Therapy For Losers

Robert L. Strauss provides a glimpse into the training methods of psychiatrist David Burns, a leader in cognitive behavioral therapy and the author of Feeling Good.  “Theo” is a fellow therapist who is frustrated that a patient dropped out of his practice:

Although Theo is obviously upset, this is a training session, not a therapy session, and so Burns asks what the two of them should do next. Theo suggests the “externalization of voices” technique, in which the therapist (or friend or spouse) hurls the patient’s negative thoughts right back at him. It’s the patient’s job to defeat those thoughts.

“People will think I’m a loser,” Burns says, as Theo’s inner voice.

“And they’d be right,” Theo answers, disheartened. “I am a loser.” (Theo has an advanced degree from Stanford.)

Burns reminds Theo that in this exercise he needs to find positive thoughts he “believes in 100 percent” that will crush his negative thoughts completely.

Round Two.

“You have to accept that you’re not going to have a successful practice,” Burns jabs.

“It’s silly to jump to conclusions,” Theo answers.

“Well, you failed the patient who dropped out,” Burns says.

“We don’t know that,” Theo answers. “That’s black or white. That’s not how the world works.”

“Still, you don’t know what you are doing.”

“I’m learning every week. I’m having some remarkable success,” Theo says more assertively. “Openings just mean that people’s schedules change. The reality is that therapists have openings.”

“The reality is that you are a loser.”

“That’s just not true!” Theo retorts with a conviction that was entirely missing moments before.

Burns asks who won the exchange.

“I did,” Theo says.

When Theo quantifies his “after” feelings, anxiety has dropped from 75 to 40 percent, inferiority from 75 to 30. He reminds himself that therapy is a science and an art.