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519: What Therapists Get Wrong—and How to Fix It

519: What Therapists Get Wrong—and How to Fix It

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Episode 519: What Therapists Get Wrong—and How to Fix It Hosts:Kevin Cornelius, LMFTDr. David BurnsGuest: Jeremy Karmel What happens when therapy becomes something you simply keep doing rather than something that actually helps you get better? In this lively and provocative episode of The Feeling Good Podcast, Kevin Cornelius, LMFT, joins Dr. David Burns and Jeremy Karmel for a candid conversation about some of the biggest problems they see in modern mental health care—and what therapists can do differently. Jeremy brings a unique perspective to the discussion: he experienced severe depression in college and spent months in different therapies and therapy groups without getting better. Then, working with one of David Burns' students, he discovered powerful cognitive therapy techniques that produced dramatic results in just two weeks. The experience left him both grateful and frustrated—and motivated to understand why effective treatment can sometimes be so difficult to find. David, Kevin, and Jeremy explore several common pitfalls in therapy, including the failure to measure results, getting lost in the past, talking about problems in vague and general terms, and assuming that every therapist is qualified to treat every kind of problem. Accountability: Is Therapy Actually Working? The conversation begins with one of David's central concerns: accountability. If someone has been coming to therapy for months—or even years—how do they know whether treatment is actually helping? Kevin shares his own experience of spending several years in therapy without clearly defined goals or any systematic testing of progress. Although he valued the relationship with his therapist, he now sees the lack of specific goals and measurement as a major limitation. By contrast, his current approach involves establishing concrete treatment goals and measuring progress before and after sessions. Jeremy points out that many people in therapy cannot even answer a basic question: What are you working on? Without clear goals, it becomes difficult for patients to hold therapists—or themselves—accountable for results. Do We Really Need to Find the Cause in the Past? The group then tackles another controversial question: Does effective therapy require uncovering the origins of a problem in childhood or the distant past? David tells the story of a woman with a severe elevator phobia who had been told in psychoanalysis that the roots of her fear were in childhood—and that overcoming it might take several more years. During a workshop, David instead helped her confront the feared elevator directly. Within minutes, her fear disappeared, and she subsequently rode skyscraper elevators without difficulty. The larger point isn't that the past is irrelevant. Rather, David argues that therapy can become unnecessarily focused on discovering hypothetical causes when the more practical question is: What is bothering you right now, and what can we do about it? The conversation extends this idea to trauma and PTSD. David describes an approach that focuses primarily on the patient's current distress rather than repeatedly dwelling on the traumatic history. Jeremy shares an example of someone whose debilitating trauma-related flashbacks improved after confronting the traumatic memory directly. From General Problems to Specific Moments: The Power of Fractals Another major theme is the distinction between general problems and specific problems. People commonly come into therapy saying things like: "I don't know who I am.""I have low self-esteem.""I'm bad at relationships.""I'm always depressed.""I have trouble with people." But what does that actually mean? David and Kevin argue that the therapist's job is to find a specific moment when the supposedly general problem was actually happening. What was going on? Where were you? Who was there? What were you feeling? And, most importantly, what were you telling yourself? David describes these specific moments as "fractals": individual situations that contain the repeating pattern of a much larger problem. By solving the specific problem, you may simultaneously begin solving the general problem. Jeremy illustrates this with his own tendency to argue. Looking at specific interactions through David's Relationship Journal helped him recognize a recurring pattern: instead of listening and looking for truth in what another person was saying, he would shift into arguing. Is Your Therapist Actually an Expert in Your Problem? The final major theme may be the most provocative: Therapists aren't necessarily experts in every problem their patients bring to therapy. David and Jeremy use dating as an example. A therapist may have extensive training in psychotherapy without having any particular expertise in dating, flirting, relationships, or the practical skills involved in meeting potential partners. Kevin offers an important distinction: therapists don't necessarily need to give advice about every ...
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