Integrating Multicultural Sensitivity into CBT

Woman Statue

A question and brief discussion on Twitter about integrating multicultural competence into CBT inspired me to look back and see what the heck we wrote for that section in our theories text. In the Twitter discussion, we agreed that Pam Hays’s work on CBT and multicultural content is good.

Here’s what I found in our theories text. Obviously it’s a short section and limited, but there are a few interesting points and a citation or two.

Cultural and Diversity Considerations in CBT

CBT focuses on symptoms as manifest within individuals. This position can be (and is) sometimes viewed as disregarding important culture, gender, and sexual diversity issues. For most cognitive-behavioral therapists, culture, gender, and sexuality aren’t primary factors that drive successful outcomes.

This position is a two-edged sword. In the featured case (in Chapter 8), Richard is a white male living a life squarely in the middle of the dominant culture. The therapist was committed to Richard’s well-being. If the client had been an Asian Indian or a bisexual or a woman experiencing domestic abuse the cognitive-behavioral therapist would have been equally committed to the client’s well-being. This is the positive side of CBT being less diversity-oriented.

The negative side is that CBT can be viewed and experienced as blaming clients for their symptoms, when the symptoms may be a function of diversity bias. D. Dobson and K. S. Dobson (2009) articulated the potential for clients to experience blame,

By virtue of looking for distorted thoughts, cognitive-behavioral therapists are more likely than other therapists to find them. Furthermore, some clients do react to the terms distorted, irrational, or dysfunctional thinking. We have heard clients say something to the effect—” Not only do I feel bad, but now I’ve learned that my thoughts are all wrong.” (p. 252)

Awareness of the possibility of client blaming is crucial. For example, what if Richard were a Black American male? And what if his therapist noticed that Richard’s thought record included numerous personalization examples? If so, instead of concluding that Richard is displaying oversensitivity and paranoid cognitions, his therapist should explore the possibility of microaggressions in Richard’s daily life.

The term microaggression was coined by Chester Pierce (1978). Microaggressions were originally defined as “the everyday subtle and often automatic ‘put-downs’ and insults directed toward Black Americans” but now this is expanded so they “can be expressed toward any marginalized group in our society” (Sue, 2010, p. 5).

Microaggressions are typically unconscious. For example, we had a female client come to us in great distress because her vocational instructor had told her “You’re pretty strong for a girl.” Although the vocational instructor defended his “compliment,” the young woman clearly didn’t experience the statement as a compliment. In this circumstance if a therapist is insensitive to culture and gender issues, the young woman might feel blamed for having irrational thoughts and overreactive behaviors. Sue (2010) recommends that mental health professionals exercise vigilance to address microaggression issues inside and outside of counseling. One way in which cognitive behavioral practitioners have addressed the potential for committing microaggressions against sexually diverse clients is by using LGBTQ affirmative CBT (Pachankis, Hatzenbuehler, Rendina, Safren, & Parsons, 2015).

Returning to racial/cultural microaggressions, let’s briefly pretend that Richard is a 6′7′′ Black American male. In his thought record he notes:

Situation: Walking into the local grocery store. Young female makes eye contact with me and then quickly turns around and goes back and locks her car.

Thoughts: She thinks I’m going to steal her car.

Emotions: Anger.

Behavior: I act rude toward her and toward other white people I see in the store.

If the Black American version of Richard has a therapist who looks at this thought record and then talks with Richard about the distorted thinking style of mind-reading (“Richard, you didn’t really know what she was thinking, did you?”) this therapist is showing cultural insensitivity and will likely be fired by Richard. This is an example of one of the many growing edges CBT should address with respect to women and minority clients.

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

As always, your reactions to this content are welcome.

 

Three Top Jokes from the Funniest Counseling and Psychotherapy Theories Text on the Planet

Corey Wubbolding and SF

Rita keeps saying I’ve been laughing more. Last night we were watching an Australian soap opera featuring an overly aggressive goat. I got the giggles. Maybe it’s all this focus on happiness lately. Then again, we’re also writing a suicide assessment and treatment book, which partly translates into living in and cherishing every moment. So who really knows what’s up with me thinking angry goats are funny?

Last week I did a Zoom appearance in Dr. Julia Taylor’s theories class at the University of Virginia. As usual (this is my third year visiting her class), Julia had her students well-prepped; we had a fantastic discussion. One student, much to my delight, said our theories text was the funniest text ever, and that she learned more from it than she had in four years of reading undergraduate textbooks. I, of course, heartily agreed and thanked Alexis (I still remember her name) for her wonderful comments.

As a textbook writer, I don’t get a ton of positive feedback, but when I do, it tickles my heart and makes my day.

Today, after doing a private consultation with a mental health counselor in Denmark, I sent out a copy of the CBT chapter from our theories text. Before sending it, I read the first paragraphs, and laughed out loud. I’d forgotten that we somehow left my free associations about cognition in the chapter opening. I laughed partly because the prose was hilarious and partly because of a tinge of embarrassment that my irreverent writing might be just too much for some readers. Oh well. I hope not.

More importantly, reading that paragraph made me decide to feature three IMHO hilarious excerpts from our Counseling and Psychotherapy Theories in Context and Practice textbook (Yes, it’s funnier than it sounds, but then, that’s a very low hurdle). https://www.amazon.com/gp/product/1119473314?pf_rd_p=ab873d20-a0ca-439b-ac45-cd78f07a84d8&pf_rd_r=FT4RVJG8794EET839Y97

Excerpt One: Free Associating to Cognition

Chapter Eight starts with the following magic.

We have many ideas about how to open a chapter about cognition. John wanted to say something pithy like, “You are what you think,” but Ralph Waldo Emerson got there first. Rita was considering, “As a woman thinketh” (a feminist version of James Allen’s 1903 book titled, “As a man thinketh”), but John countered with “As a person thinketh” and by then we’d grown weary of the word thinketh. Then Rita waxed Shakespeare-esk, saying, “There is nothing either good or bad but thinking makes it so” which seemed a little better than the Buddha’s, “What you think you become” until we found the writings of Hafiz (a 14th century Persian poet):

Zero

Is where the Real Fun starts

There’s too much counting

Everywhere else!

(Ladinsky, 1996, p. 47)

Although Albert Ellis might respond to this poem by asking, “What the Holy Hell are you thinking,” we thought it was about clearing a cognitive space for meditation. Let’s start with zero.

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

Okay. Just in case you’re not ROTFL now, here’s a clip from the existential chapter that will knock your socks off. This comes under the heading, “The I-Am Experience”

Excerpt Two: Existentialists and Hyphens

Existentialists like to use hyphens to capture the interconnectedness of phenomenological experience. For example, in contrast to May’s I-am experience, Boss (1963) and Binswanger (1933) used Dasein (which is translated to being-in-the-world) to describe the sense-of-existence. Also, the phrase, “Dasein choosing,” which is translated to the-person-who-is-responsible-for-his-existence choosing is used. We should note that this practice is in no way related to our own hyphenated last names, although it has inspired John to consider adding a hyphenated middle name so he can refer to himself in the third person as, “John-who-is-responsible-for-his-existence-Sommers-Flanagan,” which he thinks sort of rolls right off the tongue.

It follows, as-if-anything-really-follows-from-the-preceding, that existential therapy is nearly always in the service of self-awareness or self-discovery. However, unlike psychoanalysts, existentialists expand and illuminate client self-awareness rather than interpreting client unconscious processes. This is because existentialists believe the entirety of an individual’s human experience is accessible to consciousness.

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

And now, the grand finale (although there are many more where these come from), and my personal favorite, from Chapter 11: Constructive Theory and Therapy

Excerpt Three: I’m Not Afraid of Philosophers

In this chapter, we de-emphasize distinctions between constructivist and social constructionist perspectives. Mostly, we lump them together as constructive theories and therapies and emphasize the intriguing intervention strategies developed within these paradigms. This may upset staunch constructivists or radical social constructionists, but we take this risk with full confidence in our personal safety—because most constructive types are nonviolent, strongly preferring to think, write, and engage in intellectual discussion. Therefore, within our own socially or individually constructed realities, we’ve concluded that we’re in no danger of bodily harm from angry constructive theorists or therapists.

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

I’m sure many of you haven’t gotten the delight out of these hilarious counseling and psychotherapy theories humor that I have. Maybe that’s a sign that you too, should start studying happiness. On the other hand, reading theories books may have permanently warped my sense of humor. Either way, I hope you find sparkling moments and laughter here and there in your lives.

Happiness is Coming . . .

From M 2019 Spring

There’s hardly any place more beautiful than Missoula in the spring. . . which, despite the looming winter, will come to the University of Montana in January (we call Jan-May “Spring” semester). In the past, UM has been rated as the most “Gorgeous” campus in the U.S. Just saying.

Although I love UM, UM also sometimes gives me frustration. That’s natural. Last month, I submitted an op-ed piece to the campus newspaper, “The Kaimin.” I never heard back. Hmm. Oh well. I’m not TOO frustrated, because I know an alternative and exciting venue where I can get it published for sure. . . right here!

Just so I reach my audience, please share this with all the Kaimin readers you know, or other college/university students.

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

For many students, college life is a blissful state of intellectual growth, social relationships, and recreation. My memories as a graduate student at the University of Montana are some of the best of my life. But, to be honest, I also recall going to the campus health center (way before it was called Curry Health) with heart palpitations; I also went to individual counseling and participated in a therapeutic group. Life was good, but it wasn’t all roses and chocolate.

The truth is, the college years are times of great stress and strain for most students. Earlier this year, based on data from over 67,000 undergraduates, researchers reported: “College students face unprecedented levels of distress that affect their mental health” (Liu, Stevens, Wong, Yasui, & Chen, 2019). They detailed the stresses, noting that depression, anxiety, suicide, and other mental health problems are on the rise among college students. These data happened to coincide with an area of professional interest for me: I’ve often wondered, what makes people less depressed and less anxious? Or, put in more positive terms, what creates happiness or fulfillment? What factors contribute to a sense of well-being? What makes for a well-lived life?

As many of you already know, my explorations in this area have led to Rita and I developing a course I’ll be teaching this spring titled, “The Art and Science of Happiness.” In this course, we’ll explore the scientific research on happiness and psychological well-being. We’ll debunk some happiness myths. The class will also include an applied “Happiness Lab,” and all the students will be assigned personal happiness consultants. How cool is that?

In the happiness lab, students will meet in small study groups (about 10 students) to experiment with research-based techniques designed to promote emotional well-being. Examples include mindfulness (we’ve got a great egg-balancing activity all ready), savoring (did you know there are specific techniques people can use to extend and elaborate on their positive experiences?), and methods for cultivating gratitude (we’ll explore how to do this live and in-person, and through social media).

Courses on this happiness and well-being have sprung up across the country and across disciplines. From Harvard and Yale to small community colleges, the classes have not only proven popular, but are also shown to have positive effects on self-reported happiness and well-being. I’m looking forward to offering this class at UM, hopefully adding our own Griz flavor to the existing materials.

The Art and Science of Happiness will meet on Tuesdays and Thursdays from 11am to 12:20pm. You can register for it on Cyberbear (Google Cyberbear). If you have questions you want answered before you to take the plunge into a happier life, email me at john.sf@mso.umt.edu.

G is for Gratitude . . . and Gayle

Gayle Peggy and John

My family of origin had its own mythical creation story.

In the beginning, we (my two sisters and me), were playing cards in my mother’s stomach. Somehow Gayle won (I suspect she cheated), and got to be born first. Peggy won the second round (more cheating) and was thereafter dubbed first loser. Being lonely for about 33 months, I finally managed to win a game of solitaire, and was officially born second loser (aka Pokey II).

My parents named Gayle, Gale Caren. Being smart, independent, and convinced she knew better than anyone, at about age 12, Gale protested. She convinced my parents to take legal action to spell her name correctly. Who does that? From then on, she was and is Gayle Karen. I will always remember her spelling it, loud and clear, G-A-Y-L-E. Whenever the speech-to-text function on my phone misspells her name, I immediately change it. From early on, Gayle knew what was right. As it turns out, according to the Freakonomics dudes, children who grow up with oddly spelled names experience worse educational and achievement outcomes. Duh! G-A-Y-L-E knew that back in 1964, took matters into her own hands, and changed the arc of her destiny.

As we know from developmental research, girls who grow up with a clear sense of identity and an assertive (I know what I want) style, do well in life. Gayle knew what she wanted. She became known as the “bossy” one. But Gayle was much more than bossy; she was a leader.

The famous existential group psychotherapist, Irvin Yalom (who, by the way, at age 88 will be keynoting again for the American Counseling Association in San Diego in April), says that group leaders are, by default, role-models and norm setters. Whoever takes the lead, implicitly and explicitly sets behavioral standards for everyone else. As group members, we cannot help but be influenced by the leader’s norms and behaviors. Group leaders show us the way.

In my family, more often than not, Gayle showed us the way.

In her early teens, Gayle designed and produced a neighborhood newspaper. Who does that? At age nine, I got to be the neighborhood sports reporter. Gayle mentored me as I wrote my very first publication. How many nine-year-old boys get big sisters who publish their first article?

Gayle organized backyard carnivals. Among the many backyard activities, we had fishing booths; fishing booth are like portable walls that carnival attendees sling ropes over. Then, two people behind the wall who are running the booth, grab the rope, and use clothes pins to clip on the “fishing” prize. These were big events. Gayle was a legacy in the neighborhood; she was a genius at organizing events and willing them to happen. Gayle was often the force that led us to organize ourselves into a family team that made things happen.

Not only did I learn skills of leadership from Gayle, I also learned skills of followership. Put in terms used by the famous psychological theorist Alfred Adler, Gayle taught me how to be in a community and how to cooperate. Gayle didn’t (and still doesn’t) know Adler or Yalom or any other famous names in psychology, but sometimes when I study them, I think to myself, ah . . . I started learning about these things before I turned 10, from Gayle.

Sometimes Gayle made mistakes and taught us things we shouldn’t do. Older siblings are great for that. I remember and tease Gayle for some of her quirks. But I think the only reason I get so much delight in remembering a few of Gayle’s neurotic behaviors is because they were exceptions. Most of the time (and I’m talking directly to you now Gayle), you weren’t just the bossy one; you were the  smart one, the  organized one, the relentlessly focused one, and the one who helped your subordinates (Peggy and me) learn how to be smarter and how to contribute to the good of the family and neighborhood.

Later in life when you experienced challenges and sadness, you modeled for me how people can cope with unplanned hardships and come out stronger on the other side. You were (and are still) a role model for me for that, and for so many other things. But in particular, your ability to sift the wheat from the chaff and focus like a laser on what’s important in the moment is illuminating.

Somehow, despite no college education, you took yourself from waitressing at Earl Kelley’s buffet diner, to being a bank teller, to being a bank vice president, and on to becoming an IT leader with AT&T and Blue Shield of Oregon. You are the epitome of American success. You worked your way to the top.

I hope you know that I know, despite me having a Ph.D., and Peggy (who bit me) having a Master’s degree, in our family, you were always the smart one. You were always the leader. You could discern the right and moral direction without a compass or a Bible. I am amazed and humbled at your success. I am happy and grateful to have been led by you, to follow you, and to learn from you. I am forever grateful that you cheated in our first card game, because, really I was the winner; I won the prize of having you as my big sister.

G is for Gratitude. G is for Gayle. G is for a tie (with Peggy, even though she bit me), for the Greatest sister of all time.

Happy late birthday from your brother, who, as you know, is usually late in all things.

Draft Counseling and Psychotherapy Syllabus

Below I’m including a drafty copy of our Counseling Theories syllabus from the University of Montana. My apologies for the wacky font action.

Theories III Photo

**Draft – 2016 Standards Alignment in Progress**

 COUN 511: COUNSELING THEORIES & TECHNIQUES

COURSE SYLLABUS – UNIVERSITY OF MONTANA – Fall 2019

____________________________________________________________

INSTRUCTOR INFORMATION HERE:

Office:

Office Hours:

Email:

SCHEDULED CLASS MEETINGS:  Class meets on Mondays from 4:00pm to 6:50pm, beginning Monday, August 26, 2019. The oral final exam for graduate students is TBA.

COURSE CONTENT AND DESCRIPTION:  This course is an overview of major theories of counseling and psychotherapy with a special focus on gender, culture, counselor preparation, and common theory-based assessment and case formulation strategies. Because the purpose of counseling and psychotherapy is to help individuals make personally meaningful changes in their lives, we will consistently examine the means through which traditional theories attempt to produce such changes. Students will read about historical and intellectual foundations of major counseling theories, while at the same time, observing skills and techniques employed by practitioners using those theoretical perspectives. There will be opportunities, through assignments and class discussions, for students to analyze clients as well as themselves through the various lenses of psychological theories. Overall, students are encouraged not only to explore all the major theoretical orientations, but also to explore their personal beliefs and values in an effort to develop and deepen their understanding of counseling and psychotherapy process and outcome.

TEXTBOOK:  Required: Sommers-Flanagan, J., & Sommers-Flanagan, R. (2018). Counseling and Psychotherapy Theories in Context and Practice (3rd ed). Hoboken: NJ: Wiley.

Recommended: Sommers-Flanagan, J., & Sommers-Flanagan, R. (2012). Student manual for Counseling and Psychotherapy Theories in Context and Practice (2nd ed). Hoboken: NJ: Wiley.

COURSE OBJECTIVES: The purpose of this course is to introduce you to theories and techniques used by a variety of mental health professionals, school counselors, and other human service providers. We will explore and discuss the major theories and their practical application.

CACREP-Related Course Objectives: This course is a first Fall semester requirement for graduate students in Counseling at the University of Montana. The course includes content related to CACREP Core Standards and CACREP Specialty Standards. Specific key performance indicators are evaluated through course assignments, midterm and final examinations, and via an oral examination at the end of the semester. The oral examination focuses on the content of counseling theories and their application. The goals of the assessments in this course are to determine (a) how well the Counselor Education faculty is teaching specific CACREP-related objectives, (b) students’ ability to articulate and apply counseling theories, and (c) student readiness to enroll in counseling practicum (COUN 530).

DISABILITY ACCOMMODATIONS: If you are a student with a disability and wish to discuss reasonable accommodations for this course, contact me privately to discuss the specific modifications you wish to request. Please be advised I may request that you provide a letter from Disability Services for Students verifying your right to reasonable modifications. If you have not yet contacted Disability Services, located in Lommasson Center 154, please do so in order to verify your disability and to coordinate your reasonable modifications. For more information, visit the Disability Services website at www.umt.edu/dss/.

ACADEMIC INTEGRITY: All students must practice academic honesty.  Academic misconduct is subject to an academic penalty by the course instructor and/or disciplinary sanction by the University.  All students need to be familiar with the Student Conduct Code.  The Code is available for review online at http://www.umt.edu/vpsa/policies/student_conduct.php.

IN-CLASS BEHAVIOR STANDARDS AND LEARNING ENVIRONMENT: In the Department of Counseling and at the University of Montana we strive to establish and maintain a positive learning environment. The expectation is that we will strive to treat one another with respect . . . even when we disagree. This also means that students (and faculty) will turn off their cell phones and not engage in internet shopping/surfing/social networking during class. If calls and texting are necessary, you should either not attend class or take care of your calling and texting at class break. If you need to be on-call due to employment responsibilities, please let me know.

TEACHING METHODS:

1.  Lectures/class demonstrations.

  1. Guest lectures/student presentations.
  2. Video/DVD/Film presentations.
  3. Class activities.
  4. Class discussions.

GRADING PROCEDURES:  Grades are based on completion of class assignments, midterm and final examination scores, and class participation/attendance. Course assignments are listed and described in a separate section. The grading scale is below:

A   = 93%+                        B-  = 80-82%               D+ = 67-69%

  • = 90-92% C+ = 77-79%               D   = 63-66%

B+ = 87-89%                     C   = 73-76%               D-  = 60-62%

B    = 83-86%                    C-  = 70-72%               F    = Below 60%

APPROXIMATE SCHEDULE OF CLASS TOPICS AND ASSIGNMENTS

Week Date Assigned Reading In-Class Topic Assignments Due
1 8/26 Ch. 1

 

In future weeks, read chapters before class

Syllabus distribution and introduction to counseling and psychotherapy.

 

 

 

Be sure to login to the Moodle course supplement. This is mostly for communication and to give me something to complain about.
XX 9/2 None Labor Day No Class  
2 9/9

 

Ch. 2 Psychoanalytic Theory and Therapy.

 

 
3 9/16 Ch. 3 Individual psychology and Adlerian therapy – Guest Lecture with Dr. Veronica “Roni” Johnson  
4 9/23 Ch. 4 Existential theory and therapy Initial theories reflection paper due, by midnight 9/22/19  (30 points)
5 9/30

 

 

Review chapters 1-4 and lectures Midterm #1 – 1st hour: Covers chapters 1-4. [From 5:30pm to 6:50pm there will be a WHOLE CLASS skills lab focusing on person-centered therapy and mental imagery] Midterm #1 (50 pts)

Chapters 1-4 plus lecture material

6 10/7 Ch. 5 The person-centered approach.  
7 10/14 Ch. 6 Gestalt theory and techniques.  
8 10/21 Ch. 7 Behavioral theory and therapy.  
9 10/28 Ch. 8 Cognitive approaches (or CBT).  
10 11/4 Review readings and lectures. Midterm #2 – 1st hour.

Covers chapters 5-8, plus lectures. [From 5:30pm to 6:50pm there will be a WHOLE CLASS skills lab focusing on CBT.]

Midterm #2 (50 pts).

Chapters 5-8, plus lectures

9 11/11 Ch. 9 Choice theory and reality therapy  
11 11/18 Ch. 10 Feminist theory and therapy.  
12 11/25 Ch. 11 Constructive theory and therapy.  
13 12/2 Ch. 13 and 14 Multicultural theory and therapy and Counseling integration. Final papers due by midnight on Friday, 12/6/19
14 Week of 12/9 Review readings and lectures. Final examination.

Covers chapters 9, 10, 11, 13, 14

Final exam (50 pts). Chapters 9, 10, 11, 13, 14, plus lectures

The graduate oral final exam is TBD

OFFICIAL ASSIGNMENT DESCRIPTIONS

There are 290 possible points available (YOU CAN CHOOSE TO DO #3 A or B, BUT NOT BOTH).

  1. Two Midterm Examinations (50 points each; 100 total): These are standard multiple choice and short answer exams. They will cover material from all the lectures and chapters as outlined in the syllabus and worth 50 points each. You’ll be expected to take the exams at their scheduled times; if you have a time conflict, contact us in advance and we’ll set up an alternative exam time. If you have a last minute crisis (e.g., an accident, illness, or emergency) contact us ASAP and we’ll be flexible. In all cases, you’ll need to arrange a special time and sit for the exam within one week of the original exam date or you’ll get a zero. We will be flexible the first time. If a pattern of irresponsibility emerges, we’ll become less flexible and you’ll be required to take a much harder examination.
  1. Initial Theories Reflection Paper (30 points; see calendar for due date): This is a short paper designed to accomplish three objectives: (a) give you an opportunity, early in the course, to explore a concept from the text or from class in greater depth; (b) provide you with an initial, simple library-related assignment; (c) provide me with an early sample of your writing skills.

The paper can focus on virtually any topic addressed in class or covered in the first four chapters of the text. Here’s what you should do:

  • Select a topic: Sample topics include
    • The great psychotherapy debate
    • Informed consent
    • Multicultural competence
    • Doing no harm
    • The seduction hypothesis
    • Defense mechanisms
    • Feminism and psychoanalysis
    • Why children misbehave
    • Earliest recollections
    • Paradoxical strategies
  • Read the section in the text about that topic
  • Go to the library (or do an online search) and find a professional journal reference pertaining to your topic and then list it in APA format in the reference section of your paper.
  • Write a three page paper (following APA format) on your selected topic
  • In your paper write (a) a description of the topic or issue and why you think it is an especially important topic for beginning counselors; (b) additional information that you learned about the topic through your library research; (c) a reflection that includes critical comments about the topic/issue; and (d) some concluding comments about how this topic is relevant for you and your work in the future as a counselor

The paper will be graded in the following areas: (a) attention to detail/typos, etc. (3 points; 10%); (b) following APA format (3 points; 10%); (c) writing skills/grammar/organization (6 points; 20%); (d) general summary and accuracy regarding the topic chosen (12 points; 40%); (e) inclusion of some original and interesting thoughts about the topic (6 points; 20%).

  1. Choose ONE of the following assignments to complete:
    1. Theories or Cultural Book Review and Critique (50 points; see calendar for due date): The purpose of this assignment is for you, as an individual, to dive deeper into, and learn more about, a theory of interest to you. I have many books in my office that you can peruse for this assignment or you can go to the library or you can buy something on your own. After you’ve selected a book and check with me to make sure it’s acceptable, there are three parts to this assignment: (a) read your selected book; (b) write a four-page summary and critique of the book (include both a summary and critique—focusing on the book’s strengths and weaknesses as well as a description of how you will apply the information you learned from the book to your life in the future); and (c) be prepared to provide a ten-minute presentation on the book at our final class, although please note that book presentations may or may not happen depending on time – TBA. If they do, you should just say if you recommend the book to others and how you rate it on a 1-100 scale and engage the class in a brief demonstration of something you learned from the book.

Grading Procedures

This assignment is worth 50 points. To earn the 50 points you will need to turn in high quality work. You will lose points for typos, misspelled words, concepts that are defined poorly or used incorrectly, incomplete or unclear descriptions of the text. In particular, you will be graded on the quality of your summary and critique. Your summary will need to be accurate and show that you understand the content of the book. Your critique should show some sophistication of thought and reflection. Although your personal opinion is desired, you should also provide a critique based on a professional source (e.g., the text, a journal article, etc). Failure to cite at least one relevant reference linked to the book content will cause you to lose five points.

  1. Personal Change Project (50 points; see calendar for due date): The purpose of this assignment is for you to apply some sort of personal change strategy to yourself. Previously this was a purely behavior modification project, but due to diverse student interest, you can now engage in any personal change strategy you like.

The Details

You’ll be using APA Style. That means you’ll have the following sections:

  • Introduction: In this section you’ll introduce your target behavior and your rationale for choosing to change it. You’ll include a small bit of background research on different methods for potentially modifying your target behavior. This will require at least two professional journal citations (please, DO NOT cite online and unsubstantiated gibberish). Although you may have some incredible ideas yourself, the point is for you to NOT completely rely on your own idiosyncratic ideas about how to change your target behavior. For example, let’s say you chose to reduce your intake of sugar. There have been many books and articles written on diet change. I would expect you to read and reference a few of these.
  • Method: In this section you will identify and define a specific, measurable behavior that you would like to increase, decrease, or eliminate. This behavior is called your “target behavior.” For example, you might choose to increase exercise behavior. To begin this assignment, you need to have a clear, operational description of the behavior and a method for measuring the occurrence of the behavior. For example, if you select “push-ups” as your behavior to increase, you would need to define exactly what you meant by “push-up” and then detail a method for obsessively tracking (measuring) of your push-up behavior. Other behaviors people have chosen in the past include: (a) increasing dream recall; (b) decreasing cigarette smoking; (c) increasing smiling behavior; (d) decreasing fingernail biting behavior; (e) increasing study behavior, etc. Of course, I encourage you to identify what you want to change, rather than simply choosing one of the aforementioned target behaviors. The method also includes a description of your change plan. Describe it so well that it could be replicated. Your plan SHOULD NOT rely exclusively on your WILLPOWER. It should flow from your introduction or brief look at the scientific literature. When I grade your assignment I’m interested in the specific techniques you’ve gleaned from the text or outside readings. For example, if you’re using a behavioral approach, I’d look for you to use strategies like: (a) positive reinforcement; (b) punishment; (c) response cost; (d) negative reinforcement; (e) stimulus control; (f) stimulus generalization; (g) fading; (h) unconditioned stimulus; (i) conditioned stimulus, etc. If you choose to use a cognitive approach, consider using the three column technique, shades of gray, visualization, rational disputing, etc. Your method section includes the method through which you plan to make your changes. Please inform John of your target behavior before proceeding with the assignment. Email me at sf@mso.umt.edu or pass me a note in class informing me of your chosen behavior and general strategy. Tip: Don’t select an infrequent behavior because then it will take you several years to get done. Write a contract for yourself (e.g., “I Rita SF, do solemnly swear. . .”). Include the behavior, the plan, your goals, and a space for you and a witness (someone in your social environment) to sign and co-sign the contract.
  • Results: I’ll be looking for two main things in your results section. First, I want to see numbers or a chart or graph that you’ve used to track your target behavior. This will include a baseline measurement of your target behavior over at least one week. I need to be able to see and understand your progress or lack thereof. Second, to capture your qualitative experience, I want to see a weekly journal entry about how it’s going. Discuss your feelings, your personal experience and perspective, and why you think the project is working or not working. You can also modify your change plan during the semester, as long as you clearly identify how and why you’re going to change your approach in your weekly journal entry, also noting that in your results section. Remember that good counselors are very flexible and creative in their approach.
  • Discussion: The discussion is your reflection on the project. It focuses on “what happened” (the results) but also provides a platform for you to speculate on what helped, what didn’t, and why.
  • References: You need at least two professional citations in APA format.
  • Appendix: Include a signed (and countersigned) contract to yourself as a commitment to this behavior change project.

Grading Procedures

This assignment is worth 50 points. To earn the 50 points you will need to turn in high quality work. However, your grade on this project is NOT AT ALL based on your success or failure in changing your behavior.

You will lose points for typos, misspelled words, concepts that are defined poorly or used incorrectly, incomplete or unclear descriptions of what you did and what happened, etc. Failure to cite at least a couple of relevant studies, articles, or books will also lose significant points. Follow the outline and you’ll have a good start. Please do your best work. Good luck and have fun!

  1. Attendance (30 points): We’ll take attendance at every class. Perfect attendance is worth 30 points. You’ll lose an increasing number of points for each class missed (even if you miss class for legitimate reasons). You lose 0 points for missing one class (everyone deserves a mental health day), 6 points for missing two classes, 9 more (total = 15) for the third, 15 more (all 30 points are lost) for the fourth. There will be in-class reflection assignments. If you don’t turn these in or do a poor job you’ll lose attendance points. To be fair, you can earn back points from missing class by completing additional assignments. You can earn attendance points back by listening to recorded lectures (as available), contacting Kindle Lewis (the TA) who will give you an additional assignment (e.g., writing an essay or responding to several lecture-related questions). Alternative assignments may be used at our discretion. If you’re motivated you can recover lost points.
  1. Graduate Skills Lab (30 points): All students enrolled in COUN 511 or taking the course for graduate credit will participate in a Counseling Skills Lab. We will break into smaller groups for this and the exact time and place for the lab is TBA. It will consist of 6-8 meetings (two of which will be after the first midterm) during which you practice the skills associated with specific theories on each other. We will start communicating about lab meeting times during the first week of the semester. If you miss one Grad Lab, you lose 15 points. If you miss two Grad Labs, you lose all 30 points.
  1. Final Oral Examination (50 points): For all graduate students, you will sit for a small (about 10 students) 90 minute group examination. You will be given short answer questions and a role-play assignment at least one week prior to the exam to help you prepare and study. During the exam, you’ll be asked, at random, several questions from the questions you’ve been given (and hopefully have studied) and you’ll be asked to demonstrate via role-play several skills associated with at least one theoretical orientation. This exam format is designed to help you learn to orally articulate and apply some of the theories concepts we’ve studied during the semester.

CACREP KPIs for Core and Specialty Counseling Competencies

All courses in the Department of Counseling include content related to our national Counseling and Counseling-Related Educational Programs (CACREP) accreditation. CACREP identifies specific Core Standards as well as Specialty Standards. The following Table includes a listing of the CACREP Core and Specialty Standards covered by COUN 511 course content. Additionally, some of the standards listed below are the focus of Key Performance Indicators (KPIs). KPIs are specific CACREP standards that are systematically evaluated in order to determine whether students are learning key CACREP-related course content. In this course (COUN 511), the KPIs are evaluated through using the course assignments, experiential laboratory activities, midterm and final examinations, and via an oral examination at the end of the semester.

Core Standard Content Found Key Performance Indicator
2. SOCIAL AND CULTURAL DIVERSITY    
b. theories and models of multicultural counseling, cultural identity development, and social justice and advocacy

 

COUN 511 – Students read about how each theory addresses culture, sexuality, and spirituality.

 

c. multicultural counseling competencies

 

COUN 511 – Students read about the MCCs in Chapter 1 and Chapter 13 of the textbook

 

 
d. the impact of heritage, attitudes, beliefs, understandings, and acculturative experiences on an individual’s views of others

 

COUN 511 – Students read about this content in Chapter 13 and participate in a classroom activity.

 

 
5. COUNSELING AND HELPING RELATIONSHIPS    
a. theories and models of counseling

 

COUN 511 – Students read about theories and models of counseling in their textbook and practice techniques linked to the theories in their counseling labs. Two midterm examinations and one oral final examination are used to measure student knowledge three times during the course.
b. a systems approach to conceptualizing clients

 

COUN 511 – Students read about systems approaches in Chapters 11 and 12.  
f. counselor characteristics and behaviors that influence the counseling process

 

COUN 511 – Students read about specific counselor characteristics and behaviors that influence counseling process and outcomes in the textbook.

 

 
g. essential interviewing, counseling, and case conceptualization skills

 

COUN 511 – Students read about how to engage in case formulation and treatment planning in every theories chapter of the textbook.

 

 
h. developmentally relevant counseling treatment or intervention plans

 

COUN 511 – Students read about counseling theories, treatments, and interventions that are more or less useful with specific developmental populations in the textbook.

 

None
i. development of measurable outcomes for clients

 

COUN 511 – Students read about measuring outcomes in every theories chapter of the textbook.

 

 
j. evidence-based counseling strategies and techniques for prevention and intervention COUN 511 – Students read about evidence pertaining to counseling strategies and techniques associated with each theory in the textbook.  
n. processes for aiding students in developing a personal model of counseling COUN 511 – Students read about how to integrate their personal ideas with existing theoretical models in the textbook. Students take a theoretical orientation test and write a one-page reflection on their initial preferred model of counseling.
8. RESEARCH AND PROGRAM EVALUATION    
a. the importance of research in advancing the counseling profession, including how to critique research to inform counseling practice

 

COUN 511 – Students read about research linked to each theory presented in the textbook.  
b. identification of evidence-based counseling practices

 

COUN 511 – Students read about evidence-based counseling practices in every chapter of the textbook.  
d. development of outcome measures for counseling programs

 

COUN 511 – Students read about theory-based counseling outcome measures in every theories chapter.

 

 
e. evaluation of counseling interventions and programs

 

COUN 511 – Students read about theory-based counseling outcome measures in every theories chapter.

 

 

 

 

 

 

 

 

Happy, Happy, Thanks

Turkeys in Yard

Yesterday several naïve turkeys gathered outside our front window, apparently oblivious to the upcoming holiday. My not having a turkey hunting license or a shotgun made them safer than they might have been otherwise. Today, along with a thin blanket of new snow, I’m wishing them a happy day.

Having started reading “There, there” by Tommy Orange has added complexity to my urges to offer the traditional American Happy Thanksgiving greeting. I’m just speaking for myself here. These are personal reflections, not political reflections. As the late William Glasser (1998) liked to say (paraphrasing here), trouble tends to start when people discover, not only what’s right for them, but also what’s right for others. To honor Glasser (and avoid trouble), I feel compelled to write: I recognize that my own personal reflections may or may not be relevant or meaningful to you, and that you should celebrate as you like.

Here are some words (among many) from the prologue to There, there, that complexify my Thanksgiving Day greetings:

“In 1621, colonists invited Massasoit, the chief of the Wampanoags, to a feast after a recent land deal. Massasoit came with ninety of his men. That meal is why we still eat a meal together in November. . . . But that one wasn’t a thanksgiving meal. It was a land-deal meal. Two years later there was another, similar meal meant to symbolize eternal friendship. Two hundred Indians dropped dead that night from an unknown poison.”

As a nation, we’ve not been good to Native or Indigenous peoples. That’s obvious, even based on most (rather whitewashed) history books. Our historic oppression of Indian people has been horrific. That’s a fact I find important to acknowledge. I’m an Italian-Austrian-French-English Jewish-Catholic mostly white male. It’s doubtful than many or any of my ethnic/racial peoples were particularly good to the Indigenous Americans. I feel sad for that.

But somewhere in my brain I hold onto the idea that maybe Thanksgiving can still be meaningful. Giving thanks, showing gratitude, and being generous are behaviors that improve communities and enhance physical and emotional health. All the happiness researchers repeatedly say that we should be repeatedly grateful, and that expressing gratitude offers bidirectional short- and long-term benefits. Both the giver and the receiver of gratitude are on the receiving end of increased health and wellness.

For today, I offer gratitude to my Native American and American Indian friends and students and brothers and sisters. I’m grateful to have learned from you and to have you in my life. Although I cannot fix past wrongs, today and in the future I can recognize your value, contribute to your causes, appreciate your culture, and be grateful for what you bring to the world. For many reasons, we now find ourselves in this together. I hope to be gracious and helpful as we live together in peace and equity. There will be bumps in the road; my hope is that we can smooth the bumps together. Just because the narrative around that first Thanksgiving was fictional, doesn’t mean we can’t build a future that includes coming together and sharing our lives in important and meaningful ways. It’s possible that I and many of my ethnic/racial peoples can be particularly good to the Indigenous Americans in the future. I feel happy for that hope.

Happy, happy, thanks to everyone.

Resources: Huffpost published a nice article on six things non-native allies can do for Thanksgiving.    https://www.huffpost.com/entry/ally-to-native-americans-on-thanksgiving_l_5ddc4237e4b00149f7223b30?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuaHVmZnBvc3QuY29tLw&guce_referrer_sig=AQAAAAjPZEONsO8kbskt8Qfrnm4VaVkk0kZo1hmmiYv9dANmXAL4aKKHsfcH-Oj5-HBI917vRV6-BSQGvu4G0fWSxIYxK1_hdfDrPqlEXqKCdjh9CysuPHTMZbjJAolZJ0JjfwDpdocP_pYGzuKejzZjKVZwbROe-8HyHfA7-itWaale

In today’s Missoulian there’s an article on the Happiness class Rita and I are developing and that I’ll be teaching this Spring semester at the University of Montana: https://missoulian.com/news/local/happiness-there-s-a-university-of-montana-class-for-that/article_7789f0fd-cb94-505d-a708-ab4bc214a4ff.html

The Evidence Base for Psychoanalytic Therapies: It Just Might Be Better Than You Think

Sunset 2019In recent days there’s been a bit of a kerfuffle on Twitter regarding the relative efficacy of psychoanalytic and cognitive-behavioral therapies (CBT). Of course, the standard mantra in the media and among many mental health professionals is that the science shows that CBT is superior and the treatment of choice for many, if not most, mental and emotional problems. Well, as is often the case in life and psychotherapy, reality is much less clear.

This post isn’t about fake news or alternative facts. Instead, I hope it’s about a balanced perspective. As a psychotherapist-counselor-professor-clinical psychologist, I like to think I don’t have an allegiance to any single therapy approach. Although I know I can’t claim perfect objectivity, I do have a broad view. One factor that has helped me have a broad view is that I read lots of professional journal articles in order to be able to write my theories of counseling and psychotherapy textbook.

Below, I’ve inserted an excerpt from the end of the psychoanalytic chapter of our textbook. Whether you’re a CBT or psychoanalytic fan, or perhaps a fan of a different approach, I hope you find this short review of psychoanalytic treatment efficacy interesting. The bottom line for me is captured by an old quotation from Freud (who wasn’t known for his flexible thinking). Purportedly, he said, “There are many ways and means of conducting psychotherapy. All that lead to recovery are good.” I might add the following to Freud’s comment: There are many different clients with many different problems and many different individual and cultural perspectives. I’m convinced that most clients are best served if therapists tweak their approaches to fit the client, rather than expecting the client to fit into narrow clinical procedures based on pure (or rigid) theoretical perspectives.

Here’s the excerpt . . .

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

Conducting rigorous research on longer-term treatments, such as psychoanalytic therapy, is challenging and cost prohibitive. Psychoanalytic approaches are often less symptom- or diagnosis-focused, seeking instead to facilitate client insight and improve interpersonal relationships. Because empirically supported treatments focus on whether a specific psychological procedure reduces symptoms associated with a medical diagnosis, “proving” the efficacy of complex therapy approaches is difficult—especially when compared to the lesser challenges inherent in evaluating symptom-focused treatments. Partly because of these complexities, some reviewers contend that psychoanalytic psychotherapies are less efficacious than cognitive and behavioral therapies (Busch, 2015; Tolin, 2010).

The good news for psychoanalytic therapy fans is that evidence is accumulating to support treatment efficacy. The less good news is that some of the research support remains methodologically weak and the wide variety of psychoanalytic approaches makes it difficult to come to clear conclusions. Nevertheless, the most recent meta-analytic studies, literature reviews, and individual randomized controlled studies support the efficacy of psychoanalytically oriented therapies for the treatment of a variety of mental disorders. According to Leichsenring, Klein, and Salzer (2014), there is empirical support for the efficacy of psychoanalytic psychotherapies in treating:

  • Depressive disorders.
  • Anxiety disorders.
  • Somatic symptom disorders.
  • Eating disorders.
  • Substance-related disorders.
  • Borderline personality disorder.

The evidence for the efficacy of psychodynamic approaches for depressive disorders is strong. In a recent meta-analysis, Driessen and colleagues (2015) evaluated 54 studies, including 3,946 patients. They reported that short-term psychodynamic psychotherapy (STPP) was associated with improvements in general psychopathology and quality of life measures (d = 0.49–0.69) and all outcome measures (d = 0.57–1.18); they also noted that patients continued to improve at follow-up (d = 0.20–1.04). Further, no differences were found between STPP and other psychotherapies. On anxiety measures, STPP appeared significantly superior to other psychotherapies at post-treatment (d = 0.35) and follow-up (d = 0.76).

In a previous meta-analytic review, Shedler (2010) also concluded that psychodynamic therapies were equivalent to “. . . other treatments that have been actively promoted as ‘empirically supported’ and ‘evidence based’” (p. 107). He also reported that psychodynamic therapies had more robust long-term effects.

Table 2.2 provides a sampling of meta-analytic evidence supporting psychodynamic therapies. For comparison purposes, the original meta-analyses conducted by Smith and colleagues are included (Smith & Glass, 1977; Smith et al., 1980). Notably, Smith, Glass, and Miller reported that psychodynamic approaches were significantly more efficacious than no treatment and approximately equivalent to other therapy approaches.

Table 2.2 also includes the average effect size (ES or d; see Chapter 1) for antidepressant medications (ES = 0.31 for serotonin-specific reuptake inhibitors or SSRIs). This comparison data shows that psychodynamic psychotherapy is more effective than SSRI treatment for depression. Additionally, the benefits of psychoanalytic therapy tend to increase over time (Driessen et al., 2015; Shedler, 2010). This implies that psychoanalytic psychotherapy clients develop insights and acquire skills that continue to improve their functioning into the future—which is clearly not the case for antidepressant medication treatment (Whitaker, 2010). One of the ways psychotherapists explain this difference in longer term efficacy is with the statement: “A pill is not a skill.”

Table 2.2 A Sampling of Psychodynamic Psychotherapy Meta-analyses

Authors Outcome focus Number of studies ES or d
Abbass et al. (2009) General psychiatric symptoms 8 0.6
Anderson & Lambert (1995) Various 9 0.85
de Maat et al. (2009) Long-term treatment 10 0.78
Driessen et al. (2015) Depression 54 0.57–1.18
Comparison research
Turner et al. (2008) Meds for Major depression 74 0.31
Smith et al. (1977) Different therapies 375 0.68
  Many problems    
Smith et al. (1980) Different therapies 475 0.75
  Many problems    

Note: This is a sampling of meta-analytic psychoanalytic psychotherapy reviews. We’ve omitted several reviews with very high effect sizes partly because of criticisms related to their statistical methodology (see Driessen et al., 2015, and Shedler, 2010, for more complete reviews). This table is not comprehensive; it’s only a reasonable representation of psychoanalytic psychotherapy meta-analyses.

We recommend you take the preceding research findings (and Table 2.2) with a grain of salt. Conducting systematic research on something as subjective as human mental and emotional problems always includes error. One source of error is the allegiance effect (Luborsky et al., 1999). The allegiance effect is the empirically supported tendency for the researcher’s therapy preference or allegiance to significantly predict outcome study results.  Luborsky and colleagues (1999) analyzed results from 29 different adult psychotherapy studies and reported that about two thirds of the variation in outcome was accounted for by the researcher’s theoretical orientation (e.g., psychoanalytic researchers reported more positive outcomes for psychoanalytic therapy and behavior therapists discovered that behavior therapy was more effective).

The implications of the allegiance effect help explain why, shortly after Shedler’s (2010) publication extolling the virtues of psychodynamic psychotherapy, several critiques and rebuttals were published (Anestis, Anestis, & Lilienfeld, 2011; McKay, 2011). The critics claimed that Shedler’s review was biased and accused him of overlooking weaknesses within the meta-analyses he reviewed (e.g., poor outcome measures, pooling the effects of small samples with little power and poor designs, lack of treatment integrity effects). Although Shedler’s critics raised important points, the critics themselves had their own biases. The problem is that all researchers (and writers) have an allegiance of one sort of another.

One of our favorite ways of understanding the allegiance effect is articulated in a story about the great New York Yankee baseball player, Yogi Berra. One day, when a player on Yogi’s team was called out on a close play at second base, Yogi went charging on to the field to protest. The umpire explained that he, unlike Yogi, was an objective observer and that he, unlike Yogi, had been only about 5 feet from the play, while Yogi had been over 100 feet away, in the dugout. When Yogi heard the umpire’s logic, he became even angrier and snapped back, “Listen ump, I wouldn’t have seen it, if I hadn’t believed it” (adapted from Leber, 1991).

The “I saw it because I believed it” phenomenon is also called confirmation bias (Masnick & Zimmerman, 2009; Nickerson, 1998). Confirmation bias involves seeking, interpreting, and valuing evidence that supports pre-existing beliefs, while ignoring and devaluing evidence contrary to preexisting beliefs. Consequently, psychoanalytically oriented individuals see support for their perspective and behavior therapists see support for theirs. However, despite these caveats, based on accumulating research, psychodynamic approaches have a reasonably good record of efficacy.

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

Although this particular review has many limitations, I’m convinced that most of us, most of the time, are better off following the advice of Marvin Goldrfried (and others) and focusing on the common therapeutic factors, or, as Norcross calls a subset of common factors, empirically-supported relationships.

For more information, check out Goldfried’s recent article on obtaining consensus in psychotherapy:  https://www.stonybrook.edu/commcms/psychology/_pdfs/clinical/Goldfried%20AP%20Consensus%20AP.pdf

 

The place to click if you want to learn about psychotherapy, counseling, or whatever John SF is thinking about.