Talking about “Teen Love” on the Practically Perfect Parenting Podcast

Hand holding

The latest Practically Perfect Parenting Podcast just went live. You can listen on iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

Or Libsyn: http://practicallyperfectparenting.libsyn.com/

The description of the Teen Love episode is below.

When John mentions the title of this episode of the Practically Perfect Parenting Podcast, Sara emits the sophisticated professional response of “Eewww gross.” Don’t worry. Things get better from there, because you get to hear a wide range of strategies for teaching children about healthy relationships, including Sara’s super-secret and bizarrely named strategy called “the spinach in the muffins technique.” You also get to hear several inappropriate self-disclosures, unfair accusations (as in when Sara says John just wants to reminisce about his Teen Love experiences), the Romeo and Juliet effect, and how much Sara’s teenage boys look forward to her talking with them about sexuality and intimacy. In the end, we agree that healthy relationships are the number one predictor of happiness and offer fantastic resources like the Dibble Institute https://www.dibbleinstitute.org/ and the CDC’s Teen Dating Violence webpage:  https://www.cdc.gov/violenceprevention/intimatepartnerviolence/teen-dating-violence.html.

The Practically Perfect Parenting Podcast (PPPP) is brought to you in part by the Charles Engelhard Foundation and the National Parenting Education Network . . . but you should also be aware that the views expressed on this and every episode of the PPPP do not necessarily reflect the views of our sponsors, our listeners, or anyone other than Sara Polanchek and John Sommers-Flanagan. . . and, of  course, sometimes we’re not even certain that we agree with what we just said.

The PPPP provides general educational information designed to promote positive parenting practices, but this podcast should not be considered a source of professional advice. If you have questions about specific parenting or caretaking scenarios, we recommend that you seek professional services with someone who can help you address the unique situations that you’re facing in your life.

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How to Make a Collaborative Plan for Terminating Counseling without Ever Using the Word Termination

Stone Smirk

Not long ago I noticed some of my excellent and well-intended supervisees talking with their clients about “termination.” They would say things like, “We need to prepare for termination” or “Let’s talk about termination today.” When this happened, I’d get nervous, squirm a bit, and eventually find a way to tell my supervisees that, although we use the word termination all the time when talking with each other ABOUT counseling, we shouldn’t use it when talking with clients DURING counseling.

Instead of saying termination, it’s preferable to talk about final sessions, or the ending of counseling, or to use normal and jargon-free words that speak to the reality that all good things—including counseling—must end. Sometimes the number of counseling sessions possible is dictated in advance by employee assistance program guidelines or insurance companies; other times, clients and counselors have more freedom to work together as long as the work is helpful or productive. Either way, ongoing conversations linking goals to progress is a part of an evidence-based approach to counseling and psychotherapy. Effective counselors connect the “ending” of counseling with the goals that were, in the beginning of counseling, collaboratively identified (and then possibly modified as needed).

Although you should use your own words, statements like some of the following can help you talk with clients or students about termination without using the word termination.

  • “Let’s talk about how our counseling is going and whether we’re making progress toward your goals”
  • “How do you feel about our counseling together?”
  • “I’d love to talk about what I can do differently to keep helping you move forward toward your goals.”

Speaking of termination—and now I’m speaking to you and not my clients—below you’ll find a Termination Checklist that you might find helpful as you talk with your students about preparing for termination. As will everything, this checklist is imperfect, but it’s a good start to help all of us address the ending of counseling, before counseling actually ends.

Termination Checklist

[Adapted from Sommers-Flanagan, J., and Sommers-Flanagan, R., (2007).
Tough Kids, Cool Counseling: User-Friendly Approaches with Challenging Youth.
Alexandria, VA: American Counseling Association]

This is a guide to help you think about termination—even though some of the details will be different for you and your client(s).

_____ 1. At the outset and throughout counseling, identify progress in the movement toward termination (e.g., “Before our meeting today, I noticed we have 4 more sessions left,” or “You are doing so well at home, at school, and with your friends. . . let’s talk about how much longer you’ll want or need to come for counseling”).

_____ 2. Reminisce about early sessions or the first time you and your client met. For example: “I remember something you said when we first met, you said: ‘there’s no way in hell I’m gonna talk with you about anything important.’ Remember that? I have it right here in my notes. You weren’t exactly excited about coming for counseling.”

_____ 3. Identify and describe positive behaviors, attitude, and/or emotional changes. This is part of the process of providing feedback regarding problem resolution and goal attainment: “I’ve noticed something about you that has changed. Do you mind if I share what I’ve noticed?” [Client gives permission]. It used to be that you wouldn’t let adults get close to you. And you wouldn’t accept compliments from adults. Now, from what you and your parents tell me and from how you act in here, it’s obvious that you give adults a chance. You don’t automatically push adults away from you. I think that’s a good thing.”

_____ 4. You should acknowledge, in advance, that the end of counseling is coming up, but there’s a possibility you’ll see each other in the future. “Our next session will be our last session. I guess there’s a chance we might see each other sometime, at the mall or somewhere. If we do see each other, I hope it’s okay for me to say hello. But I want you to know that I’ll wait for you to say hello first. And of course, if we see each other in public, I’ll never say anything about you having been in counseling.”

_____ 5. Identify a positive personal attribute that you noticed during counseling. This should be a personal characteristic separate from your client’s goals: “From the beginning of our time together, I’ve always enjoyed your sense of humor. You’re really creative and really funny, but you can be serious too. Thanks for letting me see both those sides. It took courage for you to get serious and tell me how you’ve been feeling about your mom.”

_____ 6. If there’s unfinished business (and there always will be) provide encouragement for continued work and personal growth: “Of course, your life isn’t perfect, but I have confidence that you’ll keep working on communicating well with your sister and those other things we’ve been talking about.” You may want to say that even though your client doesn’t “need” counseling, choosing to come back for counseling in the future might be helpful: “You know some people come to counseling to work on big problems; other people come because they find counseling helps them be a better person; and other people just like counseling. You might decide you want start up again for any of these reasons.”

_____ 7. Provide opportunities for feedback to you: “I’d like to hear from you. What did you think was most helpful about coming to counseling? What did you think was least helpful?” You can add to this any genuine statements about things you wish you’d done differently. For example, if your client got angry at you for misunderstanding something and this was processed earlier, you might say: “And of course I wish I had heard you correctly and understood you the first time around on that [issue], but I’m glad we were able to talk through it and keep working together.”

_____ 8. If it’s possible, let the client know that he or she may return for counseling in the future: “I hope you know you can come back for a meeting sometime in the future if you want or need to.”

_____ 9. Make a statement about your hope for the client’s positive future: “I’ll be thinking of you and hoping that things work out for the best. Of course, like I said in the beginning, I’m hoping you get what you want out of life, just as long as it’s legal and healthy.”

_____ 10. As needed, listen to and discuss how your client is feeling about ending counseling. Don’t make this into a big deal, but offer opportunities for the client to say “I can hardly wait for the end of this counseling crap” or “I wish we could keep meeting.” Whatever your client is feeling about termination warrants respectful listening.

_____ 11. Consider a parting gift. Although I don’t routinely recommend this with adults, with young clients you might give a meaningful gift at the end of counseling. It could be anything from a painted rock to a blank notebook for writing or a written card. The point is to give a gift that’s not especially expensive, but that might hold meaning for your client in the future.

For more information on termination with youth, go to: https://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly-ebook/dp/B00QYU630Q/ref=sr_1_7?s=books&ie=UTF8&qid=1550512844&sr=1-7&keywords=sommers-flanagan

The End of Mental Illness, Part I

Irrigation Sunrise

For years I’ve planned to write a scintillating review of the words and phrases I now, as a wise and mature adult, refuse to use. The “c-word” (expelled in 1976) and “r-word,” (out forever in 1980), and “n-word” (never used) are notable, but they’re old and tired targets that most self-respecting people in the 21th century have also banished.

BTW, I got rid of tireless in 1988 (who doesn’t get tired, especially after the birth of a child, an all-nighter, or a long day’s work?). On a related note, I got rid of countless in the early 1980s, when, while studying statistics, it became obvious to me that everything was countable, unless you got too tired or too lazy to do the counting. But, even then it didn’t make much sense to just stop counting or to lose track and suddenly declare something countless. More than anything else, the word countless struck me as lazy. I would go with the lazy explanation for countless were it not for the fact that I also eliminated lazy from my vocabulary about 15 years ago when I read about Alfred Adler’s description of people who are lazy as not lazy, but instead people whose goals are beyond their reach and consequently, they experience discouragement (and not laziness).

More recently, I’ve grown weary of “the new brain-science” (how can it be that the media continues to refer to science from the 1990s as perpetually “new” but somehow the pleats in my pants have become so “old-fashioned” that I can no longer wear them in public?). On a related note, neurocounseling and neuropsychotherapy would be on my list for potential banishment, but because they’re new terms that people invented (along with polyvagal), purely for marketing purposes, they can’t be banished, because quite conveniently, I refuse to acknowledge their existence.

All this silly ranting about words makes me sound like a crank—even to myself. But as I get older, I find that worries over sounding like a crank are, in fact, more motivating than worrisome. Indeed, I’m embracing my intellectually snooty crankiness as evidence that I’m fully addressing the crisis inherent in Erik Erikson’s seventh psychosocial developmental stage: Generativity vs. Stagnation. Yes, that’s right, instead of stagnating, I’m cranking my generativity up to a level commensurate with my age.

In contrast to all these aforementioned banished or unacknowledged words, most people (who are otherwise reasonably intelligent) continue to use the term mental illness. As a consequence, the words mental illness have now risen to the coveted #1 spot on my billboard of eliminated words.

My preoccupation with avoiding term mental illness isn’t a news flash, as my University of Montana students would happily attest. For well over a decade, I’ve been explaining to students that I don’t use the term mental illness, and warn them, with what little roguish power I can muster, that perhaps when handing in their various papers throughout the semester, they also, at least for the time being and so as to not irritate their paper-grader, ought to follow my lead.

In my social life, whenever mental illness comes up in conversation, I like to cleverly state, “I never use the term mental illness unless I’m using it to explain why I never use the term mental illness.” This repartee typically piques the interest (or ire) of my conversational cohort, usually stimulating a question like, “Why don’t you ever use the term mental illness?”

“Wow. Thanks.” I say. “I thought you’d never ask.”

Three main cornerstones form the foundation for why I’ve made a solemn oath to stop privileging the words mental illness. But first, a tangential example.

This morning, once again, I’m awake at 3:30am, despite my plan to sleep until 7:00am. I know this awakening experience very well; I also know the label for this experience is insomnia, or, more specifically, terminal insomnia, or more casually known as, early morning awakening.

After this particular early morning awakening, I briefly engaged in meditative breathing until my thoughts crowded out the meditation. Having thoughts bubble up and crowd out meditative breathing is probably a common phenomenon, because neurotic thoughts, spiritual thoughts, existential thoughts, and nearly any thoughts at all, are nearly always far more interesting than meditative breathing.

A favorite statement among existentialists is that humans are meaning makers. As with many things existential, the appropriate response is something my teenage clients have modeled for me, “Well, duh.” Channeling my ever-present inner-teen, I want to respond to my inner-existentialist with a pithy retort like, “Yeah. Of course. Humans are meaning makers. Maybe we should talk about something even more obvious, like, we all die.”

What I find fascinating about the existential claim that humans are meaning makers is that existentialists always say it with gravity and amazement, as if being a meaning-maker is a profoundly good thing.

But, like life, meaning-making is not all good, and sometimes, not good at all. As I lay in bed along with my early morning awakening, it’s nearly impossible not to begin wondering about the meaning of the dream that woke me up (there was a broken anatomical bust of Henry David Thoreau in a small ocean-side creek at Arch Cape, Oregon); even more engaging however, is the so-called lived experience of terminal insomnia, and so my middle-of-the-night dream interpretation gets pushed aside for a more pressing question. “What’s the meaning of my regular waking in the middle of the night?” My brain, without consent, calls out this question, in an all-natural and completely unhelpful lived meaning-making experience. The explanations parade through my hippocampus: Could my awakening be purely physiological? Could it be that I missed my daily caffeine curfew by 30 minutes? Perhaps this is the natural consequence. But if so, why would I awaken now, after falling asleep as my head hit the pillow and sleeping for 4½ hours, instead of having a more easily explained experience of initial insomnia.

Of course, the most common explanation for early morning awakening is neurochemically filed in my brain and easily accessible. Without effort, I recall that terminal insomnia is a common symptom of clinical depression. I’ve known that for about 40 years. Now, by 3:45am, the various competing theories have completely crowded out my breathing meditation and will settle for nothing less than my full attention.

Is my terminal insomnia simply a product of the half-life of caffeine, or a full-bladder, or primary insomnia? Or is it something even more malignant, a biological indicator of clinical depression? Do I have a mental disorder? Although that might be the case, after briefly depressing myself with the contemplation of being depressed, I also begin refuting that hypothesis. My memory of taking an online “depression” test emerges, along with my score in the mild-to-moderate depression range. I might have believed the online questionnaire result, had it not been conveniently placed on the website of a pharmaceutical company and had it not culminated in the message, “Your score indicates you may be experiencing clinical depression. Check with your doctor. Lexapro may be right for you?”

Given that I’m absolutely certain that Lexapro isn’t right for me, the pattern analysis and search for deeper meaning breaks down here. I am a meaning-maker. I woke up at 3:30am. Now it’s 4am and I’m still awake. So what? It happens. When it does, I like to get up and write. It’s productive time. My stunning meaning-making conclusion is my usual conclusion: believing that I have a mental disorder is unproductive; in contrast, believing that I’m creatively inspired to write at 3:30am is vastly preferable and consistent with what Henry David Thoreau would want me to do in this moment.

What does all this have to do with eliminating the term mental illness from the human vocabulary?

Mental Illness Lacks a Suitable Professional Definition

Mental illness is a term without a professional or scientific foundation. Even the American Psychiatric Association doesn’t use mental illness in its latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The World Health Organization doesn’t use it either. I pointed out this fun fact while attending a public journalism lecture at the University of Montana. I asked the journalist-speaker why she used “mental illness” when the American Psychiatric Association and World Health Organization don’t use it. Initially taken aback, she quickly recovered, explaining that she and other journalists were trying to put mental health problems on par with physical health problems. That’s not a bad rationale. Mostly I want mental and physical health parity too, but what I don’t want is an assumption that all mental health problems are physical illnesses and therefore require medical treatments. Besides, whenever people make up (or embrace) non-professional and scientifically unfounded terminology to further their goals, their goals begin to seem more personal and political and less pure. In the end, I don’t think it’s right to make up words to negatively classify a group of fellow humans.

A side note: The American Psychiatric Association and World Health Organization are not left-leaning bleeding hearts; they would happily use mental illness if they felt it justified. Back in 2000, the authors of the 4th edition of the Diagnostic and Statistical Manual explained their reasoning:

The term “disorder” is used throughout the classification, so as to avoid even greater problems inherent in the use of terms such as “disease” and “illness.” “Disorder” is not an exact term, but it is used here to imply the existence of a clinically recognizable set of symptoms or behavior associated in most cases with distress and with interference with personal functions. Social deviance or conflict alone, without personal dysfunction, should not be included in mental disorder as defined here.

Broadly, my first reason for refusing to use the term mental illness is that it’s not used in the definitive publications that define mental disorders. It’s too broad and consequently, unhelpful. If mental illness isn’t good enough for the American Psychiatric Association and the World Health Organization, it’s not good enough for me.

Mental Illness is Too Judgmental

When asked about diverse sexualities, Pope Francis summarized my second reason for not using the term mental illness. He famously responded, “Who am I to judge?” I love this message and believe it’s a good guide for most things in life. Who am I (or anyone) to judge (or label) someone as having a mental illness?

You might answer this question by recognizing that I’m a mental health professional and therefore empowered to judge whether someone has a mental disorder; I’m empowered to apply specific mental disorder labels (after an adequate assessment). Sure, that’s all true. But I also have a duty to be helpful; although the communication of a diagnostic label might be helpful for professional discourse, insurance reimbursement, and scientific research, I don’t see how it’s helpful to categorize a whole group of individuals as “the mentally ill.” Hippocrates founded medical science. His first rule was “Do no harm.” As fun and entertaining as diagnosing other people and myself may be, I’ve come to the conclusion that doing so is often more harmful and limiting than good.

Think about it this way. Would it be any LESS helpful for us to delete the words “the mentally ill” and replace them with “people with mental health issues?” I think not. But you can decide what fits for you.

To the extent that it’s helpful to individual clients or patients, I’m perfectly fine with, after an adequate collaborative assessment process, diagnosing individuals with specific mental disorders. I believe that process, when done well, can help. What I’m against is using a broad-brush to label a large group of fellow humans in a way that can be used for oppression and marginalization. Why not just say that everyone has mental health problems and that some people have bigger and harder to deal with mental health problems. As Carl Jung used to say, “We’re all in the soup together.”

Mental Illness Resists De-stigmatization

Mental illness and its proxies, mental disease and brain disease, are inherently, deeply, and irretrievably stigmatizing. I know several different national and local organizations that are explicitly dedicated to de-stigmatizing mental illness. My problems with this is that the words mental illness are already so saturated with negative meaning that they resist de-stigmatization. The words mental illness instantly and systematically shrink the chance for therapeutic change and positive human transmorgrification.

If you look back in time, you’ll find that mental illness was created by people who typically have a political or personal interest in labeling and placing individuals into a less-than, worse-than, not-as-good-as, category. The terminology of brain disease and brain-disabling conditions are even worse. What I’m wishing for are kinder, gentler, and less stigmatizing words to describe the natural human struggle with psychological, emotional, and behavioral problems. If you’ve got some, please send them my way. I need help in my tireless efforts to let go of my crankiness and embrace hope, especially when I wake up in the middle of the night.

 

My Incredibly Insightful Comments on Self-Disclosure in Therapy from Counseling Today Magazine

Here’s a photo of me talking too much.

OLYMPUS DIGITAL CAMERA

Now imagine that I finally realize I’m talking too much, and to control myself, I place my hand over my mouth

***************************

Along with 10 other professionals, I was asked to write 300 words on using self-disclosure in counseling. All the comments were published this morning in the Counseling Today magazine.

I liked all the commentaries. You can read them here: https://ct.counseling.org/2019/01/counselor-self-disclosure-encouragement-or-impediment-to-client-growth/

But I was especially happy to see that three of the 11 selected professionals were linked to the University of Montana. Kim Parrow (doc student) and Sidney Shaw (former doc student) both provided their insights for the article. How cool is that?

Speaking of cool, and I know this isn’t appropriate, but I really liked my own commentary. I liked it partly because it sounds pretty smart and partly because I do a nice job of making fun of myself. And so here’s my short comment about self-disclosure in counseling:

My first thought about self-disclosure is that it’s a multidimensional, multipurpose and creative counselor response (or technique) that includes a fascinating dialectic. On one hand, self-disclosure should be intentional. If counselors aren’t aware that they’re using self-disclosure and why they’re using it, then they’re probably just chatting. On the other hand, self-disclosure should be a spontaneous interpersonal act.

Self-disclosure is an act that involves revealing oneself. As Carl Rogers would likely say, if your words aren’t honest and authentic, then your words aren’t therapeutic. From my perspective — which is mostly person-centered — the purest (but not only) purpose of self-disclosure is to deepen interpersonal connection. As multicultural experts have noted, self-disclosure can facilitate trust more effectively than a blank slate, because transparency helps clients know who you are and where you stand. What’s less often discussed is that it’s impossible to not self-disclose; we’re constantly disclosing who we are through our clothing, mannerisms, informed consent form, office accoutrements and questions.

I remember working with a 19-year-old white, cisgender, heterosexual male. He told me he was diagnosed as having reactive attachment disorder. After listening for 15 minutes, I was convinced that there was no possible way he could meet the diagnostic criteria for reactive attachment disorder. First, I used an Adlerian-inspired question/disclosure: “What if it turned out you didn’t really have reactive attachment disorder?”

You might not consider a question as self-disclosure, but every question you ask doesn’t simply inquire, it simultaneously reveals your interests.

Later, I disclosed directly, using immediacy: “As I sit and listen to all your positive relationships, it makes me think you don’t have reactive attachment disorder.” Despite my interpersonally clever use of an educational intervention embedded in a self-disclosure, my client didn’t budge, countering with, “That doesn’t make any sense, because I’m diagnosed with reactive attachment disorder.”

At that point, I wanted to use self-disclosure to share with him all the ways in which I was a smarter and better health care professional than whoever had originally misdiagnosed him. Fortunately, I experienced a flash of self-awareness. Instead of using disclosure to enhance my credibility, I spontaneously disclosed, “I’ve been talking way too much. I’m just going to put my hand over my mouth and listen to you for a while.”

As I put my hand over my mouth, my client smiled. The rest of the session was — in both our opinions — a rousing success.

 

Peggy Bit Me

Peggy Ellen (Sommers) Lotz was born on a cool, crisp day in Vancouver, Washington. The high temperature was 45 degrees. I know that because I read it in the Farmer’s Almanac. The date was January 28, 1955. That makes today her birthday. Happy Birthday Peggy!

Peggy is my older sister (but not the oldest; that distinction goes to Gayle, who will get her story later).

According to family legend, Peggy first introduced herself to me by biting my big toe. I was a newborn, my mother was holding me. Apparently, at age 2¾, Peggy didn’t appreciate me stealing all of our mother’s attention. I very much wish this incident had been video-recorded, not just for historical posterity, but also because I know it would go viral on the internet, just like the “Charlie bit me” video. Besides, if I had the video it would also mark the only time in recorded history that Peggy ever did anything mean toward anyone else.

I’ve long since forgiven Peggy for biting me. It was easy because of who she was, is, and always will be.

Throughout my childhood and teen years, Peggy would say terrible things to me like, “I’m busting with pride over you” and “I’m you’re biggest fan.” Seriously. And she meant it. I’ve read about this thing called sibling rivalry; I just never experienced it. There’s a famous psychologist named Alfred Adler who wrote about how children who are encouraged can do nearly anything. Peggy is the most flat-out encouraging person I’ve ever met. She helped me believe in myself. And that biting incident . . . well, knowing Peggy, I probably deserved it.

Peggy is pure of heart. From age 2¾—to whatever age she’s turning today—Peggy has acted toward others with kindness. Everything she does is laced with good intentions. Teach special education children. Check. Get your Master’s degree and become a school counselor. Check. Be a force for defending children from abuse. Check. Be a fantastic mom. Check. Return to the regular classroom and teach another decade because you love teaching and you love children and they love you. Check. Take care of our mother who needs caretaking. Check.

Growing up, our mom always said Peggy would become a social worker because she had empathy for everyone, took care of injured animals, and was naturally the most amiable person in our family, on our block, and maybe on the planet. If you need something, call Peggy.

Peggy is also smart and funny. Like most of us, she’s at her funniest when she’s not even trying. Take, for example, some profound “Peggy sayings.” My favorites are, “Nobody’s gonna pull the wool over my shoulders” and “You just gotta keep your shoulder to the grindstone.”

When you see her next, you might want to ask her if she has a thing about shoulders.

She also loves it when I tell the story of how surprised she was that they didn’t make her get a new driver’s license when she moved to Pullman to go to Washington State University. Be sure to ask about that too.

Peggy, today is your birthday. You being born was a happy day in the world.

I hope you know I’ve forgiven you for the biting thing. I also hope you know how much I admire you for who you are and the kindness you spread in the world. I hope you know that I know, you are a gift to me, our family, and so many more people.

And I hope you know I’m busting with pride over you, because, as you probably already know, nobody’s pulling any wool over my shoulders.

I love you Peggy. Have a fantastic birthday. You deserve it.

Guidelines for Using Congruence in Counseling and Psychotherapy

20160709_135123

Consistent with my recent preoccupation with evidence-based relationships in counseling and psychotherapy, I’m posting a short excerpt from the 6th edition of our Clinical Interviewing textbook (check it out here: https://www.amazon.com/gp/product/1119215587/ref=dbs_a_def_rwt_bibl_vppi_i0)

Here’s the excerpt, coming at you from Chapter 7: Evidence-Based Relationships.

Students often have questions about how congruence sounds and looks in a clinical interview. Common questions (and brief answers) follow:

  • Does congruence mean I say what I’m really thinking in the session? [Usually not. Your thoughts may mean something important and may warrant being shared at some point, but initial spontaneous thoughts and reactions to clients should stimulate personal reflection, not immediate disclosure.]
  • What if I dislike something a client says or does? Am I being incongruent if I don’t express my dislike? [No. If you have an aversion to something your client says or does, reflect on it, rather than reacting with judgment. As Rogers (1957) recommended, if you have a negative reaction, try to transform it to your internal experience and find a way to express it in a positive manner.]
  • If I feel sexually attracted to a client, should I be “congruent” and share my feelings? [Absolutely not. As discussed in Chapter 2, you should NEVER share feelings of sexual attraction with clients. Doing so is manipulative and unethical. Deal with your sexual issues and attractions in supervision and on your own time.]

One general guideline for determining when and how to be transparent or congruent is to ask: Would the disclosure help facilitate my client’s work?  Making this decision involves relying on your clinical judgment—which is difficult for everyone, but especially for new clinicians. Too much self-disclosure—even in the service of congruence or authenticity—can muddy the assessment or therapeutic focus. The key is to maintain balance; self-disclosure in the service of congruence should be limited, purposeful, and based on solid theoretical foundations (Ziv-Beiman, 2013)

Rogers (1958) was wary about excessive self-disclosure:

Certainly the aim is not for the therapist to express or talk about his (sic) own feelings, but primarily that he should not be deceiving the client as to himself. At times he may need to talk about some of his own feelings (either to the client, or to a colleague or superior) if they are standing in the way. (pp. 133–134)

Imagine that you’re working with a client and you feel the impulse to self-disclose in the spirit of being congruent. If you’re not confident your comment will be facilitative or will keep the focus on the client, then you shouldn’t disclose. Given the challenges inherent in deciding how to be congruent, you should discuss struggles with self-disclosure with peers or supervisors. This can deepen your understanding of how to be therapeutically congruent.

Based on recommendations from the literature (Farber, 2006; Kolden et al., 2011; Ziv-Beiman, 2013) and our own clinical experiences, we offer the following guidelines for self-disclosures:

  • Examine your motives for the self-disclosure you have in mind.Is it more about you or more about your client?
  • Ask yourself if the disclosure is likely to be facilitative.
  • Ask yourself if the comment will keep the focus on the client or will it distract from the client’s process and issues?
  • Consider the possibility of a negative reaction. Could your client respond in a negative or unpredictable manner?
  • Remember, congruence doesn’t mean you say whatever comes to mind; it means that when you do speak, you do so with honesty and integrity.

Case Example 7.1:

Congruence Across Cultures

Cultural identity has many dimensions (Collins, Arthur, & Wong-Wylie, 2010). In this example, during an initial clinical interview with an African American male teenager, the clinician uses congruence across several different cultural domains.

Client: This is stupid. What do you know about me and my life?

Clinician: I think you’re saying that we’re very different and I totally agree. As you can probably guess, I’ve never been in a gang or lived in a neighborhood like yours. And you can see that I’m not a Black teenager and so I don’t know much about you and what your life is like. But I’d like to know. And I’d like to be of help to you in some way during our time together.

This clinician is being open and congruent and speaking about obvious differences that might interfere with the clinician-client relationship. It would be nice to claim that being open like this always improves clinician-client connection, but nothing always works. However, as researchers have reported, congruence tends to facilitate improved treatment process and also contributes to positive outcomes, at least in small ways (Kolden et al., 2011; Tao, Owen, Pace, & Imel, 2015).

Top Blogs for 2018

JSF Dance Party

Reviewing the past is a bit easier than predicting the future; so despite my love predicting what will happen tomorrow, today’s blog is about yesterday.

Last year was rough. Nearly everyone agrees on that, although I suspect that finding consensus on who to blame for last year’s roughness would make fodder for unpleasant argument rather than agreement.

In the midst of all this disagreement, I decided to see which of my blogs garnered the most interest. That’s sort of like picking out blog posts that were agreeable reads.

I recognize that this info might only be of interest to me. Then again, this is a blog and blogs are traditionally about whatever interests the blogger. Sorry about that. There’s no peer review. Apparently I submitted this post to myself and it passed my rigorous editorial review.

First, a look way back to late 2011 when this blog started with what one of my favorite topics: the amazing Mary Cover Jones. https://johnsommersflanagan.com/2011/11/25/a-black-friday-tribute-to-mary-cover-jones-and-her-evidence-based-cookies/

Back then, in 2011, I had a total of 1,522 blog “hits” with the top blog being a very short “26 Years with Rita” message. https://johnsommersflanagan.com/2011/12/30/26-years-with-rita/

In 2012, the first full year of JSF blogging, there were 15,486 hits, with the favorite new 1,167 hit post being “Two Sample Mental Status Examination Reports.”

Fast forward to 2018. Overall there were 156,811 hits, with the hottest post–by a landslide with 62,647 hits being. . . drum roll: “Two Sample Mental Status Examination Reports.”  https://johnsommersflanagan.com/2012/08/10/two-sample-mental-status-examination-reports/

The second most popular post of 2018 was:

The wildly popular 2015 post (with 14, five star likes) “Constructive vs. Social Constructionism: What’s the Difference?” and 11,691 hits. https://johnsommersflanagan.com/2015/12/05/constructivism-vs-social-constructionism-whats-the-difference/

The top three new posts from 2018 were:

#1: “Bad News in Threes” https://johnsommersflanagan.com/2018/06/08/bad-news-in-threes-kate-spade-anthony-bourdain-and-the-cdc-suicide-report/

#2: “The Diagnostic Clinical Interview” https://johnsommersflanagan.com/2018/02/27/the-diagnostic-clinical-interview-tips-and-strategies/

#3: “New Journal Article” https://johnsommersflanagan.com/2018/03/09/new-journal-article-conversations-about-suicide-strategies-for-detecting-and-assessing-suicide-risk/

Okay. That’s enough self-reflection. Soon and next, I’ll be posting my 2018 New Year’s resolution. Here’s to hoping that happens soon.

And for now, before we run out of January. . .

Happy New Year!

 

 

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