482: Live Work with Madeleine, I'm Helpless! Part 1 of 3

Live Work with Madeleine

I'm Helpless! Part 1 of 3

Today, we are pleased to present one of our favorite podcast topics—live work with a real human being who is suffering. We will be working with Madeleine, a woman who read a disturbing article while at the hairdresser and freaked out, sensing that one of her daughters might be in mortal danger.

This live and unedited session was first presented as part of a free webinar on September 11, 2025. There was no preparation or role-playing—everything was absolutely real and spontaneous, exactly as it evolved in real time. We present Part 1 as our final Feeling Good Podcast for our 2025 season. This is our most powerful and popular type of podcast, and we hope you enjoy it. We also give a big thanks to our courageous "patient," Madeleine.

My co-therapist will be Dr. Jill Levitt, a clinical psychologist and Director of Training at the Feeling Good Institute in Mountain View, California. Jill and I greatly enjoy working together as co-therapists when we teach and we typically see our "patient" for an extended, two-hour session.

We find that this is the most effective format for teaching, and that way, we can frequently complete a course of therapy in a single session. However, you do not need more than one therapist to do effective TEAM CBT, and you can do it in conventional 50 minute sessions as well. But often, you can do vastly more in a double session.

We will not be engaged in an ongoing therapeutic relationship with Madeleine. When we work with therapists, they are doing personal work as a part of their training. We feel that this experience is vital for every therapist who hopes to do world-class TEAM CBT with their own patients / clients.

More than 2,000 individuals registered for this workshop. Although the workshop was open to everyone, only 13% of the participants identified as general public, while 87% identified as mental health professionals. 

In Part 1, which we present today, we focused on T = Testing and E = Empathy phases of the TEAM session.

In Part 2, which you will hear next week, we will focus on A = Paradoxical Agenda Setting and M = Methods. We will also show you the changes in her scores on the Daily Mood Log (DML) and Brief Mood Survey (BMS) from the start to the end of the session, as well as Madeleine's scores on the Evaluation of Therapy Session (EOTS) at the end, including what she liked the most and least about the session. That way, we can see clearly how much improvement there was (or wasn't) during the session, and how Jill and I did in terms of empathy, helpfulness, and other scales that evaluate the patient's view of the session.

In Part 3, which you will hear in two weeks, we did more Externalization of Voices along with Cognitive Exposure, since we had some loose ends we wanted to tie up before completing our work with Madeleine. This follow-up session occurred many weeks after the initial session at the workshop, and will also serve as a follow-up to see how Madeleine did in the days following the live work.

Part 1 of 3

Our "patient," Madeleine, is a courageous woman who experienced sheer panic after being triggered at the hair salon while reading an article about a young woman who was abducted. Since Madeleine's oldest daughter's is away at college, taking a year abroad, Madeleine realized she could not protect her from predators and freaked out, thinking about all the horrible things that could happen to her.

In addition, Madeleine had many self-critical thoughts about ways she thought she had failed her daughter when her daughter was growing up, and worried about her daughter's judgement:

She hasn't always made the best decisions about guys she's gone out with, and she's shared everything with me. She says, 'Don't worry mom. I've learned from this.'"

At the start of the session, we reviewed Madeleine's scores on the Brief Mood Survey (BMS). This indicated only minimal depression (5/20), with no suicidal urges or anger, but her anxiety was still extremely elevated (18/20).

In addition, her Positive Feelings score was only 20 out of 40, with 0 meaning no positive feelings at all, and 40 being the highest possible feelings. However, her Re