519: What Therapists Get Wrong—and How to Fix It

Episode 519: What Therapists Get Wrong—and How to Fix It

Hosts:
Kevin Cornelius, LMFT
Dr. David Burns
Guest:
Jeremy Karmel

What happens when therapy becomes something you simply keep doing rather than something that actually helps you get better?

In this lively and provocative episode of The Feeling Good Podcast, Kevin Cornelius, LMFT, joins Dr. David Burns and Jeremy Karmel for a candid conversation about some of the biggest problems they see in modern mental health care—and what therapists can do differently.

Jeremy brings a unique perspective to the discussion: he experienced severe depression in college and spent months in different therapies and therapy groups without getting better. Then, working with one of David Burns’ students, he discovered powerful cognitive therapy techniques that produced dramatic results in just two weeks. The experience left him both grateful and frustrated—and motivated to understand why effective treatment can sometimes be so difficult to find.

David, Kevin, and Jeremy explore several common pitfalls in therapy, including the failure to measure results, getting lost in the past, talking about problems in vague and general terms, and assuming that every therapist is qualified to treat every kind of problem.

Accountability: Is Therapy Actually Working?

The conversation begins with one of David's central concerns: accountability.

If someone has been coming to therapy for months—or even years—how do they know whether treatment is actually helping?

Kevin shares his own experience of spending several years in therapy without clearly defined goals or any systematic testing of progress. Although he valued the relationship with his therapist, he now sees the lack of specific goals and measurement as a major limitation. By contrast, his current approach involves establishing concrete treatment goals and measuring progress before and after sessions.

Jeremy points out that many people in therapy cannot even answer a basic question: What are you working on? Without clear goals, it becomes difficult for patients to hold therapists—or themselves—accountable for results.

Do We Really Need to Find the Cause in the Past?

The group then tackles another controversial question: Does effective therapy require uncovering the origins of a problem in childhood or the distant past?

David tells the story of a woman with a severe elevator phobia who had been told in psychoanalysis that the roots of her fear were in childhood—and that overcoming it might take several more years. During a workshop, David instead helped her confront the feared elevator directly. Within minutes, her fear disappeared, and she subsequently rode skyscraper elevators without difficulty.

The larger point isn't that the past is irrelevant. Rather, David argues that therapy can become unnecessarily focused on discovering hypothetical causes when the more practical question is: What is bothering you right now, and what can we do about it?

The conversation extends this idea to trauma and PTSD. David describes an approach that focuses primarily on the patient's current distress rather than repeatedly dwelling on the traumatic history. Jeremy shares an example of someone whose debilitating trauma-related flashbacks improved after confronting the traumatic memory directly.

From General Problems to Specific Moments: The Power of Fractals

Another major theme is the distinction between general problems and specific problems.

People commonly come into therapy saying things like:

• “I don't know who I am.”
• “I have low self-esteem.”
• “I'm bad at relationships.”
• “I'm always depressed.”
• “I have trouble with people.”

But what does that actually mean?

David and Kevin argue that the therapist's job is to find a specific moment when the supposedly general problem was actually happening. What was going on? Where were you? Who was there? What were you feeling? And, most importantly, what were you telling yourself?

David describes these specific moments as “fractals”: individual situations that contain the repeating pattern of a much larger problem. By solving the specific problem, you may simultaneously begin solving the general problem.

Jeremy illustrates this with his own tendency to argue. Looking at specific interactions through David's Relationship Journal helped him recognize a recurring pattern: instead of listening and looking for truth in what another person was saying, he would shift into arguing.

Is Your Therapist Actually an Expert in Your Problem?

The final major theme may be the most provocative: Therapists aren't necessarily experts in every problem their patients bring to therapy.

David and Jeremy use dating as an example. A therapist may have extensive training in psychotherapy without having any particular expertise in dating, flirting, relationships, or the practical skills involved in meeting potential partners.

Kevin offers an important distinction: therapists don't necessarily need to give advice about every subject. Instead, they can help clients identify the thoughts, emotions, behaviors, and communication patterns that are getting in their way.

This leads to a broader principle: therapy is not one-size-fits-all. Different problems require different skills, and therapists should be honest about what they know—and what they don't.

Kevin describes how he deliberately developed greater expertise in treating anxiety rather than trying to present himself as an expert in everything.

Key Takeaways

1. Therapy should have measurable goals.
   If you don't know what you're trying to accomplish, it becomes difficult to determine whether therapy is working.
2. Relief and effectiveness aren't necessarily the same thing.
   A supportive therapeutic relationship can feel valuable while still failing to produce meaningful progress on the problems that brought someone to therapy.
3. Don't automatically assume the past is the key to the cure.
   The speakers argue that many problems can be addressed more effectively by focusing on what is happening in the present.
4. Get specific.
   Instead of discussing “low self-esteem,” “identity,” or “relationship problems” in the abstract, identify a specific recent moment when the problem occurred.
5. Specific moments can reveal larger patterns.
   The “fractal” concept suggests that a single upsetting interaction may contain the same cognitive and emotional patterns that repeatedly create suffering elsewhere.
6. Therapists aren't experts at everything.
   A psychotherapy credential doesn't automatically make someone an expert in every problem a client might bring.
7. Specialization matters.
   Therapists can become much more effective by developing deep expertise in particular problems and treatment methods.
8. Therapists should be willing to say, “I'm not the right person for this.”
   Recognizing the limits of one's expertise can be a sign of professionalism and humility rather than weakness.
9. The ultimate question is simple: Is the patient getting better?
   For David, Kevin, and Jeremy, accountability means keeping the focus on results—and continually learning better ways to help people achieve them.

About This Episode

This episode features Dr. David Burns, Kevin Cornelius, LMFT, and Jeremy Karmel, a former therapy client whose own experience with ineffective treatment led him to become deeply involved in developing the Feeling Great app.

The conversation is candid, humorous, and intentionally provocative—but its central message is constructive: when therapists identify weaknesses in their approach, measure their results, develop better skills, and remain humble about what they don't know, they can become dramatically more effective.

As David puts it near the end of the episode, there are problems in therapy—but there are also solutions, and learning new skills can open the door to much greater effectiveness.

About Jeremy Karmel

Jeremy Karmel works with David Burns on the Feeling Great app and became passionate about TEAM-CBT after experiencing a dramatic recovery from severe depression during college. After trying numerous forms of therapy without success, he worked with Matt May and experienced a complete clearing of his depression in approximately two weeks.

If You Enjoyed This Episode

If this conversation resonated with you, please subscribe to The Feeling Good Podcast, leave a rating or review, and share this episode with someone who struggles with anxiety or avoidance. Your support helps more people discover practical, evidence-based tools for overcoming fear and building happier lives.

Listener Survey

We'd love to hear from you!
Your feedback helps shape future episodes and allows us to create content that is as helpful and meaningful as possible. Please use this link to take the feedback survey and share your thoughts with us about this episode.
Your voice matters—and as David points out in this episode, sometimes the most important conversations begin when we're willing to express what we're really thinking and feeling.

Thank you for listening to The Feeling Good Podcast!

Contact Information

Kevin Cornelius, LMFT is a Level 5 Certified Master TEAM-CBT Therapist and Trainer and the Clinical Director of Feeling Good Institute--Silicon Valley. He specializes in the treatment of trauma, anxiety, depression, relationship problems and insomnia. You can reach Kevin at [e-mail] and visit his website at www.tools4change.me.

You can reach Dr. Burns at [e-mail].

Feeling down in these turbulent times? Take a ride on our Feeling Great app.

Feeling Great feels wonderful!

You owe it to yourself to feel GREAT!

Give the Greatest Gifts of ALL--Love and Happiness!