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Published: March 18, 2024, 8 a.m.

Featured Photo is Dr. Amy Huberman The Amy Story Part 1: True Confessions of a \u201cFraud\u201d and a \u201cFailure\u201d Part 2: The Joys of Doing the Laundry

Amy and her exuberant son, Sasha, and husband, Poppy

Today\u2019s podcast, and next week\u2019s podcast, include a single, two-hour session with Amy Huberman, MD. Amy is a psychiatrist in private practice in Baltimore, MD. She also serves on the volunteer faculty at the Johns Hopkins University School of Medicine.

Amy specializes in brief, intensive psychotherapy to help people overcome struggles with anxiety, OCD, and trauma, but today comes to us to get some help with her own anxiety. Often doing our own work can be a vitally important part of our training and growth as mental health professionals.

Amy has been upset because she is stuck with two of her patients, and she\u2019s telling herself that she\u2019s a \u201cfraud\u201d and a \u201cfailure.\u201d Although her life is undoubtedly very different from yours, the root cause of her problem might be very similar to the source of your unhappiness, especially if you sometimes get down in the dumps and tell yourself that you\u2019re just not good enough.

My co-therapist for this session is Jill Levitt, Ph.D. co-founder and Director of Clinical Training at the Feeling Good Institute in Mt. View California. Jill also serves on the Adjunct Faculty at the Stanford Medical School and is co-leader of my weekly TEAM Therapy training group at Stanford, Tuesdays from 5-7:00 pm pst.\xa0 If you are interested in joining David and Jill's Tuesday group, please contact Ed Walton, edwalton100@gmail.com.

That group is now virtual and therapists from the Bay Area and around the world are welcome to attend. It is free of charge. Rhonda Barovsky also runs a free weekly training group with Richard Lam, on Wednesdays, from 9-11:00 am pst, which is also free of charge. If you are interested in joining the Wednesday group, please contact Ana Teresa Silva, ateresasilva6@gmail.com.\xa0 Because the groups are virtual, they are open to therapists from around the world.

Amy has been a member of our Tuesday training group, and is a highly skilled, certified TEAM therapist. Like nearly all the mental health professionals who come for training every Tuesday, Amy has incredibly high standards and is sometimes harshly self-critical when she feels she is not living up to them.

At the same time, those high standards can be strongly motivating, and this can create strong feelings of ambivalence when it\u2019s time to change.

Sound familiar? If you\u2019re struggling with perfectionism, you might want to check out these two podcasts!

Part 1. The True Confessions of a \u201cFraud\u201d and a \u201cFailure\u201d

Amy opened by saying she was anxious and telling herself:

I\u2019m about to reveal my weaknesses and my inner self\u2014This is something I\u2019ve never done before in such a public setting. . . I also have to confess that I\u2019m struggling with social anxiety right now. I\u2019m afraid that my patients might see this and think, \u201cI don\u2019t want to work with her! I want to work with a competent psychiatrist.\u201d

I Included that because I am hoping you will appreciate Amy\u2019s incredible courage and gift of sharing her true inner self today!

Amy described the problem that\u2019s been bothering her for several weeks. Although she specializes in the short-term treatment of anxiety, she has been struggling with two patients with OCD symptoms who have been stuck and not making significant progress for a long time.

This has triggered feelings of shame and intense anxiety which have invaded Amy\u2019s every moment when she\u2019s NOT seeing patients, and has even prevented her from getting restful sleep at night. She keeps ruminating and beating up on herself.

You can see Amy's\xa0 Daily Mood Log Amy here.. As you can see, she was feeling intensely sad, panicky and ashamed, and rated these three feelings as 80% on a scale from 0 (not at all) to 100 (the most severe). She was also feeling worthless and defective which she rated at 100%, as well as hopeless (90%) and stuck (80%).

As you know, feelings do not result from the events in our lives (in Amy\u2019s case, the fact that two of her patients were stuck), but rather from her thoughts, or interpretations, of those events. You can see on her Daily Mood Log that she was being intensely self-critical, telling herself that she was failing her patients, that she should refund their money, that she was not competent to practice psychotherapy and should find a new career, that she \u201cshould\u201d know how to get them unstuck, and more, and finally that she was a fraud and a failure.

Her belief in all of these thoughts was super high, ranging from 80% to 100%. And if you\u2019ve ever felt down or inadequate, I\u2019m sure you recognize the same types of thoughts in your own thinking, telling yourself that you\u2019re a failure, or not good enough, and so forth.

During the session, Jill and David went through the TEAM acronym:

T = Testing

We measured her negative feelings at the start of the session so we could measure them again at the end to see how we did.

E = Empathy

We listened and supported Amy without trying to \u201chelp\u201d or \u201csave\u201d her. The goal was to understand her thoughts and feelings accurately, while providing a sense of compassion, warmth, and acceptance.

This phase of the two-hour session lasted about 30 minutes, and Amy told us how she constantly ruminated about those two patients, asking herself \u201cWhat am I doing wrong, what am I missing, what should I be doing differently?\u201d She described these thoughts as a relentless \u201cbroken record in my brain.\u201d

She confessed that her deepest fear was, \u201cWhat if they kill themselves and I was responsible for their deaths?\u201d She said this fear was almost unbearable!\u201d

I pointed out that was also my deepest fear when I was in private practice\u2014I was never upset by treating large numbers of severely depressed patients in back-to-back sessions, and it always made me happy, since I felt I had something to offer. But if I said something that hurt someone\u2019s feelings, I found that pain almost unbearable until I saw the patient again the next week, and could talk things over and get back on a positive track.

Jill pointed out that Amy\u2019s ruminations showed that she was a highly responsible psychiatrist who cared deeply about her patients! And while that is certainly a positive thing, the intensity of her fears had invaded every minute of her life, making her life miserable, even when she was with her family.

Amy said her fears have intensified since 2020, when she transitioned away from a traditional psychiatric practice involving long-term weekly psychotherapy and med-management, to focusing on short-term intensive psychotherapy using the TEAM model.

Then we asked her to grade us at the end, thinking about three categories of Empathy:

1. Did we understand how she was thinking?
2. Did we understand how she was feeling?
3. Did she feel cared about and accepted?

She gave us an A, which triggered our move to the next phase of our work with Amy.

A = Assessment of Resistance

In this phase of the session, we pinpointed Amy\u2019s goals for our session and\xa0 melted away her potential resistance to her stated goal of learning to give up that self-critical voice in her brain. We asked her to imagine we had a Magic Button, and if she pushed it, all of her negative thoughts and feelings would instantly disappear, with no effort on her part, and she\u2019d feel jubilant and happy.

She said she wasn\u2019t so sure she\u2019d do that. Most patients say YES, but Amy is familiar with the TEAM approach and knows that negative thoughts and feelings often result from some of our positive qualities.

Our strategy at this phase of the session was paradoxical: Instead of trying to help, save, or rescue Amy, and instead of trying to persuade her to change, we took the role of her subconscious resistance to change. With her help, we listed some of the many positives in her negative thoughts and feelings by asking these two questions.

1. What does this negative thought or feeling show about you and your core values that\u2019s positive and awesome?
2. How might this this negative thought or feeling be helping you and your patients?

Here are just a few of the positives we found in her negative thoughts and feelings:

The Positives in Amy\u2019s Negative Feelings

Feeling What this Shows Inadequacy Keeps me from being overconfident \xa0 Keeps me humble, so I\u2019m open to what I may be missing \xa0 Shows I care about constant growth and learning \xa0 Shows I\u2019m listening \xa0 Shows I care about my patients Anxiety Motivates me to think about things from other perspectives \xa0 Motivates me to work hard \xa0 Keeps me honest \xa0 Shows that I have high standards \xa0 My high standards have motivated me to learn a lot.

You can do the same kind of Positive Reframing with all Amy\u2019s negative thoughts and feelings, as well as your own. The list of positives would be long and impressive!

After listing these positives, we asked Amy these three questions:

1. Are these positives real?
2. Are they important?
3. Are they powerful?

How would YOU answer these questions if you were Amy?

She gave a strong yes to all three questions.

At the end we pointed out that it might not be such a great idea to push the Magic Button to eliminate the negative voice in her brain, because then all these positives would also disappear.

Instead, she decided to use the Magic Dial to reduce her negative feelings to some lower level where she could keep all the positives but suffer much less. Here you can see her goals for how she wanted to feel at the end of her session.

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Emotions % Now % Goal % After Sad, blue, depressed, down, unhappy 80 25 \xa0 Anxious, worried, panicky, nervous, frightened 80 20 \xa0 Guilty, remorseful, bad, ashamed 90 5 \xa0 Worthless, inadequate, defective, incompetent 100 15 \xa0 Lonely, unloved, unwanted, rejected, alone \xa0 \xa0 \xa0 Embarrassed, foolish, humiliated, self-conscious \xa0 \xa0 \xa0 Hopeless, discouraged, pessimistic, despairing 90 5 \xa0 Frustrated, stuck, thwarted, defeated 80 5 \xa0 Angry, mad, resentful, annoyed, irritated, upset, furious \xa0 \xa0 \xa0 Other \xa0 \xa0 \xa0

\xa0

As you can see, she decided to aim for fairly large reductions in all six of her negative feelings.

These goals are not guarantees she will be able to reduce her feelings. In addition, the goals are not rigid, since she may be able to reduce them even further once she begins to challenge her negative thoughts.

Our real aim at this phase of our work was to reduce her feelings of shame and failure so she could see that her \u201csymptoms\u201d were NOT the expression of what was WRONG with her, but the expression of what was RIGHT with her. Paradoxically, this often reduces the resistance to change and vastly enhances the possibility of rapid and dramatic change during the final, M = Methods portion of the session that you\u2019ll hear next week, along with some follow-up information.

The important thing we\u2019ve hopefully accomplished is reducing Amy\u2019s resistance so she can learn how to challenge and defeat the relentless and hostile voice in her brain that constantly puts her down whenever she fails to live up to her extremely high, and arguably perfectionistic, standards.

End of Part 1
Thanks for listening today. Be sure to tune in to the exciting conclusion of the work with Amy next week!

Rhonda, Amy, Jill, and David