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 unsure what therapeutic resistance is, read about it here. 

If you want to listen to the entire Dr.Burns -Podcast, take a listen here:

Here is the condensed, written version. 

The agenda-setting invites 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? 

Dr. Burns - Podcast

How do we melt resistance?

Step 1 – Invitation – Once the situation has been explained and the story told, ask if there is something in the condition 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 he got a bad performance review at work that affected his self-esteem (When? Where? What was going on? Feeling?).

Step 4 – Conceptualization – In what way is the above person facing a problem? The four potential categories are depression, anxiety, relational, or non-problem.

What is a non-problem? A non-problem is when we feel something entirely normal and healthy. For example, there are two kinds of grief. Although both are very hard to experience, uncomplicated grief is healthy, regular, and, therefore, a non-problem. 

On the other hand, complicated grief is characterized by distorted thoughts like self-blame or guilt. These malformed thoughts and feelings make grieving a complex process, 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 must address resistance first. Ironically, therapist compassion and the 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 arduous. It seems unfair when you have to do the job (process resistance – you are the one that needs to commit to changing) when everyone else 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 will move forward and convince the clinician that they want help (resistance overcome).   

If this podcast summary has piqued your interest and you want to hear more, I highly recommend Dr. Burns’ Feeling Good website. His podcasts are located here.