Today, Rhonda and David answer several challenging questions submitted by listeners like you. What schools of therapy are embedded in TEAM? Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither? “Can TEAM-CBT help bipolar patients during the depressed phase?” How do you make Externalization of Voices work? I get stuck! For example, my patient said, "It's unfair that I cannot get a job!" Is there a cure for OCD? 1. What schools of therapy are embedded in TEAM? Dear Dr. Burns, I have some questions specifically about T.E.A.M. therapy. You mention in a blog post that T.E.A.M. therapy "integrates features and techniques from more than a dozen schools of therapy." I'm aware of many of the CBT techniques you use, but I don't think I've read yet of any technique belonging to any other schools of therapy. Would you be so kind as to mention such techniques? Madelen Hi Madelen, This is important because I believe we need to get away from competing schools of therapy and need to create a new, data-driven structure for therapy based on research on how therapy works, which is what TEAM is. At the M = Methods part of the session, you can include methods from any school of therapy. Here are some of the schools of therapy that I draw upon TEAM-CBT. Individual / Interpersonal downward arrow: same (psychoanalytic / psychodynamic) Flooding / Experimental technique: behavior therapy (exposure) Externalization of Voices: Gestalt / Psychodrama / Buddhism Acceptance Paradox: Buddhism Self-Defense Paradigm: REBT CBA / Paradoxical CBA / Devil’s Advocate: Motivational techniques Identify the distortions / examine the evidence: cognitive therapy Empathy: Rogerian (humanistic) therapy Five Secrets / Forced Empathy: Interpersonal therapy Shame-Attacking Exercises: Humor-based therapy / Buddhism Be Specific / Let’s Define Terms: Semantic Feared Fantasy: Role-Playing / Psychodrama / Exposure One-Minute Drill / Relationship Probe: Couple’s Therapy Time Projection / Memory Rescripting: Hypnotherapy Anti-Procrastination Sheet: Behavioral activation therapy (Lewinsohn-type therapy) Brief Mood Survey / Evaluation of Therapy Session: data-driven therapy Talk Show Host / Smile and Hello Practice / Flirting Training: Modeling / teaching effective social behavior Storytelling: indirect hypnosis. Positive Reframing: Paradoxical psychotherapy. Hidden emotion technique: psychoanalytic / psychodynamic Do you need more? Can provide if you want. Let me know why you have this particular interest!At any rate, I really enjoyed and appreciate your thoughtful questions, thanks!David 2. Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither? Hello Dr Burns, I would like to thank you for your podcasts. I greatly enjoy listening to them and find them very much helpful both in my personal life and my work as a psychologist. I do have a question: you talk about how cognitive distortions cause anxiety and depression. Are cognitive distortions also a result of depression and anxiety? For instance, if a person was to become depressed after experiencing loss, would they then discount the positive in their lives to a larger extent, for example? Thank you very much! Audrey Hi Audrey, Yes, depression creates a negative bias in perceptions, so you pick out information and details that support your distorted thoughts, like "I'm a loser" or "my case is hopeless." My research, which I'll report in my new book, Feeling Great (sept 2020) indicates that negative thoughts trigger feelings of depression and anxiety, which, in turn trigger more negative thoughts. This is a negative vicious cycle. There is also a positive cycle, in that positive thoughts that you believe to be true trigger positive feelings, which, in turn trigger more positive thoughts! Thanks for the question, Audrey. david  3. “Can TEAM-CBT help bipolar patients during the depressed phase?” Name: Sarah Comment: Hi, Dr. Burns. I am a big fan of your work and very much enjoy reading your blogs and listening to you and Fabrice on you weekly podcasts. I am writing with a question that has to do with the depression side of bipolar disorder and the potential usefulness of CBT. I have not heard you speak about this topic before. My sister in law lives in Switzerland and has been diagnosed with a fairly severe case of bipolar disorder. She does not cycle rapidly, but her manic and depressive states are quite severe. In fact, she has been hospitalized several times during her manic episodes. For the first time in her life, I believe my sister in law has finally accepted the fact that she is bipolar, and she is actively pursuing treatment and trying to get better. After hearing me talk about all the great information I have learned from you, my husband has hunted down several CBT practitioners in Switzerland, in the hopes that changing my sister in law’s thoughts will help her navigate the overwhelming depression she is currently experiencing. Unfortunately, most of the practitioners she has contacted have said that they cannot help her, because she has bipolar disorder. Of course, this is only adding to her sense of hopelessness. In your opinion, could CBT and challenging negative thought distortions be helpful to someone who is bipolar and currently experiencing the depressive side of the disease? In my mind (a layperson who has used CBT to help with panic disorder) it seems so obvious that it could help, but several Swiss psychotherapists seem to disagree with me! Are these therapists afraid to take on a complicated case or is there really nothing they can do? I would love to hear your take on it. Thank you so much for your endless work helping people to feel good! Sarah David will describe his experience running the lithium clinic in Philadelphia at the VA hospital, and will discuss the very important role of good psychotherapy for bipolar patients, although medications will also play an important role in the treatment. 4. Externalization of Voices: How do you make it work? I get stuck! "It's unfair that I cannot get a job!" Dear Dr Burns and Rhonda, I've just finished listening to all of the Feeling Good Podcasts. What a gift! My immense gratitude to you and Fabrice for the time and effort that has gone into these podcasts, as well as the wonderful show-notes. I am a family physician and I work with impoverished patients, many of them refugees. Depression and anxiety are common. We can't find CBT therapists for our patients within their means, so I end up trying to provide some counselling despite not having much background or training (a dangerous proposition, I know, but we have little choice.) Medications tend not to be too helpful, as David points out. I am starting to try to integrate TEAM concepts. I have a question about Externalization of Voices. In all of the examples you've shared in the podcast, whenever David does a role reversal and models the positive voice, he always seems to "win huge". I'm less experienced and find I'm not batting 1000. What do you do when neither you nor the patient have been able to win huge? Many thanks again for all you do, Calvin PS The episode on How to Help and How Not to Help was one of the best yet! Hi Calvin, Thanks for the kind comments! Can you tell me what the thought is that you’ve failed with? All the best, David D. Burns, M.D. Hi David, There have been a couple of examples where we could only get a small win. With the first patient, the thought he was tackling was: "It's not fair that I've worked so hard in life, but I can't get a job." I tried modelling self-defense, along the lines of "I've accomplished a lot given how many challenges I've faced." I also tried suggesting the Acceptance Paradox with something like: "It's true that life's not fair. Who said it should be fair?" This was only a 'small win.' I felt stuck. Another patient felt her chronic insomnia was driven by anxiety. She feared she would never sleep well again. The though was "I'm going to be chronically tired and no longer able to enjoy life the way I used to." We tried: "Sure, I may be more tired than I used to be, but I'll still be able to enjoy life to some extent." Again, this was a small win, not enough to crush it. Thanks again for your willingness to help! Calvin David’s response Hi Calvin, All therapeutic failure, pretty much, results from a failure of agenda setting. I’m not sure you’ve been trained in A = Paradoxical Agenda Setting. The A of TEAM is now also called Assessment of Resistance. When people can’t easily crush a Negative Thought, it is nearly always because they are holding on to it. This is called “resistance.” Let’s focus on the first thought, "It's not fair that I've worked so hard in life, but I can't get a job." This thought triggers anger, and anger is the hardest emotion to change because it makes us feel morally superior and often protects us from feelings of inadequacy, failure, or inferiority. If you do not deal with the underlying resistance to change, the patient will defeat your efforts. When you do Positive Reframing, you start with a Daily Mood Log with one specific moment when the patient was upset and wants help. The anger will be only one of a large number of negative emotions the patient circles and rates, and there will always be numerous negative thoughts as well. The negative feelings might also include sad and down, anxious, ashamed, inadequate, abandoned, embarrassed, discouraged / hopeless, frustrated, and a number of anger words like annoyed, resentful, mad, and so forth. This is super abbreviated, but you would then do A = Paradoxical Agenda Setting (also now called Assessment of Resistance.) You would start with a Straightforward or (better in this case) Paradoxical Invitation—does the patient want help with how he’s feeling? You might tell him he has every right to feel angry and upset and might not want help with his negative feelings as long as he has no job. If he insists he DOES want help, you can ask the Miracle Cure Question, and steer him toward saying he’d like all of his negative thoughts and feelings to disappear, so he’d feel happy. Then you can ask the Magic Button question. If like most patients, he says he WOULD push the button, you can tell him there is no Magic Button, but you DO have lots of powerful techniques that could be tremendously helpful. But you’re not sure it would be a good idea to use these techniques. When he asks why not, you could say it would be important to look at the positive aspects of his negative thoughts and feelings first. Then you do Positive Reframing, and together you can list up to 20 or more positives that are based on each negative emotion and each negative feeling. To generate the list of positives, you can ask: 1. What are some benefits, or advantages, of this negative thought or feeling? 2. What does this negative thought or feeling show about me, and my core values, that’s positive and awesome? For example, My sadness is appropriate, given that I don’t have a job. If I was feeling happy about this, it wouldn’t make sense. The sadness shows my passion for life, for work, and for being productive. My anger shows that I have a moral compass and value fairness. My anxiety motivates me to be vigilant and to look for a job, so I don’t get complacent and starve. My anxiety, in other words, is a form of self-love. My anger shows self-respect, since I have a lot to offer and contribute. My hopelessness or discouragement shows that I’m honest and realistic, since I have tried so often and failed. This is just an example, and with a real patient, it can be very powerful as I have the facts and know the patient, whereas in this example I am just making things up. Then once you have a long and incredibly compelling list, you can ask, “Well, given all of those positives, why would you want to press that Magic Button? If you push it, all these positives will go down the drain at the same time that your negative thoughts and feelings disappear. Then you resolve the patient’s dilemma with the Magic Dial. All this is done AFTER E = Empathy (you have to get an A from your patient) and BEFORE using any M = Methods, like externalization of voices. If you do this skillfully, the Externalization of Voices technique will go way better, because the person will be determined to reduce the anger and other negative feelings. But if the patient says he or she does not want to change, and wants to be intensely angry, that’s fine, too! If this is not clear enough, you could also get some paid case consultations from someone at the Feeling Good Institute, which could be invaluable. This is the most challenging and valuable tool of all! Not sure how much training you’ve had in TEAM.  There are online classes that are excellent. Also, on my workshop page you can check out my upcoming workshop with Dr. Jill Levitt on resistance. There are podcasts, too, on resistance / paradoxical agenda setting as well as fractal psychotherapy. Thanks! David 5. Is there a cure for Obsessive Compulsive Disorder (OCD)? Hi Dr. Burns, I have been suffering from OCD and depression post the delivery of my daughter and have been on antidepressants for the last 7 years. I have recently start going for counseling too with a psychologist. In fact, she is the one who recommended your book which I am finding very useful. Your website is very helpful too. I had just one general question: Are OCD and Depression 100% curable or are they only controllable and one has to be on medicines for the rest of their lives? Reason why I am asking this is the last time we tried to taper down the medicines I ended up having a worse relapse. I want to know if I can plan for a second pregnancy. I know you do not reply to personal messages but would really be grateful if you could reply to this mail Looking forward to hearing from you Regards "Betsy" In my dialogue with Rhonda, I emphasize that I rarely use medications in the treatment of anxiety and depression, including OCD, and I would urge this listener to use the search function on my website to search for podcasts and blogs on antidepressants, anxiety, OCD, and Relapse Prevention Training, and you will find lots of specific resources. For example, if you type in OCD, you will find the Sara story (episode 162) plus lots of additional great resources on OCD, including podcasts 43 - 45 (this page provides links to all the podcasts), and more. Also, my books, When Panic Attacks, and the Feeling Good Handbook, could be very helpful, and you can link to them from my books page. I use four models in the treatment of OCD, and you can find them if you listen to the basic podcasts on anxiety and its treatment. They are the Hidden Emotion Model, the Motivational Model, the Exposure Model, and the Cognitive Model. All are crucial important for recovery, and clearly explained in the podcasts on anxiety. Thanks for listening today, and thanks for all the kind comments and totally awesome questions! David and Rhonda

Today, Rhonda and David talk about how to give potentially hurtful feedback when you sense racial bias in a friend or colleague. She describes an incident in her office where the glass coffee table in her waiting room was found smashed and shattered when her office mate "Steve" (not his real name) arrived Monday morning. Although many people, including the cleaning crew, had used the office over the weekend, Steve asked Rhonda to discuss the broken table with someone who uses her office on the weekends, Kenya.  Kenya is African American, and a highly esteemed professional and beloved friend and colleague of Rhonda's.  Rhonda thought there was implicit bias being played out in this situation but did not know how to discuss it with Steve. But how can she convey these feelings to her office mate, who conveyed the impression that a black man must be the one who broke the table? David suggests one of the advanced communication techniques called "Changing the Focus" discussed and demonstrated in a previous podcast #158.  They illustrate how to apply that method to the current situation, and struggle a bit along the way! David reiterates the story of when he was accused of being racist at a psychotherapy workshop near the Texas / Mexico border, and how his own teachings in that very workshop saved the day for him. He emphasizes that it can be so painful to be accused of racist tendencies, or to discover them in yourself, and that this is another case where the cover-up is far worse than the crime! David and Rhonda

Today, Rhonda and David answer three great questions submitted by listeners like you. I am confused about the terms, negative and positive distortions. Help! “How do you treat an “existential crisis?” Can you use the Five Secrets with someone in a hypo-manic state? Won’t agreeing with their accusations just make things worse?  1. I am confused about the terms, negative and positive distortions. Dear Dr. Burns, I do have one question about terms I have heard on the podcast. The terms that confuse me are "negative distortions" and "positive distortions." I think I understand that they are both "bad" distortions, but the  positive distortions are distortions related to moods or thoughts that are unhealthily high or "up," such as in mania or narcissism. And negative distortions are the ones related to lower mood states/depression. Is this correct? I don't know if it is a brain thing, but even though I think I understand the concepts, my brain still seems to automatically think of positive distortions as good, and so I become quite confused when trying to understand how to fight them or help someone else fight them . . . Thank you again, so much, for all of your hard work on the podcast, as well as your diligence in training therapists in your TEAM model. I am a super-fan of the model already after only a week or so of listening! And the Five Secrets have challenged me to examine my communication abilities much more honestly and helped me in several important interactions already (even as a novice making many mistakes😬). Thank you, thank you, thank you! Please also tell Fabrice and Rhonda many thanks for all of their hard work and excellence as well. They both bring such gifts and refreshing honesty, brilliance  and genuineness to the discussions. I especially admire Rhonda for sharing her personal work. Such powerful and transformative stuff! It gives me hope that someday I might be a fraction as brave to DO that kind of work, much less share it openly with others for their benefit. What a generous as well as brave thing to do! I feel so hopeful and encouraged to know there are therapists like you, Fabrice, and Rhonda helping people to heal from vast amounts of mental and emotional suffering. I can't wait for TEAM to be as commonly known everywhere as CBT is now. Sign me up to volunteer for any promotional efforts if that is ever needed! For now, I will continue to tell everyone, including quite a few other counselor friends, about the podcast and the TEAM model. Sincerely, A new super-fan podcast listener, Holly Miller Hi Holly, Many people are confused, so this is a great question! Rhonda and I will gladly discuss this on our podcast. And thanks for your kind words! david  2. Can you use the Five Secrets with someone in a hypo-manic state? Won’t agreeing with their accusations just make things worse? Hi David and Rhonda, Thank you so much for the podcast. I have been an avid listener since the early days of the podcast, and it has helped me through very difficult times and still is. My question is related to my relationship with my future to be divorcee. She is at times in a hypo mania state due to her bipolar illness (which is diagnosed and treated). Is it possible to use the five secrets of effective communication with someone who is in a state of hypo mania? I feel that agreeing with unreasonable accusations and complains is not helping at all and only causes her to hold to these claims. I know that you usually like to relate to specific correspondence but it is more of a general question. I hope you can give me some guidelines on what works and what doesn’t. Thanks! Al Hi Al, The devil is in the details. Can you provide a specific example of one thing she said, and exactly what you said next, that you need some help with? General questions about the Five Secrets are NEVER productive. Great question, thanks! david David D. Burns, M.D. Hi Dr. Burns, Thanks for the prompt reply. Well, I was asking a general question if it is possible at all to use the 5 Secrets with someone who is totally unreasonable? She would say "You started to be a father when you decided to divorce" referring to the fact that I am claiming for joint custody. The fact of the matter is that she has been going in and out of long depression periods and manic periods and I had to take care of the kids, maintain the house and keep a job (working from home). I would answer that I was there taking care of the kids all the years and now that I decide to break I want to keep my fair share of the time with them. Prior to that she always claimed that I am not a good spouse although I took care of her during all the years and had at times to reduce my workload in order to be available for the kids and her. So, the claims and accusations are always discounting what I did for her and the kids. And she is not accepting the fact that she has been ill and that this had a toll on the family. She says I need to look forward even though these episodes on hypo mania keep repeating. Hope I was specific enough. If you still feel I am vague then it may be that this is not the right forum to ask such questions and may need to get proper consultation. All the best and looking forward to reading the new book. I already started with the free chapter. Al David and Rhonda describe 'mania" and "hypo-mania" model how to find truth in criticisms that seem irrational, exaggerated, untrue, or unfair. They also discuss the tendency to blame others for the problems in our relationships, and why and how that is rarely or never helpful. 3. “How do you treat an “existential crisis?” Good afternoon Dr. Burns, Have you treated anyone that went through an existential crisis before and were you successful? I have a wife that deals with depression and I was in the past able to help her (even though my mind set was "life is awesome. so why or how can you be upset?") I have also dealt with my own anxiety and was able to get myself out of that 10 years ago, using exposure techniques. But I have ran into a bit of a wall here with what I believe is an existential crisis. I've noticed that I am unable to find anything of that subject in any of your topics. Thank you for your time, Dr. Burns. In the podcast, Rhonda and I demonstrate how to respond effectively to someone who is depressed, and why cheer-leading (“life is awesome,” etc.) will generally not be helpful. Hi Arturo, There are no existential crises in California at this time, as the Buddha pointed out more than 2500 years ago. However, specific and real problems exist, and once you identify what’s bugging you and you deal with it you’ll find your “existential crisis” has disappeared. Check out my podcast on the teenage girl who was having an “identity crisis." Our podcast on “How to Help” might also be useful to you! You might also enjoy my book, When Panic Attacks, especially the section on the Hidden Emotion Technique. If you go to my website, you can type any topic in the search box in the right-hand panel of every page, and a lot of useful information, will suddenly pop up. David and Rhonda

In my workshops and weekly training group for community therapists at Stanford, we often include personal work as a part of the training. The personal work can help in several ways: When you’ve successfully done your own personal work, you will feel greater joy and energy in your personal life and in your clinical work as well. You will have a much deeper understanding of how TEAM-CBT actually works. You will be able to deliver faster and deeper therapy to your patients. You’ll be able to tell your patients, “I know how you feel, because I’ve been there myself. And what a joy it’s going to be to show you the way out of the woods, too!” Those who observe the therapy develop a greater understanding of how the fine points of effective therapy. When the person in the “patient” role has a profound change, we all share that joy and feel inspired by the miracles that can often be accomplished in a relatively short period of time. As they say, “seeing is believing.” Rhonda recently surveyed some of our listeners about live therapy we sometimes offer on our podcasts—do you prefer to have the live therapy presented all at once, in an extended, two-hour podcast, or split up over two or more podcasts with expert commentary along the way? Our listeners were split on this. So today we are presenting an actual and dramatic therapy session in its entirely. If you don’t have two hours to listen all at once, you can stop after an hour or so, and then return to the last portion when you have more time. And please let us know what you think of this live therapy podcast format! In today’s session, we are very grateful to Sarah, a certified TEAM-CBT therapist, for allowing us to share her very personal and powerful session with you. Sarah was having intense anxiety during her sessions with patients, and her anxiety was bordering on panic. This is actually not unusual. In my experience, most shrinks struggle with feelings of insecurity from time to time. But when we shrinks experience insecurities, we often feel strong shame as well, telling ourselves that we “should” have it all together because we are supposedly “experts.” I’m no exception! I can remember how anxious I used to feel on Sundays when I was starting out in private practice. I’d tell myself, “Wow, I’m going to have all of these high-powered patients tomorrow, and what if they notice that I don’t actually know what I’m doing half of the time!?” But then, halfway through Monday morning, it would dawn on me that my patients didn’t seem to notice or care about my flaws, and I’d relax! Although Sarah brought a Daily Mood Log to the session, listing all of the negative thoughts that were triggering her anxiety, along with many other intense negative feelings, the session took an unexpected turn in the direction of the Hidden Emotion Model. We’ve done several podcasts on this powerful technique before, and now you have the chance to see how it works first-hand! Instead of challenging Sarah’s negative thoughts, as we usually do, we asked whether there was something bothering Sarah that she wasn’t telling us about, due to her arguably excessive “niceness.” I think you’ll enjoy listening, and you may learn a little, too! My co-therapists for this session included Dr. Rhonda Barovsky, my beloved and brilliant podcast host, as well as Kevin Cornelius, MFT, a fabulous TEAM therapist whom I’ve recently featured in a recent blog! Rhonda and I want to thank you, Sarah, once again, for your tremendous courage and generosity! David and Rhonda

Rhonda and David are joined today by Jeremy Karmel who is working with David on a new Feeling Great app. Rhonda begins by reading several amazing emails from fans whose lives have been changed by the podcasts as well as David’s books, including Jessica, Tim, and Mike. Thank you, everyone, for such kind and thoughtful comments! This great photo of Rhonda is courtesy of Nancy Mueller, a local photographer who kindly took some pics at my home in Los Altos, California. David describes his upcoming book, Feeling Great, which will be released in September of 2020. It will move well beyond his first book, Feeling Good: The New Mood Therapy, all will incorporate all of the latest hi-speed treatment techniques in TEAM-CBT (aka “Feeling Great Therapy.”) David describes his excitement about the team he is working with to publish his latest book, including Linda Jackson at PESI (the publishing company), and Jenessa Jackson, his editor. Jeremy describes why he approached David to develop a Feeling Great app. As a Stanford student, he was depressed and had to drop out of school for semester. Antidepressants and talk therapy had done nothing for him, so he was feeling hopeless. Then Jeremy discovered one of Dr. Burns’ students, Dr. Matthew May, and recovered in just two weeks, which was mind-blowing. Matt was one of the first practitioners in the world to use the new TEAM-CBT, Jeremy felt a tremendous drive to make these powerful new techniques available to people around the world. David and Rhonda, of course, share this goal! In fact, Rhonda has recently gone to Mexico City as well as India to support the sudden and strong emergence of TEAM-CBT in those countries. Rhonda asks Jeremy many questions about the amazing recovery he experienced in his work with Dr. May, and how he’s been doing since. Then Rhonda, Jeremy, and David address a number of intriguing questions about the new app. For example, there is tremendous evidence from research that David’s first book, Feeling Good, has significant antidepressant effects. In fact, many published studies have confirmed that more than 50% of depressed individuals will recover or improve dramatically within four weeks if you just give them a copy of the book. Is it possible that an app that incorporates all the great methods in Feeling Good, plus all the new techniques in TEAM-CBT, could be even more effective? And if so, would this mean that an electronic app could even outperform human therapists as well as antidepressant medications? David says that this has been his dream for more than 40 years, and he thinks this is a definite possibility. Jeremy agrees, since the app, now in creation, has the potential to be far more powerful and systematic than reading a book or even going to a therapist. Rhonda asks: "Are you trying to put human therapists out of business?" David believes that there will always be a place for human therapists, since the person to person support and connection is invaluable and desperately needed. However, the Feeling Great app can actually be a friend of human therapists, just as his book, Feeling Good, has been, working hand in hand with therapists helping to accelerate the recovery of their patients. In addition, the app can bring rapid help and relief to millions of people worldwide who cannot afford therapy, and those who simply cannot find effective therapy. David emphasizes the goal of having an entirely free version of the app for people without resources. Rhonda asks: "Will you be doing research as well as self-help “treatment” with the new app?" The answer to that is absolutely, yes, and the implications for incredible research into the causes and treatments for depression, anxiety and relationship problems are immense, especially if thousands or even tens of thousands of individuals use the Feeling Great app. For example, David has developed many psychological assessment instruments to help therapists and patients alike, but the costs and time required to develop and validate even a single short test can be substantial. In contrast, one might get more than enough data to evaluate a new instrument in just one day, which is mind-boggling. In addition, every time someone uses the app, we will learn more and more about what works, and what does not. This type of analysis is vitally important, but practically impossible, or at the very least arduous and confusing, when working with human therapists, due to the complexity of what’s happening, and the intense bias of therapists and researchers alike. The computer, by way of contrast, does not mind being wrong and moving in different and more promising directions! Rhonda, Jeremy and David will let all of you know when a beta version of the new app, is available, and hopes that many of you will try it out and let us know what you think! David will also let you know when pre-ordering for his new book, Feeling Great will be available as well! David and Rhonda Thanks for listening to today's podcast! David    

Rhonda and David are joined today by Dr. Michael Greenwald, who was in the studio following his recording of last week’s podcast. We address a fascinating question submitted by a podcast fan: Sally asks” “How can I help my depressed husband who is leaving me?” Hello Dr David, My husband is going through severe depression and anxiety. He blames me frequently for all the bad decisions he made, and he says he married the wrong woman. He regrets almost every decision he made and says he made the decision [to marry me] under my pressure. Our marriage of 20 years is almost leading to separation. I don’t want to separate, but I don’t know how I can improve the situation. He doesn’t want to go to any doctor. Do you think if I decide to go to TEAM certified therapist, they can work on me to get him out of his depression? If yes, how many sessions will it take? Sally David, Rhonda and Michael discuss this sad and difficult situation that Sally describes. Feeling loved and cared about is vitally important to nearly all of us, and when an important relationship is threatened, it can be extremely painful. It sounds like Sally's husband may be on the verge of leaving her. David describes a powerful and paradoxical strategy he described in Feeling Good: The New Mood Therapy, that he has often used to help abandoned wives. The approach is the opposite of "chasing," and is based on experimental research on the most effective ways of shaping the behavior of rats! It also sounds like Sally and her husband have some significant difficulties communicating in a loving and supportive way, like nearly all couples who are not getting along, and certainly some couples therapy or consultation might be a useful step. However, the prognosis for couples therapy isn't terribly positive unless both partners are strongly committed to each other, and willing to work on their own problems, as opposed to trying to change or “fix” the other person. We place a strong emphasis on the Five Secrets of Effective Communication, especially the listening skills, when criticized by a patient, family member, colleague, or just about anyone. If Sally committed herself to learning to use these skills—which are NOT easy to learn—she might be able to develop a more loving and satisfying relationship with her husband, whether or not they separate or stay together. David expresses the opinion that her fixation on “helping” or “fixing” him might be misguided, and might actually irritate him and drive him away. Rhonda, Michael and David illustrate David’s “Intimacy Exercise,” which is a way of learning to use the Five Secrets, and they practice with three of the criticisms Sally has heard from her husband: “You pressured me into marrying you.” “You’re to blame for all the bad decisions I’ve made.” “I married the wrong woman.” After each exchange, the person playing Sally’s role receives a grade (A, B, C, etc.) along with a brief analysis of why, followed by role-reversals. These role play demonstrations might be interesting and useful for you, too, because you’ll see how this exercise works, and your eyes will also be opened to just how challenging it can be to respond to a painful criticism in a skillful way, and how mind-blowing it is when you do it right. You will also see that trained mental health professionals often make mistakes when learning these skills, and how you can increase your skills through this type of practice. David emailed Sally with some additional resources that could be helpful to her. Hi Sally, Thank you so much for your question, and for giving us the permission to read and discuss your question on a podcast. We will, however, change your name to protect your identity. For referrals for treatment, you can check the referral page on my website,  or go to the website of the Feeling Good Institute. There may be some excellent therapists in your area, too. I would recommend the recent Feeling Good Podcast on “How to Help, and How NOT to Help.” . The idea is that listening is sometimes far more effective and respectful than trying to “help” someone who is angry with you. Also, the podcasts on the Five Secrets of Effective Communication, starting with #65, could be helpful, along with my book, Feeling Good Together. There’s also search function on almost every page of my website, and if you type in “Five Secrets,” you’ll get a wealth of free resources. Your husband might benefit from my book, Feeling Good: The New Mood Therapy, available on Amazon for less than $10. Research studies indicate that more than 50% of depressed individuals improve substantially within four weeks of being given a copy of this book, with no other treatment. However, the depressed individual must be looking for help, and it’s not clear to me whether the treatment is more your idea, or his idea. You seem to be asking for training in how to treat your husband. Perhaps, instead, you could learn to respond to him more skillfully and effectively using the Five Secrets. Learning how to do psychotherapy requires many years of training, and since he is not asking you for treatment or for help, that plan does not seem likely to be effective, at least based on what I know. In fact, trying to “treat” someone who is clearly annoyed with you runs the danger of creating more tension and anger, but this is not consultation, just general teaching. You would have to consult with a mental health professional for suggestions. Obviously, we cannot treat you or make any meaningful treatment recommendations in this context. But there is no doubt in my mind that there are many things you can do to improve the way you communicate with him and relate to him, if that would interest you. But this would require looking at your own role in the relationship, as well as lots of hard work and practice to learn to use the Five Secrets. Sincerely, David D. Burns, M.D. Thanks for listening to today's podcast! David

In today’s podcast, Rhonda and David are honored to interview Dr. Michael Greenwald, a courageous clinical psychologist who helped make the Atlanta Intensive a truly amazing event. Michael volunteered for the live demonstration to work on his lifelong problem with social anxiety, which seems to be a popular topic these days, and likely a personal problem for many podcast fans. My co-therapist was Thai-An Truong, a highly respected TEAM therapist and TEAM therapy trainer from Oklahoma City. Thai-An also joins today’s podcast via Zoom and dialogues with Michael for the first time since the intensive. The session with Michael was powerful and inspiring, with a good 50% of the audience in tears (of joy) at the end. Michael recorded the session on his cell phone, but the quality was not up to the quality of our podcast recordings, so he agreed to fly up to the “Murietta Studios” from his home in Los Angeles so we could at least describe what happened and share the magic with you. If we can find a way to do some sound enhancement on the cellphone recording of the session, we will likely publish it as a separate mid-week podcast for those who like to hear the incredible therapeutic process unfolding in real time. If you review Michael’s Daily Mood Log at the start of the session, you’ll see that he was feeling depressed, anxious, ashamed, worthless, lonely, self-conscious, discouraged and stuck, and all of these feelings were intense. In addition, he told us that he wasn’t feeling much joy, self-esteem, pleasure or satisfaction in his life. But the strongest feeling was anxiety. He said that coming up on stage to face his fears was an enormous challenge, and that this was the first time he’d ever done something like this. We will do T = Testing again at the end to see what changed, and by how much. We’ll also ask Michael to complete the Empathy and Helpfulness surveys, so we can find out how he experienced Thai-An and David during the session. You may be saddened by the upsetting event Michael recorded at the top of his Daily Mood Log, which was “sitting with my son and trying to make conversation with him.” He said their conversations were always pretty superficial, and that he would typically leave the room after short interactions with his son because he felt so anxious. Here’s an example of a typical exchange. Michael’s son, a graduate student in clinical psychology, was working on his applications to internship programs. Michael: What’s up? Son: I’m working on my applications to internship programs. Michael: That’s good. How’s it going? Are you getting them in on time? Son: Yah, it’s fine. Michael: Are you completing them? Do you want me to look at them? Son: All fine. If you review the negative thoughts on Michael’s Daily Mood Log, you’ll see that he felt like a failure as a father because he did not know how to get close to his son or how to tell him just how much he loved him. He was telling himself things like this: Something is wrong with me because I can’t talk to him. 100% I am failing him as a father. 100% He deserves so much better than me. 100% He must wish he had a different father. 95% And more. I was sad to see that Michael had been beating up on himself pretty badly for years, and I'm pretty sure that the therapists in the audience felt the same way, because it was so clear that he was a tremendously humble, giving and loving father who was totally devoted to his sons. I found myself thinking, "My gosh, I wish I'd been half the father that Michael is!" The E = Empathy phase of the session lasted about 30 minutes. Michael indicated that Thai-An and I had done a good job, and that he felt understood and accepted, so we went on to A = Assessment of Resistance in a step-by-step manner, using these tools: The “Invitation Step” to find out if he was ready to roll up his sleeves and get to work on his social anxiety The “Miracle Cure” question to find out what he hoped would happen in the session The “Magic Button,” to see if he’d want all of his negative thoughts and feelings to disappear suddenly, just by pushing it “Positive Reframing,” asking Michael these two questions about each negative thought or feeling: “What does this negative thought or feeling show about you and your core values that’s positive and awesome?” “What are some benefits, or advantages, of this negative thought or feeling?” At first, these questions didn’t make any sense to Michael, since he was so used to thinking about his negative thoughts and feelings in a negative light, thinking they were “bad” and were the result of some kind of personality defect or mental disorder, like “social anxiety disorder” described in the DSM5. This is also the hardest part of TEAM-CBT for therapists to learn, because it is so anti-intuitive. But as the list of positives grew, Michael began to “get it,” and we could actually see his mood lightening up before our very eyes. It was so cool, and this was the first hint the audience had that something remarkable was afoot. This, for sure, is one of the most powerful and innovative components of TEAM-CBT. The “Pivot Question” and “Magic Dial” Question. Michael decided it wouldn’t be such a great idea to press the Magic Button, since then all of the positives on the Positive Reframing list would go down the drain along with his negative thoughts and feelings. He decided, instead, to dial down his negative feelings to much lower levels that would allow him to feel better without losing any of the positives. You can see this on the “% Goal” column of his DML For example, he decided that it would be desirable to dial his depression down from 85% to 20%, since some sadness was appropriate, given his difficulties getting close to his son. In fact, if his depression disappeared completely, it would be like saying he didn’t really care. Michael decided to dial down the rest of his negative feelings as well in the range of 5% (for discouraged and stuck) to 15% (for anxiety), and 10% for the rest of his negative feelings. This ended the A = Assessment of Resistance phase of the session, and that took about 25 minutes. We then went on to M = Methods, focusing on his negative thoughts, one at a time, and attacking them with a variety of techniques like Identify the Distortions, Externalization of Voices, Acceptance / Self-Defense Paradigms, Examine the Evidence, and the Paradoxical Double Standard Technique. At the end, we went into the audience so Michael could ask participants if they were judging him, and what they thought about him as a father. This is called the Survey Technique, and it is usually pretty threatening to people with social anxiety, or any of us, really! But as you’ll hear in the podcast, the feedback he received was jaw-dropping. Thai-An joined us at the end and dialogued with Michael about the loneliness he’d struggled with, as well as how he could most effectively share his feelings of love and insecurity with his son. His “homework” after the session was to call his son and report back to all of us the next morning! The next morning, Michael reported that he’d had the most phenomenal dialogue ever with his son! He was practically floating on air, and reports that after the intensive, his life has changed dramatically in many ways, including: A terrific relationship with his son. Feelings of true joy, even ecstasy, that he’d never previously experienced or even thought possible. Way better connections with people in general, due to being open and vulnerable for the first time. Greatly improved clinical experiences as a result of using TEAM-CBT in his clinical work. In fact, he is thinking of starting a free weekly TEAM-CBT practice group in the Los Angeles area, and hopefully opening a Feeling Great treatment center somewhere down the line. Make sure you contact Michael if you are interested joining his weekly practice group. (drmichaeldg@gmail.com) You can see his amazing mood scores at the end of the session on his final DML. He also gave us perfect scores on the Empathy and Helpfulness scales, and described his experience as a “transformation.” After the session, he added that he’d seen that people really could improve quickly during other live demonstrations at my workshops, but felt skeptical that a TEAM session could trigger joy, even euphoria, as he’d never actually felt those kinds of feelings. But now, he realized this was actually possible! I would like to thank Michael, as well as my amazing co-therapist, Thai-An Truong. Thai-An is located in Oklahoma City and specializes in treating post-partum depression with TEAM-CBT. She also does one-on-one case consultation as well as awesome online TEAM training for mental health professionals, including free weekly webinars as well as her “TEAM-CBT bootcamp intensives.” If you would like to contact Thai-An, she can be reached at Thai-An Truong thaian@lastingchangetherapy.com. After the show was recorded, I received this amazing email from Michael. I think you'll enjoy it! Dr. Burns, Just some additional thoughts I'd like to mention about the changes I've noticed since the Atlanta therapy demo. The ones you put in the show notes are totally accurate. But the positive changes I've experienced since the demo go way beyond those. I'm not writing this to suggest you include these; I'm great with what you wrote. I only wanted to elaborate a bit on how things have been for me because it's such an incredible change for me. Please feel free to add to the notes, or not, at your discretion. And by the way, we are now two months post-demo and my mood scores remain essentially at zero with high positive feelings. My stress tolerance has increased a great deal. Prior to the demo, when I made a mistake or did something stupid, I would rip into myself with intensely harsh criticism and self-judgment (I think I shared with you about the time I dropped the bottle of Cologne as one example showing the different reactions to myself). Now, when the same sorts of things happen, those harsh voices are absent or merely a whisper, and easily dismissed. So there is no accompanying self-hatred like before. I'm far more outgoing with people in general. I feel closer than ever to my friends and family. I've been more present and available to my friends and family. I'm more open and far less defensive than I've ever been in my life. I feel more positive feelings than ever, and I laugh more than ever. I have more compassion for others as well as for myself. I'm more aware of my emotional world and have more access to my feelings. I'm able to connect more with others in general. The types of situations that would trigger feelings of irritability or anger, no longer do. I'm more able to be available for others, whether in my personal or professional life. I'm closer with my wife, and, honestly, with everyone in my family and social circle. I've been in several social gatherings since the demo, and my levels of anxiety have never been lower, and my level of engagement and participation has never been higher; I'm like a different person. I'm more optimistic and hopeful than before. So I know this is a bit of rambling, but I just wanted to mention these things. As I  had discussed with you during our visit, I've been struck by how far-reaching the benefits of the therapy demo have been for me. We focused on the one moment of one problem on the DML. We blew away those negative thoughts and feelings. That outcome, had it been limited to that specific target, would have been amazing and a total success for me. But as per your model, that was a 'fractal'. And the change in the brain circuits happened with that fractal and the new networks were created, and I feel that they continue to grow. For me, it's truly been the opposite of the drop of ink in the glass of water, discoloring everything, as a distorted thought or belief will do. The therapy demo was the drop of 'clarity' that shined the light on all my distorted thoughts and beliefs at one time. Maybe that's corny, but this is what it feels like to me. So feel free to use or not use any of this as you see fit. I only wanted to mention these things. There's more, but I think this gives the flavor. Thanks again. Love, Michael Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast. See below for details and links! David    

Rhonda, Fabrice, and David discuss psychedelic-assisted psychotherapy, Fabrice’s wonderful new marriage, his fascinating new podcast (http://peaceatlast.us/), and more. David and Rhonda are thrilled to have our beloved friend and colleague, Dr. Fabrice Nye, as the special guest on today’s podcast. Many of you will remember Fabrice as the man who gave birth to the Feeling Good Podcast, and acted as host for the first 133 podcasts. Fabrice describes many events since he turned over the reins to Rhonda earlier this year, including his recent marriage and move to the beautiful but fire-ravaged Russian River area roughly 100 miles north of San Francisco. However, Fabrice still maintains his clinical practice on a part time basis in Redwood City, in the San Francisco Bay area. The main focus of today’s podcast is Fabrice’s participation in promising new research on the treatment of PTSD. The participants in the study are veterans receiving psychotherapy that is assisted by treatment with MDMA during extended treatment session. MDMD is also known as the party drug, Ecstasy. However, the MDMA used in the research is chemically pure, whereas Ecstasy is generally obtained on the street and may not be pure. Fabrice describes MDMA as an “empathogen” that makes people more loving and more in touch with their emotions. This can make it easier for patients with PTSD to talk about their traumatic experiences and painful feelings, which people with PTSD usually try to avoid. Avoidance makes all forms of anxiety much worse, where as exposure is usually beneficial. Patients in the study received three treatment sessions, and a preliminary analysis indicated that one third of them improved to the point that they no longer had symptoms severe enough to be diagnosed with PTSD. Further studies are in progress, including a study with a control group, as well as follow-up studies to find out whether the improvement continued and whether some of the patients relapsed. Fabrice also describes the fascinating new trend in treatment of a variety of conditions with psychedelics, including psilocybin, mescaline, and ayawauska. I expressed my personal support for this trend, as these substances have been used by hundreds, if not thousands of years, for spiritual purposes by indigenous people throughout the world. And perhaps the coolest thing we learned was that Fabrice will be starting his own terrific podcast entitled PeaceAtLast.us about the time today’s podcast will be published. PeaceAtLast.us will focus on the overlap between spirituality and psychotherapy, a topic that I have always found extremely interesting and helpful in my own clinical work using TEAM-CBT. You might want to check out the new Fabrice podcast! I know that Rhonda and I will! After the podcast, we received the following email from Fabrice, which includes many resources for those of you wanting more information about psychedelics and psychotherapy, as well as his new podcast. Hi David and Rhonda, It felt so good to be reunited with you for an hour. Wish we didn’t have to cut it so short. Here are some of the links that you may want to provide to your listeners. Multidisciplinary Association of Psychedelic Studies (MAPS), which sponsors and funds the Phase 3 trial of MDMA-assisted psychotherapy for PTSD: https://maps.org/ Michal & Annie Mithoefer, lead researchers for the study: https://mapspublicbenefit.com/staff/michael-mithoefer-m-d/ Psychedelic research at Johns Hopkins University: https://hopkinspsychedelic.org/ Roland Griffiths, main researcher for psilocybin studies at JHU: https://hopkinspsychedelic.org/griffiths List of federal clinical trials involving psychedelics in the U.S.: https://clinicaltrials.gov/ct2/results?cond=&term=psychedelic&cntry=US Article on how to have a legal psychedelic experience (but not necessarily a safe one): https://psychedelic.support/resources/legal-ways-to-pursue-psychedelic-experiences/ And finally... Here’s how to find my new podcast, to be launched on February 6, 2020: http://peaceatlast.us/ Fabrice Nye fabrice@life.net    

  Rhonda and David discuss two challenging questions submitted by listeners like you.  Question #1: Cindy asks: My suicidal daughter refuses to talk to me! What can I do? Comment: Dear David, I stumbled upon you teaching in another podcast a few months ago. Immediately I was stunned by how much your words echoed in my mind. I have listened to your book three times in Audible and many of your podcasts. You Changed my life!!! I am much more relaxed now and I can sleep!!! I talked about you with my massage therapist and she bought your book for her daughter (who has anxiety attacks) and her niece. Her daughter is an aspiring artist who said that she would buy your book and give them away to teens when she becomes famous. I now ask you to change another life, that of my daughter's. She has been depressed for more than 20 years, suicidal (bought a noose, watches suicide movies, talked about ways to kill herself) and no therapists could help. We went to therapy together this past summer and it only ended that she abruptly canceled and is no longer responding to me by any means: phone, text, card, or email. The last time I saw her was late August and she was very down and had very poor personal hygiene. I have since sent her a loving text at least every other day, I offer to drive to her city (an hour away) to have dinner with her, I sincerely apologized for everything I could think of that I have done wrong since she was a child, I sent gifts to her by mail, I invite her to come for holidays, I ask her cousins to call (she did respond to them). No response to me at all. I am wondering how to communicate with a loved one who just totally shut you off. Always your fan, Cindy Thank you, Cindy. Sorry to hear about your daughter, very concerning. My heart goes out to you. Our own daughter had a rough time as a teenager, too, but now is doing great. I hope things evolve with your daughter, too. This podcast may help: https://feelinggood.com/2019/10/28/164-how-to-help-and-how-not-to-help/ as well as this one: https://feelinggood.com/2019/02/04/126-how-to-communicate-with-someone-who-refuses-to-talk-to-you/ The first podcast highlights common errors in trying to “help” someone who is hurting, and emphasizes how to respond more effectively, using the Five Secrets of Effective Communication. The second podcast illustrates how to get people to open up using one of the advanced secrets called “Multiple Choice Empathy / Multiple Choice Disarming. My book, Feeling Good Together, explains these techniques in detail, with practice exercises, and includes an entire chapter on how to talk to someone who refuses to talk to you. You can learn more on my book page. (https://feelinggood.com/books/). Some support from a mental health professional might also be helpful to you, as these techniques sound simple, but are actually challenging to master. Your daughter might also benefit from my book, Feeling Good: The New Mood Therapy (https://feelinggood.com/books/). It is not a substitute for treatment from a mental health professional, but research studies indicate that more than 60% of the people who read it improve significantly in just four weeks. It is inexpensive, and I’ve linked to it if you want to take a look. All the best, David Question #2: Lorna asks: How can I deal with my jealousy? Comment: Hi David, I've recently discovered your books and your podcast and CBT has really been helping me in my personal life. I really want to thank you for all the amazing work you do!! The issue I'm having however seems to still really get my moods down and I was wondering if perhaps you could offer some general advice via the podcast. I'm in a great relationship but the ex-girlfriend of my partner has recently moved back to the city where we live and now we are in similar social circles. They were together for a very long time and now I'm really struggling with the prospect of spending time with her. When we all spend time together, it’s actually fine, but afterwards I really struggle with thinking about them together, getting to know her and thinking about her personality and how we compare. I think most people would find this uncomfortable, but it really has triggered a downward spiral for me. My partner and I argued about it and I struggle to let things go that were said in arguments. Do you have any advice on dealing with a situation of an ex-partner being on the scene and perhaps how to not dwell on things that were said during arguments? Thanks, Lorna Hi Lorna, Thanks, might work. What does this mean: “Do you have any advice on dealing with a situation of an ex-partner being on the scene and perhaps how to not dwell on things that were said during arguments?” The rest of the email seems to suggest feelings of jealousy, insecurity, and so forth, as if she is a threat to your current relationship. is this correct? David Hi David, Thanks so much for getting back to me! I don't actually think she is a threat to our relationship, and don't feel that they have feelings anymore for each other, but it just makes me super uncomfortable to think about how long they spent together. I'm always comparing our relationship to what I think their relationship was like in the past. I know I should stop thinking about those things but I really struggle to stop! I know my partner and I are very much in love but I keep having thoughts like “It’s not fair that I have to spend time with her,” or “I feel really guilty because he wants to be friends with her but can't due to how I feel about the situation.” I also feel like he blames me. I was hoping you could shed some light on what you think in general is a good strategy for dealing with situations where an ex-girlfriend/boyfriend of your partner is on the scene and you all have to spend time together. I do have feelings of jealousy and insecurity but I struggle to understand why as I don't believe they want to be together anymore at all. We had a few arguments about it initially where he said things like “you are just angry that I have an ex-girlfriend” or “what's the big deal about it all?” I was so hurt by the way he made my feelings seem petty and trivial. We have both apologized but I keep remembering what he said and how hurt it made me feel. Do you have any advice on letting go of past arguments when the 'problematic situation' (ex-girlfriend being around) is still on-going? Thank you so much! Lorna David and Rhonda discuss this question, and include David’s story in Intimate Connections as a medical student when David had a broken jaw and the ex-boyfriend of Judy, the girl he was living with in Palo Alto, charged into his house with a tough-looking friend and demanded to see Judy. David called the police, and the two fellows left and set, "we're going to get you!" David was terrified, since his jaw was still broken, and got some jaw-dropping advice the advice from his buddy, Sergio. You will be surprised to hear about what happened next! In addition to learning to "let go" of jealousy, Rhonda and David discuss many additional strategies for dealing with jealousy, including: Use of Self-Disclosure Positive Reframing: do you really want to give up your jealousy and vigilance? Cost-Benefit Analysis: Is it worth the hassle of constantly being suspicious, as opposed to simply deciding to trust and let the chips fall here they may? Downward Arrow: What are you the most afraid of? Love Addiction Fear of Rejection Fear of Being Alone Overcoming the fear of being alone and the “need” for this man’s love, or any man’s love, is discussed in the first section of Intimate Connections. Exposure: You could fantasize the two of them together, making yourself as anxious and jealous as possible, until the feelings diminish and disappear. Self-Monitoring: Counting your thoughts about them on a wrist counter or cell phone for four weeks. David describes his work with an intensely jealous law student after his girlfriend broke up with him so she could date another fellow in his class. Understand the frequent ineffectiveness of apologizing, and why it doesn’t work! This is really important. David describes a powerful vignette about a troubled couple, where “I’m sorry” was CLEARLY a way of saying “shut up, I don’t want to feel about how hurt and angry you feel.” The Five Secrets of Effective Communication are a vastly more effective way of dealing with negative feelings. David and Rhonda contrast effective vs. dysfunctional “apologizing.” While it can be important to say "I'm sorry," this formulaic response is usually insufficient because it often ends the conversation but the difficult or hurtful feelings remain. What's important to add is talking about the other person's feelings, thoughts and experiences of the conflict and sharing your own thoughts and feelings.  When you say, "I'm sorry," it's sometimes insufficient because it often ends the conversation, but the difficult or hurtful feelings remain. What's important to add is talking about the other person's feelings, thoughts and experiences of the conflict and sharing yours. After David emailed Lorna with the outline for the podcast, Lorna replied: Hi David, Thank you sounds great! Can’t wait to listen to the episode. I think I will definitely order your book - I think it’s the only one missing for me to have the complete collection. Thanks again! Lorna Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast. See below for details and links! David

Rhonda and David address a question from Karolina, a therapist in Poland who was failing with a depressed patient who felt totally convinced he was a “useless” human being. I think you will find their discussion of this case fascinating, as it deals with the cause of practically ALL therapeutic failure, and illustrates the solution al well, using TEAM-CBT methods and concepts. Today’s podcast is intended for therapists and patients alike! For the show notes, we are including the email David received from Karolina, as well as his initial response. Dear Dr. Burns, I've been listening to your podcast for 6 months now and it's been so helpful with my work as a therapist as well as in my personal life. I'm starting to develop a habit of considering every unwanted state with a "what does it say that's awesome about me?" and I'm much happier now :). I'm wondering if you'd consider helping me some more. I have a client who's been struggling with depression for many years. At the moment he's doing ok and his mood is up. Lately the topic of his uselessness came up again and he's willing to work on that. He said he'll consider the possibility that he's not a useless human being and asked me to not to dismiss the possibility that he is - that's how he'll know that I'm not just trying to cheer him up. It's been bugging me ever since. Although I've agreed, I really can't find in me any part that is ready to think that. I strongly believe he's not a useless person. I can't imagine labeling anyone in that way and in his case it feels so personal as I like him very much and I care about him. I'm starting to have dreams about our next session when I fail him by trying to convince him to think as I do. How can I be open about our conclusion when my mind is already fixed? Any thoughts on this would be deeply appreciated. Best wishes from Poland Karolina Hi Karolina, Thanks! The term has no meaning. It is just a vague put down, like what a bully might say. I might ask him what time of day he was feeling useless, and then have him fill out a Daily Mood Log for that moment, step by step. We can only help him at one specific moment. You can use a large number of techniques but must first get an A on Empathy, and then do effective paradoxical agenda setting, starting with the Paradoxical Invitation Step and then asking “what type of help would you be looking for?” then you can do the Magic Button and Positive Reframing. All of the negative thoughts and feelings on the Daily Mood Log will be advantageous and will show something about him that is awesome and positive. You should be able to generate a list of at least 25 overwhelming positives. Then you can use the Magic Dial. When you get to M = Methods, you can put the thought, “I am a useless human being” in the middle of a recovery circle, and then select a minimum of 16 methods to challenge it. You can start with Identify the Distortions. There are likely at least 9 distortions in the thought, including AON, OG, MF, DP, MAG / MIN; ER; LAB; SH; SB. You can try, “let’s define terms,” and ask what’s the definition of a “useless human being”? You’ll find that no matter how you try to define it, The definition will apply to all human beings. The definition will apply to no human beings. The definition does not apply to him. The definition does not make sense. The definition is based on some kind of arbitrary cut-off points. You can do this as a role-play, being a close friend trying to find out if you’re useless, and asking him for guidance on how to find out. You can do the Paradoxical Double Standard Techniques, Downward Arrow, Hidden Emotion, Externalization of Voices, Acceptance Paradox / Self-Defense Paradigm, Examine the Evidence, Semantic Method, and on and on. The problem is NOT that he’s a “useless human being” but rather that he’s obsessing and wasting time on a meaningless construct, and beating up on himself. The whole key to success will be agenda setting. You can take the position that maybe this is not something that he really wants to challenge, since it may be working for him, and also reflects all those 25 wonderful things about him. The whole key to success will be agenda setting. You can take the position that maybe this is not something that he really wants to challenge, since it may be working for him, and also reflects all those 25 wonderful things about him. Remember that just about 99.9% of therapeutic failure results from Agenda Setting errors. Is this something you want to help him with, or something he is desperately asking you for help with? I am almost 100% positive that this is your agenda, not his. In fact, your need to “help” him with this may actually keep him stuck. In fact, here is the proof. You write: “I'm starting to have dreams about our next session when I fail him by trying to convince him to think as I do. How can I be open about our conclusion when my mind is already fixed?” If you don’t understand this, I recommend some supervision from a TEAM therapists or join one of the online classes, or attend my workshop on resistance, coming up in a month or so, check out my website workshop page for details. You can join online. David D. Burns, M.D. Hi Dr. Burns, Thank you so much for your quick and thorough response! I kinda felt that my "helping" is the issue here as I've felt my own frustration rising... Thanks for reminding me that uselessness is just a meaningless concept, I needed that. And I love the idea of role-playing as a friend asking for help with defining his uselessness. I'll pace myself, though, and give us time to walk through all the steps, especially Empathy and Agenda Setting and check how it goes and what my clients wants, not I. I appreciate information on the resources and supervision I can access online, so good to know there are options! You can use my real name, can't wait to hear the podcast :). Karolina Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast. See below for details and links! David