What is T.E.A.M. Therapy?

In a therapy career that is now approaching two decades, I have had some recent experiences that I would have never thought possible when I started.  I want to share two stories with you - I’m changing some details for privacy, of course, but the heart of these stories is true.

Client #1 is an older man who had recently moved to Savannah, who I was meeting with online. He was suffering from crippling anxiety and depression and having thoughts of ending his life that terrified him.  We met multiple hours a week for 3 weeks, and then had a couple of 1 hour per week follow up sessions.  By the end of that time he was joyful, happy, calm and confident.  He had no thoughts of suicide, and reported complete elimination of his symptoms.  He had also agreed to let me check in with him 6 months later, and when we talked then he was doing even better than when we completed treatment.

Client #2 is a woman in her mid 40’s in rural Georgia who had been suffering from depression and anger at her wife for almost five years.  She thought her life was ruined by a decision that her wife had pressured her into during the heart of the COVID crisis.  She had tried therapy before, and she had done some self-help work, and still she was stuck.  Within 5 hours of treatment her depression and her grudge were gone.  She had a revelation and an insight that she wasn’t able to see before.  She was happy again, and no longer angry with her wife.  She still had work to do to strengthen the relationship, but it seemed possible again and with a little more time she learned a viable path to that improvement.  As we completed our last session she told me how at the beginning she doubted this would be possible in a short amount of time, and now she wishes she could let everyone know how much change can happen so quickly.

Had you asked me 10 years ago if such dramatic change was possible in such a short time, I would have definitely said no.  What has changed since then? I have learned about TEAM therapy (sometimes called TEAM-CBT. it has some CBT roots, but it is so much more than what is usually called CBT).

So what is TEAM?  It is a structure for therapy. While learning it I have also acquired many tools to help my clients change rapidly.  It is also an acronym, so I’ll give a brief introduction here, and then in later newsletters I will go into more detail.  It was created by Dr. David Burns, along with many collaborators - including things he learned from his patients and his students.

Testing:  When practicing TEAM therapy all of my clients do brief symptom assessments before and after every session.  This serves a few important functions.  One, it helps me know what my clients are feeling quickly.  Studies have shown that therapists are not much better than the general public at recognizing how our clients are feeling.  The testing gives our clients a chance to let us know right up front.  Also, by testing before and after each session, we can see if what we are doing in session works.  Basketball players improve their skills by taking shots.  Immediately after the ball leaves their hands they get feedback on whether they did well or not - the ball either goes through the net, or it doesn’t.  For therapists, the results of our work are often more ambiguous.  That ambiguity can’t be eliminated entirely, but getting clear feedback on the effectiveness of our interventions, can help us improve over time as we see what works and what doesn’t.  And since each client is different, it also helps us learn what helps this particular client quickly.

Empathy:  I think we can all agree that empathy is the bedrock of mental health therapy.  Our clients hunger to be understood and validated.  It is truly hard to find someone in the world who will listen with their full attention, and do their best to see what the world looks like through your eyes. This is a key part of the service we all offer our clients.  In TEAM we use deliberate practice to continually hone our empathy skills, so that our clients feel deeply understood.  It is axiomatic (as with many approaches to therapy) that our clients need to feel completely understood and supported before we attempt any techniques to help our clients change - otherwise attempts at change almost always fall flat. Plus, we use the Testing to get feedback from our clients on whether we have understood them or not.

Addressing Resistance: To be perfectly honest, this is the most innovative and exciting part of TEAM, and as part of the acronym the “A” is doing a lot of work.  As a result it has had multiple names through the years, and you may see places where the A stands for Agenda Setting (paradoxical) or Assessment of Resistance.  I like addressing resistance best, because our hope here is to reduce or minimize resistance to change.  In TEAM we assume all humans have some ambivalence about change.  I would be willing to bet $1000 that almost everyone reading this has something they would like to change about themselves, but they don’t do it.  I know I do.  So in this phase of therapy we start by clarifying what the client wants to get out of their work with us.  Then we have tools and techniques to help them bring the unconscious resistance to conscious awareness so they can then argue for change.  This is a very important part - we don’t try to convince them to change - we validate the good reasons not to, and put the client in the position to argue for change.  In my opinion, this is the step that allows for the quick results I wrote about at the beginning of this article.

Methods:  This part currently includes 100+ different ways to help people change their thoughts and feelings.  A lot of the earliest methods are what people would think of as traditional CBT tools - examining the evidence, identifying distortions in thoughts, etc.  But thanks to the testing aspect of TEAM, tons more methods get added as they prove themselves effective.  We all know there is no one path to healing for everybody - there are tons of roads to recovery, and each individual has different paths to walk.  During methods we make our best guesses about which tools will work, and then we try them out.  If they work, great, we know this is an effective tool for this person.  If they don’t work – great, we can mark that off the list and keep going until we find the ones that do.  My current list of methods includes CBT tools, role playing exercises (I’ve found these very powerful), in vivo and imaginal exposure, motivational tools, and uncovering techniques to get to clients’ underlying beliefs.  

Thank you so much for reading this far.  TEAM therapy has revolutionized my practice and my life.  I’m going to be writing more about TEAM in the months to come, and hope to start a regular practice group for anyone who is interested in learning.  I would love to share TEAM with any therapist who is interested.  Please email me at lj@feelinggoodinstitute.com if you would like to learn more.