Episode 5: Effective Communication for Teens with Mariya Pavlovsky

How do you improve communication? Talk with your EAR! That is, Empathy, Assertiveness and Respect. When we talk with our EAR, the emphasis is on listening well and trying to see the world through the eyes of the other person. In this episode, TEAM-CBT Therapists Mariya Pavlovsky and Kevin Cornelius discuss how to present the Interpersonal Model of TEAM-CBT to teens to help them learn effective communication skills and improve their relationships. Mariya Pavlovsky is a Licensed Marriage and Family Therapist at Feeling Good Institute in Mountain View, CA. She is available to work with new patients. You can learn more about Mariya and schedule a a free consultation to discuss possibly working with her in therapy at her website, MariyaPavlovskyLMFT.com

• Transcript

  Kevin Cornelius: Today we have Mariya Pavlovsky with us. Welcome, Mariya.

  Mariya Pavlovsky: Thank you. I'm so happy to be here.

  Kevin Cornelius: Oh, it's great to have you here with us. And welcome to the Tools4Change Podcast. We'd love to get to know a little bit about you. So I know that you're a licensed marriage and family therapist, is that right?

  Mariya Pavlovsky: Yes.

  Kevin Cornelius: Yeah. And in private practice at Feeling Good Institute in Mountain View.

  Mariya Pavlovsky: Correct.

  Kevin Cornelius: Yeah. And maybe you can give the people listing an idea of, you know, who are the types of clients that you're usually working with.

  Mariya Pavlovsky: Yeah, absolutely. So, I'm a licensed marriage and family therapist. I work out of the Mountain View office, but I also work virtually anywhere in California. And I mean, I see people all across the lifespan, so I don't necessarily have any limits on that. I tend to get a lot of, at least recently, teenagers and young adults, kind of college age individuals. I do enjoy seeing teenagers and young adults. I enjoy seeing everyone, but I tend to get that group of people also like, you know, folks out of college like maybe in their thirties. In terms of individuals who I particularly like to gravitate to, I really enjoy, you know, aside from everyone that I see, but I do also enjoy doing like parent coaching.

  I like working with parents of the teens that I see as well. I feel like that ends up happening quite a bit, even if the referral is just for the teenager, I do end up incorporating their parents. And yeah, I enjoy this job that I have. I don't even think, you know, I don't know. I love this profession. I love my job. I enjoy all my clients and things like that.

  Kevin Cornelius: Wonderful. And when you said that you work with people all across the lifespan. Are you working with children younger than teens, or is it pretty much teens and older? Oh, children younger than teens too.

  Mariya Pavlovsky: Yeah. So I do have kids who are younger. At the Feeling Good Institute, the youngest I've seen is like on regular therapy kind of weekly basis, was an eight year old I saw for a little while. And then just in general, outside of FGI, I guess like in other positions, I've seen kids as young as six.

  Kevin Cornelius: Okay. And I'm curious, is there any type of problems that you think that you specialize in helping people with?

  Mariya Pavlovsky: I guess I like to work with anxiety. I like to work also with depression. For the teenagers and my young adults who are in college, we tend to do also a lot of like habit and addiction work. A lot of procrastination happening. I think that with the teens, other than doing like habit and addiction stuff, and also some anxiety and depression, like, it's all kind of like, you know, it's all in there. But when I do introduce the parents into the work, we do also do a little bit of communication training and the five secrets of effective communication; I teach the teens and I teach their parents separately. And that usually makes things go a lot smoother when we have family sessions. Of course they're not like experts in it, but there is some understanding of how we can speak to each other kind of in a respectful way, even if we don't agree with one another.

  Kevin Cornelius: Yeah, I like what you just said that when you're working with teens and parents, it's helpful to teach both the teen and the parents at least something about five secrets, so that they're already practicing communicating respectfully even when there's a conflict going on. So that if you're having a family session together, there's some kind of like understanding of we're going to attempt to speak in a respectful way to each other. Did I hear that right?

  Mariya Pavlovsky: Yeah. Absolutely. I do try to set up our family sessions, and so I don't necessarily do family therapy from kind of like, from the get go type of thing, I don't take on families myself. But I do think that obviously it's important to work with families - with the parents of teens, because I see them for maybe an hour a week, but their parents have them for all the other hours. And so, I do usually incorporate them at some point. And I think what's important is to make sure that it's a positive experience for everyone. And one of the ways I know to create a positive experience in this family session is to have some sort of like outline and some sort of rules, and incorporating the five secrets helps kind of established kind of a foundation of respect in the room.

  Kevin Cornelius: Yeah. And I love everything you're saying, and I think that one of the things that I've learned about Five Secrets that's most important is that we're not attempting to not have conflicts. Like, conflicts are inevitable, and to try and get rid of them is probably not super helpful to anyone. But can I have a conflict with you in a way that's respectful and that actually creates an opportunity for us to feel closer to each other rather than pushing us away from each other? And it sounds like you're doing a great job of creating that possibility with some guidelines before you bring, say, parents and a teenager together in a session. Is that sound right?

  Mariya Pavlovsky: Yes, that is the goal. And I think ultimately what my goal in bringing like parents and teens together in this way is to create like a different experience for everyone. Because when at home or when there's things that are happening and the parents, for example, are stressed that the kids aren't turning in all of their work. Nowadays, I guess parents have access, my parents didn't have access to any of my grades.

  Kevin Cornelius: Exactly

  Mariya Pavlovsky: Have access to all grades at any, like, just on their phones. And so, as they see, for example, like kids not turning in work or things like that. I mean, it's immediate conflict. It's immediate kind of an interrogation that ends up happening. And then the kids tend to feel like they're constantly being nitpicked and constantly being kind of almost harassed by their parents. And so, that kind of spirals into other things potentially with anxiety and kind of maintaining some of the negative habits of procrastination or maybe even depression and things like that. And the point is kind of similar to I think what we as therapists try to provide for our clients, which is this kind of different experience of being with another person. There's a term for it, but I forgot. Oh my gosh.

  Kevin Cornelius: Therapeutic stance?

  Mariya Pavlovsky: Or like this experience - I'm not going to remember it right now, but the idea being to trying to create like a different experience and for the parents and the kids to leave the room having this different way of communicating. Even if it was for only like 50 minutes, like that's something that they can then take and remember and kind of have a reference in the future for, that it doesn't always have to be like a conflict.

  Kevin Cornelius: Wonderful. And I think that people who are listening to this may or may not already be familiar with the Five Secrets. And so, something that comes to mind for me is, maybe it would be great to have you show us, let's say that you're introducing the Five Secrets to a teenager because they have been procrastinating doing their homework and their grades are suffering and there's been some conflict with parents, and maybe even you are preparing for bringing in parents into a session with them, right? And you're just trying to help them understand like what the five secrets are and how that could be a useful tool for them. Before I ask you to show us how you would do that, though, I want to clarify something that, of course, we don't just throw methods at people when we're working with them. So, this is assuming that you've already spent lots of time getting to know this teenager, bonding with them, connecting with them on a personal level and creating some trust with them. You've been using testing too, too, to figure out how are they doing with mood. You might even be tracking in some way, what is their procrastination, if that's a problem that you're helping them with - lots of empathy

  So I'm going kind of through the team model testing, and then lots of empathy. And then of course, a lot of assessment of resistance. So if somebody, let's say the teenager is saying, I do want to have a better relationship with my parents than I do, because it just seems like we're always in conflict over my schoolwork and my grades. Let's imagine you've already done lots of really good assessment of resistance around that, what would you do with them, by the way, to address any kind of resistance to change in their relationship with their parents?

  Mariya Pavlovsky: So the way that I use the team model with teens - I mean, I do use it, but I can't say that it's like the way that I would use it with adults necessarily. I think it has to be like woven in, into just like kind of regular conversation with kids. But there's always this conversation that I do have about, you know, what are the good reasons just to continue either... well, if it's for habits and addictions, of course we do, what are the good reasons for continuing this habit. But in terms of the communication stuff, well, what are the good reasons for continuing to, for example, like, ignore your parents when they speak to you or yell or slam doors. Like, what are the good reasons?

  And for some kids, they have lots of good reasons that sometimes they want to keep a distance from their parents and this is one way to do it. And it kind of, if we're talking about like, what is a show that's really wonderful about them? Well, they want to kind of protect their energy and their space. And I think kids these days, and again, I don't know, when I was a teenager, I do not remember doing this amount of work and these sorts of level of work that the kids are doing nowadays. I don't even do it as an adult. I barely understand half the things that they say when they talk about their classwork. Kids are very smart nowadays, and I think the pressure that a lot of these kids are under is just through the roof. I do not remember it being like this when I was in high school personally.

  But I think that with all of the stress and the pressure and all of that, you know, sometimes creating this distance with parents is the only way they can have a break. And I think that that is a wonderful thing, to be able to protect, you know, the little kind of mental energy that they have. But anyways, we do that. But ultimately, before we get to the point where like, okay, well, let's plan out a family session, let's try to potentially improve the situation - we do talk about, you know, in relationships whether they want to improve the relationship with their parents, whether they want to kind of keep things the same way and then just get through it in the next few years before they leave to college. I mean, it's not really a possibility, but, you know, do they want to kind of disconnect even more? I mean, that's generally not an option. Most of the kids say they want a better relationship with their parents.

  Kevin Cornelius: Well, I really like that you brought that up. What you're mentioning is the concept of interpersonal decision making. So when we're doing relationship work with people, no matter what the relationship is that they're working on, whether it's a parent-child relationship or a partner or a spouse or something; everybody always has three choices about what to do in a relationship. You were just mentioning them. It's, stick with the status quo and figure out how to survive it, do the hard work of working on their own role in order to improve the relationship, or the third one is leave the relationship. And I heard you saying like, you know, maybe most teens don't really have that as an option. I'm going to leave my relationship with my parents, but they could emotionally leave it, like distance themselves even more from them and just kind of silo themselves and just kind of can't wait to get out the door and get onto adult life when high school's over. And you said that when you explore that with teens, that more often than not, they actually are wanting a closer relationship with their parents. Is that right?

  Mariya Pavlovsky: Yeah. I found that most kids I end up doing this with, they do want a better relationship. They don't want to be like constantly stressed out in their own house or just around their parents. So yeah, I do find that kids are interested in improving. And I don't push it either. You know, sometimes it does happen where maybe they decide actually the status quo is fine, let's work on how am I going to just deal with the next few years? And so then that goes into some other type of work, maybe with using the daily mood log and things like that of how do they just kind of like lower their own emotional intensity around certain situations at home. But most kids do want things to get better, which is nice.

  Kevin Cornelius: I think that is nice. And so I was thinking about this idea that, let's say somebody, you know, you did kind of explore with them that interpersonal decision-making, they've made it clear that, yeah, I do want to have a better relationship with my parents. I'm wondering how do you address, well, you just said you bring to life, or you kind of explore them all the good reasons to actually remain distant from them. And that sounds like what you're doing is almost like a paradoxical cost benefit analysis. Is that what that is?

  Mariya Pavlovsky: Yes.

  Kevin Cornelius: And tell us what that is. What is a paradoxical cost benefit analysis for relationships?

  Mariya Pavlovsky: I mean, in general, the cost benefit analysis - normally the way we do any kind of cost benefit analysis, people tend to do like, what are the cons of a situation or start with that, and what are the pros? But in this situation, we actually talk about what are all of the advantages to it initially. We're trying to kind of bring to light some of that resistance to change and kind of bring to light, you know, because otherwise what happens is, obviously there's the obvious like, well, maybe you should, I don't know, have a better relationship with your parents because they're your parents. And of course - and usually kids will take the stance of yeah, but you don't understand, they're this, they're that, so it's like a yes/but situation that ends up happening.

  And if we just kind of highlight all of the good reasons for them to just say exactly the way that it is, you know, for them not to get closer to them and highlight what are the wonderful reasons that are kind of underlie this experience of not wanting to get close; once we name all of those things, it tends to push people to the other side and they start to name things like, "Yeah, but it's really hard. You know, we used to have a lot of fun together as a family. I actually used to really like hiking with my dad or mom or something." They start to like, bring up all of these reasons, well, maybe it's not so great to stay the same.

  Kevin Cornelius: You said so many important things just now and I'm just going to back it up a little bit. So, a cost benefit analysis in general is just looking at the advantages versus the disadvantages of something. And to make it paradoxical would be, you would look at the advantages of the way things are and the disadvantages of changing. Is that right?

  Mariya Pavlovsky: Yeah.

  Kevin Cornelius: So for instance, what are all the advantages of having conflicts with my, you know, kind of protecting my... well, actually no, that would be one of the advantages. What are the advantages of remaining more distant from my parents and what would be the disadvantages of getting closer to them? And it sounded like the reason to use that in a paradoxical way like that is because here you are, another adult in this teenager's life, who, if we're coming to them and saying, "Oh, yeah, you want to have a better relationship with your parents? Well, let's look at the good reasons to keep things the way that they are and also the good reasons not to, to actually change." It can almost maybe come across as like, we're kind of trying to convince them to have a closer relationship with their parents, and we want to be really sensitive to any kind of coercion sensitivity. So if we're really paradoxical with it, let's just look at the advantages of the way things are and the disadvantages of changing them. Then it gives that teenager the opportunity for them to make the argument of, "Well, yeah, but I missed them. We used to have a better relationship and I want that again. Or I actually long to like get along with my parents and there are some things about them that I like and it would be great to have a better relationship with them."

  But it's all coming from them; it's their idea, once we just focused on all the good reasons for keeping the problems that they're having. And so, let's say that that's gone really well, right? Let's say I'm a teenager in a session with you. I know kind of comical because I'm a 55 year old man, I do not look like a teenager, but we'll just pretend. I'm a teenager and I've convinced you that actually, I do want to do what would be kind of hard work to work on my role and the problem with my parents - to take a look at how I could change the way that I'm communicating, even though that might be kind of unfair for me to be just focusing on myself. Maybe you could just show people who are listening, like, how would you introduce even what the five secrets are to a teenager for the first time? Because I think that that would be really great for people to hear.

  Mariya Pavlovsky: Yeah. Just a side note, I just think this is kind of - because you're like the king of five secrets.

  Kevin Cornelius: Well, that's a really nice thing to say. I'll just put it out there. If you were in one of the sessions that I had with a teenager this week, you might think otherwise.

  Mariya Pavlovsky: But in general, for me, that's how I think of you, so it's like, oh my gosh. So for teens, again, it's not always necessarily the language of team that I use with them. But, I tend to, you know, in terms of sharing what the five secrets are, I usually say like, "I have these tools that I think will make either the family session or any kind of conversation that you're trying to have with your parents a little bit nicer to have." I always end up saying that, like, that it does feel unfair, you know, I'm going to share these tools and I'm going to ask you kind of to look at them and to use them and for us to come up with these responses. And I know that maybe all you want to do is yell at your parents, or not yell at them, just basically ignore your parents. And I know that it feels unfair, and I feel that too. And yet at the same time, you've told me that you do want things to get better, and this is kind of the, you know, not the only way, but one of the big ways that I know that we can make things better faster for you. And then I kind of go into showing them what the five secrets are, will review all of the steps to it, and then -

  Kevin Cornelius: What are the five secrets, Maria?

  Mariya Pavlovsky: So, the first one is the disarming technique. And that's where we try to find some grain of truth in what the other person is saying. And so for example, if the parent says something like, "Well, Hey, Kevin, you never turn your work in on time." And even though as Kevin you know that that's not true, in fact, you've turned in lots of your work in somewhat on time, you know, there is some truth to it because there's missing assignments. There's a reason why your parents are coming at you in this way. And so, I would kind of work with Kevin when it comes to like the disarming technique for Kevin to find some truth in what they're saying. So it might sound like, "You're right. I haven't turned in a lot of assignments recently. That's true."

  And it's not to say that you've never turned in the assignments, but recently maybe there's been some missed assignments, and that's absolutely just the reality of the situation. And that one's hard to do. They're all hard to do, to be quite honest, especially when we're upset. And then we have the thought empathy and our feeling empathy, and the thought empathy has to do with somewhat reflecting back or summarizing maybe what the parent had said. And the feeling empathy sometimes sounds a little bit weird from the kid's perspective to say that a parent, I think sometimes when I do this with parents, the feeling empathy really goes a long way with parents using it with the teens.

  But feeling empathy is kind of putting yourself in the other person's shoes. So, Kevin putting himself in the shoes of his parents, and we kind of talk about like, "Well, why are your parents even coming at you in this way? Why are they upset?" And kind of talking about, you know, and usually the kids say, "Well, they're frustrated that I haven't turned in this work. Or they're feeling nervous because the end of the semester is coming, or they're feeling angry because I also haven't been cleaning the dog poop outside, and here's just another thing that I'm not doing." So, we do kind of talk about what are all kind of, maybe the feelings that parents are having that they're, again, upset with the kid.

  And one of the other parts of the five secrets is stroking which is basically saying something that they genuinely kind of feel is like a positive, whether in the parent or they're in the relationship. It might sound from the kid's perspective like, you know, it's weird because from the kid's perspective, it's a little bit different. And I'm just thinking as a kid what I might say to a parent, but might sound like, you know, I really love you and I value this, I value our relationship; I don't want it to be so high conflict. Maybe they're not using these words, and we always try to like use the words of the kid if we're working with the kids. There might be some slang in there. I don't know. Kids also have a completely new vocabulary nowadays with how they talk.

  Kevin Cornelius: Yeah, I like all the things that you're saying, Maria, and I'm thinking, let's imagine that, you know, what my parents said to me was, "Hey, Kevin, you never turned in your homework." And so far you've mentioned three of the five secrets, right? Disarming, which is where I would try to find something that I could agree with, with what the parents are saying, even if it was unreasonable or unfair. And then thought and feeling, empathy. The thought empathy is being able to kind of repeat back what it is I'm hearing, and then the feeling is imagining what the parent is feeling when they say that to me - so what feelings might they have. Let's face it, for a teenager with a parent, they're probably not thinking about that a lot usually. They're probably maybe more focused on themselves and their feelings and what's unfair in a situation like this.

  And then stroking, which is finding something that's true, that's positive that you could say about the other person, right? Considered just even those three of the five secrets for a moment? Maybe let's trade roles for a minute. Let's say I was the parent and you were a teen who was going to use those secrets well; see what it's like to respond to me when I'm the parent saying what I'm going to say to you, which is the thing we set up. You're a teen and you're going to try to use disarming thought and feeling empathy and some stroking. "Gosh, Maria, you never turn in your homework."

  Mariya Pavlovsky: You're right - Dad. You're right, dad. I really haven't been turning in my homework, especially in the last two weeks. I imagine you're feeling really angry with me right now. But I guess I just also want to say that I love you, but you're right, I haven't turned in the work.

  Kevin Cornelius: Okay, great. I think that that was a really good demonstration of those three secrets, and in pretty teen friendly language, I would say, right? Maybe some teens might bristle at, you know, do I really want to tell my parents I love them when they're getting out...?

  Mariya Pavlovsky: I know. That's why I also was like, I don't know,

  Kevin Cornelius: Yeah. There's another secret that we haven't talked about yet. What's another one that we could maybe throw in here that might make this actually a little bit easier to respond using those other secrets?

  Mariya Pavlovsky: Yeah, so there's also an "I feel" statement that comes from the teen. So, if the feeling empathy is, you know, what is the other person kind of feeling during this interaction, for example, the parent; the I feel statement allows the teen to talk about how they're feeling. Maybe they're feeling angry, which they usually are, or frustrated or disappointed or annoyed. And so, it allows them to kind of speak to what's happening for them as well. And oftentimes I find that there's a lot of comment, you know, the parents are angry, the kid is angry. Or there's disappointment that the parent has and usually the kid is also feeling disappointed about something as well in the interaction. So it's kind of also a nice way to connect on kind of on the feelings level because everyone kind of understands that feeling of anger or disappointment or whatever it may be.

  Kevin Cornelius: Great. So I was just imagining if I was the teen and my parents have just told me, "Hey, you never do your homework," and I'm jumping right too and finding something about that to agree with, it might be really great to also share how I'm feeling hearing that. Like, "Yeah, you're right. I haven't been doing much of my homework lately, and you're probably feeling pretty frustrated with me right now. I have to admit, I'm feeling kind of defensive, like I want to defend myself and point out things I have been doing. But I get it that you're noticing the things that I didn't turn in because you're concerned about me. And I think that that's a good thing. You're trying to help me and make sure I do the best I can in school. But I definitely do get irritated sometimes when you're trying to help me." So I was just using just those secrets, the disarm, the thought and feeling empathy, the stroking, and then also some I feel, right? Now, what's the, what's the one we haven't talked about yet?

  Mariya Pavlovsky: Yeah. So the last one is inquiry. So that one has to do with opening up kind of... well, for asking a question, you know, what has it been like for the other person? So, what's it been like for you, Dad, to look at my Schoology and see that I haven't turned in my work in the last week? But basically what is it like for the other person and the goal being to kind of open the floor up to them for them to kind of speak to their feelings of whatever frustration or being disappointed and to kind of get their perspective.

  Kevin Cornelius: I think what would be really probably good right now is let's see what it would be like I'll be a parent again, and I'll hit you with that same criticism, and then you can respond using all five of the secrets, so we can hear kind of like, what's a great response to a parent saying this to a teenager.

  Mariya Pavlovsky: I don't know if it's a great response. It'll be a response.

  Kevin Cornelius: A response. Well, a response using the five secrets. And let's keep in mind like the reason why we use the five secrets. And tell me if I'm right about this. The reason why the teen would want to use the five secrets is so that instead of just focusing on the problem of the homework hasn't been getting done and trying to solve that problem, or even solve the problem of the parents getting on your back for not doing the homework; what we're doing is we're using the conflict over homework completion as an opportunity to get closer to each other. To understand each other more and to share our feelings with each other, even when we're feeling kind of negatively towards each other. We're kind of putting problem solving aside and saying, you're important enough to me that I want to know about your feelings even when you're frustrated with me. Does that sound like it?

  Mariya Pavlovsky: Yes, because the content isn't that important. Like whether it's homework you didn't do, or you didn't clean your room, or you said you were going to do the dish, like it's all the same ultimately, and it continuously like repeats itself in just kind of different ways. And so yeah, this is a way of kind of coming together on a deeper level. Because all of this other stuff, the homework, the dishes, like, it's very superficial, and it could be solved if we weren't maybe harboring certain emotions towards one another.

  Kevin Cornelius: Okay. I brought that up because I think that the thing that I learned that helped me the most with using Five Secrets, not just in my own life, but also with clients, is this idea that problem solving is the cause of most problems in relationships. And refusing to solve problems is usually the solution to relationship problems. And what we mean by refusing to solve problems, what do we do instead? Well, we focus on what are you feeling and what am I feeling? What's it like to be in this conflict with each other right now?

  Mariya Pavlovsky: I guess like another point I would kind of make on this when it comes to what I've noticed with teens is that, it's not that they don't know what the solution is. They know that they have to turn their work in, but there's usually something that's happening kind of under the surface, where either this motivation is being affected, but it's usually having to do with the kind of day-to-day interactions that they're having with their parents, with teachers, with friends. But I found that a lot of it does have to do with the interactions that they end up having at home with their parents, where they kind of end up feeling less motivated or just kind of like, almost out of spite sometimes. I don't know if it's conscious all the time, but kind of like, "Well, I don't want to do this right now, I want to be left alone in general." So yeah, there's usually something under that. And so, the five secrets helps to get to that.

  Kevin Cornelius: And so what's give you now that opportunity to use all five secrets while responding to the parent, if that's okay? Hey Maria, you never turn your homework in on time.

  Mariya Pavlovsky: Hi, Dad. You're right! You're right! I haven't been turning my homework in on time, especially this past two weeks. There's probably a lot of zeros that you've seen in my Schoology, and I imagine you might be feeling really frustrated with me because we keep having this conversation over and over again that I should be turning my work in. You might even be feeling angry that I'm not turning this work in. To be honest, I've actually been feeling kind of angry myself. I've been feeling kind of frustrated with some of the interactions that we've been having and kind of feeling kind of low motivation as well because of it. And I guess I'm bringing this up because I appreciate you checking on my schoolwork and I know you're doing it from a good place. You know, I know you care about me, I know you want me to do well, and I love you for that. I guess I'm just wondering also, what it's been like for you to look up my Schoology account and I guess see all of those zeros. Maybe you can just share more about what it's been like for you.

  Kevin Cornelius: Okay, great.

  Mariya Pavlovsky: Did I miss one of them?

  Kevin Cornelius: I think you got all of them in there. I heard some disarming, I heard some thought and feeling empathy. There was inquiry there at the end that was really great. There was lots of stroking and you also talked about your feelings.

  Mariya Pavlovsky: Yeah. And with kids, we don't do all of like, you know, when I teach them, I teach all of them and we practice like all of them. But usually when we get into like a family session, I don't expect anyone, you know, first of all, I don't expect a teen or a parent to necessarily like know the five secrets and be able to use all of them. So there's usually like parts of them are being used. I think to me, like in a family session, the ones that I tend to like to hear the most is feeling empathy. I think it's nice when parents are able to say, "You know, I imagine it's been really tough for you that I've been nagging on you this whole year."

  Like some of them, especially in a family session that I personally like to highlight quite a bit, and the other thing that I think in a family session that ends up working well is that when the feelings are brought up, it's a kind of a nice way for me as the therapist to be like, "Well, it sounds like both of you guys have been really angry." Kind of, where's the commonalities in all of this? It sounds like both of you guys have, or the whole family has been really frustrated and angry and this has been like, incredibly stressful for everyone that the work isn't being turned in, or something like that. And we kind of come together as like a unit at that time because we're all kind of having the same experience, and we're all kind of then able to look at this problem together because it's bothering everyone.

  Kevin Cornelius: Yeah. Well, the time is flying by here and we're almost at the end of our time together for this podcast. I'd love to find out some information about you and your availability for working with people. Do you have room in your calendar for new clients often? Or sometimes?

  Mariya Pavlovsky: Sometimes. I tend to be kind of booked. Although, if somebody does either email me or call me, you know, depending on the case and depending on the time that they need, I do try to make room for people. And the other part is like, I can't really, you know, like for example, I'm full right now, but I can't predict what next month is going to be like necessarily as people graduate. There is more availability in the summers as people kind of like taper off, especially kids, they take breaks. And in the summer, I would have more availability for things like more intensive therapy where there's more hours that I could give to a particular person who might need it in a shorter amount of time. It's hard to know. Like right now I'm a little bit full, tomorrow I might not be, so I don't know.

  Kevin Cornelius: Yeah. I'm sure people are who are listening are feeling a connection with you and really interested in the way that you're talking about how you work with people and they may want to explore the possibility of having you as their therapist or a therapist for their family member. If they wanted to explore that with you, they could probably make an appointment for a free consultation with you, right? And how would they reach you for that?

  Mariya Pavlovsky: Yeah, it would be my preference. My calendar is currently closed to consultations because I am full right now, but on our website, my email is listed, so if people just email me, that's one way, and then I could set up a 15 minute consultation kind of on my own with them. The way that our website works, like technically, my calendar's not open to that right now.

  Kevin Cornelius: So a person could contact you and it's Mariya@feelinggood institute.com, is that right?

  Mariya Pavlovsky: Correct. Yes.

  Kevin Cornelius: And that's Mariya with a y? M-A-R-I-Y-A, is that right?

  Mariya Pavlovsky: Yeah.

  Kevin Cornelius: At website at feelinggoodinstitute.com. And also, I don't remember, I think you have your own website as well, don't you? What is your website that people can visit?

  Mariya Pavlovsky: I do. My website is, let me bring it up because I don't have it off the top of my... It's mariyapavlovskylmft.com.

  Kevin Cornelius: And that's at lmft.com?

  Mariya Pavlovsky: No, no, it's just .com. This is the website that

  Kevin Cornelius: Wait, I'm sorry. What's wrong with me? It's not an email address. Mariyapavlovskylmft.com. I'll put that in the the notes for this episode. And then people, if they want to, they could go and read about you and make appointments with you. They couldn't do better than to have you as their therapist. That would be so awesome. Thank you so much for being here with me. And for those of you listening, we'll be talking to you next time.

  Mariya Pavlovsky: Thank you. It was fun.

  Kevin Cornelius: Thank you..

Episode 4: Parents of Depressed Teens with Ryan Moeller

Note: In this episode, Ryan Moeller, LMFT and I explore working with the Five Secrets of Effective Communication and the Relationship Journal. These are powerful tools created by Dr. David Burns. You can learn more about these tools on Dr. Burns’ website, www.feelinggood.com. You can learn more about the Interpersonal Model of TEAM-CBT at this link. You can also get a lot of help from Dr. Burns’ fantastic book “Feeling Good Together.”

• Transcript

  Kevin Cornelius: On today's episode, we have Ryan Moeller with us. Hello, Ryan.

  Ryan Moeller: Hello. Hello. Thank you for having me on, and I'm glad to be here.

  Kevin Cornelius: Oh, it's my pleasure to have you here. I'm so happy that I'm going to get a chance to learn a little bit more about you and about the work that you do with your clients. And so, I'd like to, for those people who are listening who aren't familiar with you yet, Ryan, maybe you could tell us just a little bit about who you are and what it is you do.

  Ryan Moeller: Yeah, thank you. I'm a licensed marriage and family therapist. I'm located here in Mountain View, California, and I'm in private practice. I work with primarily adults and teenagers and a few tweens, mostly working on issues such as, depression, anxiety, school stress is a big one, you know, for a lot of tweens also, you know, stuff like that. School pressure as well as a lot of work on screen time, procrastinating, getting good habits as well for getting everything done on time. So, those are some of the bigger issues that - most common issues that I said I work with my patients.

  Kevin Cornelius: Okay. So you just said a lot of important things there, and especially, it sounds like when you're working with teens and tweens, you're helping them a lot with depression, anxiety, school stress, screen time, procrastination, and getting things turned in on time, right?

  Ryan Moeller: Yeah.

  Kevin Cornelius: A question popped into my mind as you were saying that, because I talk to parents sometimes, right? So parents will make an appointment for a free consultation because they're actually looking for therapy for their teenager, and sometimes maybe the teen is not so onboard with participating in the therapy, and it can be a little bit awkward sometimes to talk to the parent who's got lots of concerns for their child, and then they have this child who maybe is open to therapy, maybe isn't, maybe is really overwhelmed with schoolwork already, so is a kind of therapy that requires homework, a good fit for them. And I'm wondering if you could share some of your wisdom about how you talk about those things with parents.

  Ryan Moeller: Gosh, yeah. That is the question of the ages right the. You bring up a really, really salient point, and frankly, probably a pretty common one about the different desires and goals between parents and kids. And if I may, I kind of think of it as a spectrum when working with teenagers, on the one hand, there is the ideal client, you know, the teenager that asks their parents, "Hey, can you take me to therapy? I want to get some help." Those are great. On the other side, there's the ones that their parents are kind of forcing them and or they really don't want to, and they're in the middle, right? Maybe their parents kind of encourage them to, and they're kind of open to it, but not super into it, right?

  So you know, there's a lot of exploring and learning about where they are in that spectrum and kind of working from there, right? So, you know, if they're kind of interested, not super motivated, but they're into it. You know, what I like to do is, you know what David Burns calls dangling the carrots, right? The idea of really talked to them about what you can offer and kind of in a really excited tone, right? You know, being confident in what you can offer and about how you can help them. And sometimes they take that carrot, which is great, and sometimes they don't. And in those situations, you know, sometimes you can work with the parents instead. And you can be very forthcoming in them and saying, "Hey, you know, I would really love to work with you on problem X, but you know, I can totally see why you wouldn't and far be it for me to force you to do so. But just want to let you know that your parents are very concerned about it, and I'll probably work with them on it." So really depends on the situation, but that's often kind of the mindset that I like to do, right? We don't want to force kids to be in therapy, but we can entice them and show them what we can offer.

  Kevin Cornelius: Yeah. I love what you're saying, Ryan. I found myself in situations maybe before I was in private practice when I worked for more of a non-profit agency that - I was pre-licensed, and so it was very low fee and a lot of people were coming to us because maybe they were court ordered or maybe just parents were bringing kids in and saying, "You know, help! Do something with my child, I can't help them." And I have to say, sitting in a room for 50 minutes with somebody who doesn't want to be there, it's kind of like both of us are on detention. I don't like to put myself in that kind of position where therapy feels like a punishment for the teenager and also for me. And so, I like what you said that, you know, we don't try to force anybody to be in a therapy session.

  I think that's great that you can dangle the carrot and where we're explaining all of the potential benefits of the therapy in a positive and upbeat way, but not really trying to talk to anybody into anything. 'You know, this is what I have to offer, and if you want it, that's great, and if you don't, then of course I'll be working with your parents, or I'll offer to work with your parents instead." I wanted to ask you, - well, just take the first example of what you said you work with people on, right? Like, you'll probably work a lot with teens on depression, right? And so, I'm imagining a parent coming to you for a consultation. Of course, they're observing that their child is in bed a lot you know, maybe had some bad habits that they've gotten into as a way of kind of avoiding negative feelings, like, I don't know, video games all the time, or YouTube all the time, or something kind of falling behind in school, maybe even some school refusal sometimes. And just really low mood and low energy and low motivation. I'm curious. Maybe you could share with us; what would you say to the parent that you could be helpful to them with? Let's say that depressed teenager actually kind of doesn't want to come to therapy and you're going to work with the parents instead, what is it you could help a parent with in that situation?

  Ryan Moeller: Yeah, yeah. Gosh. That is a very good question and a very painful situation for a parent to be in. It almost sounds like in the sense that the parent is the patient. Is that kind of what you're kind of getting at? Are you kind of working with a parent as the patient, is that right?

  Kevin Cornelius: Well, I think that that's, now that you say that, I think that that's probably the only thing that we could offer them, right? If the teenagers not wanting to participate in therapy, then maybe what we have to offer the parent is, how about if I worked with you? Maybe this is difficult for you, you know, maybe you're experiencing some moods that you don't like. Maybe this feels painful or maybe you would like some help with communicating effectively with your child. And also, maybe you could just use some empathy and support around what this is like for you. So yeah, I guess you're right, we would, you would be offering to say, what if the therapy was for you more than for your child at this time.

  Ryan Moeller: Again, I ask that kind of question because it can be a little - I do think that dynamic does change a little bit if you're providing a parent session for child patient versus the parent is the patient, right? And yeah, if the parent is the patient, then I think you brought up some really great points about how we can conceptualize it, right? I can imagine, you know, perhaps as part of the kid being depressed, they probably have some really strong and negative thoughts that I'll love to help them with, right? You brought up the thing about communication, and that's actually one of the bigger things I do work with on parents is, I do like going over building the relationships with their kids using the five secrets of effective communication. That's pretty important, right?

  Because, I don't know about each specific case, but quite often this depressed kid probably isn't feeling very connected to their parents or probably for many people in general, right? They might be feeling kind of turned off or maybe some resentment or probably feeling quite disconnected from the parents. I do like hearing about getting more information about what their relationship is like, what do they do for fun of each other, what sort of joy and engagement do they have with each other. I will also say for this parent clients, you know, I do like giving some basic psychoeducation on depression, how it manifests and how it works. And we kind of can go over. In a similar way with working with the five secrets, is exploring ways to encourage them to do things that can be helpful for their mental health, but in a way that's very warm, empathing and caring versus being like an ultimatum or a consequence or something like that, right?

  So we know about, like you mentioned about these kids that would be playing video games all day or sleeping in, not socializing, isolating. We know that in order for them to feel better, you know, one aspect would be to improve their habits. Now, if the parent thinks that the goal would be to storm in and force them to do something, that's probably not going to be very helpful, right? So it would be kind of exploring ways that we can encourage their kids to do better, to recover, but without making it a battle. So, those are a few of the things that kind of come up for me when you bring up these types of situations.

  Kevin Cornelius: Ryan, I love the direction that we're going in here. If it's okay with you, what I'd like to ask you to try is maybe a little bit of a role play with me. Let's say I'm a parent of a teenager and my teen is sleeping all the time, falling behind in school, obviously depressed, is pretty unfriendly towards me, and as maybe even expressed, you know, some suicidal thoughts and what sometimes people do when they're really depressed. You're going to work with me and you're going to introduce to me the concept of the communication tools that you have to offer. And let's say that I've never been introduced to these before. Because I'll say for people who are listening to this episode, even if they've listened to the other episodes I have on the podcast, they haven't been introduced to the Five Secrets yet unless they have read one of Dr. Burns' books. So, I think it would be really interesting for people listening to hear you describe to me like what is it that you could help me with, with communicating with my teenager.

  Ryan Moeller: Yeah. So for going right into it, you know, I would first like give that parent quite a bit of my own empathy, right? Telling them how painful and scary and difficult it must be to be parenting this kid and dealing with the challenges. And I would tell you, frankly, you know, I like to hear, you know, I'm also hearing from you that your relationship with, let's say, your son is not so good. And as I may have mentioned before, you know, one of the big symptoms of depression for teenagers is feeling disconnected and isolated from their parents, and from frankly many people, right? They kind of just connect from real life friendships and things like that.

  And so, you know, I'd like to offer you, if that's okay, there are some pretty distinctive and really helpful strategies that I can really help you with to improve your relationship with your son. Now, setting aside here, I can... well, let's take a step back, Kevin, because I think, you know, throughout this role play, I would also do say, you know, normally when we talk about the five secrets, we present it, but we also talk about the interpersonal stuff as well, the interpersonal model, right? I'd say, again, for people that are listening that might know where I'm coming from, it's sort of this idea that in order to improve a relationship, there might be some resistance to that, right? There might be some good reasons not to open up or to try to get closer with this person. And I think that is one thing that we can address as well. So that was a little bit - sorry if I kind of -

  Kevin Cornelius: No, I love what you just said, Ryan. So yeah, I was kind of jumping to like this method of learning the five secrets, but I like that you pulled back and said in the big picture before you would start working with a parent, you would explain to them, you know, what the interpersonal model is and why they might not be interested in using it. And you know, because while a great close relationship can be created with another person using these tools there are also powerful good reasons not to use them. And you'd want to bring all of those to conscious awareness and discuss them and kind of have this patient you're working with convince you that even though there are many good reasons not to use them, they still would want to do the work involved to get better. Is that kind of where we're going?

  Ryan Moeller: Exactly. I don't think I could have said that better than you have, frankly.

  Kevin Cornelius: And that kind of helps us understand the TEAM model itself a little bit more clearly, right? Because of course, TEAM is that acronym T for testing, E for empathy, and then a for assessment of resistance. And when it comes to, let's say, a parent with their depressed teenager wanting to be able to communicate more effectively with them; I could imagine, like for me as a parent, if I was coming in in that situation, probably, but I want to be able to "communicate better" is, these are the things I want you to do and these are the things I want you to stop doing, right? And I just want you to get better, right? And you know, the interpersonal model that you were referring to, maybe there's a different goal in mind, right?

  Ryan Moeller: Right. You said it so beautifully. When people think about getting closer and building communication, what they really mean is, how can I manipulate you to do what I want more effectively? How can I say these magic words, get you to do your homework on time, or to stop playing video games and things like that. And what we are offering with the five secrets is something that's a bit more powerful. Much more powerful, but also a bit different, right? You know, the idea that I do think that I can really help you become more connected, more vulnerable and even more close with your kid. But at the same time, you know, there might be some really good reasons not to, right?

  I mean, if this kid is, you know, probably has a lot of depressed, you know, adolescents are usually often angry and irritable. So I can imagine your kid might, you know, would say angry outbursts to you. They might be defiant at times. They are quite often doing things that you don't want them to, which can probably engender some very strong negative feelings and blame. And the question is if you want to, to really get closer to them, you're going to have to look at your your own role in things and to kind of overcome the blame and not have that be the force there, right? So yeah, we would definitely go through that process and and see if they really wants to truly get closer with the kid.

  Kevin Cornelius: Yeah. I just want to slow down for a moment. You said something super important, a lot of really good things in there, but the most important thing that stood out to me was, I can just see myself being in this position so much as a parent, but I'm coming to you because I want you to show me how I can convince my child to change. And that's not what your role is really, is what you're saying, right? Like, your role is going to be to help me have a better relationship with my child, where there's trust that's built and where there's greater closeness and intimacy and understanding and support. And in order for that to happen, I'd have to be willing to let go of blaming my child for the problems that the two of us have. I think that's what I heard you say.

  Ryan Moeller: No, absolutely. Yeah, so that would be the big hurdle to overcome. And you think of a good point about change, you know, and you bring up how a parent wants the kid to change. But what we're offering is once you change, you know, examine your role and change how you communicate, that actually can change how the kid acts. And sort of sort of indirectly; kind of when we create our own interpersonal reality. When you change, everything changes, to an extent. And that's a little bit more philosophical than what I would say to most of my patients, frankly. That mindset does seem to work. Everyone's connected in a way, and so, yeah.

  Kevin Cornelius: Well, Ryan, I think that you and I are some more in this way. If I was going to work with a parent on improving their relationship with their child, you know, I would explain to them that I would love to work with you. I'm wondering if what I have to offer is even fair to you because you'd be actually doing lots of changing, right? You'd be focusing actually on your role in the problem, not just as somebody who's contributing to the problem that you're noticing, but you'd also be taking a close look at how is it that you're actually causing the behavior that you don't like in the other person. Because we are all creating our own interpersonal reality in every moment through the way that we communicate with others, and sometimes it can be really hard to look at what it is that we've done that's created the situation that we're in, that we're unhappy with.

  And if a person is interested in doing that, right? If they're okay with looking just at their own role and taking responsibility for doing all of the changing, then we've got so much to offer you, right? There's so many great things I can show you, and I think it's going to be awesome for you. But it does require only looking at what you can change. And then I think that that's a really great piece to give somebody too, what you said, which is, while we're not going to focus on making the other person change, because pretty much no good has ever come of that, right? I think almost every movie about relationships that you go to see, that's the story. It's like if somebody tries to change somebody else, it doesn't go so well.

  But if I was to start, you know, listening really well to another person, sharing my own feelings openly and honestly in a really respectful way, they can't not change, because I've changed so much. But we don't come in saying, I'm going to figure out how to manipulate this other person and change them, right? I liked that you use that term manipulate. I think that's so right on. And so, let's think about again; you brought us back to our big picture of the team model, right? And so, let's say that there has been some testing done, and you've given a parent tons of empathy, really helping understand them, built a great relationship with them, you know, they really trust you, they feel supported and heard by you. And then you've come in and there's been some assessment of resistance, so the parent understands that really all you can help them with is changing their own behavior. and maybe you've even helped them see that it would be more to... they've decided that there's more disadvantages in blaming their child than advantages, so they really are motivated to look at their own role in the problem. and then now we're at the point where you could introduce like, what are the communication tools that somebody could use to communicate well with another person? And I would love to hear how it is that you introduce those tools to somebody. Would that be okay?

  Ryan Moeller: Yeah. Yeah. So speaking of - now we're in the methods portion of the model, right? The actual need of the specific techniques. I'm going to have it like a few different break it down a little bit, to two key things. Well, the first thing I would ask would be to, you know, and maybe we've done it already from earlier, but I would love to get a specific interaction with them and their kid, right? Something basically, you know, what their kids said and then what you said, right? That would probably be a good step to kind of see what the interaction is. And again, it's very simple - one phrase that their kids said and then their response. And so, I would have that kind of in the back of my head or even up at front about seeing the stage there, and from there, yes, I would introduce the five secrets of communication, right?

  Kevin Cornelius: Well, Ryan, I don't mean to interrupt you. I want to say let's do what you just said. Because you're introducing a relationship journal, and so let's imagine that I'm the parent that's come to you and you can talk me through that, and I'll give you that information and you can show me how you would work on that with someone. Is that okay?

  Ryan Moeller: Yeah, sure. So if I were to, I would introduce the relationship journal and say, "Hey, you know, I'm glad that we've kind of worked through the steps and I'm really glad to hear that you really wants to improve your relationship with your child, and I'd love to do that. I was thinking maybe... can you think of a specific interaction you've had with your teen, you know, starting with something that they said, then following up with something that you said." So, just that quick little interchange. Does that make sense?

  Kevin Cornelius: I think it does. Like, you mean, and maybe one that didn't go so well.

  Ryan Moeller: Right.

  Kevin Cornelius: One that like shows what our conflict is.

  Ryan Moeller: Right.

  Kevin Cornelius: Sure I can think of one of those. So the other day my son was late getting up for school, just kept hitting [unclear29:00] button and not getting out bed. And I kept coming to the door and kind of like, "Come on, let's go." And he said to me, it was basically, "Oh, what's the point? I'm not going to do well at school today anyway." And my response was, "The point is, you need to get up and go to school and be on time."

  Ryan Moeller: Right, right. So he said, "What's the point? I'm not going to do well at school anyways." And then my response is, 'The point is, you need to get up and get to school and be on time." Is that right?

  Kevin Cornelius: Yes.

  Ryan Moeller: Yeah. Yeah. I would have you, you know, present you a relationship journal and have you write it down, right? Write down in these steps here so we can kind of have it captured. Now from here, you know, I can imagine this interaction is quite emotionally charged for you. Now, I'd love to maybe start with the first step of when your son said, "What's the point? I'm not going to do well at school anyways." Maybe you can kind of share with me - what emotions do you think he was probably expressing at that point? You know, just for your best guesses.

  Kevin Cornelius: Oh, like, what was he feeling then?

  Ryan Moeller: Yeah.

  Kevin Cornelius: When he said that?

  Ryan Moeller: When you said that.

  Kevin Cornelius: Yeah. So he said I'm not going to do well in school anyway, so what's the point? It sounds like he's feeling hopeless.

  Ryan Moeller: Oh, definitely. Yeah.

  Kevin Cornelius: Maybe irritated with me. I keep coming to the door and bugging him.

  Ryan Moeller: Right.

  Kevin Cornelius: It sounds, you know, that's like depressing, like he sounds depressed, right?

  Ryan Moeller: Yeah.

  Kevin Cornelius: Maybe guilty, you know, I'm not going to do well anyway. Maybe he's feeling kind of bad about himself for not doing well in school, or even defective.

  Ryan Moeller: Probably incompetent, right?

  Kevin Cornelius: Incompetent. Oh, that's a good one. I'll write that down. Kind of discouraged, right?

  Ryan Moeller: Well, absolutely.

  Ryan Moeller: That's the thing about, when it comes to school refusal, right? Is the more that they're behind, the amounts more and more and more, which it's a very painful cycle, right?

  Kevin Cornelius: Sure. When you say that, it makes me think that maybe he just feels overwhelmed.

  Ryan Moeller: Yeah.

  Kevin Cornelius: Stressed out, right? And I don't know, maybe even angry at me.

  Ryan Moeller: Probably.

  Kevin Cornelius: Yeah, that's probably the feeling that he most often shares, that's for sure. Okay, that's probably a good list.

  Ryan Moeller: Yeah, we got a lot of really strong feelings that, of course, we don't know exactly what he is feeling, but I think given what he said, it makes a lot of sense, right?

  Kevin Cornelius: Yeah. Okay.

  Ryan Moeller: Yeah. So the next thing from here is, is we would do this exact same thing for yourself and your feelings when you said, you know, the point is you need to get up and get to school and be on time. You know, maybe you can kind of take a look internally and kind of ask yourself, you know, when you were saying that and when you had this interaction with your son, what were you feeling?

  Kevin Cornelius: Yeah, I was feeling frustrated. I think also worried about the consequences of him being late again. I'm also concerned, you know, he just looks like a mess, right? He's just lying there not getting up, just looks - it's just kind of like you want to shake him and say, come on, wake up and get with the program. But I'm also deeply concerned about his wellbeing. So maybe I'm also feeling a little bit - I don't know how to say it. Like, well, I guess guilty myself, right? Because I don't know what to do to help him do better. I've tried so many things and it seems like the things that I'm doing aren't working, so I feel kind of de defective as a parent. Maybe I could say maybe I'm also feeling defective like he is.

  Ryan Moeller: Right. I can imagine you may have at some point, "What am I doing wrong? I'm totally failing."

  Kevin Cornelius: Yeah. I'm feeling kind of hopeless, because am I going to be able to do anything to help him get out of this? And and I guess he and I have some feelings in common here because I feel pretty angry too with the situation, with myself, with him. That's probably a pretty good list for my feelings.

  Ryan Moeller: You know, as you're going for this, I feel a lot of like, even though this is a role play, I feel so connected to this pretend patient and what they're going through.

  Kevin Cornelius: Yeah.

  Ryan Moeller: You know, this is similar thing does play out quite a bit.

  Kevin Cornelius: Yeah.

  Ryan Moeller: Anyways, back to the role play.

  Kevin Cornelius: Sure.

  Ryan Moeller: Well, I guess from here, you know, maybe Kevin, any comments or questions about where we're at right here and all that before you continue?

  Kevin Cornelius: Yeah, I guess the way that you helped me look at this, like right away, I'm already noticing more of like what this was like for him and also for me that I hadn't thought about before. And I think it also maybe gets me in touch with some sadness that I feel about the whole thing. Like, maybe I should put down sadness is one of the feelings. This isn't what I wanted for him, you know, for his high school life to be like, so that's sad. And I guess the fact that we have a lot of the same negative feelings in common is surprising to me - kind of was, you know, it seems meaningful.

  Ryan Moeller: I think we've got a lot of, lot of good energy here and part of me wants to go straight to, you know, because I can see your mind is already starting to feel more empathic for your son. You know, even just going over how they might be feeling that can definitely really go past these defenses and really get in touch with the tender side of what your son is going through. So I think from here you can kind of ask; when you said this response, when your son, you know, who was most lucky, you know, feeling guilty, hopeless, discouraged, overwhelmed and stressed and angry when he said, "What's the point? I'm not going to do well at school anyways." And you said the point is he needed to get up and get to school and be on time. I mean, did that response... how do you think that - do you think that made the problem better or worse? What happened afterwards?

  Kevin Cornelius: Well, it definitely makes it worse because then he just digs the heels in even more. Like, if it was possible for him to bury himself anymore in those blankets, he would just burrow right in.

  Ryan Moeller: Yeah. How do you feel when you brought that up?

  Kevin Cornelius: I feel sad about that, you know, and I'm frustrated with myself right that probably my attitude isn't very caring or helpful, and so I'm just kind of making the situation worse instead of helping, which is what I was trying to do.

  Ryan Moeller: Yeah. I hear you, you know, kind of acknowledging this sort of feeling with sadness and frustration, and the same that you've been saying that you've been realizing that your attitude hasn't been that helpful. And from here, I'd like to offer and show you some great techniques and tools that can help with that. You know, namely, there's a thing called the Five Secrets of Effective Communication, would be open to learn more about that?

  Kevin Cornelius: Sure. Yeah.

  Ryan Moeller: Yeah. Awesome. I hope so. So the five secrets are a bunch of different ways to communicate essentially, right? So the first one is the disarming technique, in which you, you find the truth in what the other person is saying. Even if it's greater at truth; you find it and acknowledge it, and to really kind of see where they're coming from. This is a very difficult one, but it's probably one of the most powerful ones. The second one is empathy, and you can kind of divide it into two parts. There's thought empathy and feeling empathy. Thought empathy is when you kind of summarize and paraphrase what the other person is saying, and this can kind of denotes, you know, that you are really listening, right? That you're really trying to understand them. When someone summarizes what you said, it kind of gives the idea that that they're trying to understand you, which can be helpful. The fueling empathy is when you kind of take your best guess at what the other person is feeling, right? I got you so far?

  Kevin Cornelius: Yeah.

  Ryan Moeller: Awesome. Awesome. And again, when we do feeling empathy, we don't actually know what they're feeling is providing the best guess. So after that, there's inquiry, which is asking gentle probing questions to learn more about what the other person is thinking and feeling and what they're experiencing, which is distinctly different than interrogation, right? Which sometimes people can [unclear41:19] to you, but it's doing this in the attitude of gentleness and curiosity, right? So that's inquiry.

  After that there's I feel statements, which is expressing your own feelings in a thoughtful, respectful manner, right? And when I say feelings, I mean feeling like as an emotion word, right? Saying like, you know what, I have to admit, I'm feeling a little sad or a little unhappy or a bit concern, right? Something like that. What I see some people make the mistake of saying, you know what, I feel like you're not listening to me. Which is not a feeling, right? That's just saying, you know, you're not listening to me, which is quite the opposite of what we're trying to get here, right? And the final secret is stroking or complimenting, so to speak, which is basically having a tone of respect and care for the person throughout this interaction. And ideally, you know, trying to weave in some genuine, authentic compliments if you can. So, this sounds like a lot.

  Kevin Cornelius: Good. Yeah, yeah. Well, I want to pause there for a second because we're going to have to wrap up our podcast soon. But I like the way that you just presented the five secrets varied effectively, and I'm wondering if you'd be willing to try doing one more. I don't mean to put you on the spot here, but I want to see if you could show us, and I realize you wouldn't do this in a session with a client right now, right? You would facilitate them expressing this with using the Five Secrets, right? Yeah, but just for the listener who doesn't know what Five Secrets are and what this would even sound like, like what would I disarm? What do these things even mean? If I was to play the role of this teenager and I said to you this statement, could you try replying to me using Five Secrets? And you can see what that sounds like. Is that okay?

  Ryan Moeller: Yeah, I can give it a shot. I do want to kind of disclaim that when we practice the Five Secret, so we give a lot of trial and error, right? Very rarely do we have that great, wonderful response in one goal. Sorry, one go.

  Kevin Cornelius: Yeah.

  Ryan Moeller: But yeah.

  Kevin Cornelius: So no pressure, Ryan. I'm not expecting a, you know, we don't need an A+ response off the bat, but I think it would be really interesting for people listening to hear what it would even sound like to even try to use five secrets to respond to this person who's lying in bed, not getting up over and over again. So I'll hit you with my statement and then see what it's like to use some five secrets with me. "You know, dad, what's the point? I'm not going to do well in school anyway."

  Ryan Moeller: Oh, gosh, son. My heart really goes out to you when you say that, and I feel so sad hearing you. I can only imagine what it's been like for you with the situation for school, you know. I'm guessing you might be feeling pretty hopeless and discouraged. And not only he's been struggling so much with this and so many troubles with the teachers and with some of the other students. Like, I totally don't blame you if you're feeling really down and unhappy with what's been going on. And like I said, I'm a bit feeling unhappy hearing that and feeling a bit worried, worried about you, because I'm seeing you falling so far behind and I can't help but feel some concern. And I'm only really expressing this because son, I really love you so much and I really care about you and I just want the best for you. And I realize I've been kind of on your case lately too, as I think about it, I've been really just nagging you and not really hearing you out. And I've probably been a little bit dismissive of what you've been telling me. You know, telling me your concerns and frankly, son, you wouldn't be that surprised if you're a little frustrated with me too. And I totally get it. This is kind of a long-winded, but I'll love to kind of hear little more about what you're going through and what this has been like for you. And I really wanted to help you and support you, and I really want to know bit more about what your struggles have been like and what I can do to help.

  Kevin Cornelius: Okay. Thank you for doing that, Ryan. I think you did that really well. And I think you've given us all a lot to think about, you know, about what is helpful to somebody when they're in a situation like that, and to use empathy and respect and your own "I feel" statements and all that so beautifully. I think this would probably go a long way towards building a better relationship with someone. There's more for us to think about and explore in another podcast and at another time. But of course, it strikes me that if I was a parent listening to this, you know, I would be thinking, but what about the problem of him not getting up and going to school on time? And it's a real tricky thing, because as a parent, you do have to kind of help problems solve.

  Ryan Moeller: If it may. So a few endpoints here, you know, using the five secrets and practicing ii is a lifelong journey. No one's going to be perfect. It takes a long time, but you do bring up the good point about the consequences, you know, perhaps implementing some behavioral changes on your own, you know, accountability, right? Things like that, and this is especially helpful for younger kids, right? Of course you have to have limits and impose consequences and boundaries for what you do, right? And that's a whole nother kind of worms. But I think one of my main teaching points I give, I give parents is that empathy, you know, being able to be empathetic and supportive and use the Five Secrets is not at all inclusive with setting specific boundaries, and implementing consequences if need be and things like that.

  So I just want to kind of bring that out there is that by using the five secrets and being warm empathic and connecting, that doesn't preclude the use of your own parenting basically. You bring up the point about people not going to school; you know, what I often see is they would end up playing video games instead, and it's like, 'Well, gosh, this is a great reason for me to be depressed or anxious.. I get to play video games all day instead of avoiding the actual things they have to do." And parents have, you know, I'm not saying every parent should take away video games at all times. Its a whole nother story, but parents have the right to impose natural consequences based on the kids' behaviors. And that's a whole nother, you know, intricate dance of how that works. But I think the main message I want to give as we close is that these two things, empathy and accountability, they're not separate from each other. You can do both at once.

  Kevin Cornelius: Okay. So, in other words, I might even have more success having a better relationship with my child if I can set boundaries in a way that's understanding and uses empathy and warmth and respect like that.

  Ryan Moeller: And again, every everyone's situation is different, right? But yeah, just want to kind of give that.

  Kevin Cornelius: Okay. Well, Ryan, this hour went by so fast, I feel like I need another hour with you to talk about this topic. Maybe I'll bring you back again for a future episode. I want to make sure for people who are looking for a therapist that they understand a couple of things about how to reach you. So I'm wondering, by the way, do you have a website that you use for introducing yourself to people?

  Ryan Moeller: Yeah. Gosh, so currently it's down. I'm rewriting it, redoing it, but I do work under the Feeling Good Institute. So if you contact the Feel Good Institute, my contact information is on there. Alternativley, you can just email me at ryan@feelinggoodinstitute.com.

  Kevin Cornelius: Okay. Great. And yeah, that's a good point that you're on the Feeling Good Institute website, so feelinggoodinstitute.com, there's a directory where people could look up Ryan. And Ryan, your last name is M-O-E-L-L-E-R.

  Ryan Moeller: Correct.

  Kevin Cornelius: And somebody could put that in and then they would see some great information about you and how to contact you and get started with you if they were interested in working with you. And I think it's good for people listening to know that you work with, of course, teenagers adults, parents, and sometimes together.

  Ryan Moeller: Right, right.

  Kevin Cornelius: What a treat to have you here today, and thanks for going with the flow and having me throw some crazy role play ideas at you. Yeah. And I think that people listening to this got to get a great sense of some of the things that you have to offer parents and teenagers and how we can listen to people and use effective communication, so I really appreciate that, Ryan. Thank you.

  Ryan Moeller: Yeah, thank you for having me on.

  Kevin Cornelius: You're welcome. Okay. Until next time.

  Ryan Moeller: Right. Take care. Bye.

Episode 3-Chronic Worrying with Indrani Mookerjee

• Transcript

  Kevin: Today we have Indrani Mookerjee. Hello, Indrani, nice to have you join us on the podcast.

  Indrani: Hi, Kevin. It's good to be here.

  Kevin: Yeah, thank you so much. I'm really excited to talk to you. Of course, Indrani, I know you because I've had the pleasure of being in a couple of different training groups with you weekly and spend a lot of hours learning from you and with you. And for the people who are listening to our Tools for Change podcast today, I would love to give them a chance to get to know a little bit about you. So, maybe you could tell us all a little bit about you, your background as a therapist your practice and the patients that you're finding yourself working with most often.

  Indrani: Absolutely. I would love to do that. Yeah, so I've been a therapist for a long time. I practice in Columbia, Maryland. I have a group practice, just a group of very wonderful clinicians with different specialties. I went to school in Washington University in St. Louis. And then I got additional training in cognitive behavioral therapy, and that's when I heard about Dr. Burns. And because I live in the outskirts of the Washington DC area, I've seen Dr. Burns several times in for workshops and seminars and conferences. But I didn't really get serious about TEAM until about 2017 or so. So 2018, I went to my first intensive in San Francisco with Dr. Burns. I went back again in 2019 and this wonderful journey started ever since. And I'm pretty sure I saw you there, Kevin. Yeah, you were one of my heroes. You still are. And you're just so eloquent and articulate and so smooth. And so, got TEAM certified at different levels, and so now I'm certified at level four. And guess that's exclusively what I do now in my practice here in Columbia.

  Kevin: Wow. and I just love hearing about your journey, especially studying CBT and then being introduced to Dr. David Burns because he's such a pioneer in cognitive behavioral therapy, and the creator of TEAM CBT, which is what this podcast is really about. We're talking about the tools of TEAM CBT and how we use them with our patients. And there's something about meeting Dr. Burns and learning from him that really interested you, and so you attended these intensive trainings. So the intensives are a week long, all day series of workshops that David does basically by himself. I think he does do live therapy work with a co-therapist, usually Jill Levitt. I think I was at both of those weeklong intensives that you were at, and it's just this wonderful time to learn from him and it's such a great model of therapy. And maybe you could tell us a little bit about the areas that you specialize in and the kind of patients you usually find yourself working with, and how you've been able to use TEAM in your work with them.

  Indrani: Yeah, absolutely. So I see a lot of patients with mood issues, mostly anxiety. I also see people who might have habits or addictions problem, usually eating, compulsive eating procrastination and now increasingly, technology, the different kinds of technology. And then a lot of my patients, of course, have relationship problems, mostly marriage problems. So, it's a mix. And thanks to this very kind of targeted measurement driven approach that you and I have access to, Kevin, you know, we really have a model to work with all these people, all kinds of issues across the board.

  Kevin: As I was listening to you talk, I was just immediately picturing the conceptualization of the problems and imagining the different methods that you would be using for helping people who brought in those problems. So, it makes sense to me that you see people with a variety of problems, because the TEAM model really helps us work with someone with whatever it is that they're struggling with. Because we're still going to be using testing to notice what are the problems and how strong are they? Empathy, you're going to really listen to somebody really well and try to see the world through their eyes and understand them as much as another person can, and also give them lots of warmth and support and concern, right? And then that assessment of resistance, there's lots of good reasons for them to keep the symptoms that they've been having, to keep their negative thoughts and feelings and behaviors. And then the wonderful effective methods that help someone make change.

  And you and I spoke a little bit before we recorded the podcast today, and I think we thought that maybe a great area of focus that would be helpful to a lot of the people listening to this today would be anxiety, specifically what's sometimes called generalized anxiety disorder, or just in plain speaking would be excessive worrying. So I'm wondering, can you maybe help paint a picture for us, Like maybe tell us about, you can think of a, a patient that's come in with excessive worrying and how they were struggling before they worked with you. Would that be okay?

  Indrani: Absolutely. I was hoping you would ask me that because that's one of my favorite kinds of people to work with because I'm a recovering warrior that that's long gone in my past, but I know how difficult that can be and how painful it can be. But I'm always excited to share the tools that worked for me because it got me out of it and it's not a problem anymore. So yes, I would love to give you an example of a person that I've been working - it did even take me that long. I've seen her probably for six sessions and she's well on her way to recovery. A school teacher, she's in a leadership position in the public school here. A woman in her early fifties, had some health problems, but has helped overcome them, but has this kind of frequent and recurrent worry that things are not going to work out. So something might happen - when she goes to school, something might happen to her kids, something will happen to her husband when he's traveling, her mother might get sick. There is this constant and recurrent worry that has really been pretty damaging to her because it's not only stopped her from enjoying life which she has a good life, but it's also impacting her focus, her concentration, it's taking her longer to do things, making her irritable and anxious, and also she's having trouble with insomnia and other symptoms because of the worrying.

  Kevin: Okay. I'm just taking some notes as you and I are talking here, and I'm imagining other people who are listening to this who may have struggled with worrying. It struck me that as you were describing her, I think a lot of people, myself included, could relate to what it is that she's struggled with. There's just something about us as human beings. It's kind of the way our brain works, that we start to really worry about what could go wrong. And that could lead to so much discomfort and pain and fear that it starts to get in the way of us being able to function and live the life that we want to live, free of all that pain and fear. I mean, you mentioned this patient was having problems focusing at work, and also losing a lot of sleep, having problems with insomnia which then leads to its own list of problems with energy and focus.

  And you tell me if you agreed, Indrani, that one of the things that happens when we lose sleep because of anxiety is that these two problems kind of feed on each other and make each other worse. Not to get too technical, but when we're really struggling with fear and anxiety, there's a part of our brain that becomes overactive. The amygdala, it gets overactive, and it makes us think that we're in danger when we're not, so the body responds as if there's a threat. Everybody's probably heard of this like fight, flight or freeze response, which is why we're all alive. It's why people exist still because we have that system that protects our safety. But when we haven't gotten enough sleep, the problem is, is that then that part of the brain can become overactive. It's not functioning as well. Am I on the right track?

  Indrani: Yeah, you're absolutely on the right track. Are's a perseverative quality to it, so we can't shake it. And the reason why it's a problem, and you're absolutely right that worry or anxiety is an adaptive emotion. It keeps us safe, it keeps us alert, it kind of keeps us vigilant. We are alerted to dangerous things around us at the same time, and that's healthy. But if I'm doing it when there is absolutely no danger to my life or limb in any way, then that becomes an unhealthy response. And then because as you said, it feeds up on itself, now it's become a vicious cycle. And so the things that I worry about actually starts coming true. I forget things. I'm becoming irritable. I'm behind on my tasks. And so now it sort of takes on a life of its own, and that's when it becomes a problem. And that's exactly where I found this person.

  Kevin: And something you just said reminded me of something that helped me with understanding how to help people with anxiety a little bit more too, which is that part of our brain, like the amygdala, it doesn't know the difference between an actual legitimate threat to our safety and a negative thought that causes fear. It responds to both of them similarly. And so, that's why a big part of treating anxiety involves exposure. We don't want to avoid the things that we're afraid of happening; we want to face them and experience the anxiety, so that that part of the brain can relearn and understand that I can feel really anxious, and that doesn't mean that my life is in danger. And the reason why that's really important too, is because in our modern times, we don't get chased by predators. That's not a problem that most of us face, so our threats have become of a psychological nature. It's our worries, the things that we're afraid of that might come true. And I was just thinking about how sad that is when you described that vicious cycle that a person can get trapped into. And it sounds like the woman that you have in mind that you were telling us about has been stuck in kind of a vicious cycle like that.

  Indrani: Yeah. And what you're saying, Kevin, is so important because I think TEAM has so many elements that some other models of therapy may or may not have, mostly don't have. One of them is of course the structure, and the very targeted approach to the anxious thoughts. So in this case because it's anxiety, we are looking at what this woman is telling herself to cause her to feel the feelings that she's feeling, and TEAM model is very targeted to that. And then of course because we are measuring empathy, we are measuring all of the interventions as well and measuring our impact, the impact of treatment, and we are measuring the resistance. And in our world, as Kevin, in the TEAM world, resistance is a good thing. Resistance is protective resistance shows many wonderful things about the person.

  And then when you, when you were talking about exposure, to me, that's another genius of TEAM, is we put exposure front and center for the treatment of anxiety, because like you were saying, the body cannot tell whether this is real danger or not. And the only way that we can teach our body and our brain to know the difference is by exposing ourselves to the perceived danger. And it's an incredibly powerful tool, as you know Kevin, that actually really helped this person that I'm talking about. Exposure helped her a lot. She didn't want it. She was scared of it, understandably, but it worked really, really well for her.

  Kevin: Indrani, I'd love to, and of course we won't reveal anything about this person that would identify them in any way, because we always protect confidentiality of patients. I'm wondering if you could help us understand, let's say that we were, of course we would've gone through a testing phase in the beginning, and actually before and after every session. But let's say you did some testing and discovered that there was a problem with chronic worrying for this person, right? And then when you meet with her and just to learn like what are the worries on this person's mind and the kinds of thoughts that are bothering them in a moment in time when worry is really high. Like, what are the kinds of thoughts that we would be talking about here that are causing this worry?

  Indrani: Yeah, I mean, that's exactly what I mean. That's like the first step after we get a good baseline understanding of what her anxiety is, depression, anger, positive feelings, relationship feelings, all of that. In that moment, then I would ask her something like, you know, I would of course allow her to talk about what she was there for, what she wanted help with. Just as an aside, I think it would be useful for our listeners to know that before Kevin or I, or any TEAM therapist sees a patient, we actually do a phone screening, where we kind of tell patients about this approach. We try to understand a little bit about what they need help with and then explain our approach. And for everybody with anxiety, we also talk about exposure as a method that we would be using.

  So it starts early, so by the time the patient comes to us, they have a little bit of a background. And so, I generally allow my patients to just tell me, sort of get it off their chest, and then I invite them to get to work. And if they're ready to kind of dive in and get to work, then I will ask my patients something like, "Well, tell me a specific moment in time when you found yourself extremely worried and overwhelmed by it." And then we would generate what we call a daily mood log. And on that daily mood log from that specific moment in time, we identify - well the patient will identify all of her feeling, and we rate those feelings on a scale of zero to hundred. And then we generate the negative thoughts that are driving those feelings.

  And I just want tell you, Kevin, at this point, I'm sure you can relate to that as well, sometimes patients - and it's hard for them to connect the thoughts to the feeling because they feel so bad and they feel so many kind of distressing sensations in their bodies that it's hard for them to connect to that. But we eventually get to those thoughts, and those thoughts are something like, and I can tell you some of my patient's thoughts were, "Something bad is going to happen today. The people at work will be angry with me. My kid will be angry because I didn't pick her up from her soccer game. I'm going to mess up. I will hurt someone's feelings." So those were sort of the thoughts that were coming up for her, and so that's kind of how we sort of go - it's a back and forth and generate some really robust juicy 13 or 14 thoughts on that daily mood log.

  And I just wanted to, just a quick addition there if I might; I don't want the listeners to think that this will take three or four years. This takes, the whole thing from start to this point, it probably take 15 to 20 minutes in the session, 25 minutes at the most.

  Kevin: Yeah. That is really important to point out because our therapy is a brief model. I think you said earlier, these patients are finding recovery and their work with you in six to eight hours it sounds like. And I like the way you described the process of looking at one moment when this is a problem, and then what was the person feeling in that moment and how strong were their feelings, and what thoughts caused those feelings.

  Indrani: They believe those thoughts in that moment.

  Kevin: That's right. And exactly how much do you believe the thoughts that cause the negative feelings. Because when we're treating an anxiety problem, it's important to understand that events don't cause our feelings; it's our thoughts that do. And the kinds of thoughts that lead to really excessive worrying as an example; usually have something about them that's not true. And so we're not at the part of methods yet in your description, but eventually we're going to get to a point where we're going to use methods that prove that those thoughts aren't true. And that's when the change happens and how we feel. And I'm thinking about in our model of TEAM, we've talked about T=Testing and E=empathy, where you're really understanding this person and what she's experiencing and also given her lots of support and building trust with her. So that then the next logical part of the model would then be the A=Assessment of resistance.

  When we're looking at, well, there's outcome resistance and there's process resistance, and a tool of outcome resistance would maybe be initially checking in - I could imagine asking this woman that you were talking about, if everything went well in our work together on this problem, what would be different? Let's say a miracle occurred and you got exactly what you need. Like, what would that be? What's the miracle you're looking for? Is that something that the two of you explored it all?

  Indrani: Absolutely. And that I think it could be a stylistic thing. I generally ask that question after I get a specific moment in time.

  Kevin: Great. Yeah, right away.

  Indrani: Yeah. That, "Oh, I felt so anxious this morning when I was getting ready to go to work." And then I get some preliminary thoughts, I get all the feelings and miracle happened by the end of our session, so that I give the message to my patient that you don't have to wait 20 years for the miracle. There is a finite period of time when you're actually going to see improvements. So, if there's a miracle happened by the end of the session, what would that look like? What would change? And then I could actually go on to ask a few more questions. Like, so why would that be important to you? And what she said was or what I would want is, I would want to get up in the morning feeling excited about going to school and why that would be important to her is because she loves teaching. She said, "This is what I love doing. I trained many years for it. I love doing what I'm doing." And then I ask another question is that, "What would you be doing differently if you woke up thinking that I love teaching?" And then she would say, "Oh, I wouldn't spend so much time worrying. I would get ready quicker. I might go for a walk." And now I have her vision and now she and I are now looking at what that life without worry could look like and would look like. So, that's to answer the question.

  And then there is another place as well, Kevin, where we can check, so that is a miracle cure. But then again, once we generate, when we identified all the feeling, I will offer her the magic button. And then I asked her, "Well if magically all of these feelings went away, here's a button that you can push and these feelings will go away magically, would you push the button?" And then let her give me a yes or no answer. Regardless of the her answer, we're still going to go on to the next step of checking the benefits of these feelings that come to her. There's some clear advantages to have those feelings and what it says about her that is beautiful, which is basically her core value. I mean, that takes a little bit of time, takes a little bit of priming, because most patients are not used to thinking of their negative feeling in this kind of positive way, so we basically positively reframe their negative feeling.

  Kevin: It's a really beautiful and powerful part of the therapy, and probably what sets TEAM apart the most from other kinds of therapy. And I was just thinking a way that we could bring this to life for people who are new to TEAM and listening to this, I'm imagining your patient has shared with you that they were feeling anxious and worried and afraid at like a level of like 90%, when they got up in the morning and thinking about, I'm getting ready for going into school today. And then they were having this thought that led to those feelings, like, something bad is going to happen today, and people at work are going to be angry with me. And so, imagine that I'm this person, I'm this patient, and I've said that I actually would love to push a magic button and have those thoughts and feelings go away so that I could go to work and actually enjoy my day teaching because I love teaching so much. And I want to be free of this problem, and I want to not be trapped by anxiety. Could you maybe show us how would you introduce positive reframing? And maybe you could have me positively reframe my feelings and thoughts that we were just talking about.

  Indrani: Oh, absolutely. So I would pick the main set of feelings here, which are the feelings on the anxious line, which would be anxious, worried, panicky, frightened, and nervous. And she picked a few other feelings, but this was the one that stood out - this was the one that was causing her most distress, and that was actually at 100. We can certainly demo the positive reframe, kind of do a quick roll play on that. And I might say something, like just assuming that you said yes to pushing the magic button, which is what she said, "Absolutely, give me the button." And so then I would say something to you like, "Yeah, I mean, that would make sense, Kevin, why you would want push the magic button because it's painful for you. These feelings are pretty intense. At the same time I just want to make sure that you're not going to lose anything by pushing this button, because a lot of times there's some really good reasons why you have these feelings, even though they're painful and fairly intense. Would you be willing to look at some of the benefits that these feelings have for you? And also what it says about you that is so positive and beautiful?"

  Kevin: Sure, of course.

  Indrani: Just getting out of the role play for a second here, Kevin. I always ask people to write, because I can never do anything in my head. And so, at that point say something like, "Great here's a piece of paper. Let's draw a line down the middle on one side, let's put emotions and thoughts; on the other side let's put benefits and values. And let's start with the anxious - your anxious feelings. So let's write anxious, worried, all of that, the ones that she checked off on that line," which were all, in this person's case. "Let's write that down. And Kevin, can you tell me what are some benefits or advantages? What were some benefits for you to have those feelings this morning when you were getting ready for school? How did it help you?"

  Kevin: That's, that's, that's an interesting question. And it's kind of hard to answer to because I keep thinking of the anxiety as a bad thing, right? Well, I'm there I'm getting ready to go in and teach, and I'm feeling really worried and anxious and panicking and nervous and frightened, how is that helping me? I think it would make me really careful about preparing myself for my day.

  Indrani: Exactly. So it might have helped you kind of prepare and maybe plan your day.

  Kevin: Yeah, plan and prepare because I don't want to make mistakes that would make my coworkers angry.

  Indrani: So it might prevent me from making mistakes as much as I can. Can you think of any other benefits that these feelings of anxiety have for you?

  Kevin: Well, I'm going to choose my words really carefully when I'm communicating with my students and my coworkers, if I'm worried about offending them or causing conflict with them.

  Indrani: Exactly. So you would choose your words carefully, you would be alert to using any kind of language or words that might potentially offend them. Kind of would keep you alert for that, help you choose words carefully. And I mean, you're doing great. And Kevin, what does it say about you? What would say anxiety say about you that is so beautiful? Can you think of some core values that might be reflected in these anxious emotions?

  Kevin: Well, when I look at those benefits that it's giving me, it kind of shows me that I value planning ahead and being prepared for things. And that's true, I am very careful and I don't like to do things kind of halfway or I'm a pretty thorough detail-oriented person. Would that be a value you are looking for?

  Indrani: Absolutely. That's great. And would that show that you have high standards, you want to do things thoroughly, you want to do things well and be detail-oriented?

  Kevin: Boy, do I! And in fact, that's sometimes it's to an extreme, but I guess to a certain degree it could be helpful, that I have my high standards.

  Indrani: Yeah. You're doing good. What else does it show about you, Kevin, that is so beautiful?

  Kevin: Well, I guess, yeah. Well, I guess because I was extra concerned about disappointing people or making them angry, maybe that shows me that my relationships with my coworkers are really important to me. Like, I want to have good, professional, respectful relationships with my colleagues, and I don't want to let them down. Does that sound?

  Indrani: It's very good. And now when I look through this list of benefits and values, Kevin, are these true, these benefits and values that you listed, that it helps you prepare and plan, it prevents you from making mistakes, shows that you don't want to hurt anyone's feelings, be vigilant, care about what your coworkers think of yo, you want be professional, have high standards, are these true?

  Kevin: Totally. Yes.

  Indrani: How much is it important to you?

  Kevin: Very, very important.

  Indrani: And are these powerful?

  Kevin: Yes.

  Indrani: Yeah, I would agree with that. And so I'm going to pause here, Kevin, and I can move on to the [unclear35:02] question, or if you want explain, I would be happy to kind of...

  Kevin: Yeah. I love, I love that we're pausing here for a moment because if you were in a session with a real patient, you would do all of the feelings on the mood log, probably. And and we don't have time to do that today. So we can imagine - well, imagine that I said that the thing I most want to change is the anxious feelings. I think that's what this patient said. So maybe we can kind of go through this next part of what you would do next with the model, with just this set of feelings and what we positively reframed and learned from that exercise. Can you show us what you would do next then?

  Indrani: Absolutely. You're right, I mean, I would go through all of the feelings. And while there are a few overlaps, each set of feelings really have their own benefits and reflect distinct values. So, I would like to kind of make sure that I we capture as many of those that are possible. This step is generally hard for my patients because they never think of any of this as being anything but negative. Because the feeling feels so painful that how can there be anything good about it? And sometimes our patients will even say that, "What do you mean their benefits to this? It feels horrible." And I think you also said it, which was great because that's exactly what happens.

  And so sometimes I might have to kind of prime the pump a little bit. And what I noticed is that once we do a few and the patient starts to kind of come up with their own benefits and values, and I always kind of focus it back to that specific moment in time so all the benefits and that specific moment in time, not their entire life, not generalities to keeps them kind of focused. And then once they come up with this and they agree that these are true and they are important and they're powerful, now I'm kind of getting their buy-in. Yes, these are good reasons for them to have the anxiety. And then I will ask what is called the pivot question, right? And that is that, "Wow, given all of these benefits and values that there are in these negative feelings of anxiety, worry, et cetera, you still want to push the magic button." Let me ask you that question, Kevin.

  Kevin: Well, that's, that's a hard question because I don't like the way that those feelings felt, but I also, I don't want to lose those benefits and those values, so yeah, I'm not sure now.

  Indrani: Yeah. So if you're not sure about pushing the magic button, which I would agree with because there's like too many good reasons for you to have these feelings. Perhaps I can offer you the magic dial, which puts you in charge of these feelings, and you can dial it as low as you want to, or as high as you want to, depending on how much you need then. So if I offered you the magic dial right now, where would you want these feelings to be? And Kevin, I sometimes think of the dial as the dial on the radio because if you're listening to Beethoven cranked up all the way, it's painful. But when we dial it just at the right spot, that's when the music sounds just divine. And so, what would be that right spot for you, sweet spot, where you can keep all the benefits, but kind of get rid of the pain?

  Kevin: I think that I'd want those to be dialed down to about 20%.

  Indrani: 20%. That's great. So you want to feel about 20% anxious and worried and panicky and nervous and frightened.

  Kevin: Yeah, and I think that that would be enough.

  Indrani: And then what would that do for you?

  Kevin: Well, I would still keep that helpfulness, right? Like, I would be mindful of what it is that I say to people and communicating well. It's certainly good to be concerned about what other people think of my work and not disappointing them. And I would still do careful work so that I wouldn't make lots of mistakes. But I wouldn't be feeling all those terrible things like the butterflies in my stomach and actually the knots in my stomach and losing sleep at night over it and dreading going into work, instead of looking forward to it. So if it was dialed down enough, like to 20, maybe I would really look forward to going into work.

  Indrani: Yeah, that makes sense if that's what you want. And so Kevin, let's get started, now that you've dialed it down to 20, let's look at your thoughts and see what we can do that will make your anxiety go down to 20 instead of this that it's at right now. And then you would go onto the distortion.

  Kevin: Sure. Yeah. And so I'd love to pause for a moment and kind of catch people up on all the great things that you just did. Indrani, for people who are listening is very skillfully using tools of TEAM CBT, and what she was just doing right now was assessing resistance. Because all of us actually do have resistance to change, and like you said in TEAM CBT, we don't view that as a bad thing, but as a good thing. And what we do is, we look at the negative feelings and thoughts that this patient is having in that moment, not as a sign of all of the things that are wrong with them, but it really of what's right with them. Why does it make sense that they think and feel this way? And how is it helping them and what does it show about their values that's really positive.

  And one of the things that I really like about that Indrani is, and actually I'm quoting Dr. Burns when I say this, but it's having a lot of meaning for me lately, which is sometimes the biggest change that a person can make is accepting themselves, the way that they are without changing. Because a lot of the time, maybe you've noticed this, when people come in, especially with an anxiety problem, they're telling themselves all the time, "I shouldn't be so afraid. I shouldn't have this anxiety. It's bad for me. I need to get rid of it. I need to push it away. This is wrong for me to feel this way." And one of the problems is, with anxiety especially; the more we try to push it away what happens is the bigger it gets, until it becomes like this huge monster in our life.

  And so if a person can be invited to actually just accept themselves as a human being who sometimes is afraid and really afraid, really anxious and nervous and concerned about what other people think of them, and that that's okay, but that's a human trait that we have. And that's not only just okay, but it's helping them and it's showing beautiful things about them. That's a big step in the change that we're looking for, as well as also reducing resist resistance to therapy methods. And I think that one thing I wanted to make sure I said about that... Oh, I just thought what you did was so beautiful Indrani. Like, I'm totally there with this idea that when they dialed down that radio right to be sweet spot, where the music sounds beautiful, they get to keep these benefits, they get to keep how the anxiety is helping them and all the beautiful values that they hold. Those beautiful values that they hold are just as beautiful as the music that you were describing.

  And when you look at it that way, you've aligned yourself with their resistant part of them. You've taken on the side of the resistance, and it's kind of like you're doing a little bit of bargaining with their unconscious mind. You're saying don't worry. I accept you the way that you are, and I'm not going to force change on you, and I'm not going to make you become a different person and you're not going to lose your beautiful music. Boy, I'm going to use that with everybody I work with from now on. I really liked that Beethoven and the radio dial that you did.

  You know, today I really enjoy the fact that we got to know you a little bit, Indrani, and hear your personal style and the way that you use the tools of TEAM, and especially this super important assessment of resistance piece. And the positive reframing and how beautiful it can be. And I know that we're not actually looking today so much at methods that lower anxiety, but we did all the work that sets it up to be able to be successful. And I think that that was great the way that you demonstrated that, and that's probably what we're going to have time to do as a demonstration today and our time together. So there's a couple things that I would love to talk to you about that would be for the benefit of people listening to this. If somebody enjoyed listening to you today and was looking for a therapist and they were in the Maryland area that you are in, not far from, I think Baltimore and also Washington DC, it's kind of in that general area?

  Indrani: Yep.

  Kevin: Are you open to accepting new patients at this time?

  Indrani: Always. I'm always accepting new patients. I'm always welcoming them into our practice. I generally see patients for about eight to 10 weeks or sessions, and so I always have openings and happy to see patients. And so the best way to contact me is that they can just email me if they want. My email address is Imookerjee25@gmail.com or they can go to the Feeling Good Institute website, and if they put in Maryland, I'll pop right up. And all kinds of information is right there. If all else fails, just Google me, you'll find me that way.

  Kevin: Very good. And I'll just mention, that's feelinggoodinstitute.com, and then there's a great search tool right there. They could even do a drop down menu and choose to find you personally on there too, and of course, Googling you. And I think you said you offer a free consultation initially.

  Indrani: Yeah, a free 15 minute initial consultation. And I'm also doing intensive, but that has to come through Feeling Good Institute and you have to contact Kevin for that, and that is another service that I offer as well.

  Kevin: Yeah, and we can talk a little bit about what that looks like too, because some people might be interested in that. So an Intensive is a whole bunch of therapy in a short amount of time so that a person can make a big powerful change right away in their therapy work. I know you do them all the time. I just had 12 hours with somebody over the last four days, and they made huge progress in lowering anxiety. And now they may move on and work with an individual therapist weekly after this, or they may have what they needed and they'll use the tools on their own, you know, they're deciding about what to do about that. And so, I love that people could consider doing that with you, right? They could work with you in traditional weekly sessions, or they may come to you for an intensive and get a lot of great benefit in a short amount of time.

  It comes to mind to me that as we're recording this, we're coming up on, like lots of holidays are coming up in November and December, so sometimes people have longer breaks and they can take advantage of that time to come in and do an intensive, so this might be a good time of year to do that. And I just want to, you know, we're going to have to to close things here soon, so I just want to say Indrani, what a joy it is to talk to you, to share your skills with our listeners and to so beautifully demonstrate how to address resistance with positive reframing. And I can only imagine the great work that you're doing with your patients and helping them with lowering anxiety and excessive worrying, and people listening to this, hopefully we'll get that awesome opportunity to work with you if they want.

  Indrani: Thank you so much, Kevin. It was entirely my pleasure. I mean, you've been my teacher for a long time, so it was such an honor to do this with you, and thank much.

  Kevin: You're very welcome. And Indrani, another thing came to my mind too that I want to mention, which is you're a level four certified TEAM CBT therapist, so you do training also, right?

  Indrani: I do.

  inteer: And if somebody is a therapist who listened to this and they were interested in learning more about being a TEAM CBT therapist, I'm guessing that they could also contact you about consultation or training. Is that true?

  Indrani: Absolutely. So I'm available for individual supervision, I can also help with prepping for the level three exam. I have been a level three examiner. I also can train organizations psychology department or psychiatry or you know, wherever there's a group of mental health providers, I'd be happy to come out and train them as well.

  Kevin: Well that's beautiful. I'm so excited to hear that. And thanks again for joining us and I'll talk to you soon.

  Indrani: Great. Thank you so much.

Episode 2-Grief with Kelly Baier

• Transcript of Episode 2-Grief with Kelly Baier

  Kevin: Today we have Kelly Baier with us. Welcome, Kelly. Good to see you.

  Kelly Baier: Thanks, Kevin.

  Kevin: Yeah, thank you so much for joining us on Tools For Change. Maybe you could tell us a little bit about yourself, the kind of work that you like to do, the kind of people who usually you work with, and then the problems they come to you for.

  Kelly Baier: Okay, that sounds good. Let's start with a little bit about my professional background. I'm a licensed clinical psychologist and a board certified behavior analyst. So even after I got my doctorate, I went back and kind of specialized in behavioral therapy which actually paired well, at the time I was doing a lot of autism work, and that has since carried over to now. I did a lot of in-home support for families and for clients. And throughout my professional trainings and everything, I've done a variety of things, and more recently discovered this passion for grief and end of life work. So, the transition kind of went from working with kids and I helped run a, a grief camp for kids who experienced the death of a loved one, and then that was shut down during Covid. And so, I really enjoyed working and supporting those families and wasn't exactly sure how I wanted to continue doing it until I heard this term "death doula" on a podcast actually. And I was like, "What is that? That sounds really intriguing." So I went back and got training as a death doula, and right now I volunteer with hospice as well.

  And so I have this weird mix of grief end of life work. I still see a lot of patients that are on the spectrum that have coexisting anxiety and depression and things like that. I still see a lot of kids and teens, even though I see people of all different ages. There's not enough therapists for everybody in general, but let alone for kids and teens, so I tend to get a lot of those referrals as well. That's just a small little taste of my professional background and kind of where I'm at today.

  Kevin: Thank you so much, Kelly. That was really impressive to hear about all of the different experiences that you've had and the kind of training that you've gotten. I'm wondering if you could also share with us how you got involved in using TEAM-CBT and what appeals to you about using TEAM with the clients that you're working with now.

  Kelly Baier: I first heard of TEAM and took a training probably over a decade ago. And I lived in San Diego at the time, and I took it to help support me in my private practice. I really liked the theory and the background of it. I liked how kind of concrete and user friendly it was, so I used it in a little bit, not as much as I am now, but a little bit in private practice years ago. And then recently came to Feeling Good Institute and had significantly more training and support and supervision and have found it just such a helpful resource. I wish that I would've learned it in graduate school, to be honest. I feel like a lot of therapists are missing out because it is just so beneficial to so many clients. And specifically with the clients I work with, and I use the term clients and patients interchangeably, so forgive me as I go back and forth. I have hospice patients and therapy clients, and so I always just use them interchangeably.

  For my clients that are on the autism spectrum, it's been really helpful because it's concrete. So a lot of, you know, like we do the rating in the beginning of the session and after the session. We can do pros and cons lists, we can do things that are really concrete and that seems to fit well with a lot of my patients that are on the autism spectrum.

  When it comes to grief and end of life issues, a lot of that isn't necessarily anything except for kind of expected emotional change, so I use it in conjunction with just supportive therapy. And then when I notice that maybe there is some cognitive distortions or like things that, you know, people may be thinking a certain way that's actually making them feel worse, then that's when I bring in TEAM. And it's been really helpful in those kind of circumstances. So even when it's a transitional life process that can bring a lot of angst for anybody in that situation, TEAM can still be really supportive, which I have found really interesting. I didn't know that before I started linking this, you know, TEAM and grief and end of life work altogether. And it's been really great, and I've gotten great feedback from my patients and stuff as well.

  Kevin: I love all the things that you're saying, Kelly, especially about, you know, when someone comes to you because they're having problems with grief, often they probably benefit a lot from empathy, right? And someone who listens, is supportive, understands them, doesn't need them to change, and lets them talk about what they're grieving about and kind of process-oriented empathy; maybe everything that they need from you. Is that true?

  Kelly Baier: Yeah, sometimes that's it.

  Kevin: Yeah. And I would imagine that probably a big portion of the people who come to you who are struggling with grief, maybe they're coming to you because they expected to grieve, obviously, right? We know that, let's say we're experiencing the death of a loved one. I think most people are aware that that's going to be really painful in the beginning. Maybe that pain has gone on longer than they expected, or it's starting to impact most areas of their life and making it difficult for them to function or enjoy life. It's having some kind of a major impact that maybe they weren't expecting. And in that case, maybe that's when tools of TEAM-CBT might be more called for, because there's maybe, along with the grief, there's something like depression that's going on, or anxiety. Am I thinking this through correctly? Is that what you're noticing with your grief patients?

  Kelly Baier: Exactly, yeah. You got it right.

  Kevin: And so, I'm just thinking of the people who are maybe listening to this and thinking you, they're looking for a therapist who has a lot of experience helping people with grief. And when they come to see you or me or whatever therapist they're going to, there's going to be an initial phase, where you're getting to know them, and I guess, we would call that assessment, right? Learning about the person and finding out a little bit about their life and what they've been experiencing, what they're coming to you for help with and how that's impacting them. And maybe checking in and seeing if there is some kind of a diagnosis of depression or anxiety or a mood problem other than those things that's - I don't know how to say this other than like maybe multiplying the grief, or I guess, complicating the grief. Is that true?

  Kelly Baier: Yes.

  Kevin: Okay. So when someone is coming to you and you're helping figure out what are the problems and how would you help them, What is that assessment process like? Like, let's say I was interested in coming to you and you just wanted to let me know what to expect from the beginning of therapy.

  Kelly Baier: For me personally, when I use TEAM-CBT with grief clients, one of my favorite things that TEAM-CBT does is that, it doesn't pressure patients into doing anything. If you don't want to change, you don't have to change. So if you're feeling really anxious and depressed, but you're okay with that, that's fine by me. I'm still here for you as a therapist, and we can work on other things, or we can utilize support and empathy, and that's okay with me too. So I really like that flexibility. And I like being able to be open and honest with my patients and saying, "Here's what I see, what does it feel like to you?" I am invested to support you in whatever that looks like. Whether it means addressing the grief or not addressing the grief, whenever it works for you is okay with me because everybody's kind of on their own trajectory.

  There's no right or wrong way to do grief, and it's just so nice to be able to have a person alongside with you, to support you through whatever may come up. And so in those times, we may be assessing. One of the terms we use is assessing for resistance. So, what are the bad things about changing? What are the good things about changing? And being able to have an open, honest conversation with patients about the possible drawbacks of feeling better; like, what an awesome experience to be able to be open and just sit with the patient and some of these thoughts and feelings.

  Kevin: I'm just sitting here really loving everything that you're saying, Kelly, and I'll start with that idea that everybody grieves differently, that there's no right or wrong way to grieve. And it seems like when a person is coming to a therapist and they're struggling with grief, we don't want to underestimate the power of just listening well and being supportive and being heard and understood by a person who doesn't need anything from you. I mean, I can see you right now, people listening to this can't see you, but as I look at your facial expression, and I imagine speaking to you, I'm just thinking if I was really struggling with grief right now, how powerful that would be to just connect with you, have you listened to me, be supportive of me, no pressure to change anything. I can just be the way that I am and have somebody, I think you said it very well, be alongside me as I'm going through this process.

  And I agree with you. That's what I love about TEAM-CTB, the fact that we call it client-centered. And what we mean by that is, it's a collaboration. This isn't expert-patient. There's nobody above anybody else. It's people who are equal, who are working together and collaborating. And the agenda of the treatment is set by the patient. We don't try to convince somebody, "I think that you need to feel differently than you do because there's something wrong with the way that you are feeling and handling these things. And I'm going to teach you how to be different than you are." That's not what we do. And I certainly would never want to participate in that. And it doesn't sound like you would ever do that. And you know, part of the podcast here is introducing people to the concepts of TEAM and helping them understand what it is that we're talking about when we say TEAM.

  I mentioned in the previous episode that TEAM has meaning on two levels. So on one level, it's what you just described to us really beautifully, that we're a team together, helping this person through this really troubled time in their life. And we don't force change on anyone. Someone comes to us and says, I want someone to talk to. And if they're just looking for support and someone to listen; great, that's what we're here for. If you're saying, I actually would like to feel differently than I do because of how it's impacting my life, then great, let's take a look at what we could do to help you with that. We are a team working together.

  And then TEAM is also an acronym that stands for what it is that we're doing in therapy, like the T=Testing, E=Empathy, A=Assessment of resistance and M=Methods. So, so far today, I think we've talked a little bit about testing and a lot about empathy. So with testing, you might be having a client take a brief mood survey, before and after you meet with them just so you can see how they're feeling. Do you use that with the patients that you're helping with grief?

  Kelly Baier: I always try to. Sometimes they are just treading water and trying to get through the day and it's not something that they're able to do at that time, so then I check in verbally with them. So I still do some sort of check in of, how are you today? But to be honest, sometimes it just doesn't work when, you know, I'm trying to email and they're like, "Look, I haven't looked at my emails in weeks," and it's just too much. They're too overwhelmed, and that's okay for me too, but we also want to assess where you are because it's important for me to see how you're changing and how best I can support you through that process.

  Kevin: Well, Kelly, I am trying not to use too dramatic of language, but I just get blown away by you and your loving, warm, kind approach to all of this. You know, to say that you're not going to even force testing on people, right? Like when somebody's coming to you and they're overwhelmed with grief, I just imagine how painful that is and how much our lives are turned upside down. And we haven't even looked at our emails in weeks and we're just trying to tread water, I think you said, right? Like, just struggling to keep things, you know, regular day to day life, things taken care of. Maybe it's too much for somebody to take a brief mood survey before and after the session. And so, you adapt that for them; you find a way of finding out how are you feeling and tracking that. I think that's beautiful. And I also like that you're considering it important to do some tracking so that we can monitor progress and see if things are going the direction that we wanted to go in, right?

  And then we talked a little bit about the E=Empathy quite a bit, that often, especially when somebody is seeking counseling for grief, that maybe most what they need is somebody to listen and be supportive. And you mentioned something that I really liked too, regarding the A=Assessment of resistance. One of the tools of that part of our therapy model would be what's called Positive Reframing. And that's where we take a look at the way that a person is feeling, and we don't look at it as something, but it's anything wrong with them, but as a representation of all the things that are right with them. Imagine somebody who's grieving and feeling overwhelmed by sadness. Well, you know, that sadness in a way is okay, isn't it? What do you think about that?

  Kelly Baier: Yeah, I think it's natural and normal. And that's what I love about that assessment of resistance is being able to look at why would you be feeling sad now? Why would you want to continue to feel sad? why would you want to kind of turn it down a little bit maybe? And maybe it's too strong of a sadness and being able to talk about that and think about it, because a lot of times we just are reacting. We're not choosing these things, we're just reacting. And so, if we can be more intentional and thoughtful about why we're doing something; great, you don't have to change, but let's kind of know why we're doing what we're doing.

  Kevin: Yeah. I'm just imagining somebody who's working with you and they're coming to you for the grief counseling and they've received lots of empathy from you. And let's say that they've accepted an invitation to work on a problem, you know, I am responding in a way that I don't like, to stressful situations. I'll just choose... I'll think of myself, you know, when I'm, when I'm feeling overwhelmed by things like this, I might become really short with people, right? And I might come to somebody because I've just noticed that I'm losing my temper more often than I want to. Let's say that I said that that was the problem that I wanted to work on with you; what's the next thing that we would do after discovering that that's the problem that I want help with?

  Kelly Baier: And that's a great example because where it puts me as a therapist is to try to conceptualize what's going on with you. Are you being short because - is it anxiety? Is it depression? Is it just a habit that, you know, you've kind of always been like, and you've just fallen back into that same habit? And to explore that with you and see where is this kind of coming from, because realistically, if it's a mood issue versus a habit issue, I would come at it and suggest different methods for that. And so the great thing is, we explore it together. And so a lot of times, even with my patients, I will be totally upfront and say, "Wow, I'm not sure if this is a mood issue or a habit issue. Let's talk about more about it." TEAM-CBT is not something where there's a wizard behind the curtain pulling all the things. We're just open and honest about it, and here's what we can offer and let's figure this out together, because like you said, we're a team, we're on the same level. I don't all of a sudden have all of these solutions for you. I have some tools that you might find helpful, so let's try to work at these things together. But that would be my next step is to try to conceptualize, "Well, where is this coming from? What's going on with you?" So, that we can come about the way that's going to give you the most support.

  Kevin: Yeah. And I'm thinking my way through our model here, and for people who are interested in therapy and wondering what it would be like to be in therapy. Let's imagine I've had a parent who has died and I've been experiencing a lot of grief about it. And I'm coming to you because I'm getting short with my children, and it's different for me. It's unusual. I'm surprised by it and I'm bothered by it, and I don't like the way that I become very angry with them when they're just being kids and just acting like themselves. And it's usually happening when I feel overwhelmed by all the details that I'm having to take of - I'm helping take care of my father's estate and I'm overwhelmed by that, and then I'm really short with the people that I love. And if that was a problem that I wanted to work on with you, and let's say that you've conceptualized that as a mood problem; then what would be the logical next step for working on that specific problem with me, do you think?

  Kelly Baier: One of the things that we try to integrate early into TEAM-CBT is this use of a daily mood log and CBT, Cognitive Behavioral Therapy, your cognitive thoughts are going to affect your behaviors, and so it's important to know what are these thoughts. So what are the thoughts? What are the feelings? What is it specifically that we want to change? What's the situation? And so, when I'm trying to get more information with a patient, oh, here's the issue that is coming up. Great, let's get all the details of it so we know exactly what is going on, because you can't choose most of your situations in life, only how you react to it, and so let's look how we're reacting to it.

  So you put down, you know, like, I blew up at my kids over dinner or whatever it was. And then there's a big chunk at the top of this daily mood log that's, "Well, what were your feelings about that?" So you were angry at the time. Were you also feeling anxious about things with your father's estate? Do you have a lot of sadness that's continuing to come up? What are these feelings? They're all okay. And it's really nice when we can put it all down. "Oh yeah, look at all this, I actually even had guilt in there! And I was ashamed about something." Well, great, let's put this all down so we can see what's triggering some of these reactions. And then we go down, and let's list some of the thoughts. You feel like you're not getting any support from the rest of your family. You feel like you're not doing a good enough job. You feel like your loved one would not agree with the things you're doing. Whatever it is, let's look at that.

  And then is it something that we want to alter any of these thoughts? Are there some, what we would call in TEAM-CBT, cognitive distortions? So, unhelpful ways of thinking. Sometimes when our thoughts, some of them can just be truths. My dad is dead. Yeah, that's a truth. We're not going to be able to change that. But, what are some of the thoughts associated with that? So, he would not agree with what I'm doing. Well, let's look into that. Is there any cognitive distortions there? I am not a good enough parent because I'm spending all this other time working on wrapping up his estate and his own affairs. Well, let's look into that. Are there any cognitive distortions there? Is there a different way of thinking that might make you feel better? I even use that in my own personal life. Once I learned it in TEAM, when I'm overwhelmed in my own personal life, I'm like, "Oh, great, let me pull out my daily mood log and see what's going on." And when you get something that is brewing internally, external, sometimes that in and of itself can just be so beneficial. And then when we get these thoughts and feelings down on paper with our patients, then we can utilize so many different methods on working to support change if that's what they're choosing to do.

  Kevin: Yeah. And I want to slow down and take a look at the process that you just described to us a little bit. So initially, you were saying let's look at a moment when you kind of exploded at one of your kids, right? And you'd use this tool called a Daily Mood log. And the first thing we do on a mood log is write down just one time that that was a problem. Because in that, when we can find recovery from the problem in that one moment at a time, it affects all the times that this is a problem for us. And in that one moment, we're going to discover everything that the person needs to work on in order to find that recovery.

  And you described beautifully at the top of the mood law, we would write down the moment where this was a problem, and then the different things that the person was feeling in that moment. And then, we pause and we might talk briefly about how our negative feelings actually happened because of our own thoughts. And the situation that I was in when I was upset and kind of blew up at my kids wasn't causing my feelings; it was what I was telling myself about that situation. There were thoughts that I was having that caused my feelings, like sadness, fear, anger, I think you said shame, guilt - whatever they might be. And then we help the person figure out, "Okay, ooh, you were feeling ashamed in that moment. What's something that you were telling yourself that led to shame?" And one of the thoughts that you threw out there that a person might be having is, "Well I'm not a good enough parent because I'm not there for my kids often enough right now," and we could write that down.

  And then once we get all of those, those feelings and those thoughts written down on paper - what I really like what you said that sometimes just getting the internal to be external, like to take those things that have been brewing inside of us and get them out and share them with another person is so powerful. And even when we're working on a mood log by ourselves, just be able to see it all written down in our handwriting, and there it is in black and white, that's what I've been telling myself, and these are the feelings that it's been causing. It's powerful to understand ourselves on that level. I like to tell patients that when they're working on a mood log by themselves, that moment where they write down all the thoughts that led to their feelings, is like showing empathy for themselves. Really, really understanding themselves in that upsetting moment and what this was like for them.

  And then when we get to that part of the model, we would usually probably want to pause for a moment and think about some of the resistance tools that you mentioned earlier. Because you said that one of the things that's so beautiful about TEAM is, we don't help somebody change something unless they convince us that they want our help. And so then we might want to check in with them with something like, you know, what would you like to be different about this? Is there anything about this that you would like to be different? Like, if our work together was really successful today what would that look like in your life? Some kind of version of maybe what people would call a miracle cure question. If a miracle occurred and this was successful, what's the change you're looking for? And then we have some tools to explore why their thoughts and feelings are actually helping them in that moment, and how they're all signs of things that are right with them. And we bring all that to conscious awareness.

  So when I'm feeling guilty for losing my temper or for not being present with my kids, or I'm feeling angry, I shouldn't be having to deal with this right now, this is too overwhelming; whatever my thoughts might be. Why do those thoughts make sense? How is it helping me to tell myself those things? And what does it show about my values that's really powerful and beautiful that I would think and feel this way in this situation? And I'm talking a lot right now, sorry about that. But when we do bring all those things to conscious awareness, and we say; "Okay, there's always great things that the way that you've been thinking and feeling have been helping you." Maybe you could show us, like, let's say I'm that patient who's just brought to light all these beautiful, great reasons to continue feeling angry and hurt and sad and anxious in this situation, I brought all those things to awareness. How would you may be potentially bridge that gap between wanting to stay the same and possibly making some change if I want to?

  Kelly Baier: A couple things I wanted to mention that were on my mind too, and then I'll get back to what you just asked me. One is that I was realizing that with my grief clients, so much of their support system is also grieving, that that's why it's so nice to be able to come in to see a therapist because everybody is affected by the loss of this loved one. And so, it can be really hard to get the support from your traditional support system. And so I just kind of wanted to mention that, that's why it's nice to be able to have somebody who is in a different place and is not currently grieving and can help support you through that. And then to kind of piggyback on what you were just saying, I see a lot of people who have grief that have associated this uncomfortable sadness as "I need to carry this with me in order to honor my loved one." If I don't feel bad, then that means that I don't miss them anymore. And that's one of the biggest forms of resistance I see in grief work is, "Well, what does this mean if I'm feeling better? Does that mean that I don't miss my loved one? Does that mean that I don't love them anymore? Does that mean I'm going to forget about them?" And to sit in that with them and assess that in the moment, because it can be really, really scary to say, "Yeah, I want to feel better even though this loved one is no longer with me. What does that mean then when all of a sudden I'm feeling better?"

  Kevin: Kelly, that was so beautiful, what you just said. And just thinking if I've lost somebody recently and I'm noticing that I feel very sad and kind of hopeless and that makes so much sense because the person meant so much to me. I love them so much. And also, an advantage of that feeling is that it's my way of honoring them and loving them. That it would be kind of weird or maybe even against my values to be happy without this person that I loved so much in my life. Like, maybe there'd be something wrong with me if I did feel better. And so, obviously I value honoring my loved one showing how important they were to me. My sadness shows that this is a significant serious loss that's meaningful. And so, I can just imagine how powerful it must be when you say to somebody, given that all of that is true, it's hard for me to understand why you would want to feel any differently. And inviting them to either accept that they wouldn't or convince you that they do want to change and why. Do you find that people sometimes do still want to feel better, even though their sadness is such a beautiful expression of their love for their person that has died?

  Kelly Baier: Yeah. So in the assessment of resistance phase, it's nice to be able to talk about, like if you want to feel better; like we talk about the magic button, would you push the magic button so that you're no longer sad about this loss? And people are like, "Well, no, that's weird. I wouldn't want to. I don't want to feel like this, but it would also be weird to not have any sadness." So then we talk about the dials, do you want to turn it down at all? So with the reasonable amount of sadness that you feel like would be a good fit in your life right now, do you have a specific goal for feeling better at the end of the session, versus next week, versus next year? Do you want to kind of keep it all the same? Just to kind of get an idea of their own expectation of how they want these dials to be.

  And so, like in your previous example with the anger, it sounded like, oh yeah, that patient would've wanted to turn down their anger so that they weren't so reactive to their own children. What about their sadness? They have a level of sadness as well because of everything that's going down. And we can see this - going back to the daily mood log, here's all of your emotions you listed. How do you feel about these levels of emotions? Do you want to turn any up? Do you want to turn any down? And being able to kind of explore that, that you don't have to get rid of all of it. That's what I think a lot of patients are like, "Well, I don't want to get rid of all my sadness because I'm grieving, this is normal, but it's affecting me negatively and it's affecting my family negatively." And you're like, "Oh, wow, that is challenging." That's all kind of mixed up together, that like, part of you wants to give up the sadness, part of you wants to hold onto it. So let's explore this and see, it doesn't have to be a black and white issue. Maybe we can just dial it down for you, and that's a more comfortable place to be right now.

  Kevin: And Kelly, an idea popped into my mind while you were saying that, which is, it also sounds like you're really setting up what relapse prevention would look like too. Because when it comes to losing people that we love and ending the overwhelming grief that might be stopping us from living the life that we want to live anymore; it's not like we suddenly feel better one day and then we never feel sadness again about this person who's gone. Like, in a way that sadness is going to be with us, probably always. I'm just thinking of my own life. I'm never going to be not a little bit sad about losing my grandparents and my father. And when I think of them, I have happy memories of them, but I also do miss them too. And so, that idea of how much is too much?

  When I'm initially overwhelmed with a recent loss and maybe that was going on for longer than I wanted to, and I got some help from a therapist. And once I decided, "Well, I want to turn this down a little bit so that I can live my life, even though I still do have this sadness with me." I'm probably going to have moments in my life where it goes way up higher than what I wanted to dial it down to. And maybe a big part of recovery from this problem is accepting that. Accepting that as human beings, we're going to have our good days in our bad days, even after we've gotten better in therapy. And I would imagine that a big part of relapse prevention with somebody who's recovering from a complicated grief problem, is understanding you're going to have bad days again. But you've got something that you can use to help yourself get out of those bad days when that happens; do you find that that's what you're sharing with people?

  Kelly Baier: Yes, exactly. And grief is like, we use the analogy all the time of its waves, and it'll come in waves and you're like, "Oh, I think I'm over it now." And then a wave will come and hit you. Maybe it's because the holidays are coming, or there was a graduation that your loved one was unable to attend. And sometimes it just it can feel out of the blue and other times you can kind of feel it coming on. But grief is kind of always there. Sometimes it's a big wave, sometimes it's just a little wave that laps up and you kind of think about them and feel it and then move on. And there's a great quote about learning to dance with a limp. So you hurt yourself, you went through this trauma and it's like having this hurt leg and it heals, "heals," but it's never the same. And you just learn to dance to go through life with this limp and you just adapt to it. And it doesn't mean that sometimes you're not going to have that pain and the hurt and it's all there.

  The great part about TEAM-CBT is we are trying to fill our patient's toolboxes. Here's all the things that you have found helpful in our work together. And so part of that relapse prevention is, well when those moments come, because they will, like, let's just be honest, no matter who we are, there will be hard times in our life. Let's go back to that toolbox and see what might be helpful for us to just do on our own. And then every single therapist is like, we can stop doing sessions right now, now, but if you need a check in session, if you need to come back and get a few new tools because the problem is a little bit different, we'll fill your toolbox up with some new tools and send you on your way. It's not about us. It's about giving our patients the tools to be able to manage their life the way that they want.

  Kevin: Yeah. Well, Kelly, I really love talking about this with you and I love listening to you and the way that you express things. And I think that we're getting close to the end of our time together for today. So, I'd like to learn a little bit about how potential clients of yours find you. Do you have your own website that you use or are you just strictly on the Feeling Good Institute website? How do people find Kelly Baier?

  Kelly Baier: I am in the works on my website. I'm revamping it, so that will be linked from the Feeling Good Institute website, but you can find me on the FGI website for right now. And one of the unique things that I do too is because I see a lot of people in their end of life, they can't come to the therapy office, so I'm more than happy to travel as long as it's, you know, somewhat in the South Bay of the Bay Area of California. I'm happy to go to homes. I do that for multiple patients who are no longer physically able to leave the house. That's a whole other topic, you know, the lack of support for people who are at the end of their life in terms of their mental health needs, so that's something else that's unique to me. You can contact me with any questions, anything that people might want support with or just resources for. Go ahead and go on to the Feeling Good Institute website and you can find me there.

  Kevin: Yeah, I think that they could maybe also reach out to you by email. Do potential clients sometimes email you? So that would be Kelly Baier. So that's kellybaier@feelinggoodinstitute.com.

  Kelly Baier: I think they shortened it. I think it's Kellyb@feelinggoodinstitute.com.

  Kevin: Oh my goodness. I'm so glad you just corrected me because I don't want to send people off the wrong direction. So Kellyb@feelinggoodinstitute.com, they can contact you. And I guess I just want to make sure, because I sort of focused in on the grief work that you do and I'm realizing that's a big part of what you do. But it sounds like you're also helping people who are at the end of their own life. Is that right?

  Kelly Baier: Yeah.

  Kevin: And then also helping people who aren't experiencing grief or end of life problems and want help with depression and anxiety, and that would be children and adults. And then you also have these special skills of working with people who are on the autism spectrum with depression and anxiety because you have some special skills and training with how to use therapy with someone who's experiencing autism as well. I think that that's just really great. I feel like I need five episodes with you, Kelly, to learn about all the things that you have expertise in. It's been really wonderful chatting with you.

  Sometimes I wonder what's it going to be like to talk to somebody for an hour. Are we going to have enough to talk about? And I feel like I've scratched the surface with you, Kelly. I want to know more. So for those people listening, if you'd like to know more about Kelly and find out about possibly working with her, again, you can reach out to her at Kellyb@feelinggoodinstitute.com. It's Kelly with a "y", and then the Feeling Good Institute website is really easy. It's just feelinggoodinstitute.com. And you'll notice on that welcome page that there's a real big good menu of choices. And one of the things that you can choose is therapist directory. And then you can just put in Kellyb and it'll bring you up to Kelly's page where you're able to make an appointment for a free 15 minute consultation with Kelly.

  And I'll say you can do the same thing with me as well. You can look at Kevin Cornelius there and I'm available for both consultations too. And then when you have your website ready to go, Kelly, let me know and I'll see if I can add that to some kind of show notes for this recording so that people can find your website too, because I'm sure people would love to do that. So I just want to say, Kelly, how much I enjoyed talking to you today as always. And thank you so much for joining us.

  Kelly Baier: Yeah, thanks Kevin for doing this because I want the information to get out about what a helpful form of therapy this is. And so, I appreciate you taking the time to do all these wonderful interviews and I look forward to hearing other people's interviews I hear on your podcast, so thank you.

  Kevin: All right. Thank you.

Episode 1-Perfectionism with Cheryl Delaney

• Transcript of Episode 1-Perfectionism with Cheryl Delaney

  Kevin: Okay. So we've got Cheryl Delaney with us today, and Cheryl, thank you so much for joining me on my first effort as an episode of "Tools for Change". That's the name of what I'm doing here. I'd love it if you would just tell people a little bit about who you are and what you do, especially thinking about people who may be looking for a therapist.

  Cheryl: Sure, yeah. I am Cheryl Delaney. I'm a TEAM therapist located in Atlanta, Georgia, and I work specifically with perfectionists.

  Kevin: Wonderful. And when you say TEAM therapist, maybe you could tell us a little bit about what you mean by that. Because you know some people are going to maybe find this on my website and see a little bit of a description of TEAM. But I'd really like to, especially when it comes to using TEAM with somebody who is struggling with perfectionism, maybe you could describe that to me like you would, to somebody who was considering working with you.

  Cheryl: Sure. This is intimidating because Kevin, you know more about TEAM or have been doing it for longer than I have. TEAM CBT is a form of therapy developed by Dr. David Burns and I think sets up therapy to be the most successful possible form that I've encountered. It really kind of builds a structure and a frame around the therapy and the connection that makes it possible for therapists to connect with whoever shows up in their office, makes it possible for that person to get what they need from the therapy, and leads to, in my opinion, the most lasting change and measurable change, in my opinion.

  So, how that would apply for perfectionist is, let's see. Let me think of somebody. I kind of break things down in my head into people who are perfectionists and are anxious all the time, and people who are perfectionist and depressed all the time and in anxiety. And that's, I think the type that people most often associate with the word perfectionism is this type A always moving, very driven and successful. Those people might have a lot to show for their hard work and their drive but can't seem to benefit from it, because emotionally they're always worried about what's coming next. There's no peace or calm or sense of enjoyment because as soon as you reach one goal, it's immediately onto the next. And so, for that person, just to explain the why TEAM is called TEAM we would measure how anxious they are. We would do some testing, so that's what the T in TEAM and they would fill out a survey to rate their symptoms. And that way we would both, myself and the client would both have a pretty good sense of where they are where when they're coming in. Because sometimes someone presents and they seem very calm and measured, and then you'll see the number on their score and realize, inside there is got to be a lot of turmoil because their anxiety is kind of in the extreme level. And you're smiling there, have you had that experience yourself?

  Kevin: Oh, very, very much so. I think that, you know, especially when you think about anxious people, they're really good at hiding their true feelings. I would put myself in the category of struggling with anxiety quite a bit, so part of that is trying to hide real feelings because you don't want to bother other people or put the spotlight on one self. At least I'll speak for myself. I wouldn't want to draw attention to myself if I'm feeling anxious. And so, I love what you're saying that the testing is really essential because when somebody takes - a very short, we're talking about a five item, not multiple choice, but a five item survey where you're rating how strong different feelings are, you can see right away, oh, that's how anxious I am. And that scale is zero through 20.

  And so I usually talk to people about how one of our goals when probably together we stay, I would work with them in agreement on this goal, is to get that anxiety level down to like, below five. Like between zero and four is kind of the ordinary range. You know, life without anxiety is not really possible or probably desirable. And I like what you were saying, Cheryl. Cheryl was mentioning that TEAM is a framework for what makes psychotherapy effective, so that we can make therapy as effective as possible. And it's also an acronym for what we're doing in the therapy session, the T E A M. So, so far we're talking about how testing helps you, Cheryl, with working with somebody who might be struggling with an anxiety-based perfectionism. Anything else you want to say about the testing, or do you want to talk a little bit about empathy and connection because that seems really important, right?

  Cheryl: Yeah, I was already getting excited about that. And I mentioned earlier that part of the job of the framework is to make that connection reliable so that I can connect with my client and they have a way of letting me know if I'm doing a good job of that. Because we also measure how well this session went at the end. Clients fill out a survey there too, to say whether the empathy was effective. But when it comes to forming that connection, one of the things that helps us mortals do is to get out of the sort of empathy habits that can actually create more distance between us and the person that we're talking to. So instead of giving advice, instead of saying, "Oh yeah, that the exact same thing happened to me," or "I know exactly how you're feeling." We have these structured tools for really understanding and checking in with the other person about how it is their feeling and getting a lot of rich detail so that we know a little bit what it's like to be living with that much anxiety.

  Kevin: Yeah. And I'm wondering if you could bring to life for us right now on a more personal or emotional level, like what it is that you're empathizing with when someone comes to you and has a lot of perfectionism that comes across as anxiety. Because I think that... am I right that - well, and by the way, maybe this is a good time to mention what your website is, what is your website?

  Cheryl: It's bitbybitcounseling.com.

  Kevin: Bitbybitcounseling.com, and I really like your website. And I remember there being some personal elements to it where you share a little bit of your own story. And I don't mean to put you on the spot right now, but maybe there's something about perfectionism that you've experienced that's drawn you to like wanting to work with people who struggle with this problem. Is that the case

  Cheryl: Completely. Yes. I think I have identified in myself, I don't know, like seven different diagnoses that I could connect with.

  Kevin: Only seven?

  Cheryl: At least, I said at least. But social anxiety is certainly in there. And I used to have more generalized anxiety, but the social anxiety still sticks around. And I haven't really done the work that I know I would need to do to get it to be lower than it is right now. I'm kind of working my way there through, you know, there was some lower hanging fruit on the diagnosis tree.

  Kevin: Okay.

  Cheryl: But when... Go ahead.

  Kevin: I was just going to say, when you say social anxiety, I think that probably perfectionists who are struggling with social anxiety are probably really overly concerned maybe with what other people think of them and wanting to make a really good impression all the time. Does that ring true for you? Is that what you're noticing in clients that you work with?

  Cheryl: Certainly. I'm even noticing it in myself right now as I'm thinking about this being a recording.

  Kevin: I'm right there with you. I'll just put a disclaimer out there right now, this is not going to be perfect. But anybody who's watching or listening to this, I'll speak for myself, I'll make some mistakes today. And actually that's one way of addressing social anxiety, is a little bit of self-disclosure or just even naming what our feelings are. I guess to kind of help us structure our conversation, I'm wondering, you know, the person who comes to you who may notice their own discomfort in social settings; maybe you could even explore a little bit like what are the different types of social anxiety perfectionism problems that people have come to you with. And obviously we're not going to say anything that anybody could identify themselves with. But is that something that would be okay to explore a little bit? Like, what are people struggling with when they want to be perfect in their social settings?

  Cheryl: Sure. The two big things that come to mind are the sense that I need to be really impressive in order for people to like me. And I need people to like me in order to be happy and fulfilled. And then the other big one is, I can't have any negative emotions, especially anger. And if I do, it's best to pretend that it's not there and hide it as well as possible.

  Kevin: Okay. I'm just taking some notes because I really like what you're saying here and I'm learning from it as we're talking. This need to impress other people so they'll like you, and then in fact also, even that need to be liked by other people would be kind of a hallmark of social anxiety. And then also, you know, negative feelings not being okay, especially anger.

  Cheryl: Yeah. And I can relate to all of those. Those are all so pretty active for me. And so when I say, you know, sometimes when therapists talk about a need to be liked, it kind of has a negative connotation or some judgment attached to it. And I just want to point out that I think that that is a very - almost universal and very positive human characteristic.

  Kevin: Totally agree with you. You were just making me think of, you know, we were talking about that TEAM acronym the A equals assessment of resistance, in which we often use what's called positive reframing to look at what's good about our so-called negative feelings. So it's pretty easy, you know, you just said really beautifully to notice that there's something beneficial about being concerned about what other people think of us and of wanting to be liked by people. It probably motivates people to be their best selves with other people with kindness and be nice and make others comfortable and enjoy being around us so that people will like us.

  Cheryl: Yeah.

  Kevin: What were you going to say?

  Cheryl: I was just going to say, even if you take that up to a society level, it's kind of what makes it possible for us all to function together.

  Kevin: Yeah. Yeah. It would be so... we would have no civilization if we didn't care at all about people liking us.

  Cheryl: Yeah. Yeah.

  Kevin: Yeah. I like the way you said that. I hadn't thought about that yet as a possible positive reframe for even just being a nice person or wanting other people to like us. Is there a downside to being really concerned with others liking us and the need to impress and to be liked?

  Cheryl: Yeah. So a few that just come off the top of my head, and it kind of brings me back to some of my darkest times when I really felt very lonely and at risk all the time. Every time I would go, even to the grocery store, let alone, you know, a family gathering or a party with friends; I just felt like at any moment I was going to say something that would get me kind of ejected from community. I'd go home and play in my head again, what I had said, what other people had said, "Was there something in there that could get me kicked out?" And it also makes people, my past self included, avoid situations where we think that those things might come up. So, it really can sort of increase any sense of loneliness. It might kind of start out by feeling disconnected when I'm with people and then suddenly I'm just by myself entirely because I just avoid those situations as much as possible, and leads to so much disconnection.

  Kevin: Yeah. I think that's really important what you just said, Cheryl, because when we're struggling with everything you just described, that fear of being rejected when we're interacting even with somebody that we run into at the grocery store who's a stranger, even an employee at the grocery store, there's this fear of being rejected by them. And so, it makes sense actually that people would avoid things that they're afraid of so they don't have to experience that fear. But I heard you saying that the avoidance has, like, it's a huge downside, where eventually a person could wind up just being very lonely and isolated and alone all the time because of that fear. You said it in an even better way, you said something like, of being kicked out of different communities, of being kind of ostracized almost as what that sounded like. And I wondering is there any other kind of downside to avoiding things that we're afraid of, like interacting with other people or maybe any other fears that might be related to perfectionism?

  Cheryl: Well, it increases the anxiety associated with the activity. And it also in some ways, it makes it harder to jump back in again, both because we're not used to... because our anxiety has increased, but also our skills have decreased.

  Kevin: Oh, wow. Of course. Yeah, if I'm avoiding talking to people because I'm afraid, and I definitely have noticed that about myself at different periods of my life, then I'm going to get kind of crummy at talking to people, and then when I do interact with them, it may not go so well. Especially because I've now turned this into a big scary problem in my mind by avoiding it and treating it as if it's dangerous. And then I'm probably not going to be my most socially skilled self. Even if I do have some conversational skills or ability to talk to people, I'm going to be so amped up with my own fears that when I do interact with people, I might kind of create kind of this confirmation that things are going to go badly. So I'm predicting in myself, "If I talk to these people, it's going to go wrong and I'm going to embarrass myself and oh, God." I fumble when I speak to people, and then I'd see that just proves it, I need to now avoid even more. And so, it can become kind of like a prison of fear, right?

  Cheryl: Yeah, a downward spiral.

  Kevin: Wow. Well, as we're talking about this, Cheryl, I feel like because you've been so kind to share that some of this has been what you've experienced, I definitely recognize this in myself too. Like, I can remember maybe in a younger period of my life, I'm living on my own in a big city and struggling to kind of find my way and build whatever my career and personal life was going to be. And then these social interactions take on so much importance, and avoidance lead into these problems that we talked about. So, I think that I'm just imagining if I was a person listening to this right now, and I have been having my own struggles with anxiety, and maybe I can relate to a lot of what it is that you've said I've noticed, you know, social anxiety in myself or perfectionism in myself. What would you say to a person who's come to you because they want help that could maybe give some hope that this is a problem that could get better? Like, let's say I came to you and I'm thinking, "Maybe I want to have therapy with you, Cheryl. What do you got for me?" What could make this better, do you think?

  Cheryl: Are you leading towards the M in TEAM, which is methods, or are you asking for the...?

  Kevin: I guess maybe the M and TEAM being methods would be a logical place to go. And I'm thinking also, like, I know when you talk to people about this, like maybe in an initial consultation you do give them some hope that this problem could get better. So, I'm curious like how you do that. What's the hope if I wanted help?

  Cheryl: Yeah. Well, let me say, I know I kind of opened up about the fact that it's not gone for me yet, but it has vastly improved over where it used to be. The grocery store example that I gave is true for my life. I used to avoid talking to anybody at a grocery store as much as possible. Now I embarrass my teenage daughter because she wants nobody to ever know that she exists. And I'm like, "Hi, I need some help at the dressing room over here." It has gotten so much better for me, and I've seen it with clients and it's such an amazing feeling to see big changes in their lives and what they've accomplished by confronting their fear essentially and deciding not to let the spiral keep going.

  Kevin: Yeah. Let's talk a little bit about kind of what that takes. Like, like what does treatment for perfectionism look like and social anxiety?

  Cheryl: So it really depends on the specific person, but if we're talking about social anxiety, then a big part of it would be talking to people and confronting that fear head on, and both practicing, showing up and engaging with people, even though there might be some anxiety going on. So it's not necessarily demolishing the anxiety entirely, you know, some of it is, I'm still going to get kind of fluttery and I'm going to be here anyway and I'm going to talk and see what happens. And it's also practicing, connecting and doing the things that you talked about, like self-disclosure and acknowledging the feelings that are going on.

  Kevin: Okay. So I'm wondering if I went to therapy with you for social anxiety and perfectionism, you'd be guiding me towards actually being more social. And so, that sounds to me like maybe some exposure techniques. Am I all on my own when I do that? Do I do things with your support? I'm not even coming for treatment and I feel a little bit nervous thinking about, "Oh God, I got to be social when I'm afraid of being social." What would that look like?

  Cheryl: Yeah. Well, would definitely be with my support, and it may or may not be with my physical support in the moment of the exposure. I work entirely online right now, so some of my clients go off and do exposure on their own with some email or messaging support before and afterwards. But some like to meet up and we go out in person and we would go together, meet somewhere in public and try out to see how much we can engage with people and maybe even how much we can embarrass ourselves.

  Kevin: Okay. Oh, wow. So you're using probably some shame attacking when you go out. So for people who aren't familiar with the method of shame attacking, what that means, tell me if I'm right, is when I'm feeling very self-conscious and super concerned about what other people think of me, and I don't want to make a fool of myself in public, and so I start avoiding going places or talking to people, which leads to that kind of loneliness and loss of social skills and a problem that kind of feeds on itself. A way of breaking out of that trap that I've brought myself into is using something like shame attacking, which is not only ceasing to avoid possibly embarrassing myself, but going out and actually embarrassing myself, like doing something that pushes me way out of my comfort zone.

  That might be silly or goofy, and the reason why is because I get to experience in real time that it doesn't really have any negative consequences on me. Other people actually don't really care what I do in public. I remember doing shame attacking with the Tuesday group when it used to meet in person at Stanford with Dr. Burns. And there's this great therapist, Jacob Tower, who goes there and he's superstar in TEAM, and I was paired up with him and I had to do the shame attacking that he asked me to do. So, I'll just share like what my thing was that I had to do. So we went to the Stanford Mall, which is kind of this high end, like glitzy, I don't know, when you were talking about trying to impress people, like this is the place you go when you want to try and impress people. It's like a very upscale mall. And they had these very fancy jewelry stores inside.

  And so my shame attacking was I had to go into this fancy jewelry store in the Stanford Mall and go up to the salesperson and ask if they had any cubic zirconia in stock. And that was interesting how that went. It was really fun. I'm actually not afraid of embarrassing myself that much, but that sort of pushed me a little bit over my comfort zone. But I'm wondering, is there any kind of really effective time that shame attacking was helpful to you or to someone? And what was the activity that was done? Is there a good story about...?

  Cheryl: Well, actually to return to your earlier point that this sounds really intimidating, I have not had many takers.

  Kevin: On doing shame attacking, yeah.

  Cheryl: Yeah. So I've done a bit of my own, but often, people will opt for other versions of, you know, maybe a more gradual kind of exposure.

  Kevin: Yeah. Well, I like that you're saying that because I can imagine for somebody who's never experienced a social anxiety exposure exercise, that the idea of going on and trying to do something really embarrassing just sounds like no way, I'm not even going to - forget that therapist. There's no way. So what would you do as a kind of a stepping stone, you said you've done maybe less intimidating, like exposure; can kind of bring that to life for us a little bit.

  Cheryl: Well, one that comes to mind is a role playing method that we actually do in session which is a - because it's a role play, it's not a real life exposure, but it is exposure to the idea, to the role of someone who would be really critical and judgemental. And I'm thinking here of feared fantasy. So, that's a role playing method where the therapist is in the role of somebody who would be really rejecting and harsh, so the client has a chance to feel what that's like to kind of enter into that nightmare.

  Kevin: Yeah. I'm wondering if I could be a client right now and you could do a feared fantasy with me, would that be okay? Because I mentioned that I've had my own social anxiety problems, so one of the things that I struggle with is, as therapists, we're often invited to go to these networking events. And I often wind up going by myself, so I don't have a companion to kind of rely on to make myself feel more comfortable. And that's sort of on purpose of it. I'll actually talk to people I don't already know when I go. But I remember going to one recently and it was perfectly nice, and I'm sure the people there were really fine warm people, but everybody was already engaged in their own conversations.

  And then I walk in and I kind of felt like, you know, the odd man out. I didn't want to intrude on anybody's conversation and it felt kind of awkward and embarrassing, and I don't know, just all of my own shyness just went way up. And so, I'm having thoughts like, "Oh, people won't want to talk to me. If I try to introduce myself they're going to think I'm rude, or they're going to be annoyed by me. I'm going to come across as this desperate therapist who wants everybody to give me referrals, and people are going to judge me and think that I don't belong here for some reason, and I'm not going to fit in." So those are kind of my scary thoughts that I have in a moment like that.

  So let's say about, you know, maybe you and I have done some other work together and we've discovered that those are my kind of automatic negative thoughts that lead to my anxiety in a social setting. And you decided that maybe a method that we would try would be feared fantasy, maybe you could set it up and walk me through it and let's do it, and then people would see how that works. And again, I just want to kind of give credit where credit is due. This is a technique created by Dr. David Burns, the creator of TEAM CBT, and we've learned that from him and from other TEAM CBT teachers, right?

  Cheryl: Yep.

  Kevin: Yeah. So, is that okay if we do this?

  Cheryl: Yeah. And we're assuming here that we have a really strong trusting connection and that you're...

  Kevin: Completely. So the other elements of TEAM we've already done, we've done lots of testing and empathy, lots of assessment of resistance to bring - so that I'm like really pro change, I really want to get rid of my social anxiety and need to be perfect and liked. And so then, you're going to help me with this method, right?

  Cheryl: Great. So, can I use your name, Kevin?

  Kevin: Sure. Yeah, I'll be Kevin. That's fine. It makes it simpler for me.

  Cheryl: So Kevin, I'd like to try a technique called the Feared Fantasy. And this is a role play method where I would be playing a really harsh and judgemental therapist at this networking event that you attended. And this would give you a chance to sort of enter into that imaginary world and see what that would be like.

  Kevin: Okay, great. How does it work in that imaginary world?

  Cheryl: Good question. So I will be sharing your negative thoughts, in this fantasy world, I actually do believe all the things that you're worried that people believe them. And not only do I believe them, I'm going to say them out loud to you.

  Kevin: Wow. Okay.

  Cheryl: And then you...

  Kevin: It's kind of like my worst nightmare come to life here.

  Cheryl: And your job will be to defeat me one of three ways. One is a kind of radical acceptance to accept the thought with a sense of humor or peace about it. The other is a kind of a self-defense and rejecting me and my cruelty. And the third would be some combination of those two things.

  Kevin: Okay.

  Cheryl: Just a little bit of self-defense, a little bit of acceptance. Does that make sense?

  Kevin: Yeah, that does make sense.

  Cheryl: Great.

  Kevin: I'm just taking notes so I'll remember what you said.

  Cheryl: Yeah. So let's give me a name. How's Marcy?

  Kevin: That sounds great. You sound very judgemental, Marcy, already.

  Cheryl: I apologies to all Marcy's.

  Kevin: I'm sure there are very nice people, but I just picturing this very judgemental Marcy right now.

  Cheryl: Okay. So Kevin, I noticed you came in here and you didn't have anybody to talk to, and you were kind of imagining that none of us would want to talk to you because we were all in our own conversations and you were right, we don't want to talk to you.

  Kevin: Oh, wow. I think I'm a little bit taken aback that you're saying that to me right now. It sounds kind of harsh. And yet, you know, I guess I'll agree with you. Like, oftentimes people don't want to talk to me, and actually I think that that's okay. Maybe you're already busy and you've got your own thing you're doing. But I have to say, it does kind of hurt a little bit to hear you say that out loud to me. But I'm curious, so why would you not want to talk to me?

  Cheryl: Well, we all kind of got here already and we've formed our connections and now you're just being kind of rude and we're annoyed by you.

  Kevin: Oh yeah. I guess it is kind of rude of me to expect you to end your conversation with other people and talk to me. So, it makes sense to me that you'd maybe be annoyed by that. Wow. Again, that kind of stings, that kind of hurts that you're saying that, so I feel a little bit, I don't know, like maybe protecting myself a little bit and not talking to you anymore right now. So I think I might take a break and go, I don't know, grab a cheese plate or something. But thanks

  Cheryl: Be before you go, can I just let you know that I judge you?

  Kevin: Well, join the club, Marcy. That was really good, I'm glad you threw that in there. Ah, that is so funny.

  Cheryl: What was that like for you?

  Kevin: That was really helpful actually. Like, I know we're demonstrating this for other people to get something out of it, but that actually was helpful to me because it's so ludicrous. First of all, do the people on the patio, at this networking event even care that I walked in enough to judge? You know, not really. They're just going to like, "Oh, there's another therapist,", you know, they're not expending any energy on me at that moment. And the fact that they're judging me, I don't know, of course that says more about them than it does about me. And it can't hurt me that somebody is judging me in the long run.

  Cheryl: They're criticizing you for coming to want to talk to other therapists and an event explicitly designed for people.

  Kevin: For talking to other therapists and meeting people. Yeah. And it's so funny you show up because my whole life I've struggled with this on and off. I mean, I can remember crossing the street to avoid walking by people because I wouldn't want them to look at me and give me a judgemental look because that would hurt so much. And on the one hand that's sad and It's understandable. I saw you raise your hand, you know, I don't feel good that that's something you went through too. But also, the reason why I like this role play method that you just did with me, and I like doing that with people too, is that it shows just how ridiculous it would be for somebody - for like a grown person to actually be that judgemental of others and to say, "I judge you. How dare you walk by me right now. Look at your funny shirt," or whatever.

  Cheryl: How little I would want that person's friendship.

  Kevin: Yeah. I wouldn't care. I don't want to care about what they think of me. So, I'm curious, like, let's say that I am your patient or your client in a session and I've had this experience of you brought this to life for me and I now see how ludicrous it is to be concerned with the other people judging me. And I have this negative thought that's come up that we've been working with, which is the people at this event will judge me. Maybe you could walk me through like, how would I turn that into a new thought that would help me feel differently? What would, maybe you could help me do that because that's what I think we would do in a therapy session. Anytime we use a method, the purpose is to kind of prove that the negative thought isn't true.

  Cheryl: Yeah. So let's see. Tell me what worked. You said that that was really helpful to you, that you...

  Kevin: Because it just showed how absurd it is that a person would judge, and also, if they really would judge me that harshly for wanting to talk to people at an event that's designed for therapists to talk to each other and meet new therapists; would I even want to talk to them? Do I even want to connect with somebody who would judge me so harshly? Probably not. And the whole thing makes me laugh because it's so silly.

  Cheryl: So, those are the things that work. So, tell me the initial thought again.

  Kevin: Oh, the initial thought was the people at this networking event will judge me harshly if I try to talk to them.

  Cheryl: Okay. So what would you say to that thought now, taking into accounting things that...?

  Kevin: Yeah. Kind of like, "Well, so what?" I guess judgemental creeps do exist, so somebody might be judging me, but if they did that would really mean that there's something not so nice about them. It doesn't mean that I am like some fool or something, or that I'm not good enough or I'm somehow a bad networking event attendee because I tried to speak to people. But also, let's be real, this is a room full of adults, professionals who are therapists. They probably are not judging me that harshly, you know? And if I tried to strike up a conversation with somebody, they would probably at least be courteous about it. They're not going to like shun me and send me out of the room or something, which is what I think I'm afraid is going to happen.

  Cheryl: Okay. I got some of that.

  Kevin: That's a lot. Sorry.

  Cheryl: But I think if we could distill it down, and you might want to write this down next to your negative thoughts. So what, judgey creeps do exist but that doesn't make me a fool. In all honesty, these people are probably nice. Does that capture...?

  Kevin: That does. And what was the last thing?

  Cheryl: In all honesty, these people are probably kind.

  Kevin: Yeah, exactly. These people are probably kind.

  Cheryl: And how much do you believe that new thought?

  Kevin: Oh, I believe that a hundred percent.

  Cheryl: Are you just saying that or is that...?

  Kevin: No, that's really true. I really believe it. Yeah, that's clearly true.

  Cheryl: And how much do you believe the initial negative thought?

  Kevin: I don't believe that anymore. Or if I do, it doesn't bother me. Like it's a minute possibility, but I don't think that that is what's going to happen, so I don't think that that can actually be something I believe anymore.

  Cheryl: Great. Well that works then.

  Kevin: Thank you. And I guess I'll just mention that, you know, because Cheryl and I use TEAM; CBT, Cognitive Behavioral Therapy, is designed to change how we feel by changing the way that we think, because when we're feeling an intense negative feeling like anxiety, it's probably being caused by thoughts that have something about them that's not true. And what Cheryl did was she brought to life my worst nightmare so that we could act it out. And I confronted that fear and realized that that was ridiculous. And I got to experience that, and it's actually not something that I'm afraid of. And it kind of got me in touch with my own sense of humor, and what it did was it did change how I feel by changing the way that I think. Like when you helped me come up with that new positive thought just now, that really does make a big shift in how I feel, now that I don't believe, "Oh, these people are judging me and don't want me to talk to them."

  Cheryl: There is I think only a certain level that this kind of exposure can trigger. Because your anxiety probably would go up again the next time you're at a networking event, and it would help that you had this new thought. but you probably still would feel, you know, your heart rate might get a little bit faster, you might still have those kind of physiological symptoms; until you were in physical space enough times that it didn't bother you anymore.

  Kevin: I love that. And I'm glad that you pointed that out because a role play method like that is great. And it did bring the fear to life, and I did address it to a certain extent. But in order to make the real change that I would be looking for, I would need to do lots of networking events or lots of going up and talking to people who I don't know until I'm used to it, and until it just doesn't bother me anymore. And that doesn't mean that I'm not going to feel anxious when I do that, but I probably will feel anxious a lot when I first do it. And I think just for you and me to talk about like as therapists and how therapy works, tell me if you agree with this.

  This is kind of my own fifth grade level of neurology that I've learned. Kind of like what's going on in the brain You know, anxiety is not bad. Anxiety is why you and I are here right now. We're related to the people who were afraid of things. Our ancient ancestors who are the ones that ran away from tigers, not the ones who went, "Ooh, kitty, how cute." So, it's necessary for our survival to have anxiety. You wouldn't want to get rid of it completely. But what's happening is, that part of the brain that's responsible for that fight, flight, or freeze response that's kept human beings alive for as long as we have been, it gets triggered now in modern times by things that are not predators. A tiger is not making me afraid to go to the networking event. My life is not in danger. They're not predators who are going to attack me, literally, but my brain doesn't know the difference. That part of my brain still kicks in and does things like make my heart rate go up, I'm probably get kind of sweaty, the adrenaline's rushing, blood's pumping into my muscle so that I can run away if I have to.

  Cheryl: Or fight somebody, I can see.

  Kevin: Or fight somebody. I'm going to get into a fight with a psychologist, you know, in the parking lot at the family therapy center. You know, that's not needed. And so, our brain, it hasn't adapted enough to like what our modern causes of our current day causes of anxiety. So the reason why exposure is so important, is that I need to go into those situations instead of avoiding them so that I can retrain my brain to tolerate the anxiety that I will feel. So it's not so much that I need to not feel anxious or not care about what other people think of me. It's probably good for me to be a little bit anxious because there's a lot at stake. I've got a career I'm building, I've got a reputation, I want to have good relationships with therapists. So if I didn't care at all, just imagine what kind of mess I would make of my life going to this networking event. But it's too much, and I don't need to have my stress response kick in just because I want to go up and hand somebody my business card and introduce myself to them. Am I describing that in a way that seems true?

  Cheryl: Yeah. One of the ways I like to think about it is, you know how you learn not to touch a hot stove? Is by touching a hot stove. So you have some kind of experience where, you know, maybe somebody does have a negative reaction to you in a social situation, maybe as a little kid. And I was a very inept little kid at social interactions. And so, you can sort of... the pain that you feel when you touch a hot stove actually creates a response, a physical response before you have any conscious thought about it.

  Kevin: Of course. Yeah.

  Cheryl: If suddenly you're now in a place with things that look like stoves, but are actually like a desk or something that you need to be really comfortable, or maybe you work in a kitchen, I don't know, stretching the metaphor here. You need to feel really comfortable and not afraid of stoves; you need to teach the physical part of your response system, in addition to all of your conscious thoughts about it. You need to have experiences of touching the thing that looks like a stove and not feeling the pain in order to convince the physical response.

  Kevin: No, it's okay. I'm following you. I think it's helpful what you're saying.

  Cheryl: There's only so much that you can do with conscious thought. There's also a physiological element and that needs to be treated too.

  Kevin: Yeah. Yeah. Well, I know we're coming to the end of our time together here, and so I'm just imagining very fortunate people out there in the State of Georgia who will hopefully be hearing your skill and warmth and empathy and ability to treat people and help people get better. And so let's say that I've listened to this podcast or this video recording and I really, I think, "You know, Cheryl, I want to talk to this person, and I want to see if I can get some help with my perfectionism or social anxiety." What would the next step be if they wanted to reach out to you?

  Cheryl: The best way to get in touch is through my website. There is a link from my website, which is again, bitbybitcounseling.com And there's a link to schedule a free 15 minute consultation. And that's a chance for clients to get to know me, for me to get to know them, and to see for both of us if it will be a good fit. And if I think that I have what it would take to help them, and if they think that I would be someone they could relate to and trust.

  Kevin: Wonderful. Well, I don't think that they could be in better hands. I certainly relate to you and trust you, Cheryl, and it was really great to do that method. I've, of course, have helped people with that method myself, and I've seen it demonstrated in workshops before, and it was really nice a new experience for me to like really experience it, especially when you said, I judge you. That was really good. That helped me a lot. So you can judge me anytime you want to, Cheryl, that'll be helpful to me.

  Cheryl: This was to delight. Thank you, Kevin.

  Kevin: Thank you. And I just want to say thank you so much to you, Cheryl, for joining us here and letting anybody who may be listening to this hopefully get some great benefit out of it. And until next time, this was Tools for Change and you can see information about upcoming episodes in the credits after that are going to roll in just a moment. So, thank you, Cheryl.

  Cheryl: Thank you, Kevin.

  Kevin: See you soon.