Getting the Most Out of Every Session: Accelerating Therapy with TEAM-CBT

In busy clinical practice, time is precious—but therapy sessions often get consumed by endless talk without clear results. This training gives you a proven roadmap for making each session more efficient, structured, and transformative. In this free 2-hour CE webinar, Angela Krumm, Ph.D. and Kevin Cornelius, M.A., LMFT share practical TEAM-CBT techniques that help therapists accelerate progress, strengthen client motivation, and create measurable change. You’ll learn how to deliver therapy that is both warm and deeply effective—whether in a standard 50-minute session or intensive therapy format.

What You’ll Learn:

• How to start sessions quickly and avoid unproductive talk

• Ways to use measurement tools without losing connection

• Strategies to close each session with energy and momentum How to integrate intensive therapy for faster results

• Relapse-prevention methods that sustain long-term change

• Approaches to assess and boost motivation for deeper engagement

About the Instructors:

Angela Krumm, Ph.D., Licensed Counseling Psychologist and Co-Founder of Feeling Good Institute, is a certified Level 5 Master Therapist and Trainer in TEAM-CBT with nearly 20 years of CBT experience.

Kevin Cornelius, M.A., LMFT, Intensive Therapy Program Manager & Clinical Director at Feeling Good Institute, is a certified Level 5 Master Therapist and Trainer with expertise in depression, anxiety, insomnia, and relationship issues.

 

IN THIS VIDEO:

 

Jill Levitt: Hi everyone and welcome to our webinar today called Getting the Most Out of Every Session:

Accelerating Therapy with TEAM-CBT. I'm very excited to be hosting this webinar together with Angela Krumm and Kevin Cornelius. I'm going to tell you guys a little bit about Feeling Good Institute and who we are and then I'll introduce the presenters. You can move to the next slide.
 

So Kevin, we're still seeing. Oh, there we go. Okay, perfect. Okay, we're just getting started here. So let me just tell you guys a little bit about who we are at Feeling Good Institute. So our mission here is to elevate the practice of therapy so that patients can recover faster and more fully. We train and certify therapists in TEAM-CBT, which is a powerful framework for delivering evidence-based therapy that was developed by Dr. David Burns, and you'll be hearing a lot more about it today. Our goal is to help therapists to move through a structured kind of five-level certification path. Next slide.
 

Jill Levitt: The one ahead, Kevin. There was one before this one. I also just want to tell you guys a little bit about our story and how we were founded. The Feeling Good Institute was founded by Maor Katz, Angela Krumm, who you'll be learning from today, and myself. We had all trained with Dr. David Burns at Stanford and back then in 2013 and before, really the only way that one could learn TEAM-CBT was to study directly with David and often to study with David for many, many years. So we started Feeling Good Institute with a dream that was to make David Burns's tools, techniques, and training style much more accessible to therapists kind of around the world without compromising the depth or the quality of the training. Everything that we do today still reflects that original intention, which is really to help therapists get better so that their patients can too.
 

At Feeling Good Institute we don't just teach techniques, we really replicate David's training style which is built on one foundational idea, and that is that we only get better as therapists through training and feedback and practice. We actually kind of double down on that philosophy. We really lean into it using the deliberate practice model, which is also evidence-based, to help therapists build their skills.
 

Jill Levitt: On this slide what I'm sharing with you and it might surprise you to hear this but it turns out that experience alone doesn't make therapists better. So just having more sessions and getting older doesn't make us better therapists and doesn't lead to better outcomes. We know this is true based on psychotherapy research studies and it turns out that if anything we all get a little bit less effective over time.
 

So then the question is what does work? What do we know works? Well, it turns out that learning skills, practicing those skills with feedback, practice, feedback, practice, feedback, then that loop, that cycle is actually what helps people to get better in therapy. You know on the basketball court, the tennis court as well and so that's what we emphasize in all of our trainings, which is learning, practicing, feedback, practicing.
 

Jill Levitt: So you you're going to be learning some skills today and some ways of approaching therapy today and then we're also going to share with you an opportunity that you'd have if you wanted to join us and learn more and practice more. If you can go to the next slide I'll just briefly touch on it now and then we'll tell you more about it at the end of the day so we can jump into the content of our presentation.
 

So later on I'll share with you guys this FastTrack program that we've created that's really designed for therapists to level up their skills quickly and effectively. We're really taking what used to take kind of years and years of intensive training. We're now offering a really highly structured, highly effective training that therapists can complete in just six months. So what you're learning today is kind of the tip of the iceberg.
 

Jill Levitt: If it seems interesting and compelling to you and you really want to learn more, I hope you'll join us and I'll I'll tell you more, I'll save the details for you for the end of the webinar. So I'll just also now touch on what many of you are going to be texting and asking about throughout the webinar today. So listen up. The way that you're going to get your CE credit is make sure you are here for two hours until 1:00 p.m. Pacific time. About five minutes till the end of the hour, I will drop the CE survey in the chat box. So you'll see it here at five of one. You'll click on the CE survey, you'll complete it and then within a week, so not the same day but within a week, you're going to get your certificate of completion emailed to you. I will remind you guys of that in the chat box because I realize people get distracted but that that's what how it's going to work. Okay, and now I get to introduce you to our awesome presenters. So let me tell you a little bit about Angela and Kevin and then I'm going to turn it over to them for the rest of the time and I'll be back with you guys to facilitate kind of a Q&A toward the end of the two hours.
 

Jill Levitt: So Dr. Angela Krumm, join me in welcoming her. She's a licensed counseling psychologist and the director of professional development at the Feeling Good Institute in Mountain View. With nearly two decades of experience practicing CBT, cognitive behavioral therapy, she specializes in treating panic disorder, phobias, and social anxiety. Angela was immediately drawn to TEAM-CBT when she saw how dramatically it improved her client outcomes. Today she dedicates a lot of her career to training other therapists, helping them to expand their skills, sharpen their effectiveness, and bring faster and more lasting change to the people that they serve. and Now I'll move on to Kevin. Welcome, Kevin. Kevin Cornelius is the intensive therapy program manager and the clinical director at the Feeling Good Institute in Mountain View, California. He's a certified level five master therapist and trainer in TEAM-CBT and also a practice leader in our FastTrack to Level Three TEAM-CBT certification course where he guides therapists through hands-on practice and real-time feedback. He specializes in treating depression, anxiety, insomnia, and relationship challenges. His background in theater informs an engaging, creative, and practical teaching style. Passionate about mentorship, Kevin leads case consultations and clinician trainings that empower therapists to bring TEAM-CBT to life in their daily practice, driving meaningful and lasting results for their clients.
 

Jill Levitt: So welcome, Angela and Kevin, and now I think I'm turning it over to you, Angela.
 

Angela: Yeah, thank you so much, Jill. What a treat. I always think this is so special to see the registrations roll in and see this variety of these awesome people who sign up to join us today. Some of you have been doing TEAM-CBT for years and have been part of our community for a long, long time and others might be brand new to Feeling Good Institute and come in today just wide-eyed and maybe a bit overwhelmed and that's okay too. We're excited you're here and good to have you all.
 

So today we have a broader goal than than what's forced on us by some very specific learning objectives. Broadly, we want you to leave today with some increased skills and comfort and confidence being effective in your session regardless of the length. We're going to talk about two types of lengths of therapy today, the more traditional, you know, 45 to 50 minute approach, and then a more intensive model that means longer and more frequent duration of sessions. You see on the screen some learning objectives. We want you to be able to describe at least one thing you can do at the actually the beginning, the middle, and the end of each brief therapy session to be more effective. We want you to be able to list some characteristics of what makes someone a good candidate for intensives and describe some benefits of of intensive. We hope you get a lot more than that as well.
 

Angela: So what we'll do today is I'll just spend a brief moment giving you an overview of TEAM-CBT so you can understand the framework and know what we mean by that and then I'll spend the first portion of the presentation talking about those more traditional 45 to 50 minute length sessions and then hand it over to Kevin who will talk about these intensive sessions. Then we'll do Q&A. So you're welcome to send your Q&A. Jill will be collecting those because of the large attendance today we won't be able to pause and do questions in the middle. So you can go ahead and send those. We'll address what we can at the end or follow up the best we can after. Okay, so what is TEAM-CBT? Let me give you that brief overview. So TEAM-CBT is a framework. It's not a new school of therapy. It's a framework that we can use to make our sessions more effective and it's transdiagnostic, which if that sounds like one of those psycho babble terms, it really just means the idea that you can use it with different diagnoses, anxiety, depression, habits and addictions, trauma, self-esteem, relationship problems and so it guides our session through this acronym T E A M. So T is for testing. That refers to the idea that we think it's imperative that we use validated measures to understand our client's mood scores and to track them across time.
 

Angela: So we collect data at the beginning of and end of every session to track progress in session and across time and we receive feedback from clients so that we can do better because it's actually not true that just because our client comes back they're getting better, right? So we have to gather testing data to to really better connect and do better. E is for empathy and we believe strongly that before we can do any methods or anything you might think of as an intervention, we have to really help clients feel both understood, safe and fully known. We have to be prepared to manage any ruptures or problems in the therapeutic relationship. So we teach a specific set of skills for empathy, not just saying be empathic but teaching five specific steps that we use to connect with humans in a really deep meaningful way. A is for assessment of resistance. Sometimes you'll see it listed as agenda setting. This is where we set specific goals with clients. We choose specific examples and we work through what we see as really healthy resistance to change, honoring the good in our symptoms and the good in the people's behaviors and actions that are present to help them really decide if they want to change or not. Finally, methods is where we roll up our sleeves and work on teaching people new tools to feel better. Many of the methods in TEAM-CBT are grounded in cognitive behavioral therapy but this is where you can also integrate methods from other disciplines and we work to figure out what works for the client in front of you, not throwing just a certain method at every human being or every diagnosis but really tailoring to what the person in front of you needs.
 

Angela: So as you can imagine we won't be teaching you all the details of each of those steps. If you are intrigued and want to learn more that that FastTrack course, Jill will tell you more about, is a great way to dig in fully and deeply. It's a powerful exciting model, just want you to have the overview for today. So next we're going to do a little poll because I would love to start by knowing how do you choose your session length, right? So today we'll be talking about how to be effective at different lengths but how do you even decide how long to meet with a client? You see these five options. I believe, Jill, correct me if I'm wrong, they can select all that apply and I just want to hear what are your most guiding principles, right? Some of you may have a lot of choice, some may not, which which of these types of things best fit how you most often decide. Okay, thank you all for responding. I love the engagement. I see that number rolling up. I'll give you just another moment if you've tuned out and you want to participate, go ahead and click that button now. Wonderful. So let's see, looks like they're still coming in fast and furious. I'll give you another minute but I can already see, I'll give you a hint, that a primary winner is this idea of going with what's traditional, right? A traditional 45 or 50 minute session and of course we understand there's good reason for that. It may be some of the other options you're seeing on the screen. Great. Let's go ahead and share those results. Great.
 

Angela: So yeah, you can see about 59% of people go with the traditional 50 minute session. 25% say they're tightly bound by insurance or organizational requirements. That's actually much lower than I expected given that many, many organizations do require a restrict to that. Less people are going based off what treatment manuals suggest and that's amazing that 44% of you are able to determine the unique client needs. So that tells me that you may be really varying your clinical work based on what a client needs and how amazing is that if we could all do it, right? I honor that not everyone has that choice or ability but how cool to say that maybe maybe we should be doing sessions based on what works for the the person in front of us. Kevin, why don't you move us ahead to the next slide. I'll just say one more thing about that for those of you who don't know the history.

45 or 50 minute session models were not based in research about what's most effective or what really works to help people get better. Freud is is generally credited with making that the norm and he even acknowledged there wasn't some well-thought-out explicit purpose for it. Eventually it started as a therapeutic hour, which became 50 minutes for convenience for the therapist. We know we're human, we need a transition and we need to do notes or use the restroom but what that tells us again it's not so much client-centered as it is tradition. So we're going to start today talking about that traditional therapy hour, that 45-50 minute model that many of us still feel locked into for whatever reason and think about how can we bring intentionality, organization, and directiveness to each of these phases of treatment, right? So I'd argue that a 50-minute session can be a bit useless and unproductive or it can be amazing and it doesn't have to be good or bad based on the the number of minutes you have but there are things we'll talk about that can make it more effective within that model. So yeah, let's go into the next slide then, Kevin. Thank you.


Okay, so let's talk about before the first session happens, even the setup. Let me pose a question for you here. How many of you ever been invited to an event or been to a new circumstance where you didn't know what to expect? I guess as we all have been. Maybe you can think of the most recent time you either signed up for something or you received that invitation and there wasn't a lot of information and how did you feel in that circumstance? Are you someone who falls into the camp of being excited about the unknown and kind of loves loves showing up for something when you don't know what to expect? Are you like maybe the majority of us who feel a little uncomfortable with that circumstance? What's going to happen here? My recent party invite that really threw me for a loop, I got an email from a parent at my kids' school who I don't know very well at all, had just met a few times, inviting me to a dinner at an address I'd never heard of up in the hills and with very little context.


I looked at who was on the invite list and I kind of dug around and I just sat with it for a while and I couldn't get myself to respond because I kept saying what is this about? You know, what's what is expected here? What is the purpose of this dinner? Who why did I get invited? What's expected of me? It wasn't until I ran into her at school one day that I was able to just share my excitement about being included and asked some questions that it all started to make sense that this was going to be a teacher a dinner to honor the teacher and that there would be bringing shared dishes and community and suddenly this started to sound like a really fun thing to be part of. Kevin, go ahead and click one more time just to show the slide there. Thank you.
 

Angela: So I would argue that being a therapist is a bit like being a good party host and that it is on us to set the expectation for what clients can expect. Many times when I'm consulting with therapists who are feeling the very human experience of being frustrated or disappointed about their clinical work, they'll say things to me that imply the client is not doing their part, right? They'll be frustrated. "Oh, the client kind of talks endlessly about the same things over and over again. They seem to not take my advice or get stuck," right? And often when we really start to dig into the stuck points, we realize that the clinician has not always made the expectations clear for the client and so let's talk about what are how can we be clearer with our clients by looking at the next slide.
 

Angela: So on the screen here you're going to see examples of things that I would argue are important things to talk about explicitly with a client prior to getting the work started together. One might even argue that these things could be communicated even before the first time you have a conversation. So you might think about what is the first piece of information a potential client sees about you? Is it a website description? Is it some type of marketing flyer? And where how are your expectations starting to be conveyed in your printed material? What about in your informed consent or intake documents, right? What about in your first verbal contact whether it's a phone consultation or something similar? So I want you to think about across all these mediums how are you setting up realistic expectations for success? So on the screen you see examples of some of the things I see and many of us who use the TEAM-CBT model see as roles and responsibilities of the client that we want to talk about. Things like arriving ready to work, arriving to session and so in a video therapy format that might mean having a strong internet connection and having privacy.


Both in person and on video it might include things like having your materials together, being on time, right? I have a strong expectation in therapy homework. I believe that you can't learn a new sport by just talking about it once a week with someone, you have to get out and swing the racket, right? And so that expectation is tremendously important to be transparent about so that if a client does not want to engage in that type of therapy, I can help them find a better fit and we can avoid frustrating them and having having a bad match experience. Again, in TEAM-CBT the expectation is that we can't do good work without understanding how you're doing and getting feedback and so doing testing forms and then I love this expectation that I see one of my client's jobs as helping me collaboratively balance time in session between supportive talk and work. I see this as a collaborative decision-making step that I need them to partner with me on.
 

Angela: Now, what about me? I'm not off the hook, right? I as the therapist, you as the therapist, have roles and responsibilities as well and you see some examples here. For example, collaboratively creating a treatment plan, generating that path of how are we going to get from where you are now to your goal, right? Staying on track. So for example, picking one goal or one problem at a time to work through and sticking with it until we've made progress to avoid jumping around in session from topic to topic. Assigning meaningful homework. I think it's a tremendously important part of our job as a therapist to pick meaningful homework, not just busy work for our clients. And then again, that shared responsibility of balancing time between supportive talk and work. So I want you to pause for a moment or I'll pause for a moment while you think what are some additional roles and responsibilities that you have based on your style of doing counseling for the clients you work with and for yourself. And I just want you to jot those down because each of our lists may vary a little bit. What would you add? What would be different for what your expectations are? And again, these are just notes for yourself.
 

Okay, so hopefully you're coming up with a few. You're you're welcome to to steal and grab these and also hoping that you're coming up with some more that you can think of. Kevin, let's next talk about what we can do at the start of the of the of each session. So I'm curious and this is an opportunity where I want you to chat some answers to Jill. I think you're going to do chat ideas to the panelist, does that sound right, Jill?
 

Jill Levitt: That's right.
 

Angela: Yeah, and so what I'd love to hear is what are some examples of your favorite opening line to start a therapy session? I remember in grad school having conversations about this, the different approaches of what what do you say? How do you begin, right? And we'll hear if Jill can just give us a few examples as they start to roll in.
 

Jill Levitt: Okay, I am going to read them to you. Let me see. Okay.
 

What brings you here today? What would you like to work on today? How can I support you today? I'd love to hear about your homework.
 

Angela: Cool.
 

Jill Levitt: What's been going on? Tell me a story about your week. Cool. Tell me a little bit about yourself. Those kinds of things.
 

Angela: Yeah.
 

Angela: Awesome, great examples. I hear some of those are maybe things you're using at the start of a very first session. Others may be the start of an ongoing session. I hear some are a bit more specific, some are tremendously open-ended. I've heard some people tell me before they have had therapists who say nothing. I think that's interesting. You I imagine walking into a therapist room and getting a warm smile in silence and wondering, "Oh, that's a different experience." Kevin, let's talk about a different approach.

So remember I'm arguing that intentionality, directiveness, and organization is what helps us make the most of each session and I do worry sometimes that our kickoff at the beginning of a session really will impact how that session flows because if we do a broad open-ended what's been going on type of question, we are asking for broad, open-ended, unstructured time, right? And some of you may feel really connected to that and I don't intend to talk you out of it today. I make space for you to of course do as you wish and I want to show you a different way that really does bring structure to your session. So I don't have a magic phrase. I don't have one perfect way to start because it's going to depend on your style and your connection to the person and how many sessions you've been in but I do have three things I'd like you to think about covering in an integrated way at the beginning of each session and those three things are to review testing data, to review homework, and then to issue an invitation to get to work.
 

Angela: Okay, and we'll talk a little bit about each of these. So generally, I do this by acknowledging this is the plan, right? So I welcome the person in whatever warm way feels right and then I share with them I'd love to take a minute to review the testing data, check in about homework and then think about our plan for today. Almost always my clients feel excited to hear that and they feel held by getting to collaborate in this check-in and setting our agenda.

So as I mentioned before, reviewing testing data is important for us to know how treatment is going but it's actually secretly a very deep way of empathizing and connecting with the person because when we have a snapshot of all of their feelings as they walk into the room, we know a lot and we have an opportunity to dig in and connect at a very deep level and really know all the feelings that are present. So it's really actually a lovely empathic way. A lot of people hear tested and think that sounds like some cold clinical thing that associates with like clipboards and white coats and actually what this is is an opportunity for us to really connect deeply around emotion.
 

Okay, homework. Why do we need to review homework early on? Well, rewind with me to the last time you've done homework. Maybe you do it all the time, maybe you haven't done it in decades. I was a pretty serious student and even I, I mean I took school seriously, even I would very quickly figure out if homework was not going to be checked that it was optional, right? We're all busy people. Your clients are busy people. If you assign homework that does not get followed up on, I would expect a near zero compliance rate on that homework over time.

And so I think it's imperative that we are following up on the homework that we we assign to people. So that's my challenge for you today is to make sure you're following up. And then of course we need to figure out how do we transition towards the work and this is an example where I wish we could we could spend a whole hour practicing a specific skill in TEAM-CBT called the invitation step and how to do that empathically and supportively. That's more stuff for like a FastTrack course. Today what I want you to think about is simple transitions that honor the plan we've been having and ask the client if they're ready to get to work.
 

Angela: So an example of that transition may be something like, "So last time we left off here, right, talking about working on and our plan for today was to follow up and do XYZ," fill in the blank, "Do you feel ready to jump in now or do you need more support or do we need to make any changes to this plan," right? So I'm reviewing where we've been, what our plan is for today as we transition forward. Again, a formal invitation step is also a lovely way that we could teach you more about it another time. So you hear the start of the session, we're covering these key pieces that need to be worked through. We're doing this in a few minutes, five to 10 minutes, and moving towards the work phase or at least inviting them to the work phase very early on in the session. Okay, so we're mastering how to be efficient at the start. Let's talk about what do we do during the session? How does our thinking shift? So as therapists now the session's moving forward, we want to continue to be intentional, organized, and directive as we move through these steps of the TEAM model. Getting organized in advance will really help you in mid-session so to stay on track. So I encourage you early on in in your work with clients to figure out how will you be organized together?
 

Will you will the client have a written notebook that they're using to track their work? Will you have shared documents online?
 

Whatever you decide, be explicit about it because mid-session I'd encourage you to model helping them stay organized by writing down their own goals. What is it we're working on right now to track and take notes on the learning that's occurring and probably most importantly to be checking off or listing the methods that you're finding that are useful for them. So in TEAM-CBT, if you teach them a really cool method like the double standard technique and it hits home and is really helpful for them, we want them to have explicit notes about how to do that technique on their own and what worked for them, right? So that they're keeping track and they're learning. I believe strongly that long-term outcomes in therapy are dependent on our ability to help clients integrate the learning and know what worked and know how to repeat it on their own, right? So they can happily graduate from therapy someday.
 

Angela: Another thing you want to focus on during each session is this important concept of focusing on one problem at a time because if your client is human, tongue in cheek, they will struggle to do this, right? If you're like most people, you're talking about one problem and it reminds you of this thing and it reminds you of this thing and suddenly we're over here or we're giving into kind of the ‘problem du jour’ of the week, this stressful thing that popped up. It's an extremely important skill and one we practice a lot in the the TEAM-CBT community and how do we lovingly and empathically help people stay on track so that they can actually learn skills they can take with them and not just jump around? So your job during the session is to focus on how can I gently bring us back? How can we focus on one problem at a time to see some progress?
 

I'll show you in a case example a bit of how we did that later. Okay, and then the third thing you're doing during the session is thinking ahead about homework. Okay, we don't want to do unnecessary busy work. We want to assign meaningful homework and so I always have a sidebar of notes in my session where I'm jotting down possible homework as we go. So as it occurs to me, as I realize, "Oh, maybe they'll work on this part for homework." "Oh, oh, they should read this thing because this is new or confusing." I'm just jotting those down so as we move towards the end of the session, which we'll talk about in a moment, we're prepared. Okay, so during session want to stay organized, bring gently bring the focus back to one problem at a time and be thinking ahead about homework.
 

Okay, here we are. Now we're thinking about the last few minutes of the session and I allocate anywhere between two and ten minutes for this phase given depending on kind of how the client's doing and and where we're at in the treatment. Sometimes it can be really brief and sometimes we need a bit more time. So when we're wrapping up a session, we want to be doing two primary things. One is lots of focus on assigning that meaningful homework and discussing the plan for the next session. Now I've mentioned the value of avoiding busy work for sure. The bulk of learning in therapy happens between sessions, you know, especially if you're only doing 45 to 50 minutes with them a week and so we need to honor this as important. There's two ways that I'd encourage you to think about finding meaningful homework. Okay, so it kind of simplifies it in my head and helps me make choices. So we can think about either practicing what we already learned, so something they've already gone through and learned they could practice more of, or we could prepare for what's next by bridging to the next session. Okay, so we can practice what they've already learned or prepare for what's next to bridge to the next session.
 

So let's just talk about an example of those. So Richard Lamb is one of our our great therapists here at at Feeling Good Institute. He shared with me one time that when he first gets a client through their first Daily Mood Log, which is a cognitive therapy tool, many of you may be familiar with the thought record, similar concept, where you're teaching clients how to work with their negative thoughts and come up with helpful rebuttals. After he's taught them how to do it, he may assign a client seven new mood logs over the course of the next week, one a day, because they've learned how to do it and now their job is to practice, practice, practice so they can become an expert at that skill, right? So that's an example. Do something together, homework is practice, practice, practice. If you are someone who assigns progressive muscle relaxation and you do one in session, you'd maybe assign that every day, right? Bridging to the next session requires us to be thinking about where are we trying to go, right? What's that treatment plan? What's the next step? And for those of you who have the gift of TEAM-CBT and your your skill set, that's an easier skill because team always creates these paths for us of how we can move someone towards their goal and if you can see that path then we can think of what's the next step.
 

So here here's an example of one I can think of now. So let's imagine I'm working with a client who is working on health goals and they want to exercise more often and so we've spent the last session in the methods working to move from their tempting thoughts that that get in the way of exercise to self-control helpful rebuttals, right? And so they've been practicing this and it's really hard work and we're digging in deep to come up with these helpful thoughts that that defeat the tempting voice that's keeping them from exercising and we only get through one or two of them in session. So my bridge to next session needs to be to finish that piece of work. I've taught them how to do it, we grappled through two together, now they need to finish up rebuttals for the rest of the tempting thoughts in the next session and maybe there's even a step of reading they could do to prepare for what we'll do next session. Okay, so that's bridging to the next. So we've come up with meaningful homework. We're keeping them moving through the homework and the next thing we want to do is discuss the plan for the next session and this luckily sometimes takes 20 seconds or less.
 

Angela: So for example, we may say to the client, "So this is exciting. We got through this step today. We worked on this piece," right? With a tempting thoughts client I'd say, "We got two of these tempting thoughts done." "So I'm excited that you're willing to do this homework to finish up this log of of self-control thoughts so next session what I'd love to do, I hope this will work, is we can solidify that learning by practicing them in roleplay until you're really knocking them out of the ballpark and once you feel really good about it then we can move on to that stuff I talked about before called stimulus control where we look at the environment to see how we can help make it easier for you to build in your new habit." Okay, so what did that take, 30 seconds maybe for me to tell the client how we'll use we'll move from where we are today, use the homework and what we'll do next time. Okay, my clients love this because they leave the session knowing where we're going and they come back in next time with the idea that probably, now things change, we'll be flexible, right, but probably that's this exciting thing is what we'll do next and they're ready to get to work. Plans do change. Things come up in people's lives and so our plans are tentative, right? They're a hypothesis of what we'll do and of course we'll pivot and be flexible based on what the client needs and what's most important but that plan offering the plan I think is a gift to them to help them stay on track and know where we're going. Okay, so that's the pointers for the end of each session. Let me give you just a few minutes of examples of how this these components of effectiveness might work with a real client. I'll talk you through a case example of a client who I'm calling Arushi who I worked with recently and Arushi is a mid-40s female married, moved to the US in her 20s for college from India where she grew up. She works in the science fields. She has two elementary age children and has experienced off and on depression throughout much of her adult life. At the start of treatment when she came in to me she was feeling herself really struggling to get her stay started every day, really withdrawing from work and procrastinating more, feeling a bit despondent about her career trajectory and her marriage. She described her one light as she put it as her kids. They were really a source of joy for her and the the trigger to this episode was not her first experience of kind of low-level depression was an argument with her husband about their relationship with his parents, her in-laws. She was feeling unseen and unprioritized by her husband and feeling a bit hopeless about the future and how they would navigate this really challenging relationship. You'll see on the screen here some of the goals she identified like increasing her happiness overall or reducing depression, improving the relationship with her husband, and increasing work productivity. So we talked about the setup being an important part.
 

Angela: And so on this next slide we're going to look at what did Arushi and I cover in actually the first two meetings, which I collectively called the intake. Your your intake process may be much shorter. It may be much longer. It may depend on the client. This took about two sessions for us to get through this content. So of course in the TEAM model we were doing lots of that E-step, empathy and building rapport, very gaining very deep understanding of her her unique way of seeing the world, all the factors that were contributing to her struggles. I was gathering assessment and background information to understand how to work with her best and we were setting expectations for client and therapist roles. So again, as mentioned before, this is explicit conversations that are reinforced by my paperwork about how the client and I can work together. It's kind of a fun discussion of role setting. We also worked on through answers to something that David Burns, a real gift he's given us in the community, that he calls his administrative memos. He has two of them that really help with these conversations about client and therapist roles because ask clients to self-reflect on their readiness to do homework, their you know willingness to commit to sessions, their commitment to being honest and open with therapist and even ticking off examples of things that might get in the way, right, things that might make it hard to do those things.
 

So we talked about the answers to those questions and then we spent a good amount of time collaboratively discussing and committing to a treatment plan. Again, that's where we came up with those those goals on the first sheet. Arushi decided that for her first goal she wanted to focus on increasing happiness and specifically she wanted to tackle the feelings of misery and despondency that accompanies each morning when she wakes up. She realized that how she started her day focusing on all these struggles left her feeling hopeless and unmotivated then it felt like it spun out from there. So we just agreed to hold off on the other two areas, honoring the need to work on one problem at a time until we'd made progress there. You'll see already on this slide that there's homework happening and the homework you see here are just examples of things that I set up as background learning to move us ahead. So I believe in high levels of transparency with clients.
 

I want them to know the approach. I want them to understand the methods I'm using so they can decide if they agree with it and if it works for them or not. She'd already done a bit of research about CBT and showed up asking, found me because she wanted CBT and so she was excited to get into the approach to the reading I assigned her through one of David Burns's books, which you see mentioned there. Let's look at what happened after those first two sessions of intakes.
 

So our third meeting together, now you begin to see the structure of what do we do at the beginning, the middle, and the end of each session to increase effectiveness, right? So we did about five to ten minutes of reviewing her mood surveys, lots of empathy and connection around what I'm seeing there and checking in about the homework she did. You know, in this session the homework check-in is brief. She'd done background reading, it made sense to her, there wasn't a lot of need to talk about it in depth other than to just validate her reading and answer a couple brief questions. This allows us to get to the middle session where remember my goals are things like keeping us on track, thinking ahead about homework, balancing the time between supportive talking and getting to work and so in this session specifically I was able to issue the invitation. She agreed she was ready to get to work and we chose that moment in time where she wakes up. We started our first Daily Mood Log, which is again a hallmark of cognitive therapy is these concepts of what are your thoughts and how do we learn to change them and we even got to do some agenda setting around positive reframing, which is this really cool step, which again we won't have time to teach you today but in short it teaches us to honor all the good reasons clients might want to hold on to their negative emotions and all the good things it shows about them.
 

So as you look at this example, when we get to the end we're we're thinking through Arushi and I together how to set up homework that can help us deepen the learning we started and bridge to the next session. So you'll see what's assigned here does both those things. The first part is deepening learning and completing a step that we were on and then starting to bridge to the next thing, right? So that she could I'm sorry the second part was practicing what we'd done with a new example to solidify the learning. Okay, great.
 

So session four, you see kind of similarly beginning, middle, end, right? You're hopefully starting to see some pattern here. We're at the beginning and welcoming people in with this structure. In this session it was fun. We were getting into some of the methods where she's actually beginning to come up with rebuttals to her negative thoughts. She's starting to see the value and not just letting these negative thoughts kind of rule the show but arguing back with them and here her homework is really deepening the learning by reading about the topics we talked about, finishing what we did so that we can be prepared to move forward. Okay, we'll show you one one more example. You'll see similarities, different methods on session five.
 

Angela: Here again, opening with the warmth and the connection interventions and then focusing on homework that moves us ahead. Around this time is when Arushi was starting to really feel like she'd made adequate progress on this first goal and really understood the model that she could start applying it to new topics and new problem areas and it freed us up to move on to one of her other goals. In her case, it was such a touching moment where she admitted to me that she'd chosen the morning moments as a bit of a safe example to start with and then really wanted to deepen into what she saw as the harder work, which was the relationship work with her husband and a lot of the hurt and the pain there. And so you'll see on the next slide as you finish one problem area it opens up this opportunity to decide where to go next, right? What's our next example or goal that we want to work on because we didn't jump around topics those first sessions because we saw the model through and really worked one example through deeply.
 

We made progress where we were then able to shift gears and focus on something else that she she really cared about and allowed us to practice to move to the next goal. In our final session, with any client I always recommend doing some good. Kevin, go ahead and move us forward one slide please. We want to do some really great processing of what happened in therapy when we're wrapping up. We want to look back at what was successful and look ahead. In TEAM-CBT, we use the term relapse prevention to talk about preparing for a future backslide, right, moment in time where they may fall back into the old thinking or start to suffer again, start to struggle and so we want to prepare ahead for those and really normalize that as part of people's life process. So we have specific skills we teach to do that but in a final session we at least want to do our best to prepare for that, create a summary of what was effective and then teach about ongoing commitments to homework so they can solidify their gains. Okay, so let's let's talk about some summary points. Hopefully you saw some of the beginning, middle, and end structure in that case example. These are some take-homes I want you to grab before I turn it over to Kevin to work on to talk with you about the longer sessions. So again, I want you to think about can you increase your effectiveness at clarifying client and therapist roles and responsibilities and being explicit with your clients about that? Remember we can be a better team if we know what to expect and if we agree to it, right? So do this collaboratively with your clients.
 

We want you to issue the invitation to work early in session. Another way to think about that is that we're balancing talk, support, empathy with work, right? And so this assumes that that it's not enough to listen, right, that people won't always make lasting meaningful change if even if we're really good listeners but that we need to roll up our sleeves and get to work and so we want to think think carefully about how do we do that and if that's a skill you want more help with we'd love to help you learn and practice how to do that in a really meaningful effective way. We talked a lot about homework. We want to assign homework that deepens learning or bridges to the next session. There is a webinar that Maor Katz and I put on that's free and available on our website that specifically talks about assigning meaningful homework and that's a great one for those of you who kind of want to dig into this and improve your homework assigning skills. And then maybe the simplest and yet most most powerful part I can offer you today is encouraging to end your session by stating a tentative plan for the next session. Give the clients the gift of knowing that there's a a plan, right? Make a suggestion of what you might do the next week, how you might move forward and trust that it's okay if it's not perfect or if that you think about it more, they think about it more, you can always pivot but offering that plan really helps clients to feel held and know that there's there's a path forward. So thank you for thinking about these 45 to 50 minute sessions with me. We're going to turn it over to Kevin now to think about this exciting part of what to do with our longer sessions.
 

Kevin: Thank you so much, Angela, and I'm going to point out to you today that TEAM structure that Angela so beautifully gave you a brief introduction to today, if you're not already familiar with it, is going to be a structure that you'll recognize as I'm talking about intensives also. I'm going to start today by talking about just what do we mean by intensive one-on-one therapy. So that's where we're using longer, more frequent sessions over a short period of time so that we can accelerate the patient's recovery.
 

This treatment is one-to-one, it's not group therapy and it's very customized, it's very tailored to each patient's individual needs. Just to give you an example, we may do, I would say an average amount of time for intensives for us would be around 12 hours over the course of two weeks, so maybe 3 - 2 hour sessions per week for a couple of weeks and then we would follow up the intensive with weekly hourly sessions to maintain and build upon progress. I just I mentioned that so you can kind of wrap your mind around what do we mean by an intensive, how long are these sessions going to be? I do have a question for everybody with another poll for you. We want to learn like who's already doing intensive therapy with your clients. So have you ever provided this to your clients? Please answer, you've got a few options of what your answer might be and we'll let everybody chime in here. I see the numbers climbing. It's very exciting and we'll give you a little bit longer to log in your answer. I feel like we should have some music like on a game show or something here to make this more entertaining while we're waiting for all the answers to come in.
 

I'll refrain from singing. You don't need to hear my singing today. All right, so I'm noticing right away that the majority of answers is no, I have not ever provided intense the intensive therapy. That's really exciting to me actually because that means I've got some fun things to share with you that might open your mind to the possibility of doing intensives and then a good deal of you, 31% of you, have done intensives but not often, just a few times. It was about 59% of you who have never done them and then there's a few of us here today about 11% who have done intensives many times. I think we're ready to maybe stop sharing the poll. Oh, you can see the results now, so take a moment to look at that. I just reviewed them with you but you can see what people said in their answers and I'll move forward here.
 

Jill Levitt: I did stop sharing. If it's still showing up you just need to click the button on your screen, Kevin, but.
 

Kevin: Okay, great. Yeah, thank you. One thing I wanted to point out is that there is research that supports this idea of doing intensive therapy and and you can see this is about a study that I wrote a very short research brief highlighting what they found that when you do longer more frequent sessions the the outcomes are stronger.
 

So you can imagine having treatment for anxiety and depression being spread out over 12 weeks one hour at a time versus doing that over the course of one to two weeks, very condensed masked treatment. The the research shows that actually doing that in the more masked form or intensive form creates better outcomes and I put a copy of that research brief in the handout packet that you have that you could download today. So that'll give you some more information about we're not just saying this and it's not just anecdotal that intensives are a good idea but there's some research to back it up too.
 

Then I'd like to talk to you about why I like doing a presentation like this. I'm very passionate about doing intensive one-on-one therapy. A lot of my treatment with clients is in intensives and and doing intensives has really helped transform my practice and the way that I work with people. It's very rewarding to see people make such profound change and build confidence in their own skills. This makes me think of somebody that I'm working with right now, a young woman who has really struggled with depression. It ended up with a hospitalization and doing a PHP and an IOP program and she came in feeling pretty hopeless and when I said, "Oh yeah, we're going to we're going to do this over 12 hours over two weeks," her eyes just got huge. She was just like, "How how can that possibly be helpful? How am I going to make progress in 12 hours?" I let her know that typically within the first five hours of treatment we see a huge reduction in symptoms and then our remaining time together is making sure she knows how to recreate that for herself, that she knows how to use the tools without me because I want to make me unnecessary.
 

She was, you know, skeptical still and then, you know, sure enough, we're halfway through her intensive right now and her symptoms are at zero for her depression and anxiety and she would have never expected to see that prior to coming in. So that's why it's really so exciting to see people build confidence in their own skills when they see through their testing that Angela was mentioning that they actually are getting better and of course they can feel that they're getting better too. Intensive one-on-one therapy has really helped me become a better therapist because I've gotten much better at being consistent with setting really simple achievable goals in the work that I do with all of my clients.
 

Kevin: Then I want to tell you one other brief story about getting started in intensive therapy because I think that, you know, I think we saw 59% of you have not ever used intensives and, you know, I'll just share my own experience. Before I ever decided to do intensive therapy, I heard about it. I was fortunate enough to study a lot with Dr. Burns and with Jill Levit who's here today before I joined Feeling Good Institute and then got lots of training with with Angela and I heard a lot David talking about intensives and he was encouraging me to consider, you know, trying to become a therapist at Feeling Good Institute and he had this vision of, "You could be doing these intensives with people coming in from all over the world and you'll work with them for one week and they're going to get so much better. It's going to be great." I'm just thinking how on earth could I ever do that? Do I have the skills to be able to work with somebody and, oh my gosh, the pressure of they're going to come in from another country and work with me for just one week and they could get better.
 

It was the idea of that was scary to me and then fast forward a little bit. I was a pre-licensed therapist here under supervision with Angela and she was encouraging me to take on an intensive and she had a client that she thought would be a great fit for me. I trust Angela 100% and even though I felt my own misgivings about my skills, she was encouraging me so I thought, well, she knows more than me so I guess I'll consider doing this and the the person that I worked with, we'll just call Christine, she was a college student who was really really suffering. She had horrible social anxiety. She was a left her first semester of college early and had to have a hospitalization because her anxiety social anxiety was so strong that it also led to intense depression. She was telling herself things like, "I have no hope." "I'll never be able to make it in college. Other people think I'm stupid. I'm going to make a fool of myself if I ever return to school. Other people judge me and they're right to judge me." It was pretty bad and so I was nervous about taking on this intensive but I I have to say that once I was went through the intake process and set the goals with her and we sat down in her first session and I used testing as a bridge to provide her with lots of empathy and understanding and support and I really was putting all my focus on her and I was no longer stuck in my own head with my own fears but I was trying to understand her and where she was coming from as much as possible and that really helped my own fears about can I do this intensive really disappear.
 

Then I had this structure of T E A M to follow and I also had this wonderful gift of time that I had never had before because my sessions were longer than usual and I was having them right away. I didn't have to wait a week in between sessions. There was just a one-day break in between our sessions and so the momentum was really wonderful. We didn't have, maybe some of you might have noticed, sometimes there's a tendency to take three steps forward and then two steps back over and over like if the client didn't do their homework as well as they had said they would or just that space in between sessions sometimes stops the ball from rolling downhill, so to speak.
 

Kevin: So actually the the intensive was really successful. It was exciting to work with her. I loved being able to just go through the TEAM-CBT model without any pauses really and and helped this person achieve her goals. She was able to return to college successfully and not have social anxiety hold her back anymore so I was ready to do more and and really hungry to do more intensive therapy after that. I would like to share with you results of my recent work doing intensive so that you can see that you know there is some you know data just with my own clients that would show that this is successful. So in your handout packet I gave you the details of this, the testing before the first session and after the last session for 10 recent intensive clients and you can see that the outcomes here were on average a 65% reduction in depression and a 64% reduction in anxiety, which I think when we compare that to what average outcome studies are for psychotherapy, that's pretty significant to make that that much of a reduction and it's because of all of the the work the patients are doing in the session and following this model is is so effective and also that momentum that that I talked about really helped the treatment be successful.
 

Then one thing you'll notice when you look at the details in that handout, when we're using the the Burns Brief Mood Survey, which is what I've been using with all of these particular clients, there's a depression scale between 0 and 20 and there's an anxiety score between 0 and 20 and on that scale anything that's below five I think it's fair to call that subclinical. It's not a clinical depression or anxiety problem but rather we all have negative feelings that are normal, right? So to have the client get down to that range of between zero and four is ideal and with all of those clients they did that. So I would say, you know, 100% success with these 10 clients using the intensive and they would describe their their success in the intensive that way as well. So that's exciting to me to be able to look at the numbers and see how has this been working and I hope that's encouraging to you to consider doing intensives and and possibly using the TEAM model and we can of course support you in that. There are FastTrack courses coming up and when we say FastTrack what we mean is it's a way of bringing yourself to level three advanced TEAM-CBT therapist in a in a relatively short amount of time. I believe it's six months is the course.
 

Kevin: So let's talk about the benefits of doing this one-on-one intensive therapy. Well I talked earlier about how that momentum is really important. We can see our clients getting relief from their painful symptoms quickly and, you know, when I'm talking to a client about the possibility of doing an intensive, if they've got the availability in their schedule and they can handle longer, more frequent sessions, it's a great option because for me, if I was really struggling with depression, do I want to stretch that out over eight weeks or would I like to get that done in one week? I'd kind of like to get that done in one week and move on with my life and not be held back by these problems anymore.
 

So that's a big benefit of an intensive and then also we really put an emphasis on the client learning skills that can be very empowering for them. One of the things that I really like about doing TEAM-CBT is it keeps me accountable for not encouraging the client to only rely upon coming to me for session after session in order to get better. I actually want to make me unnecessary right away. I want to put myself out of a job, so to speak, with this client as soon as possible so that they're very empowered and they know what to help themselves. They don't need to to just keep coming to me for weeks and months, right? And so I'll describe to a person who's considering doing an intensive, it's kind of like you're going to a little mini graduate school to learn how to become your own best therapist because you're going to have these great tools that you'll be able to use for the rest of your life and, you know, I like meeting with you and talking to you and that's great but, you know, you're not here to to be my friend and hang out with me.
 

You're here to make yourself feel better so the worst case scenario is you'll feel so great you won't you won't ever have to see me again and that's actually the best case scenario also. It can be a really great fit to do an intensive for somebody who's taking a break from their schedule in some way. So maybe it's a student who's on a break from school or a lot of clients have taken leave from their work schedule. They've gotten medical leave and they've got lots of time on their hands and they can take advantage of that time doing an intensive and some people will even come here. They'll use some vacation time and maybe I don't think of therapy as my ideal vacation but they use some vacation time to come and just make huge progress and then and then go back to their busy life and and for some people they can avoid something like a hospitalization or really intense partial hospitalization by doing intensive one-on-one therapy instead. One of the benefits of our program is it's very customized to meet the individual needs of this client. It is not a set schedule that they have to work their life around. It's not a regimented program but rather we're everything that we're doing is meeting this client's needs right as they are right now when we when we set up the intensive.
 

Kevin: So there are some concerns that we have found have been a really great fit for doing intensive therapy. Things like social anxiety, specific phobias, if somebody has a panic disorder or maybe they're struggling with chronic worrying or a generalized anxiety disorder, of course depression and low self-esteem. We can do habit changing, helping someone eliminate their procrastination habit or they may also be struggling with other habits or maybe even an addiction. I will say that we can do work in an intensive format for an addiction problem but that would be with the caveat that they really need to be getting other support as well. Like usually a a substance use disorder for instance is going to require some social support and ongoing work after the intensive.
 

I would never want to convey to somebody, "You're going to become cured of, you know, using alcohol for the rest of your life with our one week work together." That that's not an expectation that I would set with somebody but what we could do is make a lot of progress and get them on the right path and set them up for success and then make a really great plan for after the treatment is complete. So let's talk about who makes a really great candidate for being a client in intensive one-on-one therapy. Well, first of all, we want to always keep in mind safety so this person really needs to be stable. They're not in crisis. They're not in danger of harming themselves. Also this person shows a willingness to set specific goals for therapy. You know, if I'm meeting with someone for let's say an initial consultation to see if maybe an intensive will be a great fit for them, if I check in with them about well what would you most want to get out of this therapy? What what are your goals? What are the main concerns that you want to address and they can't give me an answer to that? They're kind of shifting around with things like, "Well, I don't really know what I want to get out of therapy. I just heard that therapy is a great idea for a person to get to know themselves really well or achieve personal growth or I'm really interested in self-actualization and understanding who I am."
 

Then I would I would encourage them to seek maybe a different kind of treatment. That those are great goals for another type of therapy but not really for goal oriented specific intensive therapy. If the person wants to work on one problem at a time, they like that idea and and and they like the idea of choosing between one and three really specific goals and focusing in on those and and really achieving those goals, then intensives could be great for them. They also have to have a willingness to do homework and I will be checking in with that person about that during our first conversation, right, during the initial consultation because if somebody hates the idea of homework, then again I would gently and kindly encourage them to maybe consider something different because without homework the type of work that we're doing is not going to be successful. Usually clients actually get worse instead of better without doing psychotherapy homework and without doing it in the right amount and I don't like to sign up to help people feel worse. I want to help them get better so we would make sure that that homework component isn't a problem. So if somebody is saying things like, "Homework, oh, that sounds like school. I hated school and I don't want to do homework. I just want to come and talk to you and get better." Then I accept that, right? Like that's I have respect for somebody who says that they don't like those things but I would again kindly, you know, guide them towards finding a different way of working that would be a better fit for them, right, because daily psychotherapy homework is not the right choice for every person and I'm not here to talk people into doing things that they don't want to do but I also have to be honest with them that without that homework this just wouldn't be the right approach.
 

Then we also want to check in, you know, does this person think that coming to longer, higher intensity sessions would work for them? You know, that again that's not a great fit for everybody so they might want to consider instead of doing 12 hours over one or two weeks, maybe what they would like is sort of in between that hourly 50 minute session and an intensive so maybe they want to meet with me for an hour more than once a week or maybe they would like to work once a week but for a longer session. So it's not a formal intensive but we're giving a higher dose of therapy but not as fully intensive. So we we want to be flexible and come up with a plan that really fits what this client can participate in and have it be a really rich, rewarding, wonderful experience for them rather than I'm overwhelmed by the amount of therapy that we're doing.
 

Kevin: Then we want to use our imagination to consider who would be a great fit for this. So I've just put some examples but I'm sure, you know, we're all a little bit different and you've had different experiences with the clients that you like to work with and so you can use your own creativity to think about who would this be great for. So I really love working with high school and college students who are on a break. That's a great way to provide an intensive. Also sometimes somebody has a a a more supportive counseling type therapist that they've had a long relationship with and they really love doing that. They've been working with a therapist for a while. That person is somebody that they go to for support and to just be heard and understood and not have somebody who has an agenda for them to be different than they are, right? That's that's a beautiful thing.
 

However, the therapist is noticing you're really struggling with panic disorder and that's not what we're addressing when we're doing supportive weekly counseling so maybe, you know, an intensive to work with somebody for one week and really get the skills to help yourself overcome that panic disorder would be a great idea and so they might refer their client to us to achieve that goal and then of course we collaborate with that referring therapist. We we coordinate our care so that we're all just one big team working together on achieving this client's goals and then we return them to that therapist to continue that relationship and that supportive counseling that they love. Maybe there's a person who, I mentioned this before, has taken a leave of absence from work and and they want to make significant progress quickly and be able to return to work. Or maybe somebody is stepping down from a higher level of care. They might have they might be leaving a residential addiction treatment program and they're no longer using a substance to help them with handling negative emotions and life's challenges. They might come to us for an intensive to learn skills. What am I going to use instead of the substance that I've turned to? Well, I can I can use these skills that I learned in this intensive to help myself with my my feelings that I used to address with a substance or somebody had a hospitalization for a primary mental health concern and then they want to have a step down from that intense level of treatment to something that helps them return back to their regular life so that they don't have to have a relapse have brought them into that hospitalization. And sometimes people are living in an area where there are limited therapy resources. They don't have a therapist near them who does intensive therapy. A lot of the people who come to us at Feeling Good Institute come to us because of that name Feeling Good and that association with Dr. Burns and his books and his podcast and his resources is they've learned about TEAM-CBT and they really want to get the benefits of it but there isn't a therapist where they live who can provide them with TEAM-CBT specifically and so then they might fly here, stay in a hotel, work with us for a week and get the progress that they need and then return to their life. So I put that out there for you to consider that as a possibility for you if you've learned these skills and you're putting yourself out there as a TEAM-CBT therapist, you know, offering intensives might be a really great way to build and expand your your practice and of course there are more options here that you might think of.
 

Okay, we do want to think about who would not be a good fit and I mentioned that a little bit earlier but we'll go more more specifically here. So definitely if somebody is having really strong suicidal thoughts and urges and you're even concerned that maybe they've got means chosen and they've even talked about, you know, they've had a plan or there was a recent suicide attempt and they're not able to make a firm commitment that turning to suicide is just not an option that they would follow through now and in the future, then we would want to get them to a higher level of a care and address that before they would do an intensive.
 

Kevin: Maybe somebody just really prefers long-term supportive counseling and something that's so goal oriented and specific is not what they're looking for. Something that sadly happens a lot of the time is, you know, someone may notice their family member is really struggling with mental health problems and they see their family member suffering and this has been going on for a long time and it's somebody that they love and care about so much. Maybe it's their adult child or even their actual child like somebody who's under 18 because we do intensives at 12 and older and they're thinking, "I'm looking for something to help them. What's out there?" And they're and they're doing their own research and they discover TEAM-CBT and they see intensive therapy is an option and they think, "Wouldn't that be amazing? Like my family member could get so much relief from their suffering in between one and three weeks working with this TEAM-CBT model. It's fantastic. I can't wait to tell my family member about this." And they and they're trying to drag this person into therapy and unfortunately that person is not really on board with it at all.
 

And so sometimes family members make an appointment for a consultation themselves to talk about their family member that they think would be great for an intensive and then we have to gently discuss with them, "Well, I love that you're wanting to help your family member. Do they want this help? Are they saying, 'Yeah, I'm looking for whatever it takes to get better and I'm willing to do the hard work that it would take and intensive therapy sounds like a really good idea to me.'" Or are you trying to talk them into it? And and then we would want to, you know, sensitively explore that with them and see is this really a good fit and I would have a consultation with that potential client and really make sure that this is their idea, that they're on board for this, that they're not kind of being dragged into something that they don't want to do.
 

Some people really that whatever their energy level is, their their ability, their stamina is not a good fit for an intensive. Like to do longer more frequent sessions would actually be a burden for them and then we wouldn't encourage intensive therapy. Then if somebody is still actively continuing to use substances and they really need to detox, please don't do an intensive, right? They need to address that first before they would come and do this kind of intense work with us. Okay, so we also want to think about everybody has their own individual concerns that we really want to keep in mind.
 

Kevin: Sometimes cultural background, we want to think about that when we're looking at doing an intensive. Not all cultures are really into goal oriented treatment. That might not be a good fit for them and we want to be sensitive to that or we might want to think about, excuse me, I'm getting a little bit of a dry throat, watch me take a sip of water, sorry about that. Can we adjust the goals and make it more suitable to that person's specific cultural needs or if somebody has neurodivergence and that might impact the use of longer more frequent sessions.
 

So again, we want to be flexible and adjust our plan to fit to fit that need or maybe someone has a disability that we need to consider when we're setting the schedule. So the the whole theme here is we really want to be flexible and sensitive and responsive and treat people as individuals and this is not a cookie cutter approach that we try to force people to fit into our agenda. It's the opposite of that. This is highly customized and respectful of somebody's individual needs. Okay, so I've mapped out here a process for you to understand from beginning to end what an intensive is. So we start with an an initial consultation, which I mentioned before, where I'm trying to let the client know what an intensive is like and I'm also trying to find out what do they want to work on? Can they set specific achievable goals? Are they interested in doing therapy homework? You know, is doing long longer more frequent sessions a good fit for them? Then we would have an initial assessment where we do goal setting. So our process here at Feeling Good Institute involves sending them quite a bit of forms to fill out before we have what we call a goal setting session. That gives us lots of information and so there are diagnostic surveys. There's a new patient information form where they're letting us know things about their background and also what their goals are for the treatment. What kind of help have they already received? Are they working with a psychiatrist or a doctor who's giving them medications and what are those medications? That sort of thing.
 

It's it's a lot. It takes them a while. It takes about 30 to 45 minutes for them to fill out everything but it gives us lots of great information that saves us time so that when we meet and for a goal setting session, which in our process is a 50 minute session, we can really focus in on setting between one and three specific achievable goals while also connecting with this person and providing them with some empathy and support and understanding and connecting with them on a human level while we're also trying to convey hope and let them know there is a plan that we're going to follow in order to achieve your specific goals.
 

Kevin: When I do these goal setting sessions I really want that client to come away with a sense of hope because we have set goals that mean something to them that are relevant to them or they really would change something in their life right now and then I've laid out for them a clear plan that they understand so they can think, "Okay, this this is achievable. I can do this." When we're before be intensive, they're going to have some homework and I'll talk to you as we go through the presentation the types of homework depending upon the goals that the the person wants to achieve. At the beginning of the intensive, we are going to be using this TEAM model all throughout the treatment. So we'll begin with testing and providing empathy as Angela was describing with her client as well and then we're going to move into assessing and addressing resistance before we would then move on to methods.
 

So probably in that first session in an intensive, I'm imagining that probably about 45 minutes, maybe an hour is going to be dedicated just to empathy and understanding and support before I would issue an invitation and move on to, you know, other agenda setting or assessment of resistance steps. Then during the treatment, we're going to really help the client gently stick to one goal at a time much like what Angela was describing with weekly 50 minute sessions but it's even more important when we're doing an intensive because we have a limited amount of time and we do really need to stick to our goals and achieve them before moving on to another goal.
 

So we also have homework that's happening even in between intensive sessions so that we can help the client learn how to use the methods that they're learning and also have that homework be relevant and move the treatment forward. Then as we're ending the treatment, we're going to be reviewing what was achieved. We're going to give the client a really great summary of the treatment with our recommendations for ongoing steps if there is more to do after the intensive is complete and give them some recommended homework to do and then usually what we do with our intensives is recommend two weekly 1-hour follow-up sessions in order to maintain and build upon the progress that the client made in the intensive. So at the end of the intensive, by the way, we've also done that relapse prevention training that's so important that Angela mentioned and then we give them really important relevant homework and let them know I'm going to be checking in with you at these weekly hourly sessions for the next two weeks to see how you're doing with that homework. Are you able to use, for instance, a tool like the Daily Mood Log and all the methods that we've been teaching you on your own and you might have some questions as you attempt to do it on your own because you've been doing this intensively with me for the last one, two, or three weeks. We want to set you up for success and make sure that you know how to do that on your own as we end the treatment. So that's our process in a nutshell.
 

Kevin: Then we want to talk about creating the client's treatment plan and we're going to be setting specific achievable goals that will guide us in creating that treatment plan. So first of all, let's talk about why would we want to use goals in therapy? Just because we think it sounds great or is there anything that shows that this is effective? And there's this really great article I found that supports this with research and it shows that goals can really help focus and direct the clients and the therapist's attention in their work together and that it's extremely important in short-term work where interventions have to be tightly focused so that we can get those results that we want to get to within our time limits such as in an intensive.
 

Also setting goals for therapy can really give the client hope and energize them towards those goals and boost their persistence and make them more likely to do the work that they need to do in order to make the treatment successful and research shows that people are more likely to achieve their goals if those clinical goals are they're bought in on them, right? That's a collaboration that's happened between the client and the therapist, then their clinical outcomes are going to be better. Okay, so when we're creating a treatment plan, I'm offering a structure that you might want to consider trying in order to have clear goals that can be achieved in this brief intense amount of time that we're working together. So there's a tool that I think a lot of therapists use, we definitely use it in the TEAM-CBT world, called the miracle cure question.
 

So I may ask the client, "Let's use your imagination right now. If you had a magic wand you could wave and a miracle happened and you got exactly what you needed out of coming to this intensive treatment with me, what would be different? What's the miracle you're looking for?" And I let them explain that to me and they're really picturing how their life would be different if this treatment was really successful. Then I work with them on translating their goals, their hopes and dreams for what they would achieve, what they would achieve in this intensive into kind of therapist's language, into, you know, TEAM-CBT language. What are one or two skill-based treatment goals that that we could use in order to make that miracle happen? Then I will talk to them about homework and give them homework to do before we begin during the treatment and afterwards step five there ongoing homework and then we always want to include relapse prevention training as a big part of our treatment plan.
 

This idea that negative feelings are a normal part of life. The likelihood that you're going to feel very negatively again even though you're feeling great at the end of this intensive is 100% and we want to accept that and understand that our negative feelings are actually an important part of life but that doesn't mean that it has to turn into a full-blown relapse of a depression problem or an anxiety problem that caused a person to need therapy and we and we set that up for them skillfully with some specific methods.
 

Kevin: Okay, so let's bring this to life by talking about a client. So we'll this is a case that that I had and we'll call this client Cynthia. I'll just let you know that I've changed some things about this client in order to protect this person's identity so I am not revealing somebody's personal private information here. This is very adjusted but the the the heart of what happened in the treatment is is true. So let's consider Cynthia, a 40-year-old African-American cisgender lesbian married woman living in Los Angeles with her wife and they had three elementary and middle school age children. Cynthia had this really successful career in television writing and recently got this dream promotion, this just great breakthrough in her career where she got a really lucrative script deal to write for a hit TV series.
 

The way that she described the problem was that there is this paradox in her life. The more successful that she got financially, the more anxious she became about money and recently she and her wife were looking at buying a new car. The cars that they did have were quite old and they were too small for their growing family so they wanted to get new cars but looking at one and getting really close to buying it and being at the dealership and considering the contract and, you know, the payments and the whole thing became overwhelming and she described herself as going into an anxiety spiral and that just kept getting worse and worse and now impacts every area of her life.
 

So she pulled out of that car buying deal and she's been racked with guilt, depression and anxiety ever since that happened and that's why she was coming to me and wanting to get the benefits of intensive therapy. So her goals, her miracle cure, when I asked her, "What's the miracle you're looking for? How would you know that it had been achieved?" She said, "Well, I'd be able to spend this hard-earned money that I'm that I'm earning with all this success that I'm having without becoming overwhelmed by fear and I want to lower my anxiety and my depression and have the skills to prevent this from happening again in the future." So then when we laid out a treatment plan for her intensive, the goals for treatment number one, learn and practice the skills for, and I would word this differently actually, what I would say is we're managing anxiety in a more healthy manner by lowering avoidance of anxiety and increasing her tolerance for anxiety and then the second goal was to learn and practice the skills for lowering depression.
 

Then I gave her some pre-intensive homework. I really like to use this book When Panic Attacks by Dr. David Burns. It's really great for treating both anxiety and depression that often comes hand in hand with it and so I had her starting from the beginning of the book and reading it for about 20 to 30 minutes daily doing the written exercises in it to introduce her to the approach and set her up for success in the intensive. Then the intensive schedule was 12 hours over two weeks and then two weekly one-hour follow-up sessions and we were going to be using cognitive therapy methods, exposure methods, resistance reducing methods, which is part of that agenda setting or assessment of resistance that we talked about in that TEAM model and then we would end the treatment with relapse prevention training and ongoing homework.
 

Kevin: So now let's broaden our view a little bit and talk about clients in general when we're preparing to start an intensive. We definitely want to use pre-intensive homework wisely. So these are some books that I've been taught to use and you're going to notice kind of a theme here. I'm very fully bought in to the whole David Burns approach since I work at Feeling Good Institute and that's all based on his book Feeling Good. So I love using his tools and his books.
 

I don't want to say that's the only way to go though, right? So you've got books that you love and that you would want to recommend to your clients and but you want to think about what's a book that's really great for setting up the client for success with depression? Well, I really like to use Feeling Great. Of course his book Feeling Good or the Feeling Good Handbook are are excellent options as well. When a client is struggling with anxiety, When Panic Attacks is one of my favorite books of all time and and it's great for helping somebody set up for success with an anxiety problem and then if somebody is struggling with an unwanted habit or an addiction, on Dr. Burns's website FeelingGood.com, highlighted right away and on the welcome page is this ability to get free chapters that help people with habits and addictions.
 

So I would have them download that and they could read and start working with that in order to prepare for changing a habit or an addiction in intensive therapy. Okay, so during the intensive we're always going to want to utilize testing. We're taking our brief mood survey before and after every session so we can see how are we doing. Are we seeing negative symptoms going down and positive feelings going up? We expect to see change in one session but definitely over the course of multiple sessions and reviewing that testing skillfully with the client not only helps us empathize and connect with them but it also helps us build hope for them because when they see that the numbers are changing, they've got evidence that shows, "I actually am getting better," and that can help move the treatment forward.


So we're going to be tracking progress towards reaching the client's goals. We do this before the initial assessment, we'll do it before and after every session and then sometimes it's a great idea to let the client know, "I'm going to send you a brief mood survey to fill out again a month after you've completed your treatment because we want to see how your ongoing homework is helping you maintain your progress."
 

And so I'm planting a seed there when the clients knows, "Oh, I'm going to be getting this survey and my therapist is going to be paying attention to have I been doing my homework and am I maintaining my progress?" It kind of helps them with a little bit of accountability to not just stop doing what helped them in the intensive when they're returning to their busy regular life. Then of course empathy is so key. So we're always going to be and it's not, you know, this TEAM structure helps us stay on a great path and keep ourselves organized and make the treatment effective but we wouldn't want to imply that I do empathy for 15 minutes and then I then turn to only doing agenda setting.
 

Empathy is something that we're doing throughout all of T E A and M. We're always listening and responding to what the client's experience is in the present moment from moment to moment. So we don't just begin with empathy but we constantly use empathy. You know that listening well, conveying warmth, understanding, that's just such a huge key to effective therapy especially in an intensive because when we're so focused on achieving goals, we don't want it to become cold and calculated and feel like it's just a I'm their spreadsheet partner or something, right, helping them fill out forms. We want there's a human connection that has to be there throughout the intense the the treatment.
 

Kevin: Then of course the initial phase of treatment has to involve building trust and connection so that we can be successful with the other elements that we're going to be sharing with them. We want to melt away resistance to change, which is what we do with agenda setting or assessing and addressing resistance. So building skills to assess and address the resistance that we encounter in therapy has been a real key to successful treatment. I mean, I can say that for me personally it totally transformed the way that I work with clients and then my colleagues that I work with who also use TEAM-CBT have seen that transform their work as well and it's especially true when doing intensives.
 

The reasons why the reason why we can help somebody find recovery from a mood problem in such a short amount of time is because we do have skills that are great at addressing resistance and that's an essential part of the training that we do at FGI and you've got lots of training opportunities that you'll learn about and that you can you can explore on our website and then lowering resistance helps make our methods more effective when we want to make rapid change in a brief amount of time. So let's bring it back to Cynthia and find out what happened in that treatment. Well before her first session, her pre-session testing showed that she had a moderate score of 12 out of 20 for depression and then anxiety is getting more into the extreme range at 13 out of 20.

That first session was two hours. There was about 30 minutes spent just on empathy and when it was clear that she was being heard and understood and supported well, we then used our tools for melting away resistance for about 45 minutes, which led to about 30 minutes of starting to use cognitive methods and then the final 15 minutes of that session involved assigning homework and using post session testing and then these were the results of just that first session. She was able to make a 50% reduction in depression and a 46% reduction in anxiety so we were on track to achieving her goals in the therapy.
 

Kevin: Then let's talk about in a more broader perspective during the treatment what are we doing? So when we're treating depression, we're going to be focusing a lot on cognitive therapy and looking at changing the thoughts that lead to depression in order to change the way the client is feeling and then we're also going to want to use behavioral methods because there are classic methods that we want to check for that make depression worse, right? Procrastination, self-isolating, poor diet and sleep habits, problems with personal hygiene, things like that, we want to look out for and address. For pre-intensive homework for depression I already mentioned Feeling Great is one option and then how about anxiety? Well during the treatment we want to make sure that we get to exposures, right? We want to help the client stop avoiding the things that cause their anxiety and develop a new relationship where they're saying, "Bring it on anxiety. Come along for the ride. I'm no longer trying to avoid you. You feel uncomfortable but you're not dangerous."
 

So we get that by using cognitive flooding, in vivo exposure, interoceptive exposure, which is exposure to the physical sensations of panic and anxiety. Shame attacking exercise s are really important for social anxiety and then initial homework would be again using a book such as When Panic Attacks that is specific about treating anxiety. When we're looking at habits and addictions, motivation is going to be the number one priority. So think about it. Let's say somebody is coming in and they really want to address their cell phone addiction. They're looking at their cell phone constantly and they don't want to do that anymore and you know they're saying this is having a big impact on my life. My family feels hurt because I'm always paying attention to my phone more than them and I'm it's it's making me so distracted and it's keeping me from enjoying my life.
 

They want to give that up but let's face it, we're asking them to give up one surefire source of pleasure in their life that they've always been able to turn to so we're going to have to address that effectively. We have tools like a triple paradox where we look at the the advantages of their habit or addiction, the disadvantages of giving it up and all the beautiful things about their values that this habit shows. That's just one way of addressing resistance and our plan is to focus on what is life going to be like on that first day after our work together is complete. We're most likely going to follow up addiction work with additional treatment to to monitor progress and maintain change and then additional initial homework is going to be using those chapters I mentioned from his website.
 

Kevin: All of the treatment would need relapse prevention training. We want to discuss really well the concept of recovery and the probability of relapse. A return of negative feelings is inevitable but it does not have to turn into a full-blown relapse of the problems that brought you into treatment because we're going to teach you how to how to address that and set yourself up for success. With this case example of Cynthia, some challenges came up. We had to add a couple of weeks on to the treatment because she had unexpected need to travel for work and that meant that two hours were added so instead of 12 hours we had 14 hours but that wound up being okay because we met that challenge by making sure she was doing effective homework even while she was traveling. She followed through on that. That enabled us to keep the momentum of the treatment going and so that taught me schedule challenges can be handled with flexibility without derailing the treatment and specific achievable homework goals are really important.
 

This particular client with her 8 - 110 minute sessions over four weeks helped her make a 67% reduction in depression and a 77% reduction in anxiety and also as I discussed before symptoms were within a healthy range. They were within a healthy range of negative feelings, between zero and five is ideal, right? We give the client a treatment summary. I gave you an example of that in my handout packet to you so you can see in more detail what that looks like but we talk about their goals, all of the methods that they learned, our recommended homework and then what we recommend for followup. I'm going to breeze through this because I have not left enough time to go through this. I want to make sure that there's Q&A so there was a client who worked on a different problem with me, which had to do with his self-esteem and how he viewed himself and he was having a lots of struggles with his business that was that led to him feeling horrible about himself and he'd also developed some habits that he wanted to change and he wanted to lower his depression and anxiety and stop criticizing himself so much and end his procrastination habits.
 

So that turned into these specific achievable goals, learning and practicing skills for helping with anxiety and depression and procrastination and then we talked about what are the methods that we're going to use that are specific for achieving those goals and then some followup would be required at the end. So some challenges came up while working with him. I noticed, and Angela touched on this in her wonderful presentation, we want to make sure that the client isn't getting lost in this work, that they're staying organized and that they understand how to use the methods and it was clear that that was not helping with this client. So we slowed things down and I helped him organize his notes. We moved more slowly through one problem at a time and that helped him get back on track.
 

So I learned that I really want to make sure that this client is going to know how to use the tools when he's done with the treatment and I may have to work a little bit more slowly than I want to work because this person has never used these these methods before. They need to learn how to use them themselves. He made a 50% reduction in his depression and anxiety and thought that this was really successful. So I'll let you review this when you look at our slides that you can download to understand some tips that I've learned from challenges with intensives but it's a review of of what I just presented with those two case examples. Then I'll mention that intensives at Feeling Good Institute are constantly available and I love to collaborate with other therapists so if you have a client who you think would be a great fit for our program and that would enhance your work with your client, then you can reach out to me, kevin@feelinggoodinstitute.com and I can help set up your your client for success and then return them to your care when we're done. So I'm going to turn this over to Jill who has some more things to tell us.
 

Jill Levitt: Thank you so much, Kevin and Angela. So I hope you'll all stick around. Here's kind of the plan for our remaining 15 minutes. I'm just going to tell you guys a little bit, maybe two minutes worth of talking to you guys a little bit about some other trainings that we have and then we're going to spend about 10 minutes doing a Q&A with Angela and Kevin. I've collected a ton of questions from you all and we'll be able to answer some of them and then with five minutes left to go I will drop the CE survey in the chat box. So if you can go to the next slide, Kevin, I'm just going to share with you guys a little bit because we've been getting questions about how can I learn more about this? Angela and Kevin had so many interesting things to say. So I will say that if today's training sparked some interest for you, if you feel excited to sort of take what you've learned and and get your your skills, increase your skills or take your skills to the next level, we would love to invite you to the FastTrack to Level Three TEAM-CBT Certification course and this is kind of our most efficient and powerful way to help therapists kind of uplevel their skills. If you can move to the next slide, Kevin.


So Angela and Kevin talked to you about many techniques today. Actually people even wrote in the chat box, "I want to learn more about assigning homework. I want to learn more about these empathy skills they're referring to. What's the double standard technique?" And so in the FastTrack to Level Three course we actually cover most of these 50 methods that are on the slide, actually in the course of six months and I'm going to break the course down for you in just a second but if you're interested the next kind of iteration or the next cohort of the course starts in January and there's a coupon code there that I put in the chat box as well that's called "skill up 50" which if you register for the course by the end of the day today and you use that you can get $50 off. Kevin, will you move to the next slide for me?
 

Jill Levitt: So this slide is kind of busy. We know it has a lot but we kind of wanted to give you a full picture of what's included. So it's a hybrid course format which means that every week you have asynchronous material, videos that you watch of me training. So kind of didactic teaching with slides and handouts, lots of interviews of me and David Burns who kind of created this model. So there's all this asynchronous material you can consume and learn on your own between 30 minutes and an hour of that each week and then every week you join a live online deliberate practice group. So Kevin's leading one of those groups right now and some of the groups are run by Maor Katz, the founder of Feeling Good Institute and Mike Christensen, really phenomenal trainers and in those practice groups you actually have an opportunity to practice the skills that you learned on your own and all together it's about 46 continuing education credits.


You also get David Burns's Toolkit, which includes all the measures we've been talking about, many, many tools and handouts and things like that and it includes TEAM-CBT Level Two and Three certification and exam fees and we added a 30-day money back guarantee because we want people to know they can even try it and if you're not happy in the first 30 days then you can get your money back. I think that's all I wanted to say about it on this slide but if you're interested in registering you can go to the Feeling Good Institute website or you can go simply to this fasttrackcbt.com and I also put the link in the chat box and then on this slide I won't read these testimonials but often students will reach out to me during the course to say, you know, "I wish I had had this course in graduate school," or, "Finally I'm learning tools that are improving my therapy outcomes." So just wanted to share some of those comments with you that make us feel really good and excited to be able to teach and train therapists. So let me now facilitate the Q&A and you can go back and remember to use the coupon code. So let me go back and I have a list of questions for you guys and then in a few minutes I'll put the link to to complete the survey in the chat.

 

Q&A Session