244: The Paradoxical Nature of TEAM, Featuring the Fabulous Matthew May, MD

The Paradoxical Nature of TEAM In today’s podcast, we are honored to feature Matthew May, MD, a brilliant and beloved colleague of Rhonda and David. Rhonda suggested the topic for today’s podcast on the Paradoxical Nature of TEAM, and Matt and I were more than excited to dive into this cool topic! We reviewed the paradoxical nature of the four components of TEAM. As you will see, each paradox requires one of the four "great deaths" of the therapist's "self," or "ego." The Paradoxes in T = Testing TEAM therapists assess how the patient is feeling “right now” in at least six dimensions just before the start and just after the end of every therapy session using brief, extremely accurate scales for negative feelings like depression, suicidal urges, anxiety, and anger, as well as happiness and marital / relationship satisfaction. These scales are like an emotional X-ray machine so therapists can see, for the first time, exactly how effective or ineffective they are in every single therapy session. You can also see exactly what happens to the patient’s feelings between therapy sessions. Therapists may make several potentially disturbing discoveries during Testing. His or her perception of how the patient feels are frequently wildly inaccurate. The therapist’s perceptions of the degree of improvement in his patients may be shocking, since the therapist will often discover that patients have not improved, and may even feel worse. These “disturbing” discoveries can be celebrated, because the therapist, if humble and open, can accept the fact that his or her therapeutic strategies are not sufficient, and that meaningful change has not yet happened. The therapist can search for and try different treatment methods that may be more helpful for each patient. Paradoxically, the therapist’s failures become golden opportunities for learning and growth every day, and your patients will become the greatest teachers you’ve ever had. This involves the first of four “great deaths” for the TEAM therapist—the death of the “self” that has expert understanding of how patients actually feel. You will discover that your perceptions are very inaccurate in many or even most situations. This discovery can transform the way you practice if you have the courage and humility to try something new! The Paradoxes in E = Empathy At the start of the session, the therapist attempts to listen and provide an empathic, compassionate connection with the patient, reflecting back how the patient is thinking and feeling and convey acceptance and warmth. But here’s what happens in TEAM. When assessing empathy with the “What’s My Grade Technique” during the session, the therapist will often / nearly always discover that you didn’t really “get” the patient. When you review your scores on the Empathy and Helpfulness Scales that patients complete at the end of every session, most therapists are shocked to see that they get failing grades from most or nearly all patients after most or nearly all therapy sessions. Paradoxically, this is a big plus because it allows the therapist to explore his / her failures with the patient in a spirit of humility and curiosity at the start of the next session. If done skillfully, this can lead to therapeutic breakthroughs as well as a significant deepening of the therapeutic alliance. But this also requires a second “great death” of the therapist’s ego, because patients’ criticisms on the feedback forms will nearly always be accurate, and often biting. If you have the courage and skill to acknowledge that truth, the therapeutic relationship can be instantly transformed. Learning skillful empathy skills, using the Five Secrets of Effective Communication, requires tremendous commitment and practice, and the “beginner’s mindset.” The Paradoxes in A = Assessment of Resistance (formerly called Paradoxical Agenda Setting) During this phase, the therapist brings the patient’s subconscious resistance to conscious awareness, and melts the resistance away using approximately 20 “resistance melting” techniques, such as Positive Reframing, the Paradoxical Invitation, the Acid Test, the Gentle Ultimatum, the Externalization of Resistance, Sitting with Open Hands, and more. During this phase, the therapist, paradoxically, does NOT try to “help” the patient, but instead assumes the voice of the patient’s subconscious resistance, helping the patient suddenly “see” why she or he actually should NOT change. Paradoxically, the moment the patient “gets it,” there will be an illumination, and the patient will suddenly lose his or her resistance and become way more open and collaborative. This what makes the rapid recovery in TEAM-CBT possible. The patient also discovers, paradoxically, that his or her symptoms, like depression, hopelessness, and feelings of worthlessness, anxiety, or rage, are NOT the expression of what is wrong with him or her, like a “mental disorder” or “chemical imbalance in the brain--but the manifestation of what is right with him or her. In other words, there are tremendous benefits hidden in every negative thought and feeling. In addition, every negative thought and feeling reveals something positive and awesome about the patient and his or her core values. These discoveries can be mind-blowing for the patient and therapist. Matt and Rhonda do an entertaining role play of a woman who is enraged with her husband, and blames him for all of the problems in her marriage. Matt beautifully illustrates (as he always does!) exactly how to “Sit with Open Hands” and transform her angry resistance into enthusiastic collaboration and a willingness to examine her own role in the problem. Matt and David also discuss an amazing concept called “therapeutic entanglement,” borrowed from quantum physics. They explain how the minds of the therapist are often connected, constantly mirroring each other during the session. So, the more the therapist becomes the resistant and oppositional part of the patient’s subconscious mind, the more the patient assumes the helpful mind an role of the therapist. This phase of the therapy involves the third “great death,” because the therapist’s “helping” or “rescuing” ego has to die. That’s because your job is to see exactly why the patient should not change, and to help the patient discover this as well. The moment the patient “sees” this, and “gets it” at the gut level, recovery will be just a stone’s throw away. The Paradox in M = Methods. At this stage, the therapist focuses on one of the patient’s negative thoughts, like “I’m a loser,” or “I’m unloveable,” or “I’m a hopeless case,” and selects ten or fifteen M = Methods to challenge and crush the thought. Methods might include Explain the Distortions, Examine the Evidence, the Paradoxical Double Standard, the Externalization of Voices, the Acceptance Paradox, and more. TEAM-CBT includes more than 100 methods drawn from more than a dozen schools of therapy. The goal is not therapeutic success, but therapeutic failure. That’s because the faster you fail, the faster you’ll get to the technique that works. And the very moment the patient stops believing the Negative Thought that’s causing his or her negative feelings, the feelings will change. This phenomenon can sometimes be dramatic, even mind blowing. But even in this process, the therapist is almost always playing the role of the patient’s negative thoughts, and the patient is the one who is arguing for change. The M = Methods involves the death of the therapist’s “expert self,” thinking that you’re going to help, rescue or save the patient with your favorite brand or school of therapy, or the exciting new method you learned in some workshop and taught by some charismatic guru. TEAM involves giving up all the schools of therapy, and the spirit of “failing joyously” using a wide variety of methods drawn from more than a dozen schools of therapy. TEAM is not a new school of therapy, but a science-based, data-driven framework for how all therapy works. And so, that’s a little peek into the extensively paradoxical nature of TEAM-CBT! What’s the point in having such a paradoxical approach to therapy? I (David) can only speak from personal experience, I love having tools that can work dramatically and quickly for the vast majority of my patients. That’s because the moment they “recover,” I “recover,” too, and we both become euphoric. So I’m highly motivated to push for rapid and dramatic changes, and this is usually (but not always) possible. I love having a form of therapy that makes patient resistance virtually impossible. I no longer have to deal with resistance. It is impossible for a patient to resist, due in large part to the Buddhist concept of “sitting with open hands.” I love empowering my patients so that they don’t have to hang around with me for months or years waiting for change that never happens. It’s exciting to put the tools for change in their hands, so they’ll know how to deal with the inevitable relapses of negative thoughts and feelings that all human beings will experience, from time to time, for the rest of their lives. Rhonda and I are convinced that Dr. May is one of the greatest therapists on the planet earth. If you have a question or would like to contact Dr. May, please check out his website at: (www.matthewmaymd.com) Rhonda and David

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