Ask David Five Secrets Relationship Questions Kate asks: I love listening to your podcasts and am currently reading my way through your book, Feeling Good. I appreciate that you have written and spoken about relationship problems at length, but in what I have read and heard so far I do not see how this can apply to the current climate of casual dating and hook up culture which is fueled by apps such as Tinder. I don't know how it's possible to build relationships when the dominant mentality is that people are disposable. It feels like no matter how much I find truth in what my date says, stroke them and empathize with them, that they will disappear ('ghost') at the drop of a hat. I think this may be a significant problem for many of your listeners, and would greatly appreciate your thoughts, as well as any practical steps on how to date in today's world. * * *  Eli asks: Your work has helped me tremendously over the past 2 years. However, recently I’ve discovered something about myself that I don’t know how to change. I’d be really curious to hear your thoughts. For some reason, when it comes to sex, it seems that I have a lot of self-worth wrapped up in my sex drive. I’m realizing when my wife and I have sex I feel like I’m on top of the world afterwards. I feel so positive the following few days and I feel mentally and emotionally healthy. But it’s devastatingly real that the reverse is true as well... when we don’t have sex (and particularly when I reach out and she’s not in the mood) and when a week or so passes that we don’t have sex, I find myself feeling very insecure. I feel ugly, unlovable and generally less valuable as a person. Is there an exercise you would recommend for me to discover possible hidden thoughts/emotions that could be causing this? Is it possible to change this about myself? I want to have a close, intimate relationship with my wife (sexually and non-sexually) but I also want to feel valuable and positive whether or not we’re sexually active. PS - If, by chance, you address this on the podcast, could you refer to me as “Eli” or something else anonymous as you usually do. Thank you for all you have do! * * *  Susan asks: You seem like a good person to ask this question partly because you are a man. Someone I know, I won’t say whom, told me he felt emasculated when I asked him to take my car to the gas station to get the wipers replaced. He said that he should be able to replace them himself but doesn’t actually know how, so he would prefer if I took the car to the service station. I said that was stupid, granted not very diplomatic, and he said that’s what he gets for expressing his feelings, which I frequently complain he does not do. To me “emasculated“ is more of a concept or a thought. I will not get into toxic masculinity and the patriarchy, but I am curious what you think. By the way, this person and I have benefited a lot from your relationship journal exercise, thankfully we did not need it this time :-) * * *  Knaidu asks: Here’s a specific example which occurred whilst I was trying to use the disarming technique. It is one where I failed to use the technique. Anyway, I was meeting a friend of mine, and was a running a few min late for our lunch appointment. I couldn't send her text to let her know as I was driving. I arrived at least 5 min late. When I arrived she immediately said "I knew it all along, you really don't want to meet with me or actually have lunch with me!” I tried to explain that I was stuck in a traffic jam and couldn't text, but it didn’t work. Here’s what I said:  “Please Mrs. X, I was stuck in a traffic jam and that's why I am late. Have I ever said I don't want to meet with you? And if I didn't why have I bothered to arrive at all, I mean I could have just not arrived if I didn't want to meet you!" After I said that she stormed off. I am afraid I could agree with her idea that I didn't really want to meet with her, because the truth was I did want to meet but couldn't help being late. I could agree with something that was not real to me and if I did try to agree, I would be lying to her. Please help me, David and Rhonda! Thanks for tuning in, and keep the great questions coming! David and Rhonda

New Ask David Questions Kelly asks: Would love to hear a podcast about to use or not to use touch in therapy. I personally feel touch is extremely helpful (what is more natural than to hug or put a hand on someone hurting), however I believe our profession has become so “professionalized” that is leaves out such a power act of healing. Did you ever use touch when you were practicing, and do you feel it is appropriate? Against Machines Taking Over asks: You say that depression always results from distorted thoughts. But the sadness that results from a failure, rejection, or disappointment is not distorted. Can you explain a bit more about this? Against Machines Taking Over also asks: Is there something you used to advocate for before but then you changed your mind? Eduardo asks: How do you treat hypochondriasis. Almost all articles and advices I've read for hypochondriasis try to cover the writer's back by first and foremost telling you that you should get yourself checked for real causes for your concern. Eduardo also asks: I've been struggling with anxiety, and after reading When Panic Attacks, I got very interested in giving The Hidden Emotion model a try, but it seems to be structure-less. It seems to require a lot of detective work with no clear sheet or procedure. It's just Detective Work, and then do something about it. Is there some newer technique to dig into what's eating you?

In today's podcast, Rhonda and I interview the incredibly brilliant, funny, and creative Amy Spector. Amy is a licensed marriage and family therapist and credentialed school counselor with over a decade of experience working with adolescents and their families. She is passionate about providing school-based mental health services and advocates for legislation to mandate universal mental health care for youth. Amy works with "at risk" teenagers at Vicente High School in Martinez, California. This is a continuation high school, as well as teens at Briones School, an independent study school. Her students are credit deficient and at risk of not graduating from high school. Nearly all have experienced significant trauma and most are severely depressed, anxious and angry when first referred to Amy, and some have suicidal thoughts or urges as well. Although you might think that this would be an exceptionally challenging, oppositional, and frustrating group to work with, Amy has had tremendous success treating these teenagers with TEAM-CBT. She measures symptom severity at the start and end of every session, just as we do with adults, and often reports a phenomenal reduction of 60% in depression and anxiety in a single, 30-minute therapy session. Although this may be hard, or even impossible, to believe, it is real, and you'll see why when you listen to this amazing interview. Amy's secret involves a combination of superb E = Empathy skills to form a meaningful relationship, along with A = Paradoxical Agenda Setting to reduce resistance, followed by truly creative applications of M = Methods. And, of course, she does T = Testing with every student at every session, and plots her effectiveness over time. Amy describes her work with a severely anxious young man with artistic skills, who drew an "Anxiety Hero" figure who saves the world by worrying constantly about every little thing, plus a "Chilled Out" figure who never worries and ends up getting hit by a bus. In other words, Amy skillfully emphasized the many BENEFITS of the young's man's constant anxiety, as well as the downside of getting cured. This paradoxically boosted his motivation, and he improved rapidly. This is prototypical TEAM, which is difficult for many therapists to learn, because therapists are so used to, and addicted to, "helping." Amy has developed expertise in aligning with the resistance of her students. paradoxically, she ends up on the same page, and this allows some awesome TEAMwork to emerge. Amy, Rhonda and David talk about the idea of teaching TEAM through creative innovations, with many examples of games Amy has created. For example, she created a game with another one of our fabulous TEAM-CBT therapists, Brandon Vance, MD, which can be played with teens and adults, called "Tune In / Tune Up." This game provides a really fun way to learn the 5-Secrets of Effective Communication. If you're interested, you can check it out at  www.gamefulmind.com. Amy and her students have also created a podcast that you might want check out. Although I (David) have been primarily an adult shrink, I have really enjoyed working with teenagers as well. A few years back, I tested hundreds of juveniles who had been arrested in California, many for violent crimes, including murder, at the request of the probation department, using my Brief Mood Survey to find out how depressed, anxious, suicidal, and angry the kids were. Toward the end of the podcast, I describe what happened when I was invited to visit two groups of incarcerated gang members at the Juvenile Hall in San Mateo, California to find out how they felt about the tests I administered, and to get their take on the causes of so much teen violence. I think you'll find this episode to be fun, funny, and inspiring! Amy is a strong advocate for including mental health training in high schools, and her experience illustrates the enormous potential for rapid and profound mental health growth and learning in teens. If you would like to contact Amy, she can be reached at babyfreud@gmail.com.    

Are there some special techniques therapists need to use when working with LGBTQ patients? Does the therapeutic approach have to be different? In today’s podcast, Rhonda and David interview Kyle Jones, a brilliant 5th year PhD student at Palo Alto University. Kyle has been a member of David’s training group at Stanford for the past four years, and now sees patients at the Feeling Good Institute in Mt. View, California. Today’s program is based on Kyle’s doctoral research on the treatment of LGBTQ patients. To get the interview started, Kyle defines LGBTQ: L = lesbian G = gay B = bisexual T = transsexual Q = questioning, or queer. Then Rhonda asks the obvious question: How does the treatment of LGBTQ individuals differ from the treatment of individuals who are heterosexual? What are the key differences? What special techniques or procedures should therapists use? And what does Kyle’s research reveal about the important factors in the treatment of gay individuals? Kyle emphasizes that most important factor is the therapist’s attitude toward the patient, as opposed to any special techniques or procedures that are unique to the treatment of the gay population. Sensitivity to and awareness of the unique challenges this population faces in terms of hatred and prejudice are tremendously important. Kyle points out that some therapists place an excessive focus on the patient’s gayness, while some tend to sweep this “uncomfortable” issue under the rug. Kyle emphasizes that the therapeutic approach is largely the same for gay and straight patients. In TEAM, we first provide strong empathy, so the patient feels understood and accepted. This, of course, is crucial for all patients. Then we set the agenda, asking the patient if she or he wants help, and if so, what is the problem that he or she wants help with? In other words, there is no special “agenda” that the therapist should impose on the treatment simply because the patient is gay. Kyle mentions that this is not a trivial point, because many therapists will try to set the agenda for the patient, thinking there is some “correct” way one should treat gay people, or some “correct” set of issues that must be addressed. David points out that thinking there is a special approach to gay patients could actually be viewed as a type of bias, thinking that the treatment of members of the LGBTQ community must be somehow “different” or special. In TEAM, we do NOT treat disorders, diagnoses, or “types” of patients. We treat humans in a highly individualize way, using the fractal approach described in a previous podcast. In other words, we ask the client to describe one specific moment when he or she was upset and wants help. Then the treatment flows from the exploration of that specific moment, because all the patient’s problems will be encapsulated in how she or he was thinking, feeling, and behaving at that moment. The treatment might then focus on depression, anxiety, a relationship problem, or a habit or addiction. Rhonda, Kyle and David discuss the problem of therapists who have a strong anti-gay bias. David talks about his father's work, trying to convert gay students at the University of Arizona after he retired from his work as a Lutheran Minister in Phoenix, and how much shame and anger David felt about this. David described his positive bias toward LGBTQ individuals, because of the suffering most have had to endure due to hatred and prejudice. David asks whether gays therapists are obligated to announce their sexual orientation to their patients, and Rhonda and Kyle come up with some pretty cool answers! Rhonda points out that when and how to do self-disclosure is a question all therapists face, and that the goal of self-disclosure in therapy should be on how best to help the patient, not the therapist. Again, this question of the hows, whens and ifs of self-disclosure is a general therapy issue, and not something specific to gay therapists. Kyle and David reflect on some of the personal work Kyle did during his training program, and how important that work has been to Kyle as he has evolved into a dynamic, compassionate therapist and teacher. They reminisce about the first personal work Kyle did with David on one of the Sunday hikes. Kyle was feeling depressed because he’d just been rejected, unexpectedly, by his boyfriend, and was able to turn the situation around dramatically and quickly using TEAM-CBT. Kyle also describes his own discovery during college that he was gay, and what happened when he shared his sexual orientation with his parents and brother. The message of this podcast turned out to be pretty simple and basic. The key to the effective treatment of all of our patients is acceptance. The therapist needs to accept the patient, and the patient needs to learn to accept himself or herself. In fact, acceptance seems to be the path to recovery and enlightenment for all of us, whether gay or straight! David D. Burns, MD, Rhonda Barovsky, PsyD and Kyle Jones (PhD candidate)  

What can you do when you can’t identify your negative thoughts? Is it really true that our feelings always result from negative thoughts? How can I get over my public speaking anxiety? Rubens, a faithful and enthusiastic Feeling Good Podcast fan, sent me an email with a terrific question that has both  practical and theoretical implications. He wrote: Dear Mr. David, I've read "Feeling Good" and I'm reading "When Panic Attacks" now. Both have and are helping me immensely. However, the one thing I have never understood is that my anxieties and worries often don't come as a thought. For instance, I have an academic presentation tomorrow, and I'm suffering from much anxiety because of that. But the symptoms did not appear because I thought in my mind the sentence "you are going to fail!". In my case, it is usually silent. I just remember that I have a presentation tomorrow, then I immediately feel worried. My chest hurts before any thought. How do I counter-argument my thoughts, if I have none? Thank you for replying, Mr. David!  In today's podcast, Rhonda and I address this question and explain what to do when you can't pinpoint your negative thoughts. There are  two really good methods. We will also demonstrate how to deal with some of the negative thoughts that typically trigger public speaking anxiety. The cure involves changing the way you think, and changing the way you communicate with the people in your audience. If you've ever struggled with public speaking anxiety, this podcast may be helpful for you! Thank you again, Rubens, for your excellent question! David D. Burns, MD / Rhonda Barovsky, PsyD  

I recently published the results of a survey of Feeling Good Podcast fans like yourself. The findings were overwhelmingly positive and illuminating. However, there were a few criticisms as well, like the excellent and thoughtful comments Rhonda and I will address in this podcast. I appreciate negative feedback, as this provides the greatest opportunities for growth and learning.  However, like most people, I sometimes find criticisms emotionally challenging  and want to lash out, defending myself! Do you sometimes feel that way, too? When I feel defensive, its because I think I have a "self" or some cherished "territory" that's under attack. When I let go of this "self," it can be incredibly liberating to find truth in a criticism and discover that the feedback is really coming from a trusted colleague or friend, rather than some enemy who is trying to destroy or defeat you!  Here's what s/he wrote: Dr. Burns, you seem to disregard healing modalities outside of CBT. CBT is wonderful and nobody teachers it better than Dr Burns—I believe that it is a foundational practice to well-being. However, working with difficult emotions is very important and not always well addressed through CBT alone. Thinking CBT is the answer for most issues is loaded with cognitive distortions. Example--Discounting the Positive in other practices, All or Nothing Thinking, Magical Thinking, and seeing CBT as a “cure all.” In my personal healing journey CBT has been absolutely essential--as has self compassion, learning to let things go, inner child work, mindfulness, somatic awareness and more. I have noticed there has repeatedly been a dismissive tone for other valuable practices. Obviously. the Feeling Good Podcast is about CBT and sticking to your expertise is essential. However, I would be careful not to disregard other healing practices that could potentially help someone out. I have such respect for Dr Burns and his team-but your words carry weight- please be thoughtful about discounting other methods that could be helping someone. Thank you, whoever you are, for this thought-provoking feedback. And you are SO RIGHT. Cognitive Therapy has value for some problems, but it is definitely NOT a panacea. In fact, no treatment is! The belief that you have THE ANSWER for everything is incredibly misguided but unfortunately, way too common in our field.  I have no doubt that many people have shared your concerns. Let us know what you think after you hear today's podcast!  David and Rhonda

How would you overcome the fear of aging? Can you use TEAM for sports psychology? Describe your typical day, David-- do you ever get down or anxious? Hi Listeners: Thanks for your many and awesome questions. I love to answer them! And there will be more to come in future podcasts. Your questions are GREAT!  Vipul: Tell us about your new book, Feeling Great. How will it be different from Feeling Good? And can people with schizoaffective disorder be helped? (story with Stirling Moorey) Guy: What’s a nervous breakdown? Rob: How would you treat a field goal kicker who’s afraid of missing the winning field goal? Would you use positive visualizations? Michael: How would you treat someone with the fear of aging? I turn 60 in a few months, and have been experiencing anxiety around not be able to do some of the things I love as I age. Hidem: How fast is fast? I notice your frequent use of the term "High Speed Recovery" (and even Warp Speed) when describing the benefits of TEAM CBT. How rapidly does the average patient recover? Brittany: I had an idea that I think would benefit a lot of us. I’d like you to do a podcast on a week or a day in your life. The ups & downs of your moods, triggers, etc., & most importantly how you deal with them. Do you write out your own Negative Thoughts a Daily Mood Log? Thank you for all of your great questions, comments, and testimonials! Rhonda and I really appreciate that!   David and Rhonda PS Here's a great question we did not get to today. We'll do it in a future Ask David, as it's really important.  Rubens: What can you do when you can’t identify your negative thoughts? I get anxious, but don’t seem to have any negative thoughts. Is it really true that our feelings always result from negative thoughts?  

Is it REALLY Possible? And Can the Effects Last? Rhonda and David interview Garry, a veteran who David treated for PTSD several years ago at a trauma workshop in Michigan. Garry describes how a repressed horrific memory from his childhood suddenly and forcefully re-emerged when he smelled some Queen Anne’s Lace that were in blossom. He suddenly remembered how a school bus he was riding home on hit a horse with a boy, Tommy, who was riding bareback, when the horse suddenly lurched in front of the bus. Tommy was Gary’s classmate. The bus driver said, “Don’t look!” But Garry watched as his friend, who was trapped under the dead horse, “bled out” and died. Once this totally forgotten memory re-emerged decades later, roughly 18 months prior to Garry’s session with David, it constantly intruded into Garry’s every interaction for the next year and a half. Garry says, “I was seeing Tommy all the time, and having symptoms of anxiety, intrusive memory and dissociation experiences. I would often see the image of Tommy lying on the pavement superimposed over conversations I was happened with people in an intimate way. It was quite disturbing and anxiety provoking.” Garry tearfully describes what he experienced during his TEAM-CBT session with David, including his dissociation at one point during the session, and the profound changes he experienced by the end of the session. Can severe PTSD be treated in a single therapy session? Did Garry really improve? Were the changes real? Did they last? And how did the therapy work? You’ll find out when you listen to this amazing and inspiring interview! We are incredibly indebted to Garry for his courage and openness to share this experience with all of you!    

Hi Listeners: Most people do not do a very good at helping loved ones, colleagues, or friends who are upset and complaining. Have you ever noticed that when you try to help or give advice they just keep complaining? This can be very frustrating--fortunately there's a fabulous solution to this universal problem.  This special podcast features our guest, Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute. Jill is also one of the teachers at David's Tuesday evening psychotherapy training group at Stanford, as is our esteemed podcast host, Dr. Rhonda. Jill describes the "helping" errors she made when her son became despondent after some painful foot surgery. Following the surgery, he was in a cast for weeks, and when the cast was removed, he discovered that he could not move or feel his toes. This is common, and results from muscle atrophy when you are in a cast, and is not dangerous. However, Jill's son was very discouraged and frustrated, and told his mom that he didn't feel like going to school and thought he wasn't ever going to get better. Jill felt exhausted from all the demands on her that day, trying to get him off to school, and trying to get to work on time, and so forth, and gave in to the urge to say things like, "You're going to be fine," which were totally ineffective.  Jill describes a similar error that she made when her mother also complained about foot problems and the need for surgery. Her mother loves to hike and was upset that she'd be unable to hike for some time. Jill, perhaps feeling a little impatient with her mom, suggested other forms of exercise, like swimming, and this simply increased her mother's complaints. I'll bet you've experienced this same thing when you tried to "help" someone who was complaining. Even therapists make this type of error all the time.  Rhonda, Jill, and I discussed the most common errors we all make when we lose patience with someone who's complaining, and illustrated the techniques that are effective. As usual, they involve the Five Secrets of Effective Communication, especially Disarming, Stroking, and Feeling Empathy, along with some compassionate I Feel Statements. We also discussed the phenomenon of drifting in and out of Enlightenment, a concept first described by the Buddha. It is easy to drift out of enlightenment when we are rushing around, trying to get breakfast on the table, lunches made, kids to school, and ourselves off to work. It's so easy to feel overwhelmed and frustrated at those moments. Part of the process may include forgiving ourselves when we make mistakes, and using the 5-Secrets to repair relationships with our loved ones when we do. In fact, this can even lead to deeper and more loving relationships.  We also discussed a closely related and possibly controversial theme--is it okay to use the Five Secrets just to get someone to stop complaining, especially if you're angry with that person and they tend to complain most or all of the time? Do you always have to use the Five Secrets in a totally sincere manner?  I want to thank Dr. Levitt for joining us in this inspiring and illuminating podcast. Whenever Jill teaches, the heavens open up, and this podcast is no exception. Jill is simply a fabulous therapist, teacher, and human being!  Click here if you are interested in some online training with Jill! David and Rhonda

Hi Listeners: Many of our podcasts are inspired by listeners like you who send us really cool emails with show ideas. Sometimes the emails are from people wanting self-help with emotional or relationship conflicts. And sometimes, they are from therapists wanting more training and information about TEAM. Rhonda and I love your emails! Yesterday, I got the following email from Dipti Joshi, one of our listeners and TEAM-CBT therapists from India. Dipti flew all the way from India to Canada with her lovely daughter last summer for my Intensive in Whistler, Canada. I am hopeful that Dipti will one day create the first TEAM Treatment and Training Center in India. How cool would that be! Here’s the email that Dipti sent me: Dear David, I am really enjoying all the educational materials available on your website. Thank you! I will soon be taking my Level 3 TEAM certification exam, and am seeking your kind blessings for the same! Also, I have a special request for you. Is it possible to have a workshop or podcast on “paradoxical techniques?” I feel this is a very challenging area, and that a lot of skill is needed. Perhaps you can also talk about why paradoxical techniques can be so effective. Meanwhile can you suggest me something to read or listen to for this? Regards, Dipti  Thanks, Dipit! Today’s podcast will be an introduction to the use of paradox in TEAM therapy, a kind of overview. When my new book, Feeling Great, comes out, I am hoping to do a series of workshops on a variety of powerful paradoxical techniques. And of course, the new book will have a great deal of instruction on paradoxical techniques as well. These are the four key components of TEAM: T = Testing E = Empathy A = (Paradoxical) Agenda Setting M = Methods In today's podcast, Dr. Rhonda and I will explain why each of these components is inherently paradoxical. For example, when you do the T = Testing, you assess changes in the patient’s symptoms from the start to the end of the session, and the patient rates you on the Empathy and Helpfulness scales as well, When you look at the ratings, you will probably discover that you aren’t helping your patient much, if at all. You may also discover that your perxceptions of how the patient feels, and how the patients feels about  you, are off-base, and sometimes alarmingly so. This can be very disturbing, especially if you’re not use to this kind of information. However, in TEAM, we are actually hoping for failure, and welcome that kind of "disturbing" information. Why is this? Isn’t therapy all about recovery and making positive changes? Why in the world would the therapist want to know that he or she is not helping? It's because many of the most important breakthroughs in therapy come from the therapist's discovery that he or she is failing. We WANT to fail! Why?  David illustrates this paradox by describing his discovery that he was not actually helping a patient he thought he’d helped enormously. David explains how and why this shocking information led to a tremendous breakthrough. When you review how your patient rated you at the end of the session, you may discover that your patient gives you failing grades on the E = Empathy scale. The patient’s ratings may indicate that he or she didn't experience you as sufficiently warm and caring, or completely trustworthy, and that you didn’t really “get” how she or he was feeling inside. Once again, as TEAM therapists we welcome failing grades on the Empathy Scale. Why? It’s because your worst therapeutic failure will nearly always be your greatest success in disguise. How can this be? It seems absurd, or impossible. Karl Rogers told us that empathy is the necessary and sufficient condition for personality change. So why would a TEAM therapist hope to discover that he or she is failing in this category? You’ll discover the explanation for this paradox on today’s podcast. When the patient asks for help during the A = Agenda Setting phase of the session, the TEAM therapist doesn’t jump in and offer to help, using this or that therapy method. In fact, the TEAM therapist will often assume the role of the patient subconscious resistance and argue for the status quo, sincerely encouraging the patient to cling to the feelings of depression, anxiety, shame, worthlessness, hopelessness, and anger. The therapist will bring out all the reasons why the patient should RESIST change. Why in the world would a therapist want to do that? It sounds crazy! You'll find out on this podcast. And finally, during the M = Methods phase of the session, the TEAM therapist will be working with the patient on his or her negative thoughts, like, “I’m worthless,” or “I’m not as good as I should be,” or "I'm hopelessly damaged because of the abuse I experienced as a child." And the TEAM therapist’s goal is not success, but rather failing as fast as you can, trying technique after technique that DOESN'T work and the patient's belief in the Negative Thought is still 100%. Why would a therapist want to fail over and over? Isn’t that the opposite of what a skillful, compassionate, and effective therapist would want to do? Listen to this podcast and you’ll discover the answer to these questions. You’ll also see that the patient, not the therapist, is the expert in TEAM, and discover how the patient, and not the therapist, guides all the changing. David and Rhonda talk about the important difference between healthy and unhealthy use of paradoxical ideas and techniques in therapy, and describe how narcissistic therapists may use paradoxical techniques in an effort to manipulate “resistant” or annoying patients. This dysfunctional use of paradox is unfortunately common, and will rarely or never be effective.  David and Rhonda