Top 3 Things I Learned Practicing TEAM-CBT In My First 3 Years
The Beginning of a Great Idea
My journey with TEAM-CBT started more than 7 years ago when I was first drawn to David Burns’ Podcast describing what he was calling “High Speed Therapy”. I threw myself into the weeds of the TEAM-CBT structure with reckless abandon because I wanted to offer what David offers. This naturally extended towards a desire to start my private practice right out of my residency program. I thought this was a great idea at the time!
Pictured: Me!
Imagining how great things would be.
It was an awful idea!
Pictured: Me!
Wondering where it all went wrong.
While I had a lot of rewarding experiences, a good percentage of my initial experiences were crappy to say the least. I was head strong, over-confident, and had unreasonably high expectations so it wasn’t too surprising I was constantly getting stuck. Despite getting stuck, I ended up learning a lot!
Here are the top 3 things I learned in my first 3 years of practice:
Evaluation
The Initial Mistake: Evaluation is very important. Spend as many appointments as is necessary to complete the Evaluation.
In my excitement to get to the Daily Mood Log or the Relationship Journal with clients, I’d rush through the EASY, the memos, policies, and screeners. The absolute bare minimum of time was dedicated towards fleshing out the client’s symptoms and diagnoses. I had basically tossed out all my history taking skills I learned in Residency trying to cash in on some fancy TEAM-CBT shenanigans I had learned. Not a good idea.
The first year of my practice was almost nothing but therapeutic flops and disappointment. There were a ton of impassable issues that weren’t given the full attention they deserved such as suicidality, personality disorders, setting limitations, etc. I was not having a good time, and I seriously considered giving up on my private practice!
Everyone: I hate spending time on paperwork and busywork!
DO IT ANYWAY! And stop eating pencils. That’s weird.
The Solution: I decided to conceptualize the Evaluation as a Period of time as opposed to an initial meeting.
I would tell potential clients I’d provide them an evaluation for 2-4 (or more) appointments completely dedicated to mutually informed consent. Virtually zero percent of time during the evaluation period would be dedicated to utilizing methods/tools to help solve the client’s problems.
I told them that I’d only start a therapy relationship when we’ve both indicated full understanding and informed agreement to my policies, our understanding of the client’s symptoms, their diagnoses, and my recommendations. Following this new perspective led to a more stable framework which helped me avoid headaches. The incidence of getting stuck dramatically decreased.
Empathy
The Initial Mistake: Empathy is much more than just the 5 Secrets of Effective Communication.
I initially believed using the 5 secrets was empathy. I’d copy what David does on the podcasts: repeat back the scores on the Brief Mood Survey, do some 5 secrets, maybe fill out a Daily Mood Log as we went along, ask for a grade, and then offer an invitation.
This worked very well in the training groups I’ve been a part of, but it just was not working for my outpatient practice. Some clients liked it, but many others were very put off. I recall one client telling me they were right on the verge of saying something important, and then I unceremoniously interrupted them asking for an arbitrary grade. Something wasn’t right!
The Solution: I decided to conceptualize empathy as more than just 5 communication tools. The conceptualization I settled on is that Empathy = Understanding.
The 5 secrets, while very important tools, are just a small piece of Empathy. Just like any other tool, I couldn’t just throw them at my clients as rote formula. I eventually phased out of asking for grades on empathy and making invitations. I instead focused on fully understanding the patient’s problems and symptoms – when the client is fully understood, the client will begin to understand themselves.
People don’t have a manual for “why” they suffer and “how” to fix it
That’s what they come to us for.
In other words, if you and the client both know why they are having their symptoms now, then you will both know how to resolve them. Jumping into homework or methods becomes natural after that point. Understanding is a huge key to effective therapy.
Defining Therapy
The Initial Mistake: Therapy is a process that leads to understanding and acceptance. All tools, approaches, and perspectives aim to give these two outcomes to clients. I was mistaken to think of therapy as anything else.
When I first got started on my TEAM-CBT journey, I saw therapy as a solution to peoples’ Depression and Anxiety. Any time I got stuck, it was evidence that a piece of the puzzle was missing. If only I could “find” that missing piece, then therapy will start working again!
While that search led me to many new approaches and perspectives, it never fully satisfied the missing piece of the puzzle. While I got stuck a lot less throughout the years, it would still inevitably happen. I would then have to get back onto that stressful treadmill to search for what was missing. Something needed to change.
The Solution: I decided to seek out my own therapy. This gave me the courage to give up on constantly searching for a solution when that solution is already present in all of us.
The solution is not just learning new tools or perspectives. It’s also not just subscribing to the right approach such as TEAM-CBT, or IFS, or ACT, or Empathy, or Psychoanalysis. The solution is to do NOTHING. This is a hot take that requires explanation, so let me explain.
Pictured: My cat, Katniss.
She has to do literally NOTHING but be a cat in order to succeed.
Isn’t that right?? Who’s a good girl? You are!
Each therapy tool and approach are just as good as the next – the difference in effectiveness is likely going to be comparable to placebo. What matters most in therapy is our intention and how we structure our practice so we can reinforce our intention. If you get those two things right, then recovery will be the main logical outcome. I decided that my intention would be to offer understanding and acceptance to clients.
I would STOP offering “therapy”, tools, and approaches to my clients for the following reasons. “Therapy” is the process - being in therapy is not an offer-able outcome. Tools are just ways to interact with clients and get them thinking why they have their symptoms right now - there’s nothing all that special about them otherwise. Approaches are just personal philosophies transformed into modalities – regardless of the philosophy, it has to be consistent with everything else in the practice or it will be a wasted philosophy.
After adopting this mindset, setting boundaries and limits became incredibly easy. I no longer felt stuck when something wasn’t working, no longer felt guilty for asking for radical accountability, and no longer felt worried about clients not recovering while working with me. To sum this all up and to get back to what I said earlier, when you have the proper intention and structure, then you literally have to do NOTHING but play the role of a therapist.
Concluding Words
That’s what I’ve learned within the past 3 years of practice since I started this journey. While there were many ups and downs along the way and not everything worked out exactly the way I had expected them to, the most useful thing I learned overall was how to adapt.
So, what are my conclusions on TEAM CBT after practicing it for 3 years? To keep it short:
Two Thumbs Up!
Yeah, it was pretty good! Give it a shot, I guess.
You’ll definitely learn a lot if you have the stomach to experience all the hardship that comes with operating your own private practice. As for me, when I look back on these past 3 years, I no longer see it as a string of ups and downs. I now see it as an unbroken chain of events leading to me writing this for you today. I’m more than grateful to have been alive to experience it.
