All posts by johnsommersflanagan

Handouts for the American Mental Health Counseling Association Conference

These past two days I’ve been hanging out in Seattle with some very cool mental health counselors (as well as my very cool sister and her only mildly deranged husband). As a consequence, I promised to post these two powerpoint presentations to enable quick internet access. And so, if you were at the conference or you’re just a powerpoint presentation junkie, links to the two presentations are below:

1. Ethics: A Fresh Approach (two hour workshop with Rich Ponton — who is also very cool)

Ethics A Fresh Approach

2. How to Listen so Parents will Talk (three hour workshop)

How to Listen for AMHCA

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

Sometimes it just seems easier to be snarky than balanced. This basic truth comes to mind because of a recent analysis I did of the Cultural Formulation Interview (CFI) from the DSM-5. As I read about the CFI and looked through its Introduction and 16 questions for “patients,” I kept thinking to myself things like,

“Seriously . . . could this really be the best cultural sensitivity that the American Psychiatric Association can manage when it comes to guidelines for interviewing minority cultures?”

And,

“Who wrote this and why didn’t they ask me for some help?” (insert smiley face here; please note that some of my colleagues at the University of Montana have noticed—and commented—on the fact that I tend to insert a smiley face icon right after texting or emailing my personal version of punchy, snarky, sarcasm).

Ha! is all I have to say to them (FYI: Ha! is my programmed default back up to my default smiley face snark signal).

Anyway . . . the point! It’s way easier for me to be critical of the American Psychiatric Association than balanced. In truth, the CFI is a reasonable effort. And, if you think about where the APA is coming from (and likely going to) then the CFI is a massive effort. I should be saying, “Cool! I’m so excited to see the CFI as part of the DSM-5.

All this is prologue for the excerpt I include below. This is an excerpt from a draft chapter I’m writing for the Handbook of Clinical Psychology . . . to be published at some point in the not too distant future. Here’s the excerpt; it focuses on cultural adaptations we can make when conducting initial clinical interviews with minority clients; forgive the roughness of the draft.

Cultural Adaptations

A clinical interview is a first impression, and first impressions are powerful influences on later relational interactions, which is why we need to make cultural adaptations when conducting clinical interviews. One of the best sources for cultural adaptations is the already-existing guidance from psychotherapy research on working multiculturally. These guidelines include: (a) using small talk and self-disclosure with some cultural groups, (b) when feasible, conducting initial interviews in the patient’s native language, (c) seeking professional consultations with professionals familiar with the patient’s culture; (d) avoiding the use of interpreters except in emergency situations; (e) providing services (e.g., childcare) that help increase patient retention, (f) oral administration of written materials to patients with limited literacy, (g) having awareness and sensitivity to client age and acculturation, (h) aligning assessment and treatment goals with client culturally-informed expectations and values, (i) regularly soliciting feedback regarding progress and client expectations and responding immediately to client feedback, and (j) explicitly incorporating cultural content and cultural values into the interview, especially with patients not acculturated to the dominant culture (see Griner & Smith, 2006; Hays, 2008; Smith, Rodriguez, & Bernal, 2011).

Cultural awareness, cross cultural sensitivity, and making cultural adaptations are especially important to assessment and diagnosis. This is partly because mental health professionals have a long history of inappropriately or inaccurately assigning psychiatric diagnoses to cultural minority groups (Paniagua, 2014). To address this challenge, in the latest edition of the Diagnostic and Statistical Manual (DSM-5; American Psychiatric Association, 2014), a Cultural Formulation Interview (CFI) protocol is included to aid the diagnostic interview process.

The CFI is a highly structured brief interview. It is not a method for assigning clinical diagnoses; instead, its purpose is to function as a supplementary interview that enhances the clinician’s understanding of potential cultural factors. It also may aid in the diagnostic decision-making process. The CFI includes an introduction and four sections (composed of 16 specific questions). The four sections include:

1. Cultural definition of the problem
2. Cultural perceptions of cause, context, and support
3. Cultural factors affecting self-coping and past help seeking
4. Cultural factors affecting current help seeking

Questions from each section are worded in ways to help clinicians gently explore cultural dimensions of their clients’ problems. Question 2 is a good representation: “Sometimes people have different ways of describing their problem to their family, friends, or others in their community. How would you describe your problem to them?” (American Psychiatric Association, 2014).

Clinicians are encouraged to use the CFI in research and clinical settings. There is also a mechanism for users to provide the American Psychiatric Association with feedback on the CFI’s utility. It may be reproduced for research and clinical work without permission, which is a cool thing.

If you Google: “Cultural Formulation Interview” the first non-advertised hit should be a .pdf of the CFI.

If you Google: “Clinical Interviewing” the first several hits will take you to some form or another of our text on the topic.

Here’s a photo of me “working” inter-culturally with my brother-in-law (insert smiley face here):

Rebekah.Johnson.photo_0451

 

 

Behavioral Activation Therapy: Let’s Just Skip the Cognitions

This is a short excerpt from the text: Counseling and Psychotherapy Theories in Context and Practice

It describes a research-based behavioral approach to counseling and psychotherapy.

Over half a century ago, Skinner suggested that depression was caused by an interruption of healthy behavioral activities that had previously been maintained through positive reinforcement. Later, this idea was expanded based on the initial work of Ferster (1973) and Lewinsohn (1974; Lewinsohn & Libet, 1972). The focus was on observations that:

“. . . depressed individuals find fewer activities pleasant, engage in pleasant activities less frequently, and obtain therefore less positive reinforcement than other individuals.” (Cuijpers, van Straten, & Warmerdam, 2007, p. 319)

From the behavioral perspective, the thinking goes like this:
1.   Observation: Individuals experiencing depression engage in fewer pleasant activities and obtain less daily positive reinforcement.

2.   Hypothesis: Individuals with depressive symptoms might improve or recover if they change their behavior (while not paying any attention to their thoughts or feelings associated with depression).

Like the good scientists they are, behavior therapists have tested this hypothesis and found that behavior change—all by itself—can produce positive treatment outcomes among clients with depression. The main point is to get clients with depressive symptoms to change their behavior patterns so they engage in more pleasant activities and experience more positive reinforcement
Originally, behavioral activation was referred to as activity scheduling and used as a component of various cognitive and behavioral treatments for depression (A. T. Beck, Rush, Shaw, & Emery, 1979; Lewinsohn, Steinmetz, Antonuccio, & Teri, 1984). During this time activity scheduling was viewed as one piece or part of an overall cognitive behavior treatment (CBT) for depression.
However, in 1996, Jacobson and colleagues conducted a dismantling study on CBT for depression. They compared the whole CBT package with activity scheduling (which they referred to as behavioral activation), with behavioral activation (BA) only, and with CBT for automatic thoughts only. Somewhat surprisingly, BA by itself was equivalent to the other treatment components—even at two-year follow-up (Gortner, Gollan, Dobson, & Jacobson, 1998; Jacobson et al., 1996).

As is often the case, this exciting research finding stimulated further exploration and research associated with behavioral activation. In particular, two separate research teams developed treatment manuals focusing on behavioral activation. Jacobson and colleagues (Jacobson, Martell, & Dimidjian, 2001) developed an expanded BA protocol and Lejuez, Hopko, Hopko, and McNeil (2001) developed a brief (12 session) behavioral activation treatment for depression (BATD) manual and a more recent 10 session revised manual (Lejuez, Hopko, Acierno, Daughters, & Pagoto, 2011).

Implementation of the BATD protocol is described in a short vignette later in the behavioral theory and therapy chapter in the text: Counseling and Psychotherapy Theories in Context and Practice by John and Rita Sommers-Flanagan. See: http://www.wiley.com/WileyCDA/WileyTitle/productCd-0470617934.html

Or, on Amazon: http://www.amazon.com/John-Sommers-Flanagan/e/B0030LK6NM/ref=ntt_dp_epwbk_1

Several people engaging in behavioral activation therapy at a wedding.

Dancing

 

A Short Piece on Disrespecting Teenagers

The post below is from psychotherapy.net and so you can view it there too: http://www.psychotherapy.net/blog/title/a-short-piece-on-disrespecting-teenagers

Also, I strongly recommend that you check out psychotherapy.net as a potential go-to resource on all things psychotherapeutic. Their video and streaming collection is awesome and extensive. Go to: http://www.psychotherapy.net/

Okay. Here’s the post:

A Short Piece on Disrespecting Teenagers

We have an American cultural norm to disrespect teenagers. For example, it’s probably common knowledge that teens are:
• Naturally difficult
• Not willing to listen to good common sense from adults
• Emotionally unstable
• Impulsively acting without thinking through consequences

Wait. Most of these are good descriptors of Bill O’Reilly. Isn’t he an adult?

Seriously, most television shows, movies, and adult rhetoric tends toward dismissing and disrespecting teens. It’s not unusual for people to express sympathy to parents of teens. “It’s a hard time . . . I know . . . I hope you’re coping okay.” Just last night Stephen Colbert quipped, “Nobody likes teenagers.” Even Mark Twain had his funny and famous disrespectful quotable quote on teens. Remember:

“When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

This is a clever way of suggesting that teens don’t recognize their parents’ wisdom. Although this is partly true, I’m guessing most teens don’t find it especially hilarious. Especially if their parents are treating them in ways that most of us would consider unwise—at least if we were treated similar ways in the workplace.

And now the neuroscientists have piled on with their fancy brain images. We have scientific evidence to prove, beyond any doubt, that the brains of teens aren’t fully developed. Those poor pathetic teens; their brains aren’t even fully wired up. How can we expect them to engage in mature and rational behavior? Maybe we should just keep them in cages to prevent them from getting themselves in trouble until their brain wiring matures.

This might be a good idea, but then how do we explain the occasionally immature and irrational behavior and thinking of adults? I mean, I know we’re supposed to be superior and all that, but I have to say that I’ve sometimes seen teens acting mature and adults acting otherwise. How could this be possible when we know—based on fancy brain images—that the adult brain is neurologically all-wired-up and the teen brain is under construction? Personally (and professionally), I think the neuroscience focus on underdeveloped “teen brains” is mostly (but not completely) a form of highly scientifically refined excrement from a male bovine designed to help adults and parents feel better about themselves.

And therein lies my point: I propose that we start treating teens with the respect that we traditionally reserve for ourselves and each other . . . because if we continue to disrespect teenagers and lower our expectations for their mature behavior . . . the more our expectations are likely to come true.

John and his sister, Peggy, acting immature even though their brains are completely wired up.

Peg and John Singing at Pat's Wedding

Ten Tips for Parenting through Divorce

In a previous post today there was a mention of a Tip Sheet for Parenting through Divorce and one astute blog reader noticed and asked about it . . . and so here it is. It’s also excerpted from the book “How to Listen so Parents will Talk and Talk so Parents will Listen.”

Ten Tips for Parenting through Divorce

To parent well through divorce and into the future, you should educate yourself about the unique challenges you’re likely to face and how to manage them. The following short list is a beginning. Additional resources are listed in Appendix A.

 
1. Make a commitment to good self-care. There are two big reasons why this is good advice. First, divorce is emotionally painful and stressful. If you don’t take care of yourself physically, emotionally, and spiritually, you may suffer. Second, if you’re suffering, your children will suffer right along with you.

2. Cultivate a support system for your children. You can’t do it all. Therefore, when you’re feeling exhausted your children will need other healthy adults with whom they can spend time. Identify who these adults are and ask them for help and support.

3. Listen to your children, even when it’s hard. Your children may or may not want to talk about the divorce or their feelings. In most cases, they’ll suddenly become angry, irritable, or sad and possibly direct those feelings at you. If so, listen and comfort, even if what they’re saying is hard to hear.

4. Set limits for your children. Sometimes during and after a divorce parents will start letting their children do whatever they want. This isn’t healthy. Children need limits; they need you to be a firm and loving parent.

5. Work on communicating respectfully with your child’s other parent. Practice positive communication skills. It can also help to change your language and not call your former spouse, “My ex,” but instead, “My daughter’s father” or “My son’s mother.” See Ricci’s book, Mom’s house, Dad’s house, for more information on this.

6. Develop smooth transitions from one home to another. Child exchanges can be traumatic for everyone. Having a regular and positive routine when you get your children ready to go to their other home can help. Also, avoid conflicts with the other parent during child exchanges. Exposing your child to parent–parent conflict is very unhealthy. Consider finding an outside person to help you establish a positive exchange.

7. Set limits with your child’s other parent. Consider establishing guidelines for parent–parent meetings. Don’t meet for long hours alone or make yourself spontaneously available anytime the other parent wants to talk. Instead, set up official meetings at a safe and pleasant (but not intimate) location.

8. Educate yourself. Consider taking a class or reading a book or watching an educational DVD on divorce and shared parenting.

9. Educate yourself II. Consult with legal and mental-health professionals as appropriate. Neither legal or mental health professionals should be used in an effort to manipulate or punish the other parent or the children.

10. Embark on a healthy new life. Give your child’s mom or dad privacy and maintain your own. Encourage your children to have good times with the other parent (never make your children feel guilty about having a good time with their mom or dad). Establish new family rituals to help you and your children adjust to your new lives.

Parenting Consultations with Divorced, Divorcing, and Never-Married Parents

Working with parents who are divorced, divorcing, or living separately can be both challenging and gratifying. In this excerpt from “How to Listen so Parents will Talk and Talk so Parents will Listen” we discuss some key issues and provide a case example. The main purpose of this post is to stimulate your thinking about working with this unique and interesting population of parents.

Here’s the excerpt:

Divorce will probably always be a controversial and conflict-laden issue within our society. In part, this is due to moral issues associated with divorce, but it is also due to the many knotty practical issues divorced parents frequently face.

Divorce Polemics

Divorce and single-parenting choices still carry stigma and so parents will be monitoring for any judgments you might have about them. You may have very strong opinions about divorce or about people choosing to adopt or bear children while single. If this is something you can’t put aside and be nonjudgmental about, it’s best to put your views in your informed consent so parents know this explicitly about your practice. In most cases, professionals have values and beliefs they can keep in check while working directly with people who make choices far different than the professional might have made. For instance, you might firmly believe that all children should be born into a two-parent family with parents who are married and committed to the family, but you might still be able to be very helpful to a single gay parent who adopted a 10-year-old disabled foster child.

Because they’ve sometimes faced moral and religious judgments, divorced, divorcing, and never-married parents have substantial needs for support and education. Consequently, you should prepare yourself to provide that education and support. Their parenting challenges can be particularly acute and confusing.

The issue for practitioners working with parents is to avoid laying blame and guilt on parents for divorcing (generally, they already feel guilty about how their divorce might be affecting their children). Instead, your role is to help divorced, divorcing, or never-married parents manage their difficult parenting situations more effectively. What we need to offer is (1) emotional support for divorce- and post-divorce-related stress and conflict; and (2) clear information on specific behaviors parents can engage in or avoid to help their children adjust to divorce.

Providing Support and Educational Information
Most divorcing and recently divorced parents are in substantial distress and so parents and need comfort, support, and information. Consequently, we recommend talking with parents about divorce in a way that’s empathic and educational. In the following case, a father with three children has come for help in planning to tell the children. His children are 4, 6, and 8 years old.

         Case: Talking about Divorce

PARENT: I’m really worried about how to talk with my kids about the divorce. I can’t get the right words around it. I know I’m supposed to say something reassuring like, “Your mom and I love each other, but it just hasn’t worked out and so that’s why I’m moving out because it will be best for us to live separately.” But then I worry that maybe my kids will think even though I love them now, it might not “work out” either and then I’ll end up leaving them, too.

CONSULTANT: This is tough. I respect how much thought you’ve given this. Even though the differences between you and your wife make it too hard to live together, it’s extremely hard to leave the home and torturous to talk with your kids about it.

PARENT: That’s for sure.

CONSULTANT: I can see you love your children very much and it feels really important to talk with them about the upcoming divorce using words that won’t scare them too much and that will help them know you and your wife tried, but you have now decided that the divorce is for the best. But before we do that, I have a different piece of advice.

PARENT: What’s that?

CONSULTANT: You should plan to have more than one divorce talk with your kids. I know you want to do this right and that’s great. But the good news and the bad news is that you’ll need to have this conversation many times. As your children grow older, they’ll have different questions. It’s your job to tell them you love them and to explain things in words they’ll understand, but not to tell them too much. There’s no guarantee they’ll understand this perfectly and so it may relieve pressure for you to know you’ll get other chances. Some people like to think of it like having a sex-talk. Kids will have different questions about sex at different ages and so parents shouldn’t have just one sex-talk. You need to be ready to have a sex-talk at any time as your child is growing up. The same is true for talks about divorce. You need to be ready to talk about it now and whenever your kids or you need to talk in the future. I’ve got a great tip sheet for parents going through divorce and I’d like to go over that with you, too. [See Appendix B, Tip Sheet 10: Ten Tips for Parenting through Divorce.]

In this situation, the family’s educational needs are significant, so the practitioner will probably offer the father a tip sheet, additional reading materials, and a recommendation to attend a group class on divorce and shared parenting.

It can be difficult for divorcing parents to talk with their children without blaming the other parent. This can be either blatant or subtle. We recall one parent who insisted he had the right to call his former spouse “The Whore” in front of the children “because it was the truth.” In these extreme cases, we’ve used radical acceptance to listen empathically to the emotional pain underlying this extreme perspective and then slowly and gently help the parent to understand that “telling the truth” to the children should focus on telling your personal truth and not on the other parent’s behavior. Although it can be difficult for divorced or divorcing parents to hear educational messages over the din of their emotional pain, it’s the practitioner’s job to empathically and patiently deliver the message. Usually divorced and divorcing parents eventually see that criticizing or blaming the other parent can be damaging to their children.

More information on this and other topics related to working with parents is available on this blogsite (see the Tip Sheets) and in the “How to Listen so Parents can Talk” book.

See: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=la_B0030LK6NM_1_9?s=books&ie=UTF8&qid=1403469599&sr=1-9

 

What Kind of a Man Attends the 4th National Psychotherapy with Men Conference?

Several years ago a former student caught up with me in the hall outside my office in the College of Education at the University of Montana. He had taken an Intro to Psychology course from me way back in 1982. He re-introduced himself, complimented me on my teaching from three decades previously, and then, glancing at my name on the door, asked, “What kind of a man hyphenates his last name?”

I was speechless (which doesn’t happen all that often). He had just told me of his divorce; he had marveled at me being married for 25 years; and yet there it was, a small-dose of straight on masculine-shaming.

I said what most of us probably say when questioned about our masculinity.

I said nothing.

In retrospect, I wish I’d said: “I hyphenated my name because I’m the kind of man who wants to stay married and have a real partnership with his wife.” Hmm. That might have been over-the-top.
I didn’t have a balanced answer then and I’m not sure I have a good one now. But, how about cutting to the chase and meeting his question with one of my own?

“What kind of a man questions another man about his masculinity?”

That might have been fun, but obviously not perfect. And that’s the point; it can be difficult to find the right words in response to comments on our masculinity.

This past Saturday I had the privilege of embracing all dimensions of my humanity, without needing to worry about sideways—or straight on—masculinity comments. That’s because I had the good fortune of attending the 4th National Psychotherapy with Men Conference. Of course, my comfort might have been because the chief conference organizer, Matt Englar-Carlson, a faculty member in the Department of Counseling at Cal State Fullerton, is also a hyphenator. But more likely it was because this particular conference was all about acceptance, inclusion, listening, understanding, learning . . . and most of all CONNECTION. Masculine shaming was nowhere in the room.

The conference organizers, Englar-Carlson, David Shepard, and Rebekah Smart, set the tone for understanding and inclusiveness in their opening comments. The opening keynote followed and it was BY A WOMAN . . . which this leads me to back to my masculine-shaming theme for today:

“What kind of a MEN AND MASCULINITY organization sponsors a conference on psychotherapy with men and then has an opening keynote speech BY A WOMAN?”

Answer: “The kind of organization populated by people who have the good judgment to be very interested in listening to and understanding women’s perspectives.”

And so we all got to listen to—not just any woman (although that would have been fine too, because the conference wasn’t about status)—but the renowned Judith Jordan, author of many books and co-director of the Jean Baker Miller Institute. How cool is that?

After Jordan explored how we can raise boys to be competent and connected men, we scattered to different break-out sessions. As my adolescent clients would say, this sucked because it’s hard to make hard choices. My principle regret of the whole conference was that even though I have two last names, there’s still only one of me and so I couldn’t attend EVERY SESSION, but instead had make choices. And although I was perfectly happy to start my break-out experiences listening to Christopher Kilmartin, professor of psychology at the University of Mary Washington, as Irvin Yalom would say, it meant the death of the rest of my choices.

But seriously . . . here’s the important question: “What kind of a man accepts a faculty position at an institution named THE UNIVERSITY OF MARY WASHINGTON?”

Answer: “The same kind of man who gets asked to spend a year teaching sexual assault prevention at the Air Force Academy.” Now that’s a pretty good answer.

Kilmartin was awesome (just ask my wife, because I’ve been quoting him all week). But being at his break-out session made me miss the amazing Jon Carlson who might be the kindest, gentlest, and most humble person I know with hundreds of professional publications, video productions, and spare time to raise five children (two adopted) including the hyphenated conference organizer, who happens to have full professor status despite looking like he just shaved for the first time last week.

Naturally, the psychotherapy with men conference lunch had a vegetarian option (at this point I should also mention the Starbucks coffee and whole wheat bagels in the morning and the Panera coffee and cookies in the afternoon). Right after lunch, we gathered to listen to Fredric Rabinowitz, the afternoon keynote. Rabinowitz, who also happens to play tournament poker, talked about Deepening Psychotherapy with Men. He emphasized that, for men, there’s a substantial vocabulary about defenses, but not Department of Connection. For the past 20+ years he has helped men go deep and express their pain and loss in ways that are (surprise!) contrary to how society expects men to express their pain and loss. Unfortunately, Rabinowitz had to miss an annual fancy poker tournament to attend the conference . . . which leads to the obvious question:

“What kind of a man misses a poker tournament to talk with a bunch of sensitive psychotherapy-types?”

Answer: “A pretty cool dude who knows his priorities.”

After Rabinowitz’s keynote, there were more decisions. In my program I had circled presentations by David Shepard and Michele Harway as well as Chris Liang. But I should confess here-and-now that I got slightly intoxicated with Panera coffee and cookies and ended up wandering into the wrong room with three Canadian presenters who were talking about how to help men transition from military to civilian life. It might have partially been the coffee, but the Three Canadians ROCKED MY WORLD . . . which begs the question:

“What kind of a man gets his world rocked by Three Canadians?”

Answer: “The kind of man who recognizes they have such fabulous clinical skills and compassion and cleverness that it makes him wish he was born and raised in Vancouver, B.C. instead of Vancouver, Washington (not that there’s anything wrong with Vancouver, WA).”

After my Canadian experience I staggered into Mark Stevens’s presentation on Engaging Men in the Process of Psychotherapy. Stevens showed photos of little boys and asked us to remember that ALL OF OUR MALE CLIENTS were once sensitive boys (not little men). He urged us to engage men slowly, but to not judge or underestimate them in ways that minimize or shrink their humanity. This was awesome, but I have to ask:

“What kind of a man shows photos of little boys during a professional presentation?”

Answer: “The kind of man who understands how to work effectively with men.”

At this conference you didn’t need a hyphenated name and you didn’t need an un-hyphenated name, because there was no shaming either way. There was just acceptance; acceptance of being scared boys and scared girls who are doing the best we can to openly affirm and connect with each other. And these connections reached across races, to the transgendered, to the women, and even to graduate students. If you’re interested in this sort of thing (and I think you should be), you should check out Division 51 of the American Psychological Association at: http://www.division51.org/

BTW, at the post-conference social I got to meet lore m. dickey, who presented earlier in the day on Affirmative Practice with Transgender Clients. He immediately shared with me that he is a female to male transsexual. That’s the sort of openness and connection you get at the Psychotherapy with Men conference. But I’m sure you know this leads me to another purposely masculinity-shaming question.

“What kind of a man chooses to go through a female to male transgender process?”

“The kind of a man who has achieved clarity about his male identity.”

The day ended with me hanging out with the Three Canadians—whom I should name here (Marvin Westwood, David Kuhl, and Duncan Shields). They welcomed me to their table at the social time where we engaged in an extended international mutual appreciation festival. You should really look them up.

All this brings me to my final question:

“What kind of a man writes an fluffy, complimentary, and sycophantic blog about the 4th National Psychotherapy with Men Conference?”

Answer: “The kind of man who wants to offer the conference organizers and participants the thanks and praise they deserve.”

 

Upcoming Webinar: Engaging and Treating Youth with ODD and CD

Tomorrow at noon Mountain time I’ll be doing a one-hour webinar titled: Engaging and Treating Youth with Oppositional Defiant Disorder and Conduct Disorder (and their Parents). This webinar is hosted by Western Montana Addictions Services. The webinar link for Tuesday, June 10th at noon (MST) is:

https://sas.elluminate.com/m.jnlp?sid=2008093&username=&password=M.5473E398E968F03FF120D04D57D5CF
Conference call line and pin: 571-392-7703 PIN: 832 106 441 879

Join in if you can. I’ll post the powerpoints for the webinar later today or tomorrow.

Happy Monday.

IMG_3098

 

How to Listen so Parents will Talk: Strategies for Influencing Parents — DVD filming with Alexander Street Press

This past week I was in Chicago to be filmed doing three 15 minute TED Talk like speeches for Alexander Street Press. The experience was both exciting and anxiety-provoking. . . as it’s rather challenging to deliver a 15 minute piece in a darkish studio to a camera on one take. Shannon Dermer of Governor’s State University was the smooth as silk facilitator who conducted 15 minute interviews after each speech. I was lucky enough to be filming on the same day as Paul Peluso of Florida Atlantic University. Although it was comforting to see that Paul was just as nervous as I was, it was not comforting watching him absolutely nail a perfect 10 of a presentation on Humor in Psychotherapy just a couple hours before it was my turn in front of the camera.

In the end, the filming went well, but of course during the live filming my imperfect memory led me to miss a few “lines” and so I’m posting here, a text version of the How to Listen so Parents will Talk THERAPY talk.Although my goal was to post an audio version, WordPress has thwarted that particular plan for now. . . sorry about that.

How to Talk so Parents will Listen: Strategies for Influencing Parents

When I talk with large groups about parenting, I like to begin with a survey. I ask: “How many of you ARE parents?” Of course, nearly everyone raises his or her hand. Then I ask a follow up: “How many of you WERE children.” At this question some participants laugh and a few raise their hands and others joke that they’re still immature.

“This reason I start with this survey is because if you’re a parent, you know that being a parent is an amazing and gratifying challenge. You also know that it’s 24-7; and you know it doesn’t end when your child turns 18. You’re a parent for life. And if you WERE a child, and all of you were, then you know how important it is to have a parent or caretaker who makes it perfectly clear that YOU ARE LOVED. But there’s more. If you were a child, then you also know how important it is to have a parent who not only loves you, but who is skillful . . . a parent who is dedicated to being the best parent possible.

Plain and simple: PARENTS NEED SKILLS FOR DEALING WITH THEIR CHILDREN IN THE 21ST CENTURY. And learning to be a better parent never stops.

Once upon a time I had a mom come consult with me about her five year old son. She said: “I have a strong-willed son.” My response was to acknowledge that lots of parents have strong-willed children. She said, “No, no, you don’t get it. I have a very strong-willed son, let me tell you about it. Just the other night, I asked him to go upstairs and clean his room and he put his hands on his hips and said, “NO.” So I said in response, “Yeah, yeah. He sounds very strong willed.” And she said, “Wait. There’s more. I asked him to clean his room a second time and he glared and me, and said “NO. YOU WANT A PIECE OF ME?” Then she told me the real problem. The problem was that, in fact, she did want a piece of him at that particular point in time and so she grabbed him and hauled him up the stairs in a way that was inconsistent with the kind of parent she wanted to be.

This is one of the mysteries of parenting. How can you get so angry at a small child whom you love more than anything else in the world?

Parents are a unique population and deserve an approach to counseling that’s designed to address their particular needs. In this talk I’ll mostly be using stories to talk about
a. what parents want for their children
b. what parents need in counseling
c. and how professionals can be effective helpers.

Most parents want some version of the same thing: To raise healthy and happy children who are relatively well-adjusted. But what do parents need in counseling. WHAT WILL HELP THEM GET WHAT THEY WANT?

First, parents need empathic listening. They need this big time. Our American culture puts lots of social pressure on parents . . . It’s implied that parenting should be easy and all parents should want to spend 24-7 with their child in an altered state of parental bliss. But this isn’t reality and so we need empathy for the general scrutiny parents feel in the grocery store, at church, on the playground, and everywhere else.

But they also need listening and specific empathy: like in the situation where the mom wanted to tell me about her 5-year-old son. She had specific information to share and it was really important for me to take time to listen to her unique story about her son who, unfortunately, may have been watching too many Clint Eastwood movies.

Parents come to counseling or parent education feeling simultaneously insecure and indignant. They feel insecure because of the scrutiny they feel from their parents and in-laws and society, but they also feel indignant over the possibility that anyone might have the audacity to tell them how to parent their children. As professionals, we need to be ready to handle both sides of this complex equation.

Another thing parents have taught me over the years is to never start a parenting session by sharing educational information. You should always wait to offer educational advice, even when parents ask you directly for it. When they do ask, let them know that your ideas will be more helpful later once you get to know what’s happening in their family.

This leads us to the second crucial part of what parents need in counseling. They need collaboration. We can’t be experts who tell parents what to do, instead we have to recognize that parents are the experts in the room. They’re the experts on their children, on their family dynamics, and on themselves. If we don’t engage and collaborate with parents, very little of what we offer has any chance of being helpful.

Parents also need validation to counter their possible insecurity. We call this radical acceptance or validation and it involves explicitly and specifically giving parents positive feedback. We do this by affirming, “You sure seem to know your daughter well.” And by saying, “When I listen to how committed you are to helping your son be successful in life, I can’t help but think that he’s lucky to have you as a parent.”

And so we begin with empathic listening and we move to collaboration and we make sure that we offer radical acceptance or validation and we do all this so we can get to the main point: providing parents with specific parenting tips or guidance.

And there are literally TONS of specific parenting tips that professionals can offer parents. Most of the good ones include four basic principles:

First, getting a new attitude – because developing parenting skills requires a courageous attitude to try things out.

The second one involves making a new and improved plan. Because a courageous attitude combined with a poor plan won’t get you much.

Third is to get support when you need it. Parenting in isolation is almost always a bad idea.

Fourth, underlying all tips there should be the foundation of being consistently loving.

I’d like to tell two parenting stories to illustrate all of the preceding ideas.

This first story is about a parenting struggle I had. I share it for two reasons: One is that it’s a great example of the need for parents to make a new plan to handle an old problem. And two, often it’s good to self-disclose—but not too much—when working with parents.

When my youngest child was 5-years-old, she ALSO was a strong-willed child. I vividly recall one particular ugly scene on the porch. It was time for us to leave the house. But we lived in Montana and there was snow and my daughter needed to put her boots on. Funny thing, she was on a different schedule than I was. This created tension and anger in me. And so I got down into her face and I yelled GET YOUR BOOTS ON! And her eyes got big and she did. Later that evening I was talking with my wife and she saw the scene and she said to me, “I know John, that’s not the kind of parent you want to be.” And even though it’s not easy to take feedback from our romantic partners, she was right and so obviously so, that I had no argument” which led me to tell her, “I’m not going to yell at our daughter any more. I am, instead going to whisper, because I learned in a parenting book, that sometimes when you’re angry it’s more effective to whisper than it is to yell. That was my new plan. Of course, like new plans everywhere, it needed tweaking. But it didn’t take long for me to have an opportunity to test it because if there’s anything on the planet that’s predictable, it’s that we’ll all soon have another chance to manage our anger toward our children more constructively.

It was the next day or week and my daughter did not get her boots on and she was not on the same schedule as me and I got down in her face, once again, but I remembered the plan to whisper and I did my best to transform my anger from the historical yell to the contemporary whisper and what happened was that what came out was sort of like the exorcist and I said to my daughter: “GET YOUR BOOTS ON!”

Now. I wasn’t especially proud of that, but she got her boots on.

It was the beginning of a big change for me because I learned I could play the exorcist instead of yelling; then I learned to growl and then I learned to count to three and then I learned a cool technique called Grandma’s rule where you use the formula, WHEN YOU, THEN YOU to set a limit and build in a positive outcome. Like . . . “Honey, when you get your boots on, then you can have your cell phone back.” Very cool.

What I learned from this experience is that I could be more than a one-trick parenting pony. I became the kind of parent who, although far from perfect, was able to set limits that were in my daughter’s best interest.

And what I like the best about this particular story is that daughter is now 26 years-old and she still says the same thing she used to say to me when she was 15 . . . that is, “Dad, one thing I really love about you is you never yell.” What’s cool is that I did yell, but I worked on it, I made a new plan, and now she doesn’t even remember the yelling.

I’d like to finish with one last story about how much parents need people like you to have empathy, collaborate, validate, and offer concrete parenting ideas.

I was working with a 15-year-old boy. His mom was bringing him to counseling because he and his dad weren’t speaking anymore. I hadn’t met the dad, but one day, when I went to the boy’s IEP meeting at school the dad was there. I saw this as a chance to make a connection and get him to come to counseling.

I did a little chit-chatting and sat next to him in the group meeting. Then, at one point, I asked the boy a question: “If you got an A on a test, who would you show first?” He answered, “I’d show my dad, my mom, and my special ed teacher.” This inspired me to turn to his dad and say, “It’s obvious that you’re very important to your son and so I’d like to invite you to come join him and me in counseling.” Dad gave me a glare and pushed my shoulder and began a 2-minute rant about how the school had failed his son. Everyone was stunned and then he turned back to me and said, “I’ll come to counseling. I been to counseling before and I can do it again.”

At that point I wondered if I could take back my offer.

The day the dad drove to counseling he and his son weren’t speaking, so I met with them separately. The son was clear that he would never speak to the dad again, but the dad was open. When I asked if I could offer him some ideas, he said, “Well I tried MY best and that dog don’t hunt, so I can try something else.” I was wishing for subtitles.
I told the dad I wanted him to keep his high standards for his son, but to add three things. First, I asked, do you love your son? The dad said “Yes” and so I told him, “Okay then. I want you to tell him ‘I love you’ every day.” He said, “Usually I leave that to the wife, but I can do that.” Second, I said, “Everyday, I want you to touch your son in a kind and loving way.” He asked, “You mean like give him a hug?” I said, “that would be great” and he responded, “Usually I leave that to the wife too, but I’ll give it a shot.” Third, I said, “Once a week, you should do something fun with your son, but it has to be something that he thinks is fun.” He said back: “That’s no problem. We both like to go four-wheeling, so we’ll do that.”

And they left my office for an hour-long of what I imagine was a silent trip home.

The next afternoon, I got a call from the mom. She was ecstatic. She said, “I don’t know what you did or what you said, but they’re talking again.” And then she added, “This morning, when they were in the kitchen, I was in the other room and I thought I heard them hug and when I saw my son walking down the driveway to head to school, there were tears running down his cheeks.”

This was obviously a mom who was listening and watching very closely.

Things got much better for the 15-year-old after that. He didn’t get straight As, but he stopped getting straight Fs. And I learned two things: First, I learned just how much that boy needed to get reconnected with his father. And second, I learned that sometimes, no matter how gruff parents may seem, what they need is some clear and straightforward advice about how to reconnect with their son or daughter.

My final thoughts about this topic are very simple. I hope you’re inspired enough to acquire the knowledge and skills it takes to work effectively with parents. I know their children will deeply appreciate it.

Thanks for listening.

The book upon which the talk is based is available here on Amazon:

. . . and here on Wiley: http://www.wiley.com/WileyCDA/WileyTitle/productCd-1118012968.html