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