The Feeling Good Therapist - Externalization of Voices Technique

Externalization of Voices Technique with host, Richard Lam, LMFT, featuring Deborah Rosenberg, Ph.D.

*This Technique was developed by Dr. David Burns, American Psychiatrist and Adjunct Clinical Professor Emeritus of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine.

This therapy role-play is a helpful reminder that perfection is an unattainable ideal. It exemplifies how, with the guidance of TEAM-CBT strategies, individuals can externalize and effectively challenge negative thoughts. Discover the Externalization of Voices Technique, a powerful tool by the esteemed Dr. David Burns. In this engaging conversation from Feeling Good Institute, Richard and Dr. Deborah delve into Cognitive Behavioral Therapy (CBT) skills to enhance therapeutic practice and enrich one's personal life.

We find Richard grappling with the haunting thought that they are a subpar parent, triggered by negative feedback from their child's school. One person embodies the negative side of the mind, while the other channels the positive side, in order to confront and crush these negative cognitions. The technique approach reveals an emotional self-defense strategy to challenge debilitating thoughts head-on (stop thought technique). Through acceptance, participants acknowledge the validity within these thoughts, limiting their impact. By creating a plan for change, one can pinpoint actionable steps to improve the situation while not fully embracing the negativity. The counter-attack strategy empowers individuals to wage a fight against their negative thoughts, working on how to stop negative thoughts, to ultimately take back control. Richard shares a journey toward self-acceptance, emphasizing that nobody is perfect, but there is always room for improvement.


Richard: Hi everyone! Welcome to the Feeling Good Therapist. Where we'll learn about different skills and tools to help you in your personal or even professional life as a therapist and today we have Debbie Rosenberg who will be teaching us this awesome technique called Externalization of Voices.

Deborah: Hi, thanks so much for having me. So, today we're going to be doing Externalization of Voices, which is one of my favorite methods and we're going to be doing a role play with Richard who is having the thought that he's a terrible parent after getting some negative feedback from the school about how his kid is doing, getting into some trouble and things.

Alright, so Richard let's start doing a role play, It's called Externalization of Voices and in this role play, I'm gonna be playing the negative side of your mind. So, I'm going to be throwing negative thoughts at you and you're going to be playing the positive side of your mind and your job is going to be to crush those negative thoughts as hard as you can and we're really going for a huge win over the negative thoughts. You can press them any way you want but there are four main ways that we try to crush the negative thoughts so the first is called Self-defense. I actually want you to write these down. So, if you could just grab a pen and paper.

So, the first one is called Self-defense where you defend yourself and explain why the thought is not true. The second is Radical Acceptance, where you own the true elements of the thought but with humor and peace of mind. The third is Making a Plan for Change so, if you agree with some parts of the thoughts but you don't want to accept it, you can specify what are things that you can change in the situation and Fourth is Counter-attack because sometimes our negative thoughts can feel kind of like a bully and it can be helpful to attack back and just tell the thoughts really buzz off or to leave you alone and that also can be helpful. So, you can use any or all of these strategies and again we're really going for you to have a huge win over the negative thought.

And the reason that we do the method like this is because sometimes when our negative thoughts are in our minds, they can feel really powerful and it can be very helpful to actually externalize them to get them out of our minds and really see them for what they are and then that sometimes really allows us to challenge those thoughts more effectively.

And another reason is that when we're really saying it out loud, a lot of times we can connect the challenge and negative thought at the emotional level so you know sometimes people say, okay. I can kind of understand cognitively but I don't always feel it emotionally and this is a method that really helps connect that down to the emotional level so that when we're arguing against our negative thoughts, we can really feel it emotionally and I think it kind of helps to provide that healing both cognitively and emotionally at the same time. So, you ready to jump in?

Richard: Yeah, let's do it.

Deborah: Alright, so in this method who am I?

Richard: You're kind of like the negative part of my mind.

Deborah: That's right, exactly, I'm gonna be the negative side of your mind and who are you?

Richard: The positive side.

Deborah: Okay, you ready?

Richard: Yeah.

Deborah: Alright! So Richard, I heard about your kid getting in trouble at school and that means you're a terrible parent.

Richard: Yeah, I think sometimes that happens and kids get into trouble and I mean do some things that are good.

Deborah: Okay, who won?

Richard: I guess, I did.

Deborah: Okay. Big or small?

Richard: Kind of like a small one.

Deborah: Yeah, let's go for a huge win. Would you want to try again or would you want to switch sides? And you could be the negative side of your mind and I can be the positive side.

Richard: Let's switch sides.

Deborah: Okay.

Richard: So you know, Richard you're just such a bad parent.

Deborah: That is complete baloney, I am a very loving and wonderful parent. I am home every day helping my kid with his homework. All kids get in trouble at school that's a normal thing, that happens sometimes and that's something that I can address. I can, you know figure out what's going on maybe he's having some feelings at school. I can talk to his teachers but this is really not about my parenting skills. I'm a loving wonderful present parent and I love my kid and this is just not true so get lost. Who won?

Richard: Oh, you definitely did!

Deborah: Big or small?

Richard: Big.

Deborah: Big or huge?

Richard: Oh, it was huge for sure!

Deborah: Alright, so we should switch again and this time I'll be the negative thoughts and negative side of your mind and you'll go for a huge win.

Richard: Yeah, absolutely!

Deborah: Alright, you ready?

Richard: Yep, I'm ready.

Deborah: Alright! So Richard, I've been hearing what's going on with your kid at school and that means you're a terrible parent.

Richard: You know, there's definitely a lot I can improve on just like everyone else in this world, where I can become a better parent and I think I can learn quite a bit from this experience and kind of like the more I do this, it really shows how much I care about my kids in terms of the effort and wanting to do better for them and at the same time, I do so many wonderful things for my kids as well where I go to these meetings to kind of talk about these things but not only that I help them with homework, I help them get ready for school and every day just they always tell me that they love me and I'm also kind of thinking that you know part of this is I'll just kind of prepare myself learn from this experience and do better next time.

But I wish you would just buzz off! Because a part of this is you're actually making things really challenging for me because you keep telling me this I just feel discouraged and don't want to do anything so it's actually better that you kind of stay out of my life.

Deborah: Wow! Who won?

Richard: I did!

Deborah: Big or small?

Richard: Big!

Deborah: Big or huge?

Richard: Oh, for sure huge!

Deborah: Yeah, I agree! That was a huge win. What was that like for you going through that, this method and hearing yourself say that?

Richard: It was really great, I just kind of realized and kind of like the truth behind it all and it's just like I do have like quite a bit of like opportunities to like improve and no one's going to be a perfect parents. It's not like we've been training for this all of our lives but it just feels good to kind of like notice "hey, I'm not perfect" and I'm also doing a lot of good things and I'll continue doing good thing so it’ll just, really pause that.

Deborah: Yeah! What would be a positive thought that we could write down based on what you just said?

Richard: I think a really good positive thought is, you know everyone is going to improve best parents and I'm not giving up so it kind of shows that I care quite a bit and not only that but it kind of gives me an opportunity to become better for my kids and also for myself as well and this thought in itself is definitely not serving me.

Deborah: Wow! Okay great, write that down.

Richard: Let's pause right there. That was wonderful, Debbie. Debbie did such a wonderful demonstration of externalization of voices if you're wanting to learn more about different tools and techniques you can subscribe and if you're wanting to learn more about Debbie, you can look at her descriptions below.

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