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May 25, 2020

"I don't matter!"

Did you ever feel like you aren’t important? Did you ever feel like you don’t matter? These thoughts are extremely common and can be extremely painful. I know from my clinical experience over the years, with more than 40,000 hours of therapy with people struggling with mild to extreme depression and anxiety. I know from personal experience as well, because I’ve been there personally at times! And one of the reasons I love doing therapy is because of the joy of helping someone transform these feelings of inadequacy and tears into feelings of joy and exuberance, and even laughter.

Today, my highly esteemed colleague, Matthew May MD, and I, work with our highly esteemed and beloved colleague and podcast host, Rhonda Barovsky, on concerns that emerged when a scheduling difficulty made it difficult for Rhonda to join a podcast recording on “The Phobia Cure” which was going to feature Matt May MD doing live exposure with a colleague named Danielle who has an intense fear of leeches. I suggested that Matt, Danielle and I could do the podcast without Rhonda, to save her from having to commute from her office in Walnut Creek, California to the “Murietta studios” twice in one week. (It’s a 90-minute commute in both directions, and sometimes traffic makes it even worse.)

When Rhonda read this email, she was flooded with negative emotions, which you can see on pages 1 and 2 of her Daily Mood Log at the start of her session. As you can see she felt down, anxious, ashamed, inadequate, rejected, self-conscious, angry, jealous, and more, and these feeling were intense.

Have you ever been suddenly and unexpectedly triggered like that?

What triggered Rhonda’s feelings?

According to the TEAM-CBT treatment model, our negative feelings are not the result of what happens, but how we think about it.

So, what were the thoughts that triggered Rhonda’s angst?

Take a look at the negative thoughts on her Daily Mood Log. As you can see, she was telling herself that

  • She didn’t matter and wasn’t important.
  • David didn’t value her.
  • She shouldn’t have such strong negative feelings, like jealousy.
  • The people listening to the podcast (like you, for example) will think she looks like an idiot and will judge her.
  • She shouldn’t be taking up time and space on the podcast in the “patient” role again.

One of the things I like about the TEAM model is that it gives us a clear blueprint about how to proceed. One of the things I love about Rhonda is her openness, vulnerability, courage, and intense desire to teach and reach out to others, like yourself. And one of the things I admire so intensely about Matt is his tremendous kindness and compassion which are coupled with extraordinary technical skills. I feel very blessed to have Matt and Rhonda as colleagues and friends!

In the podcast, we go through the TEAM model, step by step, starting with T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods. We encountered some tears, some memories of childhood and tons of laughter as well.

During the Assessment of Resistance, we used the Straightforward Invitation, Miracle Cure Question, Positive Reframing, and Magic Dial. To me it is always surprising to see how many positives are embedded in our so-called “negative” feelings and “negative thoughts.” Positive Reframing nearly always eliminates resistance and opens the door to rapid change. You can look at Rhonda's Positive Reframing list on page 5 of the attachment. You can also take a look at her Emotion's table when she filled in the Goal column on page 3 of the attachment.

The first thought Rhonda wanted to challenge was “I don’t matter,” and we started with the Downward Arrow Technique to identify the Self-Defeating Beliefs that gave rise to this thought, as you can see on page 4 of the attachment. Rhonda also told a moving story about her father, and how her belief that she was not important may have gotten started. She also told a beautiful story about reconciling with her father eight years before he died.

We used several methods to challenge and crush the thought, "I don't matter," including Identify the Distortions, the Double Standard Technique, the Externalization of Voices, the Feared Fantasy, the Acceptance Paradox, and Examine the Evidence to crush this thought. Several role reversals were necessary before Rhonda knocked the ball out of the park.

The first negative thought is generally the most difficult to crush. Once Rhonda no longer believed this thought, she could easily challenge and defeat the rest of her negative thoughts as well, resulting in a dramatic transformation in how she was feeling, as you can see on page 3 of the attachment. It seems like when you crush one negative thought, there is a sudden change in the brain, as if the negative circuits get turned off and the positive circuits get turned on. You will have the chance to hear this first hand when you listen to the live session.

If you'd like to take a peak at Rhonda's final Daily Mood Log, you'll see how she challenged all the rest of her Negative Thoughts. (David, link to final DML when you get the final version from Rhonda.)

To review Rhonda's Evaluation of Therapy Session, click here. 

Although this podcast was long (roughly two hours), it seemed like very little time had passed because the experience was incredibly engaging and rewarding. Rhonda, Matt and I hope you enjoyed it as well, and hope it gave you some help as well, if you—like the rest of us—have ever struggled with the fear that maybe you don’t matter, or aren’t important, either.

Let us know what you think, and thanks for listening today!

Rhonda, Matt, and David

PS Following the podcast, Matt and I received this beautiful email from Rhonda:

Dear David and Matt:

My thanks to you both for an incredibly powerful experience.  I am not enough of a poet to describe my experience and gratitude to you both.  But you helped me tackle something that has been painful for me for such a long time!

I am grateful and humbled by your brilliance and your commitment to me