crash course in empathy using cognitive behavioral therapy to grow your emotional intelligence | Otter.ai

crash course in empathy using cognitive behavioral therapy to grow your emotional intelligence

Brad Boldt54min

Dr Nissen | Doctor | Author

00:03

Hey everyone, welcome to brain health with Dr. Nissen. In this show. We explore the universe's great unknown, the human brain. And my reflections and interviews with guests will go to the forefront of psychiatry, neuroscience, nutrition and medicine to see how we can enhance our mental health, sharpen our cognition and reach better performance. This is brain health. And I'm Dr. Nissen. Let's dive right in. Welcome to the brain health reductionism podcast today I am so pleased to be here with Mike Christiansen. Mike, welcome to the show. It's great to be here. Dr. Nissen, yeah, it's great. Great being here with you too, Mike, it must be really weird. When Mike is saying darkness. And to me because I was the first time that we met, I was a medical student, he knew me when I really didn't know anything about CBT or team CBT. And I still don't know much at all in comparison to Mike. So that brings into an intro. So Mike is a registered clinical counselor. And he is a level five master team CBT therapist and trainer. And so the reason why I'm sitting here with Mike today is that Mike was actually my, my instructor when I was learning, team CBT. So for those of you who aren't familiar with therapy, in general, I'm just going to take a few steps back and, and tell you a little bit about therapy and about cognitive behavioral therapy. And then Mike can talk about, you know, the the team cognitive behavioral therapy and, and some of the ways that we can use you know, these approaches in therapy to understand better people's emotions and how it leads us to feeling how our thoughts lead us to feel certain ways and to have certain behaviors and the really intimate relationship that this has with anxiety and depression, which is something that so many people are suffering from so. So Mike works closely with his CBT pioneer, Dr. David Burns, and has been in Mike's been delivering workshops in Canada, prevent providing advanced level online training with the feeling good Institute for therapists around the world. And that's how he and I had gotten connected. Mike specializes in treating depression and anxiety, with experience and training in addictions, PTSD and relationship challenges, as well. So Mike, again, I want to say welcome and anything else that you wanted to throw in there that I didn't include in the introduction that

Speaker 1

02:39

might be interested, it's just, it's great to connect with you again, Nick, and certainly calling you Dr. Nissen is kind of an honor to be here. You know, when you say you were a student in one of my classes, you're certainly one of the one of the stars. And so when you offered the opportunity, it was something it was easy for me to jump out.

Dr Nissen | Doctor | Author

02:57

No, thanks, Mike. Well, I, so, you know, I wanted to get started again, you know, thinking that not everyone listening knows therapy, or as a therapist themselves. So, you know, I think, at least in the environment that I grew up in therapy was considered sort of this, this thing that maybe people in the city would use, you know, very wealthy people laying back in a reclining chair, and somebody, you know, asking them about their childhood. And it seemed like, you know, that's not something that really regular people do, or regular people can benefit from. But as I've gone through my training, and I'm sure, as Mike has seen throughout his career, you know, therapy can play a very important role in treating anxiety, and depression, amongst other things like, like, you know, PTSD and addictions. So, first of all, Mike, if you could help me kind of, with describing cognitive behavioral therapy and, and what is a way for, you know, for a regular person to think about cognitive behavioral therapy, and why it's something that is helpful for a lot of people?

Speaker 1

04:07

Yeah, it's such a good question, because I think my own experience was similar to what a lot of people would have been, I was actually in business and another number of other areas before I got into full time counseling and therapy work. And I'd struggled for a while at a time and thought, Oh, I'm not the kind of guy that would go to therapy, right, because I was, you know, businessman and other things. And I think this is where Dr. Burns, who kind of popularized CBT with his book, feeling good, played such a significant role in my life. And the basics of cognitive therapy or cognitive behavioral therapy. CBT is kind of what we call it is that our thoughts really drive how our emotions are how we're feeling right. So if we can change how we think we can then change how we feel. So for example, if if I had the thought coming on to your podcast, oh, no, this is gonna be, you know, a terrible thing. And, you know, all these medical people are gonna be evaluating me and you know, Dr. nissens, kind of critical, I'd be feeling kind of anxious and worried and a little hesitant, you know, maybe feeling leaving a little inadequate coming on to the show. Whereas if I have the thought office is such a great opportunity, you know, Nick is such a warm and caring guy, and it's gonna be a ton of fun, then I'm feeling excited, and looking forward to it and kind of happy about the opportunity. And so even though the situation is the same, how I'm thinking about the situation really drives home going to feel about it. And so if we can change how we think, using a number of different techniques and strategies, which is what we do in cognitive behavioral therapy, we can change how we feel, and then you can use those strategies over and over again in your life.

Dr Nissen | Doctor | Author

05:52

That's right. And, and I think that that's, you know, where a lot of people get stuck is they they're feeling depressed, or they're feeling just super worried. And they're wondering, what can I do about it. And so the approach of cognitive cognitive behavioral therapy, one one way that it's described as, like a triangle between our thoughts, our feelings, and our behaviors, and that all three of those are in constant communication with with the other. So, you know, if you're behaving a certain you're what certain way it's going to lead you to feel a certain way and to have certain thoughts. And if you're thinking a certain way, it's going to lead you to behave a certain way, and to feel a certain way. And if you're feeling a certain way, you'll have certain thoughts and certain behaviors as well. So so if we can make adjustments and what we're thinking, it will change completely how we're feeling, if we can change our thoughts, we can change even the behaviors that we start to make. And similarly, another way where we can make interventions is by changing our behaviors, if we've changed how we behave, that can also change how we feel, and it can also change some of the thoughts that we're having. So Mike just gave an example of coming on to the show and thinking, you know, if I totally change the thoughts, that I'm having this internal conversation that I'm having, I'm going to change how I feel when going on the show, and it's going to create, you know, a better result. So, this is, this is why, you know, for a lot of people, you know, you look at different podcasts or YouTube videos out there, and there's a lot of energy around like coaching and self improvement. And, and yet, you know, there's a stigma around therapy, and in so many ways they overlap, you know, and we can get so much better, we can get better outcomes in our lives, we can perform better and feel better, by using, you know, these components of cognitive behavioral therapy, of changing what we think, to start to feel different. And those are a lot of the same principles that are made very popular and are very widely accepted by, you know, these big sort of self help gurus and, you know, coaching sort of people that you'll find online.

Speaker 1

07:54

Yeah, absolutely. And I love how you describe that. And in many ways, when we're doing kind of therapy, it's really getting somebody who is highly trained with some of those skills and techniques, when you're feeling stuck, right? When you've kind of tried the other things on your own, you've tried some of the you self help books, and you listen to podcasts and just a little bit stuck, you need a second set of eyes, you know, to kind of look at the situation go, Ah, I wonder if we use this technique to challenge the way you're thinking or if you engage in this behavior, and then evaluate your thoughts based on those changes, then we can get those results that we're looking for.

Dr Nissen | Doctor | Author

08:29

Absolutely. So those those are excellent thoughts. And so I think that that brings us into the next part of, you know, who might this be helpful for who, you know, be it a disease that that we often think, you know, think from the, from the perspective of psychiatry of, you know, major depressive disorder, or post traumatic stress disorder, or just a general, you know, type of person who might be able to benefit from cognitive behavioral therapy and why?

Speaker 1

08:59

Well, certainly in the, in the early days of cognitive therapy, it was really highly validated for for depression, particularly, right, if you're challenged, or you think challenge where you feel and with a lot of research, super helpful for those that were struggling with kind of thoughts of, you know, feeling down or insecure or inadequate, you know, hopelessness. And so it's very valuable there, we can see pretty quick results with it. The, when the behavioral aspect was kind of, you know, included in incorporating this is one of the things Dr. Burns discovered, you know, when he was first doing cognitive therapy, there was still some groups of people that weren't being as helped as much as you would have liked. And so he began to incorporate some of the more behavioral techniques and this is where things like exposure techniques for anxiety can be very powerful. So when when we're looking at PTSD, there's often both components there. There's a kind of Press of component but there's also the anxiety of recurring, you know, nightmares or visions or those types of things or, or just general fears in general in general. And so that's where we combine both the cognitive techniques as well as some behavioral techniques to overcome those, those places where we're kind of stuck in, in in in Iraq.

Dr Nissen | Doctor | Author

10:20

Yeah. And I think that part of what you started to touch upon is, you know, something that makes team cognitive behavioral therapy, which is the type of therapy that you specialize in and is what you trained me in, you know, some of the different things that it brings to the table. Could you talk a little bit more about team cognitive behavioral behavioral therapy as it relates to kind of behavioral therapy? And yeah,

Speaker 1

10:41

absolutely. And this is where, you know, Dr. Burns, who's still going strong, actually, after all these years, he originally, you know, trained under Dr. Aaron Beck, who was kind of one of the fathers of cognitive therapy. And it also worked on with Albert Ellis, when he wrote the book, feeling good, it became a best seller for depression, self help, and still is one of the best sellers to this day. And he just recently released his book feeling great. But one of the things he discovered and he was a psychiatrist that was not happy with just handing out meds that didn't seem to be as effective as he would have liked. Me, he found that a certain percentage of the population that weren't actually getting betters as quickly as he would have liked. And so he, he really incorporated his research mindset, right to doing testing. So he would do a check in test before and after every session, how are you feeling before? And how are you feeling after? And how did the session go? And then he would get that feedback to see what are the components that are actually working, that's the T and testing when we talk about team and then the E is the the empathy part, he found, there's a real powerful connection, if you have a good therapeutic alliance, we call it or a good connection with your therapist or your counselor, that's the foundation of doing great work together, there has to be that mutual trust. And then the third component is the A, and he called us calls that now assessment of resistance or agenda setting. And this has really been the most recent development in the last 15 to 20 years, where he's identified the really wonderful things about hanging on to our clinging to our symptoms, right, there's actually some real benefits to feeling depressed and anxious, right? If I'm, if I'm worried about my children, that shows I Oh, I love them, I care for them, I want the best for them, and prevent bad things from happening to the prince Prince bad things from happening, right. And so it's actually a wonderful thing. And what we do in team is we honor that resistance and bring it to conscious awareness so that it's not kind of hanging on to our clinging to us, despite our best intentions. And then the M really comes back to the the methods that we use of which many are cognitive methods, we use things like identifying the distortions, and examine the evidence and, and other popular cognitive tools, as well as, you know, relationship tools or motivational tools or, or anxiety type tools with with exposure. So we found is that the speed of treatment is much higher when you've addressed that resistance piece, right? When we bring it to where we actually want our clients for our patients, driving the buses that we're and we're along side them. And I tell all of the people that I work with, ultimately, my goal is for you to get rid of is for you to get rid of me by becoming your own therapist by learning the techniques and skills and tools you need that you can apply. So once we discover a moment of recovery, they can then re apply those techniques on their own without me and they don't need long term therapy in the traditional sense,

Dr Nissen | Doctor | Author

13:51

right? Yeah. And that was something that was really powerful for me to learn about is, you know, how to honor always the role that these negative thoughts or behaviors are playing in someone's life. And that's true for depression. It's true for addictions. And so many people, you know, when you are going to help somebody that is feeling depressed, they're feeling sad, they're feeling down, you're going to them immediately with problem solving, sort of, you know, offering so you're saying, Hey, you know, let's, let's get you out of the house, let's go out for dinner or Hey, or maybe you're giving them some encouragement, and you're saying, you know, hey, you know, you things will be better, you know, don't worry about it, you're you first of all, you're not honoring exactly what they're feeling or what they're going through, which they need to sort of sit with for a while, before they're maybe ready to actually do something about it. And then secondly, you're not also identifying what this is providing to them, you know, and then somebody with an addiction, you know, there there may be that bottle of vodka might give them a tremendous, a tremendous amount of escape from their problems. And it might allow them to totally, you know, forget about the relationship stressors that they have, or about the bills they need to pay. And that's a huge value that they're getting. So you need to honor that if there's any way that they're going to, you know, let go of it. So,

Speaker 1

15:22

yeah, absolutely, I had the privilege of working in an addictions treatment center for almost seven years. And when I first started working there, my perspective would have been that, yeah, addictions are problems that people need help with. But it didn't take long, particularly with my training under Dr. Burns, that, I began to recognize that addictions actually aren't problems at all, they're actually solutions to a problem Exactly. And so when we honor how powerful that solution is, and really, they're coming to treatment, because the solution that they have is no longer working for them, there's some consequences to it. And so we want to kind of honor what, what those solutions are, and then provide alternate solutions for them, if they they solve so on it. And it's much the same, even with anxiety or depression, I, you know, I really struggle with some aspects of anxiety for a while, and, you know, even in their current day and age, there's a lot of anxious people, right, with COVID, and everything and COVID can, you know, being anxious can really protect you, because then you can be more careful, we wash our hands more, we, you know, we tend to be more careful, and so that that can be actually a beneficial thing. The problem, of course, is if it gets to an extreme, you know, in certain areas, then it, then it causes a suffering. And that's really where we're looking for alternate solutions, rather than clean to the ones that we have. Yeah,

Dr Nissen | Doctor | Author

16:50

I saw this meme. And it was it said something along the lines of, you know, people with OCD, this is the moment we've all been preparing for. And it's so true, because, you know, this, these these anxious worries and patterns of behavior of washing your hands after touching everything that you touch, you know, it's it seemed, quote unquote, unnecessary or ridiculous until now, and, but these are the roles that these anxieties are playing is they play a very legitimate role in allowing us to, you know, prevent bad things from happening to us. So if we ever want to change it, we need to, you know, first recognize a positive value that it's having, and see whether, you know, it could be dialed down, as opposed to taken away completely.

Speaker 1

17:35

Yeah, absolutely. I still love parts of my anxiety, when I go to teach a class, I get a little bit anxious before every class. And that used to be a problem for me, because then I wouldn't be able to focus or concentrate. But now it's just that energizing. Right, we often talk about, I coached sports and raced, you know, bikes at a high level for for many years. And we talked about in sports and athletes kind of playing on the edge getting that emotional edge, right. And that's really what we're looking at is you want to hang on to the the benefits of being up, you know, amped up and excited about your your performance, but not so much that it over doesn't shuts you down. These are the skills that we we teach. And and so, you know, we've needed that with sports performance as well. How do you? How do you be sharpened on top of your game? But not so overwhelmed that you lose focus? Exactly? Yeah. Well, I

Dr Nissen | Doctor | Author

18:28

think that's something that everyone could benefit from, you know, even if you're not a therapist, or a counselor or a doctor, you know, we can really benefit from honing the skills of communication and have empathy, really, which is a key tenant of emotional intelligence, of being able to recognize emotions in another person, and to, to honor them to the correct amount and, you know, to, to respond in a way that's helpful. And I really touched upon this before, but so often, you know, somebody complains to us, and we give them sort of a false encouragement of, you know, everything, everything will be fine. Or maybe it's not even a false encouragement, maybe it's real encouragement, but everyone seems to know, when they're feeling bad when they're feeling down, there needs to be honored for a while it needs to be sort of sat with for a little while, and, and so this, I think that something that would be helpful for us to go through is in within team CBT. There's this this way, or sort of disorganization of practice known as the five secrets of effective communication. So I thought it'd be good if we went through those so that, you know, people couldn't learn how to empathize better and how to sort of deal with somebody with their difficult emotions, help them to, you know, to process them with them. would, would you mind if we kind of go through what those five secrets are?

Speaker 1

19:56

Yeah, absolutely. And I think this is a this is a key He part of what we do in all of our training, the empathy piece gets infused to every part of it during the testing during the assessment of resistance using the methods. And my my opinion of Dr. Burns, David's greatest contribution to psychotherapy, which has been massive, is that he's able to take these really profound and deep, you know, concepts and make them simple enough for guys like like me to understand, for us kind of mere mortals. And when he was really working in cognitive behavior therapy, learning it, he discovered there were some people he didn't connect with very well. And it was hard to do. And he actually found that some of his students were better at connecting than he was. And so he distilled those components down and made them very simple. With these five secrets, and you'll see them in other communication techniques, they may be called something else. But with these, the combination of these five has really simplified it to make it easy for us to understand that doesn't make it's easy to do. In fact, they're extremely difficult to do. And they take a ton of practice, I still get together with a couple of colleagues of mine every two weeks, and we practice together, so I can hone my skills. And whenever I meet with David, we practice together. And he's been doing this for 50 plus years. So we never stopped learning. That's one of the beauties. So the five secrets are, are built on kind of what we call the IR acronym, e AR, right? And it's all about listening, putting yourself in a posture where you're trying to hear and understand what the other person is saying to you both on a kind of technical level, what are they actually saying what they were just saying, but also on an emotional level. And that allows you to connect more deeply with them. So the first of the five secrets is called the disarming technique. And it's particularly powerful and useful when somebody is criticizing you when they're negative. And the idea is, it's built on the kind of paradox a law of opposites, where if you agree with a criticism, you actually end up putting the lie to it, and you disarm them. So as an example, if somebody well I had somebody write in a feedback form to me once

Speaker 1

22:22

they were giving me feedback, what do you like the least about the session, and this particular gentleman said, You sock I never want to see you again. You're the worst therapist ever. And here I was kind of the top ranked, you know, team therapist in Canada, and I'm thinking, well, how can that be true? And yet, when I took a step back and thought, disarming technique, how can I agree with that? I realized, actually, it wasn't just a little bit true, it was completely true. You see, I'd missed something very important. He was trying to tell me and so I had to find some way of agreeing with him. And saying, actually, you know what, when I read what you wrote there, it was hard for me to read because it was true. I did. soco was kind of the worst therapist ever. And almost immediately, when I responded to him in that way, he, he calmed down, and then let me know more about what's going on. So the first one is hard to do. But you have to agree with the criticism, even though it seems ridiculous and absurd. And, and you will, therefore then be able to connect more deeply with somebody. The second part of the E, the empathy part is the more traditional training we get in empathy training, and that is thought empathy and feeling empathy and thought empathy is reflecting back repeating back what somebody says to us using their own words. And so we actually capture what they're saying. So, so when I responded this gentleman, I, I responded by saying, you know, when you said, you saw, kind of I want to see you again, here. They're surprised. But that was thought empathy. I was actually repeating back, we said, and the idea is that, when I tell you, I've got the message and repeat it back to you, then you know, I actually got the message, right? It's kind of a, it's kind of like the fast food, you know, rule, where if you, I think there's a guy named Harvey Karp out of, he's a pediatrician out of California, who's designed this for children. And I picked this up from him. And he, he said, when you repeat back what somebody says, it's kind of like when you go through the drive thru, and you say, I want a burger, coke and fries. And the person at the other end says, Okay, so that's a burger coke and fries, sir. That's thought empathy, right? Because now we both know we got the message. It's important to use other people's words, as accurate as we can so that they recognize Oh, you were actually paying attention. Yeah. Feeling empathy part is guessing at what their emotions are, or if they've used an emotion word, and then bring that out out into the open by saying, Oh, you know what, I imagine you're probably feeling pretty frustrated or annoyed or even upset with me. Am I on the right track with that? That's the easy part. And the empty finished kind of without inquiry So disarming technique Thought and Feeling empathy and then inquiry to check in and make sure you got it. That's the starting point. Yeah,

Dr Nissen | Doctor | Author

25:07

so I wanted to interrupt here because you know, so that you can go through the rest of it. But I think that it is so important what you were saying about the disarming technique in finding some truth about what the person is saying. This is something I see in the hospital all the time, that there will be somebody who's very upset. I remember, there's this one guy who he was leaving the hospital, and he really wanted to have a coat. And I felt really bad, because there was no coats that we could provide in the hospital. And, you know, we had the social workers look into it, and, and it was cold out. And so I really felt bad. But he, you know, he was saying, you know, this is this, this place is total garbage. You all don't care about me, you know, you're not, how are you letting me leave without having a coat? And, you know, and if I would have come up with an excuse, and said, You know, I would have loved to, but we just don't have any or, you know, it's doing the best we can we're doing the best we can Yeah, it's, I'm not, he's not he's not sure deep down whether or not I really understand what he's saying. And likely, what you'll see with people, you know, when you're arguing with them is that they tend to repeat themselves until it's clear that you understand it. So until you can communicate until you can say, one that you're right there, there's, you know, it, it is, you know, we we're not providing you with what you need, or, you know, finding something true with within what they're complaining about. And then, and then repeating back to them in their own words, what their concerns are about this, then it's clear to them, you understand you've received it. And oftentimes that helps to bring down the argument and the energy, the anger behind it, because they understand now, they've been heard. And there's you don't run into the same cycle of repeating yourself repeating yourself one person battle against the other back and forth, back and forth.

Speaker 1

27:04

Yeah, absolutely. It's a much more efficient way of communicate, even though it seems like well, we need to let them know that we're trying to do everything we can so they can understand when you know, what happens, we end up getting kind of defensive when we do that, and we get into what I call explaining mode. When you get defensive, then the other person will then be defensive back. Whereas if you let your defense down and go, Oh, you know what, sir? You're absolutely right, this situation, it sucks. It's terrible. We're not, we're not actually providing what you need. And this is a terrible situation. Yeah. Right. And you deserve better than that. You know, then you're sending the message, you're important, what you say is important. And that doesn't necessarily mean you can provide it, but at least you're connecting with them and, and try and understand where he's coming from. Right.

Dr Nissen | Doctor | Author

27:58

And, and I also wanted to linger a little bit on the empathy piece of this, and, you know, and thought, empathy, which we just mentioned, and feeling empathy, where, you know, the thought empathy being repeating back and the person's own words, what their concerns are, what they're feeling, or, you know, whatever they're trying to describe to you, and the feeling empathy, of going, that next level of, of synthesizing really kind of what they're saying, and trying to give an emotion about it. And so, you know, in this person who's leaving the hospital, and they're not getting a coat, and they need a coat, you know, you can say, you know, this must feel totally disrespectful to you, you know, that you're, you're not getting what you deserve, or what you need, or that you must feel completely, sort of discarded or unimportant to us. You know, doing that is really, I think, a powerful way to to practice empathy in your own life really thinking of, you know, how can you listen to what the person is saying and identify the emotion that they're experiencing? Because again, it will go to, though then understand that you understand them and it helps to kind of deflate the the anger or the frustration in the in the conversation going on and, and help the person to feel more hurt.

Speaker 1

29:30

Yeah, for sure. you're connecting with them using thought empathy on the kind of intellectual level right on the content level. But with the the feeling empathy, you're connecting with them on the emotional level, and then that does go to a deeper place, right. And so, you know, with this illustration, we're using saying, Oh, you know what, I imagine this is pretty frustrating for you, and you're, you know, if I were you were pretty angry about this, because this isn't Right. Right? You'd have every right to be. You know, am I on the right track there? My hearing? Yeah. Right. And this is where the inquiry follows up with the, the feeling of the because we don't, we don't actually ever really know how people are feeling we can get a sense based on their behavior and, but to tell somebody how they're feeling, rather than to bring it out in the open in a kind of inquiring way that honors their opportunity to correct you. And that comes from a very humble position. Right. I mean, you know, somebody has been a therapist for many years, I'm actually pretty poor at guessing at how people are feeling and what they're thinking. And in our, in our testing, which is one of the reasons we use testing, the research suggests that we're actually you can get better at it, but we're all still pretty poor at it. And so when we do the philia, we do it in a way that really honors, know what the senses what's going on, but also gives them an opportunity to clarify. Right? Certainly this gentleman that wrote to me, you know, you saw it kind of want to see you again, when I, when I did see him again, the following week. Fortunately, we had another opportunity. I said, Oh, you know, when I wrote you wrote you know, you said I saw, you never want to see me again, you're the worst that was ever that's thought empathy. And I thought to myself, imagine you're feeling pretty, pretty disappointed in me frustrated, pissed off, even really angry. And, and I said, I'm not Am I on the right track? And he said, Yeah, you got it. Right. And then he kind of let me have it a little bit more, right, because now we were actually conversing was opening things up. By just honoring it didn't have to be defensive, and didn't explain why I messed up, I had messed up, I missed something important, he was trying to tell me.

Dr Nissen | Doctor | Author

31:53

Awesome. So this is, you know, the E part of that EA r IR acronym that you just mentioned, it is the empathy. So we can do that by beginning with disarming the person by acknowledging the truth in whatever it is that they're describing. And then we can give thought empathy of repeating back to them what what they've, you know, described or said, and then the feeling empathy back to them. And then also, by inquiring at the end of, you know, am I getting this right? or What else? You know, what else? Am I missing here? What else would you like to add? That helps us to kind of flesh out the empathy that we provided the beginning, what's the rest of the EHR?

Speaker 1

32:32

Yeah, just one more point on the inquiry, there's kind of two, two kinds of inquiry, the one kind of inquiry is checking in to see if you've got the message. I get that right. Am I on the right track? That's one. And the other kind of inquiry is kind of the more open ended some a little bit more about, you know, kind of what you're thinking and feeling that opens up the conversation for more and judiciously placed the there Connect, you know, we're deeply or give an opportunity to, to hear more about what's going on once, and these don't necessarily go in any order, right. We put them in this order. I think it helps us to understand them and clarify and practice them. The next piece is the a part and and David titles, this kind of assertiveness, although traditional definition of assertiveness would not apply here, because usually we think of assertiveness is how do I defend my position and state my position. And what Dave is referring to here, when he talks about assertiveness is sharing how we are feeling in that moment. And not hiding ourselves from it in a very open, authentic, genuine but also humble way. Right. So just as an example, with this gentleman who wrote to me, you suck, I, you know, would have shared, you know, always hard for me to hear, to read what you wrote, that's an I feel statement, it wasn't easy, it was difficult. And I'm feeling a little kind of disappointed in in myself because you deserve better than that. And so I'm actually sharing some of my emotions with him. Now in the professional setting, there's some some balance so that you don't kind of over share your emotion that would be unethical behavior, but in the context of our relationships. Know, when we hide our emotions, it creates this barrier between us since we actually bring ourselves into the room with them. This is a little bit contradictory to what would be more traditional, you know, therapy training, or even say empathy training, where you were told it's all about the other person, or part of it being all what the other person is, you allow them, you know, the opportunity to be in the world together with you. And so we do share our emotions.

Dr Nissen | Doctor | Author

34:55

Right. And I think that you know, when somebody He's talking about something particularly about, you know, feeling sad or depressed, it can feel very vulnerable. And, and so it can be very important to share what you're feeling, as part of sort of encouraging this vulnerability and, and in making it, you know, as the sort of environment where it's comfortable to do that. Because, you know, you've, if you mentioned what you're feeling, then it's easier for the other person to mention what they're feeling.

Speaker 1

35:27

And I know often with people that come to me for help with anxiety, or I'll do an I feel state with them, when we're talking about how some of their friends or family members or other people will try to calm them down and say, Oh, just calm down and stay relaxed, you're going to be fine. And, and they smile. And I say that because it happens to kind of anyone who's been anxious before. And so my feel with them say, you know, when that happens, I've had that happened to me. There's a party that just wants to, I want to punch them because I get so frustrated and angry. Did you ever feel that way too. And they light right up? Like, that's exactly how I feel. It's because like, their friends family other well, meaning, you know, people are trying to be encouraging, but they're actually dismissing they're there. They're suffering. They're dismissing how they're feeling. And so when I share and I feel with them, they're like, Oh, you get it? Yeah, because I felt anxious, too, when people tell me to calm down and say you calm down, or posted going,

Unknown Speaker

36:27

Oh,

Speaker 1

36:28

tell me what that's like for you when you're feeling the anxiety. Right? When you have to get into a car after being in that car accident? What's that feel? Like? I imagine it's terrifying for you. I know, I had a friend who was was killed in a car accident, there's certain highways that I feel like just to tell me about your experience. I know, instantly. Now there's that deeper connection? Because I've, I've shared a little bit of mine, to help open them up. Right. Right.

Dr Nissen | Doctor | Author

37:00

Awesome. So that that covers the A then in the E A are what would be the last part of this?

Speaker 1

37:07

Well, the last one is David's termed respect. And he he defines it is telling somebody, something that you genuinely value and appreciate about them and affirm about them. So kind of in a stroking manner, you you stroke their ego in a sense, right? So he calls it stroking is that that respect, which can be hard when somebody is criticizing you, right? Now, the key when you do respect is it has to be genuine, otherwise, it will fall flat. Its people will see right through it. And so you'll notice, even when we started the podcast here, I said, you know, that Dr. Nissen, you know, it's kind of a sign of respect, and that you were, you know, kind of a real star and one of my classes and enjoyed having the opportunity was was great. That's stroking. And how did you feel when I said that felt great? Yeah, absolutely. And when you complimented me, it felt good to write. And so when we have somebody who is struggling with kind of depression, or anxiety, or addictions, for that matter, we have to be a little bit careful that we're not getting into the cheerleading mode, trying to cheer them up by saying, oh, you're, you're such a great person that's too broad. In general, it has to be specific. Right? You know, somebody's sharing with me that they're depressed and they don't feel like they're there for their family. Oh, it's so hard, isn't it? Right, it sounds like you really do care a lot about your family, I admire that. Well, that smells no stroking. Because part of their suffering is because they value their family so much that they don't feel like they can be there for them like they would like as opposed to saying, oh, you're such a great person. That's not a good stroking. That's kind of just a general platitude, right? So, when we, when we do the stroke, you can even do it with people who are attacking you. Right, like this gentleman who wrote the comment to me, you know, when I responded, saying, you know, it is hard to read what you said, because it was so true, what you wrote, I did suck, and I feel disappointed because you deserve better than that from your therapist, that's a stroking, telling him he deserves the best. You know, and on one hand, it was hard for me to read. You wrote on the other hand, it gave me a tremendous amount of respect for you that you're gonna stand up for yourself, you're not gonna put up with it. Right. And also that you trusted me enough that I could handle it. And I feel kind of honored that you would do that. And suddenly, now I'm complimenting him for attacking me. But you have to do in a genuine I was being genuine with him. I wasn't just kind of using words and We went on to actually have a really amazing working relationship togethers one of the most fun guys I've ever worked with. And when he shared his story with me, I realized, oh, let's No wonder he was so upset after I'd kind of glossed over something he'd been trying to tell me in that one session. And I still have a card, actually, that he wrote to me, not many of my clients, patients write cards, but he actually sent me a card afterwards. And one of the things he said to me in our final sessions was, you're the first person that's ever listened to me in my whole life. And on one hand, that was sad to hear, on another hand, it was an incredible honor to be invited into that place with him and be able to provide him with some, some tools and strategies to overcome some of the roles he was facing.

Dr Nissen | Doctor | Author

40:48

So that's the last part of the of the trifecta, then of the E being the empathy. The a being assertiveness are really like disclosing what you're feeling and are being respect, showing respect to the person. So I think it would be good, you know, to sort of close this out with modeling a little bit of how this would look. So if you don't mind me, putting you on the spot, I think, have a couple examples. And I think it'd be good to just model for everyone of how could you use some of these different techniques in your everyday life, also responding to people, you know, as they're, you know, describing their emotions to you. So yeah,

Speaker 1

41:31

and I love being put on the spot, because this is exactly how we do our training, in fact, have done a number of Facebook live broadcasts with David where he did the same and, and you can see my screw ups there where I missed the mark and do well, and, and so you can give me some feedback on how that sounded. And if I make some mistakes, it'll be great learning for me. And if we demonstrate some things that work really well be great learning for everyone else.

Dr Nissen | Doctor | Author

41:53

Great. Yeah. I Well, here's an example. So somebody comes to you, and they say, Oh, my day was horrible. My boss is such a jerk.

Speaker 1

42:01

Oh, yeah, it sounds like you're having a pretty, pretty tough day. You said your day was horrible. And in your bosses such jerk, I imagine you're feeling pretty frustrated and annoyed. I know. I certainly would be if I were you tell me a little bit more about what was happening today.

Dr Nissen | Doctor | Author

42:21

Awesome. So as you just heard Mike, do you know, he's thinking empathy, he said, you know, that he repeated my words back to me, my boss is such a jerk. And then, you know, gave an idea of maybe some things that might be feeling the frustration, and then he was saying he did an inquiry at the end to try to get a little bit more information. And, you know, as you're listening to this, when I'm just giving short samples like this, it's, it's hard to give a full, you know, empathetic response with such a short story or such a short, you know, sort of segment like this. So if anyone really ever has a brief complainer, just sort of, they show a little bit of I just, I'm feeling very depressed, like something very sure like that, you can just follow it with a little bit of thought, empathy, maybe a little bit of the feeling empathy. And then with my inquiry, and asking more about inquiring, to try to get them to open up more, is never going to hurt

Speaker 1

43:18

write such a key point you make they're making that you don't have to use all the five secrets every time in fact, using them all the time, every time would be an error, it would sound a little formulaic, they would often refer us to the five secrets kind of like the the keys of a piano. And you've got the five keys or the you know, strings of a guitar and I'm a musician and sometimes one well placed notes can be just powerful and magical, if it's appropriately done. And sometimes the most simple you know, music only has a few notes played, right. And other times you play them all to their fullness. So if you if you leave one out, that's okay. Now if you consistently leave one out and never use it, it'll show up then in your vacation and people will pick up on it so you might want to practice that one

Dr Nissen | Doctor | Author

44:07

but right well here's another example. You're so selfish and don't really care about anyone except for yourself

Speaker 1

44:17

you know when you when you say I'm so selfish I don't really care for no except for myself. It it hits home because I think you're pinpointing something that is so true. Something I know I struggle with a sometimes get caught up in in myself and you've nailed on the head I'm guilty as charged. And I imagine that when I'm when I'm like that, it's pretty annoying to you pretty frustrating. I know I get annoyed with myself and I feel disappointed. Because you you know you're you're important to me and it's difficult when we have this this this disconnect Am I hearing you? Right?

Dr Nissen | Doctor | Author

45:02

So that was a good example where Mike was able to use disarming then he said, You're right, you know, and that, I think that's often the case was when there's a tent, a taste of sort of anger and what the person's saying of acknowledging that they're right. And it and they are right, you know, that we all get caught up in our own lives. And we, we, you know, fail to really care about other people probably as much as we should. So, so that was a great example of disarming as well as, you know, some of the other forms of empathy and some inquiry,

Speaker 1

45:34

hard to do, because you have to set your ego aside, right, you ever sit your defensiveness aside and, and that that comes with, with intense practice. And, you know, for me, my, my kids, my family have been fantastic in helping me develop, I often give the illustration my daughter when she was about 10 or 11. kids, teenagers and adults now, but I would be listening to her and she would say, Dad, don't give me that psychology crap. And I because I was practicing the five secrets. What, what she was saying is Nice try, but you didn't do them very skillfully. You know, you're trying to do you know, thought empathy and disarming technique and stroking, but you've missed the mark. And when that happens, it's such a cool opportunity, because then you just fall back to the five secrets and practice them again. So my response would be, you're, you know, you're right. You could tell I was kind of practicing my psychology skills. Wasn't really listening to you. And I bet that's pretty annoying to you, isn't it? So? Yeah. Can you just be my dad? Yeah, you just deserve to have your dad right now. Okay, and then, and then all of a sudden, she just started talking again. Right.

Dr Nissen | Doctor | Author

46:48

Right. Yeah, it's, you know, if there ever is any part of it, that is disingenuous, you know, people will sniff that out. And so, it, it's a skill for all of us to continue to develop of really admitting our own mistakes, and really being curious about what the other person's feeling. Because otherwise, if you're being formulaic, and you're not honest about it, people will sniff it out.

Speaker 1

47:13

Yeah. And when we, when we do our practice, when we do our training, we we grade each other, we say, What grade did I get? Was it an A, B, or C or D? And that's hard? Because you're gonna set your ego aside and get a grade. Right? And then and then we talk, what did we do? Well, what worked? What felt good from kind of a gut level and a technical level? And, and then well, how could it be improved? Right? And, and you'll see David do this. You know, if you listen to David Burns podcast, and he's practicing, he'll say, What grade Do you give me? And because he's always wanting to learn. He's the master of it. So, right.

Dr Nissen | Doctor | Author

47:47

I have one final example here. So yeah, I give up life just isn't worth it.

Speaker 1

47:54

Oh, no, when you, when you say, you give up and life just isn't worth it, my, my heart sank a little. Because it sounds like you're feeling pretty, pretty hopeless, and pretty down. That's a dark place to be. And I wonder if you'd be willing to tell me a little bit more about what's what's going on for you, it's happening.

Dr Nissen | Doctor | Author

48:21

So that was another great example, where, you know, it was brief what I said to Mike and he was brief. And what he said back to me, he didn't need to do everything. But one thing that you showed there was saying my heart sank a little bit of sort of modeling, that the assertion or the sort of modeling the self disclosure of your emotions, to keep it in sort of a vulnerable sort of mood and encourage the person to say more, you know, because you've really gotten so little information from the person, but they're clearly feeling something so profound. So you know, do your best to try and try to get out more from them so you can better understand

Speaker 1

49:00

Yeah, just hear where they're coming from. And even when you say my heart sank, lose a little bit of a disarm in there, you're like, Oh, yeah, it's true. Right? You are, you're in a dark place is a tough place for you to be right now. And that makes sense. Tell me more about what it's like for you. kind of be honored to, to walk in this place with you if you'd allow me.

Dr Nissen | Doctor | Author

49:20

Awesome. Well, Mike, I think that this has been such a great little whirlwind tour of cognitive therapy team CBT. And really, I think you know, some things that a lot of people can benefit from in their everyday life is how to show better empathy to others and how to you know, change our thoughts so we can feel better and live better lives. So before sending everyone off to you Do you have a way that you know, people that could get connected with you or the feeling good Institute or the work Dr. Burns is doing?

Speaker 1

49:52

Yeah, absolutely. And it's been such a such a good time hanging out with you Nick, and be happy to do it again. Anytime. You know, the best way to get connected there are really two websites where all the information can be found the one is the feeling good Institute. So ww feeling good institute.com. And you'll see all the training options there. It should new websites going to be launched in the next few weeks here. And so you'll see some cool new changes there. And then, then Dr. Burns has his website, feeling good, calm. And he has a ton of resources in his podcasts there. I've done a few with him, you can kind of search and look me up up there. And then one final kind of shout out to David and full disclosure, I don't get anything from David for promoting him at all other than when he comes to Canada, he does buy me lunch. So that's my kickback for but his new book feeling great with some of the more updated motivational aspects was just released this this past fall, and it's now available online Amazon, in I think it's in, you know, ereader as well. And so I'd highly encourage you to check that out. But yeah, feeling good institute.com, and all of our trainings are there, and they're available. There's a number of free training for you looking for C credits, you know, for those in the medical French profession, if you're looking for a few C's, there's a number of free offerings on there that give some of the basics as well as some more advanced training, if you're interested in taking on I have, you know, quite a number of medical people do take my course in class because they often say, you know, we, we sort of did a brief section on empathy, you know, in a brief rotation, but, man, I feel like I could really use more and some of them are some of the most you know, kind of brilliant, wonderful, compassionate people and it doesn't take long with some some practice, if they are willing to kind of set your egos aside and and do it and they do wonderfully. So love to have them part of the courses.

Dr Nissen | Doctor | Author

51:54

Awesome. Well, one other plug, I would say is for really for any human being out there, but in particular those with depression or anxiety or supporting those with depression, anxiety, feeling good is such a great place to start. And in fact, that's how I got introduced to to Dr. Burns's work and later to Mike is through that amazing book that a psychiatrist I know would suggest to all of his patients with depression and anxiety. So check out feeling good feeling good Institute feeling great. These just I think you'll find them all to be very helpful. So Mike, I wanted to thank you so much, you are extremely talented, extremely smart, and at the same time, so humble and approachable. And that's why I wanted to have you on the show. You describe you're just such a good teacher, and you are a great teacher for me. And I'm sure everyone today has benefited from your great teaching. So thank you very much.

Speaker 1

52:48

Well, I'm going to give you an A plus on your on your stroking. That was well done. And certainly my journey began with a physician giving me the book feeling good, hmm. And in many ways, kind of all my life, you know, to that position today except got my start my done my undergraduate number of years before then I made the shift back into doing this this type of work and, and now we offer kind of online therapy as well throughout Canada, the United States and I have the privilege of kind of offering that to people who you know, may not have access to it. And so you can check that out on feeling. Good Institute comm as well. All right.

Dr Nissen | Doctor | Author

53:32

Hey, listeners, some of you have so kindly asked how you can support the podcast. You can help by supporting us on Patreon. So please kindly find our Patreon link in the show notes. You can also support us by leaving a review. So please let me know what you think about the show by leaving a review on iTunes. You can find me on Twitter, YouTube, Instagram and Facebook, as Dr. Nissen and it's important to note that this podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other healthcare services, including the giving of medical advice, no doctor patient relationship is formed. And the use of this information and the materials linked to this podcast is content of this podcast and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have and they should seek the assistance of their healthcare professionals for any such conditions.

00:0000:00