The Therapist s Craft Advanced Empathy Training David D. Burns, M.D. Adjunct Clinical Professor of Psychiatry and Behavioral Sciences, Stanford Medical School 1 TEAM Therapy T = Testing E = Empathy A = Agenda Setting M = Methods 2 T = Testing How Accurate are Our Perceptions of How Our Patients Feel? Depression, Suicidal Urges, Anxiety, Anger And How They Feel about Us? Therapist warmth, empathy, helpfulness 3 M.D. Page 1
Depression Use checks ( ) to indicate how you're feeling right now. 0 Not at all Before Session 1 Somewhat 2 Moderately 3 A lot 4 Extremely 0 Not at all After Session 1. Sad or down in the dumps 2. Discouraged or hopeless 3. Low self-esteem or worthlessness 4. Loss of motivation to do things 5. Loss of pleasure or satisfaction in life 1 Somewhat 2 Moderately 3 A lot Total 15 Total 17 4 Extremely Empathy 0 - Not at all true 1 - Somewhat true 2 - Moderately true 3 - Very true 4 - Completely true 1. My therapist was warm, sympathetic, and concerned. 2. My therapist seemed trustworthy. 3. My therapist treated me with respect. 4. My therapist did a good job of listening. 5. My therapist understood how I felt inside. Total Score 17 Helpfulness 0 - Not at all true 1 - Somewhat true 2 - Moderately true 3 - Very true 4 - Completely true 1. I was able to express my feelings during the session. 2. I talked about the problems that are bothering me. 3. The techniques we used were helpful. 4. The approach my therapist used made sense. 5. I learned some new ways to deal with my problems. Total Score 7 M.D. Page 2
TEAM Therapy T = Testing E = Empathy A = Agenda Setting M = Methods 7 Your Most Difficult Client (or Family Member, Colleague, etc.) What does she or he say to you? You re not helping. You don t care about me. You re a dickhead! This therapy sucks! I hope you get suicidal some day and have to work with a therapist like you. You re the best mechanic I ever had. 8 Five Secrets of Effective Communication The Disarming Technique. Find the truth in the criticism. Empathy. Thought Empathy. Paraphrase the other person s words. Feeling Empathy. Acknowledge his or her feelings. Inquiry. Ask gentle, probing questions. "I Feel" Statements. Express your feelings openly, directly, and tactfully using I feel X. Stroking. Convey liking or respect. M.D. Page 3
Law of Opposites If you disagree with a criticism which seems totally untrue and unfair, you will immediately prove that the criticism is entirely valid. This is a paradox. Law of Opposites (cont d) In contrast, if you genuinely agree with a criticism which seems totally untrue and unfair, you will immediately put the lie to it. This is also a paradox. Example of the Disarming Technique The man who said I was too young to be his patient 12 M.D. Page 4
Common Disarming Errors Not seeing the truth in the criticism Defensiveness Disarming in a patronizing way I can see how you might feel that way. Disarming in a self-effacing, unprofessional way. 13 Why Skillful Disarming is Difficult Fear Pride Anger / Resentment Psychotherapy Training We are taught that patients negative perceptions of us are distorted and based on the past, and not the reality of the relationship. 14 Disarming Technique Exercise Work in groups of 3 One patient, one therapist, and one observer 15 M.D. Page 5
Empathy Exercise (cont d) One critical or hostile comment by the patient Can be several sentences One response from the therapist Use the Five Secrets, but make sure you include the Disarming Technique 16 Empathy Exercise (cont d) Now STOP and provide feedback The patient and observer will critique s the therapist s response 17 Feedback First give a letter grade For example, That was a B-. Now give the spontaneous feedback This is what worked, and this is what didn t work. Finally, give the Five Secrets Feedback For example, You didn t really agree with me. In addition, you didn t acknowledge how angry I felt. 18 M.D. Page 6
Empathy Exercise (cont d) Remember to check your ego at the door 19 Five Secrets of Effective Communication The Disarming Technique. Find the truth in the criticism. Empathy. Thought Empathy. Paraphrase the other person s words. Feeling Empathy. Acknowledge his or her feelings. Inquiry. Ask gentle, probing questions. "I Feel" Statements. Express your feelings openly, directly, and tactfully using I feel X. Stroking. Convey liking or respect. Therapist Toolkit Assessment Tools Numerous brief and full-length tests 21 M.D. Page 7
Therapist Toolkit Treatment Tools Cognitive Behavioral Therapy (CBT) Interpersonal therapy (IT) Group, Couples, and Family Therapy 22 Toolkit (cont d) Psychometric Information Scoring keys Instructions License for Unlimited Reproduction Individuals, groups, institutions 23 Free 2011 Toolkit Upgrade If you obtained a Toolkit at the workshop, send an email to Dr. Burns for a free upgrade. You'll receive numerous new tools via email (zipped files). You can download and open them in Microsoft Word. Time-Limited Offer M.D. Page 8
Dr. Burns' email david@feelinggood.com M.D. Page 9