SPENCER: David, welcome.

DAVID: Thank you. Great to talk to you again. I really appreciate it.

SPENCER: Your previous episode was one of our listeners' favorites, so it's great to have you back.

DAVID: It's great to be back. I'm glad they liked it. Hope we can make it interesting again.

SPENCER: Now we have to exceed their high expectations. The first thing I wanted to ask you about is, what are the main causes of problems in relationships?

DAVID: Okay, well, that's an important question. I did a research study on this at the University of Pennsylvania because I had done a lot of work on depression and anxiety, but I wanted to see, what's the story with relationships? At the time, there were all these theories, kind of cognitive-type theories about things that were associated with good or bad relationships. One of them was, if you think that your partner should be able to read your mind and know how you feel, then you're going to have a bad relationship because maybe your partner can't read your mind and doesn't always know what you want and how you feel. If you don't verbalize it, then you get roadblocks, hurt feelings, and arguments. There were all these theories about being entitled, thinking people should be the way you want them to be, and all of these things. Albert Ellis had these ideas, and they all seemed very plausible. So I created a survey and got about a thousand people in the survey. Some of them were paired, like husband and wife or a gay couple, and some I just had one of the two partners. Then, I had a very sensitive marital satisfaction score that I had developed, which I still use. It's about 95-96% reliable. It's just super accurate, "How satisfied are you with this relationship?" I fed all the data into a computer. I was just learning statistics and had hired a graduate student in economics who was really good at mathematical modeling, and he was kind of teaching me. We fed all this data into the computer to have it tell us what kind of patterns of attitudes in one partner or the other are associated with happy or unhappy marriages. It's the exact question you asked. I was so excited. I was just beginning to feed the data into the computer, and I was doing a workshop in Chicago. They had a reporter there from the Chicago Tribune, and I told him about the experiment. He got all excited and even published an article in the Chicago Tribune because I thought all these patterns would come out and I could use them to diagnose relationships. I thought I was onto a big discovery. When I got back to Philadelphia, the graduate student and I started working with the data. We actually trained the computer to create and test hypotheses, and it could do this. This was the fastest computer in the United States — the Department of Defense computer. It could evaluate a thousand theories per second, and we had to go through all the different patterns of husbands and wives, or two guys, or two women, or whatever the relationship was, and see what was associated with happier or unhappy marriages. I thought it would come up with all of these complex equations and things that were going to make me famous. The computer then told us that every theory it had tested was absolutely of no value, that all of my thinking and all of the cognitive thinking, all of these fancy ideas that everyone had were just spurious. It said there's only one thing that is associated with happy or unhappy marriages in the here and now, and only one thing that predicts the future. Do you have any idea what that was?

SPENCER: No, I have no idea.

DAVID: I was incredibly disappointed. It crushed me. It said, blame. If you blame the other person, you're going to have a crappy marriage. The problem isn't that the other person is to blame. The problem is that you're blaming them, and the more you're into the pattern of blaming other people, the more miserable your relationships are going to be. Not only are they going to be miserable today, they're going to get worse in the future. I was just so disappointed because I thought this is too simple. People want something fancy, and Virgos and Scorpios and all of these pairings that people are always thinking about. The computer says that's all horseshit. As I started working with troubled couples, I began to see this is really true, and over the years, it has blown my mind what a fantastic discovery that actually was. I've developed my whole interpersonal therapy model based on that, and it's incredibly true. But it's very painful for people to let go of that because it makes us feel great to blame other people, and we feel morally superior. But that's the variable that not only leads to terrible marriages and loving relationships, it kills them. It even leads to political hostilities and hostilities between nations and wars and religious conflicts, and it leads to a lot of killing in the world.

SPENCER: It's interesting that it focused on blame. I was having a conversation with a friend the other day, and we were talking about how to improve relationships. They mentioned how when their partner blames them for something, they immediately become defensive. Then they think of examples where the partner messed up and say, "Well, what about that time you did this thing?" It ends up in a dynamic where they're both just angry at each other, and nothing gets better. So it's interesting to me that you honed in on that. I'm wondering, when you talk to a couple, and let's say one of them makes a mistake, instead of the other one blaming that person, how should they handle it? What is a better way to deal with that?

DAVID: The way I do it is, I don't just take on couples anymore. I prefer to work with just one person because I've discovered that if one person changes in a profound way, the other person will almost always change as well. It's much easier to work with a single person because it's clear that if they're going to make a change in the relationship, they have to take responsibility. What I've also discovered, which is pretty amazing, is that all the problems in a relationship are encapsulated in any one five or ten-second interaction between the two of them. It's hard to believe, but it's actually true in my experience. If you can learn how to change a troubled relationship in just one five or ten-second moment, you'll have the key to the entire solution to all the problems in that relationship. I have something I call the Relationship Journal, and when I'm working with someone, I first say, "Are you sure you want to get closer to this person?" Because if you've got a troubled relationship, you might want to leave it, you might want to stay in the relationship and act in a way that guarantees it will continue to be bad, or you might want to stay in the relationship and work to make it more loving. I'll explain those three options. The most popular is to stay in the relationship and make sure it doesn't change, ensuring it's miserable. The second is to leave, and the road less traveled is to sustain the relationship and make it loving and joyous. If that's the path someone takes, I say, "That's fantastic. Let's do it. So, tell me one thing your partner said to you that didn't work out well and exactly what you said next." I have them write it down. Then we look at how they responded to their partner, and what you'll see is what you just mentioned a moment ago: your partner said something sharp or hurtful, and then they got defensive, and it escalated. What people discover is that the very thing they're blaming their partner for is something they're forcing them to do, and that's very unflattering and painful to see. I hate to look at my own responses when I'm not getting along with a student, my wife, my son, or whatever, and it involves the death of the self, the death of your pride. But if you're willing to do it and see how your own behavior is triggering the very thing you're complaining about, then you're empowered to respond differently with what I call the five secrets of effective communication. You can suddenly turn things around by using five communication principles. I can spell them out; they're easy to explain, and they sound simple, but they're very difficult to learn. They can be learned, but it takes a lot of commitment.

SPENCER: Let's start with an example. Give us an example of a common pattern in a relationship where someone says something specific and then the other person responds. Let's start there.

DAVID: I'll give a real simplistic one. I was doing a workshop in Sacramento sponsored for the general public. I think the Sutter Health System was sponsoring that, and it was a half-day thing in a high school gymnasium. They had two to three hundred people there and asked them all to write down one thing their partner said that didn't work out well and exactly what they said next. That's all we need, and I can show you how to turn that relationship around if you're willing to. They took about five minutes to write things down, and then I asked, "Who'd like to share your example with the group?" This woman was waving her hand; she was in the front row. I called on her, and she said, "I came to this workshop to find out why men are the way they are." I said, "You know, scientists don't know why men are the way they are or why women are the way they are, but maybe we can see what's happening in your relationship if you tell me one thing that you wrote down that your husband said to you and exactly what you said next." She said, "For the last 25 years, he's been criticizing me, and he always says the same thing. He tells me, 'You never listen.' Now you tell me, Dr. Burns, why are men so critical?" I said, "We're going a little fast here. Your husband said you never listen. What did you say back? What did you say next?" That's the crucial thing to see: how you respond to your partner. Her complaint is, "Why are men so critical?" He says, "You never listen." She said, "I just ignore him when he says that." The whole audience started laughing, and they were saying something. Apparently, she could not see that when she responds like that, she proves that he's right. In addition, she forces him to keep saying that because she keeps putting up a barrier every time he says that, which confirms it. That's a classic example of when you blame your partner and overlook your own role in the problem. She could respond in a radically different manner if she wanted a loving relationship using the five secrets of effective communication. But the first question is, does she want a more loving relationship? Is she willing to pay the price, which is the death of the self and examining her own role in the problem? I've probably done this exercise with four or five thousand people with troubled relationships, and every time, it was the same. There's a simple exercise you can say, "Look at the way you responded to the other person. We can talk about what's good and bad communication. Good communication is when you listen and acknowledge the other person's point of view and feelings." That's the E of E, A, R. I say talk with your ear: E, A, R, empathy. A is assertiveness. Did I share my feelings in a non-hostile way? R is did I convey love or respect? So look at her response. Did she acknowledge her husband's feelings or point of view? No. She said nothing. She gave him the message, "You're not even worth the air that comes out of my lungs; I'm not even going to respond to you." She certainly didn't share her feelings. She was feeling hurt, lonely, and angry. Did she convey love or respect? No. She conveyed passive aggression and hostility. It's pretty upsetting for people to do that E, A, R exercise because when you've been blaming the other person, and then you look at the way you respond to them in any moment, you'll find you didn't empathize, you didn't share your feelings, and you didn't convey respect. You can learn to do these things if you're willing to pay the price, but what are you willing to pay for love? Many people, maybe most people, prefer hostility and the victim role.

SPENCER: So can you walk us through what it would look like if she responded in a healthier way? What kind of things would she say? How would she act?

DAVID: She could start with the three empathy techniques. The first is disarming techniques, where you find truth in what the other person is saying. Thought and feeling empathy is where you acknowledge their words and how they're probably feeling. Inquiry involves asking gentle questions. That's the disarming technique, Thought and Feeling empathy, and inquiry. You can also use "I feel" statements, which is the assertive technique, sharing your own feelings. Additionally, you can use some stroking to let the other person know that you care, even if you're both feeling angry and frustrated. She might say something along these lines. By the way, you can't just jump in and teach a person to do these things; they have to be willing to see that they're the culprit, not the other person. Of course, if her husband had come in, it would turn out that he was the culprit. He would have to focus on how he's communicating with her. But he wasn't there; she was there asking for help. So she might say something like, "Roger, it's painful to hear you say that I never listen, because I just realized that you're right. I've been ignoring you and arguing whenever you criticize me for 25 years. I can only imagine how hurt, angry, frustrated, unloved, and put down you feel. I want you to know that I've also been feeling alone, lonely, hurt, and angry. Right now, I'm also feeling ashamed because it suddenly dawned on me that your criticism is correct, and I haven't wanted to see that in the past. I got angry and pissed off at you, but you're my man, and I've always loved you. I'd love to feel closer. Maybe you can tell me what it's been like. I'm ready to listen now. I want to hear about your anger, your hurt, your frustration, and what it's been like all these years." Something along those lines would mean exchanging your indignance for humility and your resentment for love and closeness.

SPENCER: Would it be all right if we try this right now in a real situation?

DAVID: Sure.

SPENCER: It would involve me giving you a minor criticism. Is that okay?

DAVID: It's hard to find a minor criticism of me because I have so many flaws, huge criticisms all the time. Give it to me, and let's see if the old fart can hold his owner or is a fraud. I love it.

SPENCER: So the very minor criticism is, I asked that you try to use shorter responses in the interview because I know my audience really prefers more of a back and forth rather than longer lecture-style speeches, and your responses have been quite long. My minor criticism is just asking you to try to give shorter responses to provide the audience the kind of style of conversation they most enjoy.

DAVID: I just say thank you a million times over, you're absolutely right. That's kind of a narcissistic thing I do because I love to talk, so let's have a conversation. That's such a great example. Thank you for that.

SPENCER: The response that took away the tension for me, saying something uncomfortable, made me feel good about having said it and made it feel like you were really going to take into account what I said. So, yeah, I thought that was handled great, but maybe you could compare what would be a less healthy way of responding to that criticism, just to give the contrast.

DAVID: I mean, I'll sound like an ass. If you give me permission to sound like an ass, I will.

SPENCER: You have permission to sound like an ass.

DAVID: Okay, yeah. Well, the reason I give a long explanation is because I'm so knowledgeable [laughs], I have a lot to say. So shut up and listen. There's a quick way to alienate the other person.

SPENCER: Right. So I think when you responded the first time, you used the disarming technique you demonstrated. You showed that you thought there was truth in what I was saying, so that was really helpful. I think you also showed empathy toward my situation and for the audience.

DAVID: I could have done more along those lines. I could have said, "I can imagine you're feeling a little on the frustrated side."

SPENCER: Yeah, I could see that being helpful. And then I'm not sure if you used I feel statements; you might have.

DAVID: I could say I'm feeling a little bit embarrassed and a little bit ashamed because I did exactly the thing I promised not to do.

SPENCER: And you definitely used the stroking or affirmation part of the communication skills, offering genuine appreciation. So I think that's a really nice example, just illustrating how to do that. But you also make a really important point, which is that people might feel like they want to have a loving relationship, but they're not necessarily willing to suffer the pain that it takes to get there, which is the pain of being wrong, of admitting your side of things, of the ways you're contributing to the relationship being bad. So maybe you could unpack that a bit more. What is that pain?

DAVID: Yeah, well, it's the pain that triggers the world suffering. It's the ego, the self, the thinking that we have to defend ourselves and somehow, that we have a self, an ego, that's vulnerable to attack and that we've got to protect it. One of the nice things that I've discovered as I've gotten older is that people don't seem to care about whether I'm right or whatever. What they really love me for is when I'm vulnerable and open and hear them and don't seem like I'm trying to be so smart or so important. That's been a fantastic discovery, but it's been a whole lifetime to learn that love comes through vulnerability and through our flawed side, and not by having to be so special or having to be so great. I guess that's it in a nutshell: we just have a gut reaction to being criticized that we get defensive and don't realize how damaging it is to do that. Love is kind of like the opposite of human nature.

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SPENCER: It's funny, because I think people want to put on a good face by always being right. They think that's going to make a positive impression. But then, if you're sticking to your guns and saying, "I'm right, I'm right, I'm right," it's actually very annoying to other people, and it often makes them feel much better about us. If we say, "Hey, you know what? You made a great point. I think I might be mistaken," it actually makes them think more highly of us, even though often we're attached to the idea that the way to be liked is to be correct all the time.

DAVID: It's bizarre when you think about it, and yet that's how we function as human beings. I have a class at Stanford that is open to therapists from all around the world. They can attend for free for as long as they want. It's all virtual, so people can come from Pakistan or wherever they're from. One of the exercises we do is have one person play the role of an angry patient and rip into their therapist, being as nasty as they can imagine, and then the therapist has to find the truth in what the patient says and respond with the five secrets. It's an incredible exercise. We could try it again. We kind of did it already, but we could do it again. There's a thing called the law of opposites, which is when you find the truth in a criticism that seems unfair, you'll put the lie to it, but when you defend yourself from a criticism that seems unfair or unfounded or exaggerated, you'll prove that the critic is right. That's a kind of double paradox, and I call it the Law of Opposites.

SPENCER: What's an example?

DAVID: Well, an example was when I was trying to teach the psychiatric residents at Stanford how to communicate with angry patients. I was trying to teach them the disarming technique. Like everyone, they resisted the disarming technique. One of the residents was very high-powered. He has an MD and a PhD, so he fancies himself to be quite the brilliant fellow. On some level, he is, I suppose, in his area of research, molecular biology or whatever it is. He said, "Well, how can I agree with a patient when what the patient says is blatantly false?" I said, "Well, you know, patients never say things that are blatantly false. Can you give an example?" He said, "Well, just this morning, I was talking to this teenager who was involuntarily hospitalized. He was trying to commit suicide. I guess he was talking to the nurses and saying he was trying to get out of the hospital so he could finish and kill himself today. I told him that we couldn't release him, and he shouted at me, 'You're stupid.' How could I possibly agree with a statement like that? I have my MD from Stanford and my PhD from the Advanced Study Institute at MIT, so how can I agree that I'm stupid?" That's the kind of blindness that traps us. We think that other people's criticisms of us are wrong. I think if I were in his role, I might have said to that young man, "You know, I am feeling pretty stupid right now, you're right, because I'm like a prison warden keeping you here against your will. You're probably super angry with me and want to get out of here and do the thing that you feel so strongly that you need to do. I couldn't live with myself if I let you out of here today and you left and killed yourself. I'd be feeling shame and sadness for the rest of my life, but at the same time, I have to admit that I haven't been at all helpful to you. I've been bossing you around like a prison guard, and what you're saying is absolutely right. Tell me more about that. I want to hear what you have to say, because we're on the same page." You see that kind of response? He's agreeing with the kid that he's pretty stupid, because that's what's been going on. It is a kind of stupid interaction, but by agreeing with it, he would prove that he's not stupid, because this kid probably criticizes everybody. He feels alone, hopeless, and desperate, and nobody listens to him. People are afraid to see the truth in what he's saying. When you say things like that to an angry individual, patient, or loved one, and you do it with humility and skill, it generally transforms the interaction immediately. I've had so many patients that I've worked with who told me, "Dr. Burns, you're not helping me." When I was young, I used to feel like I had to convince them that I could help them, that I was helping them. I remember the first time I went in the opposite direction. This young woman I was working with had what's called borderline personality disorder. That's the toughest type of depression. People with it mutilate themselves with razor blades, attempt to commit suicide, and 10 to 15% of them eventually do commit suicide. It's very sad. This young woman was telling me, "Dr. Burns, you're not helping me." I finally learned to say, "You know, Sarah, what you're saying is right. You're coming in every day, and your depression scores are at the top, your hopelessness scores are at the top, and I have not been at all helpful to you. I've been giving you homework exercises that haven't seemed worth doing, and I just haven't connected with you. I want you to know that I really care about you and feel kind of ashamed and sad. I can imagine you're feeling really angry, alone, and disappointed, and kind of pissed off at me. Let's talk about it. Tell me more about what it's been like. Maybe this is the conversation we need to have to get on the same page so we can start working together in the way you want, the way I want." She just burst into tears and opened up, and we had a great dialogue. At the end of the session, she gave me the top scores on empathy and said, "You have been incredibly helpful." She really taught me something: when I agreed with her and what she was saying was true, my ego didn't want to hear it because I had this misguided notion that I was supposed to be so great that I could help anyone. When I finally admitted that I had failed her, I suddenly achieved success in her eyes, and then we were able to connect.

SPENCER: It seems that when people say things to us that seem false, often there's an element of truth in those things.

DAVID: Always, always.

SPENCER: Even if they're not always true, I would say at least often, perhaps always, if there isn't truth in the literal words, there's truth in the emotions that they're expressing.

DAVID: Yes, I love what you're saying. I call that listening to the music behind the words. There's truth in the music, even if the words are exaggerated and screwed up. If you hear that music and agree with it, and hear the beauty in that music, you can connect with the person.

SPENCER: You mentioned personality disorders. I've actually been doing a series on this podcast on personality disorders, where I've interviewed one person with narcissistic personality disorder, one with antisocial personality disorder, and one with formerly borderline personality disorder. I'm curious, when you're working with patients with these disorders, I know that many therapists will avoid them or not take them on as patients. Do you take them on as patients? And how does that change the way you try to help them?

DAVID: Early in my career, I had been at Penn, studying brain chemistry, handing out antidepressants by the bucketful, and not seeing much change with my patients. Then I heard about cognitive therapy. I was on the faculty and had a federal grant to develop a brain serotonin laboratory at Penn. Our research indicated that the chemical imbalance theory was not true.

SPENCER: That's a theory, just to clarify. That's the theory that says that the reason people are depressed is because they have a chemical imbalance in their brain.

DAVID: Yes. We tested it directly with our depressed veterans. The idea was that they didn't have enough serotonin in their brains, and we flooded their brains with serotonin, and it had no effect whatsoever on their mood. We published it in the top psychiatric journal in 1975, and the conclusion was that this does not support the chemical imbalance theory. It took the field about 30 years to catch on to that article, and now it's accepted. At any rate, I left the university because I didn't want to spend my life studying that wrong theory, and I'm sure glad I didn't. I then started with cognitive therapy, which Aaron Beck had developed. He was saying that thoughts create negative feelings, that negative thoughts are distorted, and that you can learn to change the way you think and change the way you feel. I didn't believe it at first, but I started using it with my patients, and I saw it was true. I got excited and began working with what we were calling cognitive therapy. He had his center for cognitive therapy and used to refer these really difficult patients to me. Just under 30% of them had severe borderline personality disorder. I was seeing as many as 17 sessions in a single day during those years. I was flooded with these individuals. I probably had more than anyone else in the world in my practice, and that led to the evolution of TEAM-CBT and the five secrets of effective communication. I realized that more was needed for these people than simply helping them change their distorted thoughts, although that was incredibly helpful. They also had a side of them that was fighting against the therapist, fighting against me, and there was intense resistance. That wasn't a part of the early cognitive therapy, and I had to learn what the cause of that resistance was and how to turn it around. That led to the evolution of what we now call TEAM-CBT, which is kind of like cognitive therapy on steroids, but it includes a lot of the five secrets of effective communication: how to disarm, how to connect with people who are in a rage and who are intensely hopeless and insisting that nothing could ever work for them, and how to get them on board so you have a team working together.

SPENCER: If we think about people with antisocial personality disorder, also known as sociopathy or narcissistic personality disorder, many people believe that those are untreatable disorders. Do you believe that, or do you think that you can actually work with those patients?

DAVID: I have a very scathing view of the profession. My thinking has changed so much, and we've developed an approach that is so radically beyond where other therapists are at, so I have to watch myself so I don't sound too hostile, but when you say these disorders can't be treated, that's very arrogant. It seems to me that now you're labeling people as having disorders and thinking you're supposed to know what's good for them. I've treated many narcissistic patients, and they're my favorite patients. I've never had any problem with them. I've had 40,000 hours with patients, and I would say a good third to half of those hours have been people with so-called personality disorders. But I don't go in with the idea I'm going to treat your personality disorder, because I don't see myself as a therapist; I feel like a plumber and not a god. If you have a broken toilet, give me a call. I'll come by and fix it. But I don't go from house to house evangelizing for copper pipes. I'm not trying to cure so-called personality disorders. I'm trying to help people with what they want help with. People with narcissism generally don't want help with their narcissism. They want help with some problem in their life, a marital problem, a career problem, and I give them help with those kinds of things. I want them to feel joy. I want them to feel happy. I'm not here to show you the correct way to be.

SPENCER: So suppose that you find that they're manipulating their partner a lot. Would you frame that to them as that's not achieving their own goals, rather than sort of an ethical issue saying, "Well, that's unethical, to behave that way." Would you frame it more as, "Look, if you want to have a happy relationship where you actually get your own needs met, that's self-destructive?"

DAVID: Yeah, I might point out to people that they're doing something that's self-destructive. That's what my whole interpersonal therapy model is about. But it's in the context, "Are you looking for a more loving relationship with your son, with your spouse, with your students, with whoever? If so, if I agree to work with you on that, would you be willing to look at your own role in the problem? I would have to advise you that if you do agree to do that, it's going to be extremely painful, and I don't want to take you there if that's not something that interests you. On the good side, if you're willing to experience the pain of discovering that you're creating your own interpersonal reality at every moment of every day, then you'll also be empowered to change that reality by examining your own role and changing the way you relate to your spouse or to other people." That's how I go about it, and they have to convince me that there is something they want help with, and that's called outcome resistance. Do you want to get closer to your wife, to your husband, or whoever? Then there's something called process resistance. What would it be worth to you? How much pain would you be willing to experience if I showed you how to develop a more loving marriage and relationship?

SPENCER: And I imagine someone with high levels of narcissism, it might be even more painful than for the average person.

DAVID: That's right, exactly.

SPENCER: Do you often encounter patients that say, "You know what? Actually, I'm just not willing to endure that pain. I don't care that much about having a loving relationship with this person?"

DAVID: I'd say that's where most of the world is at. Not just people with personality disorders, people with human being disorders. That's the way most people operate.

SPENCER: Because I can imagine someone who has antisocial personality disorder or sociopathy who just says, "Yeah, I don't care about a loving relationship. I just want certain things out of this person," and has a very transactional way of looking at it. But I suppose you would say that that's not that unusual, that a lot of people might look at it that way, who aren't antisocial.

DAVID: That could be. I know, from my point of view, I'm not so interested in making judgments about those kinds of things as finding, "Is there something you want my help with, and what would it be worth to you if I agreed to help you with that thing?" And that's how I get into a meaningful relationship with a potential patient.

SPENCER: How often when you're proposing that, does the patient just reject it?

DAVID: 70% of the time.

SPENCER: Wow. So 70% of the time they essentially reject your help.

DAVID: That's right, and that's quite different from working with depression and anxiety as we talked about last time. When you're depressed or anxious, you have distorted negative thoughts, "I'm a loser. I'm not good enough. I shouldn't be so screwed up." When you work with me, you discover that those thoughts aren't true, and you discover you're way better than what you thought, and that puts people on a high. They love recovery from depression because it puts them into a state of euphoria and recovery from anxiety because now you're free from your social anxiety, phobias, and fears, and you feel empowered. That's great stuff. But in interpersonal therapy, what you're going to discover is that you're way worse than what you thought. In depression, you discover you're way better than what you thought, but in relation to conflict, you discover you're way worse than what you thought, and that's pretty darn painful. If you're willing to endure that, then there is joy. It's not all negative because once you look at your role, then you can change and develop loving relationships. That's an ecstatic discovery. But most people aren't willing to pay the price. The majority of people are not willing to pay that price.

SPENCER: What happens with that 70%? Do you just leave it there?

DAVID: Well, they wage wars. They invade Ukraine, for example, and they use violence and intimidation to try to get what they want. My goal, I'm not so much of a social expert. You have to go to someone like Fareed Zakaria to hear wise statements about the world. My corner of the world is just to be able to work with people who do want help, who are hurting, and who would like to transform their lives and relationships. To me, that's a tremendously joyous process, but it's on a one person at a time basis.

SPENCER: In your office, though, when you encounter that 70%, do you just say, "Okay, well, it looks like this is not going to be a productive relationship"? You don't work with them? Or do you actually work to try to overcome those barriers, to get them where they're ready to face the pain?

DAVID: Well, if it's a relationship thing, I try to educate them early on, out of fairness. I have fantastically powerful tools to help you change a troubled relationship, but it will be a painful process at first because you're going to have to examine your own role in the problem. If you're willing to do that, we can really do some great things and develop a more loving relationship with whoever you're at odds with. But if that isn't something that you want to do, "I like you. I enjoy working with you; maybe there's something else that we could work on." I call that "sitting with open hands." I don't ever try to sell anymore because I found that people don't like to have things sold. I say to the patient, "You're going to have to sell me on the idea of working with you, and I really hope that you will." But also, there are certain limits in what I have to offer. I want you to be aware of them, and sadly, I don't know how to help you develop a better relationship with your boss unless you'd be willing to look at how you're interacting with your boss or your wife or your father-in-law or whoever the person is, and that might not be something that appeals to you, which I could definitely support. I would say that resistance has an important role in therapy, and the resistance in relationship problems is much more intense than the resistance in depression or anxiety.

SPENCER: How would you define what resistance is? Because this is a phrase that comes up a lot in therapy. I guess Freud even introduced this idea.

DAVID: Yes. He devoted his life to understanding resistance and treating resistance, and from my naive point of view, he had a total failure in both regards. I don't think he understood resistance correctly, and I don't think that his method of being on the couch five days a week, free associating, was effective for much of anything that I'm aware of. The way I understand resistance now is that it's a natural part of human behavior, and that's because even in our negative thoughts and feelings, there's a real beauty. If you're angry, if you're depressed, if you're panicky, if you're feeling inadequate and lonely, there's beauty in those feelings, and that's one of the reasons that people don't want to give up those feelings. In the past, I was just looking today on LinkedIn; there were therapists having this supposedly meaningful dialogue about resistance, and they were all saying the same things that I've heard for 50 years. People resist change because they're afraid of change. They were saying, "Oh, that's so wonderful," and so forth. To me, that's total horseshit. People resist because they're self-centered children trying to get attention. It's a very negative view of human nature. But when I'm working with someone, I try to get them to see that their resistance is an expression of their core values as a human being. Even if you have an addiction, it's actually a reflection of what's most beautiful and awesome about you, and you have to do that if you want to connect with the patient on a deeper level. The paradox is, the moment they see that their resistance is actually a good thing, they're suddenly ready to give it up. I can give you an example of an intensely resistant patient. When I was in Philadelphia, we did a big cognitive therapy program for our community. It was an inner-city gang warfare type neighborhood where our hospital was located, and we had this free, intensive group cognitive therapy program for people. One day, I went in to direct one of the groups, and they said, "You have to beware of this guy in your group named Benny because he's a tough guy in the neighborhood, and the rumor is that if he doesn't like you, you're going to get beat up or worse. So don't say anything to cross Benny." He's a heroin and cocaine dealer. He's an addict. He's flunked out of all the treatment programs in Philadelphia. He's violent and suicidally depressed, but don't cross him. I said, "Don't worry. I won't cross him." When the group started, there were about 15 patients seated in a circle in chairs, and there was a fellow pacing behind them. I said, "Oh gosh, that looks like Benny," you know, like this muscle-bound 23-year-old guy covered with tattoos — skull and crossbones and all that stuff. I said, "Benny, would you like to sit down in one of the chairs and join us?" He said, "If you try to get me to sit in one of those chairs, Doc, it's going to be the last thing you ever do." I said, "Oh, well, Benny, there's only one rule here. During the group, you have to sit in one of the chairs. You have to sit in one of the chairs or stand and pace behind or both. If you stand and pace about, you have to do it here in the room so you can hear what's going on, or go out in the hall, or both." That kind of confused him and quieted him down, but he didn't sit, and he kept challenging me, you know, intense resistance. He kept threatening to kill me and that type of thing. At one point, we were talking about distorted thoughts and how you can change those thoughts and change the way you feel. He said, "Well, Doc, I'd like to see you challenge my distorted thought." I said, "Well, sure, I'll be happy to." He said, "I'm a hopeless case, and there's not a effing thing you can do about it." So I wrote it on the whiteboard, and that's resistance. He's challenging me. He's threatening me. He's resisting me. I said, "Well, Benny, before I show you how that thought is very distorted, let's see how that thought might be working for you, helping you." We could make a list of all the benefits of telling yourself that. He said, "Doc, you don't know what the f you're talking about. I'll be dead in two years. I've flunked out of every treatment program in Philadelphia four or five times, and no one's been able to help me. I'll be dead in two years, and you can count on that. You can put that in the negative column; that's not a positive." I said, "Well, Benny, you know, there's a lot of really neat things about telling yourself you're a hopeless case. What are they?" I asked the group because he couldn't think of anything, and they started saying, "Well, he could get stoned whenever he wants." I said, "Yeah, let's put that down. Get high. That's a good benefit. Benny, I've heard you have the best cocaine and heroin in Philadelphia. I've never once had those drugs, but it must be fun." He said, "Oh yeah, yeah, I love getting stoned." Then someone else said he's the tough man and the big man in the neighborhood. I said, "Let's put that down. Gives you a lot of prestige. I heard that you were a big man, Benny, even before the group, the nurses told me to be very careful and not to cross you, or you might kill me. I'm being real careful." We started listing all these benefits. So, he makes all this money from drug dealing, and then he gets into it. He said, "I get laid all the time." Then someone said that he's very powerful. I put "powerful." I said, "Yeah, Benny, how many psychiatrists have you beaten so far?" He said, "Oh, at least 13." I said, "What's the name of the psychiatrist you're going to beat in today's group?" He said, "Oh, Dr. David Burns, no doubt about it." I put "powerful," and before long, we had like 17 very real things about him. As long as he called himself a hopeless case, he didn't have to do homework; he got all these benefits. I said, "Benny, you asked me to help you challenge this thought 'I'm a hopeless case,' and I could easily do that. It's highly distorted. It's not valid. But look at all the benefits of telling yourself this. You have unlimited money, unlimited power. Everyone worships you. Women want to get laid all the time. You don't have to pay taxes. You remind me of James Dean. You're kind of the rebel, Rebel Without a Cause, kind of a cultural hero. I heard, Benny, that when you don't like someone, you just beat the shit out of them." "That's something I've always wanted to do, but I am a minister's son, so I've had to be so nice to everyone all my life." "What was it? Is it as much fun as they say, Benny?" He said, "Oh yeah, it's fantastic." I put that down as the joys of violence, and we had all these positives. Now, notice what we're doing. He's resisting, right? I'm showing him all the good things about his resistance.

SPENCER: Now you might think some people would think, in this situation, that you're reinforcing his belief of resistance. That you're going to make him more resistant.

DAVID: That's why the field is so screwed up. People can't think beyond their noses, and they have all these silly knee-jerk reactions, thinking they've got to work in a linear rather than a paradoxical manner, work in a manner that's guaranteed to fail. But at any rate, I said to him, and at that moment, I became Benny, and I could not see any reason for him to change. I said, "Benny, I don't see how I could work with you, but I don't see why I should, because those are very real benefits for you, Benny. I can't see any reason to change if I were you, Benny." And he softened for the first time at that moment. He looked at me and said, "Doc, you read me like a book." Then he said, "Doc, can I tell the group something?" I said, "Yeah." He said, "I've never talked about this, but when I was a little boy, the only person I felt close to was my grandpa because he was a lot like me. He was in the same business I'm in, and like myself, he went into these severe depressions. I would sit on the floor, and he would talk to me, and I loved him. But one day, Doc, he started talking to me in a really dark way, and he had a sawed-off shotgun in his lap. Doc, isn't that the wrong thing to do with a little boy, scare a little boy like that?" I said, "Yeah, Benny, that doesn't sound right. Tell us what happened." Benny said, "My grandpa was saying that he had trouble with the family," and by family, I don't think he meant his wife, but he had let on earlier in the group that he's in the mafia, and I think that's what he meant by the family. His grandpa was probably a part of it too. "He said there wasn't going to be a solution to his problem. And, Doc, he put the barrel of the shotgun in his mouth. Isn't that the wrong thing to do with a little boy?" I said, "Yeah, it doesn't sound good. Benny, what happened?" He said, "Doc, Doc. He pulled the effing trigger, and he blew the back of his effing head off." Then he burst into tears, and snot was coming out of his nose. He was sobbing and shaking, and he lost it. The group started crying. There were tears going down my eyes. Then he said, "Doc, do you remember early in the group I threatened to kill you when you wanted to look at my workbook and see what my scores were on the mood test?" I said, "Yeah, Benny, I got really scared there when you threatened to kill me if I looked at your book." He said, "Well, you know why I threatened you?" I said, "No, Benny, I don't have any idea. I just knew that you didn't want me to look in your workbook." He said, "Doc, because I can't effing read or write, and there wasn't anything in my workbook, and I didn't want the people in the group to see that about me." Then he started sobbing again. That would be an example of intense resistance and how hearing, going with the patient's resistance, hearing why they're doing what they're doing, and not judging them, opened him up to form a wonderful connection. Working with someone like that is going to take an awful lot of work, and the prognosis is still probably going to be pretty guarded with people without quite the severity of sociopathy of someone like Benny and maybe even having killed a number of people. Still, he opened up and became human and formed a connection.

SPENCER: Why did that work, though? Why did that reduce his resistance?

DAVID: Well, for one thing, he realized that I liked him and admired him. I did actually like him, and I think that's a very valuable thing. I didn't see it as my job to judge him, but rather to see the world through his eyes and accept him, and he probably hadn't had an awful lot of that. He probably hadn't lived in a way that would permit that type of thing. There was a part of him that was hungry to be close, and that allowed him to be close and to form a breakthrough on a human level. Once a patient trusts you, you can then use very powerful techniques with that individual, but it's something that most therapists don't know how to do. I've tried to teach therapists, but they're slow to learn. That's one of the reasons I've developed the Feeling Great app, and I think we're not supposed to talk about that, but that trains the app to do what I do, to try to make it available on a larger scale.

SPENCER: When is that app coming out?

DAVID: It's been out for a while. As a matter of fact, for quite a number of months. We're coming up with a big revision of it. I've been working on it for five years full time, and we added AI about a year ago. It's got pretty fantastic healing powers. There are some lumps in it that we're ironing out and improving almost on a daily basis. While I work with people, 90% of the time, I can get dramatic improvement in a single session. I probably talked about that on the last podcast. A two-hour session is about all I need in my work with people, and now the app is able to get the same kinds of results in less than a day, with dramatic reductions in seven negative feelings, including anger. We're pretty excited about the potential, but not many people know about it. We don't have a marketing department, so if someone is interested, you can go to FeelingGreat.com and take a ride on it for free. If you like it, it's not expensive. If you don't have the money to pay for it, just contact us and we'll gladly give you a subscription for free.

SPENCER: Going back to Benny's case. You saw the world through his eyes, and you had genuine admiration for him, but you also talked to him about the benefits of writing himself off, of viewing himself as hopeless. Why did that help unlock his willingness to change?

DAVID: Not only Benny, but everybody. Once you see why you have all these intense negative feelings, like this hopelessness, that it's actually coming from a good part of yourself, you see. I told him he didn't have to be ashamed; it's natural what you're doing. It's logical. He probably wasn't the top kid in grammar school, and maybe he never even made it through grammar school. In a way, he was getting a lot of benefits in his life. Once your shame disappears, that opens up your soul, I might say. Our society has it set up so that if you're depressed or anxious or having relationship problems, that's because of what's wrong with you. The DSM even categorizes all these fraudulent, non-existent things that it calls personality disorders and mental disorders. It's called the Diagnostic and Statistical Manual of Mental Disorders. It isn't the problem that you have; you're shy. It's the problem you have with social anxiety disorder. They've tried to mentalize all human suffering and view it as different disorders that you have. People have tremendous shame, which doubles your problem. I was working with a woman who had two children, and just to disguise it, let's say she had two sons. One of them was super brilliant, and the other had a severe learning disability. She went to school for Mother's Day, or parents' night, when they put up the pictures for viewing. When she saw how primitive her son's picture was — this was her boy with a severe learning disability — she felt ashamed and embarrassed, thinking that the other mothers would look down on her. Then she started beating up on herself, saying a loving mother shouldn't feel this way. She also told me that sometimes he has temper tantrums, and then she gets frustrated with him, so she tells herself he shouldn't have temper tantrums and that she shouldn't get angry with him either. She has all these "shoulds" and beats up on herself, and that causes feelings of shame. My goal with her was to help her let go of that shame and stop hitting herself with these "shoulds," which I was able to do. As she relaxed, she was able to accept herself and give herself permission to feel shame. Many parents, maybe 100%, have times when they get angry and irritable and snap at their kids or feel ashamed of their kids. When she gave herself permission to have those feelings, paradoxically, they disappeared.

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SPENCER: It seems to me that people often hold this idea that if they have lots of flaws, then they're bad, and they really don't want to view themselves as bad, so they resist viewing their own flaws. I think of it differently: everyone is riddled with flaws. That's just part of the nature of being human. Being a good person is not about not having flaws, but more about trying to become the best version of yourself you can, knowing that you will never eliminate your flaws. It's a kind of constant, endless work in progress. I'm just curious to hear your reaction to that.

DAVID: I agree with you, and I would say you're halfway to enlightenment, and the last half is to give up the idea that there's such a thing as becoming a good human. I've given up on that also, but people don't understand what those words mean. It's a problem. I had a student, one of my best all-time students named Matthew May, who was a psychiatric resident at Stanford and totally brilliant. Now he's practicing here in Menlo Park, and I think he's one of the top therapists in the world, getting most people well in two to four sessions. When he was a psychiatric resident, I was supervising him. We'd get together for three hours once a week to go over his cases and also his personal issues, which is part of learning to be a mental health professional: to do your own work and straighten up yourself. Once we were driving back to my house from this pizza place we used to meet at to talk, and I was at a stoplight or a stop sign or something, and he looked at me very sincerely and said, "Dr. Burns, I want you to know that every day I'm trying so hard to become a better and better person." I looked back at him with equally sincere eyes and said, "Matt, I hope you get over that pretty soon." Then he burst into laughter, and he got his enlightenment at that moment. The labels are a cause of a lot of suffering, and thinking of yourself as a bad person or a good person, those are kind of meaningless constructs. When I'm working with people who feel depressed and think that they're bad or inferior or worthless, I help them see that those labels are just a lot of horseshit. They don't mean anything. They don't make sense, but as you say, we all have flaws, and we'll always have flaws. The goal is not to go from being a bad or worthless person to being a good or worthwhile person, but simply to get rid of those labels and to realize they have no meaning. That's, again, a part of the death of the self, the great death that the Buddha called it 2,500 years ago. Enlightenment and self-acceptance is very hard for people to grasp because they can't see it. When they look at what I would view as enlightenment or acceptance, they think that's a bad thing because it's invisible to them. The idea is to live your life, to develop the skills, to get close to people, to experience love, to experience joy, and accepting our flaws without judgment is certainly the key to a lot of joy and happiness, but we fight against doing the very thing that would transform our lives.

SPENCER: I agree with you that a lot of times labels like good and bad are unhelpful. However, I do think that people have an intuitive, system one reaction to themselves, the way Kahneman talked about, sort of your intuitive system one, and then your analytical or reflective system two. It seems to me that some people just feel, on a gut level, that they're not good, and other people feel, on a gut level, a positive feeling about themselves. This feeling often traces back to when we were young. It's often persistent for many years. Do you agree that often people have this kind of intuitive feeling about themselves that they're bad?

DAVID: Absolutely. What I wouldn't agree with is anyone who claims it's due to things that happened when we were young, and that's more of that kind of arrogance in our profession, where people pretend to know things that aren't known at this time. We don't know the cause of depression and anxiety, except that thoughts in the here and now create depression, anxiety, anger, and all negative feelings. We have a paper we're about to submit where we've proven that actually, for the first time. We probably talked about that the first time we worked together; I can't recall. Yes, negative thoughts do trigger negative feelings. It's been argued about whether that's true for 2,000 years, but we don't know why some people have so many negative thoughts and feelings, often originating in early childhood. People have come up with all kinds of theories about it, but the theories are all horseshit. Whenever you try to prove these theories, the data shows that the theories are not correct. It may be that it's something we're born with, to a large extent, that some people are maybe born as natural optimists, feeling that they're worthwhile and life is good, and others are more on the negative side, thinking that they're not worthwhile and life is no good. There could be a major genetic component to that. We don't even know that for sure. The good thing is that whatever you've got, if you want, you can change the way you think and feel. There is tremendous work, successful work, to change your mood and outlook. That's what I've devoted my life to doing: developing the methods that will allow people to do that.

SPENCER: Regarding your research, I think what you're getting at is this interesting question of, do our thoughts generate our feelings, or do our feelings generate our thoughts, or is it both? For example, if I have the thought, "I'm worthless," that might make me feel bad, but if I feel bad, that might make me more likely to have a thought like, "I'm worthless. My understanding is that it goes both directions. That thought, being in a negative mood, might make you more likely to have negative thoughts, but also having a negative thought might be more likely to put you in a bad mood. Is it not true that they both caused each other?

DAVID: Yeah, that's what I thought, also. We tested it in a group of roughly 1,800 people. There were two groups. One was 290 people in a beta test we did two years ago, and another was another group. I don't remember the exact number. I think another 1,800 people used that we did beta tests with the latest version of our app, the Feeling Great app. We had changes in negative thoughts over time, the people believing their negative thoughts, and also changes in seven negative feelings over time in both groups. We were able to do something called non-recursive modeling, which allows you to measure, for the first time, these causal loops, what came first, the chicken or the egg. Our data, which we're going to be publishing, probably trying to finalize the paper next week — I'm just waiting for my co-author to finish her editing on it and then submit it to one of the scientific journals — what our data showed, for better or worse, is that there is a massive causal effect of negative thoughts on negative feelings. If you have a negative thought and you believe it, you're going to instantly feel lousy. If I have the thought, "Man, David, you really screwed up that interview and made a fool of yourself," and I believe that, I'm going to instantly feel embarrassed, ashamed, inadequate, etc. That was what Epictetus claimed 2,000 years ago, and the Buddha made the same claim 2,500 years ago, but now we have the first measurement of the exact magnitude of that effect. We also measured the effect in the opposite direction for the first time. What is the causal effect of negative feelings on negative thinking? How strong does that exist? There is an effect, but it's so weak we were barely able to detect it, and only because we had nearly 2,000 people in the database. The computer becomes extraordinarily sensitive to tiny causes. There was a tiny cause, but it was very weak. It had very little impact on the belief in negative thoughts. It only accounted for maybe 1% of the variance in negative thoughts, whereas negative thoughts were having a massive causal effect on negative feelings, accounting for the majority of the variance in that variable. We're going to get that out there into the public domain as quickly as possible and see what people do with it. Statistical modeling is very difficult, and very few statisticians know how to do it. That's why the answer has been so slow in coming, but we think we have the data and the methodology, and we'll see what happens.

SPENCER: That's very interesting. I wonder, though, if someone is panicking, they're in an extremely high, intense emotional state of fear. It seems hard to believe that that wouldn't cause them to have more worried or scared thoughts. I wonder if your research is more about the average effects, rather than what's happening at peak intensity.

DAVID: Both great points that you're making there. It's hard to believe that when you're having a panic attack. I've treated so many people with panic attacks. I just posted a video on our Feeling Great channel. We have a new Feeling Great channel, and I post little videos. I showed a five-and-a-half-minute video showing the cure of a woman who was having a massive panic attack in my office. The moment she changed her thoughts, the panic attack disappeared. It does seem intuitive that the feelings of panic would be activating all these circuits in the brain. For some reason, we couldn't confirm that effect in our analysis, but we were able to confirm a massive causal effect in the opposite direction. Her belief was that she thought she was on the verge of death because her chest was tight and she was dizzy. She had been having five of these panic attacks a year for 10 years and had all kinds of medical help and psychiatric help, and nobody could turn off the panic attacks. The thing that did it for her was that I induced a panic attack in the office. She started sobbing and saying, "Please, Dr. Burns, I can't continue. I think I'm about to die." I said, "If you were about to die, could you stand up and do strenuous calisthenics, running in place and doing jumping jacks?" She said, "No. If I stand up, I'll pass out." I knew that couldn't be true because her heart was pounding. You can only faint if your heart slows down. I knew that wouldn't happen, so I got her to stand up and run in place and then do jumping jacks. She kept sobbing and saying she was on the verge of death and couldn't continue. At a certain point, after about four minutes, she said, "I wonder if I could do this if I was having a heart attack." I said, "Is this what you see in the hospitals, people with massive heart attacks in emergency rooms standing next to their gurneys doing jumping jacks?" At that moment, she saw that it wasn't true that she was on the verge of death. You can see her in the video I posted on YouTube. You can see her going from uncontrollable sobbing to uncontrollable laughter in about 15 seconds. That was over 30 years ago. That was the cure for her to see that that thought was the cause of her panic. Why we haven't been able to document a reverse causal pathway in a more robust way, I'm not sure. All research, including my own, has potential flaws, and you have to take all research with critical thinking and a grain of salt, but we've certainly massively confirmed the huge causal effect, which we see everyday working with people who are depressed, anxious, and angry, that thoughts do create negative feelings. It would seem that feelings should also be triggering more negative thoughts, but we couldn't confirm that.

SPENCER: The final topic I want to talk about before we wrap up is trauma. I think there's increased interest right now in trauma. There are some very popular books about it, and people often attribute many of their problems in life to childhood trauma. What is your view on trauma? To what extent do you really think it causes our problems?

DAVID: Once again, I typically find myself on the opposite page of the so-called gurus who are promoting the latest idea or fad. If it sounds good to people, they jump on it. I've treated large numbers of trauma patients and used to do a trauma workshop for a couple of years around the US and Canada, a two-day workshop for therapists. In every workshop, I asked for a volunteer who struggled with severe and horrific trauma. I can't off the top of my head ever think of a trauma patient I've had who I couldn't complete the treatment for in one session. To me, they've been the very easiest patients to treat. My methods of treating them are radically different from what the current gurus are proposing, which they say, "It takes a long time to treat trauma." I say, "No, that's the easiest thing." When I'm working with people with trauma, I'm working with them in the here and now, at a moment when they were upset, and what they were thinking and feeling at that moment. As they work through that, suddenly they don't seem to be bothered by the trauma anymore. Trauma is common. When I did research on it at the Stanford inpatient unit because I was developing a scale for post-traumatic stress disorder, I was suspicious of the way it's set up in the DSM because there's a lot of overlap with normal symptoms of depression and anxiety, and I wasn't convinced it's even a distinct entity. PTSD, the DSM makes up entities, and then the general public jumps on it. To me, it's all the blind leading the blind into ridiculous thinking. I asked 178 consecutive patients before they took my PTSD test if they'd ever had some kind of severe and horrific traumas and to list them. I was surprised. These weren't PTSD patients. For the most part, these were patients with a whole variety of ailments who were being hospitalized for horrific depression, anxiety disorders, addictions, eating disorders, and things like that. I was surprised that pretty much every patient listed at least 20 traumas that they'd had, and that was very interesting. They weren't in any way limited to PTSD. Human beings have had a lot of trauma. At any rate, I also taught at Stanford. I had a class for the residents, and I was trying to teach them the new TEAM-CBT that I've developed. I had a two-hour seminar with them once a week, and then we asked faculty to refer to their worst trauma patients, and I would treat them in front of the residents while the residents were asking questions. I don't think we had a patient that whole semester who didn't have complete recovery in that one session. Again, I'm working with patients on, "How they are feeling now. What's a moment when they are distressed? What were they thinking? What were they feeling at that moment?" They have all the same distorted thoughts that anyone else has, and when they crush those thoughts.

SPENCER: You're not delving into the trauma. You're not having them remember that past experience. You're just focusing on their current thoughts and feelings.

DAVID: If they need to, if they want to. One woman had been in three horrible rear-end collisions on the freeway where she had to make a sudden stop and was hit from behind at 65 miles an hour, and her car was totaled. It was one of these every year for three years. She had memories of flying through the air and being terrified. We did a little exposure, but her main concern was the impact on her life and her clinical work with children. Once we turned all those thoughts around, all of her negative feelings disappeared, including the severe pain she had been complaining about, which also disappeared along with her depression and anxiety. I think if you tell a person, we're going to have to do a lot of dwelling on your childhood trauma, it becomes a self-fulfilling prophecy, and then the patient dutifully comes in and talks about it for months or years. I have methods for going into the past and doing cognitive flooding or memory rescripting if those tools are desired by the patient. I've had people who had trauma from sexual abuse by babysitters and things of that nature. I find that people want help in the here and now. If you can help me feel joy today, feel whole today, and feel close to people today, that's really what I want. Once you deliver that to people, they're pretty much happy to move on with their lives. That's been my experience, for what it's worth.

SPENCER: It seems to me, and I'm curious if you would agree or not, that when something really bad and surprising happens, let's say a family member suddenly dies unexpectedly, or we get assaulted while walking on the street in our neighborhood, what can happen is we can associate certain patterns that were there at the time with intense fear. Later, we might notice that we're experiencing all this fear merely because it sort of pattern matches, in some way, aspects of this sudden, really horrible event that happened. Then we can be living with those unpleasant feelings and not even understanding why we're experiencing them all the time. Does that seem accurate to you?

DAVID: I think that can happen, for sure.

SPENCER: If that can happen, how is it that you address that in the here and now? Would it be exploring the causes of it with regard to current triggers they are having?

DAVID: I treat people individually. I would ask them to talk during the empathy phase, without any agenda at all, except to listen to what they're saying. Then I ask them to rate me in empathy: to what extent do I understand your thoughts, your feelings, what's been going on in your life, and to what extent do you feel accepted and cared about? I ask if I got an A, B, C, or D. If I get an A, then I move on to the rest of the session. If I don't get an A, I stick with empathy until I get an A. Then I say, "Now, is there some part of this that you want help with? If a miracle happens in today's session, what kind of miracle would happen by the end of the session? What would change?" Generally, what miracle they are looking for, which they don't believe is possible, is for all these intense negative thoughts and feelings to disappear. That's what we work on in the session. First, I reduce their resistance and make them aware that their negative thoughts and feelings are actually expressions of their core values as human beings and are actually helpful to them. In many ways, when we work on their negative thoughts and they blow their negative thoughts out of the water, they feel a tremendous sense of joy and empowerment. I can remember a woman I worked with who had been beaten by a narcissistic and sadistic husband for 30 years. When she came to the workshop, she had been divorced from him for 10 years, but she was still in a state of massive anxiety and depression all day, every day. She had a lot of thoughts like, "I'm defective for having put up with being beaten for 30 years. The people in this audience are probably going to judge me and think I shouldn't have put up with it for so long." She thought, "My sons could hear the screaming." She would try to muffle her screams, but she said, "I was a failure to my sons," and this was the reality she was living in. As she learned to identify the distortions in those thoughts and to talk to herself in a much more loving and kind way, she really went into a state of euphoria. It was more than recovery; it was a state of enlightenment, and that's what I try to bring people to. I believe every human being is capable of becoming enlightened. It probably sounds crazy and hard to believe what I'm saying, but that's been my experience. I think it's great that it's possible for people to turn their lives around quite quickly. Now, if you have schizophrenia, that's an untreatable thing. We can help people with schizophrenia feel better and relate more effectively to others, but you're still going to have schizophrenia until we find the cause. I'm not making ridiculous claims, but if somebody wants to change and they're hungry to change, a lot is possible in a short period of time, a surprising amount.

SPENCER: When someone has that kind of change, do the triggers of their anxiety go away, or do they still feel triggered by those things that were similar to what happened during the traumatic event? Do you need to do something like exposure therapy to get rid of those triggers?

DAVID: Yes, exposure therapy is very powerful. It's one of four models that I use in treating anxiety, including PTSD. It's not the only model, but it is certainly important. If you're treating any form of anxiety, exposure will have to be a part of your treatment to be complete. If you have a fear of heights, it doesn't make sense that you could be treated successfully for that fear without going up to heights and realizing that you're no longer afraid. There are other dimensions of treatment as well, including cognitive tools, hidden emotion tools, and motivational tools. A lot goes into the mix of effective therapy, but if a patient wants treatment for any form of anxiety but doesn't want exposure, then I say that I don't think I'm the therapist you're looking for. A lot of therapists in our community are afraid of exposure and don't use it. If you like, you can go and work with one of them, and if it doesn't work out, you're welcome to return at any time. But I have to be honest and tell you what would be required for successful treatment.

SPENCER: David, final question for you before we go. Who is Obi? What did he teach you?

DAVID: Obi was my best friend in the whole world. He was just a feral cat who showed up at our kitchen door. I used to chase him out of the yard because we had adopted two kitties from the Humane Society, and we were afraid he was trying to intrude on them or be violent with them. I couldn't understand why he was terrified of me and why he would come to our kitchen door, a sliding door. I looked at him, and he held up his paw, and it was as big as his head. Then I saw that he looked like a concentration camp victim. I realized he had some kind of bite or injury, that he was injured and couldn't hunt, and he was starving to death. He overcame his fear, and I guess he saw me as a kind of alpha. He was saying, "Could you give me some food?" We started feeding him and eventually adopted him. We had to bring him to a vet for surgery because he was near death, and we became best friends. I just loved him more than life itself. We had him for a good five, six, or seven years, and he taught me so much. He was my best teacher ever. He used to sleep on our bed with the other cats, and at four, he was still feral and wanted to go out and hunt every night from four to six. Then he'd come back and scratch on the door at six, and I'd let him back in. He'd get back up on the bed and curled in with us. One day, he didn't come back at six, and I knew he was gone. There was a mountain lion that lived in the hills behind our house and often came down and got into people's yards. I was always afraid for him, and I'm afraid that's what happened. I'll never forget him, but he taught me that my love for him and my joy in being with him was beyond anything I can explain. There was nothing special about him. He was just a feral cat. He wasn't a show cat. When he came to us, he had fleas, ticks, worms, and scars. His ears had nicks, and he was just an average cat. As I've gotten older, I'm 82 now, I go out and try to do my daily walking, which I call slogging. I used to go out and jog, and now I have low back pain. I'm lucky if I can make it a mile or two, and everyone passes me. I'm not special. I'm just David. But when Obi was with me, the thrill was beyond words. He taught me that when you no longer have to be special, life becomes special. That's like the death of the self and being grateful for what we've got. I'm grateful that I had a number of years with him, and when I go out, I'll be walking after this interview, and I'll be talking to him and telling him how much I still love him. I talk to other people I've lost as well, pets or more humans. He taught me that. When I do videos for YouTube, there's a picture of him right next to me, so I have him with me all the time in that sense. Those are the things I try to teach patients who are depressed and anxious: how to find joy. Sometimes you don't find joy by struggling to be perfect or struggling to be better, or especially to be special. It comes from a very different dimension of self-acceptance and acceptance of others, for all of our works and horrible flaws and imperfections that we have as humans.

SPENCER: David, thank you so much for coming on the podcast again. It's wonderful to talk with you.

DAVID: Thank you so much. It's always great to talk with you too, and I really love your questions and your inquiring and brutally honest mind, which is really very beautiful.

SPENCER: Thanks so much.

[outro]