Dr. David Burns Live: Real Therapy. Real Change. Real Time.

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

 

Jill Levitt: Hey, welcome everyone to our webinar this morning, David Burns live, real therapy, real change, real time. And I am honored to be here with David this morning. And this is a unique opportunity actually where we'll be teaching some and we'll be sharing with you a therapist who volunteered to share her heart with us today. And we'll be doing some personal work with her and kind of walking through the TEAM-CBT model. And we'll have lots of time also for questions and answers and discussions. So, we're really hoping that we'll bring TEAM-CBT to light with you through the courageous sharing of our volunteer and we'll introduce you to her a little bit later in the workshop. We're actually going to start the workshop just by asking a little bit about who you are. So, I'm going to run this poll. This is just so that so that we can get to know who's in the audience today. So, the poll itself should be showing up for you to let us know if you're a therapist and currently enrolled in the summer FastTrack course because this is actually kind of the kickoff event for our FastTrack course that starts next week or a therapist not currently enrolled in the FastTrack course. Or a member of the general public just coming to learn a little bit about who you are TEAM-CBT and how it might help you. I'll give you guys a minute to answer our poll so we'll know a little bit about who you are. Give you 10 more seconds and then I'm going to end the poll. I can see the answers coming in. So, I'm just giving you all another few seconds to answer our quick question and then I will end the poll and I'll share the results. So, if you didn't get to answer, we'll just take it from here. So, we've got 10% of you are a therapist currently enroll in our FastTrack course. Welcome. We're excited to get started with you next week.

 

70% of you are therapists not in the FastTrack course. So, about 80% of the audience are therapists today and about 20% of you are the general public. And we'll share opportunities kind of toward the end of the workshop or at the end of the workshop today with both therapists to do continued training and also with the general public to hear more about David's app and some other really kind of cool free trainings that we have too. So let me first just start by saying we're all really really lucky and blessed to be able to learn from you today David. So David is a world renowned psychiatrist CBT legend a best-selling author and the creator of the Feeling Great app, which you'll hear about more today. And David also is a dear friend of mine and a mentor. I've known David now for almost 18 years. And my life, my personal life, my career, my relationships, everything I feel has been so positively impacted since meeting David. So, I'm really excited to kind of have an opportunity to share David's amazing work with all of you guys today and I'll give David a chance to say hi in a minute once I get through a couple more things here. I'm also just going to tell you guys about kind of who we are at Feeling Good Institute and then we'll move on to the bulk of the work today. So at Feeling Good Institute our mission is to elevate the practice of therapy so that patients can recover faster and more fully and the way that we accomplish that is by training and certifying therapists in David Burns model of therapy called TEAM-CBT which we'll be sharing with you guys today and also offering a path for certification so that therapists have kind of a roadmap for training and we were founded by Maor Katz, Angela Krumm and myself we all trained with David at Stanford back then when we started training with David the only way that you could learn TEAM-CBT was working with David at Stamford or attending one of his intensives which he did around the world and so we started Feeling Good Institute with a dream to make David's tools and David's framework for therapy kind of more accessible and more available to therapists without compromising quality.

 

So everything that we do today kind of still reflects that original intention to help therapists get better and help patients get better too and to spread TEAM-CBT. And this slide we put up here just kind of as a reminder to therapists or sometimes a wakeup call to therapists that we know that therapist effectiveness doesn't actually change just with years of experience, but actually therapist effectiveness changes with practice. And that we all only get better and this applies not only to therapy of course to life through practice and feedback. And so how does this work? We basically you'll see a lot of our model and I've learned this completely from David is to teach something and then to have therapists practice it to get feedback to keep repeating that cycle. And that's what we emphasize in all of our trainings including one that we'll be sharing with you kind of later today. And then this question is just like before we jump in a kind of a thought question for you, a thought experiment. So we've talked about the fact that experience alone doesn't necessarily lead to better outcomes and that real growth comes from learning and practice and feedback. So the question here is like imagine what would change for you if as a therapist trying to learn you had a structure for consistent growth. And would that be kind of worth your energy? What would change for you if you had that kind of structure? So, hopefully you'll think about that as you see kind of the structured approach that we're taking today. And I'm going to share the FastTrack program with you guys at the end of the day today, just as a kind of if you'd like to learn more. But we have developed this program to offer therapists an opportunity to not just learn, but to practice the skills of TEAM-CBT.

 

And so we'll we'll share more with you about this at the end of the day today because we're getting started with a FastTrack course next week and we'd love people to join if you feel inspired at the end of the day today. And then we'll also share with you some information about the Feeling Great app too. I'll just say one quick thing which is if you've joined us and you're wondering how do I get my CE credit and you're a therapist at the end of the day today. Right at the end of the workshop, Mike is going to drop the link for the CE survey in the chat box today. And in order to get your CE credit, you do need to be present the whole time and fill out that survey today at the end of the workshop. So, please make sure you're present and you complete the survey. And then you'll receive your certificate of completion within a week. And then these are just our learning objectives. Actually, I won't read through them today, but we will make sure that we cover all of these things throughout the morning and you'll see us bring these things to life, I hope, today with our live demonstration. So, we'll do an overview of TEAM-CBT right now. We'll do a live demonstration. We'll offer you some teaching highlights and then we'll have lots of time for your questions today. So, now let me just kind of shift gears and get started with the actual training after getting some of that stuff out of the way. The acronym that you see on the screen here is for TEAM-CBT and TEAM is a framework for sort of doing all effective therapy and it's based on what we know leads to positive therapeutic outcomes and that the T in team stands for testing. That means that we use measures at the beginning and end of every therapy session with every patient and you'll see us using them with our volunteer today.

 

And those measures help us to assess symptoms kind of like taking the patient's temperature or blood pressure. They help us to stay on track. They help us to make sure that we're seeing the change that we're expecting to see over time and they also help us to know how we're doing. So we check in at the end of every session using measures to see how the session was and did the patient feel connected? Did they feel helped? And that way we can course correct. And David's going to talk a little bit about trusting in a minute. You'll see how important it is. The E in TEAM stand for empathy. And today you'll see us trying our very best to connect with our volunteer and offering empathy skills and really listening before jumping in with any kind of methods. The A in team stands for assessment of resistance and that is that we don't again just kind of throw methods at our patient, but we actually try to understand good reasons not to change. We try to think about all the good reasons the patient may not want to do the work that we're proposing that they do. And so we anticipate resistance and melt away resistance before kind of jumping into change methods and then the M in TEAM is what most people think of CBT which is cognitive behavioral and other kinds of methods that kind of bring about meaningful change and so you'll see today we'll hopefully be helping you to see this like framework and how it works in TEAM-CBT and how it's kind of a path that we use with all of our patients to bring about meaningful change so I'm gonna turn it over to David just because I feel like I'm doing a lot of talking and let David jump in and share some ideas here.

 

Dr. David Burns: You're doing a great job. I could just sit back and listen. I love your teaching. But just to pick up a little bit, the our field is filled with schools of therapy and TEAM is not a new school of therapy and I don't think we need any more schools of therapy but team is based on research and as well of course a lot of clinical experience and it's our understanding of how all effective therapy works and I'm trying to move toward a science-based data-driven approach to psychotherapy rather than a schools of therapy-based approach which is kind of so popular today. But I think we need to move beyond schools of therapy to get into a truly powerful and widely effective form of psychotherapy. And TEAM is also the sequence we follow in therapy sessions. Team is very highly individualized but we go through the T sequence with every patient in every session. What happens in the T, the E, the A and the M will be unique to each patient. And one of the neat things about TEAM is that if you have the capacity to work in extended sessions, double sessions, you may see a complete or near complete elimination of symptoms in one session. These extended sessions are desirable and those who have tried them generally never want to go back to single sessions, but they do require a high degree of skill. It's not easy. Jill and I will make it look easy, but it requires a tremendous practice. Not only learning all of these techniques, but picking up on the art of therapy, which is tremendously important. And those of you who are excited and serious, some of you may just be here out of curiosity or to get your C credits and that's totally okay. But if you kind of catch fire and you say, "Wow, I'd really love to be able to do this kind of therapy." You might want to think of coming to our free Tuesday groups at Stanford and we'll tell you more about them at the end, but they're free to therapists from all over the world. And it's two hours every Tuesday evening and we go through the whole TEAM sequence, but combining every Tuesday with practicing specific techniques, so you really learn how to do it rather than just understand it intellectually. The T equals testing involves among other things the brief mood survey and we'll show you Caroline's brief mood survey and patients take it at the beginning and end of every session. And this makes therapists accountable.

 

The instruments in it, for depression, suicide, anxiety, anger, happiness, relationship, satisfaction, and sometimes other measures are all highly accurate, highly sensitive surveys that can be completed in just a very short period of time like a minute to complete all of the surveys. But what it does, it gives a message to the therapist and to the patient that we're trying to make change happen for you today. And we're going to try to measure that because the items are written how are you feeling right now. So we can see how depressed the patient is, how angry, how anxious, how suicidal, etc. at the beginning of the session and again at the end of the session. And so for the first time therapists can not only see how effective you are or earned in every session, but also it makes us accountable. When I was a resident, we never measured anything and we didn't have many techniques. We were just supposed to talk to patients and give them anti-depressants if they were depressed. And I never saw much change and my supervisors never talked about change. It's just they thought it was a good session if the patient cried a lot and got angry during the session. But there was never any idea that we were going to move to some conclusion where the patient would wake up feeling joy and happiness. And so my whole life and the treatment was expected to go on indefinitely. And it did. In fact, I can't really remember any of my patients from my residency who really recovered. And I always had the dream, why don't we start measuring things and see if we can develop techniques that work and see If we can develop an effective treatment just like other branches of medicine or professional athletics where you see Stephen Curry in a basketball game and he and so many other basketball stars, they have tremendous skill.

 

Well, how do they get that skill? Because they can see when the ball goes through the hoop and so if it doesn't if they miss a shot, they subconsciously or consciously make a little adjustment and over time they get better and better. And that's the idea behind testing to have that same capacity. So every session with every patient becomes training for the therapist. You're learning we're learning from our patients about what works and what doesn't work. And I would say over the years my approach to therapy has evolved just dramatically. And it's because of my patients. The goals of testing are to monitor therapeutic progress and also to monitor the therapeutic alliance. People emphasize empathy and compassion and fancy themselves to be very warm and caring most therapists. But research indicates that the patients experience of the therapeutic relationship is radically different from therapists and therapists are not aware of this and your accuracy at understanding how your patients feel and how they feel about you is probably below 10% which is shocking but it means that your idea of how you're coming across to your patients can be way off. You may think you're doing great when your patients don't feel that way at all and you can think you're doing terribly when your patients think you're hitting a home run. And it's the same with the therapeutic progress. Presumably if someone's depressed and coming for the treatment of depression they want to make therapeutic progress. They want the depression to go away and maybe even more than disappear completely to go into a state of enlightenment or a state of joy. But most therapists assume that you can monitor the progress yourself.

 

And the research I've done in the Stanford inpatient unit indicates that therapists accuracy at understanding how patients feel. In other words, how severe is their depression, how suicidal are they, how angry are they, and that type of thing is less than 10%, often less than 5%. In fact, in the study I did in the inpatient unit, the therapist's ability to accurately know how angry and suicidal their patients were even after 2 to 3 hour session with the patients was zero. There was no relationship whatsoever. And the accuracy of depression was only 3% and I think anxiety was like 5%. And so in order to make progress, you've got to measure things. No science can progress without accurate measurement. And accurate measurement may sound boring, but it opens doors to tremendous mind-blowing changes in psychotherapy. You want to go into the empathy?

 

Jill Levitt: Sure. I think we'll just talk briefly about empathy and then we'll spend a little more time on the agenda setting piece. But the empathy, we say oftentimes we'll just take about a half an hour with a new patient. And you'll see David and I working with our volunteer today doing our best to connect and empathize. And we say that empathy is absolutely a necessary aspect of therapy. We can't skip that true kind of connection, listening, making sure that we really understand the patient. But empathy alone is not going to bring about meaningful change, right? So, empathy needs to be an important part of therapy and we need to do a lot more than just empathize. And the empathy framework that we use in TEAM-CBT was developed by David is called the five secrets of effective communication. And we're actually not going to be teaching each of the five secrets today, although hopefully we'll do a good job of demonstrating it, but instead we'll just share with you sort of like the highlights. And so this is the what our goal when we're empathizing with the patient and using the five secrets is what we call the zero technique, which means that we're giving zero to the patient. We're not making interpretations. We're not trying to be smart and figure things out. We're really just trying to listen and connect. And I think we have a few dos and do nots, but our goal is to listen and show that we've understood by paraphrasing what the patient says, which is what we call thought empathy and acknowledging how the patient feels, which is called feeling empathy. And again, that's like if a patient came to a session and said, "Oh, I was racing around all morning trying to get so many things done. I had to do this and that and I almost got into a car accident and I was so stressed. You know, I wouldn't just move forward. I would say, "Wow, it sounds like you had a really difficult morning. You were racing around this morning." You know, that's sort of my thought empathy and feeling really stressed and kind of overwhelmed and that that's feeling empathy. So, showing that deep understanding. We also focus on providing some compassion and warmth using I feel statements. So, I feel statements to get closer to the patient. I'm feeling sad hearing how hard things are for you. And go to the patient, go to go with the patient to the gate to hell is really referring to this idea that we're not trying to brush over things. When a patient tells us a stream of things, one of which might be hard to hear, like I don't even think therapy is helping me. We're not rushing over the difficult things. We're actually trying to connect and understand with the patient on some of the really hardest things that they're sharing with us. And so those are the what we want to focus on. And at the same time, what we're going to try hard not to do, and David, I'll let you comment on this if you'd like to as well, but is what most of us want to do as therapists kind of intuitively, which is to try to jump in and help the patient, to cheerlead the patient, to try to make them feel better, to make interpretations, to give advice. So, these are all things that we're going to try not to do in the empathy phase of therapy or really ever in TEAM-CBT. Do you want to make any any color commentary on that, David, or?

 

Dr. David Burns: Well, just I think you're doing great, Jill, as you always are when you're teaching. But this is such an important point and even if you're hearing this right now and kind of intellectually understanding it, it may go in one ear and out the other because this compulsion to help patients who are crying and who are venting and burying their souls. It's a compulsion an addiction of therapists to jump in and try to help the patient or give them advice or cheer them up in some way. And that that is not only ineffective, it's almost always irritating to the patient because it's very trivializing. It gives the message your problems are trivial and just listen to my advice and cheer up and all will be the same. And that's what we mean by empathy. With empathy, we're going with the patient to the gates of hell to be with them in their suffering. And that that's why we call it the zero technique because we're going to give nothing to the patient during empathy. Instead, we're going to receive what they're trying to share with us so that they can and to do it in a way that they'll say, "Yes, this therapist really really got me and understands my thoughts and my feelings and I feel cared about and accept." And then that's an A or an A+ on empathy. And that's what we're looking for within the first time we meet with the patient. We'll try for that to this morning as well. We can't guarantee it. We don't always get there and often you'll get a failing grade. And that's what we're hoping for is a failing grade in empathy from the patient to give us letter grade on thought empathy, feeling empathy and acceptance because then we could say tell me the part I missed. Tell me what I'm getting wrong. And then the patient will often bring you to a deeper level.

 

Jill Levitt: And then we move on to assessment of resistance. So we've done good testing and we've done A+ empathy and then we want to move on and again not just move straight to methods but connect with our patients. And this is an interesting part because many people think only a handful of patients are quote resistance but actually we use this as an opportunity to really connect with our patients. So many people who come to therapy, want to get help, but often feel a little ambivalent about changing. They may not want to give up some of the things that their symptoms show about them. And so I'll give an example. If we had a patient who came and was looking for help with her OCD, let's say it was a woman who had children and was doing excessive washing and cleaning and had many, many rules for her home and was wanting help with her OCD. Well, what are some good reasons that she's maybe not going to want to change? That's one of the questions. So, outcome resistance is, does she really want the outcome that she's asking for? If we could help her and she would no longer do any of these cleaning rituals, does she really want that? Cause she thinks that she needs to clean in order to keep her family safe? So, does she really want the outcome that she says she wants? Would she want to get rid of all of these compulsive behaviors? Cause after all, they might actually be keeping her family safe. So, there's lots of things we're going to show you. We actually we have a couple slides here about what's called positive reframing, but just understanding that many patients who come to therapy want help, but there are good reasons that they may not want to change. And we'll tell you about that. And then there's also process resistance, which is let's say a patient really does want to, let's say, in this case overcome her OCD. What is she going to need to do that's going to be really hard for her to do in order to get that outcome? And if she going to be willing to do that work, right? Is she going to be willing to actually experience germs and dirt and not wash and not do any kind of rituals? Or in the patient who's really profoundly depressed, they're going to need to do a lot of homework in order to get better and are they really going to want to do that work? And so, we focus a lot on addressing resistance. And, and we ask you to think with us for a minute here. What happens if you don't address resistance? Let's say you have a patient who seems motiv and you kind of come in and you start telling them how they should change or you start doing the work of change. Well, this picture kind of shows us what happens when we don't address resistance, which is that patients dig in their heels. They kind of yes, but you right.

 

They don't quite get it or they keep asking questions that show that they don't really want to change and then that causes kind of frustration and burnout on the part of the therapist as well as just a really non-collaborative maybe even kind of adversarial dynamic that can happen with the patient. And so one of the things that we focus on and hopefully you'll see us doing today is a method that's called positive reframing. And with positive reframing, we're asking our patients to think about what do your negative thoughts and feelings show about you that's positive and awesome. So in the case of the mom who's struggling with OCD, what is her worry about germs and what does her excessive cleaning show about her and her value system, right? What matters to her? How much she cares about her children, her high standards? What does it show about her that's beautiful and awesome? And also, what are some benefits? Maybe it keeps her family safe and keeps her feeling safe and protected. So, we ask those two questions that really kind of bring to life this outcome resistance and good reasons not to change. And in doing positive reframing and hopefully again this will we'll be able to bring this to life today. It helps the patient to actually feel kind of proud of their symptoms. We're showing them what's right about them rather than what's wrong with them. If a patient comes to therapy feeling really depressed, they probably also feel some shame about the fact that they feel depressed. And when we can help them to feel proud of their symptoms, show that their depression is really emblematic of their high standards. It can help them to feel, proud rather than shameful. And that sometimes has people feeling better right away, even before we get to some of the cognitive and behavioral methods. It can help people to no longer feel defective or broken. And certainly if we can help people feel proud of their symptoms and ask them like, why would you want to change? We kind of put the patient in the role of arguing for change and that really reduces resistance. It makes it so we're not doing that kind of push pull and we're not responsible for tugging our patients along but rather kind of joining with them and letting them be in the driver's seat.

 

Dr. David Burns: And one of the things that's hard about team is when Jill what she what Jill just told you is you said that that's good that makes sense but you probably don't grasp what it really means. What we're really talking about is as a therapist instead of this is one of the four deaths of the self for therapists who were doing TEAM, it's the death of the helping self and instead of trying to help the patient when they tell us what they want help with we try to sell them not in a gimmicky way but in a genuine way on not changing and become the voice of the patient's resistance rather than speaking in the voice of the therapeutic helper. And at the moment, you see and make the patient see why their symptoms make absolute sense and are really beautiful and awesome and not something they should need to be ashamed of or to call, a mental disorder of some kind. That's at that moment the resistance paradoxically disappears. Then you come in with methods and often the first two or three methods and you can hit the ball out of the park. The I'll talk a little bit about the methods. I'm best known for my work in cognitive therapy, but the TEAM uses more than a 100 methods drawn from more than 12 schools of psychotherapy. There's a lot of cognitive techniques that I developed even in the mid 1970s that are just as powerful and mind-blowing today as they were the day I created them. But a lot of the techniques come from psychonamic thinking or behavioral school or interpersonal methods and we used to say that that you have to use a lot of methods if a patient has a thought like I'm not good enough or I'm a failure. I'm defective. You may have to use as many as 10 or 15 or 20 or even 30 methods before they blow that negative thought out of the water.

 

And occasionally that's still true, but more often is that when you do really skillful assessment of resistance or what we used to call paradoxical agenda setting, that often just a few methods will be generally needed until the patient first sees through their negative thoughts. Suddenly, sees why they're not true and then blows them out of the water with a technique called externalization of resistance which we hope to show you shortly. And the cognitive model of course goes back to the great philosopher Epictetus and to the Buddha 500 years before Epictetus. Epictetus was 2,000 years ago and I believe the Buddha was 2500 years ago. But the whole idea is that all of your feelings, not some of your feelings, but all of your feelings are caused entirely, not in part, but entirely by your thoughts. And the second and this is so simple and so basic that a lot of people can't get it. It's a form of enlightenment to really grasp this. And the second principle is that depression and anxiety are the world's oldest cause. In other words, the thoughts that trigger depression and anxiety. I'm going to blow it when I give this workshop and everybody's going to look down on me and I'll make a fool of myself or I'm defective. I'm not as good as I should be. And why am I so socially anxious? These these thoughts are not valid. They're filled with what I call cognitive distortions. I first published in my book, Feeling Good, that they're just little ways we twist things in our minds like all or nothing thinking and overgeneralization and on and on. And then the third and most powerful thing which is kind of shocking again when we say it it goes in one ear and out the other but the when you change the way you think you can change the way you feel. But what that means is the very moment you stop believing your negative thoughts in that very instant your feelings will change. That recovery is something that happens generally in a whoosh, a sudden kind of thing over maybe 15 to 30 seconds, not over 15 to 30 months. And these are the 10 distortions which we won't go into a lot of detail now, but you can see them in your handout on the second page of the our volunteers daily mood log. The definitions of, should statements and emotional reasoning and mind reading and fortunetelling and all or nothing thinking. And you'll probably recognize that in your own thinking if you've never seen the distortions. Most of you, I suspect, are pretty familiar with the 10 cognitive distortions.

 

Jill Levitt: And I'll just say one quick thing, David. We shared the handout packet. It's an Adobe file. We shared the handout packet in the chat box. Mike did. However, some people just because of their setup on their computer or whatever their log device they're using aren't able to access the handout packet. So, I told people in the chat, but I just want to make sure everyone is hearing me. It isn't essential for your participation in the workshop. We will actually share the daily moodlog in the slides. We'll tell you guys if you want to follow along with any of the exercises what to write on your paper and the handout packet, a copy of the slides, and the recording of the webinar will be shared with all participants. So, we'll try to anchor you for those of you who are having trouble downloading the handouts. Okay, David, I'll move.

 

Dr. David Burns: And that one. Yeah. Right. Yeah. And this I kind of already went over this material, but we can go to the next slide. And there's something I call the necessary and sufficient conditions for emotional change. Let's say you have a thought, I'm defective, and the patient believes that thought 100%. I've had many patients who were absolutely sold on the idea that they were defective. And it's a fact. It's not a thought. They can't see that there's any distortions in it. But in order to change emotionally, the patient has to come up with the help of the therapist generally with a positive thought. And the positive thought has to be 100% true. Half-truths and rationalizations will not help. And that's the necessary but not sufficient condition because you can come up with a positive thought that's 100% true, but you're still anxious or depressed. Or angry or whatever. The sufficient condition is that the very moment the patient sees that the negative thought isn't true, in that very moment they'll almost instantly feel less depressed, anxious, angry, or whatever they're feeling.

 

Jill Levitt: So that's what we wanted to share with everyone ahead of time. In other words, that's sort of our overview of the TEAM-CBT model. And then our goal is to be able to bring the model to life today. And we have a therapist who offered to volunteer to do some personal work with us today. And for those of you who are able to download your handout packet, her daily mood log is on page four. Although we're not going to start with the daily mood log, actually we're going to start by introducing our volunteer and then also start with what you all saw, which is testing. P equals testing, which is actually the brief mood survey. And you don't have that in your handout packet. We don't actually have it on a slide either because our volunteer just shared it with us this morning. So, we'll go over that verbally with you guys. So, I think Caroline, you're now on screen with us. So, I just want to say hi and welcome you, Caroline, and thank you for volunteering to do work with us today.

 

Caroline: Thanks for having me. Good morning, everyone.

 

Jill Levitt: And David, do you want to get started with just going over Caroline? Sure.

 

Dr. David Burns: Yeah. I'll go over quickly Caroline. Right.

 

Jill Levitt: So we just we just kind of fresh off the press and David will kind of read the scores on the brief mood survey to us and we'll just also then really invite Caroline to share with us and all of you kind of what she's struggling with and tell us a little bit about herself and Yeah.

 

Dr. David Burns: The we have two ways to do testing that you're going to learn today. One is the brief mood survey and the other is the daily mood log. On the brief mood survey, Caroline, you filled out graciously how you were feeling before just before the session began and your score on the depression test was nine out of 20 which is in the mild to moderate range. But you changed the wording on a few of the items. The first one is sad or down in the dumps. And you changed that and put fatigue and you're experiencing that somewhat and instead of discouraged or hopeless, you marked out hopeless and put discouraged, which is somewhat. And the two items that were marked the highest on the depression test were low self-esteem, inferiority or worthlessness. And this will be clear once we start talking about what's bothering you, Caroline. And also loss of pleasure or satisfaction in life. There are no suicidal thoughts or urges. The anxiety is similar to the depression, a total of 8 out of 20, which is in the mild to moderate range. But the two highest items were tense or on edge and nervous, which were both feeling a lot right now, but that's for today. So the anxiety is being elevated a little bit just by the fact that we're doing a live demonstration. The anger is zero. The happiness was quite pronounced the responses of the positive feelings. There's 10 items on there are different aspects of happiness and positive feelings like feeling worthwhile and feeling close to people and feeling productive and motivated and feeling hopeful and satisfied with your life. And your score on this Caroline was seven out of 40 and so all the items were not at all or somewhat. So there were really none of the 10 items that you were feeling moderately or a lot or extremely. So there's the loss of happiness and joy is much more pronounced than the presence of depression and anxiety.

 

Jill Levitt: Yeah. And the only other just clarifying thing is we don't have Caroline's brief mood survey in the handout packet because Caroline just shared it with us five minutes before as would be an organic session where we're just seeing these scores for the first time. We did put a copy of a different brief mood survey just kind of for your reference of what a brief mood survey looks like in the handout packet, but I didn't want people to feel confused. So let's.

 

Dr. David Burns: Should I go over the daily mood log or do you want to dive in talking to Caroline first?

 

Jill Levitt: No, no. I think we should definitely just have Caroline first tell us about herself. We don't know anything about Caroline and just if you can share with us, even kind of the basics of who you are so we can get to know you a little bit and then tell us a little bit about yeah, what you've been struggling with, what's leading to these symptoms that we're seeing on the brief mood survey and then we can get into daily mood log after we first spend some time.

 

Dr. David Burns: Yeah. And then to start out by just thank you Caroline for volunteering. It’s kind of scary and a big step to do personal work in front of such a live audience. And we really appreciate your greatly.

 

Caroline: Well, thank you for having me here. Yeah, I'm regretting it now. It is it's hard. And I would say this is the hardest thing for me to do is be vulnerable. And I think that'll be clear. So I am a psychologist in Canada. I work primarily with families trying to help kiddos, manage anxiety, focusing on resilience. That's kind of what I love doing. I also do a lot of stuff in the neuro divergence world, too. I'm a mom. I've got two girls. One just finished her first year of university. The other one's still in junior high school for depending on where some of you live. That's kind of the basics of who I am. Maybe I can jump into some of the things. Just let me know if I'm talking too much because sometimes I will just keep on going. But when you first emailed about volunteer, I actually had just been in a research meeting and had felt a little bit like I should not have belonged there. A little bit of an imposter syndrome. So I'm like, sure, I can talk about that. But it's been really interesting because over the past week I've really realized it's more about it. I think that was just one small little piece. I'm sort of caught in this push and pull between needing to be the best and feeling like I'm never enough. And that's really, I think, the core of everything that's going on. It's interesting. Last night, I actually asked my husband and my youngest daughter if they see my self-doubt, and they both laughed immediately. And my husband's like, "Well, let me I've been waiting for this day. I've got logs of all of the things." But, he said that I create these stories to fuel self-doubt. And he said there's these there's two Carolines. There's the doctor, captain, professor that the world sees who goes out there and kicks it because you're playing a role. And when you're in that role, you're confident. But even in that role, I do a lot of ya budding.

 

My husband said like there's so many people who will come up and like you're the center of their universe, right? They just think you're amazing that you you think you're just this big meteor crashing around in outer space, right? And I do agree with that because I do feel well even my daughter, she was just in Halifax with me a week or two ago. I was doing a talk there and she came and all these people were coming up and talking to me and thanking me, right? And I'm like, I just feel like a big blonde buffoon. Like I'm happy that it was helpful and I have a hard time taking those compliments. And Before I do presentations, I usually have this big disclaimer. I'll spend a few minutes saying that I'm a crybaby. I'm going to cry during this workshop. I'm probably going to sound like a big blonde buffoon. So, if you have no idea what I'm talking about, just stop me to ask and clarify. I often will drop that I'm almost 50 in hopes that people will actually take me seriously, right? Maybe because if I'm older, even though that breaks my heart that I'm almost 50 because I feel like I've not done anything with my life, right? So, I just feel that self-doubt and nothing's ever good enough. Even my daughter, she's like, I can't even thank like compliment you and you can't take a thank you even from me, right? Cuz I'm just always beating myself up. So I think that that's a big piece of this. And I've won like I've won awards. I have literally won awards for being the best and it's still not good. And it's not that I share it. That's the other thing. Like don't share it. I don't want other people necessarily like I don't think that's it because I did win best psychologist of the year last year and I never told anyone, right? But that was a big enough one that people found out and even my co-workers were like why haven't you told us this? Congratulations. I'm like thank you. But I immediately switched the subject because I'm just too embarrassed. I and I minimize it. So I think the self-doubt piece and it's pervasive I mean there's the professional side, but even my personal achievements, like I've done fitness competitions and I've won awards there and in acting and it's always like, yeah, but sure, I won this little best actress for this little thing, but it's not an Oscar, for example. When I got my masters, well, everybody's got a masters. Then I got my PhD. Well, everybody's got their PhD, right? And so a lot of that sort of minimization. So professionally, I can come across confident, socially. That was another thing my husband was kind of laughing at me because I hide behind he's this big man. He's like, I feel like you married me because you can hide behind me.

 

Like he's literally 66, right? He's like, you can hide behind me. So you've got this trained ape to take you out socially. And he's like, if this train, meaning himself, if this train don't leave the station, neither does the conductor, meaning me, right? Like I don't go out unless he's going out. So that relational self-doubt and feeling like I don't have anything important to say, right? I love public speaking. That's a role and that's the only time I feel heard is when I'm on stage. So I think it's just feeling like I'm never good enough. And I think that's going to kill me because I'm just feeling exhausted because I'm doing everything. I'm always like I'm up at 3:00 3:30 every single morning and I run in a clinic and I supervise and I have two podcasts and I'm an assistant professor and I'm doing all of the things and I work out every day, right? People are like, "How do you do it?" Well, I haven't taken a single day off in over 14 years, even Christmas, right? Even holidays, even I was sick with COVID. Literally thought I was going to die. I'm getting like I was signing I had my husband have me sign a will cause I literally thought I was going to die, but I was still working and I feel like I have to do that. So a lot of shitting. I should myself a lot, right? I can't miss a day of working out because then I just like the beating up that I do is just terrible. So yeah, I mean that was a lot to throw at you.

 

Jill Levitt: Okay, so yes. Well, first of all, Caroline, Thank you. I actually love that you just opened up and shared so much with us. And I'm hearing you sharing a lot of self-doubt and kind of perfectionism and not feeling good enough. I'm going to take a minute if it's okay to maybe sort of like review with you a little bit about what I heard you say, see if I can do a little bit of thought and feeling empathy and just connect with you and you shared with us and again, I didn't know any of these things before just this very moment. So, I'm just sort of processing too. You're a psychologist in Canada and a mom of two girls. Said one is in high school, one is in university. And you're a very successful psychologist. You shared with us that you public speak and love it, that you care a lot about helping kids with resilience and run a clinic. And you're also a researcher now. And that was kind of what you started with realizing that you wanted some help with, right? You said you were sitting in a research meeting and feeling a bit like an impostor, like maybe research isn't your strongest of all these strengths that you have and therefore in that setting you were really not feeling good about yourself. And then kind of throughout your story, you're sharing that you feel like you need to be the best and that you're not good enough. And it sounds like you shared that with your husband and daughter kind of last night and thinking about today and you were wondering if they knew that about you and sure enough they did and both of them kind of reminded you it sounds like of all these situations where you're so accomplished and yet maybe really not able to embrace it or not feeling not able to feel really good about your accomplishments because you're always sort of minimizing them and thinking It's not that big.

 

You know, if you win an acting award, but it's not an Oscar or fitness competition, but maybe I'm not Miss Universe or like there's always something better. And it sounds like that's causing you a lot of pain, right? That you're feeling sad about it. And it sounds like I'm guessing also kind of anxious and stressed and somewhat down. And I'm thinking yeah, you also said that as you're approaching 50. You said you have this thought like I haven't done anything with my life despite sharing with us all these seemingly amazing things that you're doing. So you're aware it feels like there's this discrepancy where I'm accomplishing a lot but really not able to feel good about it or proud of it or always feeling so kind of driven, right? And even don't feel like you and give yourself a day off from exercise, from work. And, I was glad that you started to share with us that kind of vulnerability. You had some tears when you were remembering having COVID and being really sick and nearly dying, right? You said you were even like signing your will and so it was clearly very serious, but you didn't give yourself permission to take time off from work then even to kind of take care of yourself. And it sounds like that was pretty emotional for you realizing I guess just how kind of deep this perfectionism and like need to achieve and do better really run so deep for you. And I really I love everything you've shared. I feel excited to work with you and also very much feeling compassion for just how much you've accomplished and yet still how hard you are on yourself and how it, starting to feel like you're kind of burnt out, right, from never taking a day off and just not feeling good enough.

 

Caroline: Yeah.

 

Jill Levitt: How am I?

 

Caroline: Burnout piece is definitely a big piece of it. Yeah.

 

Jill Levitt: Yeah. And I didn't mention that you did also say that relationally, you kind of said this at the end, you also feel like it not just professionally but in relationships that you hide behind your husband a bit. And I'm not sure if I got all certainly not nearly as much kind of detail and color around that, but sounds like you're saying that you won't necessarily put yourself out there in social situations unless you're with him. He's kind of a safety person maybe for you. And so that's maybe a place too where you feel is it maybe you can tell us but self-conscious or anxious or not good enough.

 

Caroline: Yeah, I think there it's just that I've got nothing interesting to say. It, we, my husband and I, I mean, we've been together now 30 years, I think 97. Yeah, I think we're going into 30 years. But anyway, we used to do a lot of personal development courses. So, we've been together for so long. But we do we did these personal development courses before I was ever a psychologist or anything. And It was interesting because we, this was always something that I really struggled with and some of the work we had to do, we'd have to go in partners and we'd have to share two minutes of just saying whatever you had and the other your partner was supposed to just listen. But anytime we did that and it was my turn to talk, people literally interrupted me and started talking. And so like just this pattern of feeling like what I have to say isn't important, like I don't have a voice. And so that comes so socially I just don't right I just hide behind him and he does the talking and the only time I feel like maybe I do is when I am talking about my area of expertise right when I'm doing a workshop or things like that. So that's where that piece comes out. Socially. Yeah.

 

Jill Levitt: Okay. Yeah. So it sounds like kind of where you had started where saying like when I'm in a role and I have kind of a job to do I can deliver and feel confident in my skills. Like in that moment public speaking or presenting or helping a kid or something. But when it's kind of like there isn't a role and there isn't a this is what you're going to say, you feel really self-conscious and again less than and telling yourself that what I have to say is not important.

 

Caroline: Right. And even just being vulnerable. That's why this was so hard and why I feel so panicky doing this is just being vulnerable. Like I see I'm a very visual person and I've always seen myself sort of surrounded by a brick wall with just one brick that I can look out.

 

Dr. David Burns: Are you feeling sad right now, Caroline?

 

Caroline: Yep.

 

Dr. David Burns: Just let just go with that feeling.

 

Caroline: Trying to hold it together, right? To not be vulnerable, but it. Yeah. I feel like I think one of my greatest fears, it's a new one, I think, is just being forgotten. I'm worried about being forgotten.

 

Dr. David Burns: Yeah. And in the same ballpark as being forgotten is as being not seen in the first place except as an expert peering out from behind that and I feel very close to you not only right now in your tears but throughout what you've been saying this tremendous drive for achievement which has succeeded but has failed in a way to bring you the joy and peace and connection with others that you're yearning for so strongly. I'm wondering how you're I have two questions for you. I have a lot and I want to share your daily mood log as well, but one question is how you're feeling right now being vulnerable in front of probably a thousand people. By now that are here with us live and another thousand or more who will be seeing the video and just showing yourself naked and tearful how is how's this feel and also you say being vulnerable makes me feel panicky and so the second question is related to the first is what is it that I'm afraid of in being vulnerable what's causing my panic? And how am I feeling being vulnerable right now?

 

Caroline: I can tell you I feel like I'm having a heart attack. Physiologically, that's what I'm feeling. I think it's easier just knowing like just being able to see the two of you I think makes it a little bit easier. It's not terrible. I think just knowing we're with other therapists as well. Certainly, there's like a little tingling in the back of my mind. Well, how can she say that she's an expert if she's feeling this way herself, right? Like I think that there is a little bit of worry there.

 

Dr. David Burns: Can I write that down as another thought or do you have a piece of paper? You have your daily mood log, but it strikes me that's another thought for a daily mood log is how how How can she be an expert when she feels this way?

 

Caroline: Yeah.

 

Dr. David Burns: And so are you feeling that might be going on right now with some of the people in our audience thinking that about you?

 

Caroline: Possibly. Probably not. But.

 

Dr. David Burns: Emotionally.

 

Caroline: Yeah, I think partially and it's funny because I actually I don't know if I can articulate it, but there's something else going on. The best way I think I can say it is I feel like this is just another role too, right? Like we're all like it's not it's being vulnerable in front of other people. But I don't know who's here if we're going to go on with our day. It's not like I don't know if I'm articulating that very well, but I don't know. I do I do feel it it is hard and uncomfortable, I would say, cause it's almost like I need to put the wall back up because I don't want cause I'm sure people are probably feeling compassionate. My I almost don't want it either, right? That's really hard to and even Jill yesterday like we did a quick tech check and she's like hopefully we can be helpful to you. I was taken aback by that. I'm like helpful for me like I'm volunteering to help you. So I think I have a hard time taking that help and taking compassion or taking even love, right? Like for my daughter she'll compliment me and I'm like me like I can't that's always my response right and it's hard for me to take any love receive any love.

 

Dr. David Burns: What do you?

 

Jill Levitt: Yeah, what are you afraid would happen if you were to be vulnerable if this was real and not a role and we were here just for you just to support you and help you with what feels scary about that.

 

Caroline: I don't know if I I don't know if I have a fear. I just have a yeah. But like I don't know if it's a fear. I just don't know how it's almost like a skill deficit. I feel like more than a fear, right? I just don't know how to maybe there's an underlying piece that I don't feel like I am lovable. Maybe, if I dig down Maybe there is that. There's just more important people. There's more important people who need help.

 

Jill Levitt: But I'm not I'm not important enough to need help. Just jotting down a couple of these as sort of negative thoughts like I'm not lovable. I'm not important enough to need help. And I wonder you used this metaphor that seemed really powerful and it brought tears to your eyes and I wanted to know if I could ask you more about it cause I realized I wasn't sure if I totally understood what you were saying and it sounded so important. You said I feel like I'm surrounded by a brick wall with just like one opening and then you started to cry and could you share with us more what you were thinking when you were sharing that with us?

 

Caroline: Yeah, like to protect myself. Right? Just to stay, it's just to protect myself. I I've started doing a little bit of IFS, just dabbling a little bit in it. And I really do have that little girl. I can see myself like three or four years old, that exile, right? That little girl where so, I've got all of these other sort of superheroes, superwoman busyness and trying to protect that that core. Cause nobody else did, right? Not that I go back. It's like I'm more solution focused like that's where we where are we going to go? How do we but for me like I do think I'm just protecting myself from from getting hurt.

 

Jill Levitt: : Yeah. Like I need to protect myself or I will get hurt. So being vulnerable is putting myself at risk for getting hurt.

 

Caroline: Yeah.

 

Dr. David Burns: And then how how will I get hurt? What would hurt me the most? What would hurt that three or four year old little girl the most and.

 

Caroline: That I don't know like I think it's just. Yeah I think it comes back to being forgotten not loved and forgotten.

 

Dr. David Burns: And what and interesting and why why would I be forgotten what would it mean to me to be forgotten they're forgetting me because what I'm not interesting enough or not lovable enough or?

 

Caroline: Yeah, I think both of those.

 

Dr. David Burns: Yeah.

 

Jill Levitt: Yeah. Right. Because it sounds like you were saying that if I that the fear is like if I were vulnerable, if I did share myself that I wouldn't be loved.

 

Caroline: Yeah.

 

Jill Levitt: Like if people saw the real me, if I really shared what I was thinking and feeling that would.

 

Caroline: Yeah.

 

Jill Levitt: People I would be rejected or I would not be loved.

 

Caroline: Yeah.

 

Dr. David Burns: So is are you confronting that fear right at this moment because you're opening up quite a lot and being vulnerable?

 

Caroline: I don't know. I'm kind of stuck here with this one because I don't know if it's everybody if it's one person like I don't Yeah, I don't know. I'm sorry.

 

Jill Levitt: What now? I forgot what you were answering that you're feeling that you don't know the answer to. So, will you say what is it that you're that you were just struggling with?

 

Caroline: Well, just knowing like I mean, David asked us about being now like vulnerable now if. Right. And it feels okay now, but there's a yeah, but I just don't know what the yeah, but is. That's the biggest problem. And I think I'm going to be now I feel bad that I might be tricky because there's always a yeah, but I just don't know how to finish the end of that sentence. There's something else there, right? Like, and I don't know what I mean, I I'm always the person who will push other people away before I can get rid of rejected, but I don't know what it is that I'm.

 

Jill Levitt: That you're afraid is always. That you're that you're that you're afraid, right? I mean, it even I guess though simply the idea of saying like that I won't be loved. That I would be myself and be open and be vulnerable and somehow be rejected or criticized or again not loved, not heard, not seen.

 

Caroline: I want to be important to someone. Yeah. And I know my girls, they would say, my husband would say, and my girls would say, I just don't feel it. And I know that they do. Well, I mean, Mother's Day was what, like in May? It was ages ago. Father's Day has just come and I had made a comment, I feel bad now. I made a comment the Saturday before Father's Day just saying like, I know dad doesn't care about these kinds of holidays like Valentine's and but it is important to me. We didn't celebrate Mother's Day. I was in New Zealand. I was doing a tour speaking tour New Zealand. So, I was in New Zealand for Mother's Day. But then they ended up turning Father's Day into Mother's Day. So, I felt bad that I'm like, you guys didn't think about me for Mother's Day, but then they did. But then I felt bad because it was Father's say we're supposed to be celebrating dad, not me. So even when they do try, I'm still like, yeah, but right, we shouldn't like then I'm uncomfortable with it and I push it away. So that I'm, kind of caught in that.

 

Jill Levitt: You want it, right? You want to be loved and seen and cherished and yet you're also uncomfortable when that when that comes up for you. And I was also I one other question that I just wanted to understand because you moved through this quickly is you said something about your childhood cause you were able to say that it connected with a younger part of yourself. And so is there something there around not being seen, not being loved, not being made to feel important in your?

 

Caroline: Oh yeah. Oh. Oh yeah. Like I could go on. I mean that's a whole other There's I mean my mom was a young mom. She was a teenage mom and my bio dad I call him my sperm donor, dropped her off at the hospital when she was going into delivery and was like, "Don't put my name on. Like, I don't want anything to do with this baby." And it was a pretty I mean, we did live there. I won't go into like all of the backstory, but it could we could definitely make movies, just it was not a great place. When I started school, my mom remarried, so my stepdad, love him, he's amazing, did the best that he could, but I just felt for sure nothing was good enough. My baby brother, he's seven years younger than me. They went to everything. They never came to any of my stuff, right? I was winning awards like a best athlete award and all the top academics. I did all the things and they never came to any of my stuff. Actually, last night my husband was saying that one of one of the key memories he has of me when we first started dating is I had made a comment that in the few months that we were dating, his parents had come to more things than my parents had in my lifetime. And he said that really stood out for him. So yeah, there's a lot of stuff there for sure that just nothing was ever acknowledged or celebrated or.

 

Jill Levitt: My heart breaks. Your story, Caroline, I just want to say I do really feel very close to you having you share that with us and feels again very brave that you're sharing so much of yourself with us and it's it sounds very sad growing up and having a young mom who was doing the best that she could but at the same time raising you it sounds like on her own and though you haven't gone into detail that those first six years or something maybe. Didn't feel very safe when your mom remarried and you had a stepdad. Although you sounds like you love him and a lot of positive feelings toward him, you also still never felt good enough. And that you had this that you had a younger brother then I gather who was the child of your mom and stepdad and you definitely felt like he was treated really differently than knew that they went to all his activities and here you are having so many successes and achievements and feeling really alone with it and not having them there to celebrate you and yeah, I mean I feel so much love for you and so much love and care and compassion to hear what you've gone through and it certainly does make sense that you're still looking, for that love and acknowledgement and right that that you never got right. Yeah.

 

Dr. David Burns: And also that you you've gotten into this pattern that's been reinforced of achieving and winning and and so you've had a lot of achievements and a lot of victories. But that's actually just made it harder to feel close to people because then they're when they do admire, oh, your athletic accomplishment or your psychology of the year award, this these are just things that you've been doing. And it's not, that's not what you're looking for now is and maybe then is to be loved and cared about for who you are and being vulnerable and just to hang out with people who were just kind of average in a way. The or even below average and enjoying that. And that that's been just very elusive and your success in and trying to get some attention has been part of the trap. Because then you It's just an endless, treadmill of walking faster and faster and setting more and more records on the treadmill, but still not getting what you want. And on a very humble level, my thinking is very simple and but like Jill, I do feel very close to you when you're vulnerable and showing your weakness, where you've your life feels like it's failed you to to the thing that you you want the gold ring on the merry-go-round or the brass ring or you're you have been reaching for it but can't get it and on a very humble level it's that you're just wanting someone to love you as you are and that you have experienced a lot of rejection because when you were growing up that they didn't come to your stuff. They didn't celebrate your victories and probably didn't even realize the pain that you were experiencing then and that you're experiencing now. That's kind of my crude summary, but that is that kind of what you're what you're sharing with us?

 

Caroline: Yeah, I don't know if I recognized it when I was younger. Now I definitely did. And my husband when we first were dating, he saw the stark difference in how I was treated, between my brother and I. And looking back, like I don't even know if I invited them to stuff either because I just knew that they wouldn't come or figured that they wouldn't come. So I recognize it more now. I don't know if in the moment when I was a kid or when I was a teenager. I don't know if I would have recognized it. I mean, they came to my university graduations, right? But it was more just probably something that I was just suppressing and suppressing and suppressing and didn't even realize.

 

Dr. David Burns: So, you were a very lonely superstar.

 

Caroline: Yeah.

 

Jill Levitt: Yeah. I love that summary. Actually, I did I wondered did that resonate with you, Caroline? What David was also talking about with sort of seeking, continuing to push herself and want to do better and seeking achievement and accomplishments and really being the best and in the hopes that someone would maybe notice and love you and give you that attention, but also kind of feeling like it's a bit of a trap, right? Because you just keep trying and seeking and working and achieving. And still not feeling that sense of maybe love or being seen.

 

Caroline: And it's interesting because I don't want to be seen either, right? So that's like that's where it gets really tricky. I mean cherished in a personal sense, not like the professional, but it's exhausting. I think that's the biggest thing just being on this hamster wheel is just exhausting and I feel like I've lost my colors, right? I've just yeah, I've lost I don't even know who I am anymore. So I think it's both of those pieces. I'm just exhausted and want to be cherished but don't want to be seen. Yeah. I don't know.

 

Jill Levitt: And I want. Oh, David, did you want to say something?

 

Dr. David Burns: Yeah, I just have Well, a couple things. I just had a one last question for you and then I'd like to share your daily mood log with the group as well. Well, there's just a particular moment of your life when this is kind of being played out, but I know you scored zero on the on the anger scale and on the on your daily mood log too, you indicated that you have no anger at all. And so I'm believing you on that. But I still want to ask the question if on any level there's some resentment of toward the world that I've given so much to that that hasn't given me the love and caring or however you would put it.

 

Caroline: No, I would say no. No. And even like and even with my mom, it's more sadness for the little girl. Yeah. No, no resentment, no or anger.

 

Dr. David Burns: So, do you feel sad right now for that little girl and tired trying to be the shield all the time?

 

Jill Levitt: Tired of trying to protect the little girl. Is that what you meant? Like being the shield?

 

Caroline: Yeah.

 

Dr. David Burns: And are you, protecting her now? Are you being a shield now? Or are you?

 

Caroline: Yeah. Very much so. Yeah.

 

Dr. David Burns: Tell us, can you just tell us a little bit more about how that's playing out at this very moment?

 

Caroline: I do well with the if that stuff. I mean, I do a lot of physiological stuff and I've gotten to the point where I know where in my body I feel different things and what that is, what the message is. And right now, like right here, that is that's the core of like where the little growth is. It's just squeezing like there's just a lot of pressure there right now. It's interesting because like in my throat is where I feel like I have nothing interesting to say. I thought I would be feeling that the most here, right? That what I have to say isn't important, but I didn't think I'd get here, but here we are. This is so it's the feeling that I feel right. And the pictures I don't like I don't have stories and words, what's the story and what's the more the picture and the feeling for me.

 

Dr. David Burns: Oh, sure. Sure. Maybe a little girl doesn't have that many words yet to describe so so many fancy psychological ideas, I guess. But you you're feeling a lot of tightness in your chest and that's when you feel closest to to that of the feelings you had as a little girl.

 

Caroline: I don't know if I felt that as a little girl, but that's where I feel.

 

Dr. David Burns: I'm wondering if we should focus, on the daily mood log a little bit.

 

Jill Levitt: Yeah, I could I was just going to I think so. And I was actually just going to ask Caroline so far, usually just this for the audience as well. Usually we check in with our patient and ask how we're doing in terms of empathy and sometimes the daily mood log is part of empathy, but I think we can check in so far because we've talked so much and then we would we'll move on to the daily mood log for sure. But Caroline.

 

Dr. David Burns: Good idea. Yeah.

 

Jill Levitt: Yeah. So far and what you've shared with us and what we've shared, back with you. How are we doing in terms of empathy? Actually, David, do you want to ask the three questions?

 

Dr. David Burns: Yeah. There's three three questions. So and you can grade each with a letter grade A, B, C, D or whatever. The first question was how accurately do we understand how you're thinking? The secondly is how accurately are we understanding how you're feeling inside? And the third is to what extent are we creating an atmosphere of trust or warmth or safety or acceptance?

 

Caroline: A for sure for the last one. And I think I think you're getting it. I know I think you're getting it. I often feel misheard and misunderstood and I'm not feeling that right now. If anything, I'm I'm not sure if I've articulated myself as clearly, but I think I think you guys have got it.

 

Dr. David Burns: Okay. And okay. I think we can go with that. Do you think, Jill?

 

Jill Levitt: Yeah. Is there anything if we were to ask you, you said an A for warmth and acceptance and then I didn't hear grades for the other two, but then.

 

Dr. David Burns: Thought empathy and feeling empathy, right?

 

Jill Levitt: On reflection, you're saying I think you guys got it. I guess I would add any if there's any hesitation there. But our follow-up question would be, is there anything that you think we're not quite getting? Is there anything else that feels important to share that we've somehow missed or misunderstood, misinterpreted?

 

Caroline: No, no, I'd give you A for those as well. You guys are bang on. See, it's just the self-doubt. Like, is this me? Did I give you like, am I getting to where we need to and now we're taking up too much time and we got to get things going? Like, it's just me. You guys are doing great.

 

Dr. David Burns: Okay. Sure.

 

Jill Levitt: And to be to be clear to you and our audience because this is a little humorous, but we're not achievement oriented. So, we're not saying yes, score, we got an A, we're actually asking very specifically, not because we want a good grade, but kind of to the contrary, because if there were anything we were missing, asking what grade we get helps us to understand what we might be missing. And I'm saying that to the audience because I could see for people who don't get why we would ask, we would be thinking, "Oh, isn't this like feeding into some achievement grade oriented?" But it isn't. It's looking for where we could be failing you so we could learn and make sure we're getting it all. Under those circumstances, what I would say is, yeah, why don't we share Caroline's daily mood log? Mike, if you could go back to screen sharing for a moment, we could put it on the screen and then, we can walk people through it and then, yeah, we want to think about if there's something in here that you help with and start to move in that direction.

 

Dr. David Burns: Yeah. But just to amplify what you were saying on the grades, we don't ask for grades because we're hoping for straight A's. We're asking for grades because we're hoping for failing grades like an A- or a B+ in any category would be a failing grade. And that's something to be celebrated because then we can find out what it is that we're that we're missing. So, let's take a look at the at the daily mood log and then we can focus on what we should try to accomplish tonight.

 

Mike Christensen: Are you able to share that now?

 

Dr. David Burns: Yeah. Here, here we go. And so, at the top, the upsetting event was just being in a research collaborating collaboration meeting and it sound like this was some kind of a new group you were connecting with with regard to to doing some research and you mentioned that you've been very good at writing proposals for I presume for grants or for specific research studies and then in the meeting you were feeling down in the first category you emphasized down and that was 60 on a scale from 0 to 100. You mentioned no anxiety and let me ask you that again. You weren't feeling anxious at all, just down?

 

Caroline: Yeah, I at that point I wasn't I'm sure anxiety would ramp up if I was getting like more engaged and had a bigger role.

 

Dr. David Burns: Oh, with people. Yes, I see. Right.

 

Caroline: In that moment. I didn’t.

 

Dr. David Burns: And then on the guilty, remorseful, bad, ashamed, you circled bad and you were feeling 60% bad. And then on the inferior you're worthless, inadequate, incompetent were also highlighted and that's at 100. So that's really about the most inadequate that a human being can feel. Like if you had somebody with incredibly severe depression on an inpatient unit, that they probably wouldn't even score that high on the inferior and worthless. And the reason I'm emphasizing that the numbers because some people are against the numbers and I think if you are avoiding measurements and numbers, you're really missing something that can bring you an awful lot closer to people in an emotional way. But that if someone meets you, you say you're a great actress and then people admire you all the time and you don't end up, getting what you're hoping for, which is some real real love. But people would never be thinking that, oh boy, this this woman, psychologist of the year, she's not the one who's feeling 100% worthless and inadequate, but this shows how people are feeling inside and that that's what you want to have that information. And then you're also feeling unwanted like maybe they're not they don't want me here. Which is so sad to be thinking that in a research meeting, which would be kind of a fun thing. And, hang out with colleagues and explore things and help each other out and come up with ideas and plans. And then you were also feeling foolish and self-conscious was 100. That's the most intense a human being can feel. And discouraged was 80. And so this gives a portrait of what your negative feelings are. And with great precision and we see that you were It was just a kind of an awful kind of experience.

 

I've had experiences like that myself. I won't go into them because I don't want to waste time, but I I've also I had to present a talk at Harvard and I thought it would be with a little seminar when cognitive therapy came out. I thought it was going to be with eight people, like just shooting the breeze about cognitive therapy. And when I got there, I found it was a conference with a thousand psychiatrists and there were all these speakers from Harvard before my talk. It was a full day conference. They had all these researchers and talk and there were all these impressive people and I was just giving a talk on cognitive therapy and I just felt like kind of like you like worthless. And I was saying, "Oh my god, could I just leave? Can I get out of here?" And it was, my it was the last talk of the day. It was a full day conference. And by the time I walked up to the podium, my mouth was so dry, I couldn't make any sound at first. And so I know how that was and then you were telling yourself impostor don't believe here don't belong here you believe that 80% and certainly I didn't feel like an impostor I just felt like I don't belong here and I want out and then big big blonde buffoon then you bleed that 100 and I have no idea what to do and how to contribute and that was a 90% and I am stupid That was an 80 an 80 out of a 100. And what I have to say is not important and that's a 100. I need to be perfect. That's a 100. I'm not qualified. Everyone is way better. And that's 100. And my previous work was too easy. It wasn't real research. And when we're feeling down and depressed or anxious, it's very much like being in a in a hypnotic state. To my way of thinking at least because you're giving yourself messages which on the one hand are very distorted and not mapping on to reality in many cases but they seem to be as real and valid as the fact that there's skin on your hands and it's being in a in a hell that that's a very painful and realistic hell, does that seem that kind of accurate of how you were feeling there and experiencing in that meeting?

 

Caroline: Yeah. And one point that that I think really struck out right at the beginning was just your point about how other people minimize too that internal feeling, right? Like you're so accomplished, you've got all this stuff going like you're doing fine, you're doing great, right? Like that false sort of cheerleading and minimizing.

 

Dr. David Burns: Yeah. You're not allowed to feel this way.

 

Caroline: Yeah.

 

Dr. David Burns: So, but so that that's an extra layer of aloneness.

 

Jill Levitt: I wanted to actually, if it's okay, make a quick teaching point. I love that you brought that up, Caroline. It's interesting. I had a couple people who sent messages to me in the chat box that said, and I'm not supposed to be looking at the chat, but I was. That said like you and David should tell her how amazing she is. Doesn't she realize like how fantastic she is, how lovable she is, etc. And I just wanted to say that that was like that would be perceived Caroline is even telling us like that feels really off, right? That's what we call cheerleading and that's us trying to rescue Caroline and so we're actually intentionally not doing that, right? David and I of course have tons of positive thoughts and feelings towards Caroline as we're listening, but we're trying really hard actually just to be really present to empathise and in the end, like if Caroline is going to feel better about herself, it's going to be because of work that she does, not because of us bolstering her up and trying to make her feel better. And that would be a therapeutic error, of course, but also Caroline, you're even saying like that feels, almost like it's feeding the problem rather than helping me. So, I just kind of love that that unfolded and it's such a common therapeutic error that we make, myself included.

 

Caroline: I'm glad you pointed that out because I teach this all the time too with parents. But yeah, thank you.

 

Jill Levitt: Right. When their kids are struggling, right, not to cheerlead and things like that. So, but what I think I was going to ask David, could we ask Caroline now that we've gone through the kind of understanding her thoughts and feelings and we know that we're doing a really good job with empathy. So, we've done testing and empathy and we're starting to move toward agenda setting. David, did you want to ask Caroline the miracle cure question?

 

Dr. David Burns: Sure. Caroline, would this would this be a time to roll up our sleeves and get to work on this or do you need more time to talk and have us listen and talk and vent because that's important and we don't want to short circuit that at all?

 

Caroline: No, I don't like venting. It's good to move on. Feel like it's been a lot already.

 

Dr. David Burns: Yeah. And what would you be hoping for in this session, this morning? Like what would change by the end if we can't offer and promise miracles, but if a miracle happened, what miracle would you experience? Caroline.

 

Caroline: I feel like probably just being content without having to do all the things and beating myself up all the time that I could have a day off and not be like, "Oh my gosh, I lost 5 hours not working on my next podcast." Or, I can just be and be content for that.

 

Dr. David Burns: So, I love that that goal Caroline what you're saying is if a miracle happened by the end of our work you'd be content just to be and you wouldn't be beating yourself up with all these kinds of and negative thoughts and just to help us a little bit with that. You gave us we have all the wonderful negative thoughts you have on your daily mood log and but do you have any additional you gave us one negative thought about the group which is people are looking at me and say how how can an expert feel like this that that's one of your negative thoughts here. Are there other negative thoughts that you're having right now in this situation that we can we can add?

 

Caroline: Not in this situation. Two that came up though when we were talking was just not important enough to need help and.

 

Dr. David Burns: I'm not important enough to need help.

 

Caroline: Yeah. Yeah. And can't be vulnerable. And But that one's down because I just was vulnerable. So forget that one.

 

Jill Levitt: I wrote down that I am not important enough to need help. I am not lovable. If I share myself, I will not be loved or cherished.

 

Caroline: Yeah.

 

Dr. David Burns: Oh, was that number two? If I share myself, I won't be love or loved or cherished?

 

Jill Levitt: That Yeah, I wrote down those three, but you can correct. I am not lovable. I am not important. Enough to need help and if I share myself I will not be loved or cherished.

 

Caroline: I think the third one we can drop just the I'm not lovable and then not important enough to need help.

 

Jill Levitt: Okay. And if you're in the audience you can be writing these down as well. If you were able to get the handout packet then you'll have this daily mood log that you're seeing on screen in front of you. And if not it's actually you just want to be capturing the negative thoughts. And so the new ones we've written down, which you can write down as well, is I'm not lovable. I'm not important enough to need help. And then the other negative thoughts that we might be focusing on are the ones on the daily mood log. But as we focus on them, we'll repeat them so you'll be able to capture them and write them down.

 

Dr. David Burns: So the suppose we had a magic button here, Caroline. And this this comes to a pretty important part of our work. And if we press the magic button, all of your negative thoughts and feelings would disappear, with no effort and you would just be sitting in a state of contentment. So your goal would automatically happen. Just press that button. Would you press that button?

 

Caroline: For not all of them? But for the shoulds for sure, I guess there's no shoulds here, but like the need to be perfect, I think that kind of encompass. So some of them, yes, I would absolutely want to hit that button.

 

Dr. David Burns: Okay.

 

Jill Levitt: Can I can I interrupt for one sec, David? We had discussed maybe taking a quick bathroom break like for the audience because people don't want to miss. So I'm going to suggest we do we literally freeze frame for a moment and maybe we come back and ask that question one more time. Not that your answer should change, but that we'll start there after we take what maybe a five minute bathroom break or what seems appropriate, David.

 

Dr. David Burns: Yeah, that sounds good.

 

Jill Levitt: Okay. So, we're going to give everybody, including you, Caroline, just because the audience doesn't want to miss a moment, but they need to use the restroom. So, we'll be back in 5 minutes at, 10:50 Pacific time. So go ahead and use the restroom if you need to. I'll go do it myself. So, just. Thanks, Mike. So, we're back together again. Thanks. We just gave everyone a quick bathroom break. And David, you were asking Caroline the, magic button question. Should we start with that again just because it'll be helpful for everyone to hear the question, and then we'll hear your answer and we'll take it from there?

 

Dr. David Burns: Yeah, I think the question in simple terms is what what would you Well, okay. Your goal for the session is to be able to be contempt and not to have to beat up on yourself all the time to maybe to sit and experience some peace and maybe even some connection without performance and judgment. And then I was asking if we had a magic button and all you had to do is press it and that outcome would automatically happen. You would no longer be beating up on yourself and you'd be content. Would you press the button? And you said you weren't so sure. You, for some of the negative thoughts and feelings, you might press the magic button and want them to disappear and others you might not. And let's take a little bit of a look at that and see if we can find some positives. And some of these negative thoughts and feelings and take a look at that before we make the decision to blow everything away. Would that make sense to you Caroline?

 

Caroline: Yeah.

 

Dr. David Burns: So.

 

Jill Levitt: Yeah, and for the audience, we're doing basically the magic button and now we're doing positive reframing, which is we're going to talk with Caroline about there's probably some really good reasons to be a little hesitant and reluctant to get what you're looking for today. And so, we're going to look at your thoughts and your feelings, Caroline, and ask you some questions. We want to know, we want to think a little bit about what are your maybe feelings and thoughts show about you that are actually really beautiful and awesome and how they're an expression of your value system and how some of these thoughts and feelings also might be benefiting you and working for you and helping you.

 

Dr. David Burns: And so we could start on a thought or a feeling like I'm not lovable or feeling down or feeling bad or feeling worthless or inadequate. We could take any thought or feeling and start start there. I mean one of your strong feelings is inferior, worthless, inadequate and incompetent. And of any thought or feeling we could ask two or three questions. One would be why is this thought or feeling quite appropriate? Secondly is how does this thought or feeling help you? What are some advantages or benefits of it? And then the third would be what does this thought or feeling show about you and your core values as a human being? That's beautiful, positive or even awesome. And we could start out with a with an easy one. You when you walked in that meeting you were feeling 100% worthless and inadequate and competent and inferior. What can you and you can write on a piece of paper too while we're doing this so we come up with a list of positives. Can you see some positives in those feelings? Although those feelings are pretty feel pretty yucky and awful, but what are some beautiful things that show about you that you're feeling that way?

 

Caroline: That this is important that I want to do good work. Helps me like go and do the research to get myself better, to get the skills to help me be confident. So it's just a striving piece really.

 

Dr. David Burns: So that's one thing that the feeling of inadequacy does. It shows you that your work is important and helps you do the research and does it show as well that you have high standards?

 

Caroline: Very much so. Yeah.

 

Dr. David Burns: And have those high standards been helpful to you? Have they motivated you?

 

Caroline: Yes.

 

Dr. David Burns: And what else do those thoughts show about you, Caroline, that's beautiful, positive, or awesome? You walk into a research meeting at a top university where you're, considered a star. And you're feeling worthless.

 

Caroline: I'm not sure about that other than just wanting to do well, right? And taking yeah, just wanting to do well and wanting to support and wanting to contribute, do do meaningful work. I guess that would be

 

Dr. David Burns: Is that important? Wanting to contribute and do meaningful work?

 

Caroline: Yeah.

 

Jill Levitt: David, is it possible? Do we think or Caroline, I could ask you that maybe feeling worthless and inadequate and incompetent despite having lots of accomplishments shows a sense of humility? Does it show a humbleness?

 

Dr. David Burns: Let's add that. Yeah.

 

Jill Levitt: Does that feel right, Caroline? You're not someone who's feeling all braggy and better than others. Kind of to the contrary, your feeling inferior and adequate shows something really beautiful about you that despite lots of accomplishments, you're still wanting to be even better.

 

Caroline: Yes, I would say I would agree with that.

 

Dr. David Burns: Is that true of you?

 

Caroline: Yeah. My husband says to a fault that I just, yeah.

 

Dr. David Burns: And is that important to be humble?

 

Caroline: Absolutely it is.

 

Dr. David Burns: Is it powerful?

 

Caroline: I don't know if it Well, maybe in our work. I don't know if it's powerful. I've never thought of it that way.

 

Dr. David Burns: Anyway, it's certainly a positive. Does it show in any way your respect for others?

 

Caroline: Oh, absolutely. I mean, it is I guess I mean, it's so important in the work that we do too to be able to connect, right? And to.

 

Dr. David Burns: Add that to the list. Does it show also and again we're just taking one feeling from a list of six or eight feelings and at least a dozen 10 at least 10 powerful negative thoughts. Can you think of what else this feeling of inferiority, worthlessness, inadequacy and incompetency shows about you that's positive and awesome or that's beneficial or that's appropriate?

 

Caroline: No, I just keep coming back to just always wanting to well I guess in different words just pushing and growing. Just knowing that there's always room to grow like I love. Part of the journey. Yes.

 

Dr. David Burns: Yes. And that would also be being accountable and honest, right? That I don't know all the answers.

 

Caroline: Yeah.

 

Jill Levitt: Yeah. I love that. So it motivates me to learn and grow and keeps me accountable.

 

Caroline: Yeah.

 

Dr. David Burns: Okay. That was that was my choice. Why don't you choose a feeling or a thought and we'll we'll see if there's some positives hiding in that one.

 

Caroline: Well, that's the one I was going to choose. So.

 

Dr. David Burns: Okay.

 

Caroline: I think well the thought I mean needing to be perfect that kind of goes hand in hand. But that's the other big one I would say out of all of these that.

 

Jill Levitt: Oh yeah. I need to. I need to be perfect. Right. So we can say without How is that thought serving you? Well, how is that working for you? And then what does it show about you that's kind of beautiful and awesome?

 

Caroline: Probably the same just like high standards, striving to be I want to do good work that helps other people. I mean.

 

Jill Levitt: So also other people, right? Like I care about serving others.

 

Caroline: Yeah.

 

Jill Levitt: And you said high standards keeps me striving.

 

Caroline: So it's very similar to the feeling.

 

Jill Levitt: What about I have one that we could do that I think will have a little different flavor to it if we were to think about unlocked. You know, you're in this research meeting and you're maybe worrying about others judging you or not fitting in. And not having anything important to contribute. And so this feeling like I'm unwanted. I know it's such a terrible crappy feeling to have, but what does it show about you and your value system? And how does telling yourself or feeling unwanted, how does that actually help you?

 

Dr. David Burns: And what does it show about you that's beautiful and awesome?

 

Caroline: I think David to your question is that relationships are important. Those connections and collaborations like whatever that looks like. I would say that.

 

Dr. David Burns: Let's let's add that.

 

Caroline: Yeah.

 

Dr. David Burns: Relationships re important and and collaborations, is that true?

 

Caroline: Yeah.

 

Dr. David Burns: Is is that powerful?

 

Caroline: Yes.

 

Dr. David Burns: And what's my third question? I can't remember it now. Is it true? Is it powerful? Is it?

 

Caroline: A value that shows about me?

 

Dr. David Burns: Yeah. Well, shows that you value relationships greatly.

 

Jill Levitt: And and and also though like can we think about the other piece of the positive reframing? So when you feel unwanted, what does it do for you? What is that feeling as shitty as it is? How is it working for you? How is it serving you?

 

Caroline: Well in this case I mean I don't know if it is serving.

 

Jill Levitt: So I wonder Caroline whether this is that I'll reject them before they reject me kind of thing. Like if I tell myself I'm unwanted and somehow as bad as it feels protecting myself.

 

Dr. David Burns: Does it protect me from from speaking and getting judged?

 

Caroline: Yeah, that's what I would. Yeah. I think that there is a protection piece and if I can't protect myself, then it's going above and beyond to show my worth in other ways.

 

Jill Levitt: Yeah.

 

Caroline: Or to be appeasing, you know. So, yeah, I think there's a huge protective role there for sure.

 

Jill Levitt: Yeah.

 

Dr. David Burns: And and also a motivational thing too to do something really great so they'll want me.

 

Caroline: Yeah.

 

Jill Levitt: Right. If I'm feeling unwanted Yeah. It kind of motivates me to strive again. Right. And perform and do things that warrant being wanted.

 

Caroline: Or running away to make myself feel comfortable. I mean, there's a different protective factor, but then there's really that comes with that, right?

 

Jill Levitt: Oh, I love how I'm wrong. I tell myself I'm unwanted, maybe I'll retract or pull away. And I could see that in social situations, too, right? And then I'll protect myself by just withdrawing.

 

Caroline: Yeah

 

Jill Levitt: Totally. And David, do you do more positive reframing or should we?

 

Dr. David Burns: Well, let's let see if there's one one more that because we we we could do this all day long, but we have to limit it somewhat. But was there another thought or feeling that you'd like to do positive reframing for?

 

Caroline: I don't think so. I think that that's.

 

Dr. David Burns: You kind of got it.

 

Caroline: Yeah, I think we've got that.

 

Dr. David Burns: And so so there's some some value to these negative thoughts and feelings. And so let's look at the daily mood log again, which all of you should have. Have in your handout packet and there's a goal column next to the feelings and you you're you were well did did we find some value and feeling down Caroline?

 

Caroline: Yes.

 

Dr. David Burns: And what's the big value there?

 

Caroline: The biggest one was protective helps me strive. Is that what you mean?

 

Dr. David Burns: Yeah. We didn't do that one specifically, but can you think of some additional values and and feeling down? How that?

 

Caroline: Oh, for feeling down. Yeah. Well, I mean this is my logical psychology brain. We need to have sadness so we can withdraw and process emotions so that we can come back, you know, like to to be able to move forward. So I think just the the processing to move forward to know what it is that we want as well.

 

Jill Levitt: I think it also just if we just think from a values perspective, feeling down when you don't know as much as others in a meeting kind of just shows your high standards and how important it is to you to do well and be successful and contribute meaningfully. Yeah. And I think to be honest like when I look at down and even you know on one of the other forms I had crossed out like I'm not depressed but I'm exhausted. So being down too. I think it's just telling me I need a break. Like physically I need to have a break. So I think there's that piece too.

 

Dr. David Burns: I love that. Another thing that I wonder about you do a lot of work with families and children although you haven't mentioned it. But I'm wondering if that feeling down gives you extra compassion in your clinical work and in your research that wanting to bring relief and joy to other people.

 

Caroline: Yeah. That's true.

 

Dr. David Burns: Is that true?

 

Caroline: It is. Yeah.

 

Dr. David Burns: Yeah. So, there's a lot of value in in being down also and and so with that in mind and all of these these positives if you press the magic button then all all these values are going to disappear along with these negative thoughts and feelings. Are you sure that's something you you want to do or how do you feel about that right now?

 

Caroline: Well, no, I don't want to lose those pieces at all.

 

Dr. David Burns: So So what what then might be a goal for feeling down when you walk into a research meeting? How how down would you want to feel at at the end of our work today? If you could have a magic dial and dial it down to any level, what what would make sense to you?

 

Caroline: Probably 10 to 20.

 

Dr. David Burns: Okay. Put in the percent goal. If you have your daily mood log there, I printed mine, so I just wrote it in 10 to 20. Or you could just make a list your yourself so we remember that estimate. And you said you feel bad 60. How how bad would you want to feel?

 

Caroline: Probably 10.

 

Dr. David Burns: 10. Okay. And then how inferior, worthless, inadequate, and incompetent? That was that was a hundred.

 

Caroline: Yeah, probably 20.

 

Dr. David Burns: 20. Okay. Is that enough worthlessness?

 

Caroline: I think so.

 

Dr. David Burns: Okay. How unwanted would you like to feel?

 

Caroline: Probably 20.

 

Dr. David Burns: 20. Okay. And then how how foolish and self-conscious? That was also 100.

 

Caroline: Maybe 30. Okay. And then how discouraged that but by the way what what are we didn't mention the benefits of discouragement. What are some benefits of being 80% discouraged?

 

Caroline: I think very similar to the other ones just like problem solving figuring out like it will help me figure out what it is that I need to do so that I'm not stuck.

 

Dr. David Burns: Sure.

 

Caroline: The adaptive piece of it.

 

Dr. David Burns: How about other thing that it can can help protect you from disappointment?

 

Caroline: Yeah. For sure.

 

Dr. David Burns: And you've had a lot of disappointment in your life.

 

Caroline: Yeah.

 

Dr. David Burns: So 60 or no, you were 80% discouraged in that meeting. What would be an ideal if we could dial the discouragement down? What would you like it to dial down to?

 

Caroline: I would say 10.

 

Dr. David Burns: 10. And then let's put other. Let's put the word tired and exhausted as as another emotion cuz you had that on on the brief mood survey. And and earlier on how tired and exhausted were were you feeling?

 

Caroline: Oh, 100.

 

Dr. David Burns: 100. And then what would be a a healthy level of tired and exhausted? Because You said it's kind of a good thing. It tells you that you deserve and need a break.

 

Caroline: Yeah. I would say probably 20 for that one as well.

 

Dr. David Burns: 20. Great. Okay. Now, Jill, are you are we ready to dive in, Jill?

 

Jill Levitt: Yeah. So, I'll just make a quick teaching point again then just so people are following along. You know, we did testing, we did empathy, and then we said we were segueing to what we call agenda setting. And that's where we were just doing positive reframing with Caroline, right? And so we were looking at what do all of her thoughts and feelings show about her that are beautiful and awesome because they really are an expression of your value system and how they might be serving Caroline well, in terms of protection and a variety of other sort of benefits of your negative feelings and thoughts. And in doing that, in part, we're just deeply empathizing with Caroline. There are total benefits and beautiful things about her symptoms and then we're also in a way, reducing resistance because we're kind of saying we're not trying to help you against your will. Like hang on to these things as much as you'd like and then we're really asking in a collaborative way that goal column, that magic dial that David asked is like how bad would you want to feel? You know, what's kind of the ideal level of embarrassment to kind of keep you on your toes, but you know, or foolishness, self-consciousness. So, we kind of came up with the goals or Caroline came up with the goals of like your true goal, right? You come into therapy saying, "I want all this to be gone." But in truth, you want to hang on to some of these values while also reducing a lot of the distress and like intensely sort of self-critical nature. So, now that we've done that with Caroline, we're going to move on to methods. And so, David, yeah, I think we're ready to move on to methods. That makes sense to me.

 

Dr. David Burns: Great. And, also just another tiny little teaching point that might or might not make sense to people, but we're in what we're doing now. We're focusing on what Caroline brings us at this at at this moment. There was a lot of memories of childhood and things like that that one could could explore for, arguably a long time, weeks or months or or conceivably years, but we have everything that we need. It's here now. The problem is with us and the these are the thoughts and feelings. And that's our our focus. So we have the these two extra well there were three extra thoughts. One of them was that the about how the people in the audience are feeling. I I wrote that one down some somewhere. I can't find it now.

 

Jill Levitt: Yeah. She how could she be an expert when she feels this way? That one like?

 

Dr. David Burns: Yeah. Right. Well, is that the one? I'm not important enough to need help.

 

Jill Levitt: Oh, we got that. I'm not lovable. I'm not important enough to need help.

 

Dr. David Burns: Yeah. So, we've got those plus the eight on your daily mood log. And is there one of these that you'd like to focus on first, Caroline? I think the need to be perfect because just knowing like if I can working towards the contentment without having to do all of the things that's going to be big.

 

Dr. David Burns: Now let let's take that on page five of the handout thought number six I need to be perfect and what are some of the distortions in that thought? You can see the check of list of cognitive distortions on page five right right under the the negative thoughts.

 

Caroline: Well, the biggest one is the shoulds like for me it's the sitting all over myself. All or nothing for sure.

 

Dr. David Burns: So all or nothing. And then you said did you say? Discounting the positive or metal filter? You said something else I didn't quite get.

 

Jill Levitt: She said should statement.

 

Dr. David Burns: Oh should. Oh yeah, a should. Should an all or nothing. No, that that's great. What else is it?

 

Caroline: I think I mean I do minimize that comes with that.

 

Dr. David Burns: Yeah, great. And what else? What other distortions?

 

Caroline: I think there's mental filter that goes in there with it.

 

Dr. David Burns: Absolutely. And when you say it's a metal filter, What what do you mean exactly? Teach us what that means.

 

Caroline: Well, I mean both the mental filter and the discounting positive both like it's just I'll do a presentation and I'll get a thousand positive, good surveys and one where one person and that's the one I focus on. I think.

 

Dr. David Burns: Oh, yeah.

 

Caroline: That negativity bias, right?

 

Jill Levitt: So bias that a problem though? Why is that why is that a distortion? Why is that, you know, that's just a statement of fact? So why is, you know, mental filter a problem?

 

Caroline: Well, because I then beat myself up and don't see the good work and the helpful work that I've done and so, and I guess there's an overgeneralization there too then, right? Because this one instance, the whole workshop sucked or the whole.

 

Dr. David Burns: Yeah.

 

Caroline: All of my contributions sucked. So, they go hand in hand, don't they? They really work together.

 

Dr. David Burns: Oh, yeah. Oh, they they absolutely do.

 

Jill Levitt: Not seeing the positives. I'm not able to take in the positives. I only focus on that one negative piece, right?

 

Caroline: Yeah.

 

Dr. David Burns: Yeah. And would I found a couple more possible distortions I could mention. You may you may see them. Already. You see any other distortions, Caroline?

 

Caroline: Jumping to conclusions like because I put, you know, with the need to be perfect, I need to be perfect to be taken seriously.

 

Dr. David Burns: Yeah. So, that would be both mind reading and fortuntelling, right?

 

Caroline: Yeah.

 

Dr. David Burns: Oh, that I I love that. Yeah. And then the the two I was thinking about, you kind of mentioned it but didn't mention it as a distortion, self-blame. Beating up on yourself.

 

Caroline: Yeah.

 

Dr. David Burns: And and then and then would emotional reasoning be a part of this be a distortion?

 

Caroline: Emotional reasoning and labeling even.

 

Dr. David Burns: Yeah.

 

Jill Levitt: About why that is. How how is this labeling and and how is labeling a problem?

 

Caroline: Well, and I see this because it rubs off on my children. Just the other day, I was baking with my daughter and I left something in the oven too long. I'm like, I'm so dumb because I made a mistake, right? Because I made a mistake. It wasn't perfect. Therefore, I'm dumb. Rather than saying, "Ooh, I left it in a little too long." You know?

 

Dr. David Burns: Absolutely. Yeah. Right. I love I love what you're saying focusing on yourself, this imaginary self. Rather than the the behavior and and the error. And so you want to just jump into externalization of voices, Jill, or?

 

Jill Levitt: Yeah, we could certainly try it. Yeah. So essentially what we'd say here is there's lots of methods we could use for this particular thought and again we're getting really specific It's kind of an hourglass here, right? So many things that you shared with us. We picked this moment in time and now we're even just getting super specific and picking this one negative thought. So, yeah, we should we should we try externalization of voices on this negative thought?

 

Dr. David Burns: Yes, absolutely. If it's an aggressive technique, do you want to use an aggressive technique or more of a gentle technique or what?

 

Caroline: That's the one to be honest, my heart just all of a sudden went I don't know. We can try it. I'm not sure if I'm strong enough for that one then, but we can try it. I don't know why I'm emotional all of a sudden.

 

Dr. David Burns: You're feeling a lot of emotion right now.

 

Caroline: Yeah. I'm scared of I don't know if I can do it. Externalization avoidance.

 

Dr. David Burns: Oh, and would then that make you less perfect?

 

Caroline: I'm just no, it's not that I I'm just worried that I will believe it.

 

Jill Levitt: The negative thoughts. Or the the positive thoughts.

 

Caroline: No, no, the the negative thoughts.

 

Jill Levitt: Or that work for you.

 

Caroline: Maybe something gentler to start with.

 

Dr. David Burns: Something gentler. Sure. Standard technique. But yeah. Yeah, sure. What you want to set up the double standard technique, Jill?

 

Jill Levitt: Sure. And in fact, Caroline, I just want to say I was thinking about I was actually thinking that the three sequence of three the double the double standard technique externalization of voices and ultimately maybe even the theory of fantasy would be great.

 

Caroline: I think that yeah that that would be good. I think just to start off yeah with double standard might be good.

 

Jill Levitt: Yeah absolutely and I appreciate your transparency you know like this is a team effort here not just today with you but always with our patients right wanting to think together about kind of where they're at and what might feel good. So sure let's try the double standard technique. So, Caroline, this is a, really harsh and critical, right? Judgmental thought that you're having about yourself. I need to be perfect. And so, let's try this method. And in this method, it's a roleplay technique. And so, you actually get to be yourself. So, you can be Caroline. And I'm going to be a dear friend of yours in this role play who's also a clone of yours. So, I want you to picture someone that you really care about and you really love and you feel compassion for. But in fact, I'm just like you. So, I grew up in the same family and circumstances that you grew up in. I'm also a successful clinical psychologist. And I'm sitting in this research meeting realizing that I'm a little bit in over my head. I have so many really great accomplishments to feel so proud of, but I'm also not knowing all of the research methodology and some of the things that people are talking about and I haven't quite gotten my research off the ground and so I'm sitting here. I'm wondering if I could talk to you about my thoughts right now and if you'd be willing to to think with them think with me about them. Would that be okay?

 

Caroline: Yes, of course.

 

Jill Levitt: Yeah. So, remember you're yourself and I'm this dear friend who's also a clone of yours and and Caroline, you know, I've done a lot of of great things in my career and even in my life, but I'm definitely not a top researcher at this moment in time and I'm just telling myself this is really terrible because I need to be perfect in everything all the time. Do you think that's true? That I need to be perfect?

 

Caroline: Oh, I'm so happy you asked the question cuz I'm like it's going to be so hard not to empathize. No, that's not true at all.

 

Jill Levitt: What do you mean? How is that not true? That's isn't that just kind of the truth of the universe? I do need to be perfect at all things all the time.

 

Caroline: No, because it's unrealistic. I mean, we're humans. We are all imperfect. Nature is imperfect. If we were perfect, we would become stale. Well, not stale. We would just stall out. We wouldn't keep growing. We wouldn't keep living, right? We would just went on autopilot and then depression really at the end of the day cuz there's nothing else to learn from and to yeah.

 

Dr. David Burns: And and how how strongly do you believe what you're saying right now?

 

Caroline: 100%.

 

Dr. David Burns: Would you write that in the positive thought column? I I jotted it down and you can if if you have it printed out there or if you can if you're working on a piece of paper, it would help, but you said it's not true at all. It's not realistic. We're all imperfect and we need our imperfections to grow and learn. And I I think that's approximately what you said.

 

Caroline: Yeah.

 

Dr. David Burns: You believe that 100%.

 

Caroline: I do.

 

Dr. David Burns: And should we cross-examine her?

 

Jill Levitt: Yeah, that's Yeah, absolutely. But but you can you can jump in. We can David's now going to be your dear friend clone and take over for me. Go for it, David.

 

Dr. David Burns: Okay. Yeah, I'm I'm also a clone of yours. Yeah, I love what you're saying. It's making me feel a little better, but I'm I'm still worried that maybe I need to be need need to be perfect. Are you saying I don't need to be perfect? Is that what you said?

 

Caroline: No, not at all. Being perfect is what's going to disconnect you from other people. It's going to well, like I said, stall you out in life, in any part of your life, and it'll make life miserable for you to always strive for this impossible way of being.

 

Dr. David Burns: Oh, is that true what you're telling me?

 

Caroline: It is. Yeah.

 

Dr. David Burns: Between zero and 100. How true is it? Because I don't want to buy some false currency here.

 

Caroline: 100%.

 

Dr. David Burns: Okay. Would I love what you said could would you say it again and so we can write it down?

 

Caroline: Oh man, my working memory.

 

Jill Levitt: I wrote it down.

 

Dr. David Burns: What was it?

 

Jill Levitt: Yeah. Being because it was I love the addition here. Being perfect will disconnect you from others. So you'll write it in the first person, but being perfect would disconnect me from others make my life miserable because I'd always be striving for an impossible way of being.

 

Dr. David Burns: Yeah.

 

Jill Levitt: I don't need to be perfect because being perfect would disconnect me from others, make life miserable, And always be striving for an impossible way of being.

 

Dr. David Burns: And and then the percent belief in that you said was also 100.

 

Caroline: Yeah.

 

Dr. David Burns: And now let as soon as you're done writing that down, then I have a question for you. Okay. Yes. Now, how much do you believe I need to be perfect?

 

Caroline: I still believe it. Probably 80%.

 

Dr. David Burns: So you believe 80% you can put a line in through the 100 and put an 80. You believe that 80% and you believe 100% that that's not true at all. So at the same time, you believe it's true 80% and you believe it's not true 100% simultaneously if I'm if I've got you right.

 

Caroline: Yeah, I think so.

 

Dr. David Burns: So I'm wondering if we have have an agenda setting issue here, Jill.

 

Caroline: Well, no. It's just a ya butts but like it's just my ya butts coming up.

 

Jill Levitt: Let's ya butts but you tell me. Give me a good ya butts here ya butts what? How can I yab? I'm going to ya buttsyou in my double standard technique. I think cross-examine enough. Give me some butts.

 

Caroline: No, I guess I don't need to be perfect. I guess I I guess the ya butts is.

 

Dr. David Burns: My high standards are are help or help are important and helpful to me. Is that the ya butts?

 

Caroline: Well, yeah. And and like but then people would know the real me.

 

Jill Levitt:: So.

 

Caroline: And then I wouldn't be important and then I'd be unlovable and all that.

 

Jill Levitt: Yeah. So, can I if I could jump back back into the role play for a minute and then David if you want to go a different direction that's okay. I just um yeah I just want to remind you who I am Caroline. I'm a dear friend of yours who you really care about and love and and I'm also a clone of yours right so I am exactly like you and you were telling me that you think I don't need to be perfect because being perfect might cause disconnection and it would keep me from learning and growing and and lead to depression. But I don't know if that's really true, Caroline. I'm thinking I do need to be perfect in order to get the love of others, in order for others to like me and love me and and see me as important and and worthwhile. Don't you think I'm not good enough as I am right now? I actually really need to be perfect in all ways at all times to gain kind of love and care from others in.

 

Dr. David Burns: Including the people in this research room that I'm in. I need to be perfect for them to like me and love me, right?

 

Caroline: Well, no, because I mean you'll just you're going to alienate them if you're perfect. No one else will ever feel good enough. You're not going to be approachable. You'll be narcissistic. You're going to push other people away with that perfectionism.

 

Dr. David Burns: Would you write that down?

 

Jill Levitt: But I was just going to push you a little more here. Yeah. But I but again I So what you're saying is helpful. You're saying no, if I keep trying to be perfect, it'll actually alienate people and then I'll be unapproachable. Kind of like no one likes the person in the room who's perfect and totally has it all together. Do you really think that's true? Like is is that is that really true or are you just like trying to make me feel better?

 

Caroline: No, that's definitely true cuz other people will I mean it's natural for us to compare. It'll be very you'll be standoffish or you won't be standoffish but other people will be intimidated and won't want to.

 

Jill Levitt: But I'm afraid, Caroline, I'm afraid that if I if I stopped trying to be so perfect and people saw me just as I am right now, that they wouldn't love me and that I need to be perfect for people.

 

Caroline: Well, then that's their problem. They got something else going on on their side of things.

 

Dr. David Burns: Okay. So, I wrote down. If I try to be perfect, I'm perfect. I'll be narcissistic and push others away. This will alienate people and people will be intimidated. Is that what you said?

 

Caroline: Yeah.

 

Dr. David Burns: And how much do you believe that? Between zero and 100.

 

Caroline: 100.

 

Dr. David Burns: Put 100%. And so now, how much do you believe I need to be perfect for people to love me?

 

Caroline: I don't.

 

Dr. David Burns: Okay. So, what's the what's the numerical value on that one now?

 

Caroline: Maybe a 10.

 

Dr. David Burns: A 10. Great.

 

Jill Levitt: Can you say something about that, Caroline? What's that feeling like for you right now?

 

Caroline: I almost feel like I've just lost a piece of myself.

 

Dr. David Burns: Yeah, you did. How does that feel?

 

Caroline: Scary maybe.

 

Dr. David Burns: See, a little anxiety finally after we've been denying that pretty strongly. And what are you afraid of right now?

 

Caroline: I don't know. Maybe just that I won't be successful without it.

 

Dr. David Burns: And then how are we going to feel about you if you're not successful?

 

Caroline: Nobody cares.

 

Dr. David Burns: How strongly do you believe that?

 

Caroline: Yeah, I 100%.

 

Dr. David Burns: Well, I love I love what you're doing. Do you want to go further down this path we're on right now?

 

Caroline: Sure.

 

Jill Levitt: What were you suggesting, David? I lost the thread of what where you were going.

 

Dr. David Burns: Well, I'm not sure where we should should go, but I I think externalization of voices is always a great follow on.

 

Jill Levitt: Yeah. How would that be okay then? What we we just offered you the double standard technique.

 

Dr. David Burns: And then feared fantasy and then the experimental technique.

 

Jill Levitt: Yeah. I love all of it. So, Caroline, you were you were at a place now where you were realizing saying, "I don't need to be perfect in order to be loved for people to love me." And that had dropped lower. But let's let's hit you maybe we can hit you with that same thought again in externalization of voices to kind of seal the deal. And then we can also kind of just go down and and throw some more thoughts at you and see how you do. And so when we set up this method, just to remind you and others in the audience, we're going to do a role playing technique again, but we're switching roles. So if people are confused, we're setting aside the double standard. And now Caroline, we're going to be both going to be parts of you, Caroline. So David and I probably will take turns being negative Caroline. Kind of voicing your negative thoughts to you in the you version. And you're going to be kind of positive, rational. I like to call it rational Caroline. You're going to not bs us, but you're going to respond. You're going to try to argue against these thoughts and put us in our place. And you can do that sometimes using some self-defense, you know, poking holes in what we're saying. Sometimes using some self-acceptance and you know accepting with humor and humility some parts of these negative thoughts and sometimes we use what we call the counterattack technique which is when you kind of argue against the thought just because it's such a bully kind of thought and you can be a little fierce and feisty when you use the counterattack technique and of course I don't expect well I don't expect you to be perfect in this role play and I expect that there might be sometimes you get a little stuck or frozen and then David and I are going to offer you a role reversal. We could kind of just keep switching roles until we can really crush like all of these negative thoughts together. And so are you willing to give that a try?

 

Caroline: Yeah.

 

Dr. David Burns: And who are what's your name? Caroline.

 

Caroline: Oh Carol Caroline.

 

Dr. David Burns: What's my name?

 

Caroline: Caroline.

 

Dr. David Burns: And what's Jill's name?

 

Caroline: Caroline.

 

Dr. David Burns: Okay. Right. So you want to start it off, Jill?

 

Jill Levitt: Sure. Yeah. Caroline, we were just talking about this thought before and I just want to then remind you I'm over here being kind of your negative voice. So, Caroline, you need to be perfect in order for people to love you.

 

Caroline: Well, that's just unreasonable. Unreasonable because it's impossible for anyone to be perfect.

 

Jill Levitt: And who won that? You or me? Negative or positive?

 

Caroline: Positive.

 

Jill Levitt: And was that small? A small win or a big win?

 

Caroline: Small.

 

Jill Levitt: Yeah. Okay. And did you want to try that again or do you want to try a ro reversal? And also I could remind you that any or all of what you brought up in the double standard technique would be ammunition in the externalization of voices technique if you'd like to give it another try or else either of us can roll reverse with you.

 

Caroline: Yeah, I can try again.

 

Dr. David Burns: Okay, I'll attack you. I'm a bit more considerably more brutal than Jill. And could I talk to you for a minute, Caroline?

 

Caroline: Yeah.

 

Dr. David Burns: I I know you were doing all that phony baloney double standard stuff with Dr. Jill, but I'm that voice in your head and I want you to know that was all bull. Because you know it's a fact of the universe and you've known it since you were a little girl that you need to be perfect in order to have people love you. And that's what you want to be is loved and accepted. And that's your ticket to love and acceptance. And you know it.

 

Caroline: Well, perfectionism just pushes people away. Makes you more unlovable when you're being when you're perfect because nobody can relate to you. And then they're self-doubting and they can't be themselves. And so they're more likely to push you away and be disconnected.

 

Dr. David Burns: Who won that?

 

Caroline: I did.

 

Dr. David Burns: Big or small?

 

Caroline: Medium.

 

Dr. David Burns: Medium. Okay, good. So, you're getting a little bigger. Do you want to try a role reversal?

 

Caroline: Sure.

 

Dr. David Burns: And you want to you can attack the Jill or David? We'll now be the positive Caroline, you'll be the negative.

 

Caroline: Okay. Well, whoever wants to go, but I don't even know what to say. You have to be perfect for people to love you and for people to know. I like yeah. I don't know what else to say.

 

Dr. David Burns: There's a lot of truth in what you're saying, but there's only one problem with that.

 

Caroline: What's that?

 

Dr. David Burns: It's just a lot of horseshit. It's is what it is be because people can admire my accomplishments and I appreciate that. But I don't need to be impressing people to have people love me. I need to be showing love for other people to have them love me and trust in other people and share my humanity. That's the way I can find what I'm what I'm looking for. But you know my my I do have a big flaw.

 

Caroline: What's that?

 

Dr. David Burns: It's not the fact that I'm not perfect. That's not my flaw. My flaw is listening to you kind of beating up on me constantly. That's the that that's the problem. I I need you to to either shut up or give me some love.

 

Jill Levitt: And who will not exchange the negative which was Caroline or the positive which was David?

 

Caroline: David.

 

Jill Levitt: And how did David win?

 

Caroline: The humanity please speak

 

Caroline: That I don't need to be impressive but I just need to be interested and caring and loving toward others and share my humanity.

 

Caroline: Yeah.

 

Dr. David Burns: And if I do that that'll be like a a super accelerator on my accomplishments. People say, "Oh my god, I can't believe that this wonderful person is helping me." They say, "I I love that Caroline. She's so such a lovely, loving person. She's the best."

 

Caroline: And the horseshit piece. I don't know why that triggered me, but that was like.

 

Jill Levitt: I think I know why, Caroline. You started to cry when David said, "I don't need to listen to your bull shit and I don't need you to keep beating up on me constantly. What I actually need is a little bit of love." And that was him talking. That was you talking to you, right? That was you saying, "Caroline, I don't need you to be so mean and hurtful to me. Caroline, I actually just need you to give me a little bit of love." And I wonder if that concept of like letting go of being so harsh and critical and judgmental and just giving yourself a little love.

 

Caroline: Yeah.

 

Dr. David Burns: You want to try it? See if you can do it.

 

Caroline: I don't think I could be as eloquent as you, but I will try it.

 

Dr. David Burns: Yeah. Well, if if you're not, then then I'm more perfect and I'll gloat about that considerably.

 

Jill Levitt: I was going to say, don't worry, but we'll just look down on you and judge you and reject you. You're not as good as David.

 

Dr. David Burns: But, Caroline, I know David was throwing a lot of bull shit at you and psycho babble, but let's not forget the basic facts of the universe. It's unfortunate but true that you have to be perfect to get people to to love you, and that's just the way it is.

 

Caroline: Oh, I want to swear. It's hard for me to swear, but I'm going to. You're such an asshole. Like you, it's not anybody else. It's you who's beating up on yourself all the time has nothing to do with anybody else and and like you're starting you got to get a new story because it's just the same shit that you're throwing out all of the time and it's disrupting everything good in your life. So, you just got to back off and stop.

 

Dr. David Burns: Who won?

 

Caroline: I think I did.

 

Dr. David Burns: Big or small?

 

Caroline: I think that was big.

 

Dr. David Burns: Big or huge?

 

Caroline: Rationally I think it's huge, but I still like just the screaming right here right now is just like doesn't want to let go. But no, it it was huge.

 

Dr. David Burns: It was huge. And what was huge what was huge about it once again because we want both emotional and intellectual change that they they need each need each other. So what intellectually what made it huge?

 

Caroline: The realization that it really is just me, right? Or it's well I call them the henchmen, right? Like that that negative thought, the henchmen that just wants to like. Put a stop to all the good things. And so it really is just my own it's my own selflove. That I need to work on, right?

 

Dr. David Burns: Okay, now that we're on the edge of enlightenment, can we keep doing externalization of voices and hit some of your other negative thoughts, too, and see if you can blow them away as as well as you did that one? Well, you you beat me on that other one, Caroline, that that perfect stuff. But but here's something you cannot defeat, and that's another fact that what what you have to say isn't important, Caroline.

 

Caroline: Well then why would people come and see me in my workshops and come into the clinic and see me and invite me to research meetings and and and and like it's just another bull shit story because clearly people want to hear me and and in your own personal life that's on you because you just don't go out so nobody has the opportunity to hear you talk. So again, it's just you being the big barrier in your way.

 

Dr. David Burns: Well, okay, you got me on that one, but there here's one that you're not going to get me on, and and you and I both know this is true, Caroline, and that and that's that you're not lovable.

 

Caroline: Well, I know for sure. I mean, I have two amazing girls. Who I know love me with all their hearts. Teenagers who still want to come home and see their mama at the end of the day, who still debrief with me at the end of the day. They're not. Isn't that awesome?

 

Dr. David Burns: Just as an aside, isn't that cool?

 

Caroline: Yeah that is cuz I work with a lot of teenagers and the last person they want to talk to is their parents. So yeah, like I'm still the one I'll be the first one that they text and so no, like I know that I am and I have a husband usband who's been with me for 30 years and who's seen me do all of the stuff that I do. He sees me do my gore. He knows who I am and still is here and loves me. And I have three ridiculous dogs who love me more than anything in the world.

 

Dr. David Burns: Who's the one that taught me about love? You know this one?

 

Jill Levitt: Obie, your cat.'

 

Dr. David Burns: Yes. That's right.

 

Jill Levitt: And who’s winning now, Caroline, was that was that you that positive, Caroline, or David?

 

Caroline: Positive.

 

Jill Levitt: Was that big or small?

 

Caroline: That was big.

 

Dr. David Burns: And big or huge?

 

Caroline: Huge.

 

Dr. David Burns: Awesome. You want to do a quick round of feared fantasy, Jill?

 

Jill Levitt: Yeah. Well, so I could I ask you, Caroline, is there anything else on this list? Any other negative thoughts that you think we need to bless us to make sure we hit you with right now? Or?

 

Caroline: No, I think those are the two biggest ones that.

 

Dr. David Burns: Yeah. Okay.

 

Jill Levitt: And just for the sake of for the sake of you and like really feeling the deal and for everyone to get to see, we did a double standard technique which is kind of kind and compassionate, the externalization of voices that was a little more adversarial and powerful. And then we can hopefully kind of seal the deal with what's called the feared fantasy technique, which is even more aggressive. And did you want to set it up, David?

 

Dr. David Burns: Yeah, that we're going to go to the research meeting from hell. And in this research meeting, there's two weird rules. Number one, that if you think people are judging you, they really are. And they not only think bad things about you, they get up in your face and say them to you. And What what do you imagine people would be thinking about you? Do you do you ever think about how they're going to judge you and you're not smart enough or you're stupid or whatever?

 

Caroline: I don't know what they would actually just like that I'm a joke. Well, actually I was teaching an ethics class and they were like she is not a professor. She is maybe great in clinical work but she cannot be so, I've actually had that happen, right? Just because I'm like I had brought in like Yoda songs and yeah, I am a bit of a jokester. And so, I think that they would just say you're too much of a jokester. You can't be taken seriously. I think the most the biggest thing would be if they said you have nothing to contribute and you can't make you can't help people cuz my whole mission is to like inspire, right? To inspire people to live their best life and and how can we change the world to make it a place where we can be confident and resilient and you know so I think if they said that you have no place you know to help people and that would be.

 

Dr. David Burns: Okay then we're in the the research meeting from hell and could I speak with you for a minute Caroline?

 

Caroline: Yeah.

 

Dr. David Burns: I've been observing you and your research for some time and you know and your your talks that you give and all that that BS but I just want to tell you that in my opinion you can't you can't help people because you have nothing to contribute.

 

Caroline: Well I know I have already helped a lot of people and you know I even if I never did my research I know I'm helping people there's other things that I can be doing I don't need to do this is garbage anyways because it's going to take 17 years to actually get out to the real world to help people anyways. So, I would rather just go out there and do what we already know is helpful rather than sit around and.

 

Dr. David Burns: Who who won that?

 

Caroline: I did.

 

Dr. David Burns: Big or small?

 

Caroline: Big.

 

Dr. David Burns: Big or huge?

 

Caroline: Huge.

 

Dr. David Burns: Huge. Is there anything we can hit you with and and maybe we have time to do a quick experimental technique. Jill,

 

Jill Levitt: Anything else you want us to hit you with in feared fantasy?

 

Dr. David Burns: Like you're not a real professor. You're just a jokester.

 

Caroline: And then like maybe I am and maybe this just isn't the role for me and I can just go back to the work that I love and.

 

Dr. David Burns: Well, that's fine. But I'm a I'm a real professor and I judge you because I'm very serious. I don't joke around.

 

Caroline: Oh, good for for you. I'd rather be fun and loving and loving life than stay here in a stuffy meeting with our sticks up our butts.

 

Jill Levitt: I wish we could be high-fiving Caroline. This is definitely a moment of high five. I'm sure. And I know people in our audience are sending messages and all that, but I'm sure everyone is feeling just like the incredible shift in your energy, Caroline. And and just the fact that you're kicking ass here in the in the meeting from hell and in your own mind. So feeling a lot of excitement for you. David, what were you going to say?

 

Dr. David Burns: Well, we could do one last turn of the screw if you like. Caroline, you you you've had some thoughts about people, you know, loving you as you are. And the danger of showing your vulnerability and it seems like you've shown tremendous vulnerability here in the in the last you know almost two hours. Do you do you have any concerns about how the people in the audience are viewing you and if so would you want to ask them and find out?

 

Caroline: I can do that.

 

Dr. David Burns: Okay, go for it. And.

 

Jill Levitt: Hold on let me just clarify. So this would be called the survey technique, right? You've already done lots of self-disclosure today just in sharing your vulnerability. So, the survey technique would maybe be something like, you know, in therapy, we'd craft a question. So, David, maybe it's is it something like, now that you've heard, you know, that I'm not perfect and I've shared my vulnerability kind of how are you thinking?

 

Dr. David Burns: You've seen me cry and be kind of. Weak.

 

Jill Levitt: Yeah. And asking and would you be willing to do that. Caroline?

 

Caroline: Yes. And actually, can I ask one? I made the mistake of opening the chat over the break and there was one something that jumped out. It was just one word that jumped out at me and I closed the chat back down that I think would be a good one to ask.

 

Jill Levitt: Oh, okay.

 

Dr. David Burns: Okay. And then also, I wanted to say that there's so many incredibly beautiful comments in the chat that are, just so beautiful. Meaningful and so we also can share some of those with you too. But yes, Caroline, you wanted to ask a question.

 

Caroline: Well, I don't know even know if it's like what would you do you have an example of something you would ask?

 

Dr. David Burns Burns: Well, it's just something that you want to know like you've been afraid of showing your vulnerability for fear. You know, that won't impress people enough and they won't love you or or care about you and and you know, you might not have that concern now, but if if you do to some extent, this is a chance to to ask.

 

Caroline: Well, the thing that's jumping out at me is if people think I'm a narcissist.

 

Dr. David Burns: Oh, yeah. Sure. You can ask ask me first. See, David, are you a narcissist?

 

Caroline: Are you a narcissist, David?

 

Dr. David Burns: No, but I've been taking narcissism lessons and I'm getting there pretty fast. It was attempted humor. It was total failure. So, but you you you so you want to ask people if they think you're a narcissist and you can ask them. Sure.

 

Caroline: : Yeah. So that's my question. Do you think I'm a narcissist? So that wasn't even on my radar until I had opened up the chat and I'm like, "Oh my gosh."

 

Jill Levitt: Yeah. So let me let me read to you Caroline just because the the sooner the fastest way I can share this with you is all the chats that are coming in in the chat box. So this is.

 

Caroline: I can open up the chat. I'll open up the chat.

 

Jill Levitt: So, but if you start start at the end because there's so much else in the chat. So, I'm getting no way you're Well, I'm going to read it, Caroline, because everyone can hear it. No one else can see the chat other than the host and panelist. So, you can see it, but the audience can't. So, let me just read it to you. So, no way you're a narcissist. Nope. Don't think you're a narcissist. Not even on my radar. No way. You are open and humble minded. Not at all. Not at all. Nah. Not the slightest. Narcissists don't ask if they are narcissists. Lol. Lots of no hell. No, absolutely not. I think there's a quality of anxiety and depression that makes you think a lot about yourself, meaning generally. I think you are hard on yourself and not a narcissist. No, you are accomplished. Not a narcissist, but guarded. I am too. Not at all. I think you're very brave. What you did today made my day. Thank you for being brave enough to do what you did. Of course not. OMG. I think you're the exact opposite of a narcissist. Brave and vulnerable, compassionate and caring, cares so much about other people, cares so much about what others think. I don't think a narcissist would care about others the way that you do. You're just a human being with tons of emotions and fear just like the rest of us.

 

Dr. David Burns: Someone said, "I'm crying with you."

 

Jill Levitt: Yeah. And your vulnerability, this is a good answer to the survey technique that David wanted you to ask. Your vulnerability has made me love and respect you so much more. I see your humility and humility is truth. I experience you as so generous, brave, and relatable. Definitely not a narcissist. You've been so courageous, Caroline, and been so vulnerable and inspiring. And so, I'm sure Caroline, I do want to say, I gather there was some comment that was made to the presenters. The rest of the crew can't see it, but there may have been a comment in the chat box early on asking about that. And you know, I we can always look back, but what what if it were the case, Caroline, maybe David, this is almost a feared fantasy kind of thing, but there's 900 people in attendance today. And what if one of those people thought that you were a narcissist despite 899 thinking that you were so vulnerable and brave and and open and and that they just loved you?

 

Caroline: Well, I think the biggest thing with with that is, not that I'm worried about what other people think, but more about see me being vulnerable means me being misunderstood, which would then turn people away, right? Like more about that. So, I'm not worried about Yeah. So, it would be that it was just that people are I didn't articulate myself enough. And what was it about me that came across when I'm reaching out, right? And so then so then the story would be like say I can't reach out for help because I'm just putting myself out there to be misunderstood to be heard again. With with other people, you know, in my life.

 

Jill Levitt: And what if it were the case though, I just want you to think about it, that a person in the audience misunderstood you today. And like for example, actually, I'll just throw this out there. In the very beginning when we shared the the questionnaire with sorry the the handout with people so many people wrote oh thanks thanks great chill you're doing a great job and I got like two pretty nasty comments like Zoom is Zoom get it together or like you you know basically kind of some mean stuff from the audience that I'm failing you all because I haven't been able to give you an uploadable handout packet right and I could go home and think I really failed cuz there were probably two people that were kind of pissed that it didn't work well. Or I could, you know, feel good about today for a variety of other reasons. And I think that's kind of a similar thing you're struggling with. What if it were that 890 people were touched and connected and really understood and saw themselves in you? That's what we're getting in the chat box. Like, Caroline is me kind of comments. And yet, there might be one or two that misunderstand you and even judge you or turned off, you know, as a result of it.

 

Caroline: Yeah, I think I would just there's always going to be haters. My daughter would say, it’s not that deep, mom. It’s not deep, you still have us. We still love you right. They’re crashing out with whatever their own thing is.

 

Jill Levitt: Haters are gonna hate.

 

Caroline: Yeah

 

Jill Levitt: Yeah, I will say I’m with you. David, don't you and I struggle with the same thing? Like we get feedback every time we we put our selves out there. We make ourselves so vulnerable ourselves too in our teaching. So vulnerable to criticism and and get all sorts of feedback. Some that's good. Some that's that's negative but super helpful, right? That's what we're always looking for. And some that's just mean and mean-spirited and disconnecting and and yet we're kind of like we're here for it all and try to listen to it all but not not take it all too seriously either. David, is there more we want to do with the survey technique or do you think now?

 

Dr. David Burns: I think we've kind of done done that. Maybe we could just see kind of how how you're feeling at this point, Caroline.

 

Caroline: Yeah. Like that chest pain is gone.

 

Dr. David Burns: Yeah. Oh, that's so nice to to hear that you've been doing so so beautifully. And you've been so human and and and so real. I think you've got a lot of fans to today and you can count Jill and David as you know very strong members of your fan club if that's of any of any value to you. We're so grateful to you. Let let's see how how down you're feeling right right now.

 

Jill Levitt: We're going to go back to our testing and right after you to verbally. David will do it verbally with you. I think your the brief mood survey, right? And the.

 

Dr. David Burns: Yeah. How down are you feeling right now?

 

Caroline: No, not at all.

 

Dr. David Burns: Okay. And and that was 60 and the goal was 10 to 20. And then how guilt how bad are you feeling? That was 60, the goal was 10.

 

Caroline: Maybe 10. Yeah.

 

Dr. David Burns: Great. How inferior, worthless, inadequate, and incompetent?

 

Caroline: Not at all.

 

Dr. David Burns: And how unwanted?

 

Caroline: None.

 

Dr. David Burns: And then how foolish and self-conscious?

 

Caroline: Probably 20.

 

Dr. David Burns: 20. Good, how discouraged?

 

Caroline: Not at all.

 

Dr. David Burns: And how tired and exhausted?

 

Caroline: Oh, I'm very tired and exhausted, but in a different way. In a good way. So here.

 

Dr. David Burns: Yeah. How about a good exhausted is good. How good exhausted are you?

 

Caroline: Yeah, probably like all all of my exhaustion and tiredness is all good.

 

Dr. David Burns: Yeah. Awesome. And now are you know these are very dramatic changes. In one therapy session you you met or exceeded all of your goals and most of the negative feelings went went to zero. Are these estimates true or you just being you know nice to Jill and David?

 

Caroline: They're true for right now. Yeah, they're true. True.

 

Dr. David Burns: And and what was to your way of thinking the healing element for now for for today? What what what what allowed you to turn turn this around?

 

Caroline: I think it was the turning the frustration towards the negative Caroline, right? Like oh my gosh, like just stop. Like that that was what was powerful for me.

 

Dr. David Burns: Yes. The the counterattack technique.

 

Caroline: Yeah.

 

Dr. David Burns: Now, the what's the likelihood that these negative feelings will return with equal intensity?

 

Caroline: Oh, I'm sure they will at some point. That's just how our brains work.

 

Dr. David Burns: Yeah. So, what what homework would we have for for Caroline and Jill?

 

Jill Levitt: I was just thinking exactly the same thing. Well, I had a couple different thoughts. One thought I had was that to go through the daily mood log and make sure that you write down the positive thoughts that you came up in response to all of the questions. Sorry, all of the negative thoughts. So, we did a lot of externalization of voices. Even feared fantasy, you came up with incredibly powerful and strong and believable positive thoughts, but you need to write those down on your daily mood log. That would be my first piece of homework. My second piece of homework would be continue to do additional daily mood logs as these thoughts creep up again. You're going to keep working on them, right? You kind of have this very strong self-critical voice and we want to kind of strengthen your self-loving, self-compassionate voice. So, you could do that just by continuing to do daily mood logs, maybe practicing some double standard, with yourself. And then the other thought that I had, David, was there is a behavioral component to this too. We didn't really get to, but almost like some anti-perfectionism training. And that to me.

 

Dr. David Burns: Oh yeah.

 

Jill Levitt: We could think creatively about it. But, thoughts that come to mind would be, you know, taking a day off. Other ways in which like in in situations where you think you need to be perfect, trying to just be interested in the other person and letting go of, being impressive at all. That could take place in in social situations too where you've been hiding and and feeling kind of, less than is just kind of putting yourself out there in in an interested, friendly kind of way. So, I'm taking it a little further, but I feel like, you know, there's so many ways that this could just be getting the ball rolling for lots of really meaningful change.

 

Dr. David Burns: One thing that was helpful for for me is, you know, I was a terrible Stanford medical student and cut my classes all the time and dropped out of school for a year. Her on two occasions and then I went up to Highland Hospital in Oakland, California for for my internship and residency. And that was just a community county hospital but with tons of patients and that was very helpful for me and I I started working like a like a hornet and then one of my the pathologist said you you shouldn't be here you should go to a place like, University of Pennsylvania for your residency. And she showed me an ad that they were looking for a research resident. And and I applied for it and I I got it. And then my one of my adviserss, Miles Weber, said, "One thing I want you remember, David, because he knew how hard I was working at at Highland Hospital." And and he said, "Just remember to spend at least a half a day a week staring at walls." And he was really really telling me don't work, you know, seven days a week and take take some time off. And so I did exactly what he told me to do. And I would take off Sunday afternoons and watch sports and you know, I would be feeling really guilty and had to to fight against it. But something as simple as that can be can be really really helpful. And then also to you know maybe if you have the inclination to to to you know spend to time with friends. I have all my any students who want to come to my house on Sunday mornings at 8:30 and we go for a hike together and then we have dim sum brunch together and and we just talk about what whatever when we're hiking or we do personal work on on issues and you know they open up and share vulnerabilities and and we've been doing that for for 20 you know. Yeah. For 25 years now since we we started doing that and it's still like the the highest the highest times of the week for me and and then the highest is like working with someone like you like what we did today and and and seeing that feisty Carolyn co come out. I loved I love seeing that and I'm just so grateful to to you. I feel so close to you. Can't thank you enough.

 

Caroline: Well, thank you both.

 

Jill Levitt: And I guess we could ask just David, we we need to leave. We have about 15 minutes or something for Q&A. And then we also have some learn more opportunities we want to make sure we share with people at the end. So, Caroline, could I just ask you in an open-ended way to start us off just to share with us what that was like for you? If there's anything you want to talk about. Just about your experience and what you learned or what was what was most useful to you in the time we just spent with you. And then people have been submitting questions to Mike throughout and he has a ton of them. So we're going to try to then answer questions from the audience for about 15 minutes.

 

Caroline: Yeah. I mean it was I use a lot of these techniques and approach and I see how they work for other people and and I felt bad coming in because I'm like I don't know if it's going to work for me. Right. But it really truly like if you just I don't know it was it the empathy piece was so valuable and it was your nuggets of information that helped like have the moments, right? And so and it's funny cuz it's like nothing that I would have ever realized myself even but it was the well the anger, right? I'm like I'm not angry. I'm not but but that was was helpful to actually I think that was the most powerful thing for me. So it really is just trying I mean David you talk about failing fast right so that we can just keep like moving on because we don't know what's actually going to work. But no I think and the empathy I mean that's so huge and not the cheerleading because you're right it would have been minimizing. So all of those pieces it was just valuable. Yeah.

 

Jill Levitt: Awesome. And I feel so grateful to you. Thank you. It was really just beautiful. And we have to invite Mike on now. Mike, you're going to relay questions and you have the hardest job of all of us because you probably have 300 questions down. So, we will not get to all of them, but go ahead and and give it a try and then we'll stop with Q&A around 12:25 and I'll share slides and.

 

Dr. David Burns: We'll we'll we'll try for the 30 seconds or less answers. How about that, Phil?

 

Q&A Session