Category Archives: Cool Counseling

Free Video Links for Online Teaching

JSF Travel

This past week I’ve been grateful for the many professionals and organizations (including my publisher, John Wiley & Sons) who are providing free guidance and materials to help with the transition from face-to-face teaching to online instruction. In an effort to contribute back in a small way, I’m posting 10 counseling- and psychotherapy-related videos that can be integrated into online teaching. These videos are free and posted on my YouTube channel. The links are all below with a brief description of the video content.

Some of these videos are rough cuts and all of them are far from perfect demonstrations; that’s partly the point. Although many of the videos show reasonably good counseling skills and interesting assessment processes and therapeutic interventions, none of the videos are scripted, and so there’s plenty of room for review, analysis, critique, and discussion. You can show them as efforts to do CBT, SFBT, Motivational Interviewing, administration of a mental status examination, etc., and prompt students to describe how they would do these sessions even better.

These videos are meant to stimulate learning. In an ideal world, I would include a list of discussion questions, but I’ll leave that to you. If you like, please feel free to use these videos for educational purposes. Here’s the annotated list with video links:

  1. Counseling demonstrations with a 12-year-old.
    1. Opening a counseling session: https://www.youtube.com/watch?v=rHHrMC8t6vY
    2. The three-step emotional change trick: https://www.youtube.com/watch?v=ITWhMYANC5c
    3. John SF demonstrates the What’s Good About You? informal assessment technique: https://www.youtube.com/watch?v=MUhmLQUg_g8
    4. Closing a session: https://www.youtube.com/watch?v=GpuH80tf2jM
  2. Demo of assessment for anger management with a solution-focused spin with a 20-year-old client: https://www.youtube.com/watch?v=noE2wMMNLY4
  3. Demo of motivational interviewing with a 30-year-old client: https://www.youtube.com/watch?v=rtN7kEk0Sv4
  4. Demo of the affect bridge technique with an 18-year-old: https://www.youtube.com/watch?v=fEtiGuc914E
  5. Demo of CBT for social anxiety with a graduate student: https://www.youtube.com/watch?v=jfVeeGJHFjA
  6. Demo of an MSE with a 20-year-old: https://www.youtube.com/watch?v=adwOxj1o7po
  7. A lecture vignette of a demonstration of psychoanalytic ego defense mechanisms: https://studio.youtube.com/video/E818UlgHMXY/edit
  8. The University of Montana Department of Counseling does a spoof video of The Office: https://www.youtube.com/watch?v=eM8-I8_1CqQ

Good luck with the transition to online teaching and stay healthy!

John S-F

Happiness Homework: Conduct Two Natural Talent Interviews

Strengths

Back in the 1950s, at the University of California, a guy named Joseph met a guy named Harrington. They were both psychologists and both interested in self-awareness and interpersonal relationships. Together, combining their knowledge and experiences, they came up with a simple way to integrate their ideas about self-awareness and social awareness. Being cool and creative types (I’m guessing about this, because I never met them), to name their concept they fused or integrated their two first names.

You may have studied the Johari Window in Introductory Psychology. Just in case you didn’t, or just in case you’ve forgotten whatever you learned about it, here are a few facts.

  1. The Johari window is pronounced the Joe-Harry Window. . . because Joe Luft and Harry Ingham named it after themselves.
  2. The Johari window is designed as a tool for helping people (like us!) to expand our self-awareness.
  3. The Johari Window has four quadrants or “rooms” (see the Figure below) 

    The Open Area. The top-left room represents the part of the self that that’s wide open. It includes parts of you that are known to you (self-awareness) and those same parts that are known to others.

    The Hidden Area. The bottom left room is the part of ourselves that we know, but that we hide from others. People who are transparent generally have a small private or “hidden area.”  People who consider themselves “private people” probably have bigger hidden areas.

    The Blind Spot. The top right area represents the part of ourselves that others see, but that we don’t see (or hear). Maybe you’ve glimpsed some of your blind spot by watching yourself on video, or listening to your recorded voice, or from getting feedback from other people about how they experience you.

    The Unknown. The unknown is that mysterious part of ourselves that remains hidden to us and hidden to others.

Mostly, the Johari Window is useful as a tool for enhancing self-awareness and shrinking the Blind Spot and Unknown areas. You can think of it as getting to know the parts of ourselves that are unconscious or outside our awareness. As noted in the figure below (which I copied from this internet site: https://www.communicationtheory.org/the-johari-window-model/), there are methods for expanding self-awareness. The main method for expanding self-awareness is to ask others for feedback. Asking others, “What do you think of me?” is a powerful and straightforward self-awareness tool, but it requires social risk-taking and courage. Asking for feedback is a good, but not perfect method for expanding self-awareness because asking others for feedback may NOT expand your self-awareness if that other person doesn’t know you well or sees you inaccurately. Feedback from others is often, but not always, helpful for expanding self-awareness.

Another method for expanding self-awareness involves, ironically, being more open and transparent to others. If we want accurate feedback from others, it’s best to let others get to know us, otherwise the feedback and information they provide will be necessarily limited. To get good feedback from others, we need to provide others with good data about ourselves. Without good data, others can’t give us good feedback. See below for the Figure illustrating the Johari Window.

I’m writing about the Johari Window for educational reasons, but also because it’s a great way to introduce your Spring Break happiness assignment. This is an assignment that I made up about six years ago while teaching a career development class. I call it the Natural Talent Interview. Not surprisingly, because I made it up, I think it’s an awesome assignment that everyone will love. On the other hand, you should be the judge of that, AND, you should give me feedback on this assignment so I can expand my self-awareness!

Here’s the assignment:

Conduct Two Natural Talent Interviews: To do this assignment, identify two people whom you respect and trust. Let them know that you have an assignment to get more in touch with your personal strengths and talents. Then, get a note pad (or commit yourself to making mental notes) and ask them the following question:

What do you think are my three greatest strengths or talents?

As you’re listening, be sure to ask the person for specific examples of each talent or strength. You can take notes if you’re comfortable, or just listen and then soon afterwards document what the person said about you—both your natural talents and examples to support them.

The purpose of this assignment is to get to know your personal strengths and talents from the perspective of others. Maybe you’ve done this sort of thing before. But because things change with time, it’s worth updating the feedback you get from others or worth asking new people for feedback.

At the end, write a summary of what you learned about your natural talents and upload it to Moodle for Dan and me to read.

Thanks and happy Friday.

John S-F

 

 

Hanging out with the Virginia School Counseling Association in Richmond: The Extra Handout

Richmond Statue

I just had an awesome day with about 260 Virginia School Counselors. You know who you are, and you know you’re incredible.

Just FYI, the state of Virginia is making a big investment in adding school counselors. . . which IMHO, is a very smart and reasonable decision. Other states might want to take note and follow their lead. The problem is that many school age youth are suffering from extremely challenging home, neighborhood, and school situations. Having more competent school counselors available to support student success, student mental health, and teachers is a wise move.

For all of the VSCA members I met today, thank you for coming, but more importantly, thanks for the deeply important commitment you make to the well-being of students in your schools. You are amazing!

Here’s the extra handout, with more details than the powerpoint slides: VSCA 2020 Extra Handout

 

The Evidence Base for Psychoanalytic Therapies: It Just Might Be Better Than You Think

Sunset 2019In recent days there’s been a bit of a kerfuffle on Twitter regarding the relative efficacy of psychoanalytic and cognitive-behavioral therapies (CBT). Of course, the standard mantra in the media and among many mental health professionals is that the science shows that CBT is superior and the treatment of choice for many, if not most, mental and emotional problems. Well, as is often the case in life and psychotherapy, reality is much less clear.

This post isn’t about fake news or alternative facts. Instead, I hope it’s about a balanced perspective. As a psychotherapist-counselor-professor-clinical psychologist, I like to think I don’t have an allegiance to any single therapy approach. Although I know I can’t claim perfect objectivity, I do have a broad view. One factor that has helped me have a broad view is that I read lots of professional journal articles in order to be able to write my theories of counseling and psychotherapy textbook.

Below, I’ve inserted an excerpt from the end of the psychoanalytic chapter of our textbook. Whether you’re a CBT or psychoanalytic fan, or perhaps a fan of a different approach, I hope you find this short review of psychoanalytic treatment efficacy interesting. The bottom line for me is captured by an old quotation from Freud (who wasn’t known for his flexible thinking). Purportedly, he said, “There are many ways and means of conducting psychotherapy. All that lead to recovery are good.” I might add the following to Freud’s comment: There are many different clients with many different problems and many different individual and cultural perspectives. I’m convinced that most clients are best served if therapists tweak their approaches to fit the client, rather than expecting the client to fit into narrow clinical procedures based on pure (or rigid) theoretical perspectives.

Here’s the excerpt . . .

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Conducting rigorous research on longer-term treatments, such as psychoanalytic therapy, is challenging and cost prohibitive. Psychoanalytic approaches are often less symptom- or diagnosis-focused, seeking instead to facilitate client insight and improve interpersonal relationships. Because empirically supported treatments focus on whether a specific psychological procedure reduces symptoms associated with a medical diagnosis, “proving” the efficacy of complex therapy approaches is difficult—especially when compared to the lesser challenges inherent in evaluating symptom-focused treatments. Partly because of these complexities, some reviewers contend that psychoanalytic psychotherapies are less efficacious than cognitive and behavioral therapies (Busch, 2015; Tolin, 2010).

The good news for psychoanalytic therapy fans is that evidence is accumulating to support treatment efficacy. The less good news is that some of the research support remains methodologically weak and the wide variety of psychoanalytic approaches makes it difficult to come to clear conclusions. Nevertheless, the most recent meta-analytic studies, literature reviews, and individual randomized controlled studies support the efficacy of psychoanalytically oriented therapies for the treatment of a variety of mental disorders. According to Leichsenring, Klein, and Salzer (2014), there is empirical support for the efficacy of psychoanalytic psychotherapies in treating:

  • Depressive disorders.
  • Anxiety disorders.
  • Somatic symptom disorders.
  • Eating disorders.
  • Substance-related disorders.
  • Borderline personality disorder.

The evidence for the efficacy of psychodynamic approaches for depressive disorders is strong. In a recent meta-analysis, Driessen and colleagues (2015) evaluated 54 studies, including 3,946 patients. They reported that short-term psychodynamic psychotherapy (STPP) was associated with improvements in general psychopathology and quality of life measures (d = 0.49–0.69) and all outcome measures (d = 0.57–1.18); they also noted that patients continued to improve at follow-up (d = 0.20–1.04). Further, no differences were found between STPP and other psychotherapies. On anxiety measures, STPP appeared significantly superior to other psychotherapies at post-treatment (d = 0.35) and follow-up (d = 0.76).

In a previous meta-analytic review, Shedler (2010) also concluded that psychodynamic therapies were equivalent to “. . . other treatments that have been actively promoted as ‘empirically supported’ and ‘evidence based’” (p. 107). He also reported that psychodynamic therapies had more robust long-term effects.

Table 2.2 provides a sampling of meta-analytic evidence supporting psychodynamic therapies. For comparison purposes, the original meta-analyses conducted by Smith and colleagues are included (Smith & Glass, 1977; Smith et al., 1980). Notably, Smith, Glass, and Miller reported that psychodynamic approaches were significantly more efficacious than no treatment and approximately equivalent to other therapy approaches.

Table 2.2 also includes the average effect size (ES or d; see Chapter 1) for antidepressant medications (ES = 0.31 for serotonin-specific reuptake inhibitors or SSRIs). This comparison data shows that psychodynamic psychotherapy is more effective than SSRI treatment for depression. Additionally, the benefits of psychoanalytic therapy tend to increase over time (Driessen et al., 2015; Shedler, 2010). This implies that psychoanalytic psychotherapy clients develop insights and acquire skills that continue to improve their functioning into the future—which is clearly not the case for antidepressant medication treatment (Whitaker, 2010). One of the ways psychotherapists explain this difference in longer term efficacy is with the statement: “A pill is not a skill.”

Table 2.2 A Sampling of Psychodynamic Psychotherapy Meta-analyses

Authors Outcome focus Number of studies ES or d
Abbass et al. (2009) General psychiatric symptoms 8 0.6
Anderson & Lambert (1995) Various 9 0.85
de Maat et al. (2009) Long-term treatment 10 0.78
Driessen et al. (2015) Depression 54 0.57–1.18
Comparison research
Turner et al. (2008) Meds for Major depression 74 0.31
Smith et al. (1977) Different therapies 375 0.68
  Many problems    
Smith et al. (1980) Different therapies 475 0.75
  Many problems    

Note: This is a sampling of meta-analytic psychoanalytic psychotherapy reviews. We’ve omitted several reviews with very high effect sizes partly because of criticisms related to their statistical methodology (see Driessen et al., 2015, and Shedler, 2010, for more complete reviews). This table is not comprehensive; it’s only a reasonable representation of psychoanalytic psychotherapy meta-analyses.

We recommend you take the preceding research findings (and Table 2.2) with a grain of salt. Conducting systematic research on something as subjective as human mental and emotional problems always includes error. One source of error is the allegiance effect (Luborsky et al., 1999). The allegiance effect is the empirically supported tendency for the researcher’s therapy preference or allegiance to significantly predict outcome study results.  Luborsky and colleagues (1999) analyzed results from 29 different adult psychotherapy studies and reported that about two thirds of the variation in outcome was accounted for by the researcher’s theoretical orientation (e.g., psychoanalytic researchers reported more positive outcomes for psychoanalytic therapy and behavior therapists discovered that behavior therapy was more effective).

The implications of the allegiance effect help explain why, shortly after Shedler’s (2010) publication extolling the virtues of psychodynamic psychotherapy, several critiques and rebuttals were published (Anestis, Anestis, & Lilienfeld, 2011; McKay, 2011). The critics claimed that Shedler’s review was biased and accused him of overlooking weaknesses within the meta-analyses he reviewed (e.g., poor outcome measures, pooling the effects of small samples with little power and poor designs, lack of treatment integrity effects). Although Shedler’s critics raised important points, the critics themselves had their own biases. The problem is that all researchers (and writers) have an allegiance of one sort of another.

One of our favorite ways of understanding the allegiance effect is articulated in a story about the great New York Yankee baseball player, Yogi Berra. One day, when a player on Yogi’s team was called out on a close play at second base, Yogi went charging on to the field to protest. The umpire explained that he, unlike Yogi, was an objective observer and that he, unlike Yogi, had been only about 5 feet from the play, while Yogi had been over 100 feet away, in the dugout. When Yogi heard the umpire’s logic, he became even angrier and snapped back, “Listen ump, I wouldn’t have seen it, if I hadn’t believed it” (adapted from Leber, 1991).

The “I saw it because I believed it” phenomenon is also called confirmation bias (Masnick & Zimmerman, 2009; Nickerson, 1998). Confirmation bias involves seeking, interpreting, and valuing evidence that supports pre-existing beliefs, while ignoring and devaluing evidence contrary to preexisting beliefs. Consequently, psychoanalytically oriented individuals see support for their perspective and behavior therapists see support for theirs. However, despite these caveats, based on accumulating research, psychodynamic approaches have a reasonably good record of efficacy.

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Although this particular review has many limitations, I’m convinced that most of us, most of the time, are better off following the advice of Marvin Goldrfried (and others) and focusing on the common therapeutic factors, or, as Norcross calls a subset of common factors, empirically-supported relationships.

For more information, check out Goldfried’s recent article on obtaining consensus in psychotherapy:  https://www.stonybrook.edu/commcms/psychology/_pdfs/clinical/Goldfried%20AP%20Consensus%20AP.pdf

 

Fear, Anxiety, Loathing, and Today’s Workshop for the Thriving Institute

Even though I’m a Montana Grizzly, being back in Bozeman is always nice. Today, Rita is insisting that we go out to Burger Bobs before my evening workshop for the Thriving Institute. To be honest, Burger Bobs sounds a little heavy for my pre-workshop meal. I’m nervous, but I guess we’ll see if that’s a mistake or not.

For those in attendance (or those not in attendance), here’s the ppts for tonight. They’re like, “amazing” or at least I hope you think so.

Thrive Anxiety Beast 2019

Anybody feeling anxious? Or like a beast?

Spidey

 

Understanding and Taming the Anxiety Beast in Your Child

Nora Twirl

I’m feeling a little nervous about going back to Bozeman this coming Thursday, November 14. This time, instead of continuing on with my latest streak of suicide and happiness presentations, the focus is on something I love even more: Parenting. I’m nervous because I obviously need help and support for coming up with titles to my talks. Somehow I’ve claimed that I’ll be taming beasts this Thursday. Looking back, I’m wondering why I made up such a grandiose sounding title. Ugh. Help wanted.

Despite my own anxiety, I’ll be presenting on behalf of Thrive, a very cool parenting education and children’s support organization in Bozeman. The event is called the Thriving Institute.

Location: Bozeman Public Library

Time: 6pm to 8pm

You can register online at: allthrive.org

Check out the fancy flyer here! Thriving Institute – Understanding and Taming the Anxiety Beast in Your Child

In anticipation of Thursday’s talk, I’m re-posting a blog from last year. It’s about children and anxiety, and it’s got an accompanying podcast. Here’s the re-post!

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Facing fear and anxiety is no easy task. It’s not easy for children; and it’s not easy for their parents. Here’s a short piece of historical fiction that captures some of the dynamics that can emerge when you’re helping children face their fears.

“I’m scared.”

My nephew turned his pleading fact toward me. He was standing on the diving board. I was a few feet below. We had waited in line together. Turning back now meant social humiliation. Although I knew enough to know that the scene wasn’t about me, I still felt social pressure mounting. If he stepped down from the diving board, I’d feel the shame right along with him. My own potential embarrassment, along with the belief that he would be better served facing his fears, led me to encourage him to follow through and jump.

“You can do it,” I said.

He started to shake. “But I can’t.”

Parenting or grand-parenting or hanging out with nieces and nephews sometimes requires immense decision-making skill. I’d been through “I’m scared” situations before, with my own children, with grandchildren, with other nephews and nieces. When do you push through the fear? When do you backtrack and risk “other people” labeling you, your son, your daughter, or a child you love as “chicken?”

This particular decision wasn’t easy. I wanted my nephew to jump. I was sure he would be okay. But I also knew a little something about emotional invalidation. Sure, we want to encourage and sometimes push our children to get outside their comfort zones and take risks. On the other hand, we also want to respect their emotions. Invalidating children’s emotions tends to produce adults who don’t trust themselves. But making the decision of when to validate and when to push isn’t easy.

I reached out. My nephew took my hand. I said, “Hey. You made it up here this time. I’ll bet you’ll make the jump next time.” We turned to walk back. A kid standing in line said, “That’s okay. I was too scared to jump my first time.”

Later, when the line had shrunk, my nephew wanted to try again. “Sure,” I said. “I’ll walk over with you.”

He made the jump the second time. We celebrated his success with high-fives and an ice-cream sandwich.

Like all words, the words, “I’m scared” have meaning and provoke reactions.

Sometimes when parents hear the words, “I’m scared” they want to push back and say something like, “That’s silly” or “Too bad” or “Buck-up honeycup” or something else that’s reactive and emotionally invalidating.

The point of the story about my nephew isn’t to brag about a particular outcome. Instead, I want to recognize that most of us share in this dilemma: How can we best help children through their fears.

Just yesterday I knelt next to my granddaughter. She was too scared to join into a group activity. She held onto my knee. We were in a public setting, so I instantly felt embarrassment creeping my way. I dealt with it by engaging in chit-chat about all the activity around us, including commentary about clothes, shoes, the color of the gym. Later, when she finally joined in on the activity, I felt relief and I felt proud. I also remembered the old lesson that I’d learned so many times before. In the moment of a child’s fear, my potential emotional pain, although present, pales in comparison to whatever the child is experiencing.

If you’d like to hear more about how to help children cope with their fears, you can listen to Dr. Sara Polanchek and me chatting about this topic on our latest Practically Perfect Parenting Podcast. Here are the links.

On iTunes: https://itunes.apple.com/us/podcast/practically-perfect-parenting-podcast/id1170841304?mt=2

On Libsyn: http://practicallyperfectparenting.libsyn.com/

And follow us on Facebook: https://www.facebook.com/PracticallyPerfectParenting/

 

 

Happiness and Well-Being (in Livingston, Montana)

Cow

Yesterday, at the fabulous West Creek Ranch retreat center just North of Yellowstone Park, I introduced community leaders from Livingston, Montana to a man named James Pennebaker. It was a brief meeting. In fact, I’m not sure anyone remembers the formal introduction.

I should probably mention that James Pennebaker wasn’t in the room. The meeting consisted of me putting a short and inadequate description of one of his research studies up on a screen. The study went something like this:

Back in 1986, Pennebaker randomly assigned college students to one of two groups. The first group was instructed to write about personally traumatic life events. The second group was instructed to write about trivial topics. Both groups wrote on four consecutive days. Then, Pennebaker obtained health center records, self-reported mood ratings, physical symptoms, and physiological measures.

Pennebaker reported that, in the short-term, participants who wrote about trauma had higher blood pressure and more negative moods that the college students who wrote about trivia. But the longer term results were, IMHO, amazing. Generally, the students who wrote about trauma had fewer health center visits, better immune functioning, and overall improved physical health.

Pennebaker’s theory was that choking back important emotions takes a physical toll on the body and creates poorer health.

Since 1986, Pennebaker and others have conducted much more research on this phenomenon. The results have been similar. As a consequence, over time, Pennebaker has “penned” several books on this topic, including:

  • Opening Up: The healing power of expressing emotions
  • Writing to Heal: A guided journal for recovering from trauma & emotional upheaval
  • Expressive Writing: Words that heal
  • The Secret Life of Pronouns: What our words say about us
  • Opening Up by Writing It Down

As most of you know, after a couple decades presenting on suicide assessment and treatment, Rita and I have pivoted toward happiness and well-being. The coolest thing about talking about happiness and well-being is that doing so is WAY MORE FUN, and it results in meeting and laughing with very cool people, like the Livingston professionals.

Speaking of Livingston professionals, just in case you forgot that you met James Pennebaker, here’s a link to my powerpoints from yesterday: Livingston 2019 Final

I hope you had as much fun listening as I did talking.