514: Ask David w/ Dr. Matt May

514: Ask David w/ Dr. Matt May Schizophrenia, Resistance, TEAM's Future, and What Makes a Great Therapist

In this thought-provoking Ask David episode, Dr. David Burns is joined by Kevin Cornelius, LMFT, and special guest Dr. Matt May, psychiatrist, TEAM-CBT therapist, and longtime colleague of Dr. Burns. Together, they tackle challenging listener questions about schizophrenia, emotional suffering, resistance to change, therapist training, and the future of psychotherapy.

Along the way, the conversation becomes deeply personal as David reflects on the qualities that shaped the development of TEAM-CBT, his hopes and concerns for the future of psychotherapy, and the lessons he's learned after decades of clinical work.

Our Special Guest: Dr. Matt May

Kevin welcomes Dr. Matt May back to the podcast. Matt is a psychiatrist trained at Stanford who has worked closely with David for more than twenty years. Although trained in psychiatry, Matt explains that his work today focuses almost entirely on TEAM-CBT rather than medication management.

David praises Matt as one of the most gifted therapists he has ever known, highlighting his warmth, compassion, humility, and clinical expertise.

Question #1: Can TEAM-CBT Help the Negative Symptoms of Schizophrenia?

A listener asks whether TEAM-CBT can help with the so-called "three A's" of schizophrenia:

• Apathy
• Avolition (severe lack of motivation)
• Anhedonia (loss of pleasure)

or whether medication is the primary treatment.

David's Response

David challenges the assumptions behind the question itself.

Rather than viewing people through the lens of diagnostic labels and symptoms, he emphasizes that TEAM-CBT begins by asking:

"What would you like help with?"

He argues that therapists often fall into the trap of acting like experts who believe they already know what a patient needs based on a diagnosis. TEAM-CBT takes the opposite approach, focusing on the individual person's goals, struggles, and hopes.

David shares an early experience treating a patient with schizophrenia. Initially, he tried to challenge the patient's delusional beliefs directly through cognitive techniques. When the patient simply reinterpreted the evidence to support the delusion, David realized he was pursuing his own agenda rather than the patient's.

The lesson:

TEAM-CBT focuses on helping people with the problems they want help with—not on treating diagnostic labels.

Key Takeaways

• Diagnosis does not define the person.
• People with schizophrenia may still want help with relationships, mood, habits, goals, or self-esteem.
• Effective therapy begins with understanding what matters to the individual.
• Humility is often more helpful than expertise.

Question #2: What About Trauma, Brain Circuits, and "Underlying Vulnerabilities"?

A listener asks whether present-moment thoughts are only part of the picture and whether deeper emotional circuitry, stress physiology, or network-level brain changes also contribute to emotional suffering.

The listener also wonders whether cognitive therapy truly processes emotions like grief, fear, shame, and anger—or merely suppresses them.

Matt's Perspective

Matt offers a practical example from his own life.

One afternoon he found himself flooded with depressive thoughts and self-critical feelings. He suddenly felt hopeless, inadequate, and discouraged.

Then he realized:

He had skipped lunch and was extremely hungry.

After eating, the negative thoughts disappeared.

His point is that physical states matter. Sleep deprivation, poor nutrition, illness, intoxication, and other biological factors can influence how easily negative thoughts arise and how difficult they are to challenge.

David's Perspective

David distinguishes sharply between:

• Healthy negative emotions
• Distorted emotional suffering

He revisits a story from his medical school years, describing the death of a beloved elderly patient whose family gathered around him during his final moments.

Everyone cried.

David cried too.

But that sadness was not depression.

The grief emerged naturally from loving thoughts and genuine loss.

In contrast, depression is fueled by distorted thoughts such as:

• "I'm worthless."
• "I'm not good enough."
• "Things will never get better."

TEAM-CBT seeks to eliminate distorted suffering while preserving healthy human emotions.

Key Takeaways

• Healthy grief is not a disorder.
• TEAM-CBT does not suppress genuine emotions.
• Depression, anxiety, shame, and hopelessness often arise from distorted thoughts that can be transformed.
• Biological factors matter, but thoughts remain a powerful therapeutic target.

Question #3: What's the Biggest Misunderstanding Therapists Have About TEAM-CBT?

A listener asks:

When teaching clinicians, what misunderstanding should be corrected first?

• The belief that resistance means the patient is difficult?
• Or the belief that techniques alone are enough?

David's Answer

David emphasizes that TEAM is a system:

Testing → Empathy → Agenda Setting → Methods

Many therapists focus immediately on techniques and interventions.

But before methods can work:

1. The therapist must develop genuine empathy.
2. The therapist must uncover resistance to change.

Without empathy, patients don't feel understood.

Without addressing resistance, therapists often end up arguing with their patients.

David explains that people usually have many good reasons not to change. TEAM-CBT helps bring those reasons into awareness and resolve them before attempting intervention.

Matt's Answer

Matt reflects on his own training with David.

He recalls spending countless hours learning empathy and discovering how difficult it is not to jump in with advice, reassurance, or premature solutions.

According to Matt:

• Most therapists are tempted to help too quickly.
• Many accidentally create resistance by pushing for change.
• Understanding resistance is often one of the most challenging skills to master.

Kevin's Perspective

Kevin notes that TEAM itself naturally provides the roadmap:

• First learn testing.
• Then learn empathy.
• Then learn agenda setting.
• Only afterward focus on methods.

The sequence protects therapists from moving too quickly into problem-solving.

Question #4: What Is the Future of TEAM-CBT?

A listener named Vlad writes a heartfelt letter reflecting on the transition from Rhonda Barovsky's co-hosting role and asking:

• What is the future of TEAM-CBT?
• How might it evolve?
• What personal qualities allowed David to create such an influential therapeutic framework?

David on the Future of TEAM

David explains that much of his current work focuses on preserving and sharing TEAM-CBT for future generations.

Examples include:

• Recorded therapy sessions
• Training materials
• His psychotherapy eBook
• Psychology Today articles
• The Feeling Good Podcast
• The Feeling Great app

He hopes future therapists will continue refining, expanding, and improving the methods.

At the same time, David expresses disappointment that many mental health professionals have shown limited interest in approaches that emphasize rapid, measurable change.

He remains committed to the possibility that therapy can become far more effective than it is today.

The Personal Qualities Behind TEAM-CBT

Matt identifies several characteristics he believes contributed to David's success:

Intense Curiosity

David never accepted conventional wisdom simply because others believed it.

He continually asked:

"What actually works?"

Intellectual Honesty

David consistently measures outcomes and learns from failures rather than defending cherished theories.

Humility

Rather than seeing himself as the expert, David allows patients to become his teachers.

Compassion

According to Matt, David's genuine concern for human suffering gives life to the science.

Grit and Persistence

David spent decades refining techniques, collecting data, developing tools, and challenging accepted assumptions.

Discussion of AI and the Future of Therapy

The conversation also touches on the Feeling Great app and artificial intelligence.

David explains that the app was designed to deliver many TEAM-CBT principles to people who might not otherwise have access to therapy.

He remains hopeful that technology can help make effective treatment more widely available while preserving the human values at the heart of psychotherapy.

Memorable Themes from This Episode

• People are more important than diagnoses.
• Healthy sadness is different from depression.
• Empathy comes before technique.
• Resistance is not a problem—it is information.
• Great therapists remain curious and humble.
• Real innovation begins with measuring outcomes.
• Compassion and science work best together.

Resources Mentioned

• Feeling Great App
• Psychology Today articles by David Burns
• Episode 49 featuring Marilyn's transformational session

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

You can reach Matt May, MD @ https://www.matthewmaymd.com
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 kevin@feelinggoodinstitute.com and visit his website at www.tools4change.me.

You can reach Dr. Burns at david@feelinggood.com.

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