Happy Sunday morning. I’m at my standing desk, working on the revision of our Counseling and Psychotherapy Theories text. What fun. Actually, because I’ve been getting great and constructive feedback from many different reviewers, THIS IS much more fun than it might be otherwise.

Today I’m posting a potential new start to the theories text. It came to me because some academics have questioned the value of teaching counseling and psychotherapy theories. If you’re interested, I’d love to hear your opinion on that. Also, if you have feedback on whether the following piece makes for a good start to a theories text (or not), I’d love to hear your opinion on that too.

Here it is:

Why Learn Theories?

About a decade ago, I (John) was 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 me. He sat down, and being aware that I have a book on counseling and psychotherapy theories, initiated the sort of conversation that probably only happens among counseling, psychology, or social work professors.

He plunged right in, “I think counseling and psychotherapy 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 like to pretend I’m Carl Rogers, 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. Too much time is wasted reviewing outdated theories that were developed by old White men. What’s the point of that?”

“The old theories seem pointless to you.” I felt congruent with my inner Rogers.

“Worse than pointless,” he glared, “they’re not just unnecessary; they’re destructive! We live in a diverse culture. Those theories weren’t built for today. I’m a White heterosexual male and they don’t even fit for me. We need to focus our students on empirically-supported treatments and then teach them the technical skills they need to implement those approaches. We live in a time and a place that values action and effectiveness. That’s what our clients want and deserve. For the next edition of your theories text you should put traditional theories of counseling and psychotherapy in the dumpster where they belong.”

I lost my connection to Carl Rogers and was about to go all Albert Ellis on him when the intercom crackled to life. The flight attendant directed everyone to return to their seats. My academic colleague reluctantly rose and bid me farewell.

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

On the surface, Darrell’s argument is compelling. Counseling and psychotherapy theories must adjust themselves to address unique issues of women as well as racial, ethnic, sexual, and religious minorities. Theories also need to be more practical. “Crusty” old theories need updating and need to be more user-friendly. Students should be able to read a theories chapter and finish with a clear sense of how to apply that theory in practice.

But Darrell’s argument is also off target. Although he’s advocating an evidence-based (scientific) orientation, he doesn’t seem to appreciate the central role of theory to science. As Carl Zimmer (2016) of the New York Times recently wrote: “Theories are neither hunches nor guesses. They are the crown jewels of science” (p. D6).

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 cats are actually in a liquid state some of the time,” it’s not a theory (Zimmer, 2016). 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 a fascinating thought or statement, but it’s still not a theory.

Instead of “crown jewels,” we like to think of theories as the “foundations” from which we build our understanding of human development, suffering, self-destructive behavior, positive change, and other human experiences. Without theory, we can’t understand why people engage in self-destructive behaviors or why they sometimes suddenly stop engaging in those behaviors. 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 that exists rests on the shoulders of counseling and psychotherapy theories.

In life and psychotherapy, there are often repeating patterns. I recall making an argument similar to Darrell’s, way back in the 1980s. I complained to a professor that I just 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 with specific problems or I could grapple with deeper issues and become a real therapist with a more profound understanding of human problems, who could articulate the benefits and limitations of specific psychological change strategies, and who could 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.

Looking back, I can see both perspectives. Therapists need technical skills for implementing research-based treatments. But we also need respect and empathy for the idiosyncratic individual who comes to us for compassion and insight. We need to be able to view clients and problems from many perspectives—ranging from the indigenous to the contemporary medical model. To be really good at applying specific technical skills, we need to understand the nuance and dynamics of psychotherapy and how human change happens. And 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 of human development and change are more popular than others, they shouldn’t be confused with “pop” psychology. In fact, these theories usually aren’t well understood or accurately portrayed in the popular media.

Another reason why these theories don’t belong in the dumpster is because they’re exciting and intellectually stimulating. Put simply, the drama associated with the development and application of these theories rivals anything Hollywood has to offer. The theories in this text are woven into and derived from great literature, myth, religion, and our dominant and minority political and social systems. They can explain and predict ways we interact with each other, including how we define mental health, whether we believe in mental illness, and our views on love, meaning, death, rehabilitation, and personal responsibility. They also help us answer big questions like:

• What motivates people to do what they do?
• What disturbs thinking processes, triggers unmanageable anger, diminishes personal productivity, and destroys relationships?
• What causes one person to be satisfied with a simple and cheerful life, while others claw their way ruthlessly to the top?
• What makes some people come out stronger after facing tragedy or hardship, while others are weakened or permanently damaged?

If you’ve come this far in your studies of psychology and counseling, you know there’s no single answer to these questions. It’s common for mental health professionals to strongly disagree with each other on just about every topic under the sun. Therefore, it should be no surprise that this book—a book about the major contemporary theories and techniques of psychotherapy and counseling—will contain stunning controversies and conflict. In the following pages, we do our best to bring you more than just the theoretical basics; we also bring you the thrills and disappointments linked to these theories of human motivation, functioning, and change.

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: https://www.amazon.com/Clinical-Interviewing-John-Sommers-Flanagan/dp/1119215587/ref=sr_1_5?s=books&ie=UTF8&qid=1470784556&sr=1-5&keywords=clinical+interviewing

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.