Monthly Archives: April 2013

Counseling and Psychotherapy Theory and Practice, Parenting

Building a Therapeutic Relationship with Parents: Part II – Using Radical Acceptance

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Building a Therapeutic Relationship with Parents: Part II – Using Radical Acceptance

Radical acceptance is a central therapeutic attitude held by practitioners who work effectively with parents. Radical acceptance is both an attitude and a clinical technique. This concept was originally articulated by Marsha Linehan (1993) and is a foundational component of dialectical behavior therapy. It involves a particular attitude that builds on Carl Rogers’s core therapeutic condition of unconditional positive regard as well as Eastern (Buddhist) philosophy.

Radical acceptance enables helping professionals to approach each client or parent with an overarching, pervasive dialectic belief, which we translate as, “I completely accept you just as you are and I am committed to helping you change for the better.” When working with parents, consultants strive to simultaneously hold both of these beliefs or attitudes. On the surface, these attitudes may seem contradictory, thus the term dialectic. At a deeper level, in a helping relationship, each attitude is necessary to complete the other.

As a technique, radical acceptance serves two main functions. First, it can help you refrain from expressing negative personal reactions to statements by parents that inadvertently push your buttons (we’ll focus more on button-pushing in Chapter 2). If you hear a statement that pushes an emotional button for you, having a radical acceptance attitude would help remind you that your job is to fully accept the person in the room with you—as is. In this situation, you don’t have to say anything as you simply quiet your roiling reactions. You can just be present and nonreactive.

Second, beyond momentary silence, radical acceptance allows parenting professionals to actively embrace whatever attitudes or beliefs parents bring into the consulting room. As we’ve stated previously (J. Sommers-Flanagan & Sommers-Flanagan, 2007):

The generic version or statement of radical acceptance is to graciously welcome even the most absurd or offensive . . . [parent] . . . statements with a response like, “I’m very glad you brought that [topic] up.” (p. 275)

Radical acceptance is especially warranted when parents say something you find disagreeable. This may include racist, sexist, or insensitive comments. For example:

Parent: I believe in limiting my children’s exposure to gay people. Parents need to keep children away from evil influences.

Consultant: Thanks for sharing your perspective with me. I’m glad you brought up your worries about this. Some parents have similar beliefs but won’t say them in here. So I especially appreciate you being honest with me about your beliefs. [Adapted from Sommers-Flanagan & Sommers-Flanagan, 2007, p. 276.]

Rest assured, radical acceptance does not mean agreeing with the content of whatever parents say. Instead, it means moving beyond feeling threatened, angry, or judgmental about parents’ comments and authentically welcoming whatever comes up during the session. The main purpose of welcoming disagreeable or challenging parent comments is to communicate your commitment to openness. If you don’t communicate and value openness by welcoming all remarks, parents or caregivers may never admit their core underlying beliefs. And if parents cover up their true beliefs—especially disagreeable or embarrassing beliefs—there will be no opportunity for insight or change because the underlying beliefs will never be exposed to the light of personal and professional inspection.

Similar to person-centered therapy, one key to using radical acceptance effectively is genuineness or congruence. This means you should never falsely welcome parents’ racist, sexist, insensitive, or outrageous comments. Instead, you should welcome such comments only if you really believe that hearing them is a good thing that can benefit the counseling or consultation process.

Radical acceptance also involves letting go of the immediate need to teach parents a new and better way. We must confess that we haven’t always maintained an attitude of radical acceptance ourselves. During one memorable session, upon hearing the classic line, “I got spanked and I turned out just fine!” John, being in an impatient and surly mood, barely managed to suppress an extremely destructive impulse (he wanted to say, “Are you really so sure you turned out fine?”). Nevertheless, a judgmental and dismissive comment still slipped out and he said: “I can’t tell you how many times I’ve heard parents say what you just said.” Not surprisingly, that particular session didn’t proceed with the spirit of empathy, acceptance, and collaboration we generally recommend.

This leads us to some obvious advice: Although you cannot be radically accepting all the time, you should always avoid radical judgment. There’s no need to test the “How about I treat parents in a judgmental, dismissive manner?” technique. Outcomes associated with judgmental and disrespectful counselor behavior are quite undesirable.

Stay Tuned for Part III on Building a Therapeutic Relationship with Parents tomorrow.

Counseling and Psychotherapy Theory and Practice, Parenting

Building a Therapeutic Relationship with Parents: Part I

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Every parent is unique. But as a group, most parents have similar interests and goals. What this means for consultants and counselors and psychotherapists is that parents constitutea unique population and therefore to work effectively with parents requires a specifically tailored treatment approach and training in how to provide educational and therapeutic services for parents.

The following is an adapted excerpt from the book, “How to Listen so Parents will Talk and Talk so Parents will listen. For more info, go to: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=la_B0030LK6NM_1_4?ie=UTF8&qid=1366501670&sr=1-4

To work effectively with parents, consultants or practitioners should use an approach that, similar to person-centered therapy, is characterized by three core attitudes: (1) empathic understanding; (2) radical acceptance; and (3) collaboration.

Empathy for Parents and Parenting

As is well-known, empathic understanding is one of the three core conditions for psychotherapy originally identified by Carl Rogers (1942; 1961; 1980). Over the years, research has left no doubt that therapist empathy facilitates positive therapy outcomes (Goldfried, 2007; Greenberg, Watson, Elliot, & Bohart, 2001; Mullis & Edwards, 2001). As applied to parents, empathy involves:

The therapist’s ability and willingness to understand the parent’s thoughts, feelings, and struggles from the parent’s point of view and an ability to see, more or less completely, through the parent’s eyes and adopt the parent’s frame of reference . . . . It means entering the private perceptual world of a parent. (adapted from Rogers, 1980, pp. 85, 142)

When working with parents, counselors, psychologists, and other human services professionals must learn to sensitively enter into the parent’s unique perceptual world. The practitioner needs to demonstrate empathy and sensitivity for specific parenting challenges. A person-centered perspective also implies that professionals who work with parents show empathy for the barrage of criticism, scrutiny, and associated insecurity that parents experience due to their exposure to social and media sources. Brazelton and Sparrow (2006) capture one way in which socially driven parental insecurity can manifest itself:

When Mrs. McCormick held Tim in her lap at the playground, she sat alone on a bench across from the other mothers as if she were ashamed of Tim’s clinging. She knew that if she sat by other mothers, they would all give her advice: “Just put him down and let him cry—he’ll get over it.” “MY little girl was just like that before she finally got used to other kids.” “Get him a play date. He can learn about other children that way.” (p. 8)

This example illustrates how parents anticipate criticism and work hard to avoid it. If you’ve been a parent or you work with parents, you know how easy it is for them to feel defensive about their children’s behaviors and their parenting choices. This is partly because, like Mrs. McCormick, they’re unable to measure up to narrowly defined parenting standards and cannot face the cascade of criticism or advice they’re likely to receive when their child doesn’t behave perfectly in social settings. To provide an optimally empathic environment, practitioners should have and show empathy or attunement with parents’ sensitivity to perceived or actual criticism and counter this sensitivity by amplifying their support and acceptance (we’ll cover therapeutic methods for amplifying support and acceptance in greater detail in Chapter 4).

Similar to the empathic attitude associated with person-centered therapy, it’s crucial for professionals who work with parents to hold the attitude that parenting is naturally difficult and that making mistakes or having a child who publicly misbehaves is nothing to feel shameful about. By maintaining this attitude, practitioners provide a nonjudgmental and empathic space for parents to explore their personal doubts and fears. This is the way the theory works: By being nonjudgmental, compassionate, and openly supportive, parenting professionals provide an environment free from societal conditions of worth, which then stimulates parents to become more open and collaborative when examining their weaknesses with a trusted professional.

Part II of this three part blog post continues tomorrow.

Counseling and Psychotherapy Theory and Practice, Parenting, Personal Reflections

The Return of Mother’s Little Helper . . .

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This week Allen E. Ivey (the creator of the microcounseling approach) sent me a link to an article claiming that exercise is better for long-term brain functioning than medications. He was “venting” because he thinks this is not “new” information and instead constitutes basic common sense that everyone should embrace. The fact that exercise is good for neurological development and functioning is obvious and it can be frustrating to see the media acting surprised over and over again that life experiences—including counseling and psychotherapy—improves health, life satisfaction, and brain functioning.

Dr. Ivey’s comments and the article he sent reminded me of an unpublished piece I wrote a few years ago. It was a sarcastic commentary on a recent (at the time) publication touting the efficacy of antidepressants in treating depressive symptoms in mothers.

Here’s the piece. Sarcasm included.

The Return of Mother’s Little Helper

            Mother’s little helper is back.

            In a recent landmark study published in the Journal of the American Medical Association, a prestigious group of researchers reported that children with depression improved or recovered when their depressed mothers became less depressed. The researchers were surprised and optimistic that an environmental change—mothers becoming less depressed—could directly help children whom they thought had biological depression. This is an important finding, especially given concerns about prescribing psychotropic medicines directly to children.

            Having closely followed pharmaceutical research in child psychiatry, I’m always skeptical about landmark studies and promising new drugs, but try to stay balanced and hopeful. When I mentioned the research results to my graduate students in counseling and social work, all of whom happened to be women, they felt no need for balance or hope. They responded in unison.

            “No duh. Obviously children will do better if their mothers aren’t depressed. Who needs a study to tell you that?”

            I felt instantly defensive for pharmaceutical researchers everywhere. Okay, maybe the study demonstrated the obvious, but helping children be less depressed is clearly a good thing.

            My students weren’t convinced. They asked, “What treatment did the mothers’ get?”

            “Mostly they got Celexa.” Celexa is very similar to Prozac. They’re both classified as ‘SSRIs,’ meaning they selectively focus on making serotonin more plentiful in crucial brain regions.

            My cynical students pressed on: “Did the makers of Celexa fund the study?”

            “No,” I responded. “Forest Laboratories makes Celexa, but the study was funded by the National Institute of Mental Health.” I felt redeemed; the study was objective.

            “How many of the authors were paid by Forest Laboratories?”

            I happened to have the article with me, so I looked at the back page where financial disclosures are conveniently listed—in very small print. I squinted my way through: “Only 3 authors name Forest Laboratories as giving them money. And Forest Laboratories is thanked in the fine print for supplying all the medication for free.”

            Actually, that wasn’t too bad. There were 15 coauthors on the study; only 20% were linked to Forest Laboratories.

            But my picky students wanted to know about the numbers, so I explained that 151 mothers started the study, but 37 (24.5%) dropped out before three months. Overall, 38 of the 114 remaining mothers recovered from their depressive condition and another 16 improved somewhat. The authors report an overall response rate of 47%.

            A student pecked at her calculator and declared. “No way! Fifty-four of 151 isn’t 47%, it’s 36%; they’re either lying, cheating, or very bad at arithmetic.”

            “How about the kids,” another asked.  “How many of them got better?”

            “Well, it’s complex and hard to say, but overall the researchers report that, of 105 kids, 9 were significantly affected during the study, 4 in a positive direction and 5 in a negative direction.”

            The students mumbled and grumbled. “Are you kidding? That’s not much improvement.” They went on to rant a bit about never knowing a depressed, sleep-deprived mother—including themselves—who looked forward to 18 hours of screeching children and smelly diapers? One student, now a grandmother, noted that Valium (the original mother’s little helper) was the most prescribed drug in the U.S. from 1969-1982 and such a big pharmaceutical success that it inspired a Rolling Stones song. Unfortunately, Valium turned out to be terribly addictive, but now apparently, there’s Celexa, Prozac, and other options for overwhelmed mothers.

            After a few more stories, my students asked, “What were the study’s conclusions?”

            I read aloud: “. . . these findings suggest that it is important to provide vigorous treatment to mothers if they are depressed.”

            Throughout the room, eyes began to roll.

            “That’s a big surprise. They want depressed moms to feel guilty if they don’t take antidepressants. That’s what they mean by ‘vigorous treatment.’ As if a hard life is made better by serotonin? How much did they spend on that study anyway?”

            “I really don’t know,” I answered.  “Maybe half a million?”

            The student with the calculator pecked away again: “They should use that money to do a study on something that might really help depressed mothers.”

            “Like what?” I asked.

            “Like maybe a study on the effectiveness of splitting half a million among 114 moms—that’s over $4,300 each. They could just give them the money, or pay for some counseling and parenting consultations, or health club memberships, or childcare, or massages, or vocational training. Better yet, the researchers could use the money to train fathers to hang around the house and be helpful, rather than lying around watching sports and reading Penthouse.”

            At that point I decided class was over. I’d learned about as much as I could handle for one day.

Counseling and Psychotherapy Theory and Practice, Divorce, Group therapy, Parenting, Uncategorized

The Love Reframe

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Years ago I had the privilege and challenge of teaching a class for divorced parents through Families First in Missoula. About half of the dozen or so participants were mandated to attend. This made for an initially less-than-pleasant opening mood. As I went around the room doing introductions, I came to a man who looked a bit snarly. He announced his name and then said, “But I don’t need no stupid-ass parenting class. The only reason I’m here is because the Judge told me that if I didn’t come, I’d be forced to have supervised visits with my 12 year-old daughter. I’m here, but I don’t need this stupid-ass class.”

 

This was a difficult moment and perhaps because I’m a man, complete with a pesky “Y” chromosome, I was tempted to get into an instant pissing match right there. I felt an urge to say something like, “Well, you may not think you need this class, but apparently the Judge does and so you’d better watch how you talk in here!” Instead, somewhat to my surprise, the following words came into my mind and then out of my mouth, “Well, let me especially thank you for coming because you must really love your daughter to be willing to attend this class.”

 

As the 6 hour marathon class progressed, the snarly man settled in. He was never really pleasant, but he contributed to discussions and politely got in line at the end of class to receive his signed certificate. When I handed him the certificate, I said something like, “Hey, you know you should frame this certificate and put it on your wall at home.”

 

A few weeks after the class I got a call from the guy who didn’t need a stupid-ass parenting class. He sounded different and immediately apologized for “being a jerk in class.” Then he told me in a cracking voice that he’d taken my advice and hung the class certificate on his wall. And then it was clear he was crying when he said, “My daughter came over for an unsupervised visit and when she saw that certificate on the wall, she turned around and gave me this big old hug and said, Daddy, I am so proud of you!”

 

This experience and others like it taught me an important lesson about parents in general and fathers in particular. I’ve learned that underneath the bluster of some irritable and difficult dads there are men who desperately love their children. If we tap this potential, good things can happen.

Parenting

Who Needs Parenting Education Anyway?

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Today and tomorrow I’m in Minneapolis at the annual work meeting for the National Parenting Education Network (NPEN). The room at the Search Institute (our host for the two days) is filled with very nice and very intelligent people—all of whom are deeply dedicated to making high quality parenting education a norm in the United States. Being with these fabulous people gave me a 15-year-old flashback.

I transported back in time and saw myself as the executive director of Families First Missoula, making a routine appearance on a local television news show. The vintage female newscaster was interviewing me about the upcoming Missoula “Parents’ Convention.” The Parents’ Convention was a full-day—including  a keynote speaker and 75 minute break-out sessions—all designed specifically for parents. It was pretty darn cool.

The newscaster nodded attentively. I explained how the event was created for parents because parents often didn’t get respect for all the knowledge required to fulfill their parenting commitments. This Parents’ Convention was about treating parents as professionals. As I finished talking, the newscaster turned to the camera, exclaiming, “Do go!”

I was pretty happy.

But moments later she scrunched up her face and muttered: “If you need that sort of thing.”

I wish I’d been ready for this negation of my message. But I wasn’t and so I just ignored her. Instead, I wish I’d explained that good, competent, and effective parenting is NOT NATURAL. I wish I’d emphasized that everyone needs parenting education and that everyone should want the sort of knowledge that just might make them a little better parent.

And this flashback takes me to another one.

This time I’m doing a short stint of in-home family therapy. There’s a mom with her 8-month pregnant teenage daughter and the room is filled with worries—worries about whether this teen mom is ready for what she’s facing. In a massive effort at denial, the soon-to-be grandmother turns to me with a strange and strained grin, stating, “Once she holds that new baby in her arms, she’ll know what to do . . . don’t you think?”

The answer then—and now—is the same. “No. She will not naturally and automatically know what to do. Parents need education. Parents need support. And parents need to know they need education and support. Rarely are parents really ready to face the enormity of their task. It’s hard to competently cope with sleep deprivation, mood swings, a wailing baby with poop somehow defying gravity and making its way up your child’s back, as well as the many other emotional, physical, and psychological demands of parenting.

And so this is why I invite you all to go to the National Parent Education Network’s website. For a mere $25 a year, you can join the movement to make high quality parenting education more accessible for to all parents. Somewhere inside, behind our strange and strained grins, we all know that parents need our help and that it’s the children who will benefit.

NPEN’s website: http://npen.org/