Hey Cameron Diaz! Wanna Make a Real Difference?

Dear Cameron Diaz:

For many years you’ve been a positive and happy highlight on the silver screen. You’re smart, funny, and beautiful, an excellent combination. From your use of sperm as hair gel in There’s Something About Mary to this week’s debut of Sex Tape, you’ve given us twisted, off-beat, and edgy hilarity. You help all of us be a little less uptight.

But as a psychologist, I’m also aware there are lines that we’re better off not crossing, which brings me to my point.

In a 2011 appearance on Jimmy Kimmel Live you exclaimed, “I love porn!” At the time, it seemed all in good fun—and completely consistent with your irreverent, quirky self. However, since then, I’ve come to view public declarations of loving porn as less than harmless.

Lately I’ve been reading pornography research and have discovered some very disturbing facts. As we’ve known for decades, there’s porn, and then there’s PORN. We need better ways to define this vast array of sexual material.

Because you were once a Charlie’s Angel—dedicated to saving the world from all things evil—I want to share with you what behavioral scientists are finding about the darker side of porn. Viewing more porn is associated with:

• Engaging in sexually aggressive acts (including rape or sexual assault)
• Becoming depressed, anxious, and stressed
• Functioning more poorly in real social interactions (and ironically, becoming impotent)

Research also reveals that young boys who view lots of porn are more likely to be sex offenders. And here’s the most disturbing thing I’ve discovered. Over 80% of pornography includes violence towards women. Within this violent category, a common motif involves a man having anal sex with a woman and then having her perform oral sex, so she tastes her own feces. This illustrates why we need to make distinctions between porn that is fun, educational, or artistic, and porn that is just plain destructive.

Here’s one last thing I didn’t know. The porn industry is GARGANTUAN. It hardly needs your endorsement to survive ( This week, the industry will make hundreds of millions of dollars on films with substantially less plot than Sex Tape, and my best guess is that you wouldn’t intentionally endorse most of these plots.

Although I don’t know you personally, I have trouble believing you “love” the sort of porn that denigrates women, contributes to impotence in young men, or increases sexual assaults. This leads me to a suggestion for how you might help people understand the differences between acceptable and destructive porn.

What if we planned a tour of the late night talk shows to discuss the stark differences between artistic, gently consenting porn and violent, degrading, and damaging porn? This is a discussion our culture desperately needs, and you could take the lead. With this simple, educational message you could save thousands of people from harmful sexual relationships, or no real sexual relationships at all!

Your legacy could include people not only saying, “Cameron Diaz was talented, beautiful, and smart,” but also “After the letter from that psychologist from Montana, she became an amazing role model for healthy and fun consensual sex.”

Thanks for listening and let me know how I can help!


That psychologist from Montana



Posted by on July 17, 2014 in Personal Reflections


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Handouts for the American Mental Health Counseling Association Conference

These past two days I’ve been hanging out in Seattle with some very cool mental health counselors (as well as my very cool sister and her only mildly deranged husband). As a consequence, I promised to post these two powerpoint presentations to enable quick internet access. And so, if you were at the conference or you’re just a powerpoint presentation junkie, links to the two presentations are below:

1. Ethics: A Fresh Approach (two hour workshop with Rich Ponton — who is also very cool)

Ethics A Fresh Approach

2. How to Listen so Parents will Talk (three hour workshop)

How to Listen for AMHCA


Posted by on July 12, 2014 in Ethics, Parenting


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Cultural Adaptations in the DSM-5: Insert Foot in Mouth Here

Sometimes it just seems easier to be snarky than balanced. This basic truth comes to mind because of a recent analysis I did of the Cultural Formulation Interview (CFI) from the DSM-5. As I read about the CFI and looked through its Introduction and 16 questions for “patients,” I kept thinking to myself things like,

“Seriously . . . could this really be the best cultural sensitivity that the American Psychiatric Association can manage when it comes to guidelines for interviewing minority cultures?”


“Who wrote this and why didn’t they ask me for some help?” (insert smiley face here; please note that some of my colleagues at the University of Montana have noticed—and commented—on the fact that I tend to insert a smiley face icon right after texting or emailing my personal version of punchy, snarky, sarcasm).

Ha! is all I have to say to them (FYI: Ha! is my programmed default back up to my default smiley face snark signal).

Anyway . . . the point! It’s way easier for me to be critical of the American Psychiatric Association than balanced. In truth, the CFI is a reasonable effort. And, if you think about where the APA is coming from (and likely going to) then the CFI is a massive effort. I should be saying, “Cool! I’m so excited to see the CFI as part of the DSM-5.

All this is prologue for the excerpt I include below. This is an excerpt from a draft chapter I’m writing for the Handbook of Clinical Psychology . . . to be published at some point in the not too distant future. Here’s the excerpt; it focuses on cultural adaptations we can make when conducting initial clinical interviews with minority clients; forgive the roughness of the draft.

Cultural Adaptations

A clinical interview is a first impression, and first impressions are powerful influences on later relational interactions, which is why we need to make cultural adaptations when conducting clinical interviews. One of the best sources for cultural adaptations is the already-existing guidance from psychotherapy research on working multiculturally. These guidelines include: (a) using small talk and self-disclosure with some cultural groups, (b) when feasible, conducting initial interviews in the patient’s native language, (c) seeking professional consultations with professionals familiar with the patient’s culture; (d) avoiding the use of interpreters except in emergency situations; (e) providing services (e.g., childcare) that help increase patient retention, (f) oral administration of written materials to patients with limited literacy, (g) having awareness and sensitivity to client age and acculturation, (h) aligning assessment and treatment goals with client culturally-informed expectations and values, (i) regularly soliciting feedback regarding progress and client expectations and responding immediately to client feedback, and (j) explicitly incorporating cultural content and cultural values into the interview, especially with patients not acculturated to the dominant culture (see Griner & Smith, 2006; Hays, 2008; Smith, Rodriguez, & Bernal, 2011).

Cultural awareness, cross cultural sensitivity, and making cultural adaptations are especially important to assessment and diagnosis. This is partly because mental health professionals have a long history of inappropriately or inaccurately assigning psychiatric diagnoses to cultural minority groups (Paniagua, 2014). To address this challenge, in the latest edition of the Diagnostic and Statistical Manual (DSM-5; American Psychiatric Association, 2014), a Cultural Formulation Interview (CFI) protocol is included to aid the diagnostic interview process.

The CFI is a highly structured brief interview. It is not a method for assigning clinical diagnoses; instead, its purpose is to function as a supplementary interview that enhances the clinician’s understanding of potential cultural factors. It also may aid in the diagnostic decision-making process. The CFI includes an introduction and four sections (composed of 16 specific questions). The four sections include:

1. Cultural definition of the problem
2. Cultural perceptions of cause, context, and support
3. Cultural factors affecting self-coping and past help seeking
4. Cultural factors affecting current help seeking

Questions from each section are worded in ways to help clinicians gently explore cultural dimensions of their clients’ problems. Question 2 is a good representation: “Sometimes people have different ways of describing their problem to their family, friends, or others in their community. How would you describe your problem to them?” (American Psychiatric Association, 2014).

Clinicians are encouraged to use the CFI in research and clinical settings. There is also a mechanism for users to provide the American Psychiatric Association with feedback on the CFI’s utility. It may be reproduced for research and clinical work without permission, which is a cool thing.

If you Google: “Cultural Formulation Interview” the first non-advertised hit should be a .pdf of the CFI.

If you Google: “Clinical Interviewing” the first several hits will take you to some form or another of our text on the topic.

Here’s a photo of me “working” inter-culturally with my brother-in-law (insert smiley face here):





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Behavioral Activation Therapy: Let’s Just Skip the Cognitions

This is a short excerpt from the text: Counseling and Psychotherapy Theories in Context and Practice

It describes a research-based behavioral approach to counseling and psychotherapy.

Over half a century ago, Skinner suggested that depression was caused by an interruption of healthy behavioral activities that had previously been maintained through positive reinforcement. Later, this idea was expanded based on the initial work of Ferster (1973) and Lewinsohn (1974; Lewinsohn & Libet, 1972). The focus was on observations that:

“. . . depressed individuals find fewer activities pleasant, engage in pleasant activities less frequently, and obtain therefore less positive reinforcement than other individuals.” (Cuijpers, van Straten, & Warmerdam, 2007, p. 319)

From the behavioral perspective, the thinking goes like this:
1.   Observation: Individuals experiencing depression engage in fewer pleasant activities and obtain less daily positive reinforcement.

2.   Hypothesis: Individuals with depressive symptoms might improve or recover if they change their behavior (while not paying any attention to their thoughts or feelings associated with depression).

Like the good scientists they are, behavior therapists have tested this hypothesis and found that behavior change—all by itself—can produce positive treatment outcomes among clients with depression. The main point is to get clients with depressive symptoms to change their behavior patterns so they engage in more pleasant activities and experience more positive reinforcement
Originally, behavioral activation was referred to as activity scheduling and used as a component of various cognitive and behavioral treatments for depression (A. T. Beck, Rush, Shaw, & Emery, 1979; Lewinsohn, Steinmetz, Antonuccio, & Teri, 1984). During this time activity scheduling was viewed as one piece or part of an overall cognitive behavior treatment (CBT) for depression.
However, in 1996, Jacobson and colleagues conducted a dismantling study on CBT for depression. They compared the whole CBT package with activity scheduling (which they referred to as behavioral activation), with behavioral activation (BA) only, and with CBT for automatic thoughts only. Somewhat surprisingly, BA by itself was equivalent to the other treatment components—even at two-year follow-up (Gortner, Gollan, Dobson, & Jacobson, 1998; Jacobson et al., 1996).

As is often the case, this exciting research finding stimulated further exploration and research associated with behavioral activation. In particular, two separate research teams developed treatment manuals focusing on behavioral activation. Jacobson and colleagues (Jacobson, Martell, & Dimidjian, 2001) developed an expanded BA protocol and Lejuez, Hopko, Hopko, and McNeil (2001) developed a brief (12 session) behavioral activation treatment for depression (BATD) manual and a more recent 10 session revised manual (Lejuez, Hopko, Acierno, Daughters, & Pagoto, 2011).

Implementation of the BATD protocol is described in a short vignette later in the behavioral theory and therapy chapter in the text: Counseling and Psychotherapy Theories in Context and Practice by John and Rita Sommers-Flanagan. See:

Or, on Amazon:

Several people engaging in behavioral activation therapy at a wedding.




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A Short Piece on Disrespecting Teenagers

The post below is from and so you can view it there too:

Also, I strongly recommend that you check out as a potential go-to resource on all things psychotherapeutic. Their video and streaming collection is awesome and extensive. Go to:

Okay. Here’s the post:

A Short Piece on Disrespecting Teenagers

We have an American cultural norm to disrespect teenagers. For example, it’s probably common knowledge that teens are:
• Naturally difficult
• Not willing to listen to good common sense from adults
• Emotionally unstable
• Impulsively acting without thinking through consequences

Wait. Most of these are good descriptors of Bill O’Reilly. Isn’t he an adult?

Seriously, most television shows, movies, and adult rhetoric tends toward dismissing and disrespecting teens. It’s not unusual for people to express sympathy to parents of teens. “It’s a hard time . . . I know . . . I hope you’re coping okay.” Just last night Stephen Colbert quipped, “Nobody likes teenagers.” Even Mark Twain had his funny and famous disrespectful quotable quote on teens. Remember:

“When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

This is a clever way of suggesting that teens don’t recognize their parents’ wisdom. Although this is partly true, I’m guessing most teens don’t find it especially hilarious. Especially if their parents are treating them in ways that most of us would consider unwise—at least if we were treated similar ways in the workplace.

And now the neuroscientists have piled on with their fancy brain images. We have scientific evidence to prove, beyond any doubt, that the brains of teens aren’t fully developed. Those poor pathetic teens; their brains aren’t even fully wired up. How can we expect them to engage in mature and rational behavior? Maybe we should just keep them in cages to prevent them from getting themselves in trouble until their brain wiring matures.

This might be a good idea, but then how do we explain the occasionally immature and irrational behavior and thinking of adults? I mean, I know we’re supposed to be superior and all that, but I have to say that I’ve sometimes seen teens acting mature and adults acting otherwise. How could this be possible when we know—based on fancy brain images—that the adult brain is neurologically all-wired-up and the teen brain is under construction? Personally (and professionally), I think the neuroscience focus on underdeveloped “teen brains” is mostly (but not completely) a form of highly scientifically refined excrement from a male bovine designed to help adults and parents feel better about themselves.

And therein lies my point: I propose that we start treating teens with the respect that we traditionally reserve for ourselves and each other . . . because if we continue to disrespect teenagers and lower our expectations for their mature behavior . . . the more our expectations are likely to come true.

John and his sister, Peggy, acting immature even though their brains are completely wired up.

Peg and John Singing at Pat's Wedding


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Ten Tips for Parenting through Divorce

In a previous post today there was a mention of a Tip Sheet for Parenting through Divorce and one astute blog reader noticed and asked about it . . . and so here it is. It’s also excerpted from the book “How to Listen so Parents will Talk and Talk so Parents will Listen.”

Ten Tips for Parenting through Divorce

To parent well through divorce and into the future, you should educate yourself about the unique challenges you’re likely to face and how to manage them. The following short list is a beginning. Additional resources are listed in Appendix A.

1. Make a commitment to good self-care. There are two big reasons why this is good advice. First, divorce is emotionally painful and stressful. If you don’t take care of yourself physically, emotionally, and spiritually, you may suffer. Second, if you’re suffering, your children will suffer right along with you.

2. Cultivate a support system for your children. You can’t do it all. Therefore, when you’re feeling exhausted your children will need other healthy adults with whom they can spend time. Identify who these adults are and ask them for help and support.

3. Listen to your children, even when it’s hard. Your children may or may not want to talk about the divorce or their feelings. In most cases, they’ll suddenly become angry, irritable, or sad and possibly direct those feelings at you. If so, listen and comfort, even if what they’re saying is hard to hear.

4. Set limits for your children. Sometimes during and after a divorce parents will start letting their children do whatever they want. This isn’t healthy. Children need limits; they need you to be a firm and loving parent.

5. Work on communicating respectfully with your child’s other parent. Practice positive communication skills. It can also help to change your language and not call your former spouse, “My ex,” but instead, “My daughter’s father” or “My son’s mother.” See Ricci’s book, Mom’s house, Dad’s house, for more information on this.

6. Develop smooth transitions from one home to another. Child exchanges can be traumatic for everyone. Having a regular and positive routine when you get your children ready to go to their other home can help. Also, avoid conflicts with the other parent during child exchanges. Exposing your child to parent–parent conflict is very unhealthy. Consider finding an outside person to help you establish a positive exchange.

7. Set limits with your child’s other parent. Consider establishing guidelines for parent–parent meetings. Don’t meet for long hours alone or make yourself spontaneously available anytime the other parent wants to talk. Instead, set up official meetings at a safe and pleasant (but not intimate) location.

8. Educate yourself. Consider taking a class or reading a book or watching an educational DVD on divorce and shared parenting.

9. Educate yourself II. Consult with legal and mental-health professionals as appropriate. Neither legal or mental health professionals should be used in an effort to manipulate or punish the other parent or the children.

10. Embark on a healthy new life. Give your child’s mom or dad privacy and maintain your own. Encourage your children to have good times with the other parent (never make your children feel guilty about having a good time with their mom or dad). Establish new family rituals to help you and your children adjust to your new lives.

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Posted by on June 22, 2014 in Divorce, Parenting


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Parenting Consultations with Divorced, Divorcing, and Never-Married Parents

Working with parents who are divorced, divorcing, or living separately can be both challenging and gratifying. In this excerpt from “How to Listen so Parents will Talk and Talk so Parents will Listen” we discuss some key issues and provide a case example. The main purpose of this post is to stimulate your thinking about working with this unique and interesting population of parents.

Here’s the excerpt:

Divorce will probably always be a controversial and conflict-laden issue within our society. In part, this is due to moral issues associated with divorce, but it is also due to the many knotty practical issues divorced parents frequently face.

Divorce Polemics

Divorce and single-parenting choices still carry stigma and so parents will be monitoring for any judgments you might have about them. You may have very strong opinions about divorce or about people choosing to adopt or bear children while single. If this is something you can’t put aside and be nonjudgmental about, it’s best to put your views in your informed consent so parents know this explicitly about your practice. In most cases, professionals have values and beliefs they can keep in check while working directly with people who make choices far different than the professional might have made. For instance, you might firmly believe that all children should be born into a two-parent family with parents who are married and committed to the family, but you might still be able to be very helpful to a single gay parent who adopted a 10-year-old disabled foster child.

Because they’ve sometimes faced moral and religious judgments, divorced, divorcing, and never-married parents have substantial needs for support and education. Consequently, you should prepare yourself to provide that education and support. Their parenting challenges can be particularly acute and confusing.

The issue for practitioners working with parents is to avoid laying blame and guilt on parents for divorcing (generally, they already feel guilty about how their divorce might be affecting their children). Instead, your role is to help divorced, divorcing, or never-married parents manage their difficult parenting situations more effectively. What we need to offer is (1) emotional support for divorce- and post-divorce-related stress and conflict; and (2) clear information on specific behaviors parents can engage in or avoid to help their children adjust to divorce.

Providing Support and Educational Information
Most divorcing and recently divorced parents are in substantial distress and so parents and need comfort, support, and information. Consequently, we recommend talking with parents about divorce in a way that’s empathic and educational. In the following case, a father with three children has come for help in planning to tell the children. His children are 4, 6, and 8 years old.

         Case: Talking about Divorce

PARENT: I’m really worried about how to talk with my kids about the divorce. I can’t get the right words around it. I know I’m supposed to say something reassuring like, “Your mom and I love each other, but it just hasn’t worked out and so that’s why I’m moving out because it will be best for us to live separately.” But then I worry that maybe my kids will think even though I love them now, it might not “work out” either and then I’ll end up leaving them, too.

CONSULTANT: This is tough. I respect how much thought you’ve given this. Even though the differences between you and your wife make it too hard to live together, it’s extremely hard to leave the home and torturous to talk with your kids about it.

PARENT: That’s for sure.

CONSULTANT: I can see you love your children very much and it feels really important to talk with them about the upcoming divorce using words that won’t scare them too much and that will help them know you and your wife tried, but you have now decided that the divorce is for the best. But before we do that, I have a different piece of advice.

PARENT: What’s that?

CONSULTANT: You should plan to have more than one divorce talk with your kids. I know you want to do this right and that’s great. But the good news and the bad news is that you’ll need to have this conversation many times. As your children grow older, they’ll have different questions. It’s your job to tell them you love them and to explain things in words they’ll understand, but not to tell them too much. There’s no guarantee they’ll understand this perfectly and so it may relieve pressure for you to know you’ll get other chances. Some people like to think of it like having a sex-talk. Kids will have different questions about sex at different ages and so parents shouldn’t have just one sex-talk. You need to be ready to have a sex-talk at any time as your child is growing up. The same is true for talks about divorce. You need to be ready to talk about it now and whenever your kids or you need to talk in the future. I’ve got a great tip sheet for parents going through divorce and I’d like to go over that with you, too. [See Appendix B, Tip Sheet 10: Ten Tips for Parenting through Divorce.]

In this situation, the family’s educational needs are significant, so the practitioner will probably offer the father a tip sheet, additional reading materials, and a recommendation to attend a group class on divorce and shared parenting.

It can be difficult for divorcing parents to talk with their children without blaming the other parent. This can be either blatant or subtle. We recall one parent who insisted he had the right to call his former spouse “The Whore” in front of the children “because it was the truth.” In these extreme cases, we’ve used radical acceptance to listen empathically to the emotional pain underlying this extreme perspective and then slowly and gently help the parent to understand that “telling the truth” to the children should focus on telling your personal truth and not on the other parent’s behavior. Although it can be difficult for divorced or divorcing parents to hear educational messages over the din of their emotional pain, it’s the practitioner’s job to empathically and patiently deliver the message. Usually divorced and divorcing parents eventually see that criticizing or blaming the other parent can be damaging to their children.

More information on this and other topics related to working with parents is available on this blogsite (see the Tip Sheets) and in the “How to Listen so Parents can Talk” book.




Posted by on June 22, 2014 in Divorce, Parenting


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