Check Out These Blogs about Counseling Theories

John and Jon on M

Over the past five years I’ve written over 50 blog posts linked to teaching and learning the theory and practice of counseling and psychotherapy. While procrastinating on another project, I decided to organize these blog posts by topic. If you follow the links below, they’ll take you to blog posts relevant to specific theories. Included in some of these are a few links to short (and free) theories-based video examples. If you teach a theories course, you could select some of these links to assign students outside readings or you could peruse them yourself to stimulate a few lecture ideas.

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

Chapter 1 – Opening and Overview

A Plan for Maximizing Positive Counseling and Psychotherapy Outcomes:

Teaching Counseling and Psychotherapy Theories: Reflections on Week 1:

Reformulating Clinical Depression: The Social-Psycho-Bio Model:

What’s the Difference between Counseling and Psychotherapy?

Neuroscience New Year’s Resolutions:

Evidence-Based Relationships in Counseling and Psychotherapy:

Chapter 2 – Psychoanalytic Approaches

Attachment-Informed Psychotherapy:

The Story of Freud’s Seduction Hypothesis:

The Working Alliance in Counseling and Psychotherapy:

Chapter 3 – Adlerian Approaches: Individual Psychology

The Three-Step Emotional Change Trick:

A Parenting Homework Assignment on Natural and Logical Consequences:

More Than Praise — Other Ways Parents Can Be Positive With Their Children:

Chapter 4 – Existential Approaches

Reflections on Listening to Irvin Yalom at the ACA Conference:

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

Fun with Existential Theory:

Chapter 5 – Person-Centered Approaches

Reflections on Magic:

Listening as Meditation on

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

Why Therapists Should Never Say, “I know how you feel”:

Carl Rogers and Brain-Science do an Empathy Smackdown in Chapter 3:

An Invitation for Collaboration:

Chapter 6 – Gestalt Approaches

Go Go Gestalt: The Theories Video Shoot, Part I:

Chapter 7 – Behavioral Approaches

A Black Friday Tribute to Mary Cover Jones and her Evidence-Based Cookies:

Behavioral Activation Therapy: Let’s Just Skip the Cognitions:

Imaginal or In Vivo Exposure and Desensitization:

A New Look at Time-Out for Kids and Parents:

Information on Using Time-Out — Part II:

Talking with Parents about Positive Reinforcement:

Backward Behavior Modification:

Behaviorism for Everyone:

Chapter 8 – Cognitive-Behavioral Approaches

Positive Thinking is Not (Necessarily) Rational Thinking:

How to Use the Six Column CBT Technique:

A Quick Look at the Collaborative Cognitive Therapy Process:

Tomorrow’s Election and Confirmation Bias:

Confirmation Bias on My Way to Spearfish, South Dakota:

Chapter 9 – Choice Theory and Reality Therapy

The Seven Magic Words for Parents:

Give Information and then Back-Off: A Choice Theory Parenting Assignment:

How Parents Can Use Problem-Solving Power:

Chapter 10 – Feminist Approaches

Opening Thoughts on Feminism:

The Girl Code by Ashley Marallo:

A Guest Essay on the Girl Code and Feminism:

Feminist Culture in Music:

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

Is Solution-Focused Therapy as Powerfully Effective as Solution-Focused Therapists Would Have Us Believe?:

Secrets of the Miracle Question:

The Love Reframe:

Constructivism vs. Social Constructionism: What’s the Difference?

Chapter 12 – Family Systems Approaches

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

Chapter 13 – Multicultural Approaches

Four Good Ideas about Multicultural Counseling and Psychotherapy—In Honor of Martin Luther King, Jr.:

Good Ideas about Multicultural Counseling and Psychotherapy – Part II:

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

Psychic Communications . . . and Cultural Differences in Mental Status:

A White Male Psychologist Reflects on White Privilege:

Tips for Counseling Culturally Diverse Youth:

Chapter 14 – Integrative Approaches

Making Memories in L.A.: An Interview with Matt Englar-Carlson:

My Response to a Petition from a Theories Class at Xavier University:

With Wubbolding


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Ethical and Cultural Considerations in Non-directive Listening

This week I’m back to reviewing the page proofs for the 6th edition of Clinical Interviewing. It’s tons of fun. I’m consistently surprised when I find typos or bad sentences in material that I’ve already reviewed five times previously. Ugh. Oh well. Life is generally good . . . and once in a while I run into some interesting new content that I think is worth sharing. Here’s one excerpt. It’s toward the end of Chapter 4, titled: “Nondirective Listening Skills.” The 6th edition is coming soon:

Ethical and Multicultural Considerations

It’s likely that each client will respond to you and your listening skills differently. Some clients will love having you as a listener. They’ll be instantly impressed with your excellent interviewing skills. Other clients will be neutral. Still others will think (and possibly tell you) that your education and training are worthless and that they resent having to spend time with you.

The Ethics of Not Directing

Listening well is an essential therapeutic skill, but many clients don’t come for counseling looking for an excellent listener. They come because they want an expert. They desire guidance. They may even want to be told what to do and how to do it.

The desire for an authoritative counselor may be particularly salient within ethnic and cultural groups. For example, Asian American clients tend to want more direct guidance from their counseling professionals (Chang & O’Hara, 2013). Of course this is a generalization, but knowing that some Asian clients want an expert and will be disappointed if you don’t act in more directive ways is valuable information.

Some presenting problems, such as those present in crises or severe mental disorders, also might require more active and directive interventions. Cultural and personal expectations, presenting problem(s), and theoretical orientations can call for more directive, authoritative interactions. If so, it might be unethical for you to persist with nondirective listening and not advance to the skills and techniques described in Chapters 5 and 6. See Case Example 4.2 for a concrete example.

Case Example 4.2: When Being Nondirective Might Be Unethical

While reading the referral information, you discover that your new client is a seventeen-year-old Chinese American female with a history of cutting and parasuicidal behavior. Early in the interview she tells you, “I want to stop cutting.” This is especially good news because you know something about skills training for clients who cut. Although your active listening provides an excellent foundation, if you only listen to her, you’ll be doing her a disservice. The point is this: If you know about something that fits with your client’s specific condition and you withhold it without an exceptionally good rationale, you’re in ethical hot water. In this case, you should actively begin teaching your client alternative emotional management skills.

In another situation, you could make a case for withholding your advice and being less direct. For example, if your client is Native American and rapport development is slow and you’re not certain that she’s motivated to stop cutting, you would have a solid rationale for maintaining a nondirective listening stance with plenty of self-disclosure and a focus on developing a working alliance. Staying less direct with Native clients and respecting their process are reasonable strategies. Your client might not be ready or willing to work on developing alternative coping strategies until session 2 or 3 or 4. If you were to jump in too soon with advice on how to stop cutting, your client might not show up for session 2.

Gender, Culture, and Emotion

Imagine that you’re in an initial clinical interview with a Latino male. Your impression is that he’s angry about his wife’s employment outside the home. You’re aware that some Latinos have more traditional ideas about male and female roles in the home. This knowledge provides you with evidence to support your hypothesis about your client’s emotional state. So you intentionally use a reflection of feeling to focus in on your client’s anger:

I’m getting the sense that you’re a little angry about your wife deciding to go back to work.

He responds,

Nah. She can do whatever she wants.

You hear his words. He seems to be empowering his wife to do as she pleases. But his voice is laden with annoyance. This leads you to try again to connect with him on a deeper level. You say,

Right. But I hear a little annoyance in your voice.

This reflection of feeling prompts an emotional response, but not the one you had hoped for.

Sure. You’re right. I am annoyed. I’m fucking annoyed with you and the fact that you’re not listening to me and keep focusing on all this feelings shit.

This is a dreaded scenario for many clinicians. You take a risk to reflect what seems like an obvious emotion, and you get hostility in return. For several possible reasons, your emotional sensitivity backfires. The client moves to a defensive and aggressive place, and a relationship rupture occurs (see Chapter 7 for more on dealing with relational ruptures).

It’s tempting to use culture and gender to explain this client’s negative reaction to your reflection of feeling. But it’s not that simple.

Although culture, gender, race, and other broad classification-based variables can sometimes predict whether a specific client will be comfortable with emotional expression, individual client differences are probably more substantial determinants. In particular, comfort in expressing emotion is often a function of whether the client comes from a family-neighborhood-cultural context where emotional disclosure was a norm. For example, Knight (2014) reported that black and Latino males who were unlikely to disclose to their peers attributed this tendency directly to their experiences living in violent communities. These young men had learned that emotional expression and trusting others were bad ideas in their neighborhoods. Conversely, emotional disclosure is more likely to be in the comfort range of black and Latino males who are raised in safer community environments. This makes good common sense: Whether clients perceive you as safe to talk with about emotional concerns probably has more to do with the clients’ background and past experiences than it has to do with you.

Overall, it’s likely that clients’ willingness to tolerate feeling reflections is based on a mix of their cultural, gender, and individual experiences. To move these ideas toward application, if you have reason to suspect that your client is less comfortable focusing on emotions, you should avoid words that are emotionally specific and therefore more provocative. Examples of emotionally specific words include angry, sad, scared, and guilty.

Instead of using emotionally specific words, you can initially substitute words that are emotionally vague (and less intense). Later, as trust develops, it may be possible to use more specific emotional words. Consider the following phrases:

  • You found that frustrating.
  • It seems like that bothered you a bit.
  • It’s just a little upsetting to think about that.

Putting It in Practice 4.4 lists examples of emotionally vague words you might use instead of emotionally specific words.

Putting It in Practice 4.4: Using Vague and Emotionally Safe Words

Emotionally Specific Words    Substitute (Safer) Words

Angry                                           Frustrated, upset, bothered, annoyed

Sad                                              Down, bad, unlucky, “that sucked”

Scared                                         Bothered, “didn’t need that,” “felt like leaving”

Guilty                                           Bad, sorry, unfortunate, “bad shit”

Embarrassed                               Less than comfortable, bugged, annoyed

Note: These words may work as substitutes for more emotionally specific words, but they also may not. It will be more effective for you to work with your classmates or work setting to generate less emotionally threatening words and phrases that are culturally and locally specific.


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Posted by on August 9, 2016 in Uncategorized


APA2016 in Denver — A Symposium on Publishing Books in Psychology

Today I had the honor and privilege of chairing an APA symposium in Denver, titled: Publishing Books on Psychotherapy: Insights and Strategies from Psychologist-Authors

The cool part was that I got to listen to and comment on Melba J. Vasquez, Derald Wing Sue, and John C. Norcross as they shared their ideas about how to publish books. The other cool part was that this symposium was attended by most of the other people I know and recognize at this APA conference: Nick Heck and Nick Livingston (both grads of the U of Montana’s doc program in clinical psych) and Jerry and Marianne Corey—who just happened to drop by.

In addition to listening to three amazing authors talk about publishing, I also had a short presentation . . . and so here it is:

Publishing Books on Psychotherapy: Tips from John Sommers-Flanagan

Tip 1: Get your Writer Identity on: Writing as Professional Identity. It’s a good idea to have excellent writing role models. That’s the whole point of today’s symposium. Melba Vasquez, Derald Wing Sue, and John Norcross are perfect examples of excellent writing role models. My best first advice on writer identity is for you to have at least one role model from a distance and one close to home. Even better (maybe), being in a local or online writer’s group can get you moving toward having a WRITER identity.

One way of thinking about identity is the concept of intersectionality. The old magic 8-ball can be a useful metaphor. For most of us, many different parts of our identity are “present” most the time. There could be LGBTQ, ethnicity, familial values, age, ability/disability, occupational components, etc. Usually one or two of these “pop” up and guide our behavior. As Mary Pipher wrote (paraphrasing now)—if you want to be a writer, you need to begin thinking of yourself as a writer. That means one of the sides on that multidimensional or intersectional piece of your personal identity 8-ball should say: “Writer.” For me, one way I’ve embraced this idea is to ALWAYS (as much as I can) act like a writer. That means I proofread EVERYTHING I write, even emails! Check out this link to my blog for two readings on writer identity:

Tip 2: Face your Fears: Writing as an Act of Courage. Rejection sucks. This is true for nearly everyone. The sort of rejection that especially sucks is the rejection that comes when you’re feeling vulnerable. And writing, because it can be very personal and something you deeply identify with, can be a BIG place of vulnerability. The great writer, Cynthia Ozick once wrote that writing is essentially, “an act of courage.” So make a plan for dealing with your fears and bolstering your courage and keep on writing. Feedback can be hard. But without feedback, it’s harder to grow and develop as a writer. If you like, check out this blog post on rejection:

Tip 3: Say What You’ll Do and Do What You Said: Writing as Professional Discipline. The most popular mantra for writers is: “Writer’s write.” Well okay. That’s a good idea . . . but it’s hard to find your destination without a plan or a map. So let’s be good behavioral scientists and make a clear plan (including positive reinforcements) for how to achieve that general goal. When will you write? Where will you write? What time of day is best for you? Standing, sitting, coffee shop, private space? How will you reward yourself after or during an excellent writing day? One of the best goals for writers who want to write is to set a 300 words a day goal. That way you write at least a bit every day, and can always write more on good days when the opportunity presents itself or the muse is with you. Another part of being a disciplined writer is to be good at the grammar part of writing. Don’t forget to consult Grammar Girl, a positive online resource. Here’s a blog that touches on APA style.

Tip 4: Choose with Whom You Schmooze: Writing as Relationship. If you’re at the APA conference (today) or any other national conference (in the future), you’ll find the exhibition hall is filled with book publishers. If writing a book in psychology or counseling is a goal for you, now is not the time to be shy. Many book publishers are looking for new authors and book proposals. They all have their own particular book-writing guidelines. When you’re at a conference, go to the exhibit hall, hang out, schmooze, see what different publishers are looking for in a proposal, and talk about your excellent ideas. In most cases, you have a better chance of publishing a book if you know the publisher and the people who represent the publisher.


John Sommers-Flanagan is a Professor of Counselor Education at the University of Montana and a clinical psychologist. He is coauthor (with his wife, Rita) of the following books published with John Wiley & Sons: Clinical Interviewing (2017, 6th edition forthcoming); Counseling and Psychotherapy Theories in Context and Practice (2012, 2nd edition; 3rd edition forthcoming in 2018); How to Listen so Parents will Talk and Talk so Parents will Listen (2011); and Becoming an Ethical Helping Professional (2007).


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Posted by on August 4, 2016 in Uncategorized


Fun with Existential Theory

I think existentialists have gotten a bad rap over the years. They don’t deserve their depressive reputation. If you’re not sure about this claim, invite a bunch of existentialists over for a party. They know how to have a good time. Just think of Jean Paul Sartre and Simone de Beauvoir. I’m sure they did some table-dancing (among other things) in their time.

Why are they so much fun? Well, in addition to their tendency to go on and on about death and meaninglessness, existentialists were some of the original embracers of carpe diem. They believe in seizing the day (or moment)–regardless of whether they’re playing Pokemon Go or working with you in counseling or psychotherapy.

Below I’ve included a short excerpt from the upcoming 3rd edition of Counseling and Psychotherapy Theories in Context and Practice. One of the reasons I’m posting this is because one of the reviewers of the 2nd edition noted that we were trying too hard to to be “cute” . . . so I thought I’d see if any of you blog-readers think that’s the case. This particular excerpt is as cute as we get in this chapter. What do you think?? Overboard? Just right? Or should we try to be more like Stephen Colbert. You be the judge in this moment in time.

Theoretical Principles

As noted previously, there’s no single theorist or theory of existential psychotherapy. Consequently, although we focus on key existential philosophical and phenomenological principles, other existential writers and theorists may emphasize principles slightly different from the following.

The I-Am Experience

The I-am experience is the experience of being, of existing (R. May et al., 1958). The experience of being is often referred to as ontological experience (ontos means “to be” and logical means “the science of”). Literally, then, a major focus of existential therapy consists of exploring immediate human experience. You might think of it as suddenly waking up and being completely tuned into what it’s like to exist and be here and now in this particular moment in time.

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 almost always in the service of self-awareness or self-discovery. However, unlike psychoanalysts, existentialists seek to expand 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. It’s not so much a matter of uncovering an elusive unconscious as it is a matter of elucidating the conscious and deepening the relational.

Four Existential Ways of Being

There are four primary existential ways of being-in-the-world. They include:

  1. Umwelt: Being-with-nature or the physical world.
  2. Mitwelt: Being-with-others or the social world.
  3. Eigenwelt: Being-with-oneself or the world of the self.
  4. Uberwelt: Being-with-the-spiritual or over world.

The first three of these existential ways of being were described by Boss (1963), Binswanger (1963), and May et al. (1958). The fourth way of being was added by van Deurzen (1988).

These four dimensions of existence are ubiquitous and simultaneous. Some people focus more on one dimension than others or shift from one to another depending on particular intentions or situations. For example, while on a mountain hike up the Stillwater gorge in Montana, it’s difficult not to become profoundly into being-with-nature as water powerfully cascades around you, making all conversation (being-with-others) impossible. However, depending on other factors, this experience can take people inward toward eigenwelt, toward an uberwelt spiritual experience, or stimulate a deep mitwelt (albeit a nonverbal one). In most cases the direction that your being moves in a given situation is likely a combination of several factors, including, but not limited to: anxiety, previous experiences, intention, as well as your spiritual predisposition.



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Readers Needed for our Counseling and Psychotherapy Textbook

Hello All.

We’ve just started working on the 3rd edition revision of our textbook, “Theories of Counseling and Psychotherapy in Context and Practice.”

For each edition of this and our Clinical Interviewing textbooks, we ask interested students, professionals, and academics to provide feedback. This is usually a positive process for us and for reader-volunteers because we usually end up learning from each other.

This time around, to make things manageable on my end, I’ll be accepting the first two volunteers for each chapter. If you’re interested, take a look at the list of chapters below.

What do you get out of the deal? Well, you get that nice warm feeling . . . AND a complimentary copy of the text (when it comes out) and your name and affiliation listed in the acknowledgements section of the text, and a BIG THANKS from Rita and me for your insights and assistance.

Thanks for your potential interest and have a great weekend.

Below there’s an outline listing the existing textbook chapters. If you’re interested in reading and commenting on one of these or need more information, send me an email:

Thanks again for your interest and support!


Chapter 1: Psychotherapy and Counseling Essentials: An Introduction

Chapter 2: Psychoanalytic Approaches** [Each of the subsequent theories chapters follows the same outline as this one]**  

Biographical Information: Sigmund Freud

Historical Context

Psychoanalytic Theoretical Principles

Evolution and Development in Psychoanalytic Theory and Practice

The Practice of Psychoanalytic Therapy

Case Analysis and Treatment Planning

Evidence-Based Status

Concluding Comments

Chapter Summary

Psychoanalytic Key Terms

Recommended Readings and Resources

Chapter 3: Individual Psychology and Adlerian Therapy

Chapter 4: Existential Theory and Therapy           

Chapter 5: Person-Centered Theory and Therapy             

Chapter 6: Gestalt Theory and Therapy 

Chapter 7: Behavioral Theory and Therapy          

Chapter 8: Cognitive-Behavioral Theory and Therapy     

Chapter 9: Choice Theory and Reality Therapy   

Chapter 10: Feminist Theory and Therapy            

Chapter 11: Constructive Theory and Therapy    

Chapter 12: Family Systems Theory and Therapy              

Chapter 13: Developing Your Multicultural Orientation and Skills              

Chapter 14: Integrative and Evidence-Based New Generation Therapies 

One Theory or Many?

Psychotherapy Integration: Historical and Theoretical Trends

The Practice of Eclectic and New Generation Integrative Therapies

Concluding Comments

Chapter Summary

Integrative Key Terms

Recommended Readings and Resources



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Theories Highlights II: The Story of Freud’s Seduction Hypothesis

Let’s put it this way: When it comes to the history of counseling and psychotherapy, there’s plenty of conflict and drama. In the following excerpt from Chapter 2 of Counseling and Psychotherapy Theories in Context and Practice, you’ll get to read about Freud and his formulation and then recanting of the seduction hypothesis. Is it all true and factual? Probably not. Is it fascinating? As Freud would have likely said, “Hell yes!”

Historical Context

As suggested toward the end of Chapter 1, psychological theories are partly a product of the prevailing Zeitgeist and Ortgeist. Bankart (1997) stated:

To fathom Freud’s near-obsession with the sexual foundations of emotional distress is also to come to a fuller awareness of the sexual repression and hypocrisy in the lives of the Austrian middle class at the turn of the…[nineteenth] century and the effect of this repression on the mental health of adolescents and young adults during the time when Freud derived his theories. (p. 8)

A good illustration of psychoanalytic historical context and of Freud’s dominant persuasive powers is the dramatic story of Freud’s development and subsequent recanting of the seduction hypothesis. This story captures his psychoanalytic thinking along with the social dynamics of his time. Interestingly, there’s conflict over the truth of this story—which further illustrates the divisive nature of Freud and his legacy. As you read through the drama of the seduction hypothesis, keep in mind that certain points have been contested…but the unfolding of a spectacular drama around sexuality, sexual fantasy, and sexual abuse in a sexually repressed society is likely accurate.

The Seduction Hypothesis

In 1885, Freud went to France to study under the famous neurologist Jean Charcot. According to Jeffrey Masson, former projects director of the Freud Archives, it’s likely that Freud visited the Paris Morgue, observing autopsies of young children who had been brutally physically and sexually abused (Masson, 1984). Masson speculated that Freud’s exposure to the grisly reality of child abuse combined with stories of abuse he heard from his patients, led him to believe that hysteria was caused by child sexual abuse.

Later, Freud presented a paper titled “The Aetiology of Hysteria” at the Society for Psychiatry and Neurology in Vienna (Freud, 1896). In this paper, he outlined a controversial hypothesis:

I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood, but which can be reproduced through the work of psychoanalysis in spite of the intervening decades. (Freud, 1896, cited in Masson, 1984, p. 263)

Note that Freud stated, “. . . at the bottom of every case of hysteria.” He was emphasizing a clear causal connection between childhood sexual abuse and hysteria. This presentation was based on 18 cases (12 women and 6 men), all of which included childhood sexual abuse. At least three key points are important in this presentation:

  1. Freud’s idea about the connection between childhood sexual abuse and subsequent psychopathology may represent an early formulation of the contemporary diagnosis of Posttraumatic Stress Disorder and/or Dissociative Identity Disorder.
  2. Critics contend that in Freud’s paper, “the ‘facts’ of specific case histories are never provided” (Wilcocks, 1994).
  3. Freud may have been constructing sexual memories both through a direct pressure technique and by distorting what he heard to fit with his pre-existing ideas (Esterson, 2001).

Despite a lack of supporting detail in his presentation and the possibility that he was building evidence to support his theory, Freud goes on to suggest that hysterical symptoms don’t arise immediately, but instead develop later:

Our view then is that infantile sexual experiences…create the hysterical symptoms, but…they do not do so immediately, but . . . only exercise a pathogenic action later, when they have been aroused after puberty in the form of unconscious memories. (Freud, 1896, cited in Masson, 1984, p. 272)

It appears that Freud continued to believe his clients’ sexual abuse stories (or perhaps he believed his own constructed version of his client’s sexual abuse stories) until the late 1800s or early 1900s.

Recanting the Seduction Hypothesis

Imagine yourself alone with a great and horrible insight. In Masson’s version of the seduction hypothesis story, this was Freud’s situation. Masson (1984) describes the reception Freud received after presenting his hypothesis (and this part of the seduction hypothesis story is not disputed):

The paper…met with total silence. Afterwards, he was urged never to publish it, lest his reputation be damaged beyond repair. The silence around him deepened, as did the loneliness. But he defied his colleagues and published “The Aietology of Hysteria.” (pp. xviii–xix)

Five days after presenting his paper, Freud wrote about the experience to his friend and otolaryngologist (ear, nose and throat physician) Wilhelm Fliess. Freud’s anger is obvious:

[My] lecture on the aetiology of hysteria at the Psychiatric Society met with an icy reception from the asses, and from Kraft-Ebing [the distinguished professor and head of the Department of Psychiatry at the University of Vienna] the strange comment: “It sounds like a scientific fairy tale.” And this after one has demonstrated to them a solution to a more than thousand-year-old problem, a “source of the Nile!” They can all go to hell. (Schur, 1972, p. 104)

Although it’s clear that Freud’s lecture received “an icy reception” it’s less clear why the audience was unimpressed. According to Masson, the reception is icy because Freud is bringing up sex and sexual abuse and that psychiatry (and most professionals and citizens at the time) were uncomfortable with facts linked to high sexual abuse rates. Alternatively, others have suggested that Freud’s style, perhaps a combination of arrogance along with an absence of scientific rigor or detail, moved the audience to rebuke him. For example, Wilcocks (1994) wrote:

The inferential support offered—without detail, of course—is that in eighteen cases out of eighteen, Freud has “discovered” the same etiological factors. But since neither we nor his audience are/were privy to the circumstances of any of his cases, this claim—whatever it’s other inferential mistakes—is simply useless. (p. 129)

It may never be clear whether Freud’s motives in presenting the seduction hypothesis were noble or manipulative. However, regardless of motive, the ensuing years following his “Aetiology of Hysteria” lecture were difficult. Reportedly, his private practice was in decline and his professional life in shambles. It was at this time that Freud began what has been described as “his lonely and painful self-analysis” (Prochaska & Norcross, 2003, p. 29). His 2-year self-analysis included uncovering memories of yearning for his mother and equally powerful feelings of resentment toward his father (Bankart, 1997).

Eventually, Freud discarded his seduction hypothesis in favor of the Oedipus complex (where the child holds unconscious wishes to have sexual relations with the parent of the opposite sex). Some suggest this was because he began noticing seductive patterns in so many parent-child interactions that it was unrealistic to assume that child sexual abuse occurred at such a ubiquitous rate. Others believe Freud was ahead of his time in discovering child sexual abuse, but buckled under the social and psychological pressure, abandoning the truths his patients shared with him. Still others contend that while Freud was constructing his theoretical principles, he was projecting and mixing his own fantasies into his clients’ stories. The following statement illustrates the highly personalized nature of some of Freud’s theorizing:

I found in myself a constant love for my mother, and jealousy of my father. I now consider this to be a universal event in childhood. (R. A. Paul, 1991)

Eventually, in 1925, long after he recanted the seduction hypothesis, he reflected on his struggle:

I believed these stories, and consequently supposed that I had discovered the roots of the subsequent neurosis in these experiences of sexual seduction in childhood.… If the reader feels inclined to shake his head at my credulity, I cannot altogether blame him.… I was at last obliged to recognize that these scenes of seduction had never taken place, and that they were only fantasies which my patients had made up. (Freud, 1925, cited in Masson, 1984, p. 11)

In the creation and recanting of the seduction hypothesis, it’s difficult to sort out fact from fantasy. Perhaps this is as it should be, as it illustrates at least one formidable lesson about psychology. That is, when diving headlong into the deep psychological processes of humans, it’s possible to elicit confused and confusing storylines and to knowingly or unknowingly (unconsciously) mix (or project) our own personal issues into the plot. In the end, it may be that we create Kraft-Ebing’s “Scientific fairy tale” or, alternatively, something with lasting and meaningful significance. More likely, we create a combination of the two. (See Table 2.1 for three possible conclusions about Freud and the seduction hypothesis.)

Table 2.1: Freud’s Seduction Hypothesis: Three Conclusions

The official Freudian storyline goes something like this: Sigmund Freud was an astute observer who had to discard his earlier views about child seduction and sexual abuse to discover the more basic truth of the power of internal fantasy and of spontaneous childhood sexuality.

Although he initially believed his clients’ sexual abuse reports, he later discovered that it was not actual abuse, but imagined sexualized relationships (fantasies) between children and caretakers—aka: the Oedipus complex—that caused psychopathology.

Masson’s (1984) version, subsequently labeled “a new fable based on old myths” (Esterson, 1998), suggests that Freud was ahead of his time in recognizing child sexual abuse. These abuses were real and it was correct of Freud to identify them and to develop his seduction hypothesis. However—and unfortunately—Freud abandoned his sexually abused clients by recanting the seduction theory. He abandoned them because of pressure from medical and scientific colleagues and because society was not ready to face the reality of rampant child sexual abuse. Freudian critics suggest that Freud was an exceptionally bright, persuasive, and powerful speaker and writer, but he was practicing bad science. He was more interested in building his theory than psychological reality. Consequently, he twisted his clients’ stories, mixing them with his own issues and fantasies, and created an elaborate theory initially around sexual abuse and later around sexual fantasy. His theories, although fascinating and capturing much about the projective potential in human thinking, are more about Freud than they are about his clients.


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Theories Highlights I: What’s the difference between counseling and psychotherapy?

My younger daughter has graduated, our video shoots for the Clinical Interviewing text are “in the can,” my time with the grandkids has passed, and the family reunion is over. Now, as the summer sun blazes, I’ve retreated to my standing desk and dived head-first into revising the 3rd edition of our Counseling and Psychotherapy Theories textbook. Later today, I’ll refresh myself with a different sort of dive into the beautiful and frigid Stillwater River.

As I work on revising this textbook I’ll be posting a series of “Theories Highlights.” They will be short excerpts from the forthcoming 3rd edition. Here’s the first one. As always, I’d love feedback if you feel like sharing.

From Chapter 1:

Definitions of Counseling and Psychotherapy

Over the years, many students have asked: “Should I get a PhD in psychology, a master’s degree in counseling, or a master’s in social work?”

This question usually brings forth a lengthy response, during which we not only explain the differences between these various degrees, but also discuss additional career information pertaining to the PsyD degree, psychiatry, school counseling, school psychology, and the psychiatric nurse practitioner credential. This sometimes leads to the confusing topic of the differences between counseling and psychotherapy. If time permits during these discussions, we also share our thoughts about less-confusing topics, like the meaning of life.

Sorting out differences between mental health disciplines is difficult. Jay Haley (1977) was once asked: “In relation to being a successful therapist, what are the differences between psychiatrists, social workers, and psychologists?” He responded: “Except for ideology, salary, status, and power the differences are irrelevant” (p. 165). Haley articulated the reality that many different professional tracks can lead you toward becoming a successful therapist, despite a few ideological, salary, status, and power differences.

In this section we explore three confusing and sometimes conflict-ridden questions: What is psychotherapy? What is counseling? And what are the differences between the two?

What Is Psychotherapy?

Anna O., an early psychoanalytic patient of Josef Breuer (a mentor of Sigmund Freud), referred to the treatment she received as “the talking cure.” This is an elegant, albeit vague description of psychotherapy. Technically, it tells us very little, but at the intuitive level, it explains psychotherapy very well. Anna was saying something most people readily admit: Talking, expressing, verbalizing, or sharing one’s pain and life story is potentially healing. This definition isn’t satisfactory as a research definition, but it provides an elegant historic and foundational frame.

As we write today, heated arguments about how to practice psychotherapy continue (Baker & McFall, 2014; Laska, Gurman, & Wampold, 2014). This debate won’t soon end and is directly relevant to how psychotherapy is defined (Wampold & Imel, 2015). We explore dimensions of this debate in the pages to come. For now, keep in mind that although historically Anna O. viewed and experienced talking as her cure (an expressive process), many contemporary researchers and writers emphasize that the opposite is more important—that a future Anna O. would benefit even more from listening to and learning from her therapist (a receptive process). Based on this perspective, some factions in the great psychotherapy debate believe therapists are more effective when they actively and expertly teach their clients cognitive and behavioral principles and skills (aka psychoeducation).

We have four favorite (and different) psychotherapy definitions we’d like to share:

  • A conversation with a therapeutic purpose (Korchin, 1976).
  • The purchase of friendship (Schofield, 1964).
  • [A] situation in which two people interact and try to come to an understanding of one another, with the specific goal of accomplishing something beneficial for the complaining person (Bruch, 1981).
  • When one person with an emotional disorder gets help from another person who has a little less of an emotional disorder (J. Watkins, personal communication, October 13, 1983).

What Is Counseling?

In some settings, an evaluative or judgmental distinction is made between counseling and psychotherapy. Alfred Adler, whom we’ll get to know more intimately in Chapter 3, might say that counseling has an inferiority complex with respect to its older sibling, psychotherapy (Adler, 1958). Or, perhaps it could be that psychotherapy has a superiority complex toward its younger rival, counseling. Either way, at some point you may notice or experience people passing judgment on the relative merits of psychotherapy and counseling.

Counselors have struggled to define their craft in ways similar to psychotherapists. Consider, Kottler and Brown’s (2008) perspective:

Counseling is indeed an ambiguous enterprise. It is done by persons who can’t agree on what to call themselves, what credentials are necessary to practice, or even what the best way is to practice—whether to deal with feelings, thoughts, or behaviors; whether to be primarily supportive or confrontational; whether to focus on the past or the present. Further, the consumers of counseling services can’t exactly articulate what their concerns are, what counseling can and can’t do for them, or what they want when it’s over. (pp. 16–17)

As with the term psychotherapy, a good definition of counseling is hard to find. Here’s a sampling:

  • Counseling is the artful application of scientifically derived psychological knowledge and techniques for the purpose of changing human behavior (Burke, 1989, p. 12).
  • Counseling consists of whatever ethical activities a counselor undertakes in an effort to help the client engage in those types of behavior that will lead to a resolution of the client’s problems (Krumboltz, 1965, p. 3).
  • [Counseling is] an activity…for working with relatively normal-functioning individuals who are experiencing developmental or adjustment problems (Kottler & Brown, 1996, p. 7).

We now turn to the question of the differences between counseling and psychotherapy.

What Are the Differences Between Psychotherapy and Counseling?

Years ago, Patterson (1973) answered this question directly: “There are no essential differences between counseling and psychotherapy” (p. xiv). On this issue, we agree with Patterson and Corsini and Wedding (2000), who wrote:

Counseling and psychotherapy are the same qualitatively; they differ only quantitatively; there is nothing that a psychotherapist does that a counselor does not do. (p. 2)

This statement implies that counselors and psychotherapists engage in the same behaviors—listening, questioning, interpreting, explaining, and advising, but may do so in different proportions.

For the most part, the professional literature implies that psychotherapists are less directive, go a little deeper, work a little longer, and charge a higher fee. In contrast, counselors are slightly more directive, work more on developmentally normal—but troubling—issues, work more overtly on practical client problems, work more briefly, and charge a bit less. In the case of individual counselors and psychotherapists, each of these tendencies may be reversed. For example, some counselors work longer with clients and charge more, whereas some psychotherapists work more briefly with clients and charge less. Additionally, although it used to be that counselors worked with clients who displayed less severe problems and psychotherapists worked with patients who display more severe problems, now, perhaps because obtaining services from master’s-level counselors or social workers is less expensive, counselors often work with lower income clients whose financial stress interacts with and complicates their personal and family problems.

A Working Definition of Counseling and Psychotherapy

At the very least, there are strong similarities between counseling and psychotherapy. Because the similarities vastly outweigh the differences we use the words counseling and psychotherapy interchangeably. And sometimes we use the word therapy as an alternative.

For the purposes of this text and to keep things simple, we offer a 12-part general definition of counseling and psychotherapy (in case you weren’t sure, this reference to keeping things “simple” is an example of sarcasm). Counseling or psychotherapy is:

(a) a process that involves (b) a trained professional who abides by (c) accepted ethical guidelines and has (d) competencies for working with (e) diverse individuals who are in distress or have life problems that led them to (f) seek help (possibly at the insistence of others) or they may be (g) seeking personal growth, but either way, these parties (h) establish an explicit agreement (informed consent) to (i) work together (more or less collaboratively) toward (j) mutually acceptable goals (k) using theoretically-based or evidence-based procedures that, in the broadest sense, have been shown to (l) facilitate human learning or human development or reduce disturbing symptoms.

We should note that, although this definition is long and multifaceted, it’s still probably insufficient. For example, it wouldn’t fit for any self-administered forms of therapy, such as self-analysis or self-hypnosis—although we’re quite certain that if you read through this definition several times, you’re likely to experience a self-induced hypnotic trance-state.





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