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Intense Performance / Public Speaking Anxiety, Part 1 of 2

This Is podcast features the first of the two live therapy demonstrations that Dr. Jill Levitt and I did at our psychotherapy workshop on Sunday, May 16^th, 2021. I hope you enjoy this dramatic and inspiring session!

Jill and I believe that doing your own personal work is vitally important to the growth and credibility of a mental health professional for many reasons. First, when you\\u2019re in the patient role, you can see things from a radically different perspective, including a far greater, first-hand appreciation of the errors that shrinks make as well as what is especially helpful.

Second, if you are successful in your own work, you can tell your patients, \\u201cI know what you\\u2019re going through, and how intensely painful it is, because I\\u2019ve been there myself, and I can show you how the way out of the woods as well!\\u201d This is a message that most patients welcome.

And finally, the personal work you do with TEAM-CBT is a fantastic way of comprehending how this new approach really works.

Our \\u201cpatient\\u201d today is Michelle Wharton, a forensic and clinical psychologist from Australia. I want to thank Michelle for her tremendous courage in sharing a very personal experience with all of us. I also want to thank Dr. Levitt, who practices at the Feeling Good Institute in Mountain View, California, where she serves as Director of Clinical Training. Jill is also a co-leader at my TEAM-CBT training group at Stanford.

I am especially thrilled to share Michelle\\u2019s live session with you, since only mental health professionals are allowed to attend the workshops sponsored by the Feeling Good Institute. Many non-therapists were eager to attend, and disappointed when they learned that only shrinks could attend. By way of compensation, this podcast will give all of you the chance to hear what you missed, and I think you will NOT be disappointed!

When Jill and I asked for volunteers for the live demonstrations in the workshop, Michelle sent us this email, describing her situation.

Hi Jil and David,

I\\u2019ve just seen your email on the listserv asking for volunteers for the live therapy training on 16 May and thought I\\u2019d put up my hand. I\\u2019m an Australian clinical and forensic psychologist with Level 2 TEAM-CBT certification based in Adelaide, South Australia.

I had been thinking about volunteering to do some work on social anxiety and feelings of inadequacy. I know this has impacted me at different points in my life like

• • holding back my career
  • contributing to perfectionism, and
  • causing high anxiety in social settings.

My anxiety is probably more work-related but does impact personal relationships where I just assume I\\u2019m not particularly important. After reading your post, it just kept playing thru my mind that I wouldn\\u2019t be a very good volunteer. This thought was keeping me awake, which paradoxically also made me think I might actually be a good volunteer.

Also, from the fractal perspective, the anxiety triggered by just thinking about volunteering is probably reflective of all of my inadequacy concerns. So, I\\u2019ve attached a Daily Mood Log (DML)/ If you think it might be useful let me know.

Since I\\u2019m in Australia, the workshop will be from 1am-8am in my part of the world.

We scheduled Michelle at the start of the workshop, due to the tremendous time difference, but it still required enormous commitment on her part to work with us in the middle of the night! That kind of motivation is extremely helpful and often predicts rapid changes, but it\\u2019s no guarantee and we\\u2019ll have to see what happens in the session.

This will be a two-part podcast. In today\\u2019s podcast, you will hear the first portion of Michelle\\u2019s session (T = Testing and E = Empathy). Next week you will hear the fantastic conclusion (A = Assessment of Resistance) and M = Methods.)

I hope you enjoy the session as much as we did. Again, a big hug and thanks to Michelle, the superstar of the podcast!

T = Testing

To get started, take a look at the Daily Mood Log (LINK) that Michelle shared with us at the start of her session.

As you can see, most of Michelle\\u2019s negative feelings were intense, especially the anxiety and embarrassment, which she rated at 100%. You would not have known how overwhelming her suffering was if you had met her in daily life because she comes across as warm, bright, personable, and likeable. But inside, a part of her is dying, and that\\u2019s the part she\\u2019s been hiding and fighting desperately to change. Her actions today\\u2014opening up and become completely vulnerable in front of a large live audience of mental health professionals\\u2014required incredible courage and was a fantastic gift to all of us.

That\\u2019s one of the really important reasons for Testing. You can see exactly what you\\u2019re dealing with, in terms of the type and severity of negative feelings. Of course, we\\u2019ll ask Michelle to rate her feelings again at the end of the session. That way, we\\u2019ll know how effective\\u2014or ineffective\\u2014the session was. This information can sometimes be humbling to therapists, especially when you see that things didn\\u2019t improve during your session, but it is always illuminating.

Neither Jill nor I could conceive of doing therapy without the Testing! At the end of today\\u2019s session, we\\u2019ll also ask Michelle to rate us on Empathy, Helpfulness and other dimensions, using brief but sensitive scales that will highlight even the smallest therapeutic errors that most therapists would not otherwise be aware of.

Using these scales also requires therapist courage, because the information is often disturbing and unexpected, but it is always illuminating and potentially super helpful. That\\u2019s because you can discuss any low ratings you received at the start of the next session. If you do this skillfully and non-defensively, with warmth, respect and curiosity, the dialogue can greatly deepen the therapeutic relationship.

So, in an odd way, we often \\u201chope\\u201d for failing grades on the Empathy and Helpfulness Scales!

But processing poor scores often involves the \\u201cgreat death\\u201d of the therapist\\u2019s ego. This information can be shocking, especially if you thought, as most therapists do, that your empathy skills were good or even excellent.

In fact, you will witness such a failure in today\\u2019s session! Yikes!

But you can also ask yourself the question\\u2014did Jill and David have to be afraid of their \\u201cfailure?\\u201d Or was it actually a gift in disguise?

And if you\\u2019re a therapist, and you start using \\u201cWhat\\u2019s My Grade,\\u201d will you have to be afraid of grades lower than an A, which is the lowest passing grade?

E = Empathy

During the empathy phase of the session, Jill and I empathized while Michelle described her struggles with intense and incapacitating public speaking anxiety, which is particularly intense in professional situations. Michelle was visibly shaking and tearful as she said she was grateful and horrified to have overwhelming anxiety that has had a horrible impact on her career and has held her back. She\\u2019s avoided promotions to more senior positions that might require a good bit of public speaking.

She said,

\\u201cI can feel myself sweating, with a dry mouth, and wondering, \\u2018what are they thinking?\\u2019 They\\u2019re probably wondering how I got my qualifications, and thinking I\\u2019m stupid!

\\u201dI feel distant, and the audience feels distant, and I find myself thinking that the people in the audience are critical and judgmental. I have the image of feeling isolate, alone, and crying while people are watching.

\\u201cMy fears have even stopped me from doing clinical supervision, which is something I would totally love doing.

\\u201cThere\\u2019s a lot I\\u2019m holding back. . . but I\\u2019m not sure what.\\u201d

During the Empathy phase, Michelle poured her heart out, and both Jill and I did really careful empathy, summarizing her words, acknowledge her feelings, and using \\u201cI Feel\\u201d Statements to convey warmth and support. I\\u2019m not always the best at empathy, but Jill is a true master, and that is one of many reasons I love teaching and doing co-therapy with her.

At the end of the Empathy phase, when we were reasonably certain we\\u2019ve done a good job, we asked Michelle to rate us on Empathy. This technique is called \\u201cWhat\\u2019s My Grade,\\u201d and it is frightening but can be extraordinarily helpful.

And we spell it out, by asking, \\u201cWould you give as an A, a B, A C, a D?\\u201d This is a thousand times better than asking, \\u201cHow are we doing,\\u201d because the patient will just say \\u201cfine.\\u201d But if you ask for a grade, you\\u2019ll get the truth.

And sure enough, Michelle gave us a B! That means we\\u2019d vastly missed the mark.

Was this a good or bad result?

From a Buddhist perspective, it\\u2019s a great result, because \\u201cfailure\\u201d does not actually \\u201cexist.\\u201d Michelle actually just gave us some information that was fantastically important.

So, we simply asked, \\u201cCan you tell us about the part we missed?\\u201d And then patients will tell you something really important.

Here\'s what she said:

\\u201cThe sensation in my body right now is huge. . . I can feel it in my stomach . . . And I\\u2019m asking myself what the hell am I doing?

\\u201cI\\u2019m holding my hands tightly. . . I feel pressure on my throat . . . a knot in my stomach, shaky hands, and tears are streaming down my face. . . . The volume is turned way up right now.

\\u201cYou\\u2019re over there on one side, and I\\u2019m on the other side. . . . I feel alone. . . I feel distance. . . . This is just like standing at a podium, with a gaping divide between me and the audience. . . . I\\u2019m in a spotlight. . . . but I want to feel emotionally held.

\\u201cA part of me pushes support away, because I don\\u2019t want any cheerleading. . . and I want to be able to do this for myself, and I think that I should be able to do this for myself.

\\u201cI want to share something that I\\u2019ve been hiding. I\\u2019ve been holding back. Do I dare to do this?\\u201d

Then Michelle tearfully described a problem she\\u2019d had with bedwetting up until she was thirteen years of age. Her parents took her to a GP and a hypnotherapist, and thought she\\u2019d grow out of it. The message she heard was, \\u201cYou should get over this.\\u201d

She described waking up every morning with shame, washing the sheets each morning and taking them outside to dry.

And, she said,

\\u201cThat\\u2019s where this all started! The language I used at this time in my life was so hurtful, telling myself I couldn\\u2019t even get this right. I know that the internal bully really came to life in this moment but I had never seen it until this moment.\\u201d

David made a joke at this point and asked if the bedwetting ever stopped \\u2013 it took a second for that to sink in then we all laughed and discussed the value of humor within therapy.

David advises that humor, like any powerful healing tool, must be used with thoughtfulness, and never to hurt a patient or put him or her down. In addition, humor is usually not a good idea with a patient who is feeling angry, as it may seem like the therapist is belittling the patient.

After a bit more empathy and Jill offered an \\u201cI Feel\\u201d statement about her own nervousness prior to the start of the group and I then Jill then asked for our grade on empathy. Michelle says, \\u201cI gave you both an A and at that point and you asked if I felt ready to get to work and I said yes!\\u201d

Next week, you will hear the exciting and dramatic conclusion to this session, include A = Assessment of Resistance, M = Methods, and T = Testing at the end of the session to assess changes in negative feelings, if any, as well as how Michelle graded us on Empath and Helpfulness during the session.

We will also give you a live multi-week follow-up, to see if the effects stuck, or were just a flash in the pan, and what the most important keys to relapse prevention might have been!

Rhonda, Jill, Michelle, and David

End of Part 1