Today, you will hear the the second half of the live therapy
session that Dr. Jill Levitt and I did with Nazli, a young woman
from Turkey, at our recent “David Burns Live” workshop on May 22,
2022. Nazli has been struggling with intense performance anxiety
and generalized anxiety, and generously who volunteered to be a
“patient.” Jill and I are very grateful for Nazli’s courage in
sharing herself so courageously with all of you, and hope you enjoy
the session and learn from it.
Last week, we played the first half of the therapy session,
including the initial T =Testing and E = Empathy. Today, you will
hear the exciting conclusion, including A = Assessment of
Resistance and M = Methods, and final T = Testing.
Part 2 of the Nazli Session: A =
Assessment of Resistance and M = Methods
After a period of empathizing, Nazli gave Jill and David an A
in Empathy, so we moved on to the Assessment of Resistance portion
of the session. This often involves the following steps:
Miracle Cure Question
Jill issued a Straightforward Invitation, asking Nazli if she
was ready to get down to work, or if she needed more time to vent.
She said she was ready to go to work, so Jill asked what changes
she was hoping for during the session. This is the so-called
“Miracle Cure Question.” This helps to focus the session on
Nazli said that her hope was to reduce or eliminate the
negative thoughts and feelings that were making her clinical work
so stressful. And like nearly everyone, she said she’d eagerly
press the Magic Button.
Then Jill and David pointed out that although we didn’t have a
Magic Button, we did have some powerful techniques that could help,
but it might not be the best idea to use them. That’s because there
might be some positives hidden in her negative thoughts and
feelings, and perhaps we should first take a look.
David and Jill asked Nazli these three questions:
1. Given your circumstances, why might this negative thought or
feeling be totally appropriate and understandable?
2. What are some benefits, or advantages of this negative
thought or feeling?
3. What does this negative thought or feeling show about you
and your core values that’s positive, beautiful, or even
This technique is called Positive Reframing. The goal of
Positive Reframing is to reduce the patient’s subconscious
resistance to change, along with their feelings of shame about
their symptoms.. Paradoxically, the moment patients see the
beautiful and awesome things about their negative thoughts and
feelings, their resistance to change typically disappears. Positive
Reframing is one of the unique features of TEAM-CBT and it opens
the door to the possibility of rapid change.
As an exercise, see if you can find some positives in five of
Please do this on paper, and NOT in your head, using the blank
Positive Reframing Tool you’ll find at the end of
the Daily Mood Log.
Getting it “right” isn’t important. What is important is
trying. This will get your brain circuits firing in a new way.
Then, when you see the work that we did with Nazli, you might have
your own “ah-ha” moment, as well as a powerful new skill that may
be helpful to you as well.
Okay. Did you do that yet, or do you plan to look at the answer
without doing the exercise?
Oh! I see! You’re planning to look at the answer.
If you want to learn at a deep level, whether you’re a
therapist or lay person, do the exercise first! It may be
challenging at first, but it will fire up your brain circuits, so
when you look at the answer, you’ll suddenly have a new and deeper
understanding of Positive Reframing.
When you’re done, you can check this link to see the work that
Jill and I did with Nazli.
But either way, I’m grateful that you’re listening to these
podcasts and reading the show notes!
After we finished the Magic Dial, we went on to the M = Methods
portion of the TEAM-CBT session, and helped Nazli challenge some of
her negative thoughts using a variety of techniques including
Explain the Distortions, the Externalization of Voices, Examine the
Evidence, the Acceptance Paradox, and more.
One of the thoughts she wanted to work on first was this
“If I don’t fix this patient or make him/her satisfied, then
she/he will judge me and think poorly about me.”
Together with Nazli, we identified a number of distortions in
this thought, including a couple more that popped into my mind
while doing the show notes:
Fortune-Telling: Making a negative prediction without good
Mind-Reading: Assuming that I know how my patients are
Hidden Should Statement: Telling myself I should be doing
Mental Filtering: Selectively noticing the times sessions have
not gone well.
Discounting the Positive: Overlooking the positive feedback I
typically get from patients and supervisors.
Magnification and Minimization: Magnifying the importance or
“awfulness” of negative feedback from patients, and overlooking the
potential value of processing their negative and positive feedback
with them at the next session.
Emotional Reasoning: Thinking that my feelings of inadequacy
and anxiety mean that I really am screwing up with patients
Self-Blame: Beating up on myself constantly when I’m seeing
Nazli’s belief in this thought went down from 80% to the range
of 10% - 20%, since there was some truth in the thought. Sometimes
you’ll want to smash a negative thought, so your belief in it goes
all the way to zero. Sometimes, it’s okay just to reduce your
belief in a thought substantially, but not all the way to
We also encouraged Nazli to begin using the Brief Mood Survey
(BMS) and Patient’s Evaluation of Therapy Session (EOTS) with every
patient at every session so she can get immediate and accurate
feedback of how she’s doing, and so she can fine-tune her
therapeutic strategies based on this information.
This practice is vastly more effective than Mind-Reading, since
therapists’ perceptions of how patients feel tend to be wildly
inaccurate most of the time. If you are a therapist, T = Testing at
start and end of every is a vitally important key to personal
and professional growth, although it takes courage because
sometimes—or even often—you will have to confront some information
that may threaten your feelings of pride!
1. Are these ratings valid, or are you just trying to please
David and Jill?
2. If so, what were the effective ingredients of your session.
What, more than anything else, accounted for the significant and
rapid changes you experienced?
You will hear how she answered these vitally important
questions on the podcast, and you can see
Nazli’s BMS and EOTS after her session if you
click the link.
Thanks for tuning in last week and today! Once again, Rhonda,
Jill and I want to thank our wonderful and courageous Nazli from
the bottom of our hearts! We hope you enjoyed this session, and the
chance to look behind closed doors to see how psychotherapy
actually works in a real session with a real human being who, like
nearly all of us, struggles at times with that ancient belief that
“I’m just not good enough!”
In fact, we’re all, in many ways, “not good enough,” and will
probably never be “good enough.” But that is never the cause of our
problems, especially our lack of self-esteem.
Do you know what the actual cause is?
Do you know what the solution is?
Take your best shot, make a guess, and then you can click on
Rhonda, Jill, Nazli, 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!