Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

#495 Stop Helping! Here's How.
Featuring Thai-An Truong on Codependency
Thai-An Truong, LPC, LADC is a Certified TEAM-CBT Trainer, Level 5 and loves sharing tools and processes to help other therapists feel more confident, effective, and joyful in their work with their clients. In her private practice in Oklahoma, she is passionate about helping people heal from past trauma and OCD. She also has a special interest in helping her clients improve their relationships and overall connection with their partners and loved ones.
We often hear the word, co-dependency thrown around. Today's podcast will be unique: you'll hear a totally brilliant and lucid explanation of how to treat it within the TEAM CBT model. It will be explained and illustrated with role-playing demonstrations by Rhonda and Thai-An. These demonstrations are fantastic! You'll love them!
But let's start with what codependency is. I'll give you my take on it first, as my understanding has been based on observation. I see it as the compulsive urge to help another person who appears to be hurting or struggling.
Well, that's nothing wrong with that, for sure! But where it gets yucky is where there is an ongoing pattern of helping, followed by stuckness on the part of the person who is hurting, ending up with both parties feeling frustrated and angry.
We've talked about this general topic a great deal on the show, and in fact, TEAM CBT emerged as a radical alternative to the compulsive, codependent "helping" we often see in the community of mental health professionals. And we've seen this too, among parents and their children. Rhonda and I have done many podcasts on the topic of "How to Help and How NOT to Help," (for example, #164: https://feelinggood.com/2019/10/28/164-how-to-help-and-how-not-to-help/). And we've done many, including a great recent podcast with Dr. Taylor Chesney, on how parents can talk to teens and children without trying to control or scold them—by forming a warm and respectful relationship, using the Five Secrets.
According to a Google search, codependency involves
"excessive emotional or psychological reliance on a partner, often characterized by neglecting one's own needs. The four main types of codependency are the Caretaker, Enabler, Controller, and Adjuster. These roles represent different ways individuals, often with low self-esteem, sacrifice their well-being to manage relationships."
To get things started, Rhonda and Thai-An discuss he various definitions and meanings of co-dependency. Thai-An described an attractive woman she treated who ended up with an alcoholic man who gave her very little in terms of healthy emotional support or love. But she told herself, "He's the only one who's there for me. , , I won't be able to find anyone else."
There's also a strong dimension of "I NEED to fix this person," as opposed to asking if they need help, and deciding whether you can actually meet their need.
They also pointed out, with example, that "throwing help at people" (as I call it) actually forces them to resist.
They talked about the shame involved in codependency, and then illustrated Option B: TEAM -CBT, where empathy is always a crucially important first step. Then you can move to the Triple Paradox, to help the codependent patient illuminate three crucial motivational pieces:
Column 1: The positive rewards of trying to "help" this person.
Column 2: The downside of changing and giving up this pattern.
Column 3: What your codependency shows about you and your core values as a human being that's positive and awesome.
Then after listing 20 to 30 or more powerful reasons to continue acting in a codependent manner, you can ask them if it's working for them, or if they can think of any reasons to change. So, right away, you are modeling a totally anti-codependent way of "helping" your codependent patient.
Only then, if the patient can convince you that they really do want help, Thai-An and Rhonda modeled some kick-ass M = Methods that can be incredibly helpful, including, but not at all limited to:
The co-dependency Double Standard Technique. The role play with Rhonda and Thai-An was eye-opening and jaw-dropping!
The Devil's Advocate Technique when tempted to "help."
The Decision-Making Tool
The Externalization of Voices
And many more.
I want to thank you, Thai-An, and you, Rhonda, for a truly phenomenal podcast today. Awesome work!
From Rhonda:  Speaking for me and Thai-An, it was our pleasure and honor to be on the podcast with you David!  And always a pleasure to learn with the brilliant Thai-An, one of the most phenomenal teachers and trainers in the TEAM community.

What if the old techniques don't work now?

What can I do if I'm boring on dating apps?

How do I balance TEAM CBT with Life?

Do relapses come from out of the blue?
Carlos continues with his question(s) first addressed on last week's podcast. He'd recovered from depression using TEAM CBT, but had a question about how to challenge his negative thoughts during a relapse, as well as how to balance TEAM CBT with life. Plus a dating question from a man who's never had a date!
Today's questions begin here.
Should I use a brand-new CBT technique to help me overcome my current negative thoughts?
I've been using my previous solutions (Exposure Therapy and Daily Mood Log) however, they don't seem to help out as much as they used to.
How do I balance Team CBT and life?
I've been having a difficult time finding the right balance between Therapy and Life. Whenever I strictly do therapy, I feel good, but then feel sad that I sacrifice other activities in order to do the therapy. Inversely, whenever I do activities (while only occasionally doing therapy), I feel conned by my anxiety and feel as if I can't enjoy doing my activities.
Can you relapse despite having no apparent issues in life?
I'm currently on Christmas break, without much pressure to find a job. Yet despite this, I'm feeling more anxious right now than I was in university! How is this possible? Is there perhaps a hidden emotion or desire that I'm not expressing?
Regardless of how negative I feel right now, I'm doing my absolute best to stay positive and keep working on myself with Team CBT. I'm looking forward to resolving my anxiety with the help of your awesome tools! It was an honor speaking with you, thank you for reading!
-Carlos
David's Answer
Great question, and I'll give you a (hopefully) great answer on the podcast! But here's the quickie answer. Focus on one specific moment when you'd like to be feeling happier, or when you need help to become the person you want to be. Then use a Daily Mood Log, Habit / Addiction Log (HAL), or Relationship Journal, depending on what's needed.
This is the exact same fractal concept we use in all of TEAM CBT!
Warmly, david
 
I am overly sincere and boring on dating apps. What can I do to correct this?
Michael writes: Hi Dr burns 
I am 30 and never dated anyone. Whenever I start chatting on dating apps I seem very boring or sincere person how can I talk to someone in this?
Regards,
Michael (disguised name)

What can I do if I relapse?
Good Morning Dr. Burns,
I will make this email quick, as I'm sure you have several other emails to read through.
First off, thank you so much for your research and contributions to TEAM CBT! My mother introduced me to this form of therapy in 2022, and it has been a big help in overcoming my extremely painful perfectionism anxiety. Unfortunately, after graduating from university, I've begun relapsing once again. As such, I would like to ask a few things
Carlos:
(His remaining questions will be answered on Podcast 494.)
Is it harder to get out of a relapse than the first time?
I feel as if my relapse has been a lot trickier to get out of, despite the fact I have more tools and techniques.
David's response.
This depends entirely on whether you've done Relapse Prevention Training to prepare for relapses ahead of time. You can read all about it in the last chapter of my most recent book, Feeling Great. You can also learn about RPT on a number of podcasts, and even hear me doing it live with many individuals at the end of their personal work. Here are two examples randomly chosen among dozens I have published.
427: https://feelinggood.com/2024/12/16/426-ask-david-dreading-the-day-solving-mother-daughter-problems-romance-and-more/
389: https://feelinggood.com/2024/03/25/389-the-story-of-amy-part-2-of-2/
And you'll a great many more if you look. Just use the search function on my website and you'll find a wealth of podcasts on RPT.
Short answer: If you HAVE recovered and done RPT (takes 30 minutes) it will usually be much easier for you to smash your negative thought(s), using the same methods that helped you the first time.
If you HAVEN'T recovered and done RPT, it may be much more challenging.
Thanks for the important question, Carlos!

Download the incredible Feeling Great app today for FREE at FeelingGreat.com! This is my $99 GIFT for you. 
- Dr. David Burns

Meet the Fantastic—and Controversial—Dr. David Healy
Psychiatric Drug Companies--
What Are They NOT Telling Us?
Today, we are thrilled to interview the famed and courageous Dr. David Healy. I have admired his work for many years, but never imagined I'd have the chance to meet him and chat with him.
First things first. You may know Dr. David Healy for some of his highly controversial books, like "The Antidepressant Era," "Let Them Eat Prozac," and "Pharmageddon."
But who is he, really?
According to AI,
Dr. David Healy is a prominent Welsh psychiatrist, psychopharmacologist, and critic of the pharmaceutical industry known for his research on antidepressants, their links to suicide, and exposing industry practices like ghostwriting and disease-mongering, operating through initiatives like RxISK.org to promote drug safety. He has a long history of challenging Big Pharma, facing academic backlash (like losing a University of Toronto post) for his views, and serving as an expert witness in legal cases involving psychotropic drugs, advocating for greater transparency and patient safety. 
Healy initially worked with pharmaceutical companies, gaining firsthand knowledge of how SSRIs were marketed despite their trial weaknesses, focusing on the oversimplified serotonin hypothesis.
He then became a vocal critic, highlighting issues like ghostwriting articles and manipulating academic opinion to sell drugs, leading to conflicts with industry-funded institutions.
He founded RxISK.org, a platform for patients to report adverse drug reactions, aiming to make medicines safer.
His strong stance (on research linking SSRI antidepressants to increased suicidal thoughts and urges) led to intense and corrosive controversy, including losing a professorship at the University of Toronto (though later settled as a visiting role) and harassment, noted here and here.
In recent years, he has acted as an expert witness in cases involving drug-related suicides and homicides, bringing issues to regulators. 
In essence, Dr. David Healy is a significant, often controversial, figure dedicated to drug safety, academic integrity, and patient awareness in psychiatry, challenging established narratives and industry power. 
Taking a deeper dive, AI has added this critically important information:
David Healy has discussed numerous examples of conflicts of interest that mainly involve the influence of the pharmaceutical industry on medical research, publication, and practice. 
Key examples he has highlighted include:
Ghostwriting of Articles: Pharmaceutical companies hire medical communication firms to draft research articles or reviews, and then get prominent academics or clinicians to put their names on the papers as the sole or primary authors, a practice known as ghostwriting. The named authors often have little to no involvement in the actual research or writing.
Hiding or Misrepresenting Data: Drug companies have concealed unfavorable data or miscoded raw data on drug risks, such as the link between antidepressants and suicidal acts. This manipulation can make a drug appear safer or more effective than it actually is.
Biased Clinical Trial Design: Healy notes instances where clinical trials are designed with "tricks," such as using inadequate or excessive doses of comparison medications to make the company's own drug look superior.
Marketing-Driven Education: A large portion of continuing medical education (CME) classes for doctors are sponsored by industry. Healy argues this leads to a bias in the information presented to doctors, with an emphasis on the benefits of brand-name drugs rather than an objective assessment of all treatment options.
Gifts and Payments to Physicians: Drug companies spend billions annually on marketing directed at doctors, including free samples, sales visits, and small non-educational gifts or lunches. Healy points out that while many doctors believe these gifts don't affect their own prescribing, studies show they influence prescribing patterns and create subtle biases.
Industry Influence on Academia: Healy's own experience with a job offer being rescinded at the University of Toronto, which had received a large donation from a drug company (Eli Lilly), is a prominent case he uses to illustrate how industry funding can infringe upon academic freedom and stifle critical research.
"Disease Mongering": Healy argues that the pharmaceutical industry often engages in "disease mongering," marketing conditions to the public and physicians to create a market for their products rather than simply addressing genuine medical needs. 
So that hopefully gives you some idea of the scope of his work, and his vision of transparency and integrity in the reporting one the effectiveness and risks of psychotropic medications. In our conversation today, he emphasized the importance of listening to patients who describe side effects of medications, such as SSRIs, in described the efforts of Big Pharma to suppress such complaints, giving psychiatrists "talking points" to reassure and quiet concerned patients.
In general, a main focus of his career has been to challenge and confront the efforts of drug companies to suppress negative information about their products and troublesome and dangerous side effects. He said that one of the rationales the drug companies use is to say that disseminating that type of information will discourage many potential patients from using their products, and therefore miss out on the potential benefits of the medications. In fact, they have a name for this, "treatment hesitancy," and discourage open discussion of negative effects for this reason.
I asked Dr. Healy if he's experienced direct negative pushback from drug companies, and he gave a surprising answer—he said no, that the major pushback he's gotten has actually been from colleagues—psychiatrists who have bought the party line disseminated by the drug manufactures.
For example, when he gave his famous talk at the University of Toronto on the increase in suicidal urges associated with SSRI antidepressants, a famous psychopharmacologist, Dr. Charlie Nemeroff, got him fired.
Here's the story on Dr. Nemeroff, According to AI:
In the late 2000s, Nemeroff faced investigations and sanctions from Emory University for failing to disclose significant speaking and consulting fees from pharmaceutical companies like GlaxoSmithKline, raising questions about research integrity and conflicts of interest, notes The BMJ and The New York Times. 
Although the antidepressant effects of SSRIs are controversial and hotly debated, their effects on the nervous system are not. Dr. Healy's research indicates that they have a suppression effect on the nervous system, which dulls the senses, and this can happen within 1 to 2 days.
One of the more troublesome of these effects is called "genital numbing," which affects 9 out of 10  people talking SSRIs. This can result in difficulties with sexual arousal and greatly delayed orgasm, and apparently these effects can persist long after drug discontinuation. He said that these sensory effects can develop quickly, within a day or two of starting the medications.
Even more chilling, he said that the problem can actually get worse when you discontinue the medication, and can sometimes persist for life.
In addition, quite a few individuals have "bad trips" on SSRIs, although a minority clearly have "good trips." He said the best thing to do for a bad trip is to take the patient off of the medication immediately—and NOT increase the dose. He confirmed my impression that a common error with all antidepressants is to increase the dose—which simply increases the side effects.
In addition to the genital numbing described above, he said the SSRIs cause "emotional numbing," which means a decreased capacity for joy as well as sorrow.
One of the main activities in David Healy's life has been listening to patients, rather than discounting their complaints when they describe negative effects of medications.
When asked about what alternatives to drugs he might recommend to someone struggling with depression, he said that sometimes, just doing nothing will be helpful, since most mood problems clear up spontaneously in 12 to 14 weeks. He said that most are simply human problems, not "mental disorders," but real-life problems, like relationship conflicts or social issues.
Although we did not discuss it extensively on the show, I would point out that skillful, drug-free therapy with TEAM CBT can sometimes help as well, and that recent research has confirmed rapid often dramatic mood improvements with individuals using the Feeling Great app, which has been entirely free to anyone since the summer of 2025. 
Finally, we do not advise anyone to discontinue or modify the dosages of any medications you have been prescribed without consultation with your doctor. The information in the Feeling Good podcast is of a strictly educational nature, and is not intended as treatment or medical advice.
We thank you for listening to today's shocking but incredibly important dialogue with one of the pioneers and champions of greater ethical integrity and transparency in the psychiatric profession. It is sad, indeed, that we don't have more visionary critical thinkers like Dr. David Healy!
David (H), Rhonda, and David (B)