Today, we see lots of horrific events, and violence and hatred
seem to be on the upswing. There are the repeated and horrible mass
shootings in the US, the horrific war in the Ukraine, and the
extensive protests that are rocking Iran. Those problems are real,
and terrible in reality.
So, maybe the TEAM-CBT model, with its emphasis on our
interpretations of reality, and our relationships with others,
might seem like irrelevant and useless tools.
Or are they? Let’s check it out. Sometimes, as you’ll see,
things can a take sudden and unexpected change in direction in
TEAM-CBT if you follow the energy. There is no “formula” for
treating anything. We treat humans, not diagnoses or problems. But
we do go through the T, E, A, M model in a systematic way so we can
find out what, if anything, each patient wants help with, and then
design an individualized plan to make that happen, if
possible.
Part 1
T = Testing
Today’s guest, whom we’ll call Meina for protection, migrated
to the United States from her mother country, Iran, as a young
woman, and she’s definitely upset. In fact, her mood scores are
among the most severe that I’ve seen recently. Her depression score
of 15 out of 20 indicates severe depression, and her anxiety and
anger scores of 19 and 20 out of 20 indicates extreme anxiety and
anger.
You can see Meina’s Daily Mood Log at the start of the session
as well, with nine categories—depression, anxiety, guilt,
loneliness, humiliation, hopelessness, frustration and hatred all
estimated between 90 and 100 out of 100, again confirming the most
extreme upset a human being can experience.
As you might expect, her happiness score was 0 out of 20,
indicating no happiness at all, and her Relationship Satisfaction
Scale score, thinking of her husband, was only 19 out of 30,
indicating considerable marital distress.
What’s causing those feelings? Well, let’s take a look at her
negative thoughts and how strongly she believes them:
I’ll always suffer because of being born in Iran: 90%
My heart will stop from feeling so much hatred. 80%
There’s nothing I can do to help (the women who are
protesting.) 100%
It is pathetic that I can’t stop feeling so angry. 90%
I’m going to get sick because of these feelings. 90%
Many young women will be tortured and killed. 100%
I’m going to lose all my friends because I’m so angry. 70%
My marriage will also be negatively impacted. 100%
E = Empathy
In the empathy phase of the session, Rhonda and David simply
listened, as Meina described terrifying memories of the being a
child during the Iran Iraq war, and being left alone to care for
her younger sister when her parents were away every day, and bombs
were coming down all over the city. She said that on many occasions
she was so scared that she wanted to commit suicide by jumping out
of the window of their apartment in Iran.
And now, all those terrifying memories have come flooding her
mind again, triggered by the events in Iran, as well as her fears
and run-ins with the “morality police” when she was a young woman.
She expressed profound connection with the young women who are now
fighting the intense suppression of human rights in Iran, all in
the name of religion!
Once their car was stopped, and a policeman put a gun to her
mother’s head because she had not covered her hair properly. She
also described the attempts always to separate the girls and the
boys to prevent any type of dating or romantic behavior, and the
constant fear of being imprisoned if you did the wrong thing. Meina
tells us:
I saw friends who were beaten up, and was humiliated for eating
an apple. I was arrested for wanting to go to parties to listen to
music. I lived in constant fear of being tortured and had panic
attacks by night and by day. . . I left Iran when I was 22 and have
never gone back, for fear of ending up in prison. . .
Then, when I finally escaped to the United States, I never fit
in. The young people were interested in the latest music, and did
not seem interested in my story, in my experiences. I never felt
like I fit in. I think I’ve felt lonely my entire life.
Now I feel embarrassed, being from Iran, because it’s such a
violent country. . . And I have panic attacks every night. I cope
by imagining that I’m in Iran, visiting and counseling girls who
have been imprisoned, and giving them tips on how to use the Five
Secrets of Effective Communication so they won’t be tortured,
raped, and murdered.
Meina said she still feels alone, since few people, including
her husband, are really interested in her story, including her
horrific memories of growing up in Iran, or how she feels now. She
said she also feels intensely guilty, since she still has friends
and one relative in Iran who are facing desperate circumstances,
while she enjoys comfort and safety here in California.
She rated us as an A+ on empathy, so that brought us to A =
Assessment of Resistance.
She added that she always hides her emotions, something she
learned to do for survival in Iran, and that she’s afraid to let
them out, and continues to hold and hide them. As a result, she
struggles with constant tension and anxiety of constantly hiding
her anger.
David commented on the paradox that she looks chipper and in
control, and can be funny at times. But she feels incredible
loneliness because other people rarely know or care about how she
actually feels. She added:
What if I’m just being selfish. Maybe I shouldn’t complain so
much!
A = Assessment of Resistance
Meina said this about her goals for the session:
I know I’m not in a position to change what’s happening in
Iran, but what I do want help with is the fact that I’m so
overwhelmed with negative feelings that I’m losing my effectiveness
at work and I also don’t seem to be able to connect with my friends
and colleagues.
I don’t want to have such hatred and anger for the morality
police. And I don’t want all those painful memories to keep coming
back and ruining my life, like my uncle and grandmother who
suffered from dementia and almost constant terror towards the ends
of their lives.
At this point, we ran out of time, and had to schedule the
remainder of the session two days later.
End of Part 1
Tune in next week for the fantastic and unexpected conclusion
of the work with Meina!
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!