A Live Demonstration of TEAM-CBT with Caroline

A Summary for Therapists Learning the Art and Science of Rapid Recovery

Opening Thoughts: The Courage to Be Vulnerable

What you're about to read is something special. A couple of days ago, we had the privilege of witnessing a brave psychologist named Caroline step into the spotlight and do what most of us wouldn’t do - be completely vulnerable in front of hundreds of people. As therapists, we often hide behind our professional personas, but Caroline showed us what real healing looks like when we drop our masks.

This wasn't just a training webinar - it was a masterclass in how TEAM-CBT can create profound change in a single session when we follow the model faithfully. Let me walk you through what happened. I’ll also try and point out, along the way, some of the important points and concepts.

Overview: What This Training Covered

This 3.5-hour live webinar demonstrated the complete TEAM-CBT sequence with a volunteer who struggled with perfectionism, imposter syndrome, and the exhausting treadmill of achievement without satisfaction. You'll see:

• Live application of all four TEAM-CBT components in real-time: Seeing meaningful symptom reduction in one session.
• How to use measurement effectively.
• The difference between empathy and cheerleading.
• The paradoxical nature of agenda setting - why we become the voice of resistance.
• Powerful cognitive techniques including Double Standard, Externalization of Voices, Feared Fantasy, self-disclosure and the survey technique.

The TEAM-CBT Sequence in Action

T = Testing: Making Therapy Accountable

Caroline started with these scores on her Brief Mood Survey:

• Depression: 9/20 (mild-moderate).
• Anxiety: 8/20 (mild-moderate).
• Happiness: 7/40 (severely low positive feelings).
• Relationship Satisfaction: 18/30 (somewhat dissatisfied).

Key Teaching Point: Notice how her lack of happiness (7/40) was more pronounced than her depression. This is crucial - we're not just treating pathology, we're helping people move toward joy.

The Daily Mood Log captured her specific moment: sitting in a research meeting feeling:

• Inferior/worthless/inadequate: 100%
• Foolish/self-conscious: 100%
• Down: 60%
• Discouraged: 80%

Pearl of Wisdom: These numbers aren't just data - they're a window into human suffering. A very successful psychologist feeling 100% worthless? That's the gap between external achievement and internal experience that we must bridge.

E = Empathy: The Five Secrets in Action

Watch how we used the Five Secrets without explicitly teaching them:

• Thought Empathy: Repeating what Caroline shared with us carefully, so as not to miss any important details

• Feeling Empathy: Reflecting Caroline’s feelings back to her without trying to change them

Going to the Gates of Hell: When Caroline mentioned almost dying from COVID but not missing a day of work, we didn't rush past it. We stayed with that pain.

Watch out for cheerleading!: Though we really wanted Caroline to feel better, notice what we DIDN'T do:

• "But you're so accomplished!"
• "You shouldn't feel that way!"
• "Let me give you some advice..."

We were careful not to cheerlead and not to push our own agenda: Instead, we gave a listening ear and understanding.

A = Agenda Setting: The Art of Honoring Resistance

This is where TEAM-CBT gets counterintuitive. Instead of trying to help Caroline change, we tried to talk her OUT of changing through positive reframing.

The Magic Button Question

"Caroline, if we had a magic button that would eliminate all your negative thoughts and feelings instantly, would you press it?"

Her answer: "Not all of them."

This is gold. She intuitively knew her symptoms had value.

Positive Reframing: Finding the Beauty in Symptoms

For her feeling of "inferior, worthless, inadequate, incompetent" at 100%, we found:

• Shows high standards.
• Demonstrates humility.
• Reflects respect for others.
• Motivates learning and growth.
• Keeps her accountable and honest.

For "I need to be perfect":

• Shows she cares about serving others.
• Reflects dedication to quality work.
• Demonstrates commitment to helping people.

The Paradox: The moment Caroline saw why her symptoms made sense and were even beautiful, her resistance started to melt away. Now she was arguing FOR change, not against it.

Goal Setting with the Magic Dial

Instead of eliminating symptoms, Caroline chose realistic goals:

• Inferior feelings: 100% → 20%
• Down: 60% → 10-20%
• Discouraged: 80% → 10%

M = Methods: The Cognitive Techniques That Create Change

Method 1: Double Standard Technique

Caroline played herself. Jill played a dear friend (who was also a clone of Caroline) struggling with the same issues.

The Setup: "Caroline, I'm just like you - successful psychologist, same background - but I'm telling myself I need to be perfect. Do you think that's true?"

Caroline's Response: "No, that's not true at all. It's unrealistic. We're all imperfect. If we were perfect, we would become stale, stop growing, and go into depression."

Belief Change: "I need to be perfect" dropped from 100% to 80%.

Teaching Point: Notice how Caroline could give helpful advice to her "friend" but struggled to apply it to herself. The Double Standard technique bypasses our self-critical inner voice.

Revisit the Double Standard Technique: When Caroline’s belief in her negative thought did not drop significantly, we did not try to convince her to change, we went back into the role play and paradoxed her again, saying, “isn’t it true that I need to be perfect in everything I do in order for people to love me?”At this point Caroline won HUGE!

Positive Thought: “No, in fact trying to be perfect pushes people away, people like you better when you are open and vulnerable and make mistakes.”

Method 2: Externalization of Voices (The Heavyweight Champion)

Now we switched roles completely. David and I became Caroline's negative voice, and she had to fight back.

Negative Voice (David): "Caroline, you know it's a fact that you need to be perfect to have people love you. That's your ticket to love and acceptance."

Caroline Fighting Back: "Perfectionism just pushes people away, makes you more unlovable because nobody can relate to you."

Who won? Caroline - medium victory.

But then came the role reversal - Caroline became the negative voice, and David became the positive voice. This is where the magic happened.

David (as positive Caroline): "There's only one problem with what you're saying... it's just a lot of horse shit. I don't need to be impressive to have people love me. I need to show love for other people, show interest in them, and share my humanity. My flaw isn't that I'm not perfect - my flaw is listening to you beating up on me constantly.”

Caroline’s turn (as positive Caroline):  “You know what negative Caroline, I need you to either shut up or give me some love." She then started crying. Why? Because she heard herself - maybe for the first time - demanding self-compassion instead of self-criticism.

Method 3: Feared Fantasy (The Research Meeting from Hell)

The Setup: "Caroline, we're going to the research meeting from hell where everyone says exactly what you fear they're thinking."

Negative Voice: "Caroline, I've been observing you, and you can't help people because you have nothing to contribute."

Caroline's Response: "I know I have already helped a lot of people. Even if I never did research, I'm helping people with what I'm doing now. This research will take 17 years to get to the real world anyway. I'd rather do what we already know works."

Who won? Caroline - HUGE victory.

Another Attack: "You're not a real professor, you're just a jokester."

Caroline: "Maybe I am, and maybe this just isn't the role for me. I can go back to the work I love. I'd rather be fun and loving than stay in a stuffy meeting with people with sticks up their butts!"

The Transformation: Before and After

Final Scores:

• Down: 60% → 0%
• Bad: 60% → 10%
• Inferior/worthless: 100% → 0%
• Unwanted: 60% → 0%
• Foolish/self-conscious: 100% → 20%
• Discouraged: 80% → 0%

That's a 80-100% reduction in negative feelings in one session.

Plus Caroline said the pain and pressure she felt in her chest was gone. That tight feeling she'd carried for years, protecting the little girl inside, had lifted.

Key Learning Points for Therapists

1. Measurement Is Everything

Without numbers, we're flying blind. Caroline's scores gave us precision about her suffering and her recovery. Don't be afraid of data - it brings you closer to your patients - not further away.

2. Empathy vs. Cheerleading

Cheerleading: "But Caroline, you're so accomplished! You shouldn't feel this way!" Empathy: "It sounds like despite all your success, you're feeling exhausted and never good enough."

Cheerleading is patronizing. Empathy is a step towards healing.

3. The Paradox of Agenda Setting

We became the voice of Caroline's resistance: "Why would you want to change? Your perfectionism shows how much you care about quality work!"

The moment she felt understood and saw the value in her symptoms, she was ready to change. Resistance isn't the enemy - honoring resistance is the pathway to change.

4. Techniques Are Just Tools

Each method built on the previous one:

• Double Standard helped her see she doesn’t treat herself well.
• Externalization of Voices helped her fight back against self-criticism.
• Feared Fantasy helped her face her worst fears and discover her strength.

Some of Caroline's biggest breakthroughs came when she played her own negative voice. Sometimes we need to externalize our inner critic to see how cruel we're being to ourselves.

Scripts for Honoring "Scary" Symptoms

For Perfectionism:

"Your need to be perfect shows me how much you care about doing quality work and serving others. It demonstrates high standards and respect for the people you're trying to help. Why would you want to give up something so beautiful?"

For Feeling Worthless:

"Feeling worthless despite your accomplishments shows incredible humility. It keeps you motivated to learn and grow, and it demonstrates that you don't have an inflated ego. These feelings also give you compassion for others who struggle."

For Social Anxiety:

"Your anxiety about what others think shows how much you value relationships and connection. It motivates you to be considerate and not hurt others. Why would you want to become someone who doesn't care about others' feelings?"

Pitfalls to Avoid

1. Rushing to Methods

Don't skip empathy and agenda setting. Caroline needed to feel completely understood before she could change.

2. Cheerleading Disguised as Empathy

"You're so accomplished" isn't empathy - it's minimizing her experience.

3. Fighting Patient Resistance

When patients say "yes, but..." honor it. Explore it. Find the wisdom in it.

4. Incomplete Positive Reframing

Don't just find one benefit. Really explore what the symptoms show about their values and how they're helpful.

5. Technique Without Heart

These methods work because of the relationship and the empathy that comes first. Don't just apply techniques - connect first.

The Homework Assignment

Caroline's recovery won't last without ongoing work. Here's what we prescribed:

1. Complete the Daily Mood Log - Write down all the positive thoughts discovered today.
2. Continue Daily Mood Logs - Use them when negative thoughts return.
3. Anti-Perfectionism Training - Take days off, be interested in others rather than trying to impress them.
4. Practice Self-Compassion - When the inner critic speaks up, ask "Would I talk to a dear friend this way?"

Your Practice Assignment

1. Try Positive Reframing with your next patient who shows resistance. Don't try to convince them to change - help them see why their symptoms make sense.

2. Practice the Magic Button Question - Ask it exactly as demonstrated and see how patients respond.

3. Grade Yourself on Empathy - Ask your next three patients to grade your thought empathy, feeling empathy, and acceptance. Be prepared for failing grades - that's where learning happens.

4. Record a Session (with permission) and notice:

• How often do you cheerlead vs. empathize?
• When do you rush to methods vs. staying with feelings?
• How do you handle resistance?

Appendix: TEAM-CBT Methods Used in Sequential Order

Testing Phase:

1. Brief Mood Survey - Baseline measurement of symptoms and positive feelings.

2. Daily Mood Log - Specific situation, emotions (0-100), and negative thoughts.

Empathy Phase:

3. Five Secrets of Effective Communication - Disarming, Thought empathy, Feeling Empathy, I Feel Statements, Stroking/Affirmation, Inquiry. 

Learn more about the Five Secrets of Effective Communication →

4. Empathy Grading - Patient grades therapist on understanding and acceptance.

Agenda Setting Phase:

5. Outcome Resistance

6. Magic Button Technique - "Would you press a button to eliminate all negative feelings?"
 

7. Positive Reframing - Finding benefits and beauty in symptoms
"Why might you not want these symptoms to disappear?"
 

8. Process Resistance - "What hard work would change require?"
 

9. Magic Dial / Goal Setting - Adjusted and real targets for symptom reduction.

Methods Phase:

10. Double Standard Technique - Role play giving advice to dear friend with same problem.

11. Externalization of Voices - Therapist voices negative thoughts, patient fights back.

12. Role Reversal - Patient becomes negative voice, therapist models positive response.

13. Counter-Attack Technique - Fighting back against bullying negative thoughts.

14. Feared Fantasy - Living out worst fears in imagination to discover inner strength.

15. Survey Technique - Asking audience directly about fears of judgment.

16. Relapse Prevention - Planning for return of symptoms with specific strategies.

Each method built systematically on the previous one, creating a crescendo of insight and emotional breakthrough that led to Caroline's remarkable transformation.

Watch Dr. David Burns demonstrate TEAM-CBT live

Remember: The goal isn't perfection in applying these techniques. The goal is connection, courage, and the willingness to fail forward as we learn this beautiful art of helping people find their way back to joy.