The Practical Psychology Podcast just dropped a new episode titled “On Happiness and a Life with Meaning.” This episode includes Kyrie Russ (the show’s host” and me in conversation about happiness, CBT, life, and other things. This conversation was based, in part, on content from a keynote I gave at a conference in Helena about 2 years ago. The ppts (which is are a bit cryptic. . .) are here:
For the next several weeks I’ll be sharing from our almost new 7th edition of Clinical Interviewing.
One of our goals for the 7th edition of Clinical Interviewing is to move toward greater representation of different ethnic/cultural/sexual identities. We want all potential counseling, psychology, and social work students to be able to identify with counseling, psychology, and social work professionals. To accomplish this goal, we added greater representation by broadening our usual chapter content, as well as including case examples contributed by professionals with diverse identities.
Here’s an excerpt from Chapter 1 on culture-specific expertise
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Culture-Specific Expertise
Culture-specific expertise speaks to the need for clinicians to learn skills for working effectively with diverse populations. For example, learning the attitudes and skills associated with affirmative therapy is important for clinicians working with diverse sexualities, including lesbian, gay, bisexual, transgender, queer/questioning (sexual or gender identity), intersex, and asexual/aromantic/agender (LGBTQIA+) clients (Heck et al., 2013). Similarly, integrating skills for talking about spiritual constructs into your work with African American, Latinx, Indigenous, and traditionally religious clients is often essential (Mandelkow et al., 2021; Sandage & Strawn, 2022).
Stanley Sue (1998, 2006) described two general skills for working with diverse cultures: (a) scientific mindedness and (b) dynamic sizing.
Scientific mindedness involves forming and testing hypotheses about client culture, rather than coming to premature conclusions. Although many human experiences are universal, it’s risky to assume you know the underlying meaning of your clients’ behavior, especially minoritized clients. As Case Example 1.3 illustrates, culturally sensitive clinicians avoid stereotypic generalizations.
Dynamic sizing is a complex multicultural concept that guides clinicians on when they should and should not generalize based on an individual client’s belonging to a specific cultural group. For example, filial piety is a value associated with certain Asian families and cultures (Ge, 2021). Filial piety involves the honoring and caring for one’s parents and ancestors. However, it would be naïve to assume that all Asian people believe in or have their lives affected by this particular value; making such an assumption can inaccurately influence your expectations of client behavior. At the same time, you would be remiss if you were uninformed about the power of filial piety in some families and the possibility that it might play a large role in relationship and career decisions in many Asians’ lives. When clinicians use dynamic sizing appropriately, they remain open to significant cultural influences, but they minimize the pitfalls of stereotyping clients.
Another facet of dynamic sizing involves therapists’ knowing when to generalize their own experiences to their clients. S. Sue (2006) explained that it’s possible for clinicians who have experienced discrimination and prejudice to use their experiences to more fully understand the discrimination-related struggles of clients. However, having had experiences similar to a client may cause you to project your own thoughts and feelings onto that client—instead of drawing out the client’s emotions and showing empathy. Dynamic sizing requires that you know and understand and not know and not understand at the same time. Not knowing—or at least not presuming you know—is essential to interviewer-client collaboration.
CASE EXAMPLE 1.3: NOT AT HOME ANYWHERE
In this case, Devika Dibya Choudhuri, Ph.D., LPC (CT/MI), a self-described Buddhist, South Asian, cisfemale, middle-aged, middle-class, Queer, disabled counselor and professor at Eastern Michigan University, illustrates sophisticated cultural-specific expertise in cross-cultural work with a bi-cultural college student. Dr. Choudhuri uses self-disclosure, researches her client’s culture, and integrates culturally meaningful symbols into her sessions. Imagine how you can aspire to be like Dr. Choudhuri.
Darla, a 19-year-old Ghanian-American cisfemale college student, felt something was wrong with her. Her mother was from Ghana, while her father, with whom she had little contact, was generationally African American. She was halting in the first session, trying to decide whether she could trust me, and talking about her recent visit to Accra where her mother’s family lived. I said, “I know when I go to India, I’m American, and when I’m here, I’m Indian. Is it a bit like that for you?” She emphatically replied, “Yes! I’m not at home anywhere!” “Or,” I returned, “almost at home everywhere, like the rest of us global nomads.” She laughed, then spoke far more comfortably about her friends and boyfriend. I had, in that brief exchange, told Darla very important things about me. I self-disclosed casually about my ethnicity and international navigation, normalized her sense of homelessness, while reframing it to join a new group identity.
After having done some research, I asked Darla if her Ghanian kin were the majority Akan or a minority group. She said they were minority. I reflected on whether she might have picked up a sense of marginalization, not just from being Black in America, but also from being minority in Ghana. This became a deep and intense conversation. She reflected on how her American status in Ghana protected her from discrimination, but also alienated her from her cousins.
Another use of culture as intervention came when I brought in Adinkra (visual pictograph meaning saturated symbols originating in Ghana) for her use. Darla chose four to represent her aspirations, and then designed ways to use them in her daily life, incorporating her cultural roots into her present. One of them, Sankofa, is a symbol of the wisdom of learning from the past to build for the future; expressed in the proverb, “it is not taboo to go back for what you left behind.” Feeling grounded in multiple cultures, and being able to navigate from one context to another with her whole and complex self, rather than fragmenting, led her to see she wasn’t “wrong.” Sometimes the spaces were too limited; it was ok to fit and not fit, just as leftover food on a Ghanian table represented abundance.
[End of Case Example 1.3]
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As always, feel free to share your thoughts on and reactions to this content. We’re always looking for practical feedback that will help us continue to become better learners and teachers.
While doing supervision today, I found myself encouraging my supervisee to be more direct, to embrace his knowledge and his good judgment, and to share his knowledge and judgment with his client. This is an interesting (and perhaps surprising) stance for me to take, because, as some of you know very well, I lean hard toward Rogerian theory. I’m a fan of honoring clients’ expertise and of Carl Rogers’s words that it is “the client who knows what hurts and where to go.”
As I age (more like fine wine, and not like moldy bananas, I hope), one truth I keep feeling is that nearly everything is both-and—not either-or. Yes, I believe deeply in the naturally therapeutic process of person-centered theory and therapy; providing clients with that “certain type of environment” will facilitate self-discovery and personal growth. On the other hand, sometimes clients need guidance. In my supervision case earlier today, my point was that the client was a very long way away from deeper personal insights. That meant my supervisee needed to loan the client his good judgment and decision-making skills. As you may recognize, “loaning clients our healthy egos” is psychoanalytic language. Nevertheless, the guidance I offered my supervisee was to engage in some CBT coaching
All this reminded me of a section I updated in the 7th edition of Clinical Interviewing. The section is titled, “Client as Expert” and I’ve excerpted it below. It captures the essence of honoring client wisdom, which, IMHO, should always precede more directive interventions.
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Client as Expert
Clients are the best experts on themselves and their experiences. This is so obvious that it seems odd to mention, but sometimes therapists can get wrapped up in their expertness and usurp the client’s personal authority. Although idiosyncratic and sometimes factually inaccurate, clients’ stories and explanations about themselves and their lives are internally valid and should be respected.
CASE EXAMPLE 1.1: GOOD INTENTIONS
In one case, I (John) became preoccupied about convincing a 19-year-old client—who had been diagnosed years ago with bipolar disorder—that she wasn’t really “bipolar” anymore. Despite my good intentions (I thought the young woman would be better off without a bipolar label), there was something important for her about holding on to a bipolar identity. As a “psychological expert,” I believed it obscured her many strengths with a label that diminished her personhood. Therefore, I encouraged her to change her belief system. I told her that she didn’t meet the diagnostic criteria for bipolar disorder, but I was unsuccessful in convincing her to give up the label.
What’s clear about this case is that, although I was the diagnostic authority in the room, I couldn’t change the client’s viewpoint. She wanted to keep calling herself bipolar. Maybe that was a good thing for her. Maybe that label offered her solace? Perhaps she felt comfort in a label that helped her explain her behavior to herself. Perhaps she never will let go of the bipolar label. Perhaps I’m the one who needed to accept that as a helpful outcome.
[End of Case Example 1.1]
In recent years, practitioners from many theoretical perspectives have become outspoken about the need for expert therapists to take a backseat to their clients’ lived experiences. Whether you’re working online or face-to-face, several evidence-based approaches emphasize respect for the clients’ perspective and collaboration (David et al., 2022). These include progress monitoring, client-informed outcomes, and therapeutic assessment (Martin, 2020; Meier, 2015).
When your expert opinion conflicts with your client’s perspective, it’s good practice to defer to your client, at least initially. Over time, you’ll need your client’s expertise in the room as much as your own. If clients are unwilling to share their expertise and experiences, you’ll lose some of your potency as a helper.
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So, what’s today’s big takeaway? We start with and maintain great respect for the client’s expertise. . . and then we either stay more person-centered (or psychoanalytic) or collaboratively shift toward providing more direction and guidance. And the big question is: How do we determine whether to stay less directive or become more directive?
If you feel so inclined, let me know your thoughts on that big question.
Are you a Montana educator . . . or do you know one?
If so, maybe you—or your friend—would like three (3) bargain-rate University of Montana graduate credits. As you may know, we’ve got an online and asynchronous “Happiness for Teachers” course starting on June 17 for only $195 and the credits (or OPI hours) can contribute to raising teacher salaries. Given all that teachers do for our youth and society, it’s the least we can do. And we can do it thanks to a fantastic grant from the Arthur M. Blank Family Foundation (AMBFF: https://blankfoundation.org/).
Because I’ve written about this opportunity before, this time I want to focus on outcomes. We’ve taught this course to teachers as asynchronous semester-long courses last summer (2023) and this spring (2024). I just finished crunching the numbers for our spring outcomes; I’ve got the summer outcomes in front of me as well.
We’ve pre-post data on 16 different outcome measures. For last summer, we had statistical significance on 12 of the 16 outcomes. For this spring, we had statistical significance on 13 of the 16 outcomes. Even better, based on Cohen’s guidance, many of the effect sizes are in the medium to large range.
For you stats nerds, here’s a Table describing the outcomes:
Outcome Measure
What Teachers Reported at Post-Test
Summer – 2023 – Statistical Significance (n = 40) and Effect Size (ES is Cohen’s d)
Spring – 2024 – Statistical Significance (n = 48) and Effect Size (ES is Cohen’s d)
NAPAS: Negative Affect
Fewer negative emotional symptoms (e.g., nervousness and sadness)
p < .001 ES = .671 (medium)
p < .006 ES = .389 (small to medium)
NAPAS: Positive affect
More positive emotions (e.g., “in good spirits”)
p < .001 ES = .887 (large)
p < .001 ES = .497 (medium)
CES-D: Depression
Fewer symptoms of depression
p < .001 ES = .751 (large)
p < .013 ES = .346 (small to medium)
Sleep
Better sleep
p < .001 ES = .644 (med to large)
p < .001 ES = .502 (medium)
Headaches
Fewer headaches
p < .009 ES = .393 (small to med)
p < .001 ES = .699 (medium to large)
Gastrointestinal symptoms
Less gastrointestinal distress
p < .027 ES = .315 (small to med)
p < .023 ES = .298 (small)
Colds
Fewer and less severe colds
p < .010 ES = .382 (small to med)
p < .024 ES = .298 (small)
PHQ: Total Health
Better total health
p < .001 ES = .589 (medium)
p < .001 ES = .625 (medium to large)
Days Sick
Fewer days of physical illness
P < .015 ES = .354 (small to med)
N/A
Hope-Agency
Greater goal directed energy
p < .001 ES = .704 (med to large)
p < .008 ES = .365 (small to medium)
Hope-Pathways
Greater planning to meet goals
p < .001 ES = .545 (medium)
p < .013 ES = .341 (small to medium)
AHS: Total Hope
Higher agency and pathways hope
p < .001 ES = .677 (med to large)
p < .004 ES = .416 (small to medium)
Significant Other Support
Support from a romantic partner
p < .166 ES = .158 (minimal)
p < .195 ES = .127 (minimal)
Family Support
Support from family
p < .114 ES = .194 (minimal)
p < .030 ES = .282 (small)
Friendship Support
Support from friends
p < .165 ES = .156 (minimal)
p < .177 ES = .137 (minimal)
MSPSS: Total Social Support
Combined romantic partner, family, and friend support
p < .133 ES = .181 (small)
p < .091 ES = .198 (small)
MAAS: Mindfulness
Less distracted and more tuned into the here and now
p < .001 ES = .892 (large)
p < .001 ES = .597 (medium to large)
To summarize: If Montana educators want to have less negative affect and depression, more positive emotions, greater hope, better sleep, fewer headaches, less gastrointestinal distress, fewer colds (and days of physical illness), and greater mindfulness . . . they should register and complete this course.
I’m presenting with one of our esteemed UM Doc students, Kanbi Knippling, M.A. You can see our title in the photo. Should be interesting and excellent content for anyone working with people who have disabilities. Kanbi is taking the lead, and I’m helping, which is fun for me.
Over and over—probably because I have a friend who once told me “Redundancy works!”—I told my group class that ending groups is about “learning consolidation.” In other words, we want group members to learn something from group. At the end of each session, and especially during the final session, we want to facilitate experiences that will help group members take their key learning beyond group, and into their lives.
Because role-modeling is a central part of being a group leader, to close our group class, I gave my students a learning consolidation assignment. Although we had been in a group (of 34) together all semester, the “final paper” was, idiographic (like Adlerian theory); students got to do their final paper in their own way. I mentioned poetry as an option, and then told the story of my own risky graduate school strategy of responding to my Advanced Learning professor’s weekly homework prompts with limericks. Turned out, my professor loved the limericks, shared them with his wife who was a writer-aficionado, and I got an “A” in Advanced Learning, while polishing my limerick skills.
Several students took me seriously and sent me fun and creative final papers. But the very last paper I read, by Astrid Santana, was BEYOND MY WILDEST DREAMS! She incorporated Haiku, knock-knock jokes, and a few limericks into her reflections on our group counseling course. I was gobsmacked, and I think you will be too. Happily, I’m here to report that I have her permission to share the paper.
Because WordPress has some difficulty in handling Haiku, I’m excerpting a sampling of Astrid’s work: First, some Haiku; second, a knock-knock joke; third, a limerick. Thanks Astrid!!
Her whole paper is available in a pdf at the bottom of this post.
My Attempt at Brevity:
Reflections on My Reflections
By Astrid Santana
Universality
Even if it sinks,
we’re in this boat together.
I’m grateful for that.
Development of Socializing Techniques
Finally realizing
I was the asshole, and not
everybody else.
Imitative Behavior
They’re so curious,
insightful, calm, and funny.
Could I do this, too?
Phases of Group Therapy
Forming
Knock knock.
Who’s there?
Hugo.
Hugo who?
Hugo first. I feel uncomfortable sitting in this circle and I don’t know if I want to be here
Good news. Yesterday, I got a mysterious email from ORCID–which stands for: Open Researcher and Contributor ID. ORCID is a global, non-profit organization. Their vision is: “a world where all who participate in research, scholarship, and innovation are uniquely identified and connected to their contributions across disciplines, borders, and time.”
Cool.
Anyway, ORCID was notifying me of a change to my ORCID record. A few minutes later, I received an email from Wiley telling me that our Happy Workshop for Grad Students article was now officially published online.
As some of you know, I’ve complained about the journal publishing process, and, although I still think it’s a pretty broken and disturbing process, working with the editors and reviewers from the Journal of Humanistic Counseling was pretty smooth and pretty fabulous. Check them out: https://onlinelibrary.wiley.com/journal/21611939
And so, without further ado, here’s the Abstract, followed by methods to access the article. . .
Effects of a Single-Session, Online, Experiential Happiness Workshop on
Graduate Student Mental Health and Wellness
John Sommers-Flanagan
Jayna Mumbauer-Pisano
Daniel Salois
Kristen Byrne
Abstract
Graduate students regularly experience anxiety, sleep disturbances, and depression, but little research exists on how to support their mental health. We evaluated the effects of a single-session, online, synchronous, happiness workshop on graduate student well-being, mental health, and physical health. Forty-five students participated in a quasi-experimental study. Students attended a synchronous 2.5-h online happiness workshop, or a no-workshop control condition. After workshop completion and as compared with no-treatment controls, participants reported significant reductions in depression symptoms but no significant changes on seven other measures. At 6 months, participants reported further reductions in depression symptoms. Moreover, across four open-ended questions, 37.0%–48.1% of workshop participants (a) recalled workshop tools, (b) found them useful, (c) had been practicing them regularly, and (d) used them in sessions with clients. Despite study limitations, single-session, synchronous, online, happiness workshops may have salutatory effects on graduate student mental health. Additional research is needed.
K E Y W O R D S: depression, graduate students, mental health, single-session, wellness
I’m writing for a little social marketing assistance to support Montana Educators.
As I’ve written before, because of the generosity and funding from the Arthur M. Blank Family Foundation, we have funding to support Montana educators. The main way we’ve chosen to support Montana educators is to offer a highly subsidized three-credit course on “Happiness for Teachers” through the fantastically helpful UMOnline people at the University of Montana.
We believe this course supports Montana Educators in three ways:
The course can be used to help increase educator pay (because we believe educators should be paid more).
The course can help educators feel positive feelings more often, savor them, increase their sense of meaning, and possibly reduce depression and improve physical health.
Educators can use the information to support their students’ happiness and well-being.
We’ve got a large section of the course open and starting on June 17. I’d love to get it all filled up.
The 7th edition of Clinical Interviewing became available earlier this year. As a part of the text revision, we updated the accompanying videos, videos that Victor Yalom of Psychotherapy.net considers to be the best of their kind. And, possibly having watched more professional training videos than anyone on the planet, Victor knows what he’s talking about, and we are humbled by his endorsement.
Videos that accompany the text cover 72 learning objectives and are extensive. The bad news is that they usually, but not always, feature me. The good news is that in our video revision and upgrade, we included numerous counselors/psychotherapists of color. . . so it’s not just all me talking about how to develop your clinical interviewing skills.
If you watch them, I hope you enjoy the videos. And, if you feel so moved, please share your reactions or suggestions with me here or via email: john.sf@mso.umt.edu.
John Sommers-Flanagan 