Dr. Burns – Podcast #5 – Agenda Setting
A is for Agenda Setting – This is the 2nd post in the Dr. Burns Podcast series. This Podcast focuses on addressing resistance. If you are not sure what therapeutic resistance is, read about it here.
If you want to listen to the entire podcast, take a listen here:
Here is the condensed, written version.
Agenda setting is inviting a person to work on the problem they are experiencing.
When individuals don’t rapidly overcome problems – in one or two sessions – resistance to change has not been addressed.
Even though we yearn for change, we cling to the familiar.
Resistance is difficult to understand, even for the resistant person. Depression is the worst form of suffering. Why would someone want to cling to depression? Or addiction? Or anxiety?
How do we melt resistance?
Step 1 – Invitation – Once the situation has been explained and the story told, simply ask if there is something in the situation they want help with.
Step 2 – Specificity – We can only work on one thing at a time, so the person must prioritize – Which problem would you like to work on first?
Step 3 – Time and Place – Think of a moment when this problem occurred.
Where were you? What was going on? What were you feeling?
For example, a client wanted help with low self-esteem (specific problem) and said that he got a very poor performance review at work that affected his self-esteem (When? Where? What was going on? Feeling?).
Step 4 – Conceptualization – What problem is the above person dealing with? The 4 potential categories are depression, anxiety, relational, or a non-problem.
What is a non-problem? A non-problem is when we feel something that is completely normal and healthy. For example, there are 2 kinds of grief. Although both are very hard to experience, uncomplicated grief is healthy and normal and therefore, a non-problem.
On the other hand, complicated grief is characterized by distorted thoughts like self blame or guilt. These distorted thoughts and feelings make grieving a difficult process to go through and so people end up “stuck”.
Back to our previous example. Once the moment is revealed, determine what the problem is. In the example above, is it a self-esteem problem? Conceptualize – is it depression, anxiety, and relationship problems. It probably is all of them.
Even though we have cognitive behavioral therapy tools that can help, we have to address resistance first. Ironically, therapist compassion and need to help can be the death of successful treatment.
Step 5 – Deal with resistance (process and outcome – not sure what these are? Read about these two types of resistance here)
It is great when someone wants help. However, offering the tools is not enough. Dr. Burns frames his resistance busting technique by saying to the client, “I can show you how to overcome your self-esteem problems, but you will have to do all the work. This process will be very hard. It seems unfair when you have to do the work (process resistance – you are the one that needs to commit to changing) when it is everyone else that has the problem (outcome resistance – be able to deal with other people more effectively).
At that point, the person dealing with the problem will decide if they willing to move forward and convince the clinician that they actually want help (resistance overcome).
If this podcast summary has peaked your interest and you want to hear more, I highly recommend Dr. Burns’ Feeling Good website. His podcasts are located here.
If you have ever been in to see me, you will have heard me talk highly of Dr. David Burns and his work in Cognitive Behavioral Therapy. I have recommended