TEAM Therapy Flashcards

To become a master of TEAM Therapy - which is the best form of therapy that I have come across thus far.

1
Q

What do I say in Straightforward Agenda Setting?

A

I would say something like this: “John, you’ve mentioned a number of very difficult problems that you have been struggling with, including X, Y, and Z. I’d like to offer you more than just listening and support, as important as that is. I have a number of powerful tools that I believe could help you tremendously. As such, I’m wondering if this would be a good time for us to roll up our sleeves and get to work on one of the problems you’ve described, or if you need more time to talk and have me listen. Listening is important, and I don’t want to jump in prematurely, before you feel ready.”

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2
Q

What do I say when I’m doing Paradoxical Agenda Setting?

A

“Mary, you’ve been telling me how frustrated you feel with _________. You’ve mentioned how difficult he /she is to deal with, and so forth. I’m wondering if you want some help with your relationship with this person, or if you mainly just wanted to let me know how difficult and annoying he or she is.”

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3
Q

What is Empathy, and why is it important?

A

When we’re upset, you need someone to listen and see the world through your eyes without trying to cheer us up, change us, help us, or give us advice. Although this usually won’t cure us, it’s often a necessary first step. It can be a tremendous relief to feel that someone’s listening.
Similarly, we can empathize when you’re trying to help a friend or family member who feels upset. Usually, all they really want is for us to be a good listener.

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4
Q

What is Agenda Setting, and what is its purpose?

A

Agenda Setting is the most basic and important technique of all. First, try to define a specific problem you want help with. It must be specific as to person, place, and time. Ask yourself, “What is the specific problem I want help with? What time of day did it happen? Where was I? Who was I interacting with? What was going on?”

Second, ask yourself if you’re motivated and willing to roll up your sleeves and work on it now, rather than just talking about it endlessly. Ask yourself, “What would it be worth to me to solve this problem? How hard would I be willing to work on the solution?”

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5
Q

What is Identify the Distortions?

A

Use the Checklist of Cognitive Distortions to identify the distortions in each of your Negative Thoughts.

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6
Q

What is the Straightforward Technique?

A

You try to substitute a more positive and realistic thought for each of your Negative Thoughts. Ask yourself, “Is this Negative Thought really true? Do I really believe it? Is there another way to look at the situation?”

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7
Q

What is the Double Standard Technique?

A

Instead of putting yourself down, you talk to yourself in the same compassionate way you might talk to a dear friend who was upset. Ask yourself, “Would I say such harsh things to a friend with a similar problem? If not, why not? What would I say to him or her?”

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8
Q

What is Examine the Evidence?

A

Instead of assuming that your Negative Thought is true, you examine the evidence for it. Ask yourself, “What are the facts? What do they show?”

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9
Q

What is the Experimental Technique?

A

You do an experiment to test the validity of your Negative Thought, in much the same way that a scientist would test a theory. Ask yourself, “How could I test this Negative Thought to find out if it’s really valid?”

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10
Q

What is the Survey Technique?

A

You do a survey to find out if your thoughts are realistic. Ask yourself, “How do other people think and feel about this? Could I ask some friends about this to get some feedback?” For example, if you believe that social anxiety is rare or shameful, simply ask several friends if they’ve ever felt that way.

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11
Q

What is Reattribution?

A

Instead of blaming yourself entirely for a problem, you can think about the many factors that contributed to it. You can also focus on solving the problem instead of blaming yourself for it. Ask yourself, “What caused this problem? What did I contribute and what did others contribute? What can I learn from the situation?”

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12
Q

What is the Socratic Method?

A

Ask yourself several questions that will lead to the inconsistencies in your Negative Thoughts. For example, you might ask yourself, “When I say that I’m a ‘failure at life,’ do I mean that I fail at some things some of the time, or all things all of the time?”

If you say, “some things some of the time,” you can point out that this is true of all human beings. If you say, “all things all of the time,” you can point out that this isn’t true of anyone, since no one fails at everything.

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13
Q

What is Thinking in Shades of Grey?

A

Instead of thinking about your problems in black-and-white categories, you evaluate them in shades of gray. When things don’t work out as well as you’d hoped, you can think of the experience as a partial success or a learning opportunity. Pinpoint your specific errors instead of writing yourself off as a total failure.

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14
Q

What is Process vs. Outcome?

A

You evaluate your performance based on the process–the effort you put in–rather than the outcome. Your efforts are within your control, but the outcome is not.

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15
Q

What is the Semantic Method?

A

Substitute language that is less colorful and emotionally loaded. Instead of thinking, “I shouldn’t have made that mistake,” you can tell yourself, “It would be preferable if I hadn’t made that mistake.” This method is especially helpful for should statements and labeling.

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16
Q

What is “Let’s Define Terms?”

A

When you label yourself as “inferior” or “a fool” or “a loser,” ask yourself what those labels mean. You’ll see that there’s no such thing as a “fool” or a “loser.” Foolish behavior exists, but fools and losers do not.

Ask yourself, “What’s the definition of ‘an inferior human being’ or ‘a loser’? What is my definition of someone who is hopeless? When I say I’m hopeless, what claim am I making?”

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17
Q

What is Be Specific?

A

Stick with reality and avoid judgments about reality. For example, instead of thinking of yourself as totally defective, you can focus on your specific strengths and weaknesses.

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18
Q

What is Self-Monitoring?

A

Keep track of repetitious Negative Thoughts or anxiety-producing fantasies by counting them. You can count your thoughts in a couple of different ways. You can keep a 3x5 card in your wallet or pocket. Each time you have a Negative Thought, put a tick mark on the card. Alternatively, you can use a wrist-counter like the ones golfers wear to keep track of their scores. At the end of the day, record the total on your calendar. Usually, the upsetting thoughts will diminish and disappear after about three weeks of Self-Monitoring.

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19
Q

What is Negative Practice?

A

Schedule several minutes each day to worry or beat up on yourself mentally. For example, if you constantly beat up on yourself because of your shortcomings, you can schedule several five-minute periods each day to berate yourself and feel miserable. At those times, you can be as self-critical as you want and rip yourself to shreds with gusto. You can use the rest of the time for joyous, productive living.

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20
Q

What are the Basic Techniques?

A

The Basic Techniques include: a) Empathy; b) Agenda Setting; c) Identify the Distortions; and c) the Straightforward Technique.

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21
Q

What are the four steps of Agenda Setting?

A

a) The Invitation; b) Specificity; c) Conceptualization; and d) Methods

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21
Q

What are the Compassion-based Techniques?

A

There is only one: The Double Standard Technique

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22
Q

What is Dangling the Carrot?

A

This is the technique for overcoming resistance.

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23
Q

What is Sitting with Open Hands?

A

This is the technique for overcoming resistance.

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24
Q

What is the Magic Dial?

A

This is another useful tool to melt away Outcome Resistance. You can point out that in many cases, some negative feelings can be healthy and helpful.
Here’s the kind of thing you can say to the patient: “If you had a Magic Dial and could adjust your feelings to the ideal levels, what would those levels be? Now you have a therapy goal that won’t threaten the patient. I also reassure patients that if we are too successful, and the anxiety drops below the ideal level (in this case 20%), I will help them generate some anxiety once again so they don’t get too complacent, or too happy. This often triggers some laughter and relief.

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25
Q

What is the Fallback Position?

A

This is the technique for overcoming resistance.

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26
Q

What is the Acid Test?

A

Most patients will immediately agree to push the Magic Button. It sounds great to have all of your negative feelings suddenly vanish, just by pushing a button. However, the patient hasn’t yet grasped what we’re really offering. We’re offering to help patients feel happy and fulfilled in spite of their problems and shortcomings. We can’t change the facts of any patient’s life in today’s session. We can only help the patient develop greater happiness and self-esteem in spite of those facts. When you do the Acid Test, you make the patient suddenly aware of the implications of pressing the Magic Button.

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27
Q

What are the techniques for dealing with Process Resistance?

A

a) Gentle Ultimatum; b) Paradoxical Inquiry

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28
Q

What are the techniques for dealing with Outcome Resistance?

A

1) Dangling the Carrot; 2) Miracle Cure; 3) Magic Button; 4) Acid Test; 5) Positive Reframing; 6) Magic Dial; 6) Straightforward/Paradoxical Cost-Benefit Analysis; 7) Externalization of Resistance; 8) Devil’s Advocate Technique;

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30
Q

What are some reasons someone may NOT want to push the Magic Button?

A

.This issues vary with regards to the conceptualization of the problem, but in general they involve: a) not deserving the outcome; b) changing

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31
Q

What is the Miracle Cure?

A

This is a technique for targeting Outcome Resistance. It is both a data gathering step as well as a useful Agenda Setting tool that may give you some important insights about why the patient is stuck. Once the patient has described the problem (such as procrastination, feelings of inadequacy, or a troubled relationship), you can ask what a “miracle cure” might look like. You might say something like this: “Suppose today was the most amazing session, and you walked out of the session thinking that our work together had changed your life in some fantastic, wonderful way. What would that change look like? What would be different? What would the solution to this problem look like?”

32
Q

What are the basic PAS Techniques?

A

1) Empathy; 2) The Invitation; 3) Sitting with Open Hands; 4) Fallback Position; 5) Changing the Focus; 6) the Decision-Making Form

33
Q

When does the TEAM Therapist issue the invitation, and what does he say at that time?

A

After a period of empathy and listening, one might say: “I would like to offer you something more than just support and listening, although that’s obviously of great importance. I’m wonder if there’s something you want help with in today’s session? You’ve mentioned a lot of heartbreaking issues today, such as . . I have many powerful tools to help you deal with these problems, and I’m wondering if this would be a good time for us to roll up our sleeves and get to work. Or, if you need more time to talk and vent, that’s okay too. I don’t want to jump in prematurely, before you’re ready.”

34
Q

What are the typical sources of Outcome Resistance (Clinging to the Status Quo) with Anxiety?

A

a) Magical Thinking (My fears protect me or my loved ones. If I stop worrying, something terrible may happen); b) No Pain, No Gain (My constant worrying is the price I have to pay to do superb work. If I stop worrying, I’ll get complacent and fail; c) Conflict / Anger Phobia (I don’t want to face the problem that’s triggering my anxiety in the first place)

35
Q

What are the typical sources of Outcome Resistance (Clinging to the Status Quo) with Depression?

A

a) Worthlessness; b) Guilt; c) Realism of Depression; d) Perfectionism e) Achievement Addiction; f) Love Addiction; g) Self-Pity

36
Q

What are the Truth-Based Techniques?

A

They are: a) Examine the Evidence; b) Experimental Technique; c) Survey Method; and d) Reattribution

37
Q

What are the Logic-Based Techniques?

A

They are: a) Socratic Method; b) Thinking in Shades of Gray; and c) Process vs. Outcome

38
Q

What are the Semantic Techniques?

A

These are; 1) Semantic Method; 2) Let’s Define Terms; and 3) Be Specific

39
Q

What is Paradoxical Inquiry?

A

Paradoxical inquiry can be helpful for Outcome and Process Resistance. When the patient resists, you
can ask a paradoxical question that may lead the patient to the irrationality of the resistance, rather than using persuasion in an attempt to change the patient’s mind. For example, the patient who’s describing a conflict with his brother may say, “Why should I have to change? He’s the one who’s screwed up.” Using PI you might say, “Certainly, you shouldn’t have to change and you don’t have to change. Are you saying that you don’t want to?” You can also point out that he may be saying that he doesn’t really want to work on the relationship, and perhaps just wanted you to know how difficult and irritating his brother is. If so, you can then ask if there’s something else he’d prefer to work on. PI must be delivered with warmth, respect, and authenticity.

40
Q

How might a Gentle Ultimatum be presented with a depressed patient?

A

“Pedro, I’m looking forward to working with you to overcome the feelings of depression and
worthlessness that have been plaguing you for so many years. However, if you want me to help
you, you’re going have to do daily psychotherapy homework for 15 to 30 minutes, even when you’re not in the mood or feel convinced that it couldn’t possibly help. It’s a little like going to a tennis
coach to improve your tennis game. You’d have to practice between sessions to get the real benefit. And if you’re willing to do the homework, I believe I can show you how to change your life. That
would be exciting to me.

41
Q

What is a Brief Example of a Paradoxical Invitation?

A

“Are you asking for help with the problem with your husband, or did you simply want me to know about how lonely and frustrated you’ve been feeling?”

42
Q

How might a Gentle Ultimatum be presented with a depressed patient?

A

Or, let’s say the patient is anxious, but doesn’t want to have to use exposure. You could point out that most therapists in the community offer long-term talk therapy without exposure for patients struggling with anxiety. You could also say, “If you feel strongly that you’re looking for that approach, I feel that you have every right to pursue it—but I don’t have those kinds of skills.” You can emphasize that you have great respect for the patient and hope she or he will decide to work with you. You can also let the patient know that you feel convinced that you can do some tremendous work together (Dangling the Carrot again.) However, they should know that the exposure requirement would not be negotiable.

43
Q

What is a brief example of Sitting with Open Hands?

A

“It sounds like you don’t want any help with problems X. Y, and Z, and I’m fine with that. I’m
wondering if there’s anything else that you do want help with that we could work on together?”

44
Q

What messages is the Straightforward Invitation meant to convey?

A

The Straightforward Invitation gives the patient three messages: 1. I’m here to support you, although that’s obviously of great importance; 2. I have much more to offer you than just listening, and more will be necessary if you really want to change your life; 3. Change is possible if we work together as a team.

44
Q

What are the basic methods for addressing depression and anxiety?

A

a) Daily Mood Log; b) Recovery Circle; and c) 50 Ways to Untwist Your Thinking

45
Q

What is a brief example of Sitting with Open Hands?

A

“It sounds like you don’t want any help with problems X. Y, and Z, and I’m fine with that. I’m wondering if there’s anything else that you do want help with that we could work on together?”

46
Q

What are the basic methods for Relationship Problems?

A

a) Interpersonal Decision-Making; b) Relationship Cost-Benefit Analysis; c) Relationship Journal; and d) Five Secrets of Effective Communication

47
Q

What are the basic methods for Habits and Addictions?

A

a) Decision-Making Form; b) Habit/Addiction Log; and c) Devil’s Advocate Technique

48
Q

What are the most common sources of Outcome Resistance in Depression?

A

a) Hopelessness; b) Motivational Paralysis; c) Overwhelmed; d) Entitlement; e) Medical Model; and f) Traditional Counseling Model.

49
Q

What are the most common sources of Process Resistance with Anxiety?

A

a) Avoidance; and b) Medical Model.

50
Q

What are the most common sources of Outcome Resistance with Anger/Relationship Problems?

A

a) Low Desire; b) Martyrdom / Heroism. I like the role of victim; c) Moral Superiority; d) Gossip / Scapegoating; e) Power; f) Revenge; g) Anger addiction; g) Violence. Aggression is exciting. I enjoy hurting you; and f) Self-Righteousness

51
Q

What are the most common sources of Process Resistance with Relationship Issues?

A

a) Truth; b) Blame; c) Pride; d) Entitlement; e) Fear; f) Hopelessness.

52
Q

What are the most common sources of Outcome Resistance with Habits and Addictions?

A

a) Instant Rewards; b) Entitlement; c) Narcissism.; d) Denial; e) Conflict Phobia

53
Q

What’s an example of what to say in the Specificity aspect of Agenda setting?

A

“Can you describe one specific interaction with your husband that was upsetting to you that you want some help with? Let’s write down exactly one thing that he said to you and exactly what you said next.”

54
Q

What is an example of what to say in doing Process Resistance negotiation?

A

“What would it be worth to you, if I agreed to help you; a) Overcome your depression and feelings of inferiority?; b) Overcome your shyness in social situations?; c) Develop a more loving and satisfying relationship with X?; d) Overcome your overeating (or drinking or procrastinating, etc)

What would you bring to the table?

55
Q

What are the Quantitative Techniques?

A

a) Self-monitoring; and b) Negative Practice/Worry breaks

56
Q

What are the Humor-Based Techniques?

A

a) Paradoxical Magnification; and b) Shame-Attacking exercises

57
Q

What are the Role-Playing Techniques?

A

a) Externalization of Voices: and b) Feared Fantasy Technique

Other techniques that can be converted into role play techniques include: a) Double Standard Technique; b) Acceptance Paradox; c) The Devil’s Advocate Technique; d) the David Letterman technique; e) Flirting training; f) Five Secrets of Effective Communiaction; and g) One-Minute Drill

58
Q

What are the Philosophical/Spiritual Techniques?

A

There is only one: the Acceptance Paradox

60
Q

What are the Visual Imaging Techniques?

A

a) Time Projection; b) Humorous Imaging; and c) Cognitive Hypnosis

61
Q

What is Externalization of Voices?

A

This technique transforms intellectual understanding into emotional change at the gut
level. It’s the most powerful of all the CBT techniques, but it can be quite challenging and
even a bit upsetting at first.

You and another person will take turns playing the role of your negative thoughts and the
role of your positive thoughts. The person playing the negative thoughts attacks, and the
person playing the positive thoughts defends. Use role-reversals when you get stuck.

In the “I-I” version of the Externalization of Voices, both of you will speak in the first
person, “I.” In the “You-I” version, the person playing the negative thoughts will speak in
the second-person, “You,” and the person playing the positive thoughts will speak in the
first person, “I.” The “I-I” method is gentle and safe, but less effective. The “You-I” method
is more intimidating and challenging, but has far greater healing power.

62
Q

What are the Instructions for Externalization of Voices?

A

a) Explain that I’m going to play the negative voices in the client’s mind, and the client will play the positive voice and try to defeat me; b) Ask the client what his or her name is. Now ask your client what you’re name is; c) Attack your client with one NT, but speak in the second person (“You), then ask the client to defeat me using the second person (“I”); d) Now ask the client won the exchange - if the client says he or she one, ask them if they won small, big, or huge; e) If the client does not hit the ball out of the park, or was unconvincing, do a role reversal so that I can try to model a more powerful and effective response.

Tips - use the Self-Defense paradigm, and Acceptance Paradox, or a combination of the two.

63
Q

What is paradoxical magnification?

A

Instead of trying to refute your negative thoughts, you can buy into them and exaggerate them. Try to make them as extreme as possible. For example, if you feel inferior, you could tell yourself, “Yes, it’s true. In fact, I’m probably the most inferior person in California at this time.” Paradoxically, this can sometimes provide objectivity and relief. Of course, if you’re really upset, this technique may
have the unintended effect of making you feel even worse. If so, try another method.

64
Q

What are shame-attacking exercises?

A

If you suffer from shyness, you probably have intense fears of looking foolish in front of other people. Shame-Attacking Exercises are a specific and potent antidote to these kinds of fears. You intentionally do something foolish in public so you can get over this fear. For example, you could stand up and announce each stop on a bus or shout out the time in a crowded department store. When you make a fool of yourself on purpose, you discover that the world doesn’t come to an end after all, and that people don’t really look down on you. This discovery can be liberating.

65
Q

What are the Humor-based techniques?

A

a) Shame-Attacking exercises; and b) Paradoxical Magnification

66
Q

What are the Role-Playing Techniques?

A

a) Externalization of Voices; and b) Feared Fantasy Technique

67
Q

What is Externalization of Voices?

A

This technique transforms intellectual understanding into emotional change at the gut level. It’s the most powerful of all the CBT techniques, but it can be quite challenging and even a bit upsetting at first. You and another person will take turns playing the role of your negative thoughts and the role of your positive thoughts. The person playing the negative thoughts
attacks, and the person playing the positive thoughts defends. Use role-reversals when you get stuck. In the “I-I” version of the Externalization of Voices, both of you will speak in the first person, “I.” In the “You-I” version, the person playing the negative thoughts will speak in the second-person, “You,” and the person playing the positive thoughts will speak in the first person, “I.” The “I-I” method is gentle and safe, but less effective. The “You-I” method is more intimidating and challenging, but has far greater healing power.

68
Q

What is the Feared Fantasy technique?

A

Like the Externalization of Voices, this is a two-person technique. You and the other person act out your worst fears, such as being rejected by an exceptionally hostile critic because you aren’t smart enough or good enough. When you face
your worst fear, you often gain liberation from it. Your worst fears don’t usually turn out to be real monsters, but figments of your imagination that you can defeat with a little logic, compassion, and common sense.

69
Q

Other than Externalization of Voices and the Feared Fantasy Technique, what are some other role-playing techniques?

A

Many techniques are much more effective in a role-playing format. They include Cognitive Techniques like the Double Standard Technique and Acceptance Paradox, Motivational Techniques like the Devil’s Advocate, and Exposure Techniques like the David Letterman Technique and Flirting Training. The Interpersonal Techniques, such as the Five Secrets of Effective Communication (#49) and One-Minute Drill (#50) also work extremely well in a role-playing format.

70
Q

What is the Acceptance Paradox?

A

Instead of defending against your own self-criticisms, you can find truth in them and accept your shortcomings with tranquility. Tell yourself, “It’s true that I have many inadequacies. In fact, there is very little, if anything, about me that couldn’t be improved considerably.”

71
Q

What are the three main Advanced Empathy Techniques?

A

a) Changing the Focus; b) Multiple Choice Empathy; and c) Positive Reframing

72
Q

What is Changing the Focus?

A

In this Advance Empathy Technique, you focus on the process rather than the content of the argument. In other words, you might
gently point out that the two of you are arguing and not working together as a team. You bring
the conflict to conscious awareness in a kindly way, so you can both talk about your feelings,
rather than trying to figure out who’s right and who’s wrong.

In a sense, there’s an elephant in the room, but everyone’s ignoring the tension pretending it
isn’t there. When you change the focus, you point to the elephant and say, “Do you see what I
see?”

73
Q

What is Multiple Choice Empathy?

A

When you have no idea where someone is coming from, and they’re reluctant to tell you, you
can suggest several possibilities and ask if any of them ring a bell. It’s like priming the pump.
You might say, “I can imagine you might be feeling X, Y, or Z. Do any of those words ring a
bell?” X, Y and Z could be words from the Feeling Words chart.

Multiple-Choice Empathy can be especially helpful when the other person refuses to open up
and tell you how they’re feeling. You’ll have to be disarming rather than blaming when you list
the possible reasons why the other person doesn’t want to talk to you. You’ll also have to do
this in a way that sounds caring, respectful, and concerned, and not demanding or
condescending.

74
Q

What are the steps of Paradoxical Agenda Setting?

A

a) The Invitation (straightforward or paradoxical); b) Specificity (the client selects the problem and describes one moment when the problem was upsetting him or her; c) Conceptualization (Individual Mood problem? Relationship Problem? Habit/Addiction? Non-problem?); d) Motivation Step (the therapist melts away Outcome and Process Resistance)

75
Q

What is Positive Reframing?

A

You put a positive spin on the situation. For example, you can reframe an angry conflict as a
golden opportunity to develop a better relationship with the person you’re at odds with, rather
than viewing the problem as a prelude to Armageddon.

You can also reframe the other person’s motives or behavior in a positive way. For example, if
someone seems stubborn, dogmatic, and argumentative, you could think of them as having
intense conviction and desperately wanting you to understand them. You can also consider the
almost possibility that you haven’t been disarming them in a genuine way, and that’s the
precise reason they keep arguing. Or, if a loved one is acting nasty, you could reframe their
behavior as an expression of the hurt, loneliness, or frustration she or he is feeling.

76
Q

How did David Burns use Paradoxical Agenda setting with Ramesh?

A

“Rameesh, I have some powerful tools to help you with your low self-esteem and the problems you’re encountering at work, and I’d love to work with you. I believe you’re very smart, and I like you, and it would be a joy for me to show you how to turn your life around. I have no doubt that we could do exactly that. But I’m not sure it would be the right thing to do, and I’m really reluctant to share these tools with you.”