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Supplementary Counseling and Psychotherapy Theories Readings

Over the past four years I’ve written over 40 blog posts linked to teaching and learning the theory and practice of counseling and psychotherapy. While procrastinating on another project, I decided to organize these blog posts by topic. If you follow the links below, they’ll take you to blog posts relevant to specific theories. Included in some of these are a few links to short (and free) theories-based video examples. If you teach a theories course, you could select some of these links to assign students outside readings or you could peruse them yourself to stimulate a few lecture ideas.

Please note that if you use our Counseling and Psychotherapy Theories in Context and Practice textbook, there’s a bit of redundancy with the textbook’s content. However, if you don’t use the text, the material will be new to you and your students.

Chapter 1 – Opening and Overview

A Plan for Maximizing Positive Counseling and Psychotherapy Outcomes: http://johnsommersflanagan.com/2014/09/07/a-plan-for-maximizing-positive-counseling-and-psychotherapy-outcomes/

Teaching Counseling and Psychotherapy Theories: Reflections on Week 1: http://johnsommersflanagan.com/2012/08/29/teaching-counseling-and-psychotherapy-theories-reflections-on-week-1/

Reformulating Clinical Depression: The Social-Psycho-Bio Model: http://johnsommersflanagan.com/2013/09/03/reformulating-clinical-depression-the-social-psycho-bio-model/

Chapter 2 – Psychoanalytic Approaches

Attachment-Informed Psychotherapy: http://johnsommersflanagan.com/2015/08/12/attachment-informed-psychotherapy/

Chapter 3 – Adlerian Approaches: Individual Psychology

The Three-Step Emotional Change Trick: http://johnsommersflanagan.com/2012/09/23/the-three-step-emotional-change-trick/

A Parenting Homework Assignment on Natural and Logical Consequences: http://johnsommersflanagan.com/2011/11/30/a-parenting-homework-assignment-on-natural-and-logical-consequences/

More Than Praise — Other Ways Parents Can Be Positive With Their Children: http://johnsommersflanagan.com/2012/08/16/more-than-praise-other-ways-parents-can-be-positive-with-their-children/

Chapter 4 – Existential Approaches

Reflections on Listening to Irvin Yalom at the ACA Conference: http://johnsommersflanagan.com/2012/03/25/reflections-on-listening-to-irvin-yalom-at-the-aca-conference/

A Short Existential Case Example from Counseling and Psychotherapy Theories . . .: http://johnsommersflanagan.com/2015/08/25/a-short-existential-case-example-from-counseling-and-psychotherapy-theories/

Chapter 5 – Person-Centered Approaches

Reflections on Magic: http://johnsommersflanagan.com/2011/11/28/reflections-on-magic/

Listening as Meditation on Psychotherapy.net: http://johnsommersflanagan.com/2014/02/25/listening-as-meditation-on-psychotherapy-net/

An Interview with Natalie Rogers (Daughter of Carl Rogers) about Person-Centered Therapy: http://johnsommersflanagan.com/2015/08/04/an-interview-with-natalie-rogers-daughter-of-carl-rogers-about-person-centered-therapy/

Why Therapists Should Never Say, “I know how you feel”: http://johnsommersflanagan.com/2013/05/30/why-therapists-should-never-say-i-know-how-you-feel/

Carl Rogers and Brain-Science do an Empathy Smackdown in Chapter 3: http://johnsommersflanagan.com/2015/07/09/carl-rogers-and-brain-science-do-an-empathy-smackdown-in-chapter-3/

Chapter 6 – Gestalt Approaches

Go Go Gestalt: The Theories Video Shoot, Part I: http://johnsommersflanagan.com/2012/04/24/go-go-gestalt-the-theories-video-shoot-part-i-2/

Chapter 7 – Behavioral Approaches

A Black Friday Tribute to Mary Cover Jones and her Evidence-Based Cookies: http://johnsommersflanagan.com/2011/11/25/a-black-friday-tribute-to-mary-cover-jones-and-her-evidence-based-cookies/

Behavioral Activation Therapy: Let’s Just Skip the Cognitions: http://johnsommersflanagan.com/2014/06/30/behavioral-activation-therapy-lets-just-skip-the-cognitions/

Imaginal or In Vivo Exposure and Desensitization: http://johnsommersflanagan.com/2012/05/19/imaginal-or-in-vivo-exposure-and-desensitization-2/

A New Look at Time-Out for Kids and Parents: http://johnsommersflanagan.com/2012/08/04/a-new-look-at-time-out-for-kids-and-parents/

Information on Using Time-Out — Part II: http://johnsommersflanagan.com/2012/08/05/information-on-using-time-out-part-ii/

Talking with Parents about Positive Reinforcement: http://johnsommersflanagan.com/2014/09/06/talking-with-parents-about-positive-reinforcement/

Backward Behavior Modification: http://johnsommersflanagan.com/2012/12/02/backward-behavior-modification/

Chapter 8 – Cognitive-Behavioral Approaches

Positive Thinking is Not (Necessarily) Rational Thinking: http://johnsommersflanagan.com/2011/12/06/positive-thinking-is-not-necessarily-rational-thinking/

How to Use the Six Column CBT Technique: http://johnsommersflanagan.com/2014/02/18/how-to-use-the-six-column-cbt-technique/

A Quick Look at the Collaborative Cognitive Therapy Process: http://johnsommersflanagan.com/2012/09/30/a-quick-look-at-the-collaborative-cognitive-therapy-process/

Tomorrow’s Election and Confirmation Bias: http://johnsommersflanagan.com/2012/11/05/tomorrows-election-and-confirmation-bias/

Confirmation Bias on My Way to Spearfish, South Dakota: http://johnsommersflanagan.com/2014/04/30/confirmation-bias-on-my-way-to-spearfish-south-dakota/

Chapter 9 – Choice Theory and Reality Therapy

The Seven Magic Words for Parents: http://johnsommersflanagan.com/2012/12/23/the-seven-magic-words-for-parents/

Give Information and then Back-Off: A Choice Theory Parenting Assignment: http://johnsommersflanagan.com/2012/07/09/give-information-and-then-back-off-a-choice-theory-parenting-assignment/

How Parents Can Use Problem-Solving Power: http://johnsommersflanagan.com/2012/10/23/how-parents-can-use-problem-solving-power/

Chapter 10 – Feminist Approaches

Opening Thoughts on Feminism: http://johnsommersflanagan.com/2012/04/03/opening-thoughts-on-feminism-3/

The Girl Code by Ashley Marallo: http://johnsommersflanagan.com/2012/12/03/the-girl-code-by-ashley-marallo/

A Guest Essay on the Girl Code and Feminism: http://johnsommersflanagan.com/2014/12/07/a-guest-essay-on-the-girl-code-and-feminism/

Feminist Culture in Music: http://johnsommersflanagan.com/2013/11/18/feminist-culture-in-music/

Chapter 11 – Constructive (Solution-Based and Narrative) Approaches

Is Solution-Focused Therapy as Powerfully Effective as Solution-Focused Therapists Would Have Us Believe?: http://johnsommersflanagan.com/2012/07/01/is-solution-focused-therapy-as-powerfully-effective-as-solution-focused-therapists-would-have-us-believe-2/

Secrets of the Miracle Question: http://johnsommersflanagan.com/2015/03/04/secrets-of-the-miracle-question/

The Love Reframe: http://johnsommersflanagan.com/2013/04/07/the-love-reframe/

Chapter 12 – Family Systems Approaches

None posted on this topic. Obviously, I need help here.

Chapter 13 – Multicultural Approaches

Four Good Ideas about Multicultural Counseling and Psychotherapy—In Honor of Martin Luther King, Jr.: http://johnsommersflanagan.com/2012/01/16/four-good-ideas-about-multicultural-counseling-and-psychotherapy-in-honor-of-martin-luther-king-jr/

Good Ideas about Multicultural Counseling and Psychotherapy – Part II: http://johnsommersflanagan.com/2012/01/22/good-ideas-about-multicultural-counseling-and-psychotherapy-part-ii/

Cultural Adaptations in the DSM-5: Insert Foot in Mouth Here: http://johnsommersflanagan.com/2014/07/08/cultural-adaptations-in-the-dsm-5-insert-foot-in-mouth-here/

Psychic Communications . . . and Cultural Differences in Mental Status: http://johnsommersflanagan.com/2013/01/02/psychic-communications-and-cultural-differences-in-mental-status/

A White Male Psychologist Reflects on White Privilege: http://johnsommersflanagan.com/2012/09/14/a-white-male-psychologist-reflects-on-white-privilege/

Chapter 14 – Integrative Approaches

None on this chapter either.

 

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A Summary of the American Psychological Association’s Record Keeping Guidelines

The American Psychological Association (APA) has an online guide to record keeping for psychologists. Of the different mental health disciplines, the APA’s guidelines are the most extensive. For the full guide (and tons of fun), go to: http://www.apa.org/practice/guidelines/record-keeping.aspx. A brief summary of the guide follows.

As an introduction, the APA emphasizes that clinical records are beneficial for clients and practitioners. When done well, clinical records can:

1. Document that planning has occurred
2. Guide treatment services.
3. Allow providers to review and monitor their work.
4. Enhance continuity when there are treatment breaks or referrals to other providers.
5. Protect clients and providers during legal or ethical proceedings.
6. Fulfill insurance or third-party reimbursement requirements.

The APA’s document is a guide and not a mandate. It’s designed as aspirational. APA also notes that there’s no significant empirical research foundation upon which their guidelines are based. Instead, the guidelines are broadly based on APA policy, professional consensus, and other sources of ethics and legal information.

The following list paraphrases and summarizes APA’s 13 guidelines. There’s always the possibility that our list and descriptions include minor mistranslations. Consequently, please see the full document for comprehensive coverage of this important content.

1. Responsibility: Practitioners are responsible for the development and maintenance of their clinical records. This includes training staff in the appropriate confidential handling of client records.

2. Record Content: Records include information about the nature, delivery, treatment progress and outcomes, and fees. Information included is directly relevant to the clinical purpose of client contacts. Although detail is important, the following factors guide the level of details included in individual client case files:

a. Clients’ wishes
b. Disaster or emergency settings
c. Ethical or legal limitations (e.g., HIV testing results)
d. Contracts with third party payers
e. The APA guide includes extensive information regarding what content may or may not be appropriate.

3. Confidentiality: Maintenance of confidentiality is essential. In situations where who has access to records may be unclear (e.g., child custody conflicts), the provider seeks pertinent legal information to guide decision-making.

4. Informed Consent: Practitioners provide clients with information regarding their record keeping procedures, including limits to confidentiality.

5. Records Maintenance: Records are organized to comply with federal law (HIPAA) and accuracy is maintained.

6. Records Security: Records are kept safe from physical damage. Access to records is controlled via a variety of methods, including locked cabinets, locked storage rooms, passwords, data encryption, etc.).

7. Records Retention: Records are retained for a time period consistent with legal requirements. The general guide is seven years after service ended for adults and three years after a minor reaches age 18 (whichever is later).

8. Records Context: Because client symptoms or condition can vary with situational contexts, providers frame the content of client records within the appropriate historical context.

9. Electronic Records: Electronic records use and storage presents ongoing challenges. The best guidance is for practitioners to follow the HIPAA Security Rule, conduct a security analysis, and consistently upgrade policies and practices to keep up with changes in technology.

10. Records within Agencies: Practitioners must balance their professional ethical requirements and agency policy. The APA identifies three main areas: (a) conflicts between the agency and other requirements, (b) records ownership, and (c) records access.

11. Multiple Client Records: When providing couple, family, or group services, records management may become complex. You can consider either creating separate records for all clients or to identify a primary client and keep records for that person.

12. Financial Records: The nature of the fee agreement (including bartering agreements) as well as adjustments to account balances should be specified. Financial records include essential information such as procedure codes, treatment duration, fees paid, fee agreements, dates of service, etc.

13. Records Disposition: In the case of unexpected events, there may be a need for records transfer or disposal. This implies a need for a records transfer and disposal policy, including information on how current and former clients will be informed if the policy needs to be enacted.

The APA guide is a comprehensive document that can help all practicing clinicians maintain high ethical standards with respect to documentation.

 

A Short Existential Case Example from Counseling and Psychotherapy Theories . . .

Each chapter in Counseling and Psychotherapy Theories in Context and Practice includes at least two case vignettes. These vignettes are brief, but designed to articulate how clinicians can use specific theories to formulate cases and engage in therapeutic interactions. The following case is excerpted from the Existential Theory and Therapy chapter.

This post is part of a series of free posts available to professors and students in counseling and psychology who are teaching and learning about theories of counseling and psychotherapy. It, as well as the recommended video clip at the end, can be used for discussion purposes and/or to supplement course content.

IMG_2481

Vignette II: Using Confrontation and Visualization to Increase Personal Responsibility and Explore Deeper Feelings

In this case, a Native American counselor-in-training is working with an 18-year-old Latina female. The client has agreed to attend counseling to work on her anger and disruptive behaviors within a residential vocational training setting. Her behaviors are progressively costing her freedom at the residential setting and contributing to the possibility of her being sent home. The client says she would like to stay in the program and complete her training, but her behaviors seem to say otherwise.

Client: Yeah, I got in trouble again yesterday. I was just walking on the grass and some “ho” told me to get on the sidewalk so I flipped her off and staff saw. So I got a ticket. That’s so bogus.

Counselor: You sound like you’re not happy about getting in trouble, but you also think the ticket was stupid.

Client: It was stupid. I was just being who I am. All the women in my family are like this. We just don’t take shit.

Counselor: We’ve talked about this before. You just don’t take shit.

Client: Right.

Counselor: Can I be straight with you right now? Can I give you a little shit?

Client: Yeah, I guess. In here it’s different.

Counselor: On the one hand you tell me and everybody that you want to stay here and graduate. On the other hand, you’re not even willing to follow the rules and walk on the sidewalk instead of the grass. What do you make of that?

Client: Like I’ve been saying, I do my own thing and don’t follow anyone’s orders.

Counselor: But you want to finish your vocational training. What is it for you to walk on the sidewalk? That’s not taking any shit. All you’re doing is giving yourself trouble.

Client: I know I get myself trouble. That’s why I need help. I do want to stay here.

Counselor: What would it be like for you then . . . to just walk on the sidewalk and follow the rules?

Client: That’s weak brown-nosing bullshit.

Counselor: Then will you explore that with me? Are you strong enough to look very hard right now with me at what this being weak shit is all about?

Client: Yeah. I’m strong enough. What do you want me to do?

Counselor: Okay then. Let’s really get serious about this. Relax in your chair and imagine yourself walking on the grass and someone asks you to get on the sidewalk and then you just see yourself smiling and saying, “Oh yeah, sure.” And then you see yourself apologize. You say, “Sorry about that. My bad. You’re right. Thanks.” What does that bring up for you.

Client: Goddamn it! It just makes me feel like shit. Like I’m f-ing weak. I hate that.

In this counseling scenario the client is conceptualized as using expansive and angry behaviors to compensate for inner feelings of weakness and vulnerability. The counselor uses the client’s language to gently confront the discrepancy between what the client wants and her behaviors. As you can see from the preceding dialogue, this confrontation (and the counselor’s use of an interpersonal challenge) gets the client to look seriously at what her discrepant behavior is all about. This cooperation wouldn’t be possible without the earlier development of a therapy alliance . . . an alliance that seemed deepened by the fact that the client saw the counselor as another Brown Woman. After the confrontation and cooperation, the counselor shifts into a visualization activity designed to focus and vivify the client’s feelings. This process enabled the young Latina woman to begin understanding in greater depth why cooperating with rules triggered intense feelings of weakness. In addition, the client was able to begin articulating the meaning of feeling “weak” and how that meaning permeated and impacted her life.

To check out a 4+ minute existential counseling video clip go to: https://www.youtube.com/watch?v=jiirtIKcIeM

This clip is taken from our Counseling and Psychotherapy Theories 2 DVD set. The 2 DVD set is available through Psychotherapy.net: http://www.psychotherapy.net/video/counseling-psychotherapy-theories and Amazon: http://www.amazon.com/Counseling-Psychotherapy-Theories-Context-Practice/dp/1118402537/ref=asap_bc?ie=UTF8

 

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Women’s Cleavage and the Man’s Package in Professional Counseling and Psychotherapy

Women’s Cleavage and the Man’s Package in Professional Counseling and Psychotherapy

In 2013, for the first time in the history of counseling and psychotherapy textbook writing (at least our history), Rita and I included a section heading titled “Straight Talk about Cleavage” in the 5th edition of Clinical Interviewing. This section was inspired by comments posted on the Counselor Education and Supervision Listserv (aka CESNET). Now, we’re working on the revision for the 6th edition (affectionately referred to as CI6). For CI6 we solicited reactions from students, professional counselors, and professional psychologists. Not surprisingly, we received some fun, stimulating, and challenging responses.

For your reading pleasure, here’s the first draft of the revised section on cleavage. You’ll notice that it begins with a section on “Self-Presentation.” That’s because the cleavage and related content is a subsection of the self-presentation section.

This is a draft . . . and so please feel free to message me (or post) your comments and reactions. Thanks for reading.

Self-Presentation

You are your own primary instrument for a successful interview. Your appearance and the manner in which you present yourself to clients are important components of professional clinical interviewing.

Grooming and Attire
Choosing the right professional clothing can be difficult. Some students ignore the issue; others obsess about selecting just the right outfit. The question of how to dress may reflect a larger developmental issue: How seriously do you take yourself as a professional? Is it time to take off the ripped jeans, remove the nose ring, cover the tattoo, or lose the spike heels? Is it time to don the dreaded three-piece suit or carefully pressed skirt and come out to do battle with mature reality, as your parents may have suggested? Don’t worry. We recognize the preceding sentences are probably pushing your fashion-freedom buttons. We’re not really interested in telling you how you should dress or adorn your body. Our point is self-awareness. If you’re working in rural Texas your tattoo and nose ring will have a different effect than if you’re an intern in urban Chicago. Even if you ignore your physical self-presentation, your clients—and your supervisor—probably won’t.

We knew a student whose distinctive style included closely cropped, multicolored hair; large earrings; and an odd assortment of scarves, vests, sweaters, runner’s tights, and sandals. Imagine his effect on, say, a middle-aged dairy farmer referred to the clinic for depression, or a mother-son dyad having trouble with discipline, or the local mayor and his wife. No matter what effect you imagined, the point is that there’s likely to be an effect. Clothing, body art, and jewelry are not neutral; they’re intended to communicate, and they do (Human & Biesanz, 2012). An unusual fashion statement can be overcome, but it may use up time and energy better devoted to other issues (see Putting It in Practice 2.3). As a therapist your goals is to present yourself in a way that creates positive first impressions. This includes dress and grooming that foster rapport, trust, and credibility.

In one research study (albeit dated), Hubble and Gelso (1978) reported that clients experienced less anxiety and more positive feelings toward psychotherapists who were dressed in a manner that was slightly more formal than the client’s usual attire. The take home message from this research, along with common sense, is that it’s better to err slightly on the conservative side, at least until you’re certain that dressing more casually won’t have an adverse effect on your particular client population. As a professional colleague of ours tells her students, “A client should not walk away from your session thinking too much about what you wore” (S. Patrick, personal communication, June 27, 2015).

Straight Talk about Cleavage
Although we don’t have solid scientific data upon which to base this statement, our best guess is that most people on the planet don’t engage in open conversations about cleavage. Our goal in this section is to break that norm and to encourage you to break it along with us. To start, we should confess that the whole idea of us bringing up this topic (in writing or in person) makes us feel terribly old. But we hope this choice might reflect the wisdom and perspective that comes with aging.

In recent years we’ve noticed a greater tendency for female counseling and psychology students (especially younger females) to dress in ways that might be viewed as provocative. This includes, but is not limited to, low necklines that show considerable cleavage. Among other issues, cleavage and clothing were discussed in a series of postings on the Counselor Education and Supervision (CES) listserv in 2012. The CES discussion inspired many of the following statements that follow. Please read these bulleted statements and consider discussing them as an educational activity.

• Female (and male) students have the right to express themselves via how they dress and should be able to dress any way they want.
• Commenting on how women dress and making specific recommendations may be viewed as sexist.
• Agencies and institutions have some rights to establish dress codes regarding how their paid employees and volunteers dress.
• Despite egalitarian and feminist efforts to free women from the shackles of a patriarchal society, how women dress is still interpreted as having socially constructed messages that often, but not always, pertain to sex and sexuality.
• Although efforts to change socially constructed ideas about women dressing “sexy” can include activities like campus “slut-walks,” a counseling or psychotherapy session is probably not the venue for initiating a discourse on social and feminist change.
• For better or worse, most middle-school males and middle-aged men (and many “populations” in between) are likely to be distracted—and their ability to profit from a counseling experience may be compromised—if they have a close up view of their therapist’s breasts.
• At the very least, we think excessive cleavage (please don’t ask us to define this) is less likely to contribute to positive therapy outcomes and more likely to stimulate sexual fantasies—which we believe is probably contrary to the goals of most therapists.
• It may be useful to have young women watch themselves on video from the viewpoint of a client (of any sex or gender) and then discuss how to manage sexual attraction that might occur during therapy.

We don’t have perfect answers to the question of cleavage during a clinical interview. Guidelines depend, in part, on interview setting and specific client populations. At the very least, we recommend you think about this dimension of professional attire and hope you’ll openly discuss cleavage and related issues with fellow students, colleagues, and supervisors.

Minding the Body for Males
It’s inappropriate to stop our discussion about sexuality and sexual perceptions without addressing the other end of the sexuality and gender continuum. To start, we should emphasize that, to a large extent, our cautions about cleavage aren’t really about breasts; instead, these are comments about cultural messages pertaining to sex and sexuality and how clients are likely to perceive and react to seeing too much of certain portions of their therapist’s skin. Back in Freud’s day and setting, viewing women’s ankles was reportedly rather titillating. This observation begs the question: “Is it possible for individuals who identify as being on the male end of the sexual identity continuum to dress in ways that might be described as titillating?” When we tried to experiment with this in a group counseling class, mostly the feedback was that the males were being “gross” and “disgusting.”

Despite the fact that our students reacted negatively to the idea of males exposing their skin, we should note that throughout the history of time, therapists who engaged in inappropriate, unethical, and illegal sexual behavior with clients have been disproportionately male. This leads us to conclude that our cautions about females showing cleavage is at the least ironic and at most sexist. Consistent with feminist theory, when men sexualize a woman’s body, it shouldn’t be viewed as the woman’s fault.

These issues are obviously laden with cultural stereotypes, norms, and expectations. In an effort to balance our coverage (no pun intended) of this topic, we went online and asked professionals and colleagues to give us feedback about the “Straight Talk about Cleavage” section. A summary of this feedback is included below.

Feedback on Cleavage
A warning to male therapists: Male therapists need to watch their own flirtatious behavior. They might consult with a female therapist friend to check out anything that might be questionable. I know, most males don’t have cleavage issues, but they sometimes do make provocative comments, such as, “You know, you should take that lovely sexuality of yours and use it to your advantage.” I’m not making this up. Also, they might want to rein in, “You are so pretty. I’ll bet this gets the guys going.” I’m not making this up either. (J. Hocker, personal communication, June 27, 2015).

Extending the conversation to male therapists: I do think part of the unfairness in professional attire for women vs. men is that men’s work wear is simply “easier.” But a woman doesn’t have to dress like a man in order to be taken seriously as a professional. Curiously, I do find that the conversation regarding appearance needs to take place with men; for example, male students who want to wear flip flops, large jewelry, or “muscle” shirts. We also talk about whether or not to wear things that reveal tattoos, hair styles, and so on – so I think men are now as much a part of the conversation as women (S. Patrick, personal communication, June 27, 2015)

A Message from a Licensed School Counselor: I know professionals in counseling and teaching who exhibit poor hygiene, dress, and might toss some cleavage out from time to time. Students do notice, and it’s not cool. In my profession I want students to see me as casual, clean, and someone they’re drawn to for a good ear and safe space. I don’t want them to see cleavage ever. It’s a distraction. Cleavage is sexy and draws attention no matter what. I’m not drawn to women sexually but I’m super distracted by cleav! I can’t imagine how a person attracted to females would react! I find that when I’m not at work there are dates and social functions available that allow me to find my sexy self, but that self doesn’t fit into the school counseling profession. Yes, women should be able to wear what they want, but the reality is if you sport cleav you’ll receive notice by everyone and there’s a time and place to celebrate our cleav; work may not be the place. (M. Robbins, personal communication, June 30, 2015)

The Man’s “Package”: I noticed there’s no mention of a man’s “package” or the open seating posture many men use that gives quite a clear view of any crotch bulging that may be had. I think this deserves to be discussed as well, and not just as an afterthought – it is at least as important as cleavage to the imagination and distraction.

One thing that seems to go on in common discourse is an acceptance of the idea that men are more sexually focused than women. This is problematic on a couple fronts, I think. Although research shows some increased arousal for men from visual stimuli compared to visual stimuli for women BOTH men and women have been shown to be aroused by visual stimuli. BOTH women and men want sex for physical pleasure, not just as a relational tool. The difference is in degree to which these things are acknowledged by each sex, perhaps, but I haven’t seen compelling evidence that there’s actually a difference in the degree to which men and women can be sexually distracted by physical bodies. It’s neither then men’s nor women’s job, then, to “protect” clients from that distraction more than another (C. Yoshimura, personal communication).

Monitoring Flirtatious Behavior
Behavior standards for mental health professionals are high. This is partly true for being a professional of any type. However, mental health professional standards for dress and flirtation are higher than most other professions. If you think about the setting and process, the high standards make sense. Personal disclosures and conversations that happen during clinical interviews and other mental health-related encounters naturally involve non-sexual intimacy. It follows that deep emotional disclosures and exchanges between client and therapist might arouse feelings related to sexual intimacy in clients and/or therapists. It’s perfectly natural for non-sexual intimacy to sometimes trigger feelings of sexual intimacy . . . and so maintaining professional boundaries in this area is essential. All ethical codes that pertain to professional counselors, psychologists, and social workers prohibit sexual contact between therapist and client. The bottom line is that it’s your responsibility, as a mental health professional or student therapist, to closely monitor your attire and behavior to make certain you’re not directly or indirectly communicating flirtatiously with your clients.

 
 

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Attachment-Informed Psychotherapy

In the past decade or so I’ve been fascinated over the immense growth in popularity of all things “attachment.” Don’t get me wrong, I believe attachment concepts are robust, interesting, and sometimes useful. I guess I’m not on the attachment bandwagon . . . but I’m not altogether off the bandwagon either.

Here’s an excerpt from our Counseling and Psychotherapy Theories text on Attachment-Informed Psychotherapy. I wonder, before you read this do you know the MAIN difference between attachment-informed psychotherapy and psychoanalytic psychotherapy? I ask this because mostly psychoanalytic psychotherapy is in disfavor, but attachment approaches are all the rage. Do you know the difference?

Attachment-Informed Psychotherapy

Attachment, both as a model for healthy child development and as a template for understanding human behavior is immensely popular within the United States (Cassidy & Shaver, 2008; Wallin, 2007). This is especially ironic because attachment theory’s rise to glory parallels decreasing interest in psychoanalytic models. If you were to ask a sample of mental health professionals their thoughts on attachment theory, you’d elicit primarily positive responses—despite the fact that attachment theory is a psychoanalytically oriented approach.

John Bowlby, who was raised primarily by a nanny and sent to boarding school at age seven, began writing about the importance of parent-child interactions in the 1950s. He was a psychoanalyst. Similar to other neo-Freudians, Bowlby’s thinking deviated from Freud’s. Instead of focusing on infant or child parental fantasies, Bowlby emphasized real and observable interactions between parent and child. He believed actual caretaker-infant interactions were foundational to personality formation (aka the internal working model).

In 1970, Mary Ainsworth, a student of Bowlby’s and scholar in her own right, published a study focusing on children’s attachment styles using a research paradigm called the strange situation (Ainsworth & Bell, 1970). Ainsworth brought individual mother-child (6 to 18 months) pairs into her lab and observed them in a series of seven 3-minute episodes or interactions.

1. Parent and infant spending time alone.
2. A stranger joins parent and infant.
3. The parent leaves infant and stranger alone.
4. Parent returns and stranger leaves.
5. Parent leaves; infant left completely alone.
6. Stranger returns.
7. Parent returns and stranger leaves.

During this event sequence, Ainsworth observed the infant’s:

  • Exploration behavior.
  • Behavioral reaction to being separated from parent.
  • Behavioral reaction to the stranger.
  • Behavior when reunited with parent.

Based on this experimental paradigm, Ainsworth identified three primary attachment styles. These styles included:

1. Secure attachment.
2. Anxious-resistant insecure attachment.
3. Anxious-avoidant insecure attachment.

In 1986, Ainsworth’s student and colleague Mary Main (1986, 1990), identified a fourth attachment style labeled, disorganized/disoriented attachment.

Many contemporary therapists view attachment theory in general, and Ainsworth and Main’s attachment style formulations in particular, as having powerful implications for human relationships and the therapy process (Eagle, 2003; Wallin, 2007). For example, one of the most popular approaches to couple counseling relies heavily on attachment theory principles (Johnson, 2010). In addition, attachment theory has profoundly influenced child development and parent training programs (J. Sommers-Flanagan & R. Sommers-Flanagan, 2011).

At its core, attachment theory involves an effort to understand how early child-caretaker interactions have been internalized and subsequently serve as a model for interpersonal relationships. This is, of course, the internal working model—with an emphasis on how real (and not fantasized) early relationships have become a guide or template for all later relationships. Byrd, Patterson, and Turchik (2010) describe how attachment theory can help with selecting appropriate and effective interventions:

Therapists may be better able to select effective interventions by taking the client’s attachment pattern into consideration. For instance, a client who is comfortable with closeness may be able to make good use of the therapeutic relationship to correct dysfunctions in his or her working models of self and others. On the other hand, a client who is not comfortable with closeness may find it difficult to change internal working models through the therapeutic relationship. Finally, knowing that a client is not comfortable with closeness would allow the therapist to anticipate a relatively impoverished alliance, and therefore avoid interventions such as insight oriented or object relations therapies that rely heavily on the alliance. (p. 635)

As an internal working model, attachment theory also has implications for how therapists handle within-session interpersonal process. Later in this chapter we provide an attachment-informed psychoanalytic case example (see the Treatment Planning section).

It should be emphasized that many criticisms of attachment theory exist. Some critiques have similarities to criticisms of psychoanalytic theory. Perhaps the greatest criticism is the tendency for individuals to take the Mary Ainsworth’s 21 minutes of behavioral observations with one primary caregiver and generalize it to the entire global population. In this sense, the theory is not especially multiculturally sensitive. It seems obvious that there are many divergent ways to raise children and not all cultures subscribe to the “American” overemphasis and perhaps preoccupation with the infant’s relationship with a single caregiver (usually the mother).

Although scientific critiques have sought to reign in attachment theory as it has galloped its way into pop psychology and the media (Rutter, 1995), its popularity continues to escalate and the consequences seem to magnify the importance of an overly dramatized dance of love between a child and his or her mother. In the following excerpt from A general theory of love, you can see the language is absolute and, interestingly, rather sexist—in that children are typically portrayed as male and parents as female.

One of a parent’s most important jobs is to remain in tune with her child, because she will focus the eyes he turns toward inner and outer worlds. He faithfully receives whatever deficiencies her own vision contains. A parent who is a poor resonator cannot impart clarity. Her inexactness smears his developing precision in reading the emotional world. If she does not or cannot teach him, in adult-hood he will be unable to sense the inner states of others or himself. Deprived of the limbic compass that orients a person to his internal landscape, he will slip through his life without understanding it. (Lewis, Amini, & Lannon, 2001, p. 156)

Take a moment to imagine how Karen Horney or Mary Ainsworth might respond to this overgeneralization of attachment concepts and blaming of mothers for their children’s emotional deficiencies.

John and Nora

 

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An Interview with Natalie Rogers (Daughter of Carl Rogers) about Person-Centered Therapy

Of all the counseling and psychotherapy approaches out there, person-centered therapy might be the most quickly dismissed of them all. I’ve had therapists watch or listen to a PCT demonstration and then make dismissive comments like: “Oh yeah. That was just basic listening skills. I know all about that.”

It’s usually hard for me to figure out how to best respond to that sort of statement. What makes it hard to take is that typically, when someone says something like, “I already know all that Rogerian stuff,” it’s a surefire sign that they really don’t get person-centered therapy.

Although this is mostly just my opinion, it’s also the opinion of Natalie Rogers (daughter of Carl Rogers, the person who originally developed person-centered therapy). The following is an edited excerpt of two telephone interviews I did with her way back in 2003. This excerpt is included in our theories textbook: http://www.amazon.com/Counseling-Psychotherapy-Theories-Context-Practice/dp/0470617934/ref=cm_cr_pr_product_top?ie=UTF8

Additional interview material is in an article published in the Journal of Counseling and Development in 2007: http://onlinelibrary.wiley.com/doi/10.1002/j.1556-6678.2007.tb00454.x/abstract

And even more interview material is resting on the hard-drive of my computer.

Other fun and interesting content about person-centered therapy is in our Student Guide: http://www.amazon.com/Counseling-Psychotherapy-Theories-Context-Practice/dp/0470904372/ref=sr_1_fkmr1_1?s=books&ie=UTF8&qid=1438700878&sr=1-1-fkmr1&keywords=sommers-flanagan+student+guide

Here’s what Natalie had to say about the status of Person-Centered Therapy in the U.S.

Why Is the Person-Centered Approach Undervalued in the United States?

In the following excerpt from two telephone interviews, Natalie Rogers discusses why person-centered approaches tend to be undervalued or overlooked in the United States.

John Sommers-Flanagan (JSF): Other than the managed-care focus and an emphasis on quick fixes, can you think of any reasons why more American therapists aren’t practicing PCT?

Natalie Rogers (NR): That’s a good question. Most psychology students I know only get a chapter or two in the academic world, and they don’t really understand in any depth what the person-centered approach is about. And, most importantly, I think they haven’t experienced it. They’ve read [about] it and they’ve talked about it and they’ve analyzed it, but my own belief is that it really takes in-depth experiencing of the client-centered approach to know the healing power of empathy and congruence and unconditional positive regard.

JSF: So it’s almost like students get more of an intellectual understanding, but you’re just not seeing them get the experiential part.

NR: Even the intellectual understanding is very superficial, because they read maybe a chapter and watch the old Gloria film (Rogers, 1965). The fact that there have been 16 books written on client-centered therapy and a lot of other books now that Carl’s passed away and the research that he did is so profound . . . the in-depth research on what actually helps clients go deeper into their feelings and thoughts.

JSF: Right.

NR: You know, [how therapists can help clients go deeper into their feelings and thoughts] is hardly ever mentioned in academia as far as I know.

JSF: And what I remember from our last conversation was that you said you thought it didn’t happen in the U.S. at all and maybe a little bit in Europe?

NR: I think it does happen a lot more in Europe, and most particularly in the United Kingdom, Scotland and England. They have really excellent training programs in the client-centered approach, and the books that are coming out are coming out from there. You know in Germany they have a several-year, very extensive training program that’s also linked in, I believe, to becoming accredited or licensed as a therapist. Things are going that particular route in Europe, but none of that is here in the States.

JSF: That seems to reflect our own emphasis on the surface or the quick fix as well in that people just really haven’t gone deeper and experienced the power of PCT.

NR: Right. And then again I think the other point is that the ego needs of the therapists [appear] to be strong here. Therapists in this country seem to need to have the attitude that “I have the answers” or at least that “I know more,” and it’s . . . the old medical model that we still hold onto in this country a lot. The doctor knows what he needs to diagnose and treat, knows what’s wrong and that there are ten steps to fix it.

JSF: Right, which seems to be the opposite of the person-centered therapy of “trust the individual, trust the person.”

NR: Not just seems to be, it is the opposite. So, to actually believe, to have faith in the individual, to have faith that each person has the answers within himself or herself if given the proper conditions, and that’s a big if. That philosophy takes a great deal of humility on the part of the therapist.

JSF: For us to realize that we don’t have all the answers for another person.

NR: Right. I kind of like the gardener metaphor. That I’m the gardener and I help till the soil and I help water the plants and fertilize the plants, and care for them. And I need to understand what the plant needs, what conditions that plant needs for it to actually grow and become its full potential. That’s very different. That’s what I see as one metaphor for being a therapist. I don’t know all the answers, but I’m a person who creates the conditions for the person to grow.

JSF: Kind of the fertile field metaphor. So . . . what would you tell beginning therapists that would help them see the tremendous value of following person-centered principles?

NR: Well, I always ask my students to examine their own beliefs about psychotherapy and about what it is that creates psychological feelings and growth. I think it’s a philosophical, spiritual belief system that we’re looking at. People are using the words “methods” and “techniques,” which always puts me off, because although there certainly are methods that we use, it’s much bigger than that. It’s a belief system about the connection between mind, body, and emotional spirit. And so I ask them what do they believe creates personal growth, and what have they experienced themselves that creates growth, and we get them to think and talk about their religious experiences, their psychotherapy experiences, their experiences in nature, and their experiences in relationships. I think they’re all profound. And then when we focus in on relationships, which is what psychotherapy is about, then I want them to experience . . . from me or my colleagues in hour-long demonstrations what it means to be client-centered. So then they experience it as witnesses and they can experience it as a client.

JSF: So more students need to directly experience, or at least witness, client-centered therapy.

NR: Let me give an example. I was talking to a colleague once who had some of my training and who said that he was now using brief therapy, brief psychotherapy, and I admitted I didn’t really know what that was. We decided that he’d have to give me some ideas on what that’s like. So I listened to him describe the theory and practice for quite a while and questioned him about it. And as he was describing it, I was wondering, how would I feel if I were in the client’s chair and this was what was being done to me. And so then I felt pretty uncomfortable, and thought, “I guess I wouldn’t like it.” So I asked him, “Have you ever been a client in this kind of brief therapy yourself?” And he said “No,” and I thought that was inexcusable. To practice something on somebody else that you haven’t experienced in-depth yourself. I think it is inexcusable. So that illustrates in a kind of negative way the point that I wanted to make. You really need to have in-depth experience of that which you are going to have other people do.

 

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Today as Metaphor

[This is just a journal entry from Monday, July 20, 2015. Please ignore if you’re not into that sort of thing.]

Last night I dreamed I was doing the dishes. That’s two nights in a row. My unconscious is telling me I’ve got work to do. It might involve cleaning.

Somewhere early in the day I find myself on an eight-inch wide aluminum plank. I have an electric hand-sander in my right hand. My left arm is wrapped up and around a large beam. It’s only 20 feet down. The logical part of my brain is telling me that, even if I fall there’s little chance of instant death. Nevertheless, I notice the panic oozing from my pores. And so I step slowly out farther onto the plank. It shakes and wobbles. My heart makes its presence known.

Rita has accused me of being afraid of heights ever since she took me out to walk the underside of the Orange Street bridge in Missoula in 1984. She came to this conclusion because I just happened to be crawling along on all fours when she turned to look back at me. I’ve spent the past 30 years denying a fear of heights. “It’s not that I’m afraid of heights,” I say, “I just know my limits.”

I have a former student who would say I’m just being a typical male. My fear of admitting fear is bigger than my fear of heights. That may be so, but I’m not afraid to say that I’m afraid of other things. But a 20 foot drop from a precarious 8 inch plank . . . that’s a simple fear I can handle.

Off and on today is filled with writing and home improvement. I’m officially on sabbatical and working to revise a textbook. I tire of my personal acrophobia exposure experiments and retreat to my standing desk where I proceed to avoid working. Instead, I check:

My email
My twitter account
My LinkedIn account
Facebook
ResearchGate
The major league baseball scores
And my personal and professional blog

This is a ritual of sorts: equal parts procrastination and need for virtual attention

Maybe the next thing I should check is my insecurity.

As I write this Rita is driving to the closest clinic to get her blood drawn to see if her white blood cell count is high enough for her to have chemo on Wednesday. I stay home and write. When she returns we briefly celebrate her increased white blood cell count and then she cleans the duck shed. I head into the evening heat to chop noxious weeds with my Italian grandfather’s machete. While chopping, it’s hard to not think about cancer. The hollyhocks are in bloom, but I still need to be sure to hack the burdock and not the hollyhocks. Chemotherapy is less distinguishing. It hacks all fast-growing cells, including hair cells, stomach cells, and valuable white blood cells.

This is my life today. Nothing is happening and everything is happening. My dreams have retreated to the banal. No nightmares dare awaken me. Like most typical males I’ve escaped reality and walk on narrow aluminum planks from which I’d like to sand away all the cancer on the planet. Sometimes I notice I’m swinging my Grandfather’s machete too hard. But mostly, I want to swing it harder.

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Posted by on August 1, 2015 in Personal Reflections

 

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