By Maor Katz, M.D. | Dr. Maor Katz is the director of Feeling Good Institute
We opened the Feeling Good Institute in 2013 to help spread TEAM CBT, a new program of therapy developed by David Burns. TEAM therapy builds upon traditional CBT by focusing not only on cognitive and behavioral methods to help alleviate suffering, but also incorporating an emphasis on empathy and agenda setting, to build a strong connection between therapist and patient and to melt away our patients’ resistance to change. TEAM CBT is sometimes referred to as “CBT on steroids” or “a super-charged version of CBT.”
According to Dr. Burns’ TEAM therapy approach, the #1 error therapists make is jumping in too quickly to help our patients without first addressing possible sources of resistance. Read on to see an example of how taking the time to address resistance paradoxically motivates the patient to change.
Sue, a pleasant, intense looking forty-two year old woman said to me in session:
“Since learning I have sleep apnea and shoulder problems I’ve been having a hard time with anxiety and sleep, I’ve been a nervous wreck. My anxiety is worse than ever, it’s effecting my relationship with my husband and my daughters, and I just want to feel better!”
Before meeting Dr. Burns, my response, like any other good CBT therapist would be something like:
“Sue, you’ve been very anxious and feeling like a nervous wreck–and your anxiety is worse than ever! How awful! I have lots of tools and techniques to help you feel better.”
We would then discuss ways for Sue to feel better by teaching her cognitive and behavioral techniques to help her anxiety. This kind of therapy is somewhat effective but it is not “CBT on steroids.” The straightforward CBT approach to alleviating symptoms does not take into account all the reasons that Sue might resist changing.
Here’s how my response changed after learning TEAM CBT with Dr. Burns:
Maor: “Sue, you have been suffering from intense anxiety and difficulty sleeping. You are such an accomplished woman yet you’ve been feeling like a nervous wreck! Is that something you’d like my help with?”
Maor: “Fantastic, anxiety is one of my favourite things to work on. I’d love to help you, and I have many powerful tools that we can use to reduce your anxiety. Let me ask you this first…let’s imagine that we have a magic button here and with a push of this button your anxiety will completely disappear, and you will walk out of my office with no anxiety. Would you push this button?
Sue: “Of course!”
Maor: “Oh, so you mean you’d be OK with having breathing and orthopedic problems and not feeling worried about your health at all?”
Sue: (chuckling) “Well, no, I guess I am not sure…I probably should worry about my health a bit. I want to take good care of myself, and not ignore my health problems. I also want to take good care of my family. I worry about them too.”
Maor: “So it sounds like you are not so sure that you would push the button and make your anxiety go away completely?”
Sue: “Right….I think some anxiety is realistic given my health problems. If I weren’t worried maybe I wouldn’t make it to all of my doctor’s appointments and remind my husband of his. I am also really worried about missing things, which helps me get my daughters to their activities on time. Without anxiety I would be a different person. I wouldn’t be as careful and conscientious, I would be a slacker!”
Maor: “That makes perfect sense, feeling anxiety is part of what makes you responsible and reliable and it helps you to take good care of yourself and your family. I wouldn’t want to take that away from you! At the beginning of the session today you told me that you have been feeling about 90% anxious all week. On a scale from 0-100, how much anxiety do you think you need in order to be careful, conscientious, and thoughtful? If we had a dial instead of a button and you could dial your anxiety down to the ideal level, where would you set the dial?”
Sue: “Well, maybe 40%. I still want to be conscientious and careful about my health and my family, but my anxiety is really getting in my way! I am not sleeping well because I feel so worried, and my constant worrying is really annoying to my daughters. I’ve got to find a way to feel less anxious and to worry less!”
What have we learned from this dialogue?
- The magic button question helped Sue to realize that she is not ready to give up all of her anxiety. Sue’s answer to the question reveals that she has GOOD reasons NOT to reduce her anxiety even though she came in asking for help with it.
- The magic dial question allowed Sue to set a goal for therapy that made sense to her. Her goal of 40% anxious allows her to hold on to her conscientiousness while reducing the intensity of her distress.
- Instead of convincing Sue to change (which would likely cause her to resist), I paradoxically encouraged Sue to consider reasons NOT to change, which in fact caused her to push for change (see the last line in our dialogue)
The paradox illustrated here is a challenging concept to grasp, and yet when implemented skillfully it is this paradox that super-charges CBT.
If you are interested in learning more about our approach to therapy, or joining one of our online TEAM training groups, visit us at www.feelinggoodinstitute.com.