety, shame, inadequacy and hopelessness. Dr. Noble places a great importance on the written Daily Mood Log, which he describes as arguably the “greatest development in the history of psychology.” He says that when you describe the horrible and traumatic things that happened to you, and you record your Negative Thoughts on paper in a systematic, step-by-step way, you can look at your thoughts, feelings, and painful memories as separate from your “self” and gain some distance from them. Then, when you pinpoint the many cognitive distortions in your negative thoughts, and substitute more realistic interpretations, you gain freedom and relief because you are actually re-wiring your brain. He said that most of our human thinking is called Fast Thinking. This is the automatic thinking that we do 98% of the time as we go through our daily lives. Fast thinking is great, but growth, learning and change can only result from Slow Thinking, where we reflect and analyze things. Slow thinking takes concentration and effort because you are changing actual networks in your brain when you challenge and crush your negative thoughts with powerful techniques like the Externalization of Voices. He says that we are not just telling people to “Stop it!” or “Get over it!” Quite to the contrary, we are teaching specific, powerful techniques that give you the chance to pinpoint and modify the exact brain networks that cause your negative feelings. He explains that “language is a powerful tool for figuring out exactly how we see the world when we’re feeling down, and TEAM gives us many tools in TEAM to modify the errors in our perceptions that cause so much suffering. Mark laments on the excessive misuse of medications for individuals, including children, who are struggling with behavioral and emotional problems. He wishes more people would simply sit down with the person who is upset and ask, “What’s going on? How are you feeling? What are you thinking and telling yourself?” I have had the same thought when thinking about how therapists not familiar with TEAM or Cognitive Therapy use and promote dozens of presumably therapeutic approaches without simply asking patients, “What thoughts go through your mind when you are feeling depressed, anxious, ashamed, inadequate, or hopeless?” The answers to this question provide direct and immediate access to the brain networks that need re-wiring! Mark concludes today’s podcast by saying, “I went into medical research on cancer and other serious problems because I wanted to help people who are suffering. I’m convinced that TEAM-CBT, and the powerful Daily Mood Log that David has developed, have the potential to help millions of people around the world!” Rhonda and I are grateful for Mark’s ongoing friendship and brilliance and want to wish all of you a happy and healthy 2022! We are both very grateful for your support during the past year and hope you will continue to mention our podcast to friends or colleagues who might be interested in learning about TEAM-CBT. We look forward to celebrating the five millionth download of the Feeling Good Podcast around July! Thank you! Rhonda and David

The Sara Session—Total Blow Away! (Part 2 of 2) Last week, you heard the first part of the session with Sara, a woman haunted by feelings of anxiety and inferiority from the time she grew up in a village in Mexico. Because she received a great deal of mean-spirited put-downs, she same to see herself as an "outsider" who wasn't good enough. She has finally decided to challenge this crippling and disturbing mind-set, and in today's podcast you will witness her metamorphosis. She will also join us for the fascinating follow-up to her amazing treatment session. If you click here, you can see Sara’s Brief Mood Survey at the end of the session, along with her Evaluation of Therapy Session. As you can see, the changes in her mood scores were profound, and her ratings of Jill and David on “Empathy” and “Helpfulness” were excellent. If you click here, you can see Sara’s Daily Mood Log at the end of the session. By the end of the session, all of Sara’s negative emotions had gone down dramatically, to zero or near zero levels. However, one negative feeling, jealousy, only went down to 30%, and this feeling was still nagging at her. She said she still felt inadequate and jealous of people who had accomplished more, since she’d been procrastinating for years at promoting and developing her private practice. I don’t like to leave people with loose ends, if at all possible, and Sara clearly wanted to zap the feelings of jealousy if we could, since we hadn’t focused on this emotion at all during the session. You may be fascinated by the surprise ending to the session, and the method that allowed Sara not only to blow away her feelings of jealousy, but a discovery of how she could use those feelings to connect more deeply with her childhood friends, including those who had accomplished a lot! There were quite a few teaching points, including but not limited to these: Rapid, profound, and lasting change is possible, even when people have been struggling for years or decades, or even since childhood, with feelings of depression and inadequacy. The goal of therapy is not just a reduction in depression, but a total elimination of depression along with being catapulted into a state of enlightenment, joy or even ecstasy. Sometimes Positive Reframing can blow away a negative thought, as you'll discover in the surprise ending to her session. Sara totally threw herself, body, heart and mind into this work. That commitment is a vital ingredient of success. Several days after the session, Sara sent this beautiful note to the Tuesday group. Hello, Tuesday Group! I apologize for just now sending this email. I had told David I would email the group this past weekend with an update, but I have been TOO busy dancing away (more about this in a second). 😝 Anyway, I will try to make this email short because I tend to go overboard and write too much, and I know everyone is busy. I will just share a few things that have happened since my personal work two weeks ago. I am also forwarding the email I sent David and Jill Tuesday evening after the magical evening. First of all, THANK YOU all for your awesome support and empathy during that beautiful evening. At that time, I did not realize how much this is the story of many of us in the group (the learning disability and being bullied, humiliated and teased because of it.) I felt very connected to you and felt your love and deep compassion and understanding. Thank you! So, I was not kidding when I wrote that I am dancing away. You see, during the last two weeks when I have been at a grocery or department store, I have been dancing away to the music playing in the store. For some reason my body just gets moving and doesn’t want to stop no matter what song is playing. As you can imaging, this is not typical of me. As a matter of fact, I am not a music person let alone a dancer. I prefer to listen to NPR or a Feeling Good podcast when I’m in the car and don’t play any music at home. Anyway, when I have been at a store these last few days, I have let loose. It was really funny when a lady at the end of the aisle noticed me dancing, and said to me, ‘You go girl!” We both giggled and I kept dancing even after the song was over. I am NO longer inhibited and have allowed my body to do what it needs to do, and I really don’t care what anyone thinks or says. What a liberating feeling this is! My husband also thought it was funny that I have made silly sounds, especially during meals, and we would just burst into laughter. Needless to say, a lot has gone on since my personal work. I am definitely more relaxed, and therefore, less serious and more playful. Enjoying life!!! The main shift has been my thought that has been ingrained in me my whole life: “Que van a pensar?” which translates to "What are they going to think?” I used to care and believe this !00% but now I don’t believe it (0%) and it does not matter to me what people think. My new thought now is more powerful and I believe it 100%: "I don’t care what she (they) think. What matters is what I am telling myself!” I have noticed myself shifting to this new thought quite a bit and it has been so liberating and empowering. I cannot express enough how freeing this feels. In case you are wondering, the plans for the trip to Mexico will include a visit to my birthplace and gatherings with extended family members and high school classmates as well as some site seeing. Oh, my goodness, I said, I would make this short, and here again, I went overboard. Sorry! Once again, thank you for all the love and support!!! With immense gratitude, Sara Shane I want to thank my brilliant and beloved colleague, Dr. Jill Levitt, for her brilliant work in Sara’s treatment, and I want to thank Sara for this fabulous gift she has given all of us! When you actually SEE the magic happening, it makes all the difference in the world. And when you see the actual techniques that Jill and I were using, you will hopefully realize that you, too, can learn to use TEAM-CBT in your clinical work if you are therapist, or in your personal life if you are struggling with feelings of depression, insecurity, anxiety or low self-self-esteem. Remember, too, that we still offer unlimited free TEAM-CBT training for California mental health professionals in our Tuesday group and for therapists from around the world in Rhonda's Wednesday group. If you’re interested in the Tuesday group, contact Ed Walton edwalton100@gmail.com. If you’re interested in the Wednesday group, contact Dr. Rhonda Barovsky rhonda@feelinggreattherapycenter.com. Thanks for listening! Rhonda, Jill, Sara and David

The Sara Session—Total Blow Away! (Part 1 of 2) In one of my recent Tuesday psychotherapy training groups at Stanford, we reviewed the Interpersonal Downward Arrow Technique. This is a high-speed technique I created that allows you to rapidly identify the roles that you play in your relationships with others so you can pinpoint the patterns that create tension and unhappiness for yourself as well as the people you care about. The Interpersonal Downward Arrow Technique is similar to what psychoanalysts try to do with free association on the couch, except it only takes five to ten minutes, as opposed to five to ten years. In addition, I have also developed fairly rapid ways to change and modify those dysfunctional patterns—IF this is what you want to do. Some of the psychoanalysts call these hidden patterns “core conflicts.” The late Dr. Lester Luborsky (https://en.wikipedia.org/wiki/Lester_Luborsky), a prominent psychotherapy researcher at the University of Pennsylvania School of Medicine, has written about core conflicts extensively. He gave as an example of a core conflict, a person who might have the belief that “my needs will never be met in my personal relationships.” Beliefs like this not only create unhappiness, but they can also function as self-fulfilling prophecies. In addition, most people re not aware of these “core conflicts,” and do not realize they are just beliefs. Most people just believe that “this is just the way the world is,” and think they have a profound insight into the reality of human nature. But we actually create our own interpersonal realities at every moment of every day. Since we usually cannot “see” what we’re doing, we may wrongly conclude that we’re victims of the “badness” of others. And, of course, there is always a grain of truth in that belief as well! During the training group, we had group members identify some of their own “core conflicts,” using the Interpersonal Downward Arrow Technique, and this hit one of our members, Sara Shane, like a ton of bricks. She discovered that she sees herself as “an outsider” and has always believed she is stupid and inferior to others. And this intense belief has caused tremendous suffering for Sara for decades, including her participation in the Tuesday training group, where she is usually totally silent. Sara traced this pattern to her childhood, growing up in a village in Mexico, where she was bullied and put down because she was short and overweight, and had the darkest skin of any of her many siblings. In addition, she struggled with a learning problem and was frequently put down and labeled as stupid. Sara’s sudden decent into emotional hell was fueled by the fact that she was planning the wedding of her niece at a town in Mexico which was only two hours from the town where she grew up. And the thought of showing her daughter that town filled her with feelings of shame and terror, fearing she would run into the people she grew up with, including the people who cruelly put her down. Here’s what she wrote prior to doing personal work on this problem in a subsequent Tuesday group: Hello Jill and David, Where to begin…all day yesterday it was very painful as I thought about emailing you... As I’m writing this, I am in tears and I know it is going to take me a while to write everything I want to say. But first let me say that it has taken me a long time to even sit in front of the computer because this has been very difficult for me. I had earlier said I would email you yesterday morning but I know now why I could not. I procrastinating mainly because this hurts a lot, beyond what I had earlier experienced. Right now, I am not even paying any attention to proper writing because I just want to write this without worry about correctness and just express my feelings. Let me describe what I have been feeling physically all week long since Tuesday. I have been feeling sick to my stomach especially when I was working on the DML. I felt a hole in the pit of my stomach. I felt anxiety all over my body and felt overwhelmed. At times I could not even go one. I had to push myself to complete the Cognitive Distortions on the DML. I just wanted to run away from it all. It was that painful. But I also knew this was a good thing because I was getting down to something very important that I wanted and needed to face. So the Interpersonal Downward Arrow has been very enlightening, but also, extremely painful. And David, you are absolutely right, there is no doubt in my mind (not that there ever was), that all of our problems are encapsulated in one brief moment in time and that we create our own interpersonal reality at every minute of every day. Let me explain what transpired on Tuesday that motivated me to be a volunteer during small group practice. After postponing it for more than a year due to COVID, my niece is having her destination wedding in Mexico in November. My husband and I along with our daughter are attending the wedding. While there, we were hoping to travel to show our daughter the town I was born in and where I completed my junior and senior year of high school. After more than 20 years in February 2020, I reconnected with one of my good friends from high school. During this conversation, we talked about making plans to get together with our classmates when I went to Mexico for the wedding. However, I have not been in touch with her since then. In making more concrete plans on Tuesday morning for our trip, I realized we would be able to travel to my birth town. So the possibility of visiting with my high school classmates whom I have not seen for about 38 years produced a lot of anxiety for me. This was very disturbing because this is not even a set event. It is only a possibility. Thus, I started wondering way it was making me so anxious just thinking about it and knowing that I did not need to visit with anyone if I did not want to. I was quite distraught, thus, I decided to share these feelings during small group practice. I was feeling anxious, insecure, and afraid of being judged and criticized. I’m so glad I was able to volunteer during our small group because prior to this I didn’t realize the multitude of feelings that were buried. One of the biggest revelation was how lonely I was feeling and the immense grief I was experiencing. But even more surprising was the extreme feeling of inferiority I felt although I denied it at first when Jill asked if I was feeling inferior. It was not until we were going over the “Rules” that govern the relationship that it was very clear to me how inferior I felt. And here lays all my PAIN: “I am always an outsider because I will never be good enough.” This brings me to tears! Although I understand intellectually that my suffering results from the belief that I have a self that is not good enough and a self that others can judge, as you so beautifully wrote David in your book, Feeling Great, it is still hard for me to let go emotionally. When doing the DML, I believed my negative thoughts 100% and found 7 to 8 distortions on each, which as I mentioned earlier, it was very painful to complete. Negative Thoughts: I am always an outsider because I will never be good enough I shouldn’t get close to people so I won’t be criticized nor judged I’m not professionally successful as I should be, after all, that is why I went to school Mexican people are very judgmental Perhaps instead of typing all the DML information on here, I should send you a copy along with a copy of the CBA. I will do this in a second email. Self-Defeating Beliefs: Perceived Perfectionism - My high school classmates will not accept me with all my flaws Achievement Addiction - My worthwhileness depends on my accomplishments, professional success, and the way I look (preoccupied with my overweight) Worthlessness - I’m basically worthless, defective, and inferior to others especially some of classmates Brushfire Fallacy - Everyone will talk about me and look down on me (“Mexican people are very judgmental”) Spotlight Fallacy - Talking to people feels like I have to put on an interesting mask and perform in order to impress those around me Superwoman - I should alway be strong and never appear weak in front of others As I worked through the DML, CBA, and S-DB these last few days so much has come up for me. I couldn’t help it but to feel lots of pain as some of my childhood memories emerged of the horrible times when I was humiliated, teased, and bullied primarily by family members (both immediate and extended family members). Sadly enough, in the Mexican culture, being dark completed, short, and chubby are frown upon and a reason to be ridiculed and humiliated. And unfortunately for me, I possessed all three characteristics beside having a learning disability which was translated as me being dumb, stupid, and slow. There were plenty of moments growing up that this was extremely painful especially moments when my own family crudely laughed in my face. I quickly learned to withdrawal and became rather introverted. As I got older, I also quickly learned to tell myself things like; “But one day I’m going to show them that I am not as stupid as they think I am” and “One day I will prove them wrong.” I believe this also became my strength, motivation, and determination to go to college. I was always just an average student in college, and at times, I struggled, but what got me through was my determination to succeed and ultimately prove that I could do it. However, this also created strong fears of being humiliated and ridiculed by people in general. Thus, I have protected myself from being criticized or judged by pushing and staying away from people and have been very cautious and guarded regarding having close relationships. Also, for many years, I have avoided family gatherings where I know extended family members that use to tease me when I was a child are going to be in attendance. I have been rather sensitive to people’s humor and hardly ever joked myself unless I knew the person very well. I am happy to say though that I have made some growth in this area ever since I have joined TEAM. And, that is thanks to your innate humor, David. ; ) Any way, I hope this makes sense… Thank you so much to the two of you for the opportunity to allow me to grow and learn from my painful thoughts. I know more than ever that the only way to over come this pain is by the death of my belief in the “self”. Love, Sara This will be the first of two podcasts showcasing the amazing work that Sara did in a subsequent Tuesday group. Dr. Jill Levitt and I worked together as co-therapists, and we went through the TEAM model in a step-by-step manner. In this podcast, you’ll hear the first half of the session (T = Testing and E = Empathy) and next week you’ll hear the last half of the session (A = Assessment of Resistance) and M = Methods.) If you click here, you can see Sara’s Brief Mood Survey at the start of the session. If you click here, you can see Sara’s Daily Mood Log at the start of the session. If you click here, you can see the CBA that Sara completed prior to her personal work. Thanks for listening! Rhonda, Jill, Sara and David

272 Ask David, with Special Guest, Dr. Matthew May: Shoulds, Free Treatment, Blame, and More! Here are the questions for today’s Ask David, featuring special guest, Dr. Matt May, and, of course, Dr. Rhonda Barovsky! How can I turn off my Shoulds!? Is there a downside to treating people for free? What’s the difference between Feeling Great vs Feeling Good? Isn’t it important to blame the other person when that person really IS to blame?  How can I turn off my Shoulds!? Nice podcast! (Maurice is referring to Part 2 of “I want to be a mother.”) It’s refreshing to see that we sometimes mix our needs with wants. I also have a huge problem with regret and shame, saying to myself “I should be far more ahead in life.” “I should have dated more.” “I should have used my energy to create art and being productive.” I pinpointed the moment in my daily mood log, and it occurs usually when I compare myself with people online or with people in my friend group who seem to be far more ahead in life than me in terms of career and achievements or that they used their energy of their younger years more constructive than me because they didn’t deal with depression. I tried the semantic method to soften my thoughts regarding my should statements but telling myself “I wish I did xyz,” is carrying the same weight of regret as when I “should” myself. These thoughts also seem very realistic to me and pinpointing the distortions in them is not helping me much because there is so much resistance and weight to the thought, plus the positive thought that I subsequently come up with does not crush the negative thought. I often ask myself: ”Am I really a failure?” Maurice David’s Reply Thanks, Maurice You are struggling with resistance, which is the cause of virtually all therapeutic failure. You can use Search on my website to look up podcasts on Positive Reframing, Assessment of Resistance, and Paradoxical Agenda Setting. I usually select ten to fifteen or more methods to crush any Negative Thought, but would only use them after the resistance issue has been successfully addressed. For example, we could use “Let’s Define Terms,” as one of 15 or 20 potentially helpful techniques. It might go like this: Is “a failure” someone who fails all the time, or someone who fails some of the time. If you say, “some the time,” then we’re all “failures,” so we don’t need to worry about it. If you say, “all the time,” then no one is a “failure,” so we don’t need to worry about it. If that technique is not effective, we’d have tons more to try. You can read one of my books, like Feeling Good or Feeling Great, to learn more about the Assessment of Resistance and the use of various techniques to crush distorted thoughts. Might also use this on an Ask David. Can use a fake first name, too, if you like. Please advise. david   Is there a downside to treating people for free? Dear David and Rhonda, I live in England, and I’m close friends with a team CBT therapist in Bristol (Andy Perrson), and I’ve been listening to your podcasts for the last year. I have found them to be stimulating, thought-provoking, often really humorous but above all enormously helpful in helping me journey with other people. I have just embarked on counselling training and would love to steer myself down the same avenues as my friend Andy. I’d also like to use your methodology at a later date. In the meantime, I have a question for you. I am conscious that almost all of your work now is done on a free, pro bono basis. I think that would be my preference as well especially as I have managed to cover the economics of life from other things and it would remove any feeling of conflict, or ambiguity around my motivations in helping people. But, I am also aware that there are so many advantages in there being a financial commitment from clients. Sadly, things that are free and that spring from generosity are not always valued by the recipient, things like commitment and timekeeping become relaxed. It can be awfully irritating for the therapist (a bit like making someone a cup of tea and them not drinking it), and probably a waste of time for the client. A bit like the example you often give around the outcomes for clients who don’t do homework. I would be very interested in your view on this and on balance whether it is better to charge or not charge for treatment, in the scenario where a therapist does not have a desire to charge. David comment: I think the word “therapist” in the line above was supposed to be “patient.” I hope that makes sense. Thank you again to you and Rhonda for all your hard work. Kind regards Brad Askew (Bristol, England) David’s Reply We can reply live on the podcast. The thrust might be that you can make patients accountable even if you treat them for free.   What’s the difference between Feeling Great vs Feeling Good? Dear Dr Burns, First of all, thanks for the great work that you do and also all the podcasts you did, I am planning to order a copy of Feeling Great, your latest book. I have a quick question below. I have been searching the answer on the web but still can't find the answer. Does Feeling Great cover ALL the key concepts that were discussed in your previous book, Feeling Good? Or does one need to read BOTH books to get a fuller picture? I already own a copy of Feeling Good. However, if Feeling Great already covers all the concepts discussed in Feeling Good and also comes with updates, i may just order Feeling Great and start with that instead. Thanks. Best, Calvin David’s Reply It really depends on the intensity of your interest. There is some overlap, but also significant differences. Even though Feeling Great is way newer, there are still tons of gems in Feeling Good. David   Isn’t it important to blame the other person when that person really IS to blame? Hi David, I’ve been listening to the show for awhile. Thank you for everything you do. I just listened to episode 254, and I’m not quite sure what to think about it in the context of my situation. I think it makes sense that people are afraid to look at their own faults and what brings them to a relationship and what they contribute to a situation. And that they tend to want to blame the other person to avoid working on themselves. But what about situations of more extreme abuse? How do you not blame the other person? I recently got out of a relationship where I was raped. While in the relationship, there was a lot of coercive sex where he ignored my signals to stop and then afterwards told me that things happened because I had wanted them to. Eventually his behavior escalated to the point where he drugged and raped me while I was unconscious. It’s only been 2 months since I figured out that the relationship was too unhealthy for me and left it. I’ve been in counseling 2-3 sessions per week since then. So at least I am working on myself. And I have no contact with him. Does that mean there is not a point in using the 5 secrets? Is that only for use on other people? But the things you said about blame rang true to me. I think I avoided working on my own issues for a long time, but this situation was like a giant neon arrow saying “work here!” I think I blame myself and him both. But I also worry about blaming myself too much—I think me blaming myself is one of the reasons I felt trapped and unable to leave the relationship in the first place. Because I felt at fault and ashamed of that, I didn’t tell anyone for a long time and that normalized his behavior and allowed the relationship to continue and escalate to its extreme. By not placing enough blame on him, I also didn’t consider that he might be acting selfishly, lying, or not have my best interests at heart. Which also led to the relationship continuing longer. So I am wary about where and how to place blame. Anyway, I don’t know what else to say about this except that it has all been very emotionally difficult and I never want it to happen again, so I am diligently working on myself and looking for help in all the places. Thanks, Rachel David’s Reply The thrust of the response could focus on the idea that Self-Blame and Other-Blame are both dysfunctional. I prefer the concept of accountability, and talk about this in Feeling Good Together, which might be helpful. I think Rachel is doing well to get help for herself and her own tendencies toward Self-Blame, and think that a lot of practice with the Five Secrets could also be tremendously helpful, especially for future relationships. David Rhonda, Matt, and David