Christine Padesky is a clinical psychologist and co-founder of the Center for Cognitive Therapy in Huntington Beach, California. Along with Kathleen Mooney, she is now developing “strength-based cognitive therapy.” Padesky is the coauthor of five books, including the bestseller, Mind Over Mood. She is the recipient of the Aaron T. Beck Award from the Academy of Cognitive Therapy for significant and enduring contributions to the field of cognitive therapy and she also received the Distinguished Contribution to Psychology Award from the California Psychological Association.
The following is an edited version of a 50-minute interview. To watch the full interview visit: https://www.erickson-foundation.org/yapko-padesky-interview-january-2018/.
Michael Yapko: Let me start by asking you about some of the work that you do that is more experiential. You bring another element to cognitive therapy that a lot of people don’t. Could you please talk about the role experiential learning has played in the therapy that you do.
Christine Padesky: I’m glad you asked about that. Therapy is a learning process. I think of myself as an educator when I’m doing therapy and I want to help people learn in the best ways possible. I’m not an educator in the sense of didactically telling people things but in the sense of trying to use our relationship and the experiences that we share to maximize client learning and discovery. We know from research that one of the best ways we learn is through experience.
Talk alone can often lead to insight…but that insight can be short-lived if it’s not backed up with experience. In therapy, I try to use methods that are experiential including interactive writing and behavioral experiments. I also use a lot of imagery and sometimes role-playing and psychodrama. I put a high value on experiences because it’s through those interactive experiences that you get activation of thoughts, emotions, and behavior in ways that are going to be memorable and that the client will likely put into practice in their life.
MY: That parallels with Erickson’s work. He was a big fan of experiential learning. I think you’re doing what a good therapist does, which is getting people moving.
CP: We might have somewhat different theoretical frames and ways of understanding what we’re doing, but I have observed throughout my career that therapists from different modalities do many of the same things in the therapy hour.
MY: Can you give some insight into how you decide what kinds of action-oriented approaches you’re going to use?
CP: Some of it depends on the current therapy alliance and relationship. For example, I’m much more likely early on in a therapy relationship to do interactive writing or some behavioral experiments that are short and in-the-moment. I think to do psychodrama or a two-chair technique, I need to have a much better therapy relationship; a lot more trust. So that would be one thing, the level of the relationship. The second thing would be the client’s issues. People might have beliefs like, “If I don’t feel motivated, I can’t do something.” or “If I don’t have much energy, then it’s not possible for me to do something.”
You could talk to death about those beliefs, but usually you can break through them within a matter of minutes just by doing an experiment. So, if someone has a belief that is testable in that moment, rather than talk about it, I would just test it out right then and there. For example, someone who is depressed who says, “I don’t have energy. I can’t do things.” I might ask them, “What’s your energy level right now?” And, if they say, “It’s quite low,” I’ll be quite happy, because then I’ll say, “Well, let’s stand up for a moment and walk over here and look at this picture and talk about it for a minute.” Then I will do some kind of interaction with them for a few minutes and say, “I’m curious, what’s your energy level now?” And from that kind of experiment, it’s not just the doing of the action, but it’s the debriefing of it. I’ve tried to hone over the years skill of using a dialogue about the experience to guide client discovery. If they say their energy is higher, I’ll say, “Well, that’s interesting…we started out with you telling me if you didn’t have much energy, that you couldn’t do things. You didn’t have a lot of energy and yet you were able to do this. What do you think explains that?” I’ll ask them a series of questions and we write down a summary of what they learned and their observations. Then, I’ll ask them to reflect on that and I’ll say, “I wonder, is there a way you could use these ideas to help yourself this week?” If there’s anxiety, or if I’m wanting people to envision something positive that doesn’t yet exist in their life, then I’m more likely to use imagery because the imagery is powerful in terms of helping people imagine new things they aren’t quite confident can exist. I might also use imagery if I want people to go out in the world and practice something. We know from research that imagery practice increases the likelihood that people will go out and follow through and do something. It turns out that people think in imagery almost all of the time. I think in the decades ahead, an important part of examining cognition will be looking at imagery. Now, if we’re looking at the imagery in terms of crafting some kind of change, for example, a new behavior, then I’m going to ask the person, “How would you like to be? What would you like to do? Let’s take a few minutes and have you imagine what that might look like.” Then I’ll have them imagine what they might be doing, and I’ll try to direct their awareness to different parts of that experience. “What does that feel like in your body? What emotions are you feeling?” I get people to make more careful observations, and to draw into their attention, multiple aspects of their experience.
Sometimes if I’m working with personality disorders and more chronic conditions, I’ll have people develop an image of what they wish their life was like, or what they wish they were like. And then I’ll have them do similar things, where they can imagine scenarios. I ask them, “How does that feel physically?” Where do you feel that in your body? What emotions are you experiencing? What metaphors and additional images come to mind as you begin to enact this?” I think imagery is so wonderful and rich because it includes every aspect of experience within it.
MY: You and Kathleen Mooney have recently focused on strength-based CBT. What sparked this interest?
CP: Kathleen and I have always been interested in strengths. She did some strengths-based work in her first career, which she carried into her second career as a psychologist. When I started graduate school back in 1974, I was interested in strengths, but the zeitgeist at the time didn’t support it. I couldn’t find a single faculty member who would work with me on questions. In the late 1990s and the early part of this century, we started talking more in our trainings about strengths. What cemented this and got us intensively working in that area was the 9/11 attack. When that occurred, the next morning we had a meeting set up to plan the next year’s training program and we said, “Wow, this changes a lot of things in our country. So, what are people going to want to learn about in six months?” We decided they might be interested in resilience. When tough things happen, resilience is usually the story that follows. So we put our minds together and devised a four-step model to build resilience for people who struggled with resilience. We recognized that all of us are resilient in some areas of our lives and we all lose resilience at other points in our lives. We began to articulate a model of CBT that is strengths-based. When you work with people on depression, anxiety, or relationship difficulties, it’s worthwhile early in the first session to learn about their strengths. This is good for the therapy alliance, but it’s also good because when you hit roadblocks in therapy. I find if you lean on the client’s strengths, you can go through those roadblocks quickly.
The second thing would be using CBT to build strengths, and this is what we did with our four-step model to build resilience. We came up with a simple way of helping people identify the strengths they already had and then helped them figure out within just a couple of sessions how they could put these together to become more resilient. The third thing we developed involved developing what we call the new paradigm,” which we started out applying with personality disorders. This was meant to help people build a completely new sense of themselves and how they operate in the world, which is more strengths-based and more resilience-based and a much more transformative kind of application of strengths-based CBT. We were quite heartened that when we met with Aaron Beck, he told us that he’s taken the strengths-based idea and is now applying it to recovery-oriented work for psychosis. It’s exciting! I hope this is the future of CBT.
MY: Let’s talk about the book you co-wrote with Dennis Greenberger, Mind Over Mood, now in its second edition. That book sold unbelievably well. I read it, and it’s wonderfully practical and supportive. How were you able to put all this together, and what has the reaction been?
CP: Well, there’s always a certain amount of luck in why a book becomes successful. But, I think there are a couple of things Dennis and I did that hadn’t been done at the time we wrote the first edition and because of that, we substantially improved upon those things in the second edition. Therapists have been embracing this book and using it with a lot of clients. I think the appeal is that many therapists want to use methods with clients that have evidence-based proof of working. One of the things we’ve done in the second edition is we’ve made reading guidelines clear, so that if you’re working with a client’s depression, then read the chapters in this order. If you’re working with them on anxiety, then read the chapters in this order. We made it a bit easier for therapists to do an evidence-based CBT practice. We tried to write a book that people will want to read that’s interesting, and at the same time, skills-based. We know from current research that lots of different therapies can be helpful for depression, but what seems to predict relapse or the likelihood of relapse is whether or not people acquire skills that they can apply on a daily basis in their lives. We focused our book around teaching core skills that have been shown in research to make a difference in people’s happiness and reduce their depression, anxiety, anger, guilt, shame, etc. The second edition has 60 worksheets, 25 more than in the first. These worksheets are quite motivating for readers. The other thing we did right includes measures of each of the moods, for example, a measure for happiness, so that people can measure their mood and see if their efforts are paying off or not. That kind of feedback is important to keep people going with the program. The book’s success has been very moving for us. It’s already in eight or nine different languages, and I think by the end of this year, there will be 15 or 20 different translations available. The cross-cultural appeal of this book surprises me. I think Mind Over Mood fulfills a need for people to have a self-help book that’s interesting to read, but at the same time, teaches skills that make a difference.
MY: So, what’s next for you?
CP: Right now I’m finishing up a book on how to foster guided discovery in therapy and what types of therapist-client interactions foster client discovery. I’m also currently writing the Clinicians Guide to the second edition of Mind over Mood, which will be out in 2019. When those books are done, I am going to give myself a little creative time to think about what I want to teach therapists. I love teaching and training and consulting. I do a lot of consulting with therapists, and I’m interested in things we can do to engage clients, foster transformation, and be more creative in our therapy methods.
MY: Can people who are interested in your workshops go to your website to see your teaching schedule?
CP: Yes. It’s padesky.com. On our website there are lots of free downloads of papers that we’ve written over the years. We also have a store with training audio CDs and DVDs.
MY: Thank you so much for being so generous with your ideas and perspectives.
CP: Thank you, Michael, it’s a pleasure to talk to you.
Michael D. Yapko, Ph.D., is a clinical psychologist residing in Southern California. He is internationally recognized for his work in clinical hypnosis, brief psychotherapy, and the strategic treatment of depression, routinely teaching to professional audiences all over the world. He is the author of 15 books, including his most recent book, Taking Hypnosis to the Next Level. He is a Fellow of the American Psychological Association and the American Society of Clinical Hypnosis. He is the recipient of numerous major awards, including the Milton H. Erickson Lifetime Achievement Award for Outstanding Contributions to the field of Psychotherapy. Learn more about Dr. Yapko at www.yapko.com.