What Is TEAM: Transcript

The following is a transcript of a video explanation of TEAM-CBT.

Introduction To TEAM-CBT

I assume you aren't here because you care deeply about types of therapy. I'm guessing that you're here because you're stuck. You would like that to change. And I'm going to tell you about a type of therapy, because it's been transformative for me, understanding it might help you figure out if it's a good fit for you, and that might help you figure out your next step.

I'm Cheryl Delaney. I'm a therapist. I specialize in perfectionism, and I love my job. If you tend to hold yourself to unreasonably high standards, you're in good company and you came to the right place. 

I work with perfectionists because my life used to be so small. I was so insecure. I felt sure that I was inferior. I was sad and lonely and scared a lot of the time. It didn't always look like it, but it wasn't great. I want everyone to know that they don't have to feel that way. Let's get into it.

First, "TEAM" in full is TEAM-CBT. And it's an acronym, not an adjective. "TEAM" stands for testing, empathy, assessment and methods. And we're going to walk through each part with a specific person in mind. So I'll talk about Alex, who is a client of mine, whose details I've changed to protect her confidentiality.

Wrestling With Perfectionism: A Case Example

When we worked together, Alex was in her late 30s, had two kids, she was married, she was in middle management. She had a few employees reporting to her, but she was hoping to get a promotion in the near future. And when she first came in, she was aware of having a lot of anxiety and tied that to perfectionism, and was really focused on work. But ultimately, she decided that what she first wanted to focus on were feelings of guilt and anxiety about herself as a mom.

It was really disconcerting to her that she could feel totally competent one minute and then completely inadequate the next in the same context, and no one around her thought she was struggling. She was a devoted mom, very dependable and protective. She was successfully juggling, if sometimes resentful, of all the demands on her time from work and home and her community.

She came to me because she was in a cloud of anxiety driven by perfectionism. At first, her real focus was her work. But she ended up wanting to work on her feelings of guilt and anxiety about herself as a mom. From her descriptions, she was a devoted mom, dependable and protective. She was successfully juggling, if sometimes resentful, of all of the demands on her time from home, work, and her community.

Focusing on a Moment in Time (So We Can Create Meaningful Change)

When we got into detail about what was bothering her, she talked about a moment a few days earlier when she had lost her cool.

She was making dinner and realized she was missing a key ingredient, she'd had to leave work a bit earlier than planned, and she was still thinking through the things she'd left undone at her desk.

From the other room, her daughter called out for help with something urgently that really could have waited, and she lost it.

And looking at her daughter's face, she immediately felt guilty and regretful and kind of ticked off because, honestly, it was unreasonable. Her daughter really could have waited. It's understandable. We all have our limits, but it also wasn't in line with her values.

She didn't feel like yelling at her daughter had made anything better, and it actually made them both really sad, and she didn't feel like the kind of mother she wanted to be. So she was telling herself she was a bad mom.

Testing: An Essential Part of a Healthy Therapeutic Relationship

Now, my first job as a therapist is to understand what it’s like to be Alex as fully as I can. And a few different pathways into that. One is just watching facial expressions and body language. I can ask lots of follow-up questions and hear her story in great detail. But if I just depended on those things, I would be missing some important information. So I had Alex fill out some forms.

This is a brief mood survey, which all of my clients fill out at the beginning and end of every session. And seeing her numbers, instead of just going by my gut feeling, showed me that my impression was way off. I had basically been thinking that she was fine and wanted a tune-up. And in fact, she was suffering intensely.

Testing Helps Us Get to Important Stuff Fast

Like many people I've worked with, Alex was very skilled at putting a positive face on things, wearing a big smile, and getting through her day. And if you ask her how she was doing, she'd most likely say fine. Because testing was part of my practice, I wasn't dependent on just my gut feeling. Having used this for a few years now, I can't imagine doing therapy without it.

I get why people don't always love them, though. Numbers and tables feel out of place with what we think of as therapy. They don't exactly scream macramé plant holders and cozy mugs of tea. But they were really important to our success in working together. They not only gave me a chance to connect with Alex's true degree of suffering, but they also gave us a way to measure our progress, which also communicated to Alex that I expected us to make progress, that I expected to see changes in those.

Testing Holds Me Accountable

And that if we don't see changes in the numbers, we can tell something's going wrong, and we can change our course. And maybe the biggest benefit of testing is this, I want to know how you're doing when I'm not there to influence your answers, which means you get to tell me I was missing the point or this isn't working, which means you're more likely to be honest, and I'm more likely to know for real when there is a problem.

Testing Lets Me Know When I’ve Messed Up

And like me and many of my clients, Alex was raised to keep critical feedback to herself. She'd been taught to sweep that sort of thing under the rug, especially if it wasn't a huge issue, and she could just put it to the back of her mind. The problem is, in therapy, those things, even small ones, can actually be big enough to keep us from being effective. For therapy to work, it's essential to address even minor hurts. Otherwise there will be distance, there will be mistrust, and we won't reach our goals.

And weirdly enough, usually when people bring that sort of thing up in feedback, we talk about it, and it strengthens our connection, and sometimes we even make breakthroughs. Asking for honest feedback in survey form just lowers the bar to acknowledge when something isn't quite right. I need to know how my clients really feel, and testing is such a great way to make that easier.

Empathy: It’s Easy to Get It Wrong

Onto empathy! This is probably the most obvious component of effective therapy. I know that when I feel like I want to crawl out of my own skin because something is so awful, I most want someone to listen, connect and care. And as you're watching this, maybe you're feeling some connection and caring for Alex. Maybe you can relate to some of what she said, seeming fine to the people around her, but really filled with guilt and anxiety and fatigue, frustrated by the incompetence of her coworkers and by her own impatience with them.

And most of us will jump in with empathy there. We will talk about our own similar experiences, tell a story of a neighbor or uncle who went through something similar, maybe throw in a few pieces of advice about how to solve the problem. And one -- there are a bunch of problems with that -- But one of them is that it can kind of rush us through feeling bad. It can make it feel like we're not supposed to feel awful like we're supposed to just hurry up and see a silver lining, find a positive attitude, and get over it essentially.

And that doesn't make for effective therapy. And it just doesn't feel good as a human being. So to be a TEAM-CBT therapist is to assume that empathy is a skill to practice extensively, especially to break those bad habits that we all start out with. I have practiced for hours, really an embarrassing number of hours, hundreds of hours, to get better at this. When I started out, I was the friend that people thought of as a good listener. And I still fell into all of those traps. I went for cheerleading. I was always bringing up some anecdote from a book or a podcast, and I still screw up sometimes.

The bottom line is this, empathy is a complex, multifaceted skill, and all skills take practice. Even with all that practice, we are still going to mess up. So we practice being able to respond to our clients' negative feedback, to their anger, hurt and disappointment. So that I can be open to all of your negative feelings, even the ones you feel towards me. So when I threw a session off course, intended to say one thing, but ended up minimizing what Alex was going through, it showed up on the feedback form, thank goodness, and we were able to talk about it, get back on track, and strengthen our relationship.

This is how empathy and testing work together to support great therapy. One slip up, one bad session doesn't have to mean bad therapy overall. And it doesn't have to mean we won't get to our goals. And that brings us back to Alex's goals and Assessment. The next letter in our acronym.

Assessment: Respecting Alex’s Autonomy

And that brings us back to Alex's goals and Assessment. The next letter in our acronym. Assessment is a powerful part of this model, and maybe its most unique element. Therapy is a tricky project. There's a lot of potential for a power dynamic, for a therapist, to be dispensing wisdom from on high, and a client having other things in mind.

One of our main tasks is to stay on the same side, facing in the same direction, working on the same project, keeping you in the driver's seat, so that you are deciding how much you want to change. Whether you want to change. What's great about things as they actually are.

Uncovering Unconscious Motivations

We're digging up stuff that usually stays unconscious, and giving you back some of the agency you don't have when it stays under the surface. Let's bring this to a context that we're all more familiar with. Chances are, you've gone to see a medical doctor and gotten advice that you ended up not taking. Sometimes they don't know what you've already tried. They don't know how much you want this symptom reduced, and they assume that you want it treated at all costs. There are always costs to change, and they usually go unacknowledged. And when they do, that stuff gets in the way. And this can sound counterintuitive, but most of us feel pushed in the opposite direction when someone tells us what to do, even if they're trying to help.

I personally am very stubborn, and I hate being told what to do. So I ask Alex this, if you had a switch that you could flip that would get rid of this thought entirely, and along with it all of these intense, negative emotions, would you flip it?

It sounds appealing, but let me add that the switch does nothing to affect the outside circumstances. So dinner is still a mess, work is still undone, your daughter is still yelling to you for help, you still kind of lose it at her. Now, do you want to get rid of the thought entirely? And maybe you've had a thought like this. Maybe in your case, a bad father—could be employee, boss, friend, sibling—what could having that thought show about you that is admirable, that's important?

Understanding Trade-offs and Choosing How Much to Change

Well, we made a list, Alex and I, and here's what we came up with. It shows she cares about her kids, that she takes her responsibility to them seriously, that she's insightful and self aware enough to recognize that there's a power dynamic and that they're relatively vulnerable.

That she wants better things for them than she had as a child. And that she's even willing to beat herself up a little bit to make sure they get what they need. This thought shows her love. Now, does the thought have any advantages? For me at least, being a parent is often hard complicated, demanding. It means putting my own impulses to the side a lot. And without this thought, Alex might let things slide and not live up to her values. It might remind her that she's at risk of falling short and get her to do the hard parts.

So now we have a new question. Let's imagine that instead of a switch, we have a dial.

Maybe there's a level for this thought that could remind Alex of her values and the kind of parent she wants to be without causing such intense self-criticism. And then Alex can decide. She can say, no, I want to keep this maxed out. I am willing to live with this level of anxiety and guilt because it is so important to me to be a good parent. And keeping it so intense might keep her from getting distracted or letting herself slack off. But Alex didn't want that. She could see the good stuff it was trying to do, but it was really weighing her down. More importantly, it was standing in the way of her being the kind of parent she wanted to be. Feeling guilty and anxious all the time affected how she was in that relationship. She wanted to turn it most of the way down. But hang on to about 15 percent of those negative feelings to guard against impulsivity. And that sounds great, right? Let's all go for an 85 percent reduction in stress, anxiety, and overwhelm!

Methods: Creating Genuine, Lasting Change

But how do we get there? It seems so hard to imagine such a big change, let alone one that would persist even in those big, stressful moments. And that's where methods come in. We have over 100 methods now for creating genuine gut-level change. This is just a smattering. Some of my favorites aren't even on here.

Now, some methods are helpful for challenging a belief with analysis or logic. Those are usually helpful for getting the ball rolling, maybe sowing a seed of doubt in the negative thought. But my favorites are designed to create something more like discovery or learning, which feels different than thinking. None of my clients has ever needed my help in learning how to have a logical debate with themselves. Having a new emotional response usually demands having a different experience.

It's not enough just to hold an idea at arm's length and say, I should think a different thing. But it's almost breathtaking when you use a method that actually makes the negative thought feel untrue. Let's look at one of the methods, Alex and I used to challenge her thought. This one is called Worst, Best, Average.

Worst, Best, Average

So at the top of her page, she wrote down the role that she was thinking about. For her, it was mom. Again, this would work for any of those other roles. Then she wrote down her idea of the qualities of a good mom. Your list would be different, but she came up with patience, caring, dependability, fun and structure. Then we picked one of those qualities, starting with patience, and she gave herself a score from 0 to 100 on how patient she is when she's at her worst, then another score for how patient she is at her best, and finally, how patient she is overall.

Then we repeated that same process for the other qualities, and her page looked a bit like this:

And again, here we are with rows and columns that don't have that touchy-feely vibe, but I have come to adore the type of order that this imposes on my otherwise raccoon's nest of a wandering brain.

After all that, I asked Alex to choose one quality she'd like to improve and think of three specific steps she could take in that direction. Now, this method is unlikely to blow you out of the water. I've never gone through this with a client and had a huge emotional shift in that session. But it is often the beginning of seeing things a bit differently.

So Many Methods!

Alex and I used a bunch of other methods to get her 85 percent drop. But this one was helpful in a couple of important ways. First, it helped Alex to see that being a mom is way more than one moment in time. There are so many millions of tasks, characteristics, attributes, and skills that go into being a parent. Picking out one of those and using it as conclusive evidence that she's a bad one of the whole thing didn't make as much sense to her.

We also spent some time talking through the process. How did she land on those qualities? Is it possible that she didn't even consider choosing qualities where she feels really strong? Maybe if she had chosen another group of qualities, she would have been hundreds across the board in terms of the scoring. We talked about how she set her baseline. Where was she comparing herself to? Is she thinking about the description of an ideal parent from a book? Is she thinking about characters from movies and TV? people she knows in real life, every family she's ever seen at an amusement park?

And that helped to recalibrate Alex's own sense of how she thought of herself in these qualities. Finally, it allowed us to focus on Alex's specific value of changing the way she responds under stress. She could think in specific terms about how things were going and how she might like them to go differently instead of torturing herself with self-criticism. The beauty of having so many different tools to choose from (And again, we just had a tiny little taste!) We have so many so that we can keep going until we find one that works. They're usually pretty cumulative.

Wrapping Up

Tada! Ok, that's a very cursory overview description of TEAM-CBT. I hope it gave you some insight. One of my favorite things about this process is that it's generally fun. I'm not saying that every session is easy or happy, and if there are never tears, probably not doing my job very well. but on so many days, this work is surprisingly joyful. If you have questions, please get in touch. I will put a link to my website in the description. I will also link to feelinggood.com. That's the website of Dr. David Burns. He's the creator of TEAM-CBT, and he is professor emeritus at Stanford University. He is extremely active in writing, teaching, even developing an app. He hosts a weekly podcast where they answer listener questions and publish examples of live therapy so you get to hear the whole process behind the scenes. I highly recommend it.

Thank you for listening. I'm so passionate about this work and always glad to have more people along for the ride. Have a great day!

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Cheryl Delaney, MS, LPC

Cheryl Delaney is a Georgia-based therapist who offers online counseling for perfectionists who want more peace and connection in their lives. She’s been officially recognized as a “continuous learner” (with a certificate and everything!) as well as an easy crier. Her approach balances professionalism with warmth, making sessions both effective and encouraging. When she's not in therapist mode, Cheryl's likely spending time with her husband, three kids, and two cats or absorbed in a podcast while doing the dishes.