All posts by johnsommersflanagan

Cool Counseling, Parenting, Therapy with Adolescents, Tough Kids, Tough Kids Cool Counseling

Electronic Classrooms of Tomorrow — Powerpoint slides for “How to Listen. . .”

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This coming Thursday and Friday I’ll be in Columbus, OH for the Electronic Classrooms of Tomorrow (ECOT) conference. For Thursday, I’m presenting several break-out sessions on “How to Listen so Parents will Talk and Talk so Parents will Listen.” The powerpoints for that presentation are here:

How to Listen for ECOT

On Friday I doing an all-day workshop with the ECOT counselors with a little of everything (Tough Kids, Cool Counseling, Suicide Assessment/Intervention, and Working with Parents). Here are the ppts for Friday’s workshop:

ETOC TKCC No Tunes

Thanks very much to Emma Baucher who has been incredibly helpful in arranging this.

 

Parenting

If You Work With Parents . . . Check This Out

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This case example is used to illustrate the model Rita and I describe in our “How to Listen so Parents will Talk. . .” book.

The key principles or attitudes (similar to Rogerian approaches) are:

1. Empathy

2. Radical acceptance

3. Collaboration

Here’s the case example:

Theory into Practice: The Three Attitudes in Action

In the following example, Cassandra is discussing her son’s “strong-willed” behaviors with a parenting professional.

Case: “Wanna Piece of Me?”

Cassandra: My son is so stubborn. Everything is fine one minute, but if I ask him to do something, he goes ballistic. And then I can’t get him to do anything.

Consultant: Some kids seem built to focus on getting what they want. It sounds like your boy is very strong-willed. [A simple initial reflection using common language is used to quickly formulate the problem in a way that empathically resonates with the parent’s experience.]

Cassandra: He’s way beyond strong-willed. The other day I asked him to go upstairs and clean his room and he said “No!” [The mom wants the consultant to know that her son is not your ordinary strong-willed boy.]

Consultant: He just refused? What happened then? [The consultant shows appropriate interest and curiosity, which honors the parent’s perspective and helps build the collaborative relationship.]

Cassandra:           I asked him again and then, while standing at the bottom of the stairs, he put his hands on his hips and yelled, “I said no! You wanna piece of me??!”

Consultant: Wow. You’re right. He is in the advanced class on how to be strong-willed. What did you do next? [The consultant accepts and validates the parent’s perception of having an exceptionally strong-willed child and continues with collaborative curiosity.]

Cassandra: I carried him upstairs and spanked his butt because, at that point, I did want a piece of him! [Mom discloses becoming angry and acting on her anger.]

Consultant: It’s funny how often when our kids challenge our authority so directly, like your son did, it really does make us want a piece of them. [The consultant is universalizing, validating, and accepting the mom’s anger as normal, but does not use the word anger.]

Cassandra: It sure gets me! [Mom acknowledges that her son can really get to her, but there’s still no mention of anger.]

Consultant: I know my next question is a cliché counseling question, but I can’t help but wonder how you feel about what happened in that situation. [This is a gentle and self-effacing effort to have the parent focus on herself and perhaps reflect on her behavior.]

Cassandra: I believe he got what he deserved. [Mom does not explore her feelings or question her behavior, but instead, shows a defensive side; this suggests the consultant may have been premature in trying to get the mom to critique her own behavior.]

Consultant: It sounds like you were pretty mad. You were thinking something like, “He’s being defiant and so I’m giving him what he deserves.” [The consultant provides a corrective empathic response and uses radical acceptance; there is no effort to judge or question whether the son “deserved” physical punishment, which might be a good question, but would be premature and would likely close down exploration; the consultant also uses the personal pronoun I when reflecting the mom’s perspective, which is an example of the Rogerian technique of “walking within.”]

Cassandra: Yes, I did. But I’m also here because I need to find other ways of dealing with him. I can’t keep hauling him up the stairs and spanking him forever. It’s unacceptable for him to be disrespectful to me, but I need other options. [Mom responds to radical acceptance and empathy by opening up and expressing her interest in exploring alternatives; Miller and Rollnick (2013) might classify the therapist’s strategy as a “coming alongside” response.]

Consultant: That’s a great reason for you to be here. Of course, he shouldn’t be disrespectful to you. You don’t deserve that. But I hear you saying that you want options beyond spanking and that’s exactly one of the things we can talk about today. [The consultant accepts and validates the mom’s perspective—both her reason for seeking a consultation and the fact that she doesn’t deserve disrespect; resonating with parents about their hurt over being disrespected can be very powerful.]

Cassandra: Thank you. It feels good to talk about this, but I do need other ideas for how to handle my wonderful little monster. [Mom expresses appreciation for the validation and continues to show interest in change.]

As noted previously, parents who come for professional help are often very ambivalent about their parenting behaviors. Although they feel insecure and want to do a better job, if parenting consultants  are initially judgmental, parents can quickly become defensive and may sometimes make rather absurd declarations like, “This is a free country! I can parent any way I want!”

In Cassandra’s case, she needed to establish her right to be respected by her child (or at least not disrespected). Consequently, until the consultant demonstrated respect or unconditional positive regard or radical acceptance for Cassandra in the session, collaboration could not begin.

Another underlying principle in this example is that premature educational interventions can carry an inherently judgmental message. They convey, “I see you’re doing something wrong and, as an authority, I know what you should do instead.” Providing an educational intervention too early with parents violates the attitudes of empathy, radical acceptance, and collaboration. Even though parents usually say that educational information is exactly what they want, unless they first receive empathy and acceptance and perceive an attitude of collaboration, they will often resist the educational message.

To summarize, in Cassandra’s case, theory translates into practice in the following ways:

  • Nonjudgmental listening and empathy increase parent openness and parent–clinician collaboration.
  • Radical acceptance of undesirable parenting behaviors or attitudes strengthens the working relationship.
  • Premature efforts to provide educational information violate the core attitudes of empathy, radical acceptance, and collaboration and therefore are likely to increase defensiveness.
  • Without an adequate collaborative relationship built on empathy and acceptance, direct educational interventions with parents will be less effective.

The amazon link to the book is here: http://www.amazon.com/How-Listen-Parents-Will-Talk/dp/1118012968/ref=sr_1_2?s=books&ie=UTF8&qid=1380502481&sr=1-2&keywords=how+to+listen+so+parents+will+talk+and+talk+so+parents+will+listen

 

Writing

The Active Voice in Writing: An APA Style Blog

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[OPENING SENTENCE #1] One challenging grammatical maneuver in contemporary writing is the proper use of the active voice.

Oops.

Because this essay is about the active voice, it might be a better idea to use a more active voice for the opening sentence. What do you think of the following alternative?

[OPENING SENTENCE #2] Proper use of an active voice is a challenging grammatical maneuver in contemporary writing.

Can you see or feel the difference in these two opening sentences?

Although the use of the word maneuver is a questionable choice in both sentences, an active voice is better illustrated in the second opening sentence. That’s because “active voice” is the subject and “challenging grammatical maneuver” is the object or outcome that an active voice acts on.

I think.

Editors, publishers, and even the 6th edition of the Publication Manual of the American Psychological Association advise neophyte writers to eschew the passive voice. They also suggest eschewing words like eschew and neophyte, but that’s another topic altogether. For now, we are admonished to use the active voice. The Publication Manual also encourages prospective APA authors to use first-person language to promote clarity. I like that.

But what exactly is the active voice?

The active voice involves a subject acting on an object. For example, “She is depressed,” includes a subject “She,” a verb, “is,” and an object or outcome “depressed.” An active voice involves arranging the sentence in a way so that the subject acts on the object. Another example, “Depression crept into him” illustrates how, in some cases, it’s possible to anthropomorphize or animate an entity so that it becomes the actor and what you might usually consider the subject becomes the object that is acted upon. This is a good example of flexibility and creativity in writing, but a less good example of an active voice.

Here’s another (and clearer) example that you might find in a research paper:

“The researchers reported insignificant results.”

In this case, “The researchers” are the subject and they’re taking the action of reporting insignificant results.

Many writers find it difficult to use or maintain an active voice. The passive voice may feel easier or more natural and therefore be used when the active voice would be more clear and succinct. Here’s the passive voice version of the preceding example:

“Insignificant results were reported by the researchers.”

Note that although the passive voice is factually correct, it’s less parsimonious and less direct and therefore less desirable.

Grammar Girl is a good source for more active and passive writing examples [you can listen to her grammatically correct and calming voice at: http://www.quickanddirtytips.com/education/grammar/active-voice-versus-passive-voice?page=all#sthash.Ys1GOZN9.dpuf]. Here’s what she has to say:

A straightforward example is the sentence “Steve loves Amy.” Steve is the subject, and he is doing the action: he loves Amy, the object of the sentence.”

Another example is the title of the Marvin Gaye song “I Heard It through the Grapevine.” “I” is the subject, the one who is doing the action. “I” is hearing “it,” the object of the sentence.

In passive voice, the target of the action gets promoted to the subject position. Instead of saying, “Steve loves Amy,” I would say, “Amy is loved by Steve.” The subject of the sentence becomes Amy, but she isn’t doing anything. Rather, she is just the recipient of Steve’s love. The focus of the sentence has changed from Steve to Amy.

If you wanted to make the title of the Marvin Gaye song passive, you would say “It was heard by me through the grapevine,” not such a catchy title anymore.

Grammar Girl also noted on her podcast that sometimes writers (or speakers) intentionally use a passive voice, or at least a neutral voice. This resulted in the following examples in our University of Montana class today.

This wall is painted (neutral voice).

The painters painted this wall (active voice).

This wall was painted by painters (passive voice).

As you can see from these examples, identifying an actor (or subject) in a sentence may or may not be important or relevant. Grammar Girl also used the example of President Ronald Reagan’s famous “Mistakes were made” line. She noted that, for obvious reasons, sometimes politicians (or others) want to be vague about assigning linguistic responsibility to a specific actor. The more active voice alternative might have been: “I made mistakes.”

Finding your active voice and avoiding a passive voice requires awareness, practice, persistence, and motivation. To help with this process, I have a few tips you might want to try out.

  1. Watch out for the word “by.”

Both of the passive voice sentences in Grammar Girl’s examples included the word “by.” This is often the case. You might remind yourself of this tip by using the following self-statement [Can you reword this sentence to make it more active?]: “I’m going to say bye to by.” Or—even better—you might use the preceding self-statement to remind yourself of this tip (notice I managed to give you this tip again while getting rid of my new nemesis: the word “by.”

2.  Be aware of your use of the word “of.”

Typically, it’s a good idea to try not to use “of” more than once in a sentence. This can be hard and many good writers ignore this tip. In fact, really good writers will violate most basic writing rules. For example, the APA Publication Manual authors even ignored it. Consider the two following statements and think about which one you prefer.

From section 2.04 of the Publication Manual:

“An abstract is a brief, comprehensive summary of the contents of the article.”

An alternative:

“An abstract is a brief, comprehensive summary of the article’s contents.”

Many readers (and writers) may prefer the original APA Manual sentence. However, in my professional writing I often find myself annoyed with how many times I use the word “of” in an initial draft. And so my point is to watch out for sentences that include “of” too often. Even if it’s not technically the passive voice, using “of” too often may begin feeling passive.

3.  Don’t let your tendency to write in a passive voice stop you from writing.

No writers ever write a perfect first draft. My best advice on this is for you to start looking forward to the opportunity of transforming your passive voice into a more active voice when you edit your work.

Perhaps what’s most interesting about writing and speaking about grammar is that it—writing and speaking about grammar—can cause the writer and speaker substantial self-consciousness. And, if you’ve followed psychological research in this area, you know that self-consciousness can cause or increase anxiety. That’s why I need to confess that substantial anxiety (not to mention self-doubt) accompanied the writing of this essay. Or should I say: The writing of this essay was accompanied by substantial anxiety (no, I should not because this second example is that dratted passive voice again). That’s also why I want to end with strong encouragement for throwing off your anxieties and writing right through whatever personal writing quirks you may be facing. Write now! You can fix the quirks later.

Learning Activity

  1. Which of the following sentences from your homework reading is the best example of an active voice?

a.  “Each paragraph should be able to be read and understood in isolation from the rest of the manuscript.” (Knight & Ingersoll, 1996, p. 209)
b.  “A multitude of small details must be taken into account to produce a publishable work, and editors truly appreciate writers who are cognizant of addressing these details.” (Brewer et al., 2004, p. 21)

c.  “Ethical principles must guide every aspect of professional writing.” (Brewer et al., p. 21)

2.  Write a sentence with an active voice.

3.  Write a sentence with a passive voice.

4.  Other than spacing and citations, name one way in which the preceding blog post violates APA style.

5. (Discussion question for class) Why do you think that it’s sometimes acceptable to include a passive voice instead of an active voice?

More information on using an active voice is available generally online and specifically at Purdue’s OWL website: http://owl.english.purdue.edu/owl/resource/539/02/

Finally . . . this is NOT an official APA style blog. If you want to check out the real thing, go to: http://blog.apastyle.org/

Personal Reflections, Writing

On Being or Becoming a Writer (Again)

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While I was taking notes on Mary Pipher’s “Writing to Change the World” book, a bug flew in my eye. It was at the precise moment I was typing the following quotation: “When we equivocate we lose an opportunity to build our identities as writers. If you are not doing it already, I advise you to learn to say you are a writer” (p. 76).

Shall I really say “I am a writer!” even if it doesn’t feel quite right?

Or should I be more honest and describe the complete situation by saying, “I am a writer who is trying to write, but I have a bug that just flew in my eye and that’s making it more difficult than it might otherwise be.”

Didn’t someone once say that honesty is the best policy? And isn’t there a story about George Washington honestly confessing that he chopped down a cherry tree that he had no particular business chopping down. Of course that story is a lie and as it turns out Betsy Ross didn’t really sew the first American flag, but she had some fairly effective promotional people who either thought she did or decided to lie on her behalf.

What if I just tell a microscopic white lie to myself? Is that a problem?

Or maybe I just need an agent who will lie willy-nilly on my behalf? I’ve sort of always wanted somebody who would do something will-nilly just for me.

After all, honesty will only take you so far and the only advice my father gave me about being married was that “You don’t have to always tell your wife EVERYTHING you’re thinking.” That’s good advice, except that it contradicts with what Carl Rogers said about maintaining a transparent relationship and how he learned the most from being completely honest with his wife about the things that were most difficult to talk about.

Wouldn’t it be true, however (this, I understand, is how attorneys like to begin questioning the person who has just taken the stand), that lying destroys relationships and can take you to prison where you might share a cell with Piper Kerman. Then again, she wrote a book (Orange is the New Black) that got made into a television show and that’s pretty cool.

It’s very difficult to find clean and straight answers upon which everyone agrees. I’ve noticed this and thought I should honestly articulate this observation.

When I’m doing counseling with young people who have anger problems or who are cutting or who are embracing a negative and unhelpful identity, I sometimes ask them to consider thinking differently about themselves. The technique is a little bit of a knock off of Alfred Adler’s Acting As-If. I don’t ask them to pretend or to tell themselves bald-faced lies, but instead to tell more of the complete hairy-faced narrative truth. For example, when a girl tells me she’s got a “terrible temper,” I suggest and implore and encourage her to capture the WHOLE DARN NARRATIVE and instead tell herself something like, “I believe I’ve had a terrible temper in the past, but I’m working on it.”

Pipher (not Piper) says I should learn to call myself a writer. Obviously that worked for her and she’s been immensely successful and now she’s sharing it as a writing strategy. But what if that doesn’t work so well for me? What if my mantra is that I’m a writer who’s got a bug in his eye and that darn bug is making it terribly difficult, but I’m working on it?

What if I prefer a different hat style?

Here’s what I like instead: “I am becoming a writer.”

I most definitely like that better. I am becoming is a better fit for my tentative always in flux and change and self-reflective in-moderation identity.

I am becoming a writer.

And I hope you are too.

Personal Reflections, Writing

Professional Writing for Us Professionals Who May Not Quite be Writers . . . Yet

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This past week I’ve been searching in vain for the origin of my favorite pithy advice to aspiring writers. It may have been Flannery O’Connor or George Orwell or another literary-type who noted or shouted or penned the phrase: “Writers write.”

This nice thing about this advice is that it’s simultaneously very general and very specific and very redundant all at the same time.

But there are also different breeds of writers who write.

While I was at the University of Portland, one of my noon-time basketball buddies was a Math professor. When he wasn’t making fun of his own stutter-step dribble or teaching classes or waxing his 1967 Mustang, he was writing a mathematics text. He told me his writing philosophy—which was really more of a strategy, but then he was a math guy. Every night he wrote one page of his textbook. Just one page . . . and he didn’t go to bed until he had completed this nightly homework. He never said, “Writers write.” He just wrote.

Another one of my Portland basketball buddies was an English professor, writer, and poet. He didn’t talk much about writing, probably because he was too busy reaching in and hacking my arms as I tried to shoot. When I asked him how he thought computers had affected writing and writers (this was the late 1980s), he said he thought there was too much cutting and pasting going on. Lines or stanzas or paragraphs would find their way to places where they didn’t belong. He was a real writer; a literary guy; a pen and paper type. He also wrote every day, but he was too interested in the muse to ever start or stop himself on a clock or a page.

This brings me to my point.

In the Department of Counselor Education at the University of Montana, we have a brand new doctoral-level course on advanced research and professional writing. As a caveat, I should note that we make no claim to be real (aka literary) writers. But that won’t stop us from doing what real writers do and following their advice.

We will write . . . every day . . . and not just because writers write, but also because of what the great science fiction writer Ray Bradbury suggested: “Just write every day of your life. Read intensely. Then see what happens. Most of my friends who are put on that diet have very pleasant careers.”

We will see what happens. We would like to have very pleasant careers.

There are many writing genres and styles and venues. It can be confusing. There are blogs and grant proposals and professional journal manuscripts and book chapters and emails and books and magazine articles and personal journals and the letter you should be writing to your mother. There are also many places to publish and many more places for not publishing. Right now I have at least 50 unfinished and unpublished blogs and commentaries and journal article manuscripts and books on my computer. This work is sitting and waiting for renewed inspiration or focus or time. I fear that I’m violating Annie Dillard’s advice on whether to hold ourselves back or break free. She wrote: “Do not hoard what seems good for a later place in the book, or for another book; give it, give it all, give it now.”

Speaking of hoarding, we don’t plan to keep this writing experience all to ourselves. And this brings me to my point (again). All who read these words may participate. Here are two examples of what you can do:

  1. You can read these blogs and provide commentary or critique. For example, shortly after posting the blog, “The Long Road to Eagle Pass Texas” my wife and co-author informed me that I had made a glaring grammatical error. If you read that post and can identify a grammatical error, please offer up your feedback. You can email me directly at john.sf@mso.umt.edu or post on this blog.
  2. You can write a guest blog. Everyone in our real (not virtual) class will have this assignment. As long as the blog focuses on writing or the helping profession or both and you’re open to feedback, please submit. I will assign it to a doctoral student for review and if it makes it into this blog, you can count on an incisive, but perhaps grammatically-challenged introductory comment from me.

In the meantime, just read . . . intensely . . . and write . . . even if only for yourself . . . and struggle with the muse like a wrestler or dancer or whatever metaphor fits best for you here.

Counseling and Psychotherapy Theory and Practice, Personal Reflections, Therapy with Adolescents, Tough Kids, Tough Kids Cool Counseling

Reformulating Clinical Depression: The Social-Psycho-Bio Model

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At a 2007 Mind and Life Conference at Emory University, I had the privilege of watching and listening as Charles Nemeroff, M.D., presented a professional paper to His Holiness the Dalai Lama. [As my older daughter would likely say, Dr. Nemeroff is a very fancy biological psychiatrist.] Nemeroff noted, with some authority, that we now know that one-third of all depressive disorders are genetically-based and two-thirds are environmentally-based. Following this statement, Nemeroff continued to discuss the trajectory of “depressive illness,” focusing, in particular, on findings linked to mice with early maternal deprivation and related findings regarding trauma and depression. His conclusion was that, for some individuals (and mice), the brain is changed by early childhood trauma, while for others, the brain seems unaffected. Interestingly, at that point in the conference the Dalai Lama interrupted and there were animated interactions between him and his interpreter. Finally, the interpreter directed a question to Nemeroff, stating something like, “His Holiness is wondering, if two-thirds of depression is caused by human experience and one-third is caused by genetics, but that humans who are genetically predisposed to depression have to have a trauma for the depression to be manifest, then wouldn’t it be true to say that all depression is caused by human experience?” After a brief silence, Nemeroff responded, “Yes. That would be true.”

Most of us have heard about the biopsychosocial model in contemporary medicine. Below I’ve included some information about its origin (this info is adapted from a 2009 Journal of Contemporary Psychotherapy Article; you can find the whole article here: http://www.coping.us/images/Sommers_Campbell_2009_EBP_for_Kids.pdf).

In his 1980 call to medicine, Engel (1980; 1997) encouraged adoption of a biopsychosocial model of health and illness. Despite this recommendation and the increased use of ‘biopsychosocial’ language among non-medical practitioners, medicine has demonstrated little movement toward embracing a biopsychosocial perspective (Alonso, 2004). To some extent, the Nemeroff-Dalai Lama interaction illustrates medical professionals’ tendencies to formulate mental health problems as disease states even when their own data are contradictory. At the Mind and Life Conference, Nemeroff continued to present his illness-based depression formulation even after conceding environmental causality of depression (Nemeroff, 2007).

Although we (Sommers-Flanagan & Campbell) generally advocate medicine’s biopsychosocial model, we see utility in a slightly more radical reconceptualization of depression–especially among youth. This belief rests upon knowledge about the etiology, course, and treatment of depression, equivocal data regarding antidepressant medication effectiveness, potential developmental and medical dangers associated with short- and long-term SSRI use, research on child development and trauma, and our own clinical experience (Sommers-Flanagan & Sommers-Flanagan, 1995a; Sommers-Flanagan & Sommers-Flanagan, 2007). In short, instead of a biopsychosocial model for understanding and treating youth depression, we believe a social-psychological-biological approach is more consistent with current scientific and clinical knowledge.

A Social-Psycho-Bio Model of Clinical Depression

All humans are born into pre-determined social and cultural settings, which directly influence emotional, psychological, social, and biological functioning and development (Christopher, 1996; Sue & Sue, 2013). Although space precludes complete articulation of the social-psycho-bio model, we describe the major components below.

Social-cultural components. Many cultural factors contribute to children’s emotional and psychological development. For example, in the United States, babies are often born to socially isolated mothers living in poverty. These mothers may also be depressed themselves and have little community and governmental support (Goosby, 2007; Knitzer, 2007). In contrast, more communal and supportive cultural settings place less of a parenting burden on individual mothers, thus possibly decreasing depression. It’s likely that different degrees of cultural support to families and children translate into different degrees of relative risk for depressive experiences in children.

Recent research affirms diverging cultural assumptions about depression etiology. Whereas South Asian immigrants viewed depressive symptoms as stemming from social and moral influences (Karasz, 2005), European Americans attributed depression to biological influences. These cultural formulations or expectations likely influence medication or psychotherapeutic efficacy. Although biomedical researchers emphasize genetic contributions to depression, an individual’s depressive predisposition may be strongly influenced by overarching cultural factors. Given Nemeroff’s admission that depression is rooted in human experience, it seems appropriate to us that depression formulations lead with social and cultural, rather than biological factors.

Early caretaker-child interactions. Early caretaker-baby interactions appear to stimulate depression development in very young children. The best example of this comes from studies of maternal depression, which demonstrate that mothers’ depressive behaviors influence their children’s own emotional suffering and other neurological changes (Ashman & Dawson, 2002). This evidence for a direct effect of caregiver behavior on children’s neural activity and possible brain development supports the social-psycho-bio model.

Child trauma. Garbarino’s (2001) statement, “Risk accumulates; opportunity ameliorates” (p. 362) suggests that repeated trauma in the absence of support or opportunity can deeply damage children. Trauma typically occurs within a social and cultural context, and without requisite support and opportunity, it can initiate cognitive, emotional, and social pathology. Sufficiently intense trauma may also produce lasting “psychic scars” (Terr, 1990). Additionally, early childhood trauma drains children and adults of meaningfulness (Garbarino, 2001). There is little doubt about the powerful contribution of trauma to the development of clinical depression and other mental disorders.

Psychological/cognitive development of depressive symptoms. Considerable evidence supports a cognitive model of depression in adults, and to some extent, in adolescents and children (Kazdin & Weisz, 2003). The pioneering work of Aaron Beck (1970) emphasizes that personal experiences lead individuals to acquire specific negative beliefs about themselves, the world, and the future (i.e., the cognitive triad). Although empirical support for the cognitive triad’s contributory and maintenance roles in depression is strong, these belief systems do not rise autonomously within the psyche. Instead, as Beck notes, these deeply ingrained beliefs are learned vis-à-vis interpersonal experiences.

The development of schemata or internal working models. Theorists spanning analytic, neoanalytic, cognitive, and attachment perspectives have proposed concepts that can be described as schemata or internal working models (Ainsworth, 1989; Glasser, 1998; Morehead, 2002; Young, Klosko, & Weishaar, 2003). Although each theoretical perspective articulates the concept somewhat differently, all involve development of a psychological pattern of repetitive automatic beliefs and expectations. These beliefs and expectations, which implicate the self, the world, and others (or objects), generate repetitive behaviors and affect. A cognitive schema or internal working model arises from early social interactions and may contribute to depression and other emotional and behavioral maladies. From a behavioral perspective, depressogenic working models involve early maladaptive reinforcement contingencies, which must be unlearned before one can acquire more adaptive behavior patterns.

Regardless of theoretical orientation, the internal working model concept forms the foundation of many psychological interventions. For example, it clearly underlies CBT and interpersonal therapy (IPT), two evidence-based practices for treating depression in youth (Kazdin & Weisz, 2003). Essentially, internal working models or schemata include internalized early experiences, and they constitute the “psycho” component of the social-psycho-bio model. When positive, adaptive, and healthy early experiences predominate, internalized working models buffer or immunize the individual against stress and trauma. When critical, negative, and maladaptive experiences predominate, schemata can predispose an individual to acute, chronic, or recurrent depressive episodes.

Neurological (brain-based) manifestations of depression. In addition to social, cognitive, emotional, and motivational experiences, current and recent research has identified cortical functioning correlates of depression. These correlates include neurochemical changes and neural activity, which can be observed via Positron Emission Tomography or functional Magnetic Resonance Imaging. Typically, brain imaging studies in animals, youth, and adults are presented as evidence of biomedical or biogenetic causal factors of depression. In the social-psycho-bio model described here, we suggest that neural changes are natural and inevitable correlates of internalized depressive life experiences. Because we are all biological organisms, observable neural changes associated with clinical depression should come as no surprise. It is important to note, however, that brain changes represent a physical phenomenon correlated with depression; these changes may or may not be causative.

Individuals with more extreme, recurrent, or chronic depressive experiences are perhaps more likely to evidence neurochemical states that add to or maintain depression. Again, we view this as a natural biological process. In some circumstances, this state might require a biological agent (or medication) to be used in combination with psychotherapy to facilitate depression recovery.

Our social-psycho-bio model advocacy does not exclude biomedical contributors to depression. Instead, it identifies biological manifestations as correlates of social and psychological dimensions of depression. This argument has been articulated before, but without much success. We attribute the failure of this view to the din of medication marketing and a cultural orientation toward quick fixes. In fact, we are all biological creatures with intricately interconnected brains characterized by dazzlingly complex electrochemical communication. The search for fMRI and PET scan differences between depressed and non-depressed individuals represents a logical and natural development in our understanding of depression as it exists within the whole person. Although neurochemical changes might maintain depression, it is not necessarily the case that neurochemical factors (or the vernacular ‘chemical imbalances’) initiate depressive processes. Indeed, these neurochemical changes are just as likely to be consequences of depressive conditions. Based on this depression re-formulation, we believe that it would be appropriate to initiate antidepressant medication treatment as an adjunctive approach if previously attempted experiential interventions, including exercise, dietary adjustments, and psychotherapy failed to achieve desired effectiveness. Further, conceptualizing neurochemical changes as depressive correlates rather than causes, lead us to agree with others who maintain that medication treatment should be considered a palliative and not curative treatment (Overholser, 2006).

[Again, please note that much of the preceding is adapted from a previously published article in the Journal of Contemporary Psychotherapy. The article was titled, “Psychotherapy and (or) Medications for Depression in Youth? An Evidence-Based Review with Recommendations for Treatment.” Citations are available in the original article.]

 

Boys and Men, Personal Reflections

Hooking Up: Two Play That Game, and Not Just on Campus

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Hey. Here’s a piece Rylee S-F wrote that articulates some of the work and thinking we’ve been doing together as a father-daughter team. The focus is on male sexuality. Give a big shout-out to Rylee for getting this in the Connecticut Review and please reblog, like, and please make the world a better place by helping promote some sensible thinking about boys/men and sex. Thanks for reading! John SF

Personal Reflections, Tough Kids Cool Counseling

The Long Road to Eagle Pass Texas

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Hi.

I’m re-posting this because today, exactly one year since I made my long trek to Eagle Pass from Montana . . . I’m back again. The drive was just as long as before, but I’m back because the folks in the Eagle Pass School District are pretty darn fun to hang out with. And so here’s the original post from last year:

 

It’s a very long way from Missoula, Montana to Eagle Pass, Texas.

Just saying.

This epiphany swept over me after the early morning Missoula to Denver flight and after the Denver to San Antonio flight and right about when, after driving from San Antonio in a rental car for about an hour, I finally saw a green mileage sign that said: Eagle Pass – 95 miles. I just laughed out loud. And even though I was all by myself, I said, “It’s a long way from Missoula to Eagle Pass.” This is just a small taste of the profound thoughts I think while traveling alone.

But time and space are relative and so I entertained myself by listening to a radio station, en Espanol. Given that I have the Spanish vocabulary of a toddler, I was quite delighted with myself when I discerned that I’d tuned in to a Christian radio station. The repeated use of the words, palabra, familia, and Dios helped me make that revelation. I also monitored the temperature via my rental car thermometer and happily observed that the outside temperature never rose above 104 degrees during my drive from San Antonio to Eagle Pass.

I like to think of myself as navigationally skilled; then again, it’s also good to remind myself that denial is more than just a river in Egypt. What I did manage to efficiently find were the Texas road construction crews. Getting to my hotel was harder. I had planned to use my internet telephone GPS, which would have been a great idea had there been internet access in Eagle Pass. This prospect began dawning on me when I passed the sign saying: Eagle Pass, pop. 26,864. At that point it was still unclear to me exactly how the Eagle Pass School District (conveniently located on the Rio Grande River) decided to have me come from Montana to do a full-day Tough Kids, Cool Counseling workshop. But, given that I’d never been to Texas before and they happened to want to pay me and then they decided to purchase 45 copies of Tough Kids, Cool Counseling, I found myself faced with an offer I couldn’t refuse.

And so, I decided to engage in a bit of disoriented driving, while studiously avoiding the bridge to Mexico. I finally found a man from India at a random hotel, who spoke English in addition to Punjab and Spanish. He was kind enough to let me use his Internet because he’d never heard of the hotel I’d booked. Then, a few wrong turns later and following an episode where my rental car transformed itself from an automatic into a manual transmission, I finally made it to the bargain Microtel hotel where they obviously take the term “micro” very seriously. Staying there required that I change into my secret Ant-man identity, thereby shrinking my expectations for Internet access, pool length, fitness facilities, and room into the size of an ant while retaining the physical strength and intellectual functioning of an adult male (I should note that I intentionally selected this hotel because it’s relatively green and was happy with my choice, despite my lightly mocking tone). The good news was that Taco-Morales was right across the street and I got to experience some authentic fajitas and red rice at prices an ant could afford.

The next day, in a coffee-free state (there are no Starbucks in Eagle Pass), I found my way to the Eagle Pass Junior High library (home of the Eagles—what a surprising team name!). That was when I discovered how they’d chosen me as their School Counseling Workshop leader. As it turns out, Montana Street is just a block or two from Eagle Pass Junior High and so they had apparently thought I lived right there ON Montana Street (and not IN the State of Montana). . . which is probably why they chose to pay me a flat rate and let me cover my own travel.

But very soon I discovered everything wonderful about Eagle Pass. I got to spend the day with Mr. Salinas, Ms. Gutierrez, Mr. Lopez, Connie, Karla, Luis, Toyoko, three women named Dora, and just enough School Counselors to scoop up 45 copies of Tough Kids, Cool Counseling. This was a group with immense compassion and dedication to making the lives of their students better. They teased me, laughed at my jokes, gently corrected my Spanish mis-pronunciations, asked for me to sign their books, and treated me with mucho mas respeto than I could ever deserve. By lunchtime they began talking about when I’d come back (I gently suggested January instead of August for my next visit). After lunch, Luis beat me at the Hand-Pushing game (I was depleted and distracted from all the energy it took to keep intermittently changing into an ant-sized person to fit into my hotel). However, one of the three Doras made an excellent volunteer for my mental set riddles (thank you Dora, for demonstrating in front of your peers that, in fact, learning can happen).

In the end, I return from Eagle Pass with renewed and sustained faith and hope in the human race. The big hearts and amazing dedication of the Eagle Pass School Counselors was inspiring. Thank-you Eagle Pass, for helping to expand my world. . . while simultaneously shrinking my expectations for hotel accommodations.

Parenting, Personal Reflections

Sweating my Way through Charlotte, North Carolina

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As my sister likes to say, “we’ve got excellent pores in our family.” By “excellent” she means to say that our pores open up and leak like the Titanic. One time, way back when I was teaching at the University of Portland, I didn’t let enough time pass between playing noon-time basketball and lecturing in an Introductory Psychology class and ended up sweating so much that my glasses fogged up.

And so you can imagine how much my pores enjoyed being in Charlotte, NC in August.

When I showed up at the Ice Cream Social on Tuesday evening I was sweating so much that I was sure everyone was thinking, “Great. It’s the night before he’s scheduled to speak and our keynote for Wednesday morning is ALREADY having a panic attack.” [It’s funny how self-consciousness about something like sweating can suddenly turn on my psychic powers, because I’m pretty sure I was able to accurately read everyone’s mind at that Ice Cream Social.] But really, it wasn’t that terrible because I only had to retreat to my room to change my shirt once during the 20 minutes I spent at the Ice Cream Social.

Note to self: When visiting high humidity regions, always pack clothing that doesn’t accentuate my excellent sweating ability of my pores.

But the real point of this blog post isn’t my personal struggle with perspiration—despite the fact that writing about my sweating is, I’m sure, intrinsically interesting as well as cathartic and desensitizing. The real point is to do some flat out bragging about the Communities In Schools of North Carolina (CIS-NC) programs.

If you don’t know about the Communities in Schools organization, you should. In North Carolina this organization includes an amazing staff with boundless positive energy that they direct toward dropout prevention. If you click on the link to their organization you’ll find a cool website with excellent information http://www.cisnc.org/. Here’s their mission statement:

The mission of Communities In Schools is to surround students with a community of support, empowering them to stay in school and achieve in life. We are part of the national Communities In Schools network, which is the leading dropout prevention organization in the country, and the only such organization that is proven to decrease the dropout rate and increase on-time graduation rates.

I have to admit that before I arrived in Charlotte, I was skeptical about their claims of being “the only organization proven to decrease the dropout rate and increase on-time graduation rates.” This skepticism came from two sources: (1) decreasing drop-out rates is just extremely difficult for everyone, and (2) I’m skeptical about everything. But, after being with the ABSOLUTELY AMAZING administration and staff of CIS-NC for only a few hours, it was clear to me how and why they’re able to help students succeed. Here are a few things I learned.

  • Not only is the staff positive, energetic, and funny, they’re also smart, savvy, and fully dedicated to improving the lives of young people.
  • They utilize a rational balance of evidence-based approaches in combination with approaches that are designed to meet the unique needs of individual schools, staff, students, and settings.
  • They operate using the “5 Basics of Communities in Schools.” These common sense AND evidence-based principles include:
  1. A one-on-one relationship with a caring adult.
  2. A safe place to learn and grow.
  3. A healthy start and a healthy future.
  4. A marketable skill to use upon graduation.
  5. A chance to give back to peers and community.

In addition to all that, I learned that their staff is sensitive, supportive, and compassionate. After all, when I delivered the keynote, they nodded and smiled (showing their listening skills), laughed at all of my jokes at exactly the right time (laughing with special vigor when I did my exorcist voice), and gave me lots of positive feedback for the rest of the morning.

Now it’s up to me to determine if they were just being especially kind to their sweaty keynote speaker or whether they really enjoyed the presentations. I’m hoping for the latter.

Parenting, Therapy with Adolescents

Hello to the Communities in Schools of North Carolina

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Tomorrow I head to Billings to fly to Charlotte, North Carolina to speak at the annual training conference for the Communities in Schools of North Carolina (CIS-NC). CIS-NC is an awesome organization that helps prevent and reduce school drop-outs. I’m honored to be a part of their annual training. You can learn more about CIS-NC at: http://www.cisnc.org/

Attached to this post is the powerpoint presentation for the Wednesday opening session.

NC CIS Warts to Wings Final REV no cartoons

And here’s the one page summary from the opening session.

From Warts to Wings Handout

And here’s the powerpoint for the break-out session on “How to Listen so Parents will Talk”

How to Listen for CIS

And the one page summary for the break-out session.

How to Listen Handout