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How to Get More Out of Therapy

Dr. David Burns has some tips.

Key points

  • Reducing your belief in your negative ideas is key to improving your mood.
  • Therapists overestimate how empathic they are, and they might underestimate how badly you feel.

If you want to improve your therapy, what might you discuss with your therapist to help you move from feeling good to feeling great?

Several months ago, I talked to psychiatrist Dr. David Burns, author of multiple self-improvement books. Currently 79-years-old, Burns tirelessly writes, teaches, and produces podcasts listened to by thousands.

I also participated in his weekly therapist group at Stanford University.

Dr. Burns books, including Feeling Good and Feeling Great, detail how individuals can traverse the territory of their thoughts and emotions, learn to improve their moods, try on new behaviors, and experience desired relief and growth.

If you're going through therapy, a question you might also be asking is, "How can I use this to help me get more from my therapy?"

Here are eight tips for you, from Burns’ books and his Stanford-based training group.

1. Seek therapy which will include reducing your belief in negatively biased or distorted thoughts. Burns says, "It is impossible to reduce anyone's negative feeling without reducing their belief in the distorted thought that triggers that feeling, and this is true in all schools of psychiatry and psychology." If you're still suffering emotionally, ask prospective therapists if part of the treatment will include a look at what you're believing about yourself, others, and the future.

2. Question if you’re told that a “chemical imbalance” is to blame for your depression or anxiety. Burns’ research has indicated insufficient evidence to support a chemical imbalance in the brains of people who were depressed or anxious. He was giving out tons of antidepressants and most weren't recovering. “I knew the whole promotion of antidepressants was not sound and subsequent research has proven that." Burns found that instead, it was the application of empathy and evidence-based techniques that helped people move them through stuck points and into recovery, sometimes within a session. (Please note that this is not medical advice and you should not alter your medications without consulting your physician.)

3. Your beliefs can change; you can stop believing an imprisoning negative belief. Cognitive behavioral therapy can include your therapist asking you to step back from your ideas and question the validity, logic, and utility of them. Dr. Albert Ellis, founder of Rational Emotive Behavior Therapy, also suggested getting one’s friends to challenge you by role-playing the voice of your negative thoughts while you argue against those thoughts. Comparatively, Burns suggests that clients identify what their internal voice is saying and then "role play the negative voice" as the client argues against it. Burns says that it can help you to "debunk and release irrational thoughts".

4. Ask your therapist to slow the pace if you’re feeling resistant. Therapists might inadvertently reduce their effectiveness with you through eagerly introducing change strategies too quickly in your therapy. You might have real reasons to reject the strategy, and if your therapist is too insistent and too rapid, it could reduce your motivation and increase your inner resistance. Instead, you can ask your therapist to slow down and re-listen to you. Burns asserts, "Resistance is real and can have a massive causal effect on recovery."

5. Give your therapist feedback if they’re getting it right or missing the mark. Burns learned that therapists overestimate their level of accurate empathy, as perceived by the client, getting it right “only 9% of the time”.

6. Consider how your objectionable emotion might actually represent your positive values. Helping you identify how a negative symptom demonstrates what’s important to you, or "what is awesome about you," can help you to reduce shame. Reframe your negative symptom, and view it as adjustable to promote (rather than deflect from) your positive values.

7. You can ask your therapist to help you monitor your symptoms at each session. Especially since therapists might underestimate or overestimate your symptoms, and because you might feel reluctant to correct your therapist, therapists should incorporate symptom testing and ratings of therapist effectiveness to help keep the lines of communication open. Your therapist can obtain measures and administer them to you before and after your sessions, though some therapists might not agree to do this.

8. Therapists are people too, beware of unhelpful therapist behaviors that could be sabotaging your progress. Burns says, “Therapists as a group want to be helpful and special to the client,” he says, and this can inadvertently lead to behaviors that bring up added resistance for you in therapy. If your therapist is excessively lecturing, reassuring, rescuing, or even arguing you out of feelings that seem valid to you, and if you’re left feeling helpless following your session, consider whether a change of approach might be in order.

Open communication with your therapist combined with your ongoing effort and courageous self-advocacy can help you move toward feeling great.


To hear the full interview, go to:

To listen to Dr. Burns podcasts, read his books, or learn more about TEAM CBT, go to: