Ask David: Questions on self-esteem, recovery from PTSD, dating people with Borderline Personality Disorder, recovery on your own, and more! Jay asks: Is psychotherapy homework still required if you’ve recovered completely from depression in a single, extended therapy session? Is Ten Days to Self-Esteem better than the single chapter on this topic in Feeling Good? Are people who were abused emotionally when growing up more likely to get involved with narcissistic or borderline individuals later in life because the relationship is “familiar?” Many patients can read your books and do the exercises and recover on their own. Is a teacher or coach sometimes needed to speed things up? Is it possible for a person to become happy WITHOUT needing anyone else if they have had depression in past and/or PTSD? Also, how would Team-CBT address treating PTSD? PTSD can involve a person having multiple traumas. * * * Is psychotherapy homework still required if you’ve recovered completely from depression in a single, extended therapy session? Thanks, Jay, I will make this an Ask david, if that is okay, but here is my quick response. Although many folks now show dramatic changes in a single, two-hour therapy session, they will still have to do homework to cement those gains, including: Listening to or watching the recording of the session Finish on paper any Daily Mood Log that was done primarily in role-playing during the session. In other words, write the Positive thoughts, rate the belief, and re-rate the belief in the corresponding negative thought. Use the Daily Mood Log in the future whenever you get upset and start to have negative thoughts again. I also do Relapse Prevention Training following the initial dramatic recovery, and this takes about 30 minutes. I advise the patient that relapse, which I define as one minute or more of feeling crappy, is 100% certain, and that no human being can be happy all the time. We all hit bumps in the road from time to time. When they do relapse, their original negative thoughts will return, and they will need to use the same technique again that worked for them the first time they recovered. In addition, they will have certain predictable thoughts when they relapse, like “this proves that the therapy didn’t rally work,” or “this shows that I really am a hopeless case,” or worthless, etc. I have them record a role-play challenging these thoughts with the Externalization of Voices, and do not discharge them until they can knock all these thoughts out of the park. I tell them to save the recording, and play it if they need it when they relapse. I also tell them that if they can’t handle the relapse, I’ll be glad to give them a tune up any time they need it. I rarely hear from them again, which is sad, actually, since I have developed a fondness for nearly all the patients I’ve ever treated. But I’d rather lose them quickly to recovery, than work with them endlessly because they’re not making progress! People with Relationship Problems recover more slowly than individuals with depression or anxiety for at least three reasons, and can rarely or never be treated effectively in a single two-hour session: The outcome and process resistance to change in people with troubled relationships is typically way more intense. It takes tremendous commitment and practice to get good at the five secrets of effective communication, in the same way that learning to play piano beautifully takes much commitment and practice. Resolving relationship conflicts usually requires the death of the “self” or “ego,” and that can be painful. That’s why the Disarming Technique can be so hard for most people to learn, and many don’t even want to learn it, thinking that self-defense and arguing and fighting back is the best road to travel! * * * Is Ten Days to Self-Esteem better