By Victoria Tognozzi
Marriage and Family Therapist
My Journey with TEAM-CBT
Like most therapists, I was familiar with the work of Dr. David Burns. I had read his books, and used many of his ideas and methods ever since I became a therapist. When my teenage daughter had a bout with depression, I gave her a copy of “Feeling Good”. I wasn’t sure if she had read it or not, but she returned from college on vacation and informed me that Dr. Burns had a podcast, the FeelingGood Podcast, in which I might have some interest. I began listening to the podcast and loved what I was hearing.
Dr. Burns had developed a new approach to Cognitive Behavioral Therapy (CBT) summed up by the acronym “TEAM.”:
T=Testing; Dr. Burns was teaching that I should test, not only the patient’s mood and relationship satisfaction, but how they feel about me! Using a therapist empathy sheet at each session, the patient scores their satisfaction with the therapy session and their relationship with the therapist.
E=Empathy. As therapists, developing that empathic relationship is crucial—not that empathy solves the problems, but that it is a necessary basis for solving them.
A=Assessment of resistance, which all therapists know as that moment when you realize that the patient is ambivalent about change. The therapist shouldn’t teach or give any advice until they have assessed the patient’s motivation and have determined that the patient really wants what they are offering.
M=Methods. Dr. Burns offers at least 50 methods to use, so if one doesn’t work, you have many alternatives to try, until you find one that does.
I had been a violinist and teacher for many years before becoming a therapist. What I heard from Dr. Burns jumped out at me immediately. Without motivation on the part of the student, success eluded me. Finding that specific moment in time to work on made sense, as I already understood that global approaches yield little results. I had learned that when I focused on one small step at a time, we could make progress. And the motto of TEAM, Fail as Fast as You Can, was the clincher. I knew too well, that our mistakes are our best teachers. In TEAM, we use a recovery circle which displays 16 possible methods from which to choose. We don’t expect every method to work, so we keep trying until we find one that does. This can be very hopeful for the patient, as they see that if our first, second, etc, choice doesn’t make the grade, we have many others to try.
The more I learned about TEAM, the more I was motivated to find a training so that I could begin learning how to do it. Lucky for me, I found Dr. Leigh Harrington, a Level 5 trainer and psychiatrist, and fantastic teacher who was offering a training in Yolo County. I wasn’t really eligible to attend, but she graciously garnered an invitation for me, and I began my training with a 12-week course which introduced the basics of TEAM. Since then, I had the pleasure of attending Dr. Burns’ Tuesday group at Stanford for about 6 months, and have taken many other trainings, both group and individual. My skill has improved, and seeing my patient’s enthusiasm when they recognize that they are feeling better is a great reward.
Testing of mood and empathy sets TEAM apart from other types of therapy. Testing gives ongoing information about the patient’s concerns and how they feel about me. When I have that information, I can use it to target their needs and improve my relationship with them. As therapists, we all know that word, empathy. But to truly show empathy so that the patient experiences me as supportive and concerned, understanding and respectful, with techniques that are helpful is not a small challenge. TEAM teaches structured methods to develop that empathy, and it is a pivotal component of therapy. In TEAM-CBT, we never offer advice or interventions until that empathic connection is made and acknowledged, and the patient states they want our help. This prevents the “yes, butting” and therapist frustration, as we try and try to help someone who really doesn’t want our help.
TEAM also targets the source of the problem by being as precise as possible; In TEAM, we work with a specific moment in time when the patient is feeling bad. With this approach, you get direct information about thoughts and feelings that are present when the patient is distressed. We use this information to conceptualize the case and then inform the treatment. In order to increase the patient’s motivation and overcome their resistance, we use positive reframing of negative emotion. In this exercise, the patient looks at what is advantageous and admirable about their anxiety, guilt, etc. This step, alone, can often be an impetus for change for the patient because they begin to see themselves in a different light, instead of that defective person who is depressed.
Once the patient convinces you that they want your help and are willing to do the work (demonstrating that you’ve succeeded in overcoming outcome/process resistance), the fun begins. The multitude of methods gives many alternatives, and indeed, although the name is TEAM-CBT, you can use any method you like when you get to the methods portion. Many of Dr. Burns’ methods are powerful role plays where the patient and the therapist enjoy themselves and learn at the same time. Not only do the patients like it, the therapy session becomes invigorating for the therapist, as it is interactive and interesting.
My journey as a TEAM therapist continues as I work toward Level 3 Certification. I understand more how to weave empathy throughout the session, offer the invitation, sit with open hands if the patient is not ready, and employ the best methods for the problems presented. I continue to be so excited when the patient begins to see that they have the power to change how they feel.
About the Author
Victoria Tognozzi is a Licensed Marriage Family Therapist working with adults at Human Touch Behavioral Health in Sacramento. She attended music conservatory and spent many years as an orchestral musician and private violin teacher. 10 years ago, she changed paths to pursue her other passion: understanding why people do the things they do, and how to help them change. It continues to be fascinating.