This week I had an OpEd piece published in the Missoulian. It’s a political psychology essay, and so if you don’t like that sort of thing, no need to read it. But if you’re interested, here’s the link to the OpEd piece. https://missoulian.com/opinion/columnists/how-trump-grows-hate-in-america/article_0bd0c8ba-f994-5f17-bcac-5c4008799f8b.html
Not long ago, on This American Life, Bill Kristol, conservative journalist and #NeverTrumper (not to be confused with the comedian Billy Crystal), touted the benefits of having a legitimate contender in the republican primaries. He acknowledged former Massachusetts Governor Bill Weld’s candidacy, but I’m guessing Mr. Kristol was hoping for someone with more firepower, and maybe someone not named Bill. Naturally, after engaging in self-reflection, I immediately concluded that Bill Kristol must be thinking of me.
But why me?
Because watching me dance around Donald “Old Man” Trump in a debate, would be a #NeverTrumper’s fantasy. I’d be floating like helium and stinging like a scorpion. Because I’m a shrink, it would take me an estimated microsecond to get under Trump’s microscopically thin orange skin to reveal his huge—never seen bigger—INSECURITIES.
I’m already practicing a coughing routine; at this point, I automatically cough whenever I hear his voice. Just ask Mick Mulvaney how much Trump likes people coughing while he’s talking. I can see Trump responding to my coughing fit like an old man with uncontrollable tremors.
Speaking of Trump being an old man, I’d casually and repeatedly make note of the fact that I’m younger, stronger, fitter, and a better golfer than he is. Me being a better golfer than Trump might be a lie, but I’d still challenge him to a televised round of golf (if only to have America watch him cheat). I’d also challenge him and his sagging body to be video recorded as we meet with his physician to undergo simultaneous physical exams.
Although it’s probably unnecessary, I’d show off how much BIGGER my IQ score is, first by pointing out that anybody who knows anything about IQs, never says IQ, they always say “IQ score.” Duh, Donald! Then I’d challenge him to a spelling bee, wherein the first word would be “conservative” and the dunce that is the Donald won’t even be able to spell it, let alone act like one. Just in case he’s lucky and gets it right, the second word would be “unprecedented.”
My conservative street cred dwarfs Donald’s. He’s a weak old man who knows more about bankruptcy than he does about balancing budgets. That’s not conservative. During the debate, just before dropping the mic, I’d drop the fact that I’ve never declared bankruptcy, that I don’t live on debt, and that I’ve proportionately made way more money than he has (and I’m way younger than he is and so I’ll just keep on making money and paying taxes for far longer than he’ll be making money and not paying taxes).
Sadly, Trump puts his mental weakness on display daily. That’s not a conservative quality. He can’t resist lashing out at anyone who doesn’t worship his beautiful bleach-blonde hair. Trump insults everyone from Gold Star families to porn stars to people who suffer from mental disabilities. Strong people don’t do that. Real conservatives don’t do that. He’s. Not. Even. Close. To. Conservative.
Growing up I learned of conservative principles of integrity and self-discipline. Conservative people have excellent self-control, and lead by example.
Lead by example? Trump is every parents’ nightmare role model. Can you imagine having an Uncle Donald Trump? You’d be hiding the kids when he came to visit. Who wants to raise a weak-minded bully who cheats on his wife and whose buddies are mostly criminals? Trump’s whole behavioral palette is the antithesis of traditional conservative values. Anybody want to argue that one? Anybody? Kristol?
How about me?
I’m an old-fashioned conservative. I believe in practical solutions to personal, national, and world problems.
I live by conservative values, including honesty, respect for others’ freedoms, and a commitment to fairness and the rule of law. I want a level playing field for everyone, recognizing that for too long the field has been tilted in favor of white, wealthy, and the politically connected. Speaking of playing fields BTW, I played college football, the sport of conservatives. What sport has Trump ever played, besides golf on the taxpayer’s dime?
I’m all about Christian, Jewish, and Eastern religious values. I attend church more often than Donald. My favorite Christian value is “Love thy neighbor as thyself” . . . which is clearly NOT Trump’s favorite Christian value; he doesn’t believe in loving thy neighbor, unless the neighbor happens to be a playboy bunny or porn star.
To the best of my knowledge, which, during our debate, I would quickly point out is better than the best of Donald’s knowledge, Jesus said something about treating children with great care and compassion. Maybe Trump didn’t get the memo about Jesus loving the poor or the story about the Good Samaritan? Maybe he never listened to the voice mail Jesus left for him about not separating children from their parents and putting them in cages. In case the debate audience didn’t get the point, I’d make it clear: cages aren’t Christian, and cages aren’t conservative.
Unlike Trump, I’ve got a plan to reduce abortion rates (hint: it involves education, career opportunities, and libertarian values, not degradation of women and their personal freedoms).
Unlike Trump, I’ve got an environmental plan for an economic stimulus. Even Ronald Reagan knew you couldn’t tax cut the country to prosperity. Believe me, my economic policies would be more sophisticated than giving tax breaks to the wealthy, slapping on tariffs to raise prices for Americans, and pissing off our allies.
Unlike Trump, I’m pro-education. I wouldn’t appoint a wealthy, dull donor who hates education and has never stepped into a public school as my Secretary of Education. I’d follow the guidance of John Adams, a white, Christian, who also happened to be the second U.S. President. President Adams said that when it comes to the education of low income youth, “no expense for this purpose would be thought extravagant.”
Unlike Trump, I’m not racist, I don’t call countries “shitholes” or Tweet weird statements about “pig’s blood” or pitch my tent in white supremacist territory. I think most Americans and conservatives would appreciate a straight-up conversation about racism. We’re not a racist nation, and I’d make that point, and then make it again, and then I’d make it again.
Unlike Trump, I’ve got a foreign policy that involves something other than slumming with dictators. That alone should be a relief to bona fide conservatives. Because I’ll be taking a conservative approach, photo ops in North Korea and off-the-books meetings with Putin will not be part of my presidential foreign policy agenda.
In conclusion, let me say:
“Hey Bill Kristol, if you’re reading this, give me a call. I’m ready to be Trump’s biggest nightmare (next to you, of course). I’m happy to volunteer; it’s an easy job, especially because Trump is so old, weak, feeble, and liberal.”
Common sense, clinical intuition, non-experimental research studies, and most sentient beings all support the likelihood that physical exercise can reduce depressive symptoms.
But, to the best of my knowledge, only one, very small, randomized controlled study of exercise for treating major depressive disorder in youth has ever been conducted. This study was nicknamed the DATE study (the Depression in Adolescence Treated with Exercise study by Hughes, Barnes, Barnes, DeFina, Nakonezny, & Emslie, and published in 2013 in a journal called, Mental Health and Physical Activity).
A brief review of the DATE study provides a glimpse into the potential of exercise as an intervention for treating depression in youth.
The DATE study randomized youth ages 12 – 18 years into an aerobic/cardio group (n = 16) vs. a stretching group (n =14). Although participants exercised independently and were given a variety of exercise alternatives (they could use Wii or Jazzercize, that’s right Jazzercize), both groups were involved in 12 weeks of rigorously monitored three times weekly exercise treatment protocols.
The results were statistically and clinically significant, with the aerobic condition showing remarkably fast responses and achieving a 100% response rate (86% complete depression remission). The stretching group improved more slowly, but also had a significant positive response (67% clinical response rate; 50% complete depression remission).
Now you might be thinking, that sounds pretty good, but how do those results compare with response rates from established medical treatments, like Prozac?
The authors shared that information. They reported that documented response rates in comparable fluoxetine (Prozac) studies with youth, showed, on average, about a 52% (Prozac) and 37% (placebo) response rate. Just to be clear, let’s put those results in order of which treatment looks best:
But the authors didn’t stop there.
They noted that although Prozac shows beneficial treatment effects, clients who take Prozac and other antidepressants commonly experience uncomfortable side effects and occasional health-threatening adverse events. How do you suppose the exercise and stretch groups compared?
No big surprise here: They experienced ZERO side effects and ZERO adverse events.
In summary, the DATE study authors reported that, compared to antidepressant medication treatment with adolescents, exercise resulted in (a) a faster response rate, (b) a better response rate, (c) fewer relapses (n = 0) at six and 12 month follow-ups, and (d) zero side effects or adverse events (Hughes et al., 2103).
But here’s the kicker. Who exactly were these researchers?
This is my favorite part. The researchers were extremely high level and prestigious academics who primarily conduct pharmaceutical research. One of them was the guy responsible for the clinical studies that led to FDA approval of Prozac for treating youth with depression (Graham Emslie). The two biggest names on the study have repeatedly been funded by Eli Lilly, GlaxoSmithKline, Pfizer, and many more. The DATE study was funded by NIH.
Sadly, the DATE study hasn’t been replicated. I can’t find any new RCTs on exercise for depression among adolescents. When I told this to Rita, she just quipped, “That’s probably because the authors were murdered by pharmaceutical companies in some back alley.”
I hope not. Because, to summarize, the DATE study supports the systematic use of exercise in youth with depressive symptoms OVER and INSTEAD OF antidepressants.
Who knew?
Just about everyone.
A photo of me and my feminist inspiration.
People are often curious about why I would bother writing (and revising) a book on Counseling and Psychotherapy Theories. I usually tell them “I do it for the money” and then laugh like the witch in The Wizard of Oz.
Okay. So it’s obviously not about the money, and I don’t really laugh like that witch, because that would just be frightening and weird and ever since I fell down and hit my head while engaging in a frightening and weird act, I’ve had a pact with myself not to do things that are frightening and weird.
Anyway, to refocus . . . in response to this “Why bother” question, and to elaborate on the post from last week about “What’s your theoretical orientation?” I’m including an excerpt from Chapter One of our Theories textbook. Enjoy.
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About a decade ago, we were flying back from a professional conference when a professor (we’ll call him Darrell) from a large Midwestern university spotted an empty seat next to us. He sat down, and initiated the sort of conversation that probably only happens among university professors.
“I think theories are passé. There has to be a better way to teach students how to actually do counseling and psychotherapy.”
When confronted like this, I (John) like to pretend I’m Carl Rogers (see Chapter 5), so I paraphrased, “You’re thinking there’s a better way.”
“Yes!” he said. “All the textbooks start with Freud and crawl their way to the present. We waste time reviewing outdated theories that were developed by old white men. What’s the point?”
“The old theories seem pointless to you.” I felt congruent with my inner Rogers.
“Worse than pointless.” He glared. “They’re destructive! We live in a diverse culture. I’m a white heterosexual male and they don’t even fit me. We need to teach our students the technical skills to implement empirically supported treatments. That’s what our clients want, and that’s what they deserve. For the next edition of your theories text, you should put traditional theories of counseling and psychotherapy in the dumpster where they belong.”
John’s Carl Rogers persona was about to go all Albert Ellis (see Chapter 8) when the plane’s intercom crackled to life. The flight attendant asked everyone to return to their seats. Our colleague reluctantly rose and bid us farewell.
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On the surface, Darrell’s argument is compelling. Counseling and psychotherapy theories must address unique issues pertaining to women and racial, ethnic, sexual, and religious minorities. Theories also need to be more practical. Students should be able to read a theories chapter and finish with a clear sense of how to apply that theory in practice.
Darrell’s argument is also off target. Although he’s advocating an evidence-based (scientific) orientation, he doesn’t appreciate the central role of theory to science. From early prehistoric writing to the present, theory has been used to guide research and practice. Why? Because theory provides direction and without theory, practitioners would be setting sail without resources for navigation. In the end, you might find your way, but the trip would be shorter with GPS.
Counseling and psychotherapy theories are well-developed systems for understanding, explaining, predicting, and controlling human behavior. When someone on Twitter writes, “I have a theory that autism is caused by biological fathers who played too many computer games when they were children” it’s not a theory. More likely, it’s a thought or a guess or a goofy statement pertaining to that person’s idiosyncratic take on reality; it might be an effort to prove a point or sound clever, but it’s not a theory (actually, that particular idea isn’t even a good dissertation hypothesis).
Theories are foundations from which we build our understanding of human development, human suffering, self-destructive behavior, and positive change. Without theory, we can’t understand why people engage in self-destructive behaviors or why they sometimes stop being self-destructive. If we can’t understand why people behave in certain ways, then our ability to identify and apply effective treatments is compromised. In fact, every evidence-based or empirically supported approach rests on the shoulders of counseling and psychotherapy theory.
In life and psychotherapy, there are repeating patterns. I recall making an argument similar to Darrell’s while in graduate school. I complained to a professor that I wanted to focus on learning the essentials of becoming a great therapist. Her feedback was direct: I could become a technician who applied specific procedures to people or I could grapple with deeper issues and become a real therapist with a more profound understanding of human problems. If I chose the latter, then I could articulate the benefits and limitations of specific psychological change strategies and modify those strategies to fit unique and diverse clients.
Just like Darrell, my professor was biased, but in the opposite direction. She valued nuance, human mystery, and existential angst. She devalued what she viewed (at the time) as the superficiality of behavior therapy.
Both viewpoints have relevance to counseling and psychotherapy. We need technical skills for implementing research-based treatments, but we also need respect and empathy for idiosyncratic individuals who come to us for compassion and insight. We need the ability to view clients and problems from many perspectives—ranging from the indigenous to the contemporary medical model. To be proficient at applying specific technical skills, we need to understand the nuances and dynamics of psychotherapy and how human change happens. In the end, that means we need to study theories.
Contemporary Theories, Not Pop Psychology
Despite Darrell’s argument that traditional theories belong in the dumpster, all the theories in this text—even the old ones—are contemporary and relevant. They’re contemporary because they (a) have research support and (b) have been updated or adapted for working with diverse clients. They’re relevant because they include specific strategies and techniques that facilitate emotional, psychological, and behavioral change. Although some of these theories are more popular than others, they shouldn’t be confused with “pop” psychology.
Another reason these theories don’t belong in the dumpster is because their development and application include drama and intrigue that rival anything Hollywood has to offer. They include literature, myth, religion, and our dominant and minority political and social systems. They address and attempt to explain big issues, including:
There’s no single explanation for these and other big issues; often mental health professionals are in profound disagreement. Therefore, it should be no surprise that this book—a book about the major contemporary theories and techniques of psychotherapy and counseling—will contain controversy and conflict. We do our best to bring you more than just the theoretical facts; we also bring you the thrills and disappointments linked to contemporary theories of human motivation, functioning, and change.
On CESNET, several people asked about a “cheat sheet” to help students understand the distinctions between different counseling and psychotherapy theories,. Although many excellent options exist and some were offered up on CESNET, I’m adding mine here.
Here’s a Table with brief descriptions of each theory: Theoretical Orientation Summary Table
Here’s a short self-report “test” that students can take to self-identify their natural theoretical perspectives: What’s Your Theoretical Orientation – Short Questionnaire
I also have a longer self-report test that I can send you upon request. Just email me at john.sf@mso.umt.edu and I can send it along.
Thanks for your interest in counseling theories.
The files on this post are adapted from Chapter 1 (Psychotherapy and Counseling Essentials) of Counseling and Psychotherapy Theories in Context and Practice (2018, 3rd edition, John Wiley & Sons) by John and Rita Sommers-Flanagan.
You can request a free evaluation copies of the text through John Wiley & Sons: https://www.wiley.com/en-us/Counseling+and+Psychotherapy+Theories+in+Context+and+Practice%3A+Skills%2C+Strategies%2C+and+Techniques%2C+3rd+Edition-p-9781119279136
**Photo courtesy of the amazing Dudley Dana**
As Ella Fitzgerald and Louis Armstrong sang in 1957, it’s “Summer time and the living is easy.”
In fact, if you’re a parent living on planet Earth (or the Missoula valley) and you’re trying to regulate your children’s access to electronic devices, the living may not be easy; it may be infuriating.
Way back in 1998-2000 I had a biweekly Missoulian parenting column. One of the most popular columns I ever wrote was about a popular and challenging phenomenon among children in 1999. It started . . .
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Here’s a quick parenting quiz.
Question: “How do you spell opportunity?”
Answer: “P-O-K-E-M-O-N.”
As if you didn’t know, Pokemon paraphernalia – the movie, action figures, and yes, Pokemon trading cards – are red hot items among many grade-school children. Some adults question whether Pokemon obsessions are healthy. Others contend that Pokemon monsters are evil. Still others fuel their children’s Pokemon desire through unchecked spending.
When parents ask for my professional opinion about the Pokemon phenomenon, I put on my psychologist face. I cradle my chin in my hand and look upward in a sort of reflective way. Then I slowly speak Latin (not bothering to mention that I’m using ½ of my Latin vocabulary). I say,
“Carpe Diem!”
Then, just in case the person I’m talking with speaks even less Latin than I do, I repeat myself in English.
“Seize the day!”
This is a precious moment in history. We have at our fingertips – thanks to Pokemon monsters – frequent, repeating, and unparalleled parenting opportunities.
It doesn’t matter whether your child is into Pokemon, Furbys, Heavy Metal music, whining, or chocolate, limit-setting issues will undoubtedly arise. And limit-setting is absolutely essential. Parents must set limits — because their children won’t.
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Here’s the new question: If Pokemon monsters were all-the-rage and immensely challenging back in 1999, what monstrosities are plaguing Montana parents THIS SUMMER??
Cell phones and other electronic devices!
Even though your children’s relationships with their electronic devices is filled with crazy-making energy for parents, I deeply believe that my carpe diem advice from the 1990s still stands. All this points to using knowledge about your child, limit-setting, and logical consequences to transform the pain of dealing with electronic devices into the pleasure of having well-adjusted children.
If you want to take advantage of your child’s obsessions, consider making a short list of mutually agreeable rules (based on your family values or principles). For example:
Here’s an electronic device limit-setting example:
Let’s say you’ve talked with your son or daughter and decided that everyone in your family needs time free from all electronic devices. You make it clear that there will be no phones (or other devices) during family meals, during family chores, and during the hour before bedtime. The agreed upon consequence for violating this rule might be something like loss of phone privileges for 6 hours (if you make the consequence small, it will be easier for you to enforce and easier for your child to comply without completely freaking out). Then, if your child violates the rule, you can either give a warning-reminder (“I notice your phone is out. Please put it away or I will put it in our family phone lock-box”) or simply remind your child of the house rule and put the phone in the lock-box.
The cool thing about giving your children warnings is that it gives them a chance to change or improve their behavior. If, upon being warned, your child puts the phone away, you can praise the excellent decision-making by saying something like, “I noticed you put your phone away when I gave you the warning.” If your child makes a poor decision and temporarily loses phone privileges, then you can be empathic and encouraging, “I’m sorry you lost your phone for a while. That’s must feel upsetting. I bet you’ll make a better choice next time.”
Rather than droning on about the virtues of limit-setting to teach your children well, I’m stopping here to point out yet another fantastic opportunity.
The featured Practically Perfect Parenting episode of this week is creatively titled, Inspiring Cooperation in Your Children. And so, for more fun and entertaining information on this parenting topic, you can go to one of the following links.
On Libsyn: https://practicallyperfectparenting.libsyn.com/
On Apple: https://podcasts.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304
As always, feel free to comment, share, like, or shun this blog and the accompanying podcast.
Definitions happen.
The process through which words and concepts are defined is fascinating. By definition, definitions need to be sharp and make distinctions, and yet they also sometimes be inclusive and blurry on the edges.
In the latest (3rd) edition of Counseling and Psychotherapy Theories in Context and Practice, Rita and I take aim at the definitions of counseling and psychotherapy. Read on, and if you’re inspired to do so, let me know what you think.
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Definitions of Counseling and Psychotherapy
Many students have asked us, “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 psychiatric nursing. This sometimes leads to the confusing topic of the differences between counseling and psychotherapy. As time permits, 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). Obviously, many different professional tracks can lead you toward becoming a successful mental health professional – despite a few ideological, salary, status, and power differences.
In this section we explore three confusing 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), called her treatment 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.
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-cathartic 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-educational process). Based on this perspective, some researchers and practitioners believe therapists are more effective when they actively and expertly teach their clients cognitive and behavioral principles and skills (aka psychoeducation).
We have several favorite psychotherapy definitions:
What Is Counseling?
Counselors have struggled to define their craft in ways similar to psychotherapists. Here’s a sampling:
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) wrote: “There are no essential differences between counseling and psychotherapy” (p. xiv). We basically agree with Patterson, but we like how Corsini and Wedding (2000) framed it:
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.
The professional literature mostly 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; some counselors work longer with clients and charge more, whereas some psychotherapists work more briefly with clients and charge less.
A Working Definition of Counseling and Psychotherapy
There are strong similarities between counseling and psychotherapy. Because the similarities vastly outweigh the differences we use the words counseling and psychotherapy interchangeably. Sometimes we use the word therapy as an alternative.
To capture the natural complexity of this thing called psychotherapy, we offer the following 12-part definition. 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.
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.
*To learn more about our Counseling and Psychotherapy Theories text, all you have to do is Google it. If you’re looking for an instructor’s copy, Google the book title and then go to the Wiley website and request one. If you have troubles with that, email me . . . and I can likely help out.
